Effect of age on aortic atherosclerosis

Objective To examine the association of atherosclerosis burden in the survivors of an asymptomatic elderly cohort study and its relationship to other coronary risk factors (specifically, age) by evaluating aortic atherosclerotic wall burden by magnetic resonance imaging (MRI). Methods A total of 312 participants in an ongoing observational cohort study underwent cardiac and descending thoracic aorta imaging by MRI. Maximum wall thickness was measured and the mean wall thickness calculated.Wall/outer wall ratio was used as a normalized wall index (NWI) adjusted for artery size difference among participants. Percent wall volume (PWV) was calculated as NWI ×100.Results In this asymptomatic cohort (mean age: 76 years), the mean (SD) aortic wall area andwall thicknesswere 222 ±45 mm2 and 2.7 ±0.4 mm, respectively. Maximum wall thickness was 3.4 ±0.6 mm, and PWV was 32% ±4%. Women appeared to have smaller wall area,but after correcting for their smaller artery size, had significantly higher PWV than men (P = 0.03). Older age was associatedwith larger wall area (P = 0.04 for trend) with similar PWVs. However, there were no statistically significant associations between standard risk factors,Framingham global risk, or metabolic syndrome status, therapy for cholesterol or hypertension, coronary or aortic calcium score, and the aortic wall burden. Aortic calcificationwas associated with coronary calcification. Conclusions Asymptomatic elderly in this cohort had a greater descending thoracic aortic wall volume that correlated with age, andwomen had a significantly increased PWV compared to men. In these survivors, the atherosclerotic aortic wall burden was not significantly associated with traditional risk factors or with coronary or aortic calcium scores or coronary calcium progression. Results suggest that age, or as yet unidentified risk factor(s), may be responsible for the increase in atherosclerosis.

Association of daily sitting time and leisure-time physical activity with body fat among U.S.adults

Background:Prolonged sitting and reduced physical activity lead to low energy expenditures.However,little is known about the joint impact of daily sitting time and physical activity on body fat distribution.We investigated the independent and joint associations of daily sitting time and physical activity with body fat among adults.Methods:This was a cross-sectional analysis of U.S.nationally representative data from the National Health and Nutrition Examination Survey2011-2018 among adults aged 20 years or older.Daily sitting time and leisure-time physical activity(LTPA)were self-reported using the Global Physical Activity Questionnaire.Body fat(total and trunk fat percentage)was determined via dual X-ray absorptiometry.Results:Among 10,808 adults,about 54.6%spent 6 h/day or more sitting;more than one-half reported no LTPA(inactive)or less than 150 min/week LTPA(insufficiently active)with only 43.3%reported 150 min/week or more LTPA(active)in the past week.After fully adjusting for sociodemographic data,lifestyle behaviors,and chronic conditions,prolonged sitting time and low levels of LTPA were associated with higher total and trunk fat percentages in both sexes.When stratifying by LTPA,the association between daily sitting time and body fat appeared to be stronger in those who were inactive/insuufficiently active.In the joint analyses,inactive/insuufficiently active adults who reported sitting more than 8 h/day had the highest total(female:3.99%(95%confidence interval(95%CI):3.09%-4.88%);male:3.79%(95%CI:2.75%-4.82%))and trunk body fat percentages(female:4.21%(95%CI:3.09%-5.32%);male:4.07%(95%CI:2.95%-5.19%))when compared with those who were active and sitting less than 4 h/day.Conclusion:Prolonged daily sitting time was associated with increased body fat among U.S.adults.The higher body fat associated with 6 h/day sitting may not be offset by achieving recommended levels of physical activity.

Nanobiotechnology in the Management of Glaucoma

As the prevalence of glaucoma continues to rise, clinicians and researchers are confronted with an age-old problem: how to reduce risk factors and preserve vision in glaucoma. Current management options revolve around a validated paradigm—intraocular pressure reduction. Active investigations to improve drug delivery efficacy and surgical outcomes are flourishing. This article aims to provide the interested readers with a review of recent discoveries in nanobiotechnology for the management of glaucoma. Targeted drug-delivery systems using mesoscale vectors demonstrate promising delivery profiles. The utility of nanoparticulate therapies to support retinal ganglion cell survival is being investigated. Studies to modulate tissue regeneration and remodeling and improve post-trabeculectomy outcomes are underway. Though these modalities promise new avenues to manage glaucoma, immediate market availability is not anticipated soon.

