Inflammation and immunity in organ regeneration

The ability of vertebrates to regenerate amputated appendages is increasingly well-understood at the cellular level. Cells mediating an innate immune response and inflammation in the injured tissues are a prominent feature of the limb prior to formation of a regeneration blastema, with macrophage activity necessary for blastema growth and successful development of the new limb. Studies involving either anti-inflammatory or pro-inflammatory agents suggest that the local inflammation produced by injury and its timely resolution are both important for regeneration, with blastema patterning inhibited in the presence of unresolved inflammation. Various experiments with Xenopus larvae at stages where regenerative competence is declining show improved digit formation after treatment with certain immunosuppressive, anti-inflammatory, or antioxidant agents. Similar work with the larval Xenopus tail has implicated adaptive immunity with regenerative competence and suggests a requirement for regulatory T cells in regeneration, which also occurs in many systems of tissue regeneration. Recent analyses of the human nail organ indicate a capacity for local immune tolerance, suggesting roles for adaptive immunity in the capacity for mammalian appendage regeneration. New information and better understanding regarding the neuroendocrine-immune axis in the response to stressors, including amputation, suggest additional approaches useful for investigating effects of the immune system during repair and regeneration.     

Case-Based Discussion Regarding Challenges in Patient Selection and Procedural Planning in Left Atrial Appendage Occlusion

Atrial fibrillation (AF) accounts for most embolic strokes, especially in elderly individuals. Although anticoagulation is known to reduce the risk of embolic stroke, a significant proportion of patients have relative or absolute contraindications to anticoagulation. The left atrial appendage has been implicated as the major source of emboli in more than 90% of ischemic strokes in nonvalvular AF. Left atrial appendage occlusion offers an alternative for stroke prevention in patients with an elevated stroke risk (CHADS₂ score ≥2 or CHA₂DS₂-VASc score ≥3) who have a rationale for avoiding long-term oral anticoagulation after a shared decision-making process. However, there remain significant challenges in left atrial appendage occlusion therapy related to patient selection, the procedure itself, and postprocedural patient management decisions. In this review article, we discuss some of these challenges in a case discussion–based approach.     

Left Atrial Appendage Aneurysm—A Rare Anomaly with an Atypical Presentation

Left atrial appendage aneurysm (LAAA) is a rare condition caused by congenital dysplasia of the atrial muscles. Patients usually present with atrial tachyarrhythmias as a result of ectopic foci of atrial rhythm generation or systemic thromboembolism. We report a case of a 38‐year‐old Native American female presenting with 1‐month history of cough, in sinus rhythm, and found to have a large cyst‐like structure next to the left ventricular lateral wall on transthoracic echocardiography. This structure was later confirmed as a LAAA on cardiac magnetic resonance imaging. Patient underwent aneurysmectomy without any complications.     

中药治疗慢性附件炎性包块临床研究

目的 探讨中药治疗慢性附件炎性包块的临床疗效。方法 将96例气滞血瘀型慢性附件炎性包块病人随机分为口服中药治疗组(n＝62)和静脉注射抗生素对照组(n＝34)进行对照研究。结果 治疗组有效为93．55％，对照组有效率为41．18％；治疗组月经失调、痛经、腰痛及下腹疼痛等伴随症状的治愈率分别为70．0％、50．0％、93．5％，对照组分别为25．0％、20．0％、11．8％。两组治疗效果比较差异有显著意义(P＜0．05)。结论 中药治疗慢性附件炎性包块，疗效好，无毒副反应，值得推广应用。     

The Mammary Bud as a Skin Appendage: Unique and Shared Aspects of Development

Like other skin appendages, the embryonic mammary gland develops via extensive epithelial–mesenchymal interactions. Early stages in embryonic mammary development strikingly resemble analogous steps in the development of hair follicles and teeth. In each case the first morphological sign of development is a localized thickening in the surface epithelium that subsequently invaginates to form a mammary, hair follicle or tooth bud. Similar sets of intersecting signaling pathways are involved in patterning the mammary, hair follicle and dental epithelium, directing placode formation, and controlling bud invagination. Despite these similarities, subsequent events in the formation of these appendages are diverse. The mammary bud extends to form a sprout that begins to branch upon contact with the mammary fat pad. Hair follicles also extend into the underlying mesenchyme, but instead of branching, hair follicle epithelium folds around a condensation of dermal cells. In contrast, teeth undergo a more complex folding morphogenesis. Here, we review what is known of the molecular and cellular mechanisms controlling early steps in the development of these organs, attempt to unravel both common themes and unique aspects that can begin to explain the diversity of appendage formation, and discuss human genetic diseases that affect appendage morphogenesis.     

心房颤动患者左心耳功能的三维超声及斑点追踪成像研究

目的 应用斑点追踪成像技术及经食管实时三维超声成像评价心房颤动(房颤)患者左心耳舒缩运动及功能变化特点.方法 22例阵发性房颤组患者、21例持续性房颤患者.将左心耳分为基底段(B)、中段(M)、顶部(A)三个部分.应用三维容积法测量左心耳整体排空分数(LAA-EF)、基底段排空分数(B-EF)、中段排空分数(M-EF)和顶部排空分数(A-EF).应用斑点追踪成像技术测量左心耳基底段、中段、顶部各节段收缩期应变率(SRS)和舒张期应变率(SRD).结果 阵发性房颤组和持续性房颤组LAA-EF、B-EF、M-EF、A-EF均低于对照组,持续性房颤组低于阵发性房颤组.与对照组比较,阵发性房颤组和持续性房颤组的左心耳基底段、中间段、顶部各段的SRS和SRD均降低,以持续性房颤组降低更显著.结论 阵发性房颤和持续性房颤均可导致左心耳整体和局部舒缩功能降低,以持续性房颤为甚.

Abstract：

Objective To evaluate left atrial appendage regional function and movement changes of systolic and diastolic in patients with atrial fibrillation by speckle tracking imaging(STI) and real-time three-dimensional transesophageal echocardiography(RT-3D TEE).Methods Sixty-seven patients underwent RT-3D TEE was divided into 24 controls,22 paroxysmal atrial fibrillation,21 persistent atrial fibrillation.Left atrial appendage was divided into basal,middle and apical segment.Left atrial appendage emptying fraction of the overall (LAA-EF),basal emptying fraction (B-EF),middle emptying fraction (M-EF) and apical emptying fraction (A-EF) was measured by three-dimensional volume measurement.Each segment systolic strain rate (SRS) and diastolic strain rate (SRD) was measured by STI.Results LAA-EF,B-EF,M-EF,A-EF of paroxysmal atrial fibrillation and persistent atrial fibrillation group were lower than those of the control group,and persistent atrial fibrillation group was the lowest in the three groups.Compared with the control group,SRS and SRD of left atrial appendage basal,middle,apical segment was lower in paroxysmal atrial fibrillation group and persistent atrial fibrillation group,and persistent atrial fibrillation group decreased more significantly.Conclusions Paroxysmal atrial fibrillation and persistent atrial fibrillation can lead to left atrial appendage global or local systolic and diastolic function to reduce,and persistent atrial fibrillation decreased more significantly.