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Sutureless bioprosthetic valves are typically used in patients with a normal sized aortic root and annulus due to concerns that the stent portion of the valve will not be properly anchored. We describe an initial series of sutureless valve implantation in the setting of a diseased aortic root and ascending aortic aneurysm showing that the use of the Perceval valve is feasible in these complex situations.

BACKGROUND: Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the three-dimensional (3D) structure of the atrioventricular canal annulus prior to repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has yet to be quantified nor has it been rigorously compared to a normal mitral valve annulus. METHODS: The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared to the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis). RESULTS: The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height to valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases(p

The angle-ply multilaminate structure of the annulus fibrosus is not reestablished following discectomy which leads to reherniation of the intervertebral disc (IVD). Biomimetic scaffolds developed to repair these defects should be evaluated for their ability to support tissue regeneration by endogenous and exogenous cells. Herein a collagen-based, angle-ply multilaminate patch designed to repair the outer annulus fibrosus was assessed for its ability to support mesenchymal stromal and annulus fibrosus cell viability, elongation, alignment, extracellular matrix gene expression, and scaffold remodeling. Results demonstrated that the cells remained viable, elongated, and aligned along the collagen fiber preferred direction of the scaffold, upregulated genes associated with annulus fibrosus matrix and produced collagen on the scaffold yielding biaxial mechanical properties that resembled native annulus fibrosus tissue. In conclusion, these scaffolds have demonstrated their potential to promote a living repair of defects in the annulus fibrosus and thus may be used to prevent recurrent IVD herniations.

Rafflesia zollingeriana Koord. was one of Rafflesia that distributed in Java. Although it has been stated as a different species, R. zollingeriana is sometimes still regarded as a synonym of R. patma. In addition, there are several contradictions in description of R. zollingeriana. Therefore, further investigation is needed. This study attempts presents a full the description of the R. zollingeriana female flower. In this study, a full description of female flower of R. zollingeriana and pictures of important characters such as ramenta, annulus, perigone lobes, disc, processes, bractea are presented. This study is also compared the morphology of R. zollingeriana and R. patma, to confirm their differences in size, opening of diaphragm, blotches and warts pattern on perigone lobes and diaphragm, annulus, and ramenta.

OBJECTIVES Cases in which the left circumflex coronary artery (LCX) runs close to the mitral annulus are considered high risk for LCX injury during mitral surgery. We investigated the anatomical relationship between the LCX and the mitral annulus using 3-dimensional (3D) computed tomography (CT). METHODS We constructed 3D-CT images of the LCX and the mitral annulus before surgery in 122 patients with mitral regurgitation (MR). We classified coronary dominance by 3D-CT and MR aetiologies (degenerative, atrial functional MR, ventricular functional MR and Barlow’s disease) using echocardiography. We detected the point on the mitral annulus closest to the LCX (X point) and measured the minimum distance from the LCX to the mitral annulus (mCAD). We judged whether atrioventricular disjunction existed using CT. We also investigated the factors affecting mCAD and examined how coronary dominance and MR aetiologies relate to the location of the X point. RESULTS The median mCAD was 4.2 mm (range 0.9–11.4 mm). Considering coronary dominance and MR aetiologies, mCAD was shorter in patients with left coronary dominance and Barlow’s disease. The X point mostly existed on the lateral side of the posterior annulus, but it sometimes existed on the medial side. Multiple regression revealed left dominance and mitral annular disjunction as significant factors affecting mCAD (P = 0.01). CONCLUSIONS The anatomical relationship between the LCX and the mitral annulus can be recognized using superimposed 3D-CT images. This approach is useful to avoid LCX injury in mitral valve surgery since the X point varies between patients.

OBJECTIVES This study sought to report the calcification pattern of the mitral valve annulus and its implications for procedural and safety outcomes in transcatheter aortic valve implantation. METHODS Between November 2018 and September 2019, a total of 305 patients had transcatheter aortic valve implants at our institution. The extent of calcification of the mitral valve annulus was analysed, and the impact on safety outcomes was evaluated. RESULTS The prevalence of mitral annular calcification (MAC) was 43%. Calcification of the mitral valve annulus was either less than or at least one-third of the posterior annulus (34% and 32%), the whole posterior annulus (28%) or the extension to the attachment of the anterior leaflets (7%). Severe circumferential MAC revealed moderate paravalvular leaks in 5/8 (63%) patients and was associated with right branch bundle block [odds ratio (OR) 2.01 (0.39–3.06); P = 0.098] and low cardiac output [OR 3.12 (1.39–7.04); P = 0.033]. Subannular calcification at the anterolateral trigonum represented a risk factor for left ventricular outflow tract injury [OR 3.54 (1.38–8.27); P = 0.001] in balloon-expandable valves, associated with relevant rhythm disorders [OR 2.26 (1.17–5.65); P = 0.014] and female gender (7/8, 88%). The 30-day all-cause mortality in circumferential MAC reaching into the anterior annulus (grade IV) compared to patients with less MAC (grade I–III) was 13% vs 2% with a mean valve size of 24.6 vs 25.7 mm. CONCLUSIONS Extensive MAC was associated with moderate paravalvular leaks, with implications for the prosthesis size and survival in transcatheter aortic valve implants. In severe MAC, we recommend implanting oversized self-expandable prostheses, the goal being to reduce the risk of right branch bundle block and paravalvular leaks. Subj collection 122, 125, Mitral annular calcification (MAC) represents a chronic degenerative process in the fibrous base of the mitral valve (MV) that more commonly affects the posterior rather than the anterior annulus [1].

Accumulation of associated petroleum gas in the annulus is one of the negative factors that impede the intensification of mechanized oil production. An increase in annular gas pressure causes growth of bottomhole pressure, a decrease in back pressure to the formation and the inflow of formation fluid. In addition, accumulation of gas in the annulus leads to displacement and a decrease in the liquid level above the submersible pump. Insufficient level of the pump submersion (rod or electric submersible) causes a number of complications in the operation of mechanized production units associated with overheating of the elements in pumping units. Therefore, the development of technologies for optimizing the gas pressure in the annulus is relevant. Method for calculating the intensity of gas pressure increase in the annulus of production wells operated by submersible pumps has been developed. Analytical dependence for calculating the time interval of gas accumulation in the annulus, during which the dynamic level decreases to the pump intake, is obtained. This value can be used to estimate the frequency of gas withdrawal from the annulus using compressors. It has been found that the rate of increase in annular gas pressure in time increases non-linearly with a rise in the gas-oil ratio and a decrease in water cut, and also linearly increases with a rise in liquid flow rate. Influence of the operating (gas-oil ratio) and technological (value of the gas pressure maintained in the annulus) factors on the flow rate of the suspended reciprocating compressor driven by the beam engine, designed for forced withdrawal and redirection of the annular gas into the flow line of the well is analyzed.

