Erratum: Dendritic spine formation and synapse maturation in transcription factor-induced human iPSC-derived neurons.

[This corrects the article DOI: 10.1016/j.isci.2023.106285.].

Successful hybrid repair of a giant coronary artery aneurysm after previous coronary artery bypass grafting.

A 64-year-old woman had undergone coronary artery bypass grafting (CABG) for right coronary occlusion and the Dor procedure for a left ventricular apex aneurysm 10 years previously. A follow-up computed tomography scan showed the evolution of a giant coronary artery aneurysm (CAA) located on the proximal left circumflex artery (CX). It also revealed a previous saphenous vein graft (SVG) that was patent and located on the midline. Surgical exclusion was regarded as invasive, and isolated percutaneous intervention was unsuitable for a wide-necked CAA. Thus, a hybrid approach was planned. First, CABG (SVG-CX) via left thoracotomy was performed. Following the surgery, stent-assisted coil embolization was performed. A coronary angiogram revealed complete CAA exclusion. Learning objective: Many authors have reported successful repair for coronary artery aneurysm (CAA) with a percutaneous approach or surgery. Although there is no consensus for giant CAA repair, surgical repair including resection, ligation, and coronary artery bypass grafting have been recommended in previous reports. However, every decision should be tailored to suit each condition. In this case with the history of previous cardiovascular surgery, our hybrid approach was thought to be less invasive and feasible than isolated surgical or percutaneous repair.

Dendritic spine formation and synapse maturation in transcription factor-induced human iPSC-derived neurons.

Synaptic maturation is reportedly limited in human induced pluripotent stem cell (iPSC)-derived neurons. Notably, their ability to reach postnatal-like stages and form dendritic spines has been difficult to demonstrate unless using long-term cultured organoids. Recent transcription factor (TF)-based induction methods allow the accelerated generation of differentiated neurons, which offers an unprecedented opportunity to address further progression into late developmental stages. Herein, we report on a comprehensive time-course study of TF-induced iPSC neurons cultured in vitro through an intrinsic maturation program following neurogenesis. Moreover, we determined the transcriptional and morphological sequences of key developmental events associated with spinogenesis, including the conversion of drebrin to its brain-specific isoform A and the N-methyl-D-aspartate (NMDA) receptor subunit switch. TF-induced iPSC neurons successfully acquired structural and functional synaptic maturity, which will critically expand their utility in modeling higher brain functions and disorders.

[Open Surgery after Zone 0 Debranch Thoracic Endovascular Aortic Repair with Fenestrated Stent Graft:Report of a Case].

Thoracic endovascular aortic repair (TEVAR) has been widely used in recent years as a treatment for thoracic aortic aneurysm, but open surgery may be required for various complications that cannot be controlled by endovascular treatment alone. It is often a more challenging operation. A 78-year-old man underwent two debranch TEVAR (zone 1) for thoracic aortic aneurysm eight years before, and he received TEVAR (zone 0) again with the Najuta stent graft for re-expansion of aneurysm due to typeⅠa endoleak two years before. Since the aneurysm continued to expand and the aortic valve stenosis progressed after that, we performed total arch replacement (TAR) and aortic valve replacement (AVR). The Najuta stent graft could be removed manually. As the debranched graft had to be cut off at sternotomy, selective cerebral perfusion (SCP) was initiated at normal body temperature. It should be noted that SCP at normal body temperature may require more perfusion than hypothermic SCP. TAR was performed in combination with frozen elephant trunk, and postoperative computed tomography (CT) confirmed the disappearance of endoleak. One year has passed since the operation, but the aneurysm has not re-expanded.

Recurrent nonbacterial thrombotic endocarditis the day after mitral valve replacement.

Nonbacterial thrombotic endocarditis (NBTE) is relatively rare, with an identification rate of 1.6% at autopsy, and is associated with malignancy and systemic lupus erythematosus. Further, bioprosthetic valve NBTE is extremely rare, with only a few reports in the literature. To ensure appropriate treatment, it is essential to differentiate between NBTE from infective endocarditis (IE) as soon as possible, but this is difficult without information regarding underlying disease and sufficient time for careful investigation. Here, we report a case of recurrent NBTE of a bioprosthetic valve the day following surgery based on an initial diagnosis of IE. .

The Anterolateral Ligament Has Limited Intrinsic Healing Potential: A Serial, 3-Dimensional-Magnetic Resonance Imaging Study of Anterior Cruciate Ligament-Injured Knees From the SANTI Study Group.

