CD62L expression marks SARS-CoV-2 memory B cell subset with preference for neutralizing epitopes.

Severe acute respiratory syndrome coronavirus 2-neutralizing antibodies primarily target the spike receptor binding domain (RBD). However, B cell antigen receptors (BCRs) on RBD-binding memory B (Bmem) cells have variation in the neutralizing activities. Here, by combining single Bmem cell profiling with antibody functional assessment, we dissected the phenotype of Bmem cell harboring the potently neutralizing antibodies in coronavirus disease 2019 (COVID-19)-convalescent individuals. The neutralizing subset was marked by an elevated CD62L expression and characterized by distinct epitope preference and usage of convergent VH (variable region of immunoglobulin heavy chain) genes, accounting for the neutralizing activities. Concordantly, the correlation was observed between neutralizing antibody titers in blood and CD62L+ subset, despite the equivalent RBD binding of CD62L+ and CD62L- subset. Furthermore, the kinetics of CD62L+ subset differed between the patients who recovered from different COVID-19 severities. Our Bmem cell profiling reveals the unique phenotype of Bmem cell subset that harbors potently neutralizing BCRs, advancing our understanding of humoral protection.

ß-elemene regulates M1-M2 macrophage balance through the ERK/JNK/P38 MAPK signaling pathway.

Macrophages are classified into classically activated M1 macrophages and alternatively activated M2 macrophages, and the two phenotypes of macrophages are present during the development of various chronic diseases, including obesity-induced inflammation. In the present study, ß-elemene, which is contained in various plant substances, is predicted to treat high-fat diet (HFD)-induced macrophage dysfunction based on the Gene Expression Omnibus (GEO) database and experimental validation. ß-elemene impacts the imbalance of M1-M2 macrophages by regulating pro-inflammatory cytokines in mouse white adipose tissue both in vitro and in vivo. In addition, the RAW 264 cell line, which are macrophages from mouse ascites, is used to identify the effects of ß-elemene on inhibiting bacterial endotoxin lipopolysaccharide (LPS)-induced phosphorylation of mitogen-activated protein kinase (MAPK) pathways. These pathways both induce and are activated by pro-inflammatory cytokines, and they also participate in the process of obesity-induced inflammation. The results highlight that ß-elemene may represent a possible macrophage-mediated therapeutic medicine.

A technique for creating an experimental type Ia endoleak model in the thoracic aorta of swine.

PURPOSE: This study aimed to create an animal model of type Ia endoleak that creates persistent problems after thoracic endovascular aortic repair. MATERIALS AND METHODS: In six swine, thoracic aortic aneurysms were created using the harvested jugular vein. We created a type Ia endoleak using a composite stent-graft comprising the first stent-graft (reverse-tapered: thicker part, 16 mm; thinner part, 10 mm) and the second stent-graft (tapered: thicker part, 18-20 mm; thinner part, 16 mm). This double-component stent-graft was deployed in the abdominal aorta and then moved upward to the proximal entry site of the thoracic aneurysm using the inflated balloon for precise positioning. After the surgical procedure and on postoperative day 8, aortography was performed to detect residual endoleak, and then the swine were euthanized. RESULTS: A stable aneurysm (mean size of all aneurysms, 16.8 ± 1.72 mm × 11.8 ± 2.32 mm) and type Ia endoleak were successfully observed in all swine. A single stent-graft was sufficient in one of the six swine. CONCLUSION: A novel technique to create a type Ia endoleak model can be successfully developed in swine.

Outpatient Cardiac Rehabilitation Suppresses Deterioration of Renal Function in Patients ≥75 Years of Age With Heart Disease.

BACKGROUND: This study investigated the effect of outpatient cardiac rehabilitation (OCR) and physical activity on the estimated glomerular filtration rate based on serum cystatin C (eGFRcys) in patients with heart disease (HD) aged ≥75 years.Methods and Results:This non-randomized prospective intervention study involved 136 patients (non-OCR group, n=66; OCR group, n=70), 55 of whom were aged ≥75 years (non-OCR group, n=29; OCR group, n=26). Renal function (eGFRcys) was evaluated at discharge and 3 months thereafter. A linear mixed model (LMM) was used to assess changes in renal function over time. The hospital readmission rate within 3 months after discharge was also evaluated. LMM analysis showed that the change in eGFRcys was -2.27 and +0.48 mL/min/1.73 m2in the non-OCR and OCR groups, respectively (F=2.960, P=0.022). Further, among patients aged ≥75 years in the non-OCR and OCR groups, the change in eGFRcys was -3.83 and -1.08 mL/min/1.73 m2, respectively (F=2.719, P=0.039). The proportion of patients aged ≥75 years who were rehospitalized due to exacerbation of HD was 16.9% (n=10) and 6.7% (n=2) in the non-OCR and OCR groups, respectively. CONCLUSIONS: Among patients with HD aged ≥75 years, participation in OCR reduces the decline in renal function and hospital readmission rates.

