Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series.

"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.

Calpain signaling: from biology to therapeutic opportunities in neurodegenerative disorders.

Neurodegenerative disorders represent a major and growing healthcare challenge globally. Among the numerous molecular pathways implicated in their pathogenesis, calpain signaling has emerged as a crucial player in neuronal dysfunction and cell death. Calpain is a family of calcium-dependent cysteine proteases that is involved in many biological processes, such as signal transduction, cytoskeleton remodeling, and protein turnover. Dysregulation of calpain activation and activity has been associated with several neurodegenerative diseases, including Alzheimer's, Parkinson's, and Huntington's diseases. Understanding the intricate structure of calpains is crucial for unraveling their roles in cellular physiology and their implications in pathology. In addition, the identification of diverse abnormalities in both humans and other animal models with deficiencies in calpain highlights the significant progress made in understanding calpain biology. In this comprehensive review, we delve into the recent roles attributed to calpains and provide an overview of the mechanisms that govern their activity during the progression of neurodegenerative diseases. The possibility of utilizing calpain inhibition as a potential therapeutic approach for treating neuronal dysfunctions in neurodegenerative disorders would be an area of interest in future calpain research.

On the application of pseudo-continuous arterial spin labeled MRI for pulmonary perfusion imaging.

PURPOSE: To evaluate different approaches for the effective assessment of pulmonary perfusion with a pseudo-continuous arterial spin labeled (pCASL) MRI. MATERIALS AND METHODS: Four different approaches were evaluated: 1) Cardiac-triggered inferior vena cava (IVC) labeling; 2) IVC labeling with cardiac-triggered acquisition; 3) Right pulmonary artery (RPA) labeling with cardiac-triggered acquisition; and 4) Cardiac-triggered RPA labeling with background suppression (BGS). Each approach was evaluated in 5 healthy volunteers (n = 20) using coefficient of variation (COV) across averages. Approach 4 was also compared against a flow alternating inversion recovery (FAIR). RESULTS: The IVC labeling (Approach 1) achieved perfusion-weighted images of both lungs, although this approach was more sensitive to variations in heart rate. Cardiac-triggered acquisitions using IVC (Approach 2) and RPA (Approach 3) labeling improved signal consistencies, but were incompatible with BGS. The cardiac-triggered RPA labeling with BGS (Approach 4) achieved a COV of 0.34 ± 0.03 (p < 0.05 compared to IVC labeling approaches) and resulted in perfusion value of 434 ± 64 mL/100 g/min, which was comparable to 451 ± 181 mL/100 g/min measured by FAIR (p = 0.82). DISCUSSION: Pulmonary perfusion imaging using pCASL-MRI is highly sensitive to cardiac phase, and requires approaches to minimize flow-induced signal variations. Cardiac-triggered RPA labeling with BGS achieves reduced COV and enables robust pulmonary perfusion imaging.

Tolerability and efficacy of a reduced dose adenosine stress cardiac magnetic resonance protocol under general anesthesia in infants and children.

BACKGROUND: Intravenous adenosine induces pharmacological stress by causing vasodilatation and thus carries the risk of severe hypotension when combined with vasodilatory effects of anesthetic agents. OBJECTIVE: This study describes our experience with a reduced dose adenosine cardiac magnetic resonance imaging (MRI) protocol in young children under general anesthesia (GA). MATERIALS AND METHODS: This is a retrospective report of all patients from birth to 18 years who underwent adenosine stress cardiac MRI under GA between August 2018 and November 2022. Based on our anecdotal experience of severe adverse effects in patients receiving adenosine infusion under GA and in discussion with the pediatric anesthesia team, we developed a modified protocol starting at a dose of 110 mcg/kg/min with incremental escalation to a full dose of 140 mcg/kg/min to achieve desired hemodynamic effect. RESULTS: Twenty-two children (mean age 6.5 years, mean weight 28 kg) satisfied the inclusion criteria. The diagnoses included Kawasaki disease (7), anomalous aortic origin of left coronary artery (3), anomalous aortic origin of right coronary artery (2), coronary fistula (3), repaired d-transposition of great arteries (2), repaired anomalous left coronary artery from pulmonary artery (2), repaired truncus arteriosus with left coronary artery occlusion (1), extracardiac-Fontan with left coronary artery myocardial bridge (1), and post heart transplantation (1). Nine patients needed dose escalation beyond 110 mcg/kg/min. Two patients had transient hypotension during testing (systemic blood pressure drop > 25 mmHg). No patient developed significant heart block or bronchospasm. Six patients (repeat study in one) demonstrated inducible perfusion defects (27%) on stress perfusion sequences-5 of whom had confirmed significant coronary abnormalities on angiography or direct surgical inspection. CONCLUSION: A reduced/incremental dose adenosine stress cardiac MRI protocol under GA in children is safe and feasible. This avoids severe hypotension which is both unsafe and may result in inaccurate data.

