Cardiac-type total anomalous pulmonary venous return is not benign

ObjectiveThe objective of this study was to investigate the association between morphological variation and postsurgical pulmonary vein (PV) stenosis (PPVS) in patients with cardiac total anomalous pulmonary venous connection (TAPVC).MethodsThis single-center, retrospective study included 168 pediatric patients who underwent surgical repair of cardiac TAPVC from 2013 to 2019 (connection to the coronary sinus [CS], n = 136; connection directly to the right atrium [RA], n = 32). Three-dimensional computed tomography modeling and geometric analysis were performed to investigate the morphological features; their relevance to the PPVS was examined.ResultsThe connection type had no association with PPVS (CS type: 18% vs right atrial type: 19%; P = .89) but there was a higher incidence of PPVS in patients with a single PV orifice than > 1 orifice (P < .001). Confluence-to-total PV area ratio (hazard ratio, 4.78, 95% CI, 1.86-12.32; P = .001) and length of drainage route (hazard ratio, 1.22; 95% CI, 1.14-1.31; P < .001) had a 4- and 1-fold increase in the risk for PPVS in the CS type after adjustment for age and preoperative pulmonary venous obstruction. In the right atrial type, those with anomalous PV return to the RA roof were more likely to develop PPVS than to the posterior wall of the RA (P < .001).ConclusionsThe number of inter-junction PV orifice correlated with PPVS development in cardiac TAPVC. The confluence-to-total PV ratio, length of drainage route, and anomalous PV return to the RA roof are important predictors for PPVS. Morphological subcategorization in this clinical setting can potentially assist in surgical decision-making.     

活体大蒜及离体蒜苗对连作当归胁迫的影响

目的:通过活体大蒜(garlic)及离体蒜苗(garlic sprout)挥发物对当归(Angelica sinensis)的化感效应,探索大蒜挥发性物质对连作当归存在的化感效应,为当归大蒜间作模式缓解连作当归胁迫提供一定的理论依据。方法:试验通过对当归各生长指标及叶片保护酶系统的测定分析,讨论当归在活体大蒜及离体蒜苗挥发物的影响作用下对连作胁迫、无连作胁迫环境的适应性及抗性生长发育机制。结果:整体分析,连作胁迫条件下离体蒜苗对当归幼苗化感效应处理(DC2)下的当归生长指标、叶片保护酶活性较当归单作(CK1)整体提高17. 51%,48. 34%;连作茬口种植活体蒜苗与当归间作处理(LC2)下的当归生长指标、叶片保护酶活性较当归单作(CK2)整体提高16. 63%,36. 65%;即离体蒜苗挥发物较活体大蒜缓解当归连作胁迫作用更显著。结论:无论有无连作障碍胁迫,适当浓度的活体大蒜及离体蒜苗挥发物对当归生长指标及叶片保护酶活性均表现为明显的化感促进作用,其化感促进作用在有连作胁迫条件下表现更显著,因而间作大蒜对当归连作障碍胁迫有一定的缓解作用。     

Primary Conservative Therapy for Symptomatic Isolated Mesenteric Artery Dissection with Severely Compressed True Lumen or Large Dissecting Aneurysm

PurposeTo investigate the safety and effectiveness of primary conservative therapy for patients with symptomatic isolated mesenteric artery dissection (IMAD) with a severely compressed true lumen and/or a large dissecting aneurysm.Materials and MethodsA total of 35 consecutive patients (all men; median age, 53 y) with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture who were treated with primary conservative therapy between November 2018 and February 2020 were assessed. A severely compressed true lumen was defined as luminal stenosis > 70%. A large dissecting aneurysm was defined as dissecting aneurysm diameter ≥ 1.5 times larger than the normal mesenteric artery diameter.ResultsThere was a strong positive relationship among abdominal pain, degree of luminal stenosis, and length of dissection (R = 0.811; P < .001). Conservative treatment was successful in all patients. Abdominal pain was eliminated within 4.7 d ± 4.8 (range, 2–31 d) in all patients, within 3.6 d ± 1.2 (range, 2–6) in the 31 patients with minor or moderate abdominal pain, and within 13.3 d ± 11.9 (range, 6–31 d) in the 4 patients with severe abdominal pain. Complete or partial remodeling of the mesenteric artery was achieved in 6 (17.1%) and 29 (82.9%) patients, respectively, during 8.6 mo ± 4.3 of follow-up.ConclusionsPrimary conservative therapy can be used safely and effectively in patients with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture.     

