Colon micro- and macrooesofagisation in interposed pedicled colonic right half segments for esophagus reconstruction.

Treatment of esophageal burns may require surgical transplantation (interposition) of the colon or stomach. The interposed parts change their function and morphology. To investigate the macro- and microchanges in the transplanted colonic segment we analyzed in long-term follow-up (up to 29 years) the group of 21 patients in a retrospective study who underwent surgical interposition of pedicled colonic right half segments for esophageal burns. The data were analyzed statistically with the software package Statistica 13 (StatSoft Polska, Cracow). All calculations were performed with a significant level of P = .05. We evaluated the macro- and microanatomy of the grafts using radiology, endoscopy and histology. The adaptation of the transplanted tube was excellent. The diameter of the colonic tube was normal (35-60 mm) in 60% of females and 100% of males. Typical macrooesophagisation was found in all patients, while microoesophagisation involved inflammation, which gradually resolved over a period of about 5 years to be replaced by edema without fibrosis. Only in few patients persistent reflux was present, leading to erosions or ulcerations. All symptoms subsided after conservative treatment. We concluded macrooesophagization developed gradually after surgery, and was fully developed after 15 to 20 years. Microoesophagization appeared soon after interposition, and was obvious after 5 years. No metaplasia or dysplasia were observed (except in 1 patient), and the number of goblet cell remained constant.

Dynamic Response Study of Piezoresistive Ti3C2-MXene Sensor for Structural Impacts.

MXenes are a new family of two-dimensional (2D) nanomaterials. They are inorganic compounds of metal carbides/nitrides/carbonitrides. Titanium carbide MXene (Ti3C2-MXene) was the first 2D nanomaterial reported in the MXene family in 2011. Owing to the good physical properties of Ti3C2-MXenes (e.g., conductivity, hydrophilicity, film-forming ability, elasticity) various applications in wearable sensors, energy harvesters, supercapacitors, electronic devices, etc., have been demonstrated. This paper presents the development of a piezoresistive Ti3C2-MXene sensor followed by experimental investigations of its dynamic response behavior when subjected to structural impacts. For the experimental investigations, an inclined ball impact test setup is constructed. Stainless steel balls of different masses and radii are used to apply repeatable impacts on a vertical cantilever plate. The Ti3C2-MXene sensor is attached to this cantilever plate along with a commercial piezoceramic sensor, and their responses for the structural impacts are compared. It is observed from the experiments that the average response times of the Ti3C2-MXene sensor and piezoceramic sensor are 1.28±0.24µs and 31.19±24.61µs, respectively. The fast response time of the Ti3C2-MXene sensor makes it a promising candidate for monitoring structural impacts.

Rehydration of the Tendon Fascicle Bundles Using Simulated Body Fluid Ensures Stable Mechanical Properties of the Samples.

In this work, we investigate the influence of dehydration and subsequent rehydration of tendon fascicle bundles on their structural and mechanical properties by using distilled water, 0.9% NaCl, 10% NaCl, SBF, and double concentrated SBF (SBFx2). The properties of tendon fascicle bundles were investigated by means of uniaxial tests with relaxation periods and hysteresis for samples with various interfascicular matrix content, dissected from the anterior and posterior areas of bovine tendon. Uniaxial tests with relaxation periods and analysis of sample geometry and weight showed that dehydration alters the modulus of elasticity dependent on the interfascicular matrix content and influences the viscoelastic properties of tendon fascicle bundles. Tensile and relaxation tests revealed that changes resulting from excessive sample drying can be reversed by rehydration in an SBF bath solution for elastic strain range above the toe region. Rehydration in SBF solution led to minor differences in mechanical properties when compared to control samples. Moreover, anterior samples with greater interfascicular matrix content, despite their lower stiffness, are less sensitive to sample drying. The obtained results allow us to limit the discrepancies in the measurement of mechanical properties of wet biological samples and can be useful to researchers investigating soft tissue mechanics and the stability of transplant materials.

Correlation between electromechanical parameters (NOGA XP) and changes of myocardial ischemia in patients with refractory angina.