Association of faecal volatiles and steroids with behavioural expression during oestrous cycle of sheep (Ovis aries).

This study was investigated to determine the faecal volatiles, steroid hormones and their correlation with behavioural signs during oestrous cycle in sheep (Ovis aries). This experiment was monitored from pro-oestrous to met-oestrous phases for correlation of endocrine dependence biochemical constituents in faeces and blood to detection of oestrous biomarkers. Medroxyprogesterone acetate sponges were used for 8 days to bring uniformity of oestrus in sheep. Faeces were collected during different phases of cycle and subjected to determination of fatty acids, minerals, oestrogens and progesterone analysis. Likewise, blood samples were also obtained for enzymatic and no-enzymatic antioxidants. The results revealed that faecal progesterone and oestrogen levels significantly increased during pro-oestrous and oestrous phase, respectively (p < .05). The blood plasma enzymatic levels showed significant demarcation during the oestrous phase than other periods (p < .05). There were also reported marked variations in volatile fatty acids across different phases of the oestrous cycle. Interestingly, methyl octanoate, methyl cis-10 pentadecenoate and methyl heptadecanoate volatiles were found to be specific to oestrus period. In addition, methyl hexanoate, methyl palmitoleate and methyl cis-9 oleate were identified in met-oestrus, indicating their possible role to be an oestrous biomarker. It is concluded that the pattern of volatile compounds and faecal steroids, in association with behavioural patterns, could be measured as a non-invasive method of heat detection in sheep.

Identification of nutritional composition and antioxidant activities of fruit peels as a potential source of nutraceuticals.

Fruit peels comprise several biologically active compounds, but their nutritional composition and antioxidant potential of different fruit varieties are limited. This study aimed to determine the nutritional composition and antioxidant properties of 12 peels of different fruit varieties such as apples, pomegranates, guavas, strawberries, grapes, and citrus fruits using a ultraviolet-visible (UV-Vis) spectrophotometer, an inductively-coupled plasma atomic emission spectroscopy (ICP-AES), and an amino acid analyzer. The highest values of TPC, TFC, lycopene, ascorbic acid [total carotenoids and total antioxidant capacity (TAC)], reducing sugars, non-reducing sugars, and total soluble proteins were reported in grapes (Black seedless) 54,501.00 ± 0.82 µM/g dry wt., guava (Gola) 198.19 ± 0.46 Rutin equivalent dry wt., strawberry (Candler) 7.23 ± 0.33 mg/g dry wt., citrus (Mausami) 646.25 ± 0.96 ug/g dry wt., apple (Kala kulu-Pak) 14.19 ± 0.38 mg/g dry wt. and 12.28 ± 0.39 µM/g dry wt., strawberry (Candler) 25.13 ± 0.40 mg/g dry wt., pomegranate (Badana) 9.80 ± 0.43 mg/g dry wt., apple (Kala kullu-Irani) 30.08 ± 0.11 mg/g dry wt., and guava (Gola) 638.18 ± 0.24 mg/g dry wt. compared with its opponent peels of fruits, respectively. All 12 peels of the fruit verities had 20 amino acids and presented as dry matter basis%. The highest trend of glutamic acid + glutamine, glycine, and aspartic acid + asparagine was observed in pomegranate (Badana) 1.20 DM basis%, guava (Surhai and Gola) 1.09 and 1.09 DM basis%, and strawberry (Desi/local and Candler) 1.15 and 1.60 DM basis% in response to other fruit peels, respectively. Regarding the mineral profile, the highest values of nitrogen (764.15 ± 0.86 mg/100 g), phosphorus (53.90 ± 0.14 mg/100 g), potassium (3,443.84 ± 0.82 mg/100 g), ferric (1.44 ± 0.00 mg/100 g), magnesium (1.31 ± 0.00 mg/100 g), and manganese (0.21 ± 0.00 mg/100 g) were found in pomegranate (Badana), grapes (Black seedless), apple (Kala kulu-Pak), and pomegranate (Badana), respectively, in context to other fruit peels' extract. Principal component analysis (PCA) and agglomerative hierarchical clustering (AHC) were analyzed for determining the correlation among different peels of fruits. Significantly, high levels of variation were noticed among different variables of peels of fruit. Fruit variety and its peels have been distinctive variables in selecting genotypes. The dendrogram obtained from cluster analysis was distributed into two groups and consisted of eight varieties in the same group, and four fruit varieties were in second group. Overall, the results conclude that fruit peels have the abundant antioxidants and some minerals, which can effectively be utilized for nutraceuticals as well as for food security.