Pathophysiology and treatment of Barrett's esophagus

Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the United States. About 10%-15% of patients with GERD develop Barrett’s esophagus, which can progress to adenocarcinoma, currently the most prevalent type of esophageal cancer. The esophagus is normally lined by squamous mucosa, therefore, it is clear that for adenocarcinoma to develop, there must be a sequence of events that result in transformation of the normal squamous mucosa into columnar epithelium. This sequence begins with gastroesophageal reflux, and with continued injury metaplastic columnar epithelium develops. This article reviews the pathophysiology of Barrett’s esophagus and implications for its treatment. The effect of medical and surgical therapy of Barrett’s esophagus is compared.

Endoplasmic reticulum-mitochondrial crosstalk:a novel role for the mitochondrial peptide humanin

In this review,the interactive mechanisms of mitochondria with the endoplasmic reticulum（ER） are discussed with emphasis on the potential protective role of the mitochondria derived peptide humanin（HN） in ER stress.The ER and mitochondria are dynamic organelles capable of modifying their structure and function in response to changing environmental conditions.The ER and mitochondria join together at multiple sites and form mitochondria-ER associated membranes that participate in signal transduction pathways that are under active investigation.Our laboratory previously showed that HN protects cells from oxidative stress induced cell death and more recently,described the beneficial role of HN on ER stress-induced apoptosis in retinal pigment epithelium cells and the involvement of ER-mitochondrial cross-talk in cellular protection.The protection was achieved,in part,by the restoration of mitochondrial glutathione that was depleted by ER stress.Thus,HN may be a promising candidate for therapy for diseases that involve both oxidative and ER stress.Developing novel approaches for retinal delivery of HN,its analogues as well as small molecular weight ER stress inhibitors would prove to be a valuable approach in the treatment of age-related macular degeneration.

LEAD POISONING IN ANCIENT ROME: THE STATE OF THE QUESTION

Introduction Lead pollution as a significant health hazard appears frequently in the news,sometimes spectacularly so as in the case of the recent contamination of the watersupplyof the cityof Flint,Michiganbecause of itsuse inlead pipes in the system.'As a result,it is easy to assume that environmental lead pollution is a recent problem,but that is not the case.Lead exposure is,in fact.

Repair of Spontaneous Corneal Perforation in Pellucid Marginal Degeneration Using Amniotic Membrane

A 47-year-old woman with a history of pellucid marginal degeneration was referred for management of hydrops and peripheral perforation of the right cornea. The initial management with cyanoacrylate tissue adhesive and bandage contact lens did not preclude aqueous leakage the next day. Amniotic membrane grafting using both a surgical graft and a bandage patch was thus performed in the operating room the following day. There was no aqueous leakage on the first post-operative day. The corneal integrity was restored with resolution of the corneal edema;and the visual acuity improved from 20/400 before surgery to 20/40 three months later. This case illustrates the clinical efficacy of amniotic membrane grafting as an effective alternative in the management of spontaneous corneal perforation resulted from pellucid marginal degeneration.

Discovering the roles of subsurface microorganisms: Progress and future of deep biosphere investigation

The discovery of the marine "deep biosphere"-microorganisms living deep below the seafloor-is one of the most significant and exciting discoveries since the ocean drilling program began more than 40 years ago. Study of the deep biosphere has become a research frontier and a hot spot both for geological and biological sciences. Here, we introduce the history of the discovery of the deep biosphere, and then we describe the types of environments for life below the seafloor, the energy sources for the living creatures, the diversity of organisms within the deep biosphere, and the new tools and technologies used in this research field. We will highlight several recently completed Integrated Ocean Drilling Program Expeditions, which targeted the subseafloor deep biosphere within the crust and sediments. Finally, future research directions and challenges of deep biosphere investigation towards uncovering the roles of subsurface microorganisms will be briefly addressed.