INTRODUCTION: Cell therapy has the potential to improve symptoms and clinical outcomes in refractory angina (RFA). Further analyses are needed to evaluate factors influencing its therapeutic effectiveness. AIM: Assessment of electromechanical (EM) parameters of the left ventricle (LV) and investigation of correlation between EM parameters of the myocardium and response to CD133+ cell therapy. MATERIAL AND METHODS: Thirty patients with RFA (16 active and 14 placebo individuals) enrolled in the REGENT-VSEL trial underwent EM evaluation of the LV with intracardiac mapping system. The following parameters were analyzed: unipolar voltage (UV), bipolar voltage (BV), local linear shortening (LLS). Myocardial ischemia was evaluated with single-photon emission computed tomography (SPECT). The median value of each EM parameter was used for intra-group comparisons. RESULTS: Global EM parameters (UV, BV, LLS) of LV in active and placebo groups were 11.28 mV, 3.58 mV, 11.12%, respectively; 13.00 mV, 3.81 mV, 11.32%, respectively. EM characteristics analyzed at global and segmental levels did not predict response to CD133+ cell therapy in patients with RFA (Global UV, BV and LLS at rest R = -0.06; R = 0.2; R = -0.1 and at stress: R = 0.07, R = 0.09, R = -0.1, respectively; Segmental UV, BV, LLS at rest R = -0.2, R = 0.03, R = -0.4 and at stress R = 0.02, R = 0.2, R = -0.2, respectively). Multiple linear regression of the treated segments showed that only pre-injection SPECT levels were significantly correlated with post-injection SPECT, either at rest or stress (p < 0.05). CONCLUSIONS: Electromechanical characteristics of the left ventricle do not predict changes of myocardial perfusion by SPECT after cell therapy. Baseline SPECT results are only predictors of changes of myocardial ischemia observed at 4-month follow-up.

New Bird Sexing Strategy Developed in the Order Psittaciformes Involves Multiple Markers to Avoid Sex Misidentification: Debunked Myth of the Universal DNA Marker.

Sexing of birds is indispensable for scientific, breeding and conservation programs but is difficult in many species and is particularly problematic in the case of nestlings showing no sexual dimorphism. Most useful and efficient methods of sex determination are based on unique features of the Z and W sex chromosomes detected via PCR to distinguish males (ZZ) and females (ZW). During the last twenty-five years researchers searched for the universal marker capable of sexing a maximally wide spectrum of species in a single PCR assay. We screened the phylogenetically representative set of 135 Psittaciformes species including 59 species sexed for the first time. Two known (P2P8, CHD1iA) PCR markers and four additional W/Z polymorphisms (CHD1iE, CHD1i16, CHD1i9 and NIPBLi16) located within the Chromo Helicase DNA binding CHD1 or the Nipped-B homolog NIPBL genes were applied. We present the electrophoretic patterns obtained for the PCR products of the analyzed markers including most typical and atypical patterns allowing sex determination, as well as those obtained when the given marker failed in sexing. Technical aspects of molecular sex determination are discussed: the optimization of amplification conditions, direct PCR and potential misinterpretations. A truly universal marker has not been found, and therefore, we propose a sexing strategy based on multiple CHD1i16, NIPBLi16, CHD1i9 and CHD1iE markers. This new strategy confirms the sex of a given bird with at least two markers detecting independent Z/W polymorphisms, reduces the number of necessary PCR reactions and minimizes the risk of sex misidentification.

Correction: Dynamic response study of Ti3C2-MXene films to shockwave and impact forces.

[This corrects the article DOI: 10.1039/D0RA04879H.].

Deformation of Bioinspired MXene-Based Polymer Composites with Brick and Mortar Structures: A Computational Analysis.

In this work, the deformation behavior of MXene-based polymer composites with bioinspired brick and mortar structures is analyzed. MXene/Polymer nanocomposites are modeled at microscale for bioinspired configurations of nacre-mimetic brick-and-mortar assembly structure. MXenes (brick) with polymer matrix (mortar) are modeled using classical analytical methods and numerical methods based on finite elements (FE). The analytical methods provide less accurate estimation of elastic properties compared to the numerical one. MXene nanocomposite models analyzed with the FE method provide estimates of elastic constants in the same order of magnitude as literature-reported experimental results. Bioinspired design of MXene nanocomposites results in an effective increase of Young's modulus of the nanocomposite by 25.1% and strength (maximum stress capacity within elastic limits) enhanced by 42.3%. The brick and mortar structure of the nanocomposites leads to an interlocking mechanism between MXene fillers in the polymer matrix, resulting in effective load transfer, good strength, and damage resistance. This is demonstrated in this paper by numerical analysis of MXene nanocomposites subjected to quasi-static loads.

