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Background: Our previous work demonstrating great ease and predictability of cannulation of the major aortic arch branches with an upwardly pointing 3DR catheter, irrespective of aortic arch type, led us to hypothesize that centering or "cresting" of these vessels must occur along the superior most aspect of the aortic arch in a curvilinear fashion., Methods: We retrospectively analyzed 111 computed tomographic scans of the chest and thoracic aorta with intravenous contrast performed at our hospital between April 2011 and May 2012 utilizing TeraRecon image reconstruction software. Four studies were excluded due to poor image quality and/or surgical changes to native aortic architecture., Results: Of the 107 studies included, 104 (97.2%) demonstrated centering of the major aortic arch branches on a curvilinear line "cresting" the superior most aspect of the aortic arch irrespective of arch type. Of the three studies that did not demonstrate this "cresting," two were found to have aberrant right subclavian arteries associated with a type I aortic arch, and one had an aberrant right common carotid associated with a type II aortic arch., Conclusion: Operators engaging major aortic arch branches need to be mindful of the fact that these vessels are indeed centered on a line "cresting" along the superior most aspect of the aortic arch, and any algorithm that, by taking this information into account, reduces catheter manipulation in the aortic arch could potentially result in a reduction in distal atheroembolic events., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Host specific resistance and non-host resistance are two plant immune responses to counter pathogen invasion. Gene network organizing principles leading to quantitative differences in resistant and susceptible host during host specific resistance are poorly understood. Vascular wilt caused by root pathogen Fusarium species is complex and governed by host specific resistance in crop plants, including chickpea. Here, we temporally profiled two contrasting chickpea genotypes in disease and immune state to better understand gene expression switches in host specific resistance. Integrative gene-regulatory network elucidated tangible insight into interaction coordinators leading to pathway determination governing distinct (disease or immune) phenotypes. Global network analysis identified five major hubs with 389 co-regulated genes. Functional enrichment revealed immunome containing three subnetworks involving CTI, PTI and ETI and wilt diseasome encompassing four subnetworks highlighting pathogen perception, penetration, colonization and disease establishment. These subnetworks likely represent key components that coordinate various biological processes favouring defence or disease. Furthermore, we identified core 76 disease/immunity related genes through subcellular analysis. Our regularized network with robust statistical assessment captured known and unexpected gene interaction, candidate novel regulators as future biomarkers and first time showed system-wide quantitative architecture corresponding to genotypic characteristics in wilt landscape.

Objective: To identify a fluoroscopic bony landmark for safe percutaneous axillary artery cannulation., Background: No bony landmarks exist to guide safe percutaneous axillary artery cannulation, which is an important alternate access site for catheter-based procedures in selected patients., Methods: We retrospectively analyzed 51 consecutive percutaneous axillary artery sheath angiograms and attempted to correlate a fixed bony landmark to the proximal end of the third part of the artery. Proximal to this site, no cords of the brachial plexus traverse the anterior aspect of the vessel. Moreover, this site is proximal to the subscapular branch of the axillary artery, the first branch of its third part, and a sentinel component of the scapular anastomosis responsible for collateral blood flow to the arm., Results: With the arm abducted at 135°, the subscapular artery originated at, or distal to, the inferior border of the glenoid cavity, as seen on fluoroscopy in the anterior-posterior projection, in all patients. The origin was within 5 mm distal to the inferior border of the glenoid cavity in 17 patients (46%), 5-10 mm in 13 patients (35%), and between 10 mm and 20 mm in 7 patients (19%)., Conclusions: With the arm abducted, the origin of the subscapular artery correlates well with the inferior-most aspect of the glenoid cavity of the scapula under fluoroscopy. Axillary artery cannulation medial to this bony landmark typically lands the sheath in the second part or proximal end of the third part of the artery, thereby theoretically sparing injury to the brachial plexus and the subscapular artery.