A potential concomitance of papillary fibroelastoma in the case with cardiac myxoma.

An 84-year-old woman was referred to our hospital with a suspected cardiac tumor detected by transthoracic echocardiography performed as a preoperative examination of gastric cancer. In addition to a tumor in the left atrium, we found on cardiac ultrasound a 15-mm mobile tumor that adhered to the aortic valve. Gross findings and histological examination confirmed that the tumor in the left atrium was a cardiac myxoma, and that the tumor adhered to the aortic valve was a papillary fibroelastoma. We experienced a rare case where preoperative examination before gastrectomy accidentally revealed concomitant cardiac tumors.

Video-assisted endoscopic resection of left ventricular papillary fibroelastoma through the aortic valve.

Papillary fibroelastoma is a rare, benign cardiac tumor. Surgical resection is indicated to prevent embolization. We herein report a case of a 78-year-old asymptomatic man who was found to have a mobile left ventricular papillary fibroelastoma anchoring deep in the left ventricle by incidental transthoracic echocardiography. The tumor was resected under visualization by a video-assisted rigid endoscope with a flexible head inserted through the aortic valve into the left ventricle. Intraoperative frozen section analysis provided a pathological diagnosis of papillary fibroelastoma. The postoperative course was uneventful. This technique is recommended for the observation and resection of a tumor anchoring deep in the left ventricle and is helpful for avoiding the adverse effects of left ventriculotomy.

[Thoracic Endovascular Aortic Repair (TEVAR) Combined with Embolization Technique for Saccular Aortic Arch Aneurysm].

Many of saccular aortic arch aneurysms exist near left subclabian artery(LSA). The thoracic endovascular aneurysm repair( TEVAR) landing on zone 2 is a less invasive and suitable procedure for this type of aneurysm. However, there are several cases with the aneurysm located close to LSA necessitate landing TEVAR on zone 1 or zone 0, otherwise the aneurysm could not be sealed completely. And this procedure seems to increase the invasiveness. In order to complete the sealing of the aneurysm and also keep the less invasiveness, we performed TEVAR using an axillo-axillary bypass or simple occlusion of LSA followed by an embolization using metal coil and NBCA through the catheter which detained in the saccular aneurysm beforehand. We report our experience of seven cases have been successfully treated by this procedure with good results.

[Prevention of cerebral infarction in thoracic endovascular aneurysm repair(TEVAR) of distal aortic arch aneurysms; left subclavian artery balloon technique].

Thoracic endovascular aneurysm repair(TEVAR) has been applied more and more frequently to an atherosclerotic distal aortic arch aneurysm. Even if the procedure is successful, extensive cerebral infarction might occur, especially in the left vertebral artery area. We therefore devised a new method to prevent embolic events using a thrombectomy catheter with an end hole, which was placed at the origin of the letf subclavian artery via the radial artery. This simple left subclavian artery balloon technique not only prevents cerebral embolism in the left vertebral artery system, but also provides a position marker under X-ray, and enables tight compaction of the embolization coils.

[Efficacy of box-lesion set in maze procedure].

Comparative study of box-lesion set and past single ablation lesion set were made in 48 patient who underwent the Cox maze IV procedure for atrial fibrillation (Af) from October 2004 through October 2009. Before May 2008, the pulmonary veins were connected with single ablation lesion set (n = 20), where as a box-lesion set was performed (n = 28) after that. Their mean age was 68.6 years (age range 49-87 years). Freedom from Af recurrence was greater than 80% in both groups and there was no significant difference between the 2 groups. When left atrial diameter was larger, freedom from fibrillation recurrence was lower in both groups. In conclusion, the Cox maze IV procedure produces good surgical outocomes. More study is necessary to evaluate the effectiveness of the box-lesion set.