Dynamic response study of Ti3C2-MXene films to shockwave and impact forces.

MXenes (Titanium Carbide, Ti3C2-MXene) are two-dimensional nanomaterials that are known for their conductivity, film-forming ability, and elasticity. Though literature reports the possibility of usage of Ti3C2-MXenes for sensor development, the material properties and response need be studied in detail for designing sensors to measure dynamic variables like force, displacement, etc., in a dynamic environment. Ti3C2-MXenes due to their good electro-mechanical properties can be used for manufacturing sensing elements for engineering and biomedical applications. This paper focuses on an investigation of the dynamic response properties of Ti3C2-MXenes subjected to shockwave and impact forces. A supersonic shockwave (Mach number: 1.68, peak overpressure: 234.3 kPa) produced in a shock tube acts as an external force on the Ti3C2-MXene film placed inside the shock tube. In the experiment performed, the response time of the Ti3C2-MXene film sample has been observed to be in the range of few microseconds (∼7 µs) for the high-velocity shock. In a separate experiment, Ti3C2-MXene film samples are subjected to low-velocity impact forces through a ball drop test. The results from the ball drop test provide a response time in the range of few milliseconds (average ∼1.5 ms). In this novel demonstration, the Ti3C2-MXene film sample responds well for both low-velocity mechanical impact as well as high-velocity shockwave impact. Further, the repeatability of the dynamic response of the Ti3C2-MXene film sample is discussed along with its significant piezoresistive behavior. This work provides the basis for sensor development to measure the dynamic phenomena of pressure changes, acoustic emissions, structural vibrations, etc.

Feasibility of a voice-enabled automated platform for medical data collection: CardioCube.

AIM: A feasibility study was conducted to evaluate implementation of a voice-enabled automated platform for collection of medical data from patients with cardiovascular disease: CardioCube. METHODS: The study enrolled 22 individuals (10 males, 45.5%) including 9 patients with cardiovascular disease and 13 healthy participants. Utilizing (1) voice-enabled patient registration software implemented on the Amazon Echo and (2) web-based electronic health record (EHR) system, study participants verbally answered a set of clinical questions. Primary endpoint: accuracy of ​the ​CardioCube system. Secondary endpoints: acceptability, usability and technical performance. The study was performed at the Outpatient Cardiology Clinic, Cedars-Sinai Medical Center, Los Angeles, CA, USA. RESULTS: The CardioCube system collected 432 data points with a high agreement level between verbally provided data and corresponding EHR information (accuracy 97.51%). The CardioCube was able to automatically generate a summarized medical report, which was instantly available for a doctor in the web-based EHR system. Patients reported CardioCube was "easy to use". Applicability of the system was graded excellent by the medical staff. A single session utilized less than 0.002% of available computational resources. CONCLUSION: CardioCube can collect, index and document medical data using a voice interface. In this pilot study, CardioCube supported healthcare professionals by performing time-consuming paperwork during patient registration.

Anomalous retroaortic paravertebral course of the left innominate vein in a child with atrial septal defect.

We report the case of a 2.5-year-old boy with atrial septal defect in whom anomalous position of the left innominate vein was detected on preoperative ultrasound examination. Before joining the right brachiocephalic vein, the vessel extended from the left to the right and downward beyond the descending aorta. It was considerably flattened by the thoracic vertebral column, and was invisible on ultrasonography in this section. The appearance of the visible segments raised a suspicion of an anomalous course of persistent left superior vena cava draining into the left atrium, dilated azygos vein in a case of interrupted inferior vena cava, or partial anomalous pulmonary venous return. Since all doubts had to be resolved before open heart surgery, a decision was made to expand the diagnostic work-up to include computed tomography angiography. We present the echocardiographic and computed tomography findings of this unusual and previously unreported case of anomalous venous return.We report the case of a 2.5-year-old boy with atrial septal defect in whom anomalous position of the left innominate vein was detected on preoperative ultrasound examination. Before joining the right brachiocephalic vein, the vessel extended from the left to the right and downward beyond the descending aorta. It was considerably flattened by the thoracic vertebral column, and was invisible on ultrasonography in this section. The appearance of the visible segments raised a suspicion of an anomalous course of persistent left superior vena cava draining into the left atrium, dilated azygos vein in a case of interrupted inferior vena cava, or partial anomalous pulmonary venous return. Since all doubts had to be resolved before open heart surgery, a decision was made to expand the diagnostic work-up to include computed tomography angiography. We present the echocardiographic and computed tomography findings of this unusual and previously unreported case of anomalous venous return.