BACKGROUND: Recent imaging studies demonstrate that the anterolateral ligament (ALL) is frequently injured at the time of anterior cruciate ligament (ACL) rupture. The intrinsic healing potential of these injuries after ACL reconstruction (ACLR) has not been defined. PURPOSE/HYPOTHESIS: The primary objective was to evaluate the rate and duration of the healing process of injured ALLs after ACLR using serial 3-dimensional magnetic resonance imaging (3D-MRI). The secondary objective was to investigate whether any patient, injury, or surgical factors influenced the healing rate. The hypothesis was that serial imaging would demonstrate that the ALL has limited healing potential. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients enrolled in the study underwent 3D-MRI (slice thickness 0.5 mm) preoperatively and at 1, 6, 12, and 24 months after ACLR. Three observers determined the grade of ALL injury according to the Muramatsu classification. Inter- and intraobserver reliabilities were calculated. The rates of injury and time points for healing were determined. Full healing was defined as a change from a preoperative Muramatsu grade of B or C (indicating partial or complete injury) to grade A (normal). Multivariate analysis was used to investigate the association of aforementioned factors with the risk of incomplete healing. RESULTS: A total of 44 patients were enrolled in the study. Of them, 71.2% had an ALL injury on preoperative imaging. Overall, full healing of ALL injuries occurred at a rate of 3.2%, 15.2%, and 30.3% at 1, 6, and 12 months, respectively. There were no changes in the Muramatsu grade in any patient beyond 12 months postoperatively. None of the complete lesions demonstrated full healing, but the proportion of patients with a grade C injury decreased from 13.6% preoperatively to 4.5% at 12 months due to an improvement to grade B in 4 of 6 patients (66%). Inter- and intraobserver reliabilities of the classification system were almost perfect at 0.81-0.94 and 0.95-1.00, respectively. None of the potential risk factors investigated were predictive of an increased risk of nonhealing. CONCLUSION: ALL injuries occurred in the majority of ACL-injured knees. They had limited intrinsic healing potential, with only 30.3% healing by 12 months after ACLR. The process of healing took >6 months in half of the patients in whom it occurred. No new cases of full healing occurred beyond 12 months postoperatively. No significant risk factors for failure of full healing to occur were identified, but it is likely that this aspect of the study was underpowered.

123I-BMIPP/201Tl dual myocardial SPECT proves the efficacy of surgical treatment for an adult with Bland-White-Garland syndrome.

Bland-White-Garland (BWG) syndrome is a rare congenital heart disease in which the left coronary artery originates from the pulmonary artery (PA). Surgical treatment to rebuild a dual coronary system is recommended at the time of the diagnosis. However, no effective operative procedure has been established for adult-type BWG patients because of the paucity of such cases. We herein report a case of adult-type BWG that was successfully treated by patch closure of the orifice of the left main tract from the main PA and coronary artery bypass grafting. 123I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 201thallium (Tl) dual myocardial single-photon emission computed tomography (SPECT) were performed before surgery, early after surgery, and at three months after surgery. Before surgery, dual SPECT showed myocardial perfusion defects in the anterior and septal wall, which corresponded to the cardiovascular magnetic resonance imaging findings. Early after surgery, only 201Tl images demonstrated an improvement in the defect area. At three months after surgery, both the 201Tl and 123I-BMIPP imaging findings demonstrated an improvement in the defect area, which was correlated with the recovery of the left ventricular function. These results showed the effectiveness of this surgical approach for BWG syndrome. .

Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament-Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group.