Retrospective study of 150 IVDs.Assessment of costume algorithm ability to delineate the IAF and NP on routine T2 images.Central hyperintense region on T2-weighted MR images of normal lumbar IVDs represents a combination of IAF and NP. Ability to identify NP as distinct from IAF can help improve our understanding of IVD morphology in-vivo.Sagittal T2-weighted TSE MR images of 150 lumbar IVDs from 25 patients were analyzed. MR images were processed using a custom algorithm that markedly increased the signal intensity of structures with inherent signal intensity within 2 defined intensity thresholds. Signal intensity and contrast-to- noise ratio between outer annulus fibrosus, IAF, and NP were assessed at baseline and after processing. To assess consistency of underlying T2 differences, similar analysis was done on 108 discs from 18 patients in whom additional sagittal T2-weighted STIR images were available.Following image processing, apparent IAF and NP were rendered visible in 86% and 84.3% IVDs on T2-weighted TSE and STIR images respectively. While signal intensity of these 2 regions was inherently different (P0.001) before processing on TSE and STIR images, their visualization was facilitated by a significant increase (P0.001) in contrast-to-noise ratio after processing. Nonvisualization of NP was associated with disc degeneration (P0.001).Inherent differences exist in signal intensities of normal NP and IAF on T2-weighted MR images. Accentuating these differences using image postprocessing techniques can render these 2 structures visible.

Pankiv M. V., Paltov Ye. V., Masna Z. Z., Chelpanova I. V., Kovalska M. Ye. Dynamics of pathomorphological changes in the structural organization of the intervertebral disc at the end of the seventh and fourteenth day of experimental opioid exposure at the ultrastructural level. Journal of Education, Health and Sport. 2021;11(08):427-437. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.08.048 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2021.11.08.048 https://zenodo.org/record/5495940 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.08.2021. Revised: 16.08.2021. Accepted: 31.08.2021. UDK:714.616.711-018.3⁄.4:615.212.7]-076.4 Dynamics of pathomorphological changes in the structural organization of the intervertebral disc at the end of the seventh and fourteenth day of experimental opioid exposure at the ultrastructural level M. V. Pankiv, Ye. V. Paltov, Z. Z. Masna, I. V. Chelpanova, M. Ye. Kovalska Danylo Halytsky Lviv National Medical University Pankiv M.V. Danylo Halytsky Lviv National Medical University, Department of Normal Anatomy, Lviv, Ukraine; https: //orcid.org/0000-0002-3714-2577 Paltov Ye.V. Danylo Halytsky Lviv National Medical University, Department of Normal Anatomy, Lviv, Ukraine; https://orcid.org/0000-0002-2622-4753 Masna Z.Z. Danylo Halytsky Lviv National Medical University, Department of Operative Surgery with Topographic Anatomy, Lviv, Ukraine; https://orcid.org/0000-0003-2057-7061 Chelpanova I.V. Danylo Halytsky Lviv National Medical University, Department of Histology, Cytology and Embryology, Lviv, Ukraine; https://orcid.org/ 0000-0001-5215-814X Kovalska M. Ye. Danylo Halytsky Lviv National Medical University, Department of pathological physiology, Lviv, Ukraine; https://orcid.org/0000-0002-6232-3951 Abstract In general, the modern literature pays attention to the issues of spine pathology and intervertebral discs. A significant percentage of vertebral disorders - scoliosis, osteochondrosis, spinal disc herniation, etc., occur as a result of exposure to various factors and manifest in changes of the intervertebral discs. The aim of our work was to study at the ultrastructural level the features of pathomorphological manifestations in the structural components of the intervertebral disc at the end of the seventh and fourteenth days of experimental opioid exposure. Materials and methods of research. The objects of the study were 32 sexually mature, white, male rats, weighing 92 - 103 g, aged 4.5 months. Animals were injected with nalbupine intramuscularly once daily (at 10-11 a.m.) for 14 days. The initial dose of nalbuphine was 8 mg/kg during the first week, 15 mg/kg during the second week. It created the conditions of chronic opioid exposure. Before sampling, the animals were withdrawn from the experiment using dibutyl ether. Intervertebral discs of rats were used as a material for ultrastructural study. Ultrastructural specimens were prepared according to the accepted methods. The results of the study. As a result of the sampling after 7 days of opioid exposure we found inhomogeneous osmiophilicity and compaction of the nucleus pulposus matrix in which intensively accumulated osmiophilic grains of glycogen proteoglycans, increased the number of collagen fibers, some of them were heterogeneous. It was also noted the development of moderate degenerative changes in some notochondral cells, which was accompanied by increased vacuolization of the cytoplasm by inhomogeneous compaction of the nucleus and an increase of heterochromatin there. After 14 days necrotic changes in the cells of the nucleus pulposus, as well as the destruction of collagen fibers of the annulus fibrosus were found. In particular, an increase in the amount of heterochromatin in the nucleui of notochondral cells, which was accompanied by a decrease in the volume of the nucleui and inhomogeneous swelling of the cytoplasm. Active fibroblasts were often visualized in the annulus fibrosus. Intense osmiophilicity and thickening of collagen fibers of the annulus fibrosus were observed in some areas of the fibrous ring. Focal destruction of collagen fibers was also noted. In the areas of destruction the fibrils of collagen fibers disintegrated into an inhomogeneous fine-grained stratified mass and were located loosely. Conclusions. At the end of the first week we found that the cytoplasmic processes of chondrocytes decreased in volume, shortened, underwent fragmentation and destruction, some of them detached from the surface of the plasmolemma. At the end of the second week signs of opioid exposure progressed and manifested by an increase in the destruction of cytoplasmic processes in chondrocytes. Also focal destruction of collagen fibers was noted. Keywords: opioid; intervertebral disc; rat; seventh and fourteenth day.

Scaffolds mimicking the native annulus fibrosus (AF) extracellular matrix (ECM) structure are crucial to guide the seeding cells to regenerate aligned tissue, while fabricating such a scaffold by synthetic material is challengeable. Native acellular scaffolds derived from AF tissue certainly possess the advantages of natural structure and composition. Based on previous studies, we modified decellularization procedure and especially compared two drying methods, including gradient dehydration and freeze-drying. The decellularization process can effectively remove the host cells and antigens such as α-Gal, while maintaining the original ECM including GAG and collagen I. Compared with gradient dehydration, freeze-drying not only rendered the decellularized scaffold in dry state for storage but also gave the scaffold more aligned porous structure and hydrophilicity. And, the acellular porous scaffold manifested better capacity of supporting cell ingrowth when seeded human bone marrow mesenchymal stem cells (hBMSCs) or implanted in vivo. Furthermore, this optimized freeze-dried scaffold showed similar mechanical elastic modulus as native AF and demonstrated rare inflammatory granuloma and immune rejection as observed in HE staining and immunohistochemistry staining (IHC) of CD8 and MAC387 epitopes when implanted subcutaneously in vivo. To sum up, through our decellularization and freeze-drying procedure, an aligned porous three-dimensional scaffold derived from the natural AF ECM was successfully fabricated with good retention of ECM components and benign biocompatibility. It will be a promising scaffold for AF tissue engineering.

