Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement vs Percutaneous Mitral Valvuloplasty.

BACKGROUND: This study aimed to compare the outcomes, according to percutaneous mitral valvuloplasty (PMV) vs mitral valve replacement (MVR), of severe mitral stenosis (MS) with the updated criteria (MVA ≤ 1.5 cm2). METHODS: From the Multicenter Mitral Stenosis With Rheumatic Etiology (MASTER) registry of 3140 patients, we included patients with severe MS who underwent PMV or MVR between January 2000 and December 2021 except for previous valvular surgery/intervention, at least moderate other valvular dysfunction, and thrombus at the left atrium/appendage. Moderately severe MS (MS-MS) and very severe MS (VS-MS) were defined as 1.0 cm2 < MVA ≤ 1.5 cm2 and MVA ≤ 1.0 cm2, respectively. Primary outcomes were a composite of cardiovascular (CV) death and heart failure (HF) hospitalization. Secondary outcomes were a composite of primary outcomes and redo intervention. RESULTS: Among 442 patients (mean 56.5 ±11.9 years, women 77.1%), the MVR group (n = 260) was older, had more comorbidities, higher echoscore, larger left chambers, and higher right ventricular systolic pressure than the PMV group (n = 182). During a mean follow-up of 6.9 ± 5.2 years with inverse probability-weighted matching, primary outcomes did not differ, but the MVR group experienced fewer secondary outcomes (P = 0.010). In subgroup analysis of patients with MS-MS and VS-MS, primary outcomes did not differ. However, the MVR group in patients with VS-MS showed better secondary outcomes (P = 0.012). CONCLUSIONS: PMV or MVR did not influence CV mortality or HF hospitalization in both MS-MS and VS-MS. However, because of increased early redo intervention in the PMV group in VS-MS, MVR would be the preferable option without clear evidence of suitable morphology for PMV.

High-Resolution Tactile-Sensation Diagnostic Imaging System for Thyroid Cancer.

In this study, we propose the direct diagnosis of thyroid cancer using a small probe. The probe can easily check the abnormalities of existing thyroid tissue without relying on experts, which reduces the cost of examining thyroid tissue and enables the initial self-examination of thyroid cancer with high accuracy. A multi-layer silicon-structured probe module is used to photograph light scattered by elastic changes in thyroid tissue under pressure to obtain a tactile image of the thyroid gland. In the thyroid tissue under pressure, light scatters to the outside depending on the presence of malignant and positive properties. A simple and easy-to-use tactile-sensation imaging system is developed by documenting the characteristics of the organization of tissues by using non-invasive technology for analyzing tactile images and judging the properties of abnormal tissues.

New insights into the origin of the lumbrical muscles of the foot: tendinous slip of the flexor hallucis longus muscle.

PURPOSE: The aim of this study was to clarify the origins of the lumbricals of the foot toward a better understanding of its precise action in the gait. METHODS: The lumbricals in the foot were investigated in 66 specimens of embalmed Korean adult cadavers. RESULTS: The first lumbrical arose as two muscle bellies from both the tendon of the FDL and the tendinous slip of the FHL in 83.3 %, and as one muscle belly from the tendon of the FDL or the tendinous slip of the FHL in 16.7 %. These two muscle bellies subsequently merged to form the muscle belly of the first lumbrical. The second lumbrical arose from the tendinous slips of the FHL for the second and third toes as well as the tendon of the FDL in all specimens. The third lumbrical arose from the tendinous slips of the FHL for the third and fourth toes in 69.7 %, and the fourth lumbrical arose from the tendinous slip of the FHL for the fourth toe in 18.2 %. Some deep muscle fibers of the fourth lumbrical arose from the tendinous slip of the FHL for the second toe in 4.5 %, for the third toe in 28.8 %, and for the fourth toe in 15.2 %. CONCLUSIONS: The results of this study constitute new anatomical knowledge regarding the origin of the lumbricals, and provide insight into their specific role in production of gait. These findings will be useful for various types of surgery, biomechanics research, and rehabilitation programs.

Blending of the lateral deep slip of the platysma muscle into the buccinator muscle.

PURPOSE: The aim of this study was to clarify the prevalence of blending of the lateral deep slip of the platysma into the buccinator, and the morphologic and spatial relationships thereof. METHODS: The lateral deep slip of the platysma was investigated in 42 specimens of embalmed adult Korean cadavers. RESULTS: The lateral deep slip of the platysma was observed in 17 of the 42 specimens (40.5 %). When present, it divided from the deep portion (16 specimens, 38.1 %) or the lateral portion (1 specimen, 2.4 %) of the platysma pars modiolaris. The lateral deep slip passed deep to the facial artery, where it blended into the inferior part of the buccinator. The blending site was located inferolateral to the modiolus. After blending into the buccinator, the fibers of the lateral deep slip coursed longitudinally with the inferior fibers of the buccinator. CONCLUSION: The present description of the topography of the lateral deep slip of the platysma and its relationship with surrounding structures could improve the understanding of the detailed movements of the lower face and the related EMG activities, with the data also being useful when performing facial surgery.