The large intestine from fetal period to adulthood and its impact on the course of colonoscopy.

The human large intestine in the living adult has a total length of about 1300 mm, ranging from 1100 to 2108 mm. The development of the gut continues after birth, up to the age 4-5. The large intestine ascends at the beginning in the right abdominal quadrant, then it traverses the abdominal cavity, and finally it descends to the anus. The left and right colic flexures are the basic flexions between the transverse, ascending and descending colon, respectively. Additionally, there are secondary bendings between intestinal segments. The angles between the neighbouring parts can vary between examined subjects. Most of the angulations can be found in the transverse (range 2-9) and sigmoid colon (range 1-9), making them the most troublesome parts to pass with a colonoscope. Colonoscopy (usually performed in the left lateral or supine position) is one of the most important examination of the large intestine mucus membrane. During this procedure the endoscope is passed through the colon into the cecum or terminal ilium. The individual anatomical features (tortuosity, supernumerary loops and elongation) may slow down or interfere with the progress of the scope. We summarize current knowledge on the human large intestine from the fetal period to adulthood and carve out some aspects that are currently less known to colonoscopists.

Toll-like receptors TLR-2, TLR-4, TLR-7, and TLR-9 in tumor tissue and serum of the patients with esophageal squamous cell carcinoma and gastro-esophageal junction cancer.

BACKGROUND: Stimulation of toll-like receptors (TLRs) has been linked to the development of esophageal and gastric cancers. OBJECTIVES: The aim of the study was to evaluate the clinical significance of tissue expression and serum concentration of TLR-2, TLR-4, TLR-7 and TLR-9 in patients with esophageal squamous cell carcinoma and gastro-esophageal junction adenocarcinoma. MATERIAL AND METHODS: The study group consisted of 97 individuals: 32 with esophageal squamous cell carcinoma, 27 with gastro-esophageal junction cancer, and 38 ageand gender-matched controls. The mRNA expression and protein concentration of TLRs in tissues and sera were measured by reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) tests. RESULTS: In esophageal cancer patients, mRNA expressions of TLR-2, TLR-4 and TLR-7, and protein concentrations of all TLRs were significantly higher in tumor than in control tissue (p < 0.05). In esophageal cancer patients with lymph node metastasis, a tendency toward higher protein concentrations of tumor TLR-4 was observed. In gastro-esophageal junction adenocarcinoma subgroup, only the mRNA expression of TLR-7 and protein concentrations of TLR-4, TLR-7 and TLR-9 were significantly higher in tumors than in normal mucosa (p < 0.05). Protein concentration of TLR-9 was significantly higher in tumors of gastro-esophageal junction cancer with lymph node metastasis and depth of tumor invasion. Diagnostic potential of serum TLR-4 as a marker of gastro-esophageal junction cancer presence was reported. CONCLUSIONS: We demonstrated differences in the expression patterns of TLRs between esophageal squamous cell carcinoma and adenocarcinoma of gastro-esophageal junction, and showed circulating TLR-4 to be a potential marker of gastro-esophageal junction cancer.

Zenker diverticulum: Experience in surgical treatment of large diverticula.