Objectives This study aimed to assess whether patients with MAD also have disjunction of the tricuspid annulus. Background Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus. Whether the disjunction extends to the right side of the heart is not known. Methods In a cohort of patients with MAD, we assessed the presence of tricuspid annulus disjunction (TAD) with the use of cardiac magnetic resonance. We explored the associations between TAD and MAD characteristics and the relationship to ventricular arrhythmias (nonsustained/sustained ventricular tachycardias and aborted cardiac arrest). Results We included 84 patients (mean age: 48 ± 16 years; 63% female). We observed TAD in 42 (50%). Patients with TAD were older (age 52 ± 16 years vs. 43 ± 15 years; p = 0.02), had greater circumferential extent of MAD (164 ± 57° vs. 115 ± 58°; p = 0.002), greater maximum longitudinal MAD distance (9.4 ± 2.9 mm vs. 6.2 ± 2.8 mm; p Conclusions We report for the first time the existence of right-sided annulus disjunction as a common finding in patients with MAD. TAD was associated with more severe left-sided annulus disjunction and mitral valve prolapse, but not with ventricular arrhythmias.

Background A small aortic annulus is associated with increased risk of prosthesis–patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI). Whether specific transcatheter heart valve (THV) designs yield superior hemodynamic performance in these small anatomies remains unclear. Methods Data from 8411 consecutive patients treated with TAVI from May 2012 to April 2019 at four German centers were retrospectively evaluated. A small aortic annulus was defined as multidetector computed tomography-derived annulus area 2. TAVI was performed with a balloon-expanding intra-annular (Sapien-3, n = 288), self-expanding intra-annular (Portico, n = 110), self-expanding supra-annular (Evolut, n = 179 and Acurate-Neo, n = 428) and mechanically expanding infra-annular (Lotus, n = 64) THV according to local practice. PPM was defined as indexed effective orifice area ≤ 0.85cm2/m2. Results A small annulus was found in 1069 (12.7%) patients. PPM was detected in 38.3% overall with a higher prevalence after implantation of a balloon-expanding intra-annular or mechanically expanding infra-annular THV compared to self-expanding intra- and supra-annular THV. Multivariable analysis linked self-expanding THV (Evolut: Odds ratio [OR] 0.341, Acurate-Neo: OR 0.436, Portico: OR 0.291), postdilatation (OR 0.648) and age (OR 0.968) to lower rates of PPM, while aortic valve calcification was associated with an increased risk (OR 1.001). Paravalvular regurgitation > mild was more frequent after TAVI with self-expanding THV (p = 0.04). Conclusion In this large contemporary multicenter patient population, a substantial number of patients with a small aortic anatomy were left with PPM after TAVI. Self-expanding supra- and intra-annular THV demonstrated superior hemodynamics in these patients at risk, however at the cost of higher rates of residual paravalvular regurgitation. Graphic abstract

Merkel cell carcinoma is an extremely rare neuroendocrine neoplasm of the external auditory canal (EAC) skin, which requires wide excision and adjuvant radiation due to a high recurrence rate. In this report, we describe a case of Merkel cell carcinoma arising from the EAC which was successfully treated with endoscopic excision. A 32-years-old female patient with a history of papillary thyroid cancer was diagnosed with an EAC tumor incidentally. There was a erythematous papular lesion on the posterior EAC without any evidence of locoregional metastasis. The patient underwent endoscopic tumor resection under general anesthesia, and the final pathologic report confirmed the diagnosis of Merkel cell carcinoma. There was no clinical or radiographic evidence of recurrence or metastasis of Merkel cell tumor for 41 months after surgical resection alone.

PIVD is the protrusion from the nucleus pulposus through the rent within the annulus fibrosis. L4-L5, L5-S1 discs are most commonly affected in 95 percent of lumbar disc herniation. As we grow older the discs which are present in our vertebral column, become less flexible and begin to harden, making it more susceptible to tears. The herniated disc may be caused by a single undue strain or injury. However, as disc degeneration progresses with age, a few people may suffer herniated discs from more minor activities or twists. The patient was a 38-year-old female who presented with a complaint of pain in the neck & back which was 8 on Vas, pain in both limbs ( upper & lower) which was 7 on Vas, Numbness present in Upper limb fingers, Stiffness in all joints along with pedal edema. The patient also had a varicose vein on both lower limbs grade 3. She was admitted to the hospital because she was not able to even get up from the bed due to pain. She was working in a mess for 8 years the work included prolonged standing, bending down, lifting heavy weights, and sitting on the floor for a long period. Due to pain, she was not able to continue her work. Ayurvedic treatment along with physiotherapy treatment was going on. The patient had the same complaints before 12 months she was relieved by physiotherapy. The patient had three laser sessions done for a varicose vein but was not relieved before 1 year. According to the clinical presentation and Radiological findings the patient was diagnosed with PIVD. This case study shows that regular exercise, traction, back strengthening exercise, use of modalities such as IFT, and following proper ergonomics would reduce the symptoms associated with PIVD and varicose veins

Mitral annular calcification (MAC) is a chronic degenerative process involving the fibrous part of the mitral complex, characterized by calcium deposition and loss of valve function. MAC prevalence is 8–10%, but despite this, the clinical significance of MAC is underestimated. Currently, there are reports that complete decalcification leads to improved long-term outcomes in patients with severe MAC. An analysis of the immediate outcomes of mitral valve surgery in patients with severely calcified mitral annulus with decalcification was performed. The calcified annulus fibrosus underwent complete decalcification in all cases. Calcium deposits were removed in a single block, in 6 cases it was reconstructed with a xeno-pericardial patch; in 2 cases the annulus fibrosus was sutured. There were 2 cases of in-hospital mortality, caused by acute heart failure on day 8 in 1 patient and pulmonary embolism on day 30 after operation in the second patient. There were no complications associated with coronary artery injury and left ventricular posterior wall rupture. Experience in the treatment of severe mitral valve calcification with extensive annulus fibrosus decalcification and subsequent reconstruction is possible and gives satisfactory results.

Embryonic muscle forces are necessary for normal vertebral development and spinal curvature, but their involvement in intervertebral disc (IVD) development remains unclear. The aim of the current study was to determine how muscle contractions affect (1) notochord involution and vertebral segmentation, and (2) IVD development including the mechanical properties and morphology, as well as collagen fibre alignment in the annulus fibrosus. Muscular dysgenesis (mdg) mice were harvested at three prenatal stages: at Theiler Stage (TS)22 when notochord involution starts, at TS24 when involution is complete, and at TS27 when the IVD is formed. Vertebral and IVD development were characterised using histology, immunofluorescence, and indentation testing. The results revealed that notochord involution and vertebral segmentation occurred independently of muscle contractions between TS22 and TS24. However, in the absence of muscle contractions, we found vertebral fusion in the cervical region at TS27, along with (i) a displacement of the nucleus pulposus towards the dorsal side, (ii) a disruption of the structural arrangement of collagen in the annulus fibrosus, and (iii) an increase in viscous behaviour of the annulus fibrosus. These findings emphasise the important role of mechanical forces during IVD development, and demonstrate a critical role of muscle loading during development to enable proper annulus fibrosus formation. They further suggest a need for mechanical loading in the creation of fibre-reinforced tissue engineering replacement IVDs as a therapy for IVD degeneration.