Objectives: We sought to describe the caliber and vascular health of the subclavian and axillary arteries as related to their potential utilization in complex cardiovascular procedures., Background: Patients referred for advanced catheter-based therapies frequently have lower extremity peripheral vascular disease that may prohibit the use of large bore arterial catheters. Utilization of the upper extremity peripheral vasculature is rarely considered as an alternative access strategy. This may be due in part to a lack of familiarity with the thoracic vasculature., Methods and Results: 208 consecutive patients undergoing routine CTA prior to transcatheter aortic valve replacement were retrospectively evaluated in a systematic analysis of upper and lower extremity vasculature. Minimal luminal diameters (MLDs) for the axillary arteries and iliofemoral arteries were 6.0 ± 1.1 mm and 6.6 ± 1.8 mm respectively. Compared to the iliofemoral arteries, the axillary arteries demonstrated substantially lower rates of significant stenosis (2% vs. 12%, p < 0.01) and significantly lower rates of moderate to severe calcification disease (9% vs. 64%, p < 0.01). Diabetes and tobacco use were independently associated with smaller axillary artery caliber by MLD (p < 0.01) but not with significant stenotic disease., Conclusions: The axillary arteries are slightly smaller but less frequently diseased than the corresponding iliofemoral vessels., (© 2017 Wiley Periodicals, Inc.)

Although precisely controlled innate immune response is governed by conserved cellular events in phylogenetically diverse hosts, the underlying molecular mechanisms by which this process is regulated against a multi-host pathogen remain unknown. Fusarium oxysporum is a model multi-host pathogen, known to be associated with neuronal stress in humans and vascular wilt in plants. The interaction between innate immune and neuronal pathways is the basis of many diverse biological responses. How these processes are coordinated in response to fungal disease is not well understood. Here, we show that F. oxysporum f. sp . ciceri causes neuronal stress and intestinal disintegration, ultimately leading to the death of Caenorhabditis elegans . To explore the regulatory framework of Fusarium- associated disease, we analysed the gene expression during infection, integrated temporal gene expression, and network analysis with genetic inactivation data in Caenorhabditis elegans. We identified 1024 genes showing significant changes in expression (corrected P -values <0.05) in response to Fusarium infection. Co-expression network analysis of our data identified prognostic genes related to disease progression. These genes were dynamically expressed in various neuronal and non-neuronal tissues exhibiting diverse biological functions, including cellular homeostasis, organ patterning, stress response, and lipid metabolism. The RNA-seq analysis further identified shared and unique signalling pathways regulated by DAF-16/FOXO and SIR-2.1 linking neuronal stress, which facilitates negative regulation of intestinal innate immunity. Genetic analysis revealed that GCY-5 in ASE functions upstream of DAF-16, whereas ASI-specific SRD-1 regulates behavioural immunity. Overall, our results indicate that a ubiquitous response occurs during Fusarium infection mediated by highly conserved regulatory components and pathways, which can be exploited further for the identification of disease-responsive genes conserved among animals and plants. Finally, this study provided a novel insight into cross-species immune signalling and may facilitate the discovery of cellular therapeutic targets for Fusarium -associated disease., Competing Interests: The authors declare no conflict of interest.

Background and Aim of the Study: Tricuspid valve regurgitation (TR) is often not taken into consideration in the prognostication of patients undergoing transcatheter aortic valve replacement (TAVR). Accordingly, its impact on such patients remains relatively poorly defined. The study aim was to explore the effect of TR and parameters of right ventricular (RV) function on outcomes in patients undergoing TAVR., Methods: Baseline demographic and echocardiographic data were collected for 460 consecutive patients undergoing TAVR at the authors' institution between 2012 and 2015. A retrospective analysis was performed to determine the association of TR with all-cause mortality in these patients. The primary endpoint was 30-day rate of all-cause mortality and/or hospital re-admission., Results: Among 460 patients included in the study analysis there were 25 deaths and 40 re-admissions. Univariate analysis showed that a higher Society of Thoracic Surgeons (STS) score, severe preoperative mitral and tricuspid regurgitation were associated with statistically significant higher 30-day mortality and/or re-admission rates. On multivariate analysis, STS score (OR 1.07, 95% CI 1.012-1.126), moderate TR (OR 3.24, 95% CI 1.52-6.87) and severe TR (OR 2.5, 95% CI 1.04-6.04) were identified as significant independent predictors of all-cause mortality., Conclusions: The severity of TR is a strong independent parameter predictive of death at 30 days. Therefore, parameters of RV function such as TR should be incorporated into predictive models for patients undergoing TAVR.