An anatomic study of the medial fibers of depressor anguli oris muscle passing deep to the depressor labii inferioris muscle.

The trajectory of the medial fibers of depressor anguli oris muscle that pass deep to the depressor labii inferioris muscle (dDAO) and the anatomic relationship have not yet been examined. The aim of this study was to clarify the arrangement of the dDAO and its relationships with the surrounding structures. The dDAOs were investigated in 40 hemifaces from Korean cadavers. The dDAOs were observed in 18 of the 40 specimens (45%). The anatomic relationships of the dDAO were classified into the following 4 categories according to their connection with the incisivus labii inferioris muscle (ILI): (1) connected to the ILI and attached to the inferior border of the mandible lateral to the mentalis muscle (14 specimens, 35%), (2) connected to the ILI and intermingled with the lateral lower fibers of the mentalis muscle (2 specimens, 5%), (3) connected to the ILI but neither attached to the mandible nor intermingled with the mentalis muscle (1 specimen, 2.5%), and (4) not connected to the ILI but intermingled with the mentalis muscle (1 specimen, 2.5%). Therefore, in 17 specimens, the dDAOs were connected to the ILI (42.5%), in 14 specimens, they were attached to the inferior border of the mandible (35%), and, in 3 specimens, they were intermingled with the mentalis muscle (7.5%). The new anatomic data regarding the dDAO will contribute toward the understanding of movements of the mouth and lower face, which will be helpful when designing effective botulinum toxin type A therapies and performing various types of facial surgery.

Inhibition of c-Kit signaling by diosmetin isolated from Chrysanthemum morifolium.

The interaction of stem cell factor (SCF) with its cognate receptor c-Kit is closely associated with the survival and maturation of melanocytes. To investigate novel depigmentation agents, we screened 2,000 plant extracts for c-Kit inhibitors to identify active small molecules by using time-resolved fluorescence enzyme assays. For the active extracts identified as inhibitors of c-Kit enzyme, we evaluated the effects of the active extracts and isolated flavonoids on c-Kit phosphorylation in MO7e/melanocytes. Anti-melanogenic activity was also examined in melanocytes and melanoderm model. The flavonoids such as diosmetin, apigenin, acacetin and luteolin isolated from Chrysanthemum morifolium were found to be active in inhibiting c-Kit both at enzyme and cellular levels. In addition, these flavonoids attenuated SCF-induced proliferation of human primary melanocytes without toxicity and suppressed ultraviolet (UV) B irradiation-mediated melanin synthesis significantly. Among the active flavonoids, diosmetin was found to inhibit SCF-induced melanogenesis in a human melanoderm model. These results strongly suggest that C. morifolium extract and diosmetin have potential to suppress SCF-/UVB-induced melanogenesis, and could be developed as anti-pigmentation agents.

Morphology of the mentalis muscle and its relationship with the orbicularis oris and incisivus labii inferioris muscles.

The mentalis muscle (MT) is the only elevator of the lower lip and the chin, and it provides the major vertical support for the lower lip. However, there are few reports on the relationship between the MT and its surrounding muscles. The aim of this study was to clarify the morphology of the MT, especially in relation to the orbicularis oris muscle and the incisivus labii inferioris muscle (ILI), thereby providing data to understand the function of the MT in relation to the surrounding muscles. The MT was examined in 40 specimens of embalmed adult Korean cadavers. The medial fibers of both MTs descended anteromedially and crossed together, forming a dome-shaped chin prominence in all specimens. The lateral fibers of the MT descended inferomedially in 38 specimens (95%) and inferolaterally in 2 specimens (5%). The upper fibers of the MT were short and ran horizontally, whereas the lower fibers were long and descended inferomedially or vertically. The upper fibers of the MT were intermingled with the inferior margin of the orbicularis oris muscle in all specimens. The originating muscle fibers of the ILI were intermingled with the upper lateral MT in all specimens. Some of the ILI fibers extended inferomedially to the middle or lower portion of the MT in 22 specimens (55%). The results of this study constitute new anatomical knowledge regarding the MT and will be useful to surgeons performing various surgical procedures of the chin area.

Variation of the infrahyoid muscle: duplicated omohyoid and appearance of the levator glandulae thyroideae muscles.