A novel species, Leucoagaricus fragilis, is described from the vicinity of the Cholistan desert, Punjab, Pakistan. The taxon is characterized by white, fragile basidiomata with a light brown, umbonate disk, a radially fibrillose pileus surface rarely splitting radially, pinkish brown lamellae at maturity, a white, bent stipe that stains yellowish upon handling, an inferior annulus, sub-globose to ellipsoid basidiospores, broadly clavate to abundantly sphaeropedunculate cheilocystidia, and cylindrical pileipellis hyphae intermixed with broader clavate elements with rounded ends. Morpho-anatomical and molecular phylogenetic analyses of nrITS and nrLSU datasets confirmed a new taxon in L. sect. Piloselli. A key to the known species of Leucoagaricus in Pakistan is also provided.

Introduction: The purpose of this study was to compare the histological findings of goat bone marrow mesenchymal stem cell (BMSC) transplantation and adhesive fibrin repair for annulus fibrosus defects in intervertebral discs. Material and methods: The goats were spanided into three groups: the control group, the adhesive group and the transplantation group. In the control group, surgical instruments were used to create a fibrous ring defect in the intervertebral disc of the goats. In the adhesive group, a 1.5*1.5-cm defect was also created by surgical intervention, and the broken fiber ring was then bonded with adhesive fibrin. In the transplantation group, a gelatine sponge containing the goat BMSCs was implanted into the broken annulus fibrosus, and the wound was closed layer by layer. At 6 weeks and 12 weeks after the operation, the damaged tissues were removed, and haematoxylin and eosin (HE), trichrome gelatine (Masson), Alcian blue periodic acid-Schiff (AB-PAS) and Collagen II staining was performed. Then, the tissues from the different groups were histologically compared and analyzed. Results: Goat BMSCs have a better ability to repair defects in the fibrous ring than adhesive fibrin. Over time, the number of cells or the amount of tissue following cell transplantation was greater, indicating that the degree of repair is greater with BMSCs than with adhesive fibrin. Conclusion: Histologically, repair of the defect of the fibrous ring and prevention of nucleus pulposus protrusion were more effective in the cell transplantation group than in the other two groups.

Background: Multidetector computed tomography (MDCT) is the gold standard in annulus sizing before transcatheter aortic valve replacement (TAVR). However, MDCT has limited applicability in specific subgroups of patients, such as those with atrial fibrillation and chronic kidney disease. Two-dimensional transesophageal echocardiography (2DTEE) has traditionally been limited to the long-axis measurement of the anteroposterior diameter of the aortic annulus. We describe a new 2DTEE approach for the measurement of the major diameter of the aortic annulus. Methods: Seventy-six patients with symptomatic severe aortic valve stenosis and high surgical risk underwent MDCT and 2DTEE before TAVR. A modified five-chamber view was used to measure the major aortic annulus diameter. This was obtained starting from a mid-esophageal four chamber and retracting the TEE probe up until the left ventricular outflow tract and the left and noncoronary aortic cusps were visualized: major aortic annulus diameter was measured as the distance between their insertion points in systole. Results: Major aortic annulus diameters measured at 2DTEE showed good correlation with MDCT diameter (r = 0.79; P < 0.001) and perimeter (r = 0.87; P < 0.0001). Using factsheet-derived sizing criteria, 2DTEE alone would have allowed accurate sizing in 75% of patients, with 21% of oversizing predominantly with smaller annuli. Conclusions: We describe a new method for 2DTEE measurement of the major aortic annulus diameter; this approach is simple, correlates with MDCT, and allows adequate TAVR sizing in most patients. These findings may help in the assessment of patients with contraindications to or inadequate MDCT images.

Two new species, Leucoagaricus tropicus and Leucoagaricus brunneodiscus, are described from West Bengal, Eastern India, based on morphological details and phylogenetic analyses. Leucoagaricus tropicus is characterized by its white, medium-sized pileus with a brown to dark brown umbo, a white stipe that directly changes to brownish-red or brown on bruising or with KOH, ellipsoid basidiospores with inconspicuous germ pore, dimorphic cheilocystidia, narrowly clavate to narrowly fusiform cystidioid elements on the annulus and small cystidioid elements of the pileus covering. Leucoagaricus brunneodiscus is distinguished by the presence of colourless to orange-white drops on the stipe, brownish-orange to brown annulus with dark brown edge, ellipsoid basidiospores without a germ pore and small, clavate cheilocystidia. Detailed descriptions, field photographs of the collected basidiomata, comparisons with morphologically similar and phylogenetically related species and a phylogram generated from the combined dataset of nrITS and LSU sequences are provided. An artificial key to all Leucoagaricus taxa reported in India is also provided.

Infective endocarditis is a serious, potentially life-threatening condition. The valve leaflets and annulus are the most commonly affected sites, but involvement of the papillary muscles is extremely rare. We present the case of a 69-year-old woman who had infective endocarditis only involving the papillary muscle on 18F-FDG PET/CT.

OBJECTIVE It is very important to accurately assess the transannular patch (TAP) in the surgical treatment of tetralogy of Fallot (TOF). The pulmonary annulus index (PAI; the actual pulmonary annulus diameter divided by the expected pulmonary annulus diameter), GA ratio (the ratio of pulmonary annulus and aortic annulus), PAAI (the ratio of pulmonary annulus cross-section and aortic annulus cross-section), and pulmonary annulus Z score (PA Z score) were compared. This study aimed to analyze and explore the application value of PAI in predicting the need for TAP in children undergoing TOF repair. METHODS In total, 130 patients who were diagnosed with TOF and underwent TOF repair in Beijing Anzhen Hospital affiliated to Capital Medical University from December 2018 to December 2019 were retrospectively studied. In total, 112 cases were included in this study and 18 cases were excluded, of which 16 cases were aged above 18 years and 2 cases suffered from Down syndrome. They were divided into TAP group and no TAP group; the values of the pulmonary annulus and aortic annulus were measured. GA ratio, PAI, PAAI, the pulmonary annulus Z score, and main pulmonary artery (MPA) Z score were calculated to perform statistical analysis. RESULTS A total of 112 patients were included in the study, aged 4-177 months, with an average of 22.87 ± 30.21 months; 66 males and 46 females; weighing 5.3-29 kg, with an average of 9.94 ± 4.08 kg; three cases died, one case died of sepsis caused by pulmonary infection, one case died of low cardiac output syndrome, and one case died of multiple organ failure. In total, 62 cases (55.8%) did not undergo TAP and 50 cases (44.2%) underwent TAP. The pulmonary annulus Z score, main pulmonary artery Z score, and PAI in the TAP group were smaller than those in the no TAP group (p

Summary Annulus pressure buildup (APB) problems in shale gas wells seriously affected on the safety and efficient exploitation of shale gas all around the world. The sealing failure of the cement sheath on interfaces caused by periodically changed fluid pressure in casing during hydraulic fracturing is treated as the main reason for APB in shale gas wells. Many methods are put forward to solve the APB problem in the field, and fortunately, the preapplied annulus backpressure (PABP) method shows an excellent utility. In this paper, an analytical model is established to explain the mechanism of the PABP method increasing the sealing ability of the cement sheath. The residual strain of the cement sheath and radial stress on interfaces are considered to analyze the factors that affect the effectiveness of the PABP method. In addition, based on the field data, an experimental device is established to test the validity of the PABP method and to certify the accuracy of the analytical model established in this paper. The analytical results show that the thickness of the casing has little effect on radial stress on interfaces. The outer diameter of the casing and the thickness of the cement sheath can temperately affect the radial stress. The elastic modulus of the cement sheath and the formation rock can significantly affect the radial stress. The higher elastic modulus of the cement sheath can dramatically increase the radial stress on interfaces. On the contrary, the higher elastic modulus of formation rock will induce smaller radial stress on the interfaces. In the field, the number of newly added shale gas wells with APB problems has dramatically decreased by using the PABP method. The work in this paper can be significantly useful for researchers and engineers to reduce the APB in shale gas wells.