Sodium iodate induced retinal degeneration: new insights from an old model

Studies on the selective retinal degeneration induced by sodium iodate （NaIO3） date back to 1941; Sorsby （1941） described the effect of intravenously injected NaIO3 solution on the rabbit retina. Since then, NaIO3-induced retinal degeneration has been described in different mammalian species including sheep, rabbit, rat and mouse with varying doses and routes of administration. At the present time,

Methionine sulfoxide reductase A: Structure, function and role in ocular pathology

Methionine is a highly susceptible amino acid that can be oxidized to S and R diastereomeric forms of methionine sulfoxide by many of the reactive oxygen species generated in biological systems. Methionine sulfoxide reductases (Msrs) are thioredoxin-linked enzymes involved in the enzymatic conversion of methionine sulfoxide to methionine. Although MsrA and MsrB have the same function of methionine reduction, they differ in substrate specifi city, active site composition, subcellular localization, and evolution. MsrA has been localized in different ocular regions and is abundantly expressed in the retina and in retinal pigment epithelial (RPE) cells. MsrA protects cells from oxidative stress. Overexpression of MsrA increases resistance to cell death, while silencing or knocking down MsrA decreases cell survival; events that are mediated by mitochondria. MsrA participates in protein-protein interaction with several other cellular proteins. The interaction of MsrAwith α-crystallins is of utmost importance given the known functions of the latter in protein folding, neuroprotection, and cell survival. Oxidation of methionine residues in α-crystallins results in loss of chaperone function and possibly its antiapoptotic properties. Recent work from our laboratory has shown that MsrA is co-localized with αA and αB crystallins in the retinal samples of patients with age-related macular degen- eration. We have also found that chemically induced hypoxia regulates the expression of MsrA and MsrB2 in human RPE cells. Thus, MsrA is a critical enzyme that participates in cell and tissue protection, and its interaction with other proteins/growth factors may provide a target for therapeutic strategies to prevent degenerative diseases.

The essential role of N6-methyladenosine RNA methylation in complex eye diseases

There are many complex eye diseases which are the leading causes of blindness,however,the pathogenesis of the complex eye diseases is not fully understood,especially the underlying molecular mechanisms of N6-methyladenosine(m6A)RNA methylation in the eye diseases have not been extensive clarified.Our review summarizes the latest advances in the studies of m6A modification in the pathogenesis of the complex eye diseases,including cornea disease,cataract,diabetic retinopathy,age-related macular degeneration,proliferative vitreoretinopathy,Graves’disease,uveal melanoma,retinoblastoma,and traumatic optic neuropathy.We further discuss the possibility of developing m6A modification signatures as biomarkers for the diagnosis of the eye diseases,as well as potential therapeutic approaches.

Atrial Arrhythmias Including Atrial Fibrillation in Congenital Heart Disease:Mechanisms,Substrate Identifi cation and Interventional Approaches

Atrial arrhythmias,including atrial fibrillation,in the setting of congenital heart disease(CHD)are epidemiologically and mechanistically different from those encountered in the general population.These arrhythmias occur at younger ages in patients with CHD,and are frequently degenerative and progressive.The epidemiology,incidence,and prevalence of the spectrum of atrial arrhythmias,including atrial fibrillation,vary according to the specific CHD type,prior treatment,and residual and ongoing structural and functional sequelae.The combined impact of incisional scars,abnormal hemodynamics,atrial chamber dilatation,and increases in atrial wall thickness and distribution of fi brosis results in a highly dynamic and continuously changing atrial substrate that is highly predisposed to arrhythmias.Given the multiple substrates,individualized therapeutic plans can include pharmacologic therapy,catheter-based ablation,and surgical therapies performed concomitantly with primary surgical intervention for hemodynamically significant sequelae of CHD.Advanced imaging with CT or MRI can provide valuable information for decision making and procedural planning.Application of novel therapeutic technologies and pharmacologic agents necessitates special considerations when applied to the CHD population and requires greater study in specific subsets of CHD patients.