The purpose of this retrospective study is to show that transcervical diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a first choice procedure in selected patients and in experienced hands its safety might be compared to the minimally invasive endoscopic diverticulostomy.The study cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the patients underwent open diverticulectomy. The decision to choose open surgical repair depended on surgical risk, age of the patient, size of the diverticular septum (the distance between the top of the diverticulum and its bottom on barium study), and patient's preference.Mean age of patients was 64.6 ±â€Š11.9 years; range: 26 to 88 years. A total of 36.4% out of them finished 70 years. Postoperative mortality was nil. Two major complications (4.5%) requiring surgical intervention occurred: leak and hematoma.Data were analyzed by t test for independent samples using Statistica 12.5 software. P value <0.05 was considered statistically significant.Surgical treatment of patients with ZD should be individualized. Large Zenker diverticula with the septum longer than 6 cm should preferably be resected through an open approach because it is not possible to remove the septum completely during one-step endoscopic procedure and diverticulostomy creates a weak and large common cavity in the esophagus. Surgical repair is effective for all sizes of diverticula, but its most serious complications such as leakage or laryngeal nerve injury should be considered, especially in elderly patients with comorbidities. However, age alone should not be the main criterion if choosing the treatment option.

Anomalous origin of the right coronary artery from the main pulmonary artery treated surgically in a 6-week-old infant. A case report and review of the literature.

BACKGROUND: In the present paper, the authors describe a case of a rare congenital defect - anomalous origin of the right coronary artery from the main pulmonary artery diagnosed in a 5-week-old infant who was deemed eligible for surgical treatment based solely on echocardiography. Such anatomical abnormalities of the coronary arteries are subtle and thus extremely difficult to visualize, especially in patients in whom permanent extensive damage of the cardiac muscle has not yet occurred. For this reason, the diagnosis is usually established when the disease is highly advanced, oftentimes only postmortem. In this paper, the authors present early echocardiographic evaluation, successful surgical treatment and post-operative echocardiographic examination. CASE PRESENTATION: Fetal echocardiographic examinations demonstrated single vascular anomalies. The suspicion was verified after birth. Other congenital defects, including genetic defects, were also investigated. In the 5th week of life, cardiac ECHO showed abnormal origin of the right coronary artery from the trunk of the pulmonary artery. The child was deemed eligible for surgical treatment of the defect. The surgical translocation of the ostium of the right coronary artery to the aorta was done with success, and the child was discharged on the 14th day of hospitalization. CONCLUSION: The present case report demonstrates that careful examination of the child with precise echocardiographic examination makes it possible to establish an early diagnosis of this rare defect. This discrete defect can be treated early, before the symptoms, often connected with irreversible changes in the myocardium, appear.

Supravalvar mitral ring with a parachute mitral valve and subcoarctation of the aorta in a child with hemodynamically significant VSD. A study of the morphology, echocardiographic diagnostics and surgical therapy.

The authors present a case of echocardiographic diagnosis of supravalvar mitral ring (a fibromembranous structure that arose from the atrial surface of the mitral leaflets) in a child with a parachute mitral valve, a ventricular septal defect, and mild narrowing of the aortic isthmus. The supravalvar mitral stenosis is a typical but very infrequently detected element of the complex of anatomical abnormalities located within the left heart and the proximal aorta, called the Shone's complex (syndrome). Diagnosing an additional, hemodynamically significant anatomic defect during echocardiography was possible thanks to the detection of marked mobility limitation of the ring-adjacent part of the mitral valve mural leaflet as well as of an atypical image of turbulence occurring during the inflow from the left atrium to the left ventricle. The early diagnosis made it possible to perform complete correction of this complex congenital defect within a single operation.

Fibroblast activating protein-α expression in squamous cell carcinoma of the esophagus in primary and irradiated tumors: the use of archival FFPE material for molecular techniques.

There are numerous reports suggesting that fibroblast activating protein-α (FAP-α) plays an important role in invasion of various tumor types. We studied the expression pattern of FAP-α in esophageal squamous cell carcinoma (ESCC) patients who had not been treated primarily and those who had received neoadjuvant radiochemotherapy. Our goal was to establish whether readily available tissue specimens fixed in formalin and stored in paraffin blocks for years might still be a source of FAP-α RNA for PCR analysis. The study included 20 patients divided into two groups, 10 patients in each group. We evaluated the expression of FAP-α by PCR techniques in fresh frozen and in paraffin-embedded tissues, and compared it to the expression in non-cancer tissues. To detect the protein expression level of FAP-α in paraffin-embedded tissues we used chromogenic immunohistochemical (IHC) staining. Data were analyzed by t-test or the nonparametric Wilcoxon matched pair test using Statistica 12.5 software. We observed an increased level of the FAP-alpha gene and protein expression in cancer tissues when compared with their corresponding normal tissues. However, statistically significant differences were found only in the group of patients untreated before surgery. RNA extracted from paraffin-embedded tissue sections had very low quality, especially in the context of degradation. FAP-α remains a highly altered participant of a complex microenvironment in esophageal squamous cell carcinoma, and its role in cell signaling requires further study. In this paper, we conclude that the use of a regular RT-PCR method for diagnostic purposes, which we have presented in an earlier paper, can be as good as qRT-PCR. Also, immunohistochemistry proved to be very useful and the only reliable method that can be used on formalin-fixed, paraffin-embedded tissues stored long term.