The standard technique for accessory pathway ablation involves mapping along the mitral and tricuspid annulus to localize the regions of earliest ventricular activation during antegrade pathway conduction, earliest atrial activation during retrograde conduction or detection of an accessory pathway potential. In some cases despite what appears to be appropriate mapping, catheter positioning and adequate power delivery the ablation is not successful. In many of these cases, the pathway is felt to be inaccessible because of a location remote from the mitral or tricuspid annulus that cannot be affected by endocardial power delivery along the annulus. In the case of difficult left sided pathways, some may be reached and ablated via the coronary sinus or its branches. Right sided pathways cannot be approached in this fashion since there is no venous structure analogous to the coronary sinus around the tricuspid annulus. Alternative mapping and ablation techniques for these difficult pathways have included epicardial mapping via direct pericardial access or attempts to localize pathway insertion areas remote from the valve annulus which may be amenable to endocardial ablation. We describe the use of post-pacing interval mapping to localize the atrial input of a right sided antegrade only accessory pathway that was resistant to conventional mapping and ablation strategies.

This report describes Thismia belumensis Siti-Munirah & Suhaimi-Miloko, a novel species of achlorophyllous herb discovered in the Royal Belum State Park, Peninsular Malaysia. This new species is unlike any previously described species of Thismia. In particular, T. belumensis possesses a unique annulus, which has been expanded and modified into a cucullate (hood-like) structure. This structure covers the apical floral tube and has an opening on one side facing a thickened part of the annulus, and the off-centre floral aperture confers a zygomorphic symmetry to the flower, indicating T. belumensis is more similar to Thismia labiata J.J.Sm. This morphological detail makes this new species distinct from all other described species of Thismia. In this report, we provide descriptions, illustrations, colour plates, and the provisional conservation status of Thismia belumensis.

Background : During repair of tetralogy of fallot (TOF) we modified surgical strategies to preserve the valve and annulus if the pulmonary valve leaflets are pliable and not significantly dysplastic. Methods : Initially, the repair was done from the main pulmonary artery (Group-1, 215 patients) and later through an additional incision in the infundibulum of the right ventricle (Group-2, 73 patients). Recently, we changed the approach to commissurotomy of the fused leaflets by releasing the supra valvar tethering and delamination of the cuspal apparatus till the base to improve the mobility of the cusps and do a controlled commissurotomy (Group-3, 14 patients). With delamination, we could extend the limit of the repair to a z-score of -3.5. Results : There was no hospital mortality; two patients died at home after discharge. A mean follow-up of 42.01 months ± 19.25 is available for 198 patients (92%) for group 1, 16.03 ± 7.45 for group 2, and 4.07 ± 2.09 for group 3. The re-intervention-free survival is 94.4% in group 1. The z value improved from -3 (-3–-2) to -1.2 (-3 – 0), P = 0.001 in Group 1, from -2.8 (-3–-2.4) to -1 (-1.1–-0.7), P = 0.001 in Group 2 and from –3 (-4–-3) to -1, P = 0.001 in Group 3. In all the groups, there was trivial or mild pulmonary regurgitation. Conclusions : During repair of TOF, adequate valve/annulus sparing is possible if the repair is done from both the main pulmonary artery and infundibular incisions using the delamination technique.

Background To assess the effects of proteoglycan-depleted regions of annular disruptions on nerve ingrowth in the injury site in vivo. Methods New Zealand white rabbits (n = 18) received annular injuries at L3/4, L4/5, and L5/6. The experimental discs were randomly assigned to four groups: (a) an annular defect was created; (b) an annular defect implanted with a poly lactic-co-glycolic acid (PLGA)/fibrin/PBS plug; (c) an annular defect implanted with a PLGA/fibrin/chondroitinase ABC (chABC) plug; and (d) an uninjured L2/3 disc (control). Disc degeneration was evaluated by radiography, MRI, histology, and analysis of the proteoglycan (PG) content. Immunohistochemical detection of nerve fibers and chondroitin sulfate (CS) was performed. Results The injured discs produced progressive and reliable disc degeneration. In the defective discs, the lamellated appearance of AF (Annulus fibrosus) was replaced by extensive fibrocartilaginous-like tissue formation outside the injured sites. In contrast, newly formed tissue was distributed along small fissures, and small blood vessels appeared in the outer part of the disrupted area in the PLGA/fibrin/PBS discs. More sprouting nerve fibers grew further into the depleted annulus regions in the PLGA/fibrin/chABC discs than in the control discs and those receiving PLGA/fibrin/PBS. In addition, the innervation scores of the PLGA/fibrin/chABC discs were significantly increased compared with those of the PLGA/fibrin/PBS discs and defected discs. Conclusion ChABC-based PLGA/fibrin gel showed promising results by achieving biointegration with native annulus tissue and providing a local source for the sustained release of active chABC. Disc-derived PG-mediated inhibition of nerve and blood vessel ingrowth was abrogated by chABC enzymatic deglycosylation in an annular-injured rabbit disc degeneration model.

OBJECTIVES Tissue reaction to transcatheter mitral valve replacement in the mitral annulus remains to be elucidated. METHODS Trileaflet porcine pericardial valves were sewn onto self-expanding d-shaped nitinol stents, which were delivered transapically and in an off-pump fashion into the mitral position of 10 pigs. After at least 4 weeks of follow-up, gross pathological assessment and histological examination were performed. The specimens were stained with Movat’s pentachrome, Elastica-van-Gieson and von Kossa staining. The leucocytes, B cells, T cells or macrophages were detected by specific immunohistochemical staining. RESULTS Proper stent positioning in the mitral annulus was achieved in 9/10 animals. Nine of 10 animals survived the desired observation period. In all but one, the mitral valve stent was well integrated into the left atrium and perpendicularly embedded into the annulus by 85 ± 24%. One animal had minor fractures in the nitinol struts and another animal showed tearing of 1 of 4 tethers. Histological examination demonstrated no major tissue reaction with the nitninol struts but well-preserved overall structures around the mitral annulus in 8/9 cases. CONCLUSIONS This is the first report demonstrating good in-growth of transcatheter-delivered anatomically shaped mitral valve stents after at least 4 weeks of follow-up. Histological examination demonstrated progressive healing and neointimalization.