Accuracy of Cardiac Magnetic Resonance Imaging in Diagnosing Pediatric Cardiac Masses: A Multicenter Study.

BACKGROUND: After diagnosis of a cardiac mass, clinicians must weigh the benefits and risks of ascertaining a tissue diagnosis. Limited data are available on the accuracy of previously developed noninvasive pediatric cardiac magnetic resonance (CMR)-based diagnostic criteria. OBJECTIVES: The goals of this study were to: 1) evaluate the CMR characteristics of pediatric cardiac masses from a large international cohort; 2) test the accuracy of previously developed CMR-based diagnostic criteria; and 3) expand diagnostic criteria using new information. METHODS: CMR studies (children 0-18 years of age) with confirmatory histological and/or genetic diagnosis were analyzed by 2 reviewers, without knowledge of prior diagnosis. Diagnostic accuracy was graded as: 1) single correct diagnosis; 2) correct diagnosis among a differential; or 3) incorrect diagnosis. RESULTS: Of 213 cases, 174 (82%) had diagnoses that were represented in the previously published diagnostic criteria. In 70% of 174 cases, both reviewers achieved a single correct diagnosis (94% of fibromas, 71% of rhabdomyomas, and 50% of myxomas). When ≤2 differential diagnoses were included, both reviewers reached a correct diagnosis in 86% of cases. Of 29 malignant tumors, both reviewers indicated malignancy as a single diagnosis in 52% of cases. Including ≤2 differential diagnoses, both reviewers indicated malignancy in 83% of cases. Of 6 CMR sequences examined, acquisition of first-pass perfusion and late gadolinium enhancement were independently associated with a higher likelihood of a single correct diagnosis. CONCLUSIONS: CMR of cardiac masses in children leads to an accurate diagnosis in most cases. A comprehensive imaging protocol is associated with higher diagnostic accuracy.

The Role of Polyphenols in Regulation of Heat Shock Proteins and Gut Microbiota in Weaning Stress.

Gut microbiota is the natural residents of the intestinal ecosystem which display multiple functions that provide beneficial effects on host physiology. Disturbances in gut microbiota in weaning stress are regulated by the immune system and oxidative stress-related protein pathways. Weaning stress also alters gut microbiota response, limits digestibility, and influences animal productive performance through the production of inflammatory molecules. Heat shock proteins are the molecular chaperones that perform array functions from physiological to pathological point of view and remodeling cellular stress response. As it is involved in the defense mechanism, polyphenols ensure cellular tolerance against enormous stimuli. Polyphenols are nature-blessed compounds that show their existence in plenty of amounts. Due to their wider availability and popularity, they can exert strong immunomodulatory, antioxidative, and anti-inflammatory activities. Their promising health-promoting effects have been demonstrated in different cellular and animal studies. Dietary interventions with polyphenols may alter the gut microbiome response and attenuate the weaning stress related to inflammation. Further, polyphenols elicit health-favored effects through ameliorating inflammatory processes to improve digestibility and thereby exert a protective effect on animal production. Here, in this article, we will expand the role of dietary polyphenol intervention strategies in weaning stress which perturbs gut microbiota function and also paid emphasis to heat shock proteins in gut health. This review article gives new direction to the feed industry to formulate diet containing polyphenols which would have a significant impact on animal health.

