Sheet-Like Remodeling of the Transverse Tubular System in Human Heart Failure Impairs Excitation-Contraction Coupling and Functional Recovery by Mechanical Unloading.

BACKGROUND: Cardiac recovery in response to mechanical unloading by left ventricular assist devices (LVADs) has been demonstrated in subgroups of patients with chronic heart failure (HF). Hallmarks of HF are depletion and disorganization of the transverse tubular system (t-system) in cardiomyocytes. Here, we investigated remodeling of the t-system in human end-stage HF and its role in cardiac recovery. METHODS: Left ventricular biopsies were obtained from 5 donors and 26 patients with chronic HF undergoing implantation of LVADs. Three-dimensional confocal microscopy and computational image analysis were applied to assess t-system structure, density, and distance of ryanodine receptor clusters to the sarcolemma, including the t-system. Recovery of cardiac function in response to mechanical unloading was assessed by echocardiography during turndown of the LVAD. RESULTS: The majority of HF myocytes showed remarkable t-system remodeling, particularly sheet-like invaginations of the sarcolemma. Circularity of t-system components was decreased in HF versus controls (0.37±0.01 versus 0.46±0.02; P<0.01), and the volume/length ratio was increased in HF (0.36±0.01 versus 0.25±0.02 µm2; P<0.0001). T-system density was reduced in HF, leading to increased ryanodine receptor-sarcolemma distances (0.96±0.05 versus 0.64±0.1 µm; P<0.01). Low ryanodine receptor-sarcolemma distances at the time of LVAD implantation predicted high post-LVAD left ventricular ejection fractions (P<0.01) and ejection fraction increases during unloading (P<0.01). Ejection fraction in patients with pre-LVAD ryanodine receptor-sarcolemma distances >1 µm did not improve after mechanical unloading. In addition, calcium transients were recorded in field-stimulated isolated human cardiomyocytes and analyzed with respect to local t-system density. Calcium release in HF myocytes was restricted to regions proximal to the sarcolemma. Local calcium upstroke was delayed (23.9±4.9 versus 10.3±1.7 milliseconds; P<0.05) and more asynchronous (18.1±1.5 versus 8.9±2.2 milliseconds; P<0.01) in HF cells with low t-system density versus cells with high t-system density. CONCLUSIONS: The t-system in end-stage human HF presents a characteristic novel phenotype consisting of sheet-like invaginations of the sarcolemma. Our results suggest that the remodeled t-system impairs excitation-contraction coupling and functional recovery during chronic LVAD unloading. An intact t-system at the time of LVAD implantation may constitute a precondition and predictor for functional cardiac recovery after mechanical unloading.

[A case report of combined aesthetic diagnosis and treatment of adult concave deformity].

The non-surgical treatment of adult concave deformity can be achieved by interdisciplinary solution, which includes condylar relocation, fixed orthodontic, and functional occlusion smile design anterior prosthesis. In this study, an adult patient with concave deformity were treated by maxillary occlusal splint, conventional fixed brackets, and upper anterior teeth porcelain veneers to lead mandibular condyle to centric relation, to correct the dental arches for functional occlusion, and to gain the final desired esthetic achievement after treatments.

Insight into structural composition of dissolved organic matter in saline-alkali soil by fluorescence spectroscopy coupled with self-organizing map and structural equation modeling.

Soil salinization has been occurring all over the world, which severely affected crop production and threatened the life of mankind. It is necessary to take serious steps to improve soil fertility for the sustainability and productive capacity of agriculture. Soil samples of different depths were collected from native vegetation communities (Comm. Phragmites communis (CPC) and Comm. Populus alba (CPA)) and irrigated crops (corn fields (CFD) and seed melon fields (SMF)) in Hetao irrigation area of China. Three dimensional excitation-emission matrix (EEM) fluorescence technology combined with self-organizing map were used to analyze the dissolved organic matter (DOM) composition and structural characteristics in saline-alkali soils and its spatial distribution under different vegetation covers. Critical factors were recognized by classification and regression tree (CART) for distinguishing soil samples, and latent factors were revealed with structural equation modeling (SEM) for improving the humification degree of DOM from saline soils in Hetao irrigation area. Five components were obtained in the DOM substances, i.e., tyrosine-like (C1), tryptophan-like (C2), UV fulvic-like (C3), visible fulvic-like (C4) and humic-like (C5). The protein-like peaks were all obvious, and the fulvic-like peaks (600-735 a.u.) were conspicuous in the CPC soil than in others, except CFD1 and SMF1. C1 was the critical factor to distinguish native vegetation from irrigated crops, and C1 and C2 were the critical factors to distinguish CFD from SMF. Contrary to the HA/FA (0.20) and A/C (0.25), the path coefficient (-0.15) of sources with T/H was negative, indicating that the incremental contents of fluorenscense substances were in the sequences of protein-like > visible fulvic-like > UV fulvic-like > humic-like, affecting by the allochthonous. C1 (1.00) and C4 (1.00) were the primary components for improving the humification degree of DOM, which were principally originated from plant debris. EEM combined with self-organizing map, CART and SEM is an efficient way to distinguish different salinized soils and reveal the latent factors for improving the soil fertility.