The embryologic origin of the omohyoid muscle is different from that of the other neck muscles. A number of variations such as the absence of muscle, variable sites of origin and insertion, and multiple bellies have been reported. However, variations in the inferior belly of the omohyoid muscle are rare. There have been no reports of the combined occurrence of the omohyoid muscle variation with the appearance of the levator glandulase thyroideae muscle. Routine dissection of a 51- year-old female cadaver revealed a duplicated omohyoid muscle and the appearance of the levator glandulae thyroideae muscle. In this case, the two inferior bellies of the omohyoid muscle were found to originate inferiorly from the superior border of the scapula. One of the inferior bellies generally continued to the superior belly with the tendinous intersection. The other inferior belly continued into the sternohyoid muscle without the tendinous intersection. In this case, the levator glandulae thyroideae muscle appeared on the left side, which attached from the upper border of the thyroid gland to the inferior border of the thyroid cartilage. These variations are significant for clinicians during endoscopic diagnosis and surgery because of the arterial and nervous damage due to iatrogenic injuries. The embryologic origins of the omohyoid and levator glandulae thyroideae muscles may be similar based on the descriptions in the relevant literature.

Degradation of trichloroethylene (TCE) by nanoscale zero-valent iron (nZVI) immobilized in alginate bead.

Nowadays, many researchers have studied the environmental application of the nanoscale zero-valent iron (nZVI) and several field applications for the groundwater remediation have been reported. Still, there are many concerns on the fate and transport of the nZVI and the corresponding risks. To avoid such concerns, it was investigated to immobilize nZVI in a support and then it was applied to degrade trichloroethylene (TCE). The nZVI and palladium-doped nZVI (Fe(0)- and Fe/Pd-alginate) were immobilized in the alginate bead where ferric and barium ions are used as the cross-linking cations of the bead. According to TEM (transmission electron microscopy), the size of the immobilized ZVI was as small as a few nanometers. From the surface analysis of the Fe/Pd-alginate, it is found that the immobilized nZVI has the core-shell structure. The core is composed of single crystal Fe(0), while most of irons on the surface are oxidized to Fe(3+). When 50 g/L of Fe/Pd-alginate (3.7 g Fe/L) was introduced to the aqueous solution, >99.8% of TCE was removed and the release of metal from the support was <3% of the loaded iron. The removal of TCE by Fe/Pd-alginate followed pseudo-first-order kinetics. The observed pseudo-first-order reaction constant (k(obs)) of Fe/Pd-alginate was 6.11 h(-1) and the mass normalized rate constant (k(m)) was 1.6 L h(-1) g(-1). The k(m) is the same order of magnitude with that of iron nanoparticles. In conclusion, it is considered that Fe/Pd-alginate can be used efficiently in the treatment of chlorinated solvent.

Screening of Kit inhibitors: suppression of Kit signaling and melanogenesis by emodin.

In search of novel antipigmentation agents, a set of 3,840 compounds with natural-like synthetic or natural origin were screened against Kit (stem cell factor receptor). Emodin from the seed of Cassia tora and baicalin from Scutellariae radix showed potent inhibitory effects (IC(50) = 4.9 and 9.0 microM, respectively) on the phosphorylation of Kit. Emodin also blocked other receptor tyrosine kinase activities, such as epithelial growth factor receptor (EGFR), vascular endothelial growth factor receptor 2 (VEGFR-2), fibroblast growth factor receptor 1 (FGFR-1), platelet-derived growth factor receptor b (PDGFR-b). In contrast to emodin, aloe-emodin did not inhibit Kit activity at all. Emodin also blocked the cellular kinase activities of Kit and its down-stream p44/42 mitogen activated protein kinase (MAPK) in MO7e cells and human primary melanocytes. Emodin strongly suppressed the melanin synthesis triggered by stem cell factor (SCF) treatment. Also, emodin showed almost no toxicity up to 10 microM on cultured melanocytes as reported previously by other researchers. The results indicate that emodin is a good candidate for the development of antipigmentation agents since it can radically block the differentiation and proliferation of pigment cells by reducing Kit signaling.

Expression of TGFbeta family in the developing internal ear of rat embryos.

In order to investigate the expression patterns of the transforming growth factor (TGF)beta isoforms in the internal ear, an immunohistochemical study of rat embryos was performed. Rat embryos were taken on the 13th, 15th, 17th, and 19th day after conception and their internal ears were immunohistochemically stained against TGF beta1, beta2, and beta3. As a result, the 13-day-old embryo showed a very weak positivity to TGF beta1. After the 15th day of pregnancy, no reactivity to TGF beta1 was defected. Immunoreactivity to TGF beta2 was observed from the 15th day of pregnancy throughout the rest of the period. The ampulla of the semicircular canal and the cochlear duct showed a notably strong immunohistochemical reaction. A strong reaction to TGF beta3 was observed on the 15th day of pregnancy. However, no positive reactions were observed thereafter. A strong immunoreactivity was observed especially on the apical cytoplasms, the surfaces of the epithelial cells, and basement membranes of the cochlear duct, as well as the semicircular canals of the developing internal ear of rat embryo.