Risk Factors for Abuse in Children with Congenital Heart Disease Presenting at a Pediatric Tertiary Care Hospital

Background:Congenital heart disease(CHD)is a chronic medical condition often diagnosed at birth and requires surgical intervention,multiple hospitalizations,and lifelong care.This can put significant stress on the family,leading to altered maternal mental health,bonding and attachment issues,and the potential for child abuse.The purpose of this study is to explore the characteristics of a sample of young children with CHD who experienced hospitalization with concurrent concern for child abuse in a free-standing pediatric tertiary care hos-pital.Methods:Electronic medical records were reviewed for children aged 0–5 years old who were hospitalized with concern for child abuse between 2016 and 2020.Variables were extracted related to the history of presenta-tion,and sociodemographics including SDOH,admission,and discharge condition/follow-up.Descriptive statis-tics were used to characterize the sample and correlations to identify an association with abuse type.Results:Out of 251 hospitalizations involving concern for child abuse,49(19.5%)had a diagnosis of CHD.The majority of cases were neglect(51%),<1 year of age(80%),male(57%),Hispanic ethnicity(45%),and publicly insured(90%).CHD severity was moderate to severe(71%)with multiple co-occurring medical conditions(genetic syn-drome,failure to thrive(FTT),prematurity,history of a feeding tube,developmental delay,and intrauterine drug exposure).Correlations associated with physical abuse were age,maternal mental health,head injury,and history of Child Protective Services(CPS)involvement.Neglect correlated with age,FTT,head injury,history of a feeding tube,previous CPS involvement,and substance use.Correlates specifically related to prenatal substance use included age,maternal mental health status,history of domestic violence,CPS involvement,feeding tube,FTT,lack of housing,employment status,and public insurance.Conclusions:Our study highlights the risk for abuse in children with CHD,regardless of defect severity.The most common abuse type was neglect(mostly prenatal substance use)which was associated with few child characteristics,but many parent/caregiver and neighborhood factors.This underscores the need for individual and/or family-based screening and approaches to provide psy-chological support and needed resources to assist parents of children with CHD to prevent abuse.Interventions should focus on families of low socioeconomic status with limited support and/or resources.

Current Concepts in Restorative Implant Dentistry

Patients today are increasingly aware of dental implants,and their expectations are for esthetically and functionally pleasing implant restorations that mimic natural teeth.This presentation will give both the experienced and novice practitioner a better understanding of how restorative implant dentistry has evolved.Treatment planning and restorative options for single implants,multiple implants and fully edentulous arches will be discussed,and the use of modern materials and CADCAM technology in fabricating the most contemporary fixed implant supported prostheses will be demonstrated.

Traumatic soft tissue defects:a perspective review on reconstruction and communication priorities from the orthopaedic trauma surgeon as a partner in care

Communication and coordination between orthopedic and plastic surgeons improve outcomes in severe extremity trauma.The“orthoplastics”approach to limb salvage incorporates priorities and skillsets from both fields.Prevention of infection,coordinated skeletal and soft tissue reconstruction,and communication during recovery and rehabilitation are key priorities.The purpose of this review is to describe the orthopedic trauma surgeon’s perspectives on lower extremity reconstruction,including initial management,techniques and timing for provisional and definitive skeletal reconstruction,and considerations for rehabilitation and orthotic use to optimize functional outcomes.

Ultraviolet Nail Lamps and Squamous Cell Carcinoma: Cause and Effect, or Not?—A Case Report

Ultraviolet (UV) lamps are used in nail salons as part of standard gel nail manicures. While UV radiation is a known risk factor for the development of skin cancers, the risk from exposure to UV nail lamps is unclear. We present a case of a woman who developed squamous cell carcinoma in one finger after exposure to UV lamps. A discussion of the correlation between UV nail lamps and squamous cell carcinoma (SCC) is provided. Orthopedic surgeons frequently encounter skin cancers of the hand however the role of UV nail lamps has not yet been elucidated in the orthopedic literature. This manuscript aims to address that gap and facilitate patient counseling during such consultations.

Microsurgical restoration of failed or unsatisfactory breast reconstruction:a systematic review and pooled-analysis of outcomes