Moringa oleifera Supplementation Improves Antioxidant Status and Biochemical Indices by Attenuating Early Pregnancy Stress in Beetal Goats.

This study investigated the effects of supplementing different levels of Moringa oleifera leaf powder (MOLP) on antioxidant status and blood biochemical indices during early gestation in Beetal goats. A total of 30 goats were randomly divided into three groups (n = 10) comprising control (basal diet without MOLP), the 1.6% MOLP supplemented group (basal diet + 1.6% MOLP), and the 3.2% MOLP supplemented group (basal diet + 3.2% MOLP). The experiment started 5 days before estrus synchronization and lasted till day 60 of gestation. The MOLP significantly increased plasma flavonoids in 1.6% as well as 3.2% supplemented group on days 40 and 60 of pregnancy, while total phenolic contents were observed to be higher in the 3.2% MOLP supplemented group throughout the experiment in comparison with the control group. The supplementation improved plasma total antioxidant capacity (TAC) by decreasing malondialdehyde (MDA) and total oxidant status (TOS) in contrast to the control group. The activities of superoxide dismutase (SOD) and peroxidase (POD) were enhanced in both supplemented groups, whereas catalase (CAT) activity was noticed to be significantly high in the 3.2% MOLP supplemented group. The protein contents were significantly elevated with 1.6 and 3.2% supplementation levels from day 40 to day 60 of the experiment. Plasma sugar level, carotenoids, progesterone profile, and hydrolytic (protease and amylase) enzymes activities were improved only when supplemented with 3.2% MOLP. The findings suggest that supplementing with 3.2% MOLP provides beneficial effects on early pregnancy stress in Beetal goats.

Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients After Complete Repair.

BACKGROUND: A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. METHODS: Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. RESULTS: RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff-both in line with published data. CONCLUSIONS: This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.

Lymphatic pathway evaluation in congenital heart disease using 3D whole-heart balanced steady state free precession and T2-weighted cardiovascular magnetic resonance.

BACKGROUND: Due to passive blood flow in palliated single ventricle, central venous pressure increases chronically, ultimately impeding lymphatic drainage. Early visualization and treatment of these malformations is essential to reduce morbidity and mortality. Cardiovascular magnetic resonance (CMR) T2-weighted lymphangiography (T2w) is used for lymphatic assessment, but its low signal-to-noise ratio may result in incomplete visualization of thoracic duct pathway. 3D-balanced steady state free precession (3D-bSSFP) is commonly used to assess congenital cardiac disease anatomy. Here, we aimed to improve diagnostic imaging of thoracic duct pathway using 3D-bSSFP. METHODS: Patients underwent CMR during single ventricle or central lymphatic system assessment using T2w and 3D-bSSFP. T2w parameters included 3D-turbo spin echo (TSE), TE/TR = 600/2500 ms, resolution = 1 × 1 × 1.8 mm, respiratory triggering with bellows. 3D-bSSFP parameters included electrocardiogram triggering and diaphragm navigator, 1.6 mm isotropic resolution, TE/TR = 1.8/3.6 ms. Thoracic duct was identified independently in T2w and 3D-bSSFP images, tracked completely from cisterna chyli to its drainage site, and classified based on severity of lymphatic abnormalities. RESULTS: Forty-eight patients underwent CMR, 46 of whom were included in the study. Forty-five had congenital heart disease with single ventricle physiology. Median age at CMR was 4.3 year (range 0.9-35.1 year, IQR 2.4 year), and median weight was 14.4 kg (range, 7.9-112.9 kg, IQR 5.2 kg). Single ventricle with right dominant ventricle was noted in 31 patients. Thirty-eight patients (84%) were status post bidirectional Glenn and 7 (16%) were status post Fontan anastomosis. Thoracic duct visualization was achieved in 45 patients by T2w and 3D-bSSFP. Complete tracking to drainage site was attained in 11 patients (24%) by T2w vs 25 (54%) by 3D-bSSFP and in 28 (61%) by both. Classification of lymphatics was performed in 31 patients. CONCLUSION: Thoracic duct pathway can be visualized by 3D-bSSFP combined with T2w lymphangiography. Cardiac triggering and respiratory navigation likely help retain lymphatic signal in the retrocardiac area by 3D-bSSFP. Visualizing lymphatic system leaks is challenging on 3D-bSSFP images alone, but 3D-bSSFP offers good visualization of duct anatomy and landmark structures to help plan interventions. Together, these sequences can define abnormal lymphatic pathway following single ventricle palliative surgery, thus guiding lymphatic interventional procedures.