The "preclose" technique employing two Perclose (P) devices is well established for large-bore artery (LBA) hemostasis. Occasionally, only one Perclose deploys successfully during the initial preclose because of arterial calcification necessitating the use of the crossover balloon technique to achieve hemostasis at the LBA. We sought to determine if the combined use of one Perclose and either one Angioseal or one Mynx vascular closure device (VCD) is a safe alternative closure technique large-bore arteriotomy closure. In total, 40 patients underwent high-risk percutaneous coronary intervention (HRPCI) with Impella support, of whom 38 had common femoral artery (CFA) arteriotomies and 2 underwent percutaneous axillary arteriotomy (AA). Prior to Impella insertion, one Perclose device was predeployed. At the end of HRPCI, Impella was removed and a 0.035″ wire was inserted through the Impella sheath. This sheath was then withdrawn over the wire, and partially deployed Perclose was fully deployed. A 6-Fr sheath was advanced over a 0.035″ wire into the CFA or AA, achieving hemostasis and reducing the LBA to a 6-Fr size. The 6-Fr arteriotomy was closed with a 6-Fr Mynx or Angioseal VCD. Patients were followed at day 1 and day 30. Hybrid closure was successful in 38 of 40 cases. In one case of Mynx balloon rupture, hemostasis was achieved with heparin reversal and manual compression. In the case of Perclose failure, crossover balloon tamponade at arteriotomy site and external manual compression achieved hemostasis. Patients were free of complications at day 1 and day 30. Hybrid closure with one Perclose and either one Mynx or one Angioseal VCD is safe and effective for LBA closure.

The axillary artery is an alternative, large-caliber vessel that can be utilized in the presence of hostile aortoiliac segments. It can accommodate sheaths up to 18 Fr and is infrequently affected by atherosclerosis.

This study aims to evaluate occurrence, size, composition, and clinical significance of embolized debris during superficial femoral artery atherectomy using all commercially available atherectomy devices. Distal athero/thromboembolic events (DATE) are a universal phenomenon in lower extremity atherectomy procedures (LEAPs) due to the sheer volume of atheroma and the thrombus burden in peripheral arterial disease. Some of these events can be clinically significant. We prospectively gathered clinical and histopathological data on all commercially available atherectomy devices by using embolic protection devices (EPD) in every case. After intervention, the contents of EPD were examined both microscopically and macroscopically. Data from 59 consecutive patients undergoing LEAP were analyzed. DATE occurred 100% of the time. The composition of particulate debris varied with the device used. Grossly visible agglomerated debris was captured by the filter in the majority of patients 54/59 (91.5%). Clinically significant debris, defined by the Preventing Lower Extremity Distal Embolization Using Embolic Filter Protection registry as particle diameter > 0.2 cm, was found in 33/59 (56%) patients. The size of captured debris particles ranged from 0.1 to 2.4 mm. While DATE occurred in all patients, clinically significant DATE occurred in 56% patients undergoing LEAP regardless of the atherectomy device. In spite of a large fraction of the clinically significant debris occurring on our routine dual antiplatelet regimen, no patient suffered an amputation. Although DATE was prevented by the use of EPD in all 59 cases, more data are needed to determine whether the use of EPD translates into a long-term clinical benefit. Use of EPD and optimal thromboprophylaxis should be considered in patients, especially in the setting of compromised distal runoff.

Traditionally, brachial and common femoral arteries have served as access sites of choice, with many operators recently converting to radial artery access for coronary angiography and percutaneous intervention due to literature suggesting reduced bleeding risk, better patient outcomes, and lower hospital-associated costs. However, radial access has limitations when percutaneous procedures requiring larger sheath sizes are performed. Six Fr sheaths are considered the limit for safe use with the radial artery given that the typical luminal diameter of the vessel is approximately 2 mm, while peripheral artery disease (PAD) may often limit use of the common femoral artery, particularly in patients with multiple co-morbid risk factors. Similarly, the brachial artery has fallen out of favor due to both thrombotic and bleeding risks, while also not safely and reliably accommodating sheaths larger than 7 Fr. Here we describe 3 cases of a new entirely percutaneous technique utilizing the axillary artery for delivery of Impella 2.5 (13.5 Fr) and CP (14 Fr) cardiac-assist devices for protected percutaneous coronary intervention in the setting of prohibitive PAD.