Applying synchronous fluorescence spectroscopy conjunct second derivative and two-dimensional correlation to analyze the interactions of copper (II) with dissolved organic matter from an urbanized river.

Heavy metal speciation and distribution is significantly influenced by dissolved organic matter (DOM) exhibited in ecosystems, particularly in urbanized rivers. Synchronous fluorescence spectroscopy (SFS) conjunct second derivative and two-dimensional correlation spectroscopy (2D-COS) was devoted to characterizing interactions of DOM-copper (II). Three typical water samples were collected from Baitapu River. Only protein-like fluorescence (PLF) and fulvic-like (FLF) were identified from the SFS. Stability constant (log K) values of PLF complexes with copper (II) varied from 4.277 to 5.833, and proportion of binding fluorescent materials (f) were 0.054-2.640. The log K values of FLF complexes with copper (II) varied from 3.996 to 4.243, while the f values were 0.001-0.036. Obviously, PLF had much stronger complexing capacity than FLF. There were four obvious peaks in the principal component analysis and second derivative fluorescence spectroscopy (SDFS), i.e., tyrosine-like (TYLF), tryptophan-like (TRLF), microbial humus-like (MHLF) and FLF. The log K values of TYLF and TRLF complexes were 4.899-5.907 and 4.598-5.831, respectively, which were similar to those from PLF. The log K values of MHLF complexes varied from 4.311 to 5.760, and the f values were 0.261-8.688. The log K values of FLF complexes were ranged from 4.598 to 5.831, which were higher than those deduced from the SFS. Interestingly, by the SDSF, PLF was divided into TYLF and TRLF, which increased the parameters values from DOM-copper (II) complexes. 2D-SFS-COS revealed that the TRLF was more susceptive response to copper (II) appended than TYLF, MHLF, and FLF. Moreover, TYLF and TRLF could priorly interact with copper (II). The SDSF conjunct 2D-COS could be effective approaches for insight into the complexing heterogeneity of DOM with copper (II). The study could present a support to preventing heavy metals and organic pollution in urbanized rivers.

Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first-in-the-world case report.

Cardiogenic shock from biventricular failure that requires acute mechanical circulatory support carries high 30 day mortality. Acute mechanical circulatory support can serve as bridge to orthotopic heart transplant (OHT) in selected patients. We report a patient with biventricular failure secondary to rapidly progressive cardiac sarcoidosis refractory to medical management who was bridged to OHT with Impella 5.0 and Impella RP-temporary left and right ventricular assist devices, respectively. This is the first successful bridge to transplantation using these devices in biventricular heart failure and cardiogenic shock. We discuss considerations for using this strategy over veno-arterial extracorporeal membrane oxygenation or surgically implanted assist devices in patients with cardiogenic shock and biventricular failure as a bridge to OHT.

Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study.

BACKGROUND: Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. METHODS AND RESULTS: Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS: LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.

A molecular scheme for improved characterization of human embryonic stem cell lines.

BACKGROUND: Human embryonic stem cells (hESC) offer a renewable source of a wide range of cell types for use in research and cell-based therapies to treat disease. Inspection of protein markers provides important information about the current state of the cells and data for subsequent manipulations. However, hESC must be routinely analyzed at the genomic level to guard against deleterious changes during extensive propagation, expansion, and manipulation in vitro. RESULTS: We found that short tandem repeat (STR) analysis, human leukocyte antigen (HLA) typing, single nucleotide polymorphism (SNP) genomic analysis, mitochondrial DNA sequencing, and gene expression analysis by microarray can be used to fully describe any hESC culture in terms of its identity, stability, and undifferentiated state. CONCLUSION: Here we describe, using molecular biology alone, a comprehensive characterization of 17 different hESC lines. The use of amplified nucleic acids means that for the first time full characterization of hESC lines can be performed with little time investment and a minimum of material. The information thus gained will facilitate comparison of lines and replication of results between laboratories.