Real-World Experience Measurement of Liver Iron Concentration by R2 vs. R2 Star MRI in Hemoglobinopathies.

BACKGROUND: Non-invasive determination of liver iron concentration (LIC) is a valuable tool that guides iron chelation therapy in transfusion-dependent patients. Multiple methods have been utilized to measure LIC by MRI. The purpose of this study was to compare free breathing R2* (1/T2*) to whole-liver Ferriscan R2 method for estimation of LIC in a pediatric and young adult population who predominantly have hemoglobinopathies. METHODS: Clinical liver and cardiac MRI scans from April 2016 to May 2018 on a Phillips 1.5 T scanner were reviewed. Free breathing T2 and T2* weighted images were acquired on each patient. For T2, multi-slice spin echo sequences were obtained. For T2*, a single mid-liver slice fast gradient echo was performed starting at 0.6 ms with 1.2 ms increments with signal averaging. R2 measurements were performed by Ferriscan analysis. R2* measurements were performed by quantitative T2* map analysis. RESULTS: 107 patients underwent liver scans with the following diagnoses: 76 sickle cell anemia, 20 Thalassemia, 9 malignancies and 2 Blackfan Diamond anemia. Mean age was 12.5 ± 4.5 years. Average scan time for R2 sequences was 10 min, while R2* sequence time was 20 s. R2* estimation of LIC correlated closely with R2 with a correlation coefficient of 0.94. Agreement was strongest for LIC < 15 mg Fe/g dry weight. Overall bias from Bland-Altman plot was 0.66 with a standard deviation of 2.8 and 95% limits of agreement -4.8 to 6.1. CONCLUSION: LIC estimation by R2* correlates well with R2-Ferriscan in the pediatric age group. Due to the very short scan time of R2*, it allows imaging without sedation or anesthesia. Cardiac involvement was uncommon in this cohort.

Vitamin E and Selenium Treatment Alleviates Saline Environment-Induced Oxidative Stress through Enhanced Antioxidants and Growth Performance in Suckling Kids of Beetal Goats.

Salinity is a worldwide, threatening problem affecting socioeconomic status globally. Saline land comprises salt content in soil, plants, and drinking water. Livestock farming is the worthy option for proper utilization of saline land in a cost-effective approach. Animals reared on this land experience a variety of stresses. Such stresses promote oxidative stress and reduced animal performance. The purpose of this study was to investigate the antioxidative function of vitamin E and selenium (Se) on pregnant/nonpregnant animals reared on the saline environment. A total of 36 multiparous pregnant (n = 18) and nonpregnant (n = 18) goats weighing about 38-45 (average 41.5) kg were equally divided into control and supplemented groups. The experiment lasted from 120 days of gestation to 15 days after parturition for pregnant goats and 0 to 45 days for nonpregnant cyclic goats (>50 days post-kidding). The supplemented group was administered vitamin E (1000 mg/kg BW) and selenium (3 mg/50 kg BW), while the control group was kept on normal saline (0.9% NaCl) with the same route 15 days apart. The blood samples were collected with 15 days apart during the entire experimental period of 45 days and subjected to assessment of enzymatic/nonenzymatic antioxidants, hydrolytic enzymes, oxidants, stress metabolic biomarkers, Se, and progesterone concentration of (pregnant) animals. Results revealed that vitamin E and Se supplementation significantly enhanced the activity of enzymatic (catalase and peroxidase) and nonenzymatic antioxidants such as total phenolic/flavonoid content and vitamin C and increased blood plasma level of Se concentration in comparison with the control group (P < 0.01). Exposure to antioxidant supplementation mitigated lipid peroxidation and enhanced progesterone level and total antioxidant capacity (P < 0.01) as compared to the control group in pregnant goats. Administration of vitamin E and selenium promoted kid survival rate (100%) along with increased initial birth weight, daily average weight gain, and total weight gain in comparison with the control group. Besides, the twinning rate and sex ratio were also recorded in pregnant animals. It is concluded that vitamin E and Se supplementation ameliorated salinity-induced oxidative stress, improved antioxidant status, and enhanced reproductive and growth performance of suckling kids reared on saline land.