Aim: The objective of the study was to obtain and compare two-dimensional (2D) and three-dimensional (3D) ultrasonographic images of the kidney in different disease conditions., Materials and Methods: In this study, 11 clinical cases of different age groups of dogs suffering from kidney diseases were diagnosed by 2D and 3D ultrasonography at Teaching Veterinary Clinical Complex, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar. The ultrasound (US) machine used for this study was 3D US machine (Nemio-XG: Toshiba, Japan) having four-dimensional (4D) volumetric probe. The images were acquired with 3-6 MHz 2D curvilinear transducer and 4.2-6 MHz 4D volumetric curvilinear transducer., Results: Nephritis was diagnosed in four dogs aged between 5 months and 6 years. In all the cases of nephritis diffuse increase in echogenicity of kidney, parenchyma was observed. Two dogs with end-stage kidney disease were also diagnosed. In both 2D and 3D ultrasonography, the kidney size was decreased and architectural details were also lost in them. The cases of regional renal diseases diagnosed were hydronephrosis and nephrolithiasis. Dilated renal pelvis was the common finding in all the three cases of hydronephrosis in both 2D and 3D ultrasonogram. Nephroliths were observed in one case with the history of hematuria and oliguria. The multifocal renal disease diagnosed in this study was dysplastic polycystic kidney. In 2D ultrasonogram, six anechoic cavities appeared with thin strip of renal parenchyma. In 3D ultrasonogram, the cysts appeared as black anechoic areas., Conclusion: The result of the current study showed that the clinical conditions of kidney such as nephritis, end-stage kidney, hydronephrosis, polycystic kidney, and nephrolithiasis can be diagnosed easily using 2D and 3D ultrasonography. Visualization of renal structures was clear in 2D ultrasonography in the conditions of nephritis and end-stage kidney. However, the conditions such as hydronephrosis, polycystic kidney, and nephrolithiasis were visualized clearly in both 2D and 3D ultrasonography equally.

Objective. The use of the axillary artery as an access site has lost favor in percutaneous intervention due to the success of these procedures from a radial or brachial alternative. However, these distal access points are unable to safely accommodate anything larger than a 7-French sheath. To date no studies exist describing the size of the axillary artery in relation to the common femoral artery in a patient population. We hypothesized that the axillary artery is of comparable size to the CFA in most patients and less frequently diseased. Methods. We retrospectively reviewed 110 CT scans of the thoracic and abdominal aorta done at our institution to rule out aortic dissection in which the right axillary artery, right CFA, left axillary artery, and left CFA were visualized. Images were then reconstructed using commercially available TeraRecon software and comparative measurements made of the axillary and femoral arteries. Results. In 96 patients with complete data, the mean sizes of the right and left axillary artery were slightly smaller than the left and right CFA. A direct comparison of the sizes of the axillary artery and CFA in the same patient yielded a mean difference of 1.69 mm ± 1.74. In all patients combined, the mean difference between the axillary artery and CFA was 1.88 mm on the right and 1.68 mm on the left. In 19 patients (19.8%), the axillary artery was of the same caliber as the associated CFA. In 8 of 96 patients (8.3%), the axillary artery was larger compared to the CFA. Conclusions. Although typically smaller, the axillary artery is often of comparable size to the CFA, significantly less frequently calcified or diseased, and in almost all observed cases large enough to accommodate a sheath with up to 18 French.