Background: Mitral valve surgery can be challenging for patients with mitral annular calcification (MAC). The prevalence of MAC in patients who undergo mitral valve replacement is 19.9%. The treatment options for MAC include complete decalcification and annular reconstruction with valve repair/replacement or performing a surgical valve repair or replacement without decalcification, accepting the risk of paravalvular leak. We describe three cases of mitral valve prolapse with posterior annular calcification, which were repaired using a unique technique that does not require decalcification. Case reports: The mitral annular calcification was heavy and involved most of the posterior annulus just sparing the commissures in all the three cases. Leaflet prolapse was dealt with by using neochordae, closing any clefts, and leaflet plication. Since the MAC ring was not complete and there was chance of further dilatation of the annulus, a partial annuloplasty was done using a PTFE felt (cut as strip). There was trivial to no mitral regurgitation with this technique in the immediate postoperative and five-year follow-up period echocardiography in all the three cases. Conclusion: This technique can benefit the major subset of pure mitral valve regurgitant lesions associated with MAC, which is limited to the posterior annulus.

Objective:Operators are mindful of the balloon-to-aortic annulus ratio when performing balloon aortic valvuloplasty. The method of measurement of the aortic valve annulus has not been standardised.Methods and results:Patients who underwent aortic valvuloplasty at two paediatric centres between 2007 and 2014 were included. The valve annulus measured by echocardiography and angiography was used to calculate the balloon-to-aortic annulus ratio and measurements were compared. The primary endpoint was an increase in aortic insufficiency by ≥2 degrees. Ninety-eight patients with a median age at valvuloplasty of 2.1 months (Interquartile range (IQR): 0.2–105.5) were included. The angiographic-based annulus was 8.2 mm (IQR: 6.8–16.0), which was greater than echocardiogram-based annulus of 7.5 mm (IQR: 6.1–14.8) (p < 0.001). This corresponded to a significantly lower angiographic balloon-to-aortic annulus ratio of 0.9 (IQR: 0.9–1.0), compared to an echocardiographic ratio of 1.1 (IQR: 1.0–1.1) (p < 0.001). The degree of discrepancy in measured diameter increased with smaller valve diameters (p = 0.041) and in neonates (p = 0.044). There was significant disagreement between angiographic and echocardiographic balloon-to-aortic annulus ratio measures regarding “High” ratio of >1.2, with angiographic ratio flagging only 2/12 (16.7%) of patients flagged by echocardiographic ratio as “High” (p = 0.012). Patients who had an increase in the degree of aortic insufficiency post valvuloplasty, only 3 (5.5%) had angiographic ratio > 1.1, while 21 (38%) had echocardiographic ratio >1.1 (p < 0.001). Patients with resultant ≥ moderate insufficiency more often had an echocardiographic ratio of >1.1 than angiographic ratio of >1.1 There was no association between increase in balloon-to-aortic annulus ratio and gradient reduction.Conclusions:Angiographic measurement is associated with a greater measured aortic valve annulus and the development of aortic insufficiency. Operators should use caution when relying solely on angiographic measurement when performing balloon aortic valvuloplasty.

Electrocardiographic (ECG)-gated computed tomography (CT) can be used to determine which valve and size should be used in transcatheter aortic valve replacement (TAVR). It is beneficial to predict the accurate annulus diameter in surgical aortic valve replacement (SAVR), which can help in determining the surgical strategy. We aimed to compare the predicted aortic annulus size with the actual annulus size measured intraoperatively and to examine its validity. A total of 88 patients underwent isolated or concomitant SAVR in 2018 at our hospital. The study population consisted of 45 patients who underwent preoperative CT assessment and intraoperative measurement. The perimeter- and area-derived diameters at the level of basal attachments were determined using CT, and the lower value among the two was defined as the predicted aortic annulus (CTpredict). The predicted aortic annulus (TTEpredict) was measured by transthoracic echography in the parasternal long-axis view. An actual-sized ball sizer was inserted into the annulus intraoperatively. True annulus size was determined as the labeled size that just fits on the annulus, and labeled size plus 1 mm was determined as one that passes through the annulus. There was better agreement with minimal bias between CTpredict and true annulus size as demonstrated in the Bland–Altman analysis with an intraclass correlation coefficient of 0.796 compared with TTEpredict. ECG-gated CT is also helpful in predicting the annulus diameter even in patients undergoing SAVR. This has important clinical implications for planning SAVR, including the surgical approach.

OBJECTIVE The aim was to identify the source of cells within the center of the abnormal fibrocartilage tissue of the degenerative intervertebral disc after injury. DESIGN Cross-breeding of mice with an inducible type II promoter collagen construct (Col2CreER) to Rosa26-TdTomato mice has been shown to result in Cre-recombinase activity and Tomato expression in inner annulus fibrosus cells after tamoxifen injection. To investigate the role of the inner annulus fibrosus in the intervertebral disc injury response, tail intervertebral discs of Col2CreER/tdTomato mice were punctured with a needle and examined 1-4 wks after injury. N-cadherin was examined by immunostaining. RESULTS After the injury, the fibrocartilage in the degenerative intervertebral disc consisted of residual diseased nucleus pulposus cells and encroaching inner annulus fibrosus cells. The residual nucleus pulposus cells had lost their epithelial cell-like morphology and instead became oval shaped, with reduced adhesion to neighboring nucleus pulposus cells. This change in cellular morphology coincided with a loss of N-cadherin, which contributes to maintenance of healthy nucleus pulposus cell morphology. As expected, injured tail intervertebral discs showed reduced compressive properties as determined by biomechanical assessments. CONCLUSIONS The cellular composition of the degenerative intervertebral disc has been defined here, which is an important step in developing future treatments.

Amanita lacerosquamosa, a new species of Amanita sect. Validae, is described from southwestern China based on morphological and phylogenetic evidence. The new species is characterized by its medium-sized basidioma, greyish brown, brown to dark brown pileus with brownish grey to greyish brown, verrucose, patchy and sometimes subpyramidal remnants of the universal veil, upper-middle to lower-middle annulus on stipe with snakeskin shaped, floccose, grey to light brown squamules above the annulus, and amyloid, globose, subglobose to broadly ellipsoid basidiospores 6−7.5 × 5−7 μm.

Purpose Disc herniations are usually treated by decompression of the spinal nerves via a partial nucleotomy. As a consequence of reduced disc height (DH), reduced intradiscal pressure (IDP) and increased range of motion (ROM), accelerated degeneration may occur. Nucleus replacement implants are intended to restore those values, but are associated with the risk of extrusion. Methods In six fresh frozen lumbar spinal segments (L2-3/L3-4/L4-5/L5-S1, age median 64.5 years (57–72), Pfirrmann grade 2–3), a prolapse was provoked through a box defect (6 × 10 mm) in the annulus. The herniated nucleus material was removed and replaced by a novel collagen-based nucleus implant. An annulus closure device sealed the defect. ROM, neutral zone (NZ) and IDP were measured in the (1) intact and (2) defect state, (3) postoperatively and (4) after cyclic loading (n = 100,000 cycles) applying pure moments (± 7.5 Nm) in flexion–extension, lateral bending and axial rotation. Additionally, the change in DH was determined. Extrusion of implants or nucleus material was evaluated macroscopically. Results In all specimens, a prolapse could be provoked which decreased DH. Subsequent nucleotomy changed ROM/NZ and IDP considerably. Initial values could be restored by the implantation. Macroscopically, none of the implants nor nucleus material did migrate after cyclic loading. Conclusions In this study, a prolapse followed by a nucleotomy resulted in a biomechanical destabilisation. Implantation of the nucleus replacement combined with an annulus closure restored the intact condition without showing signs of extrusion nor migration after cyclic loading. Hence, nucleus replacements could have a new chance in combination with annulus closure devices.