Role of the Phytochemical Compounds like Modulators in Gut Microbiota and Oxidative Stress.

BACKGROUND: Currently, daily consumption of green herb functional food or medicinal herbs has increased as adopted by many people worldwide as a way of life or even as an alternative to the use of synthetic medicines. Phytochemicals, which are a series of compounds of relatively complex structures and restricted distribution in plants, usually perform the defensive functions for plants against insects, bacteria, fungi or other pathogenic factors. A series of studies have found their effectiveness in the treatment or prevention of systemic diseases such as autoimmune diseases, cancer, neurodegenerative diseases, Crohn's disease and so on. OBJECTIVE: This review systematizes the literature on the mechanisms of the phytochemicals that react against unique free radicals and prevent the oxidative stress and also summarizes their role in gut microbiota inhibiting bacterial translocation and damage to the intestinal barrier and improving the intestinal membrane condition. CONCLUSION: The gut microbiota modulation and antioxidant activities of the phytochemicals shall be emphasized on the research of the active principles of the phytochemicals.

3D advanced imaging overlay with rapid registration in CHD to reduce radiation and assist cardiac catheterisation interventions.

Novel commercially available software has enabled registration of both CT and MRI images to rapidly fuse with X-ray fluoroscopic imaging. We describe our initial experience performing cardiac catheterisations with the guidance of 3D imaging overlay using the VesselNavigator system (Philips Healthcare, Best, NL). A total of 33 patients with CHD were included in our study. Demographic, advanced imaging, and catheterisation data were collected between 1 December, 2016 and 31 January, 2019. We report successful use of this technology in both diagnostic and interventional cases such as placing stents and percutaneous valves, performing angioplasties, occlusion of collaterals, and guidance for lymphatic interventions. In addition, radiation exposure was markedly decreased when comparing our 10-15-year-old coarctation of the aorta stent angioplasty cohort to cases without the use of overlay technology and the most recently published national radiation dose benchmarks. No complications were encountered due to the application of overlay technology. 3D CT or MRI overlay for CHD intervention with rapid registration is feasible and aids decisions regarding access and planned angiographic angles. Operators found intraprocedural overlay fusion registration using placed vessel guidewires to be more accurate than attempts using bony structures.

Role of Dietary Amino Acids and Nutrient Sensing System in Pregnancy Associated Disorders.

Defective implantation is related to pregnancy-associated disorders such as spontaneous miscarriage, intrauterine fetal growth restriction and others. Several factors proclaimed to be involved such as physiological, nutritional, environmental and managemental that leads to cause oxidative stress. Overloading of free radicals promotes oxidative stress, and the internal body system could not combat its ability to encounter the damaging effects and subsequently leading to pregnancy-related disorders. During pregnancy, essential amino acids display important role for optimum fetal growth and other necessary functions for continuing fruitful pregnancy. In this context, dietary amino acids have received much attention regarding the nutritional concerns during pregnancy. Arginine, glutamine, tryptophan and taurine play a crucial role in fetal growth, development and survival while ornithine and proline are important players for the regulation of gene expression, protein synthesis and angiogenesis. Moreover, amino acids also stimulate the mammalian target of rapamycin (mTOR) signaling pathway which plays a central role in the synthesis of proteins in placenta, uterus and fetus. This review article explores the significances of dietary amino acids in pregnancy development, regulation of nutrient-sensing pathways such as mTOR, peroxisome proliferator-activated receptors (PPARs), insulin/insulin-like growth factor signaling pathway (IIS) and 5' adenosine monophosphate-activated protein kinase (AMPK) which exhibit important role in reproduction and its related problems. In addition, the antioxidant function of dietary amino acids against oxidative stress triggering pregnancy disorders and their possible outcomes will also be enlightened. Dietary supplementation of amino acids during pregnancy could help mitigate reproductive disorders and thereby improving fertility in animals as well as humans.

Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy.