Aim: The objective of this study was to obtain and compare two-dimensional (2D) and three-dimensional (3D) ultrasonographic images of the urinary bladder in different disease conditions., Materials and Methods: The present study was conducting on total 10clinical cases of the urinary bladder in dogs. The ultrasound (US) machine used for this study was 3D US machine (Nemio-XG: Toshiba, Japan) having a four-dimensional volumetric probe., Results: In the present study, the inflamed thickened wall was clearly visible with the distinction of different layers of the urinary bladder wall in some of the cases of cystitis using 2D ultrasonography. In 3D sonogram, the urinary bladder was visualized as a large anechoic structure with no distinction of different layers of the bladder wall. The cystoliths were clearly visible as hyperechoic structures with distal acoustic shadow in 2D sonogram and appeared as a bright echogenic area in 3D sonogram. In case of urinary bladder neoplasia in 2D ultrasonogram, the bladder lumen was found to be occluded with a large growth imaged as focal anechoic areas in the tissue of mixed echogenicity with small hyperechoic dots in this tissue parenchyma. In 3D ultrasonogram, a tissue of mixed echogenicity of pus was also observed., Conclusion: From the present study it was concluded that 2D and 3D ultrasonography is very helpful for diagnosis of different clinical conditions of the urinary bladder such as cystitis, cystoliths, and urinary bladder neoplasia. The cavity of urinary bladder was more clearly visualized in 3D ultrasonography, but the distinction of different layers of the bladder wall was visualized only in 2D ultrasonography. The distinct shadow of pus and cystoliths were visible in 2D ultrasonogram. The visualization of pus in 3D ultrasonography was done for the first time in present study.

Aim: The objective of the study was to obtain and compare the two-dimensional (2D) and three-dimensional (3D) ultrasonographic images of pathological conditions of the stomach in dogs in clinical cases., Materials and Methods: In our study, 12 clinical conditions of the stomach were recorded using ultrasonography. The ultrasound machine used for this study was 3D ultrasound machine (Nemio-XG: Toshiba, Japan) having four-dimensional volumetric transducer., Results: Present study was done to compare 2D and 3D ultrasonographic images in different gastric affections in dogs. In case of uremic gastropathy due to inflammatory response, the wall of the stomach was 0.6 cm thick and hyperechoic and gastric folds were also hyperechoic indicative of gastritis. In second, third, and fourth case of gastritis the wall of the stomach was 0.7, 0.6, and 0.55 cm, respectively thick and hyperechoic. In fifth and sixth case of gastritis, inflammatory response due to ingestion of polythene and sand led to gastritis and ultrasonographically, the wall of the stomach was 0.6 cm and 0.7 cm thick, respectively, and hyperechoic. In case of gastric ulcer, ultrasonographically, there was a disruption of gastric mucosal layer. In cases of gastric dilatation, anechoic content indicating fluid was seen in stomach area and due to dilatation boundary of the stomach was not clear and the increase in the lumen of the stomach was observed. In case of foreign body, ultrasonographically the wall of the stomach was 0.55 cm thick and hyperechoic. In the middle of the stomach, multiple hyperechoic shadows of the foreign bodies i.e. leather and bunch of straw of grass were observed. In case of pyloric stenosis ultrasonographically, anechoic lumen of the pylorus surrounded by 0.5 cm hypoechoic thickened muscle. In some cases, 3D ultrasonography was not diagnostic i.e. gastric foreign bodies and gastric dilatation. These conditions were better visualized on the 2D sonogram., Conclusion: The appearance of clinical conditions of the stomach such as gastritis and pyloric stenosis were more distinct on 3D ultrasonogram than 2D ultrasonogram. The 3D ultrasonography was not diagnostic in cases of gastric foreign bodies and gastric dilatation.

Acute thrombosis is the most common mode of stent-graft failure. Thrombectomy and thrombolysis have inadequate medium-term and long-term results. We propose a new technique for treating acute stent-graft thrombosis by "relining" the thrombosed graft with a second stent-graft. Ten patients were treated with this technique and have been free of any repeat intervention for up to 1 year, showing its feasibility. The Viabahn-in-Viabahn technique needs a larger study to confirm its efficacy and safety.