Rationales and choices for the treatment of patients with NYHA class II heart failure.

Heart failure (HF) in the United States represents a significant burden for patients and a tremendous strain on the healthcare system. Patients receiving a diagnosis of HF can be placed into 1 of 4 New York Heart Association (NYHA) functional classifications; the greatest proportion of patients are in the NYHA class II category, which is defined as patients having a slight limitation of physical activity but who are comfortable at rest, and for whom ordinary physical activity results in symptoms of HF. Because the severity of NYHA class II HF may be perceived as mild or unalarming by this definition, the urgency to treat this type of HF may be overlooked. However, these patients are optimal candidates for active intervention because their HF is at a critical point on the disease progression continuum when untoward changes can be halted or reversed. This review discusses the physiological consequences of NYHA class II HF with reduced ejection fraction and describes recent clinical trials that have demonstrated a therapeutic benefit for patients in this population. In doing so, we hope to establish that patients with NYHA class II disease merit careful attention and to provide reassurance to the treating community that options are available for these patients.

[A pilot study of establishing course of professional English on stomatology].

The importance of specialized English on stomatology is becoming more and more significant under the new situation. It used to be focused on vocabulary and literature teaching in the original course of specialized English, which was lack of practicability. Thus, we try to establish a course of professional English on stomatology during the postgraduate stage of the seven-year students in our college, in order to complement the course of specialized English on stomatology and improve the students' practical ability to use specialized English. In this paper, the teaching content and method, teaching materials setting and the feedback from students on the course were discussed and analyzed, in order to lay a foundation for better construction of the course.

[Analysis of vertical root fracture with two different techniques of root canal preparation].

PURPOSE: To investigate the relationship of vertical root fracture (VRF) after root canal treatment with two different technique of root canal shaping and provide clinical reference. METHODS: 1702 teeth treated with root canal treatment during recent 2 years. All teeth were divided into two groups according to different techniques of root canal shaping: 643 teeth were prepared with NiTi rotary preparation technique (NRPT) and 1059 teeth were prepared with stainless steel hand K-files preparation technique(SSPT). The clinical symptoms and signs, radiological findings were estimated. The data was analyzed by SPSS 11.5 software package. RESULTS: There were 32 teeth with vertical root fracture, the VRF rate was 1.88%. The VRF rate in NRPT group was significantly higher than in SSPT group (P<0.01). The VRF rate with retreatment history in NRPT group was significantly higher than in SSPT group (P<0.01), but The VRF rate with post and core restoration in both NRPT and SSPT groups was not significantly different(P>0.05). CONCLUSIONS: NiTi rotary preparation technique (NRPT) was closely related with vertical root fracture (VRF). And the VRF risk would be even higher if the tooth underwent root canal retreatment case or a post-core was placed in the root canal.

[Evaluation on clinical value of serum CA-125 level in hepatitis cirrhosis].

OBJECTIVE: To determine the association between elevated levels of serum cancer antigen (CA) 125 and hepatitis cirrhosis in different stage, and also to explore the clinical application value of serum CA-125. METHODS: During June to December in 2008, 200 cases with hepatitis cirrhosis were random selected in our hospital. CA-125 levels were measured by electrochemiluminescence immunization assay in sera collected from these cases which were termed with Child-Paugh classification and analyzed by SAS. RESULTS: Serum CA-125 levels were correlated closely with ascites, primary peritonitis and liver function Child-Paugh classification, but no associated with primary carcinoma of liver and other liver function index,such as ALT, AST, ALB, TBIL and PT. CONCLUSION: The levels of serum CA-125 in hepatitis cirrhosis patients were osculating correlating with lesion of liver and ascite degree, could serve as a sensitive and conventional laboratory index for liver lesion degree and monitoring ascite generation. It was necessary to further study on the association with serum CA-125 level with primary hepatic carcinoma.