Esophageal anastomosis - how the granulation phase of wound healing improves the incidence of anastomotic leakage.

A two-stage esophagectomy with an interval for reconstruction of the esophagus creates an opportunity for the esophageal stump to recover from vessel injury and allows the formation of granulation tissue rich in proangiogenic factors, including transforming growth factor ß (TGF-ß) and vascular endothelial growth factor A (VEGF-A), which may have an impact on anastomosis healing. The present study comprised 25 patients (27 in total, 2 succumbed to complications following surgery) who underwent two-stage esophagectomy for squamous cell carcinoma in the Department of Gastrointestinal and General Surgery, Wroclaw Medical University (Wroclaw, Poland) between January 2007 and December 2012. Immunohistochemical staining for VEGF-A and TGF-ß was performed to evaluate esophageal wall specimens at the time of esophagostomy construction and prior to anastomosis, in which the cervical esophagus was connected with the colon or ileum. At the time of reconstructive surgery, a significant increase in microvessel density was observed in all esophageal specimens (P<0.03). Significant differences were also identified in the immunohistochemical staining intensity of TGF-ß and VEGF-A in the epithelium of all esophageal specimens between biopsies obtained from normal esophageal tissues at the time of esophagectomy and during reconstructive surgery. Delayed anastomosis construction provides an advantage for the esophageal stump to accumulate proangiogenic growth factors, which overlap with the subsequent proliferative stage of the anastomosed tissue and thus supports its recovery, creating an optimal environment for the healing of any fistulas.

TNF-α promotes breast cancer cell migration and enhances the concentration of membrane-associated proteases in lipid rafts.

PURPOSE: Tumor progression is associated with cell migration, invasion and metastasis. These processes are accompanied by the activation of specific proteases that are either linked to cellular membranes or are secreted into extracellular spaces. TNF-α is known to play an important role in various aspects of tumor progression. The aim of this work was to assess the effect of TNF-α on the migration of breast cancer cells and, in addition, to assess its association with the location of membrane-associated proteases in lipid rafts. METHODS: Wound scratch healing and Transwell migration assays were used to study the effect of TNF-α on the migration of both hormone-dependent and hormone-independent breast cancer-derived cells, i.e., MCF7 and MDA-MB-231, respectively. The expression and secretion of three matrix metalloproteases, MMP9, MMP2 and MT1-MMP, and two dipeptidyl peptidases, CD26 and FAP-α, was investigated using RT-PCR, Western blotting and gelatin zymography. In addition, activation of the MAPK/ERK signaling pathway was investigated by Western blotting. RESULTS: We found that a TNF-α-induced enhancement of breast cancer cell migration was accompanied by an increased secretion of MMP9, but not MMP2, into the culture media. We also found that TNF-α upregulated the expression of the dipeptidyl peptidases CD26 and FAP-α in a dose-dependent manner and, in addition, enhanced the concentration of all five proteases in lipid rafts in the breast cancer-derived cells tested, regardless of cell type. Furthermore, we found that TNF-α activated the MAPK/ERK signaling pathway by increasing the ERK1/2 phosphorylation level. Application of the MEK/ERK1/2 inhibitor U-0126 resulted in down-regulation of TNF-α-induced MMP9 secretion and abrogation of the enhanced concentration of proteases in the lipid rafts. CONCLUSIONS: From our results we conclude that TNF-α-induced activation of the MAPK/ERK signaling pathway may promote breast cancer cell migration via both upregulation of MMP9, CD26 and FAP-α and concentration of these proteases, as also MT1-MMP and MMP2, in the lipid rafts. TNF-α may serve as a potential therapeutic target in breast cancers susceptible to TNF-α stimulation.