BACKGROUND: Injury to vital structures posterior to the sternum is a complication associated with redo sternotomy in congenital cardiac surgery. The goal of our study was a novel evaluation of real-time cine cardiovascular magnetic resonance (CMR) to predict the presence of significant retrosternal adhesions of cardiac and vascular structures prior to redo sternotomy in patients with congenital heart disease. METHODS: Twenty-three patients who had prior congenital heart surgery via median sternotomy had comprehensive CMR studies prior to redo sternotomy. The real time cine (RTC) sequence that was used is an ungated balanced steady-state free precession (bSSFP) sequence using SENSitivity Encoding for acceleration with real-time reconstruction. Spontaneously breathing patients were instructed to take deep breaths during the acquisition whilst increased tidal volumes were delivered to mechanically ventilated patients. All patients underwent redo cardiac surgery subsequently and the presence and severity of retrosternal adhesions were noted at the time of the redo sternotomies. RESULTS: Median age at the time of CMR and operation were 5.5 years (range, 0.2-18.4y) and 6.1 years (range, 0.3-18.8y) respectively. There were 15 males and 8 females in the study group. Preoperative retrosternal adhesions were identified on RTC in 13 patients and confirmed in 11 (85%) at the time of surgery. In only 2 patients, no adhesions were identified on CMR but were found to have significant retrosternal adhesions at surgery; false positive rate 15% (CI 0.4-29.6%), false negative rate 20% (CI 3.7-36.4%). The total classification error of the real time cine sequence was 17% (CI 1.7-32.4%) with an overall accuracy of 83% (CI 67.7-98.4%). Standard breath-hold cine images correlated poorly with surgical findings and did not increase the diagnostic yield. CONCLUSIONS: RTC imaging can predict the presence of significant retrosternal adhesions and thus help in risk assessment prior to redo sternotomy. These findings complement the surgical planning and potentially reduce surgical complications .

Pediatric heterozygous familial hypercholesterolemia patients have locally increased aortic pulse wave velocity and wall thickness at the aortic root.

Familial hypercholesterolemia (FH) is an autosomal dominant disorder that affects 1 in 250 people. Aortic stiffness, measured by pulse wave velocity (PWV), is an independent predictor for cardiovascular events. Young FH patients are a unique group with early vessel wall disease that may serve to elucidate the determinants of aortic stiffness. We hypothesized that young FH patients would have early changes in aortic stiffness compared to healthy, age- and sex-matched reference values. Thirty-three FH patients ( ≥ 7 years age; mean age 14.6 ± 3.3 years; 26/33 on statin therapy) underwent cardiac MRI. PWV was determined using propagation of flow waveform from aortic arch phase contrast images. Distensibility and aortic wall thickness (AWT) were measured at the ascending, proximal descending, and diaphragmatic aorta. Ventricular volumes and left ventricular (LV) myocardial mass were measured from 2D cine images. These parameters were compared to age- and sex-matched reference values. FH patients had significantly higher PWV (4.5 ± 0.8 vs. 3.5 ± 0.3 m/s; p < 0.001), aortic distensibility, and ascending aortic wall thickness (1.37 ± 0.18 vs. 1.30 ± 0.02 mm; p < 0.05) compared to reference. There was no difference in aortic area or descending aortic wall thickness between groups. Young FH patients had aortic changes with increased aortic pulse wave velocity in the setting of increased aortic distensibility, accompanied by increased thickness of the ascending aortic wall. Presence of these early findings in young patients despite the majority being on statin therapy support enhanced screening and aggressive treatment of familial hypercholesterolemia to prevent potential future cardiovascular events.

Living the heart in three dimensions: applications of 3D printing in CHD.

Advances in biomedical engineering have led to three-dimensional (3D)-printed models being used for a broad range of different applications. Teaching medical personnel, communicating with patients and relatives, planning complex heart surgery, or designing new techniques for repair of CHD via cardiac catheterisation are now options available using patient-specific 3D-printed models. The management of CHD can be challenging owing to the wide spectrum of morphological conditions and the differences between patients. Direct visualisation and manipulation of the patients' individual anatomy has opened new horizons in personalised treatment, providing the possibility of performing the whole procedure in vitro beforehand, thus anticipating complications and possible outcomes. In this review, we discuss the workflow to implement 3D printing in clinical practice, the imaging modalities used for anatomical segmentation, the applications of this emerging technique in patients with structural heart disease, and its limitations and future directions.