Which one to follow? Service animal policy in the United States

BackgroundService animals are an invaluable resource to improving health among individuals with disabilities, and their use is steadily growing. Yet, United States’ current federal and state policies surrounding service animals are contradictory and burdensome, and often do not adequately protect the rights of service animal handlers.ObjectiveTo review each state’s service animal policies surrounding criminal interference, misrepresentation of a service animal, and public accessibility. To also identify inconsistencies among states’ individual policies, between state policies, and between state and federal policies, and discuss the implications of these inconsistencies.MethodsWestlaw legal research database was used to comprehensively review each state’s policies regarding the use of a service animal.Results26 states have one or more policies that are incongruous with the Americans with Disabilities Act. Further, 34 states have contradictions within their own policies and between other states. 31 states provide protections against fraudulent service animals, and there are variations in the degree of protection and ability to enforce these laws.ConclusionsBecause service animals are a vital resource to this particularly vulnerable population, it is imperative that our policies encourage their use and protect the rights of handlers. Yet, inconsistencies among current policies create confusion and ultimately deter individuals with disabilities from taking full advantage of their service animal. We are in need of clear, cohesive policy at all levels of government in order to improve health literacy and ensure that those with disabilities are able to benefit from the positive health impacts of a service animal.     

Cross-species comparison of the metabolism and excretion of selexipag

1. The metabolism of the prostacyclin receptor agonist selexipag (NS-304; ACT-293987) and its active metabolite MRE-269 (ACT-333679) has been investigated in liver microsomes and hepatocytes of rats, dogs, and monkeys. MRE-269 formation is the main pathway of selexipag metabolism, irrespective of species. Some interspecies differences were evident for both compounds in terms of both metabolic turnover and metabolic profiles. The metabolism of MRE-269 was slower than that of selexipag in all three species.

2. The metabolism of selexipag was also studied in bile-duct-cannulated rats and dogs after a single oral and intravenous dose of [¹⁴C]selexipag. MRE-269 acyl glucuronide was found in both rat and dog bile. Internal acyl migration reactions of MRE-269 glucuronide were identified in an experiment with the synthetic standard MRE-6001.

3. MRE-269 was the major component in the faeces of rats and dogs. In ex vivo study using rat and dog faeces, selexipag hydrolysis to MRE-269 by the intestinal microflora is considered to be a contributory factor in rats and dogs.

4. A taurine conjugate of MRE-269 was identified in rat bile sample. Overall, selexipag was eliminated via multiple routes in animals, including hydrolysis, oxidative metabolism, conjugation, intestinal deconjugation, and gut flora metabolism.     

Atrial Failure as a Clinical Entity: JACC Review Topic of the Week

Atrial dysfunction has been widely considered a marker or consequence of other cardiac conditions rather than the cause itself. Here, we propose the term atrial failure as a clinically relevant entity, defined as any atrial dysfunction causing impaired heart performance, symptoms, and worsening quality of life or life expectancy. Aspects of the etiology, mechanisms, and consequences of atrial failure are discussed. Recent advances in cardiac electrophysiology and imaging have improved our understanding of the highly complex atrial anatomy and function, underlying the paramount importance of the atria in optimal heart performance. It is time to reappraise the concept of the failing atrium as a primary cause or aggravating factor of the symptoms in many of our patients. The concept of atrial failure may foster basic and translational research to gain a better understanding of how to identify and manage atrial dysfunction.