PURPOSE: To determine the visualization rate of the anterolateral ligament (ALL) in uninjured and anterior cruciate ligament (ACL)-deficient knees using 3-dimensional (3D) magnetic resonance imaging (MRI) and to characterize the spectrum of ALL injury observed in ACL-deficient knees, as well as determine the interobserver and intraobserver reliability of a 3D MRI classification of ALL injury. METHODS: A total of 100 knees (60 ACL deficient and 40 uninjured) underwent 3D MRI. The ALL was evaluated by 2 blinded orthopaedic surgeons. The ALL was classified as follows: type A, continuous, clearly defined low-signal band; type B, warping, thinning, or iso-signal changes; and type C, without clear continuity. The comparison between imaging performed early after ACL injury (<1 month) and delayed imaging (>1 month) was evaluated, as was intraobserver and interobserver reliability. RESULTS: Complete visualization of the ALL was achieved in all uninjured knees. In the ACL-deficient group, 24 knees underwent early imaging, with 87.5% showing evidence of ALL injury (3 normal, or type A, knees [12.5%], 18 type B [75.0%], and 3 type C [12.5%]). The remaining 36 knees underwent delayed imaging, with 55.6% showing evidence of injury (16 type A [44.4%], 18 type B [50.0%], and 2 type C [5.6%]). The difference in the rate of injury between the 2 groups was significant (P = .03). Multivariate analysis showed that the delay from ACL injury to MRI was the only factor (negatively) associated with the rate of injury to the ALL. Interobserver reliability and intraobserver reliability of the classification of ALL type were good (κ = 0.86 and κ = 0.93, respectively). CONCLUSIONS: Three-dimensional MRI allows full visualization of the ALL in all normal knees. The rate of injury to the ALL in acutely ACL-injured knees identified on 3D MRI is higher than previous reports using standard MRI techniques. This rate is significantly higher than the rate of injury to the ALL identified on delayed imaging of ACL-injured knees. LEVEL OF EVIDENCE: Level IV, diagnostic, case-control study.

[Huge Left Thrombosis after Mitral Valvuloplasty and Maze Procedure;Report of a Case].

Generally, anticoagulation therapy is not essential for patients who maintain sinus rhythm after mitral valvuloplasty. A 66-year-old woman who had undergone mitral valvuloplasty and maze procedure for treatment of mitral valve regurgitation and atrial fibrillation 4 years ago was diagnosed as having left atrial thrombosis despite maintenance of sinus rhythm on electrocardiography. Echocardiography showed narrow mitral valvular area(1.5 cm2), loss of A wave and a huge left atrium. Repeat surgery was performed to replace the mitral valve and to remove the thrombus. The thrombus attached to the posterior wall of the left atrium with a wide basis, and was unrelated to the ablation line of maze procedure. Careful follow-up and anticoagulation therapy should be considered for patients who have a large left atrium and/or rheumatic mitral valve after valvuloplasty even though sinus rhythm is maintained.

Redefinition of tricuspid valve structures for successful ring annuloplasty.

BACKGROUND: Although numerous reports have described suturing techniques for tricuspid annuloplasty, most studies were not based on a detailed anatomy of the tricuspid annulus. Thus, the definition of the tricuspid commissures remains unclear. This study aimed to clearly define the commissures and leaflets of the tricuspid valve and subvalvular structures, and to define a standard method for tricuspid annuloplasty. METHODS: In 27 normal heart specimens without cardiac disease, the tricuspid commissure was defined using indentations of the leaflets as a point, not an area, and the length of each tricuspid annulus was measured. The relationships between the leaflets and the subvalvular structures were then examined. RESULTS: In most specimens, the posterior leaflet had 2 (62.9%) or 3 (29.6%) scallops, providing further evidence of posterior leaflet diversity. In addition, the posterior leaflet had 1 or 2 indentations, which can be mistaken for true commissures. The annulus of the posterior leaflet was significantly longer than the annuli of the other 2 leaflets (P < .00428). The annuli of the septal and the anterior leaflets were supported by the interventricular septum and the supraventricular crest, respectively, whereas the posterior leaflet annulus was distributed largely along the right ventricular free wall. CONCLUSIONS: There was a structural gap between the tricuspid leaflet indentations and the subvalvular structures. The relationships among the leaflets, commissures, and subvalvular structures differed in the septal, anterior, and posterior leaflets. This new definition of the commissural point may aid the development of a clear-cut methodology for prosthetic ring annuloplasty.

[Unplanned Ascending Aortic Graft Replacement at Valvuler Surgery in a Patient with Systemic Lupus Erythematosus;Report of a Case].

A 65-year-old woman with severe mitral stenosis was admitted to our hospital. She had been previously diagnosed with systemic lupus erythematosus (SLE) and had been taking prednisolone (5 mg/day) for 19 years. As SLE patients with prolonged steroid use are known to be at risk of an aortic dissection and aneurysm, femoral artery was chosen for arterial perfusion to reduce the risk of a dissection of the ascending aorta. However, hemostasis was difficult at the insertion point of the catheter to infuse the antegrade cardioplegic solution. An ascending aortic graft replacement was therefore performed. Histopathological examination of the aortic wall showed the presence of intimal hypertrophy and a decrease in elastic fiber content but without any evidence of vasculitis. Because prolonged steroids use is a risk factor of atherosclerotic change in the aortic wall, the aorta should be treated carefully during cardiovascular surgery in such patients.