The plant metabolite oxalic acid is increasingly recognized as a food toxin with negative effects on human nutrition. Decarboxylative degradation of oxalic acid is catalyzed, in a substrate-specific reaction, by oxalate decarboxylase (OXDC), forming formic acid and carbon dioxide. Attempts to date to reduce oxalic acid levels and to understand the biological significance of OXDC in crop plants have met with little success. To investigate the role of OXDC and the metabolic consequences of oxalate down-regulation in a heterotrophic, oxalic acid-accumulating fruit, we generated transgenic tomato (Solanum lycopersicum) plants expressing an OXDC (FvOXDC) from the fungus Flammulina velutipes specifically in the fruit. These E8.2-OXDC fruit showed up to a 90% reduction in oxalate content, which correlated with concomitant increases in calcium, iron, and citrate. Expression of OXDC affected neither carbon dioxide assimilation rates nor resulted in any detectable morphological differences in the transgenic plants. Comparative proteomic analysis suggested that metabolic remodeling was associated with the decrease in oxalate content in transgenic fruit. Examination of the E8.2-OXDC fruit proteome revealed that OXDC-responsive proteins involved in metabolism and stress responses represented the most substantially up- and down-regulated categories, respectively, in the transgenic fruit, compared with those of wild-type plants. Collectively, our study provides insights into OXDC-regulated metabolic networks and may provide a widely applicable strategy for enhancing crop nutritional value.

In the absence of a better alternate, (51)Cr release assay, with its several disadvantages is still the most common method for detection of MHC class I restricted T-cell mediated cytotoxicity. We describe a system in which the T-cell mediated cytotoxicity can be assessed using host-derived cells transfected with a bicistronic vector expressing the specific antigen and a quantifiable reporter as target cells. This overcomes the problems associated with use of radioactivity, pre-loading of target cells with reporter/antigen and the MHC restriction. We used HBV core antigen to prove the concept, as it is an established CTL target. Bicistronic vectors containing HBV core and reporter (EGFP/Fluc) gene were generated and further checked for antigen/reporter expression in human HepG2, mouse fibroblast BALB/c.3T3 and mouse lymphoma A20 cell lines. The effector cells to study the cytolytic activity were generated in vivo using BALB/c mice immunized with antigen expressing DNA clone or protein. The target cells (BALB/c.3T3 and A20) transiently transfected with bicistronic constructs were incubated with effector cells (splenocytes) from immunized mice at a different effector to target ratio. Following incubation the CTL activity was calculated by measuring the reporter luciferase in the remaining viable target cells that inversely correlates with the cytolysis of susceptible cells. The percent specific lysis measured in our assay was compared with conventional (51)Cr release assay to validate this approach. This novel bicistronic vector based cytotoxicity assay demonstrated an easy to perform, antigen-specific and non-radioactive method of determining T-cell mediated cytotoxicity.

4 different methods of colonic anastomosis, single and double layer inversion and eversion, were performed on cowcalves. Hypervascularization of neovascularized arterioles at the cut ends of colon were visualized on the 7th day by all techniques. The arterioles, later one, tended to reorganise towards normalcy. Inversion technique showed better vascularization at the anastomotic site, and the vascular pattern was nearly normal on the 14th and 28th days from surgery. Eversion technique did not exhibit satisfactory revascularization of the anastomotic site on the 7th day of study. A radiopaque area, davoid of arterioles, was noted on the 14th and 28th days from surgery.

Colonic anastomosis was conducted in 12 calves divided equally into four groups. Four suture patterns, viz. single inversion (continuous Connell), double inversion (two rows of continuous Cushing), single eversion (continuous everted mattress), double eversion (single eversion reinforced with simple continuous) were used. In each animal, anastomosis of the same technique was performed at four places. Each technique was evaluated in terms of clinical and gross observations, lumen stenosis and bursting pressure. Observations were made on the 7th, 14th and 28th day after anastomosis. None of the anastomotic techniques showed any untoward incident during the 28 days of postoperative study. Stricture formation at the site of anastomosis was minimal with the single inversion technique whereas it was maximum with the single eversion technique. Pressure for disruption of intestinal segments was higher after inversion than eversion techniques. It was concluded that the one-layer inversion anastomosis technique proved to be the best among the four techniques because (i) of its reduced incidence of adhesions; (ii) it maintains adequate lumen diameter; (iii) it withstands maximum pressure. The double layer inversion technique was conceded to be the second best choice for colonic anastomosis followed by the double eversion and single eversion techniques.