Aim: Autologous tissue transfer to salvage breast reconstruction following a previously failed or unsatisfactory reconstruction has been described by previous studies to be an effective strategy to optimize outcomes. The purpose of this systematic review is to assimilate the relevant literature to evaluate surgical and aesthetic outcomes following autologous breast reconstruction in the setting of a prior unsuccessful reconstruction. Methods: A systematic review of the English literature was performed on Pubmed/MEDLINE to identify all manuscripts reporting surgical outcomes, aesthetic outcomes, or patient satisfaction of autologous breast reconstruction in the setting of a previously failed or unsatisfactory breast reconstruction.Results: Nineteen studies met the criteria for inclusion. Of these, 15 studies reported outcomes following autologous conversion of unsuccessful prosthetic reconstruction (778 breasts). Pooled-analysis of these studies demonstrated total flap loss in 1.6%, microsurgical revision in 3.2%, total complications in 21.7%, and revision surgery in 26.5%. Review of these studies demonstrated high rates of positive aesthetic outcomes and patient satisfaction. Five studies (54 patients) evaluated outcomes following autologous salvage of prior unsuccessful autologous breast reconstruction. Pooled-analysis of these studies demonstrated no instances of microsurgical revision, total complications in 42.2%, and revision surgery in 70.0%.Total flap failure following tertiary reconstruction utilizing microsurgical free flaps occurred in 9.5%. Data describing aesthetic outcomes or patient satisfaction was lacking in these studies. Conclusion: Autologous conversion in the setting of unsuccessful prosthetic breast reconstruction appears to be valuable option to improve outcomes. There is little evidence to suggest that prior prosthetic reconstruction negatively impacts outcomes of autologous breast reconstruction. Data describing autologous breast reconstruction following prior flap loss is limited but suggests it is viable method to salvage breast reconstruction in appropriate patients.

大鼠脑微血管内皮细胞的原代培养

目的分离、培养原代脑微血管内皮细胞,建立体外血脑屏障模型。同时探索高纯度、活性好的脑微血管内皮细胞的分离培养方法。方法取3周大鼠大脑,分离皮质,经过匀浆、葡聚糖离心以及消化后,取纯度较高的脑微血管段种植于胶原蛋白包被过的塑料培养瓶中进行培养。显微镜观察及检测Ⅷ因子相关抗原。结果镜下细胞呈长梭形,7d左右细胞可融合,Ⅷ因子相关抗原免疫组化检测为阳性,且阳性细胞占绝大部分。结论本实验成功分离大鼠脑微血管内皮细胞,并进行原代培养,为脑微血管内皮细胞的进一步研究提供了模型,也为构建更高级的大鼠体外血脑屏障奠定基础。

Pediatric genitourinary tumors:Distribution,demographics,and outcomes

Importance:The diversity of pediatric genitourinary malignancies requires a timely resource detailing tumor characteristics and survival.Objective:To determine the incidence,demographics,and outcomes of all pediatric genitourinary tumors within the United States.Methods:A population-based search for patients diagnosed with genitourinary cancers under age 15 was performed using the National Cancer Institute’s Surveillance,Epidemiology,and End Results 18 registry.Information on primary tumor location,histologic type,patient age,sex,year of diagnosis,race,treatment,cause of death,and survival months was extracted.Descriptive epidemiological and survival statistics were calculated for all variables.Results:A total of 4576 cases from 1973 through 2015 were identified.The most common primary tumor sites were the kidney(80.3%),testis(12.3%),bladder(2.8%),and vagina(1.5%).Nephroblastoma(87.9%)and sarcoma(3.4%)were the most common renal malignancies.Rhabdomyosarcoma was common in the vagina,bladder,and testis at rates of 66.2%,61.2%,and 24.6%,respectively.Germ cell tumors(71.0%)were the most common primary tumor of the testis.Ten-year overall survival(OS)for renal nephroblastoma and sarcoma was 88%and 82%,respectively.Ten-year OS for RMS of the testis was 91%,the bladder was 79%,the vagina was 79%,and the prostate was 56%.Germ cell tumor 10-year OS were 96%in the testis and 100%in the vagina.Interpretation:A better understanding of the overall distribution and outcomes associated with pediatric genitourinary cancers allows physicians to best understand the patient’s disease in the context of current frequency in a genitourinary setting and reported outcomes.

Complex reconstructive surgery for a recurrent ischial pressure ulcer with contralateral muscle

The management of recurrent pressure ulcers is a frequent problem in patients with spinal cord injuries. Many local muscle and fasciocutaneous flaps can be used to cover ulcers of all sizes. However, when a recurrent pressure ulcer has been repeatedly addressed, the number of available flaps becomes quite limited. Contralateral muscles, such as the gracilis, can be used to cover recurrent ischioperineal ulcers and should be employed before last resort surgeries, such as hip disarticulation and the total thigh flap.