[Visualization of Anterolateral Ligament of the Knee Using 3D Reconstructed Variable Refocus Flip Angle-Turbo Spin Echo T2 Weighted Image].

Anterolateral ligament (ALL) is one of the lateral structures in the knee that contributes to the internal rotational stability of tibia. ALL has been referred to in some recent reports to re-emphasize its importance. We visualized the ALL on 3D-MRI in 32 knees of 27 healthy volunteers (23 male knees, 4 female knees; mean age: 37 years). 3D-MRIs were performed using 1.5-T scanner [T(2) weighted image (WI), SPACE: Sampling Perfection with Application optimized Contrast using different flip angle Evolutions] in the knee extended positions. The visualization rate of the ALL, the mean angle to the lateral collateral ligament (LCL), and the width and the thickness of the ALL at the joint level were investigated. The visualization rate was 100%. The mean angle to the LCL was 10.6 degrees. The mean width and the mean thickness of the ALL were 6.4 mm and 1.0 mm, respectively. The ALL is a very thin ligament with a somewhat oblique course between the lateral femoral epicondyle and the mid-third area of lateral tibial condyle. Therefore, the slice thickness and the slice angle can easily affect the ALL visualization. 3D-MRI enables acquiring thin-slice imaging data over a relatively short time, and arbitrary sections aligned with the course of the ALL can later be selected.

Remodeling of heat-treated cortical bone allografts for posterior lumbar interbody fusion: serial 10-year follow-up.

We have selected heat-treated bone allografts as the graft material since the Tokai Bone Bank, the first regional bone bank in Japan, was established in 1992. In this study, we examined changes in bone mineral density (BMD), and morphology observed by magnetic resonance imaging (MRI), and histological findings of bone grafts in cases followed up for 7-10 years after bone grafting to grasp the remodeling of heat-treated cortical bone allografts for posterior lumber interbody fusion (PLIF). BMD of bone grafts was reduced by half at 10 years after grafting. MRI revealed that bone grafts were indistinguishable initially in only 22.2% of cases, whereas after a lengthy period of 10 years distinguishable in many cases. Histologically, new bone formation at the graft-host interface was observed earlier, at 1 year after grafting, than that at the periphery of canals in the specimens. The laminated structure of the cortical bone eroded over time, and fragmented bone trabeculae were observed in the specimens at 8 years or longer after grafting, though necrotic bone still remained in some sites.

Serial evaluation of human anterior cruciate ligament grafts by contrast-enhanced magnetic resonance imaging: comparison of allografts and autografts.

PURPOSE: The purpose of this study was to clarify the difference in remodeling between allografts and autografts in anterior cruciate ligament reconstruction. METHODS: We examined 24 knees with bone-patellar tendon-bone allografts and 20 knees with central-third bone-patellar tendon-bone autografts. Surgical patients from January 1997 to December 2002 were included in the study, and more than 1 year had passed since surgery. The mean postoperative follow-up was 24.0 months in the allograft group and 21.3 months in the autograft group. Patients with a positive Lachman test were excluded. The operative method and postoperative rehabilitation programs were the same. All allografts were provided by Tokai Regional Bone Bank, the only regional bone bank in Japan. Contrast-enhanced magnetic resonance imaging (1.0 T, T1-weighted, sagittal section, infusion of 0.2-mL/kg gadolinium-diethylenetriamine pentaacetic acid [Gd-DTPA]) was performed for all knees at 1, 4, 6, and 12 months after surgery and performed for some knees irregularly thereafter. The signal/noise quotient (SNQ) of grafts was calculated by use of magnetic resonance imaging based on the method of Weiler et al. (2001) as follows: SNQ = (Signal of ACL graft - Signal of quadriceps tendon)/Signal of background. RESULTS: The SNQ of allografts was significantly lower than for autografts 12 months after surgery. As for the SNQ 1 month after surgery, there was no difference before or after Gd-DTPA infusion in the allografts; however, the SNQ was significantly higher after Gd-DTPA infusion in autografts. The SNQ after Gd-DTPA infusion continued to increase until 12 to 24 months in the allograft group but peaked at 4 or 6 months in the autograft group. CONCLUSIONS: Compared with autologous tendons, allogeneic tendons have a slower onset and rate of revascularization. LEVEL OF EVIDENCE: Level III, retrospective comparative study.