The aperture on the pollen surface provides an exit for the emerging pollen tube. Apertures exhibit huge morphological variation across plant species-grasses, including rice, possess a complex aperture consisting of an annulus and an operculum-but little is known about how this species-specific cell-surface pattern forms. Here, we report a lectin receptor-like kinase in Oryza sativa, OsDAF1, which is essential for annulus formation and thus for fertility. OsDAF1 is evenly distributed in early microsporocytes but localizes to the distal pre-aperture site at the tetrad stage. We further reveal that the rice orthologue of a key aperture factor in Arabidopsis, OsINP1, has conserved and diversified roles in rice aperture formation. Disruption of OsINP1 prevents formation of the aperture, precluding pollen-tube germination. Furthermore, our results demonstrate that OsINP1 is required for polarization of OsDAF1 via direct protein interaction, suggesting that OsINP1 has an additional role in the formation of annulus that is absent in Arabidopsis. Our study reveals the importance of the aperture for rice grain yield and reveals mechanisms controlling pollen aperture development in cereal species.

Tissue engineering has shown a remarkable result in medical applications. Further exploration, these multidisciplinary fields are also given a possibility as an alternative medication for intervertebral disc (IVD) degeneration. Focusing on the annulus fibrous repair, to improve the mechanical properties of biomaterials, a composite made of chitosan and polycaprolactone (PCL) was developed in this present study. Due to its tuneable properties, the electrospinning-based method was used in the experiment to create the chitosan/PCL composite. Varies concentration of PCL (11, 12, and 13 wt%) and a different ratio of precursors chitosan to PCL (1:1; 1:3; 1:5) were used to optimize the composition of natural and synthetic polymer in the composite nanofibers. The obtained nanofibers were then characterized using Scanning Electron Microscopy (SEM) to observe the morphology, swelling test, Fourier Transform Infrared (FTIR) spectroscopy, and Differential Scanning Calorimetry (DSC). The results show that the increasing concentration and composition of PCL could form the more homogeneous and larger diameter of nanofiber with fewer beads compare to the lower composition of PCL nanofiber. Meanwhile, the swelling percentage decreases by increasing the amount of PCL. FTIR results also show that all samples of composite nanofibers contain both chitosan and PCL.

This paper deals with the bioconvection of microploar fluid in an annulus containing microorganisms in which the outer cylinder is rotating. A mathematical model, with a fully coupled system of partial differential equations presenting the velocity, total mass, momentum, thermal energy, mass diffusion, and motile microorganisms is presented. A suitable transformations is adopted to reduce the governing non-linear governing to a set of non-linear ordinary differential equations and then linearized by means of successive linearization method. The resulign linearized equaions are solved using Chebyshev collocation method. The illustrating analysis of influences of the various flow governing physical parameters such as the micropolar coupling number, the bioconvection Schmidt-number, Prandtl number, Lewis number and bioconvection Peclet-number and Reynolds number on motile microorganism distribution are studied and is presented. Also, the density number of motile microorganism is examined for various governing parameters along with slip parameter of motile microorganism.

Current tissue engineering strategies through scaffold-based approaches fail to recapitulate the complex three-dimensional microarchitecture and biochemical composition of the native Annulus Fibrosus tissue. Considering limited access to healthy annulus fibrosus cells from patients, this study explored the potential of bone marrow stromal cells (BMSC) to fabricate a scaffold-free multilamellar annulus fibrosus-like tissue by integrating micropatterning technologies into multi-layered BMSC engineering. BMSC sheet with cells and collagen fibres aligned at ~30° with respect to their longitudinal dimension were developed on a microgroove-patterned PDMS substrate. Two sheets were then stacked together in alternating directions to form an angle-ply bilayer tissue, which was rolled up, sliced to form a multi-lamellar angle-ply tissue and cultured in a customized medium. The development of the annulus fibrosus-like tissue was further characterized by histological, gene expression and microscopic and mechanical analysis. We demonstrated that the engineered annulus fibrosus-like tissue with aligned BMSC sheet showed parallel collagen fibrils, biochemical composition and microstructures that resemble the native disk. Furthermore, aligned cell sheet showed enhanced expression of annulus fibrosus associated extracellular matrix markers and higher mechanical strength than that of the non-aligned cell sheet. The present study provides a new strategy in annulus fibrosus tissue engineering methodology to develop a scaffold-free annulus fibrosus-like tissue that resembles the microarchitecture and biochemical attributes of a native tissue. This can potentially lead to a promising avenue for advancing BMSC-mediated annulus fibrosus regeneration towards future clinical applications.

OBJECTIVES: Degenerative mitral regurgitation (DMR) is classified into different phenotypes based on the extent of leaflet degeneration. Our aim is to demonstrate that phenotype complexity predicts the extent of structural abnormalities of mitral annulus (MA). METHODS AND RESULTS: Seventy-five patients with DMR and severe valve regurgitation and 23 patients with normal mitral valve were studied using 3D transesophageal echocardiography. Classification of DMR was done by allocating each 3D echocardiography result under five categories: fibroelastic deficiency (FED), FED+, forme fruste, Barlow's disease Mitral annular disjunction (BD MAD)- or BD MAD+. MA was reconstructed in early systole and in end systole. We tested for a trend toward enlargement and flattening of MA in end systole and for a difference in MA dynamics from early systole to end systole with a worsening of DMR phenotype, in the whole spectrum of subjects ranging from controls to BD MAD+. A significant trend was observed toward larger anteroposterior diameter, intercommissural diameter, annulus circumference, and annulus area (P

At our institution, we actively perform aortic valve neocuspidization (AVNeo) for aortic valve stenosis (AS) with a small annulus. In this report, we aimed to evaluate the midterm outcome of AVNeo for AS with a small annulus. From February 2011 to May 2017, we performed AVNeo for AS with a small annulus in 34 patients. Their mean age was 77.0 ± 9.1 years. Preoperative transthoracic echocardiography (TTE) revealed a mean peak pressure gradient average of 84.2 ± 31.1 mmHg. The effective orifice area index (EOAi) was 0.45 ± 0.14 cm2/m2. The mean annulus diameter was 18.4 ± 1.1 mm. Our procedure complies with the three cuspid suturing to the aortic annulus with glutaraldehyde-treated autologous pericardium. There were no conversion to aortic valve replacement and no concomitant annulus enlargement. There were two inhospital mortalities resulting from a noncardiac cause. Three patients underwent reoperation owing to aortic regurgitation (n = 2) and infective endocarditis (n = 1). One patient underwent a pacemaker implantation for complete atrioventricular block. The mean follow-up period was 28.0 ± 22.7 months. Postoperative TTE showed a mean peak pressure gradient average of 18.3 ± 9.4 mmHg and a calculated mean EOAi of 1.18 ± 0.35 cm2/m2. The freedom from reoperation rates were 94.1% and 90.8% at 1 year and 5 years of follow-up, respectively. The overall survival rates were 91.2% and 76.8% at 1 and 5 years of follow-up, respectively. The midterm outcome of AVNeo for AS with a small annulus was excellent. The long-term outcome and reliability of this procedure must be fully clarified.

Golden Shiner Notemigonus crysoleucas is found in many lakes and ponds across the southeastern United States. Though it is a common species, otolith age validation methods have not been published. The objective of this study was to confirm annulus formation in lapillar otoliths of Golden Shiners collected monthly from September 2015 through August 2016 in Lake Jackson, Florida (Leon County). We collected at least 12 individuals each month of similar length (168–249 mm; presumably of the same cohort) to document annulus formation throughout the year. We sacrificed a total of 177 individuals from the 2013 year class, and we used their lapillar otoliths for marginal incremental analysis to calculate an index of completion and validate annulus formation. The monthly index of completion was highest from January through March and lowest in May and June, indicating that annuli were deposited once per year and confirming that lapillar otoliths are a valid age estimation structure for Golden Shiners.

Low back pain (LBP) is a chronic condition that can affect up to 80% of the global population. It is the number one cause of disability worldwide and has enormous socioeconomic consequences. One of the main causes of this condition is intervertebral disc (IVD) degeneration. IVD degenerative processes and inflammation associated with it has been the subject of many studies in both tissue and cell level. It is believed that the phenotype of the resident cells within the IVD directly affects homeostasis of the tissue. At the same time, IVDs located between vertebral bodies of spine are under various mechanical loading conditions in vivo. Therefore, investigating how mechanical loading can affect the behaviour of IVD cells has been a subject of many research articles. In this review paper, following a brief explanation of the anatomy of the IVD and its resident cells, we compiled mechanobiological studies of IVD cells (specifically, annulus fibrosus and nucleus pulposus cells) and synthesized and discussed the key findings of the field.

Background: This disease of heart is named after Fallot who correlated the pathologic and clinical manifestations of this cardiac malformation in his description of L'anatomie pathologique de la maladie bleu by 1888. He was the first to appreciate the complex of this cardiac malformation which he coined a “Tetralogy” consisting of pulmonary stenosis, Ventricular Septal Defect (VSD), dextroposition of the aorta, and RV hypertrophy. Aim of Study: To collect, review and analyze the data of Fallot patient undergoing total repair and to compare the early outcome of Fallot repair with preservation of the annulus versus transannular patch. Patients and Methods: This is a retrospective analysis which conducted at the Cardiothoracic Surgery at Ain Shams University Hospital from the first of January 2014 till the end of December 2016. Results: The majority of patients with TOF have a bicuspid or tricuspid PV, which is the most favorable surgical anatomy for preserving the PV, independent of the presence or degree of leaflet dysplasia. We believe that the preservation of the PV annulus and PV function during early repair of TOF, by combining intraoperative PV dilation and additional surgical procedures, can be extended to the majority of patients with classic TOF. The recent introduction of more-complex PV plasty techniques allowed us to further extend the applicability of PV-preservation techniques. Conclusion: The optimal repair technique would be there-fore, dictated to the anatomical substrate of the lesion, the patient's age, prevailing surgical practice and other patient preoperative characteristics which all should be taken into relevance in an effort to improve patient outcomes.

For next generation tissue-engineered constructs and regenerative medicine to succeed clinically, the basic biology and extracellular matrix composition of tissues that these repair techniques seek to restore have to be fully determined. Using the latest reagents coupled with tried and tested methodologies, we continue to uncover previously undetected structural proteins in mature intervertebral disc. In this study we show that the “embryonic” type IIA procollagen isoform (containing a cysteine-rich amino propeptide) was biochemically detectable in the annulus fibrosus of both calf and mature steer intervertebral discs, but not in the nucleus pulposus where the type IIB isoform was predominantly localized. Specifically, the triple-helical type IIA procollagen isoform immunolocalized in the outer margins of the inner annulus fibrosus. Triple helical processed type II collagen exclusively localized within the interlamellae regions and with type IIA procollagen in the intra-lamellae regions. Mass spectrometry of the α1 (II) collagen chains from the region where type IIA procollagen localized showed high 3-hydroxylation of Proline-944, a post-translational modification that is correlated with thin collagen fibrils as in the nucleus pulposus. The findings implicate small diameter fibrils of type IIA procollagen in select regions of the annulus fibrosus where it likely contributes to the organization of collagen bundles and structural properties within the type I-type II collagen transition zone.

Wells plug & abandonment was carried out in a deepwater field (Field C) offshore West Africa. There were 15 deepwater subsea wells, in this field. Thirteen of the wells were completed with Open Water Vertical Xmas Tree (OXT) while remaining two were completed with Enhanced Vertical Xmas Tree (EVXT). All the wells were permanently abandoned with permanent barriers established in accordance to Norsok D-010, rev. 2013. This involved establishing well barriers which would both horizontally and vertically effective. The operator evaluated several methods in establishing well barriers for the permanent abandonment purpose of these 15 wells. The barriers placement for areas with good annulus cement were straightforward as an internal cement plug could be spotted as a permanent barrier. For this particular field, it is noted that all of the 15 wells have hydrocarbon bearing and permeable formations above the top of expected annulus lead cement which is designed basically to manage ECD during cementing job rather than giving good annular isolation. Due to this, it is important for the operator to employ the best technique that could establish a permanent cement barrier both inside the casing and in the annulus at the same time. Operator learned that Section Milling was the widely accepted method to establish barrier in cases where there is poor cement or the annulus cement is not present particularly in land and offshore wells. However, this technique poses severe operational risk especially in a deepwater operation mode. Upon review, it was determined that Perforate, Wash and Cement (PWC) technology has been proven and it would become a valuable technique in establishing well barrier which complies with abandonment requirement as per the industry guidelines. High risk activities for deepwater operations such as section milling could be avoided by employing this method. Nonetheless, the Perforate, Wash and Cement (PWC) technology has its own set of risks especially with its method of establishing the well barrier immediately upon setting it. This involves drilling and re-logging the well immediately after setting the cement in annulus to prove the barrier. Upon discussion with PWC contractor, it was agreed that the verification technique may create additional hazards as it could jeopardize the integrity of the installed barrier in the annulus. The additional requirement for cement verification process will also prolong the project duration, hence is an additional cost to the project too. Operator worked together with the Perforate Wash and Cement (PWC) Contractor and Well Examiner to determine the best verification method for PWC plugs with the objective to comply with regulation on cement verification while at the same time, resulting in most cost-efficient and time-efficient operation. The establishment of Element Acceptance Criteria as an alternative Barrier Verification Process for PWC technology is necessary to improve the reliability of the system as well as reducing associated risks. In total, 18 PWC operations were successfully carried out throughout the campaign. An extensive after action review was conducted at the completion of each job to capture the valuable lessons learnt. These lessons learnt are shared in this paper as well which could add value for future operations with similar settings. It is expected that this paper will serve as a reference in the establishment of Element Acceptance Criteria as well as its implementation during the P&A campaign. It is hoped that the lessons learnt shared in the paper could assist other Operators on planning for similar campaigns in the future.