A Case Report-Endoscopic Treatments of 47 Incomplete Pancreatic Divisum (IPD) Cases in our Hospital – Special Emphasis on our New Procedures: Rendezvous Pre-Cut Method and Reverse Balloon Dilation Method

We have treated 47 cases of incomplete pancreatic divisum (IPD) in theses 7 years. They were classified by the modified“Hirooka’s classification”— stenotic fusion type I / II, ansa pancreatica type, branch fusion type I / II / III, and one was unclassified. 36 cases were treated by ESWL and/or endoscopy. In difficult cases, we performed our new endoscopic procedures-rendezvous precut method and reverse balloon dilation method, with good results. The therapeutic success rate of IPD via major papilla was 100% (10/10) and via minor papilla 96% (24/25) without severe complications. After endoscopic treatment, the prognosis was good in 32, fair in 3 and one had an operation. In calcified IPD cases, endoscopic treatments were performed many times by stone and pain relapse, and EPS is still placed in 24 cases.

Characterization of a Novel Family IV Esterase Containing a Predicted CzcO Domain and a Family V Esterase with Broad Substrate Specificity from an Oil-Polluted Mud Flat Metagenomic Library

Two novel esterase genes, est2L and est4L, were identified from a previously constructed metagenomic library derived from an oil-polluted mud flat sample. The encoded Est2L and Est4L were composed of 839 and 267 amino acids, respectively, without signal peptides. Est2L was a unique fusion type of protein composed of two domains: a domain of the CzcO superfamily, associated with a cationic diffusion promoter with CzcD, and a domain of the acetylesterase superfamily, belonging to family IV with conserved motifs, such as HGG, GXSAG, and GXPP. Est2L was the first fused esterase with a CzcO domain. Est4L belonged to family V with GXS, GXSMGG, and PTL motifs. Native Est2L and Est4L were found to be in dimeric and tetrameric forms, respectively. Est2L and Est4L showed the highest activities at 60 °C and 50 °C, respectively, and at a pH of 10.0. Est2L preferred short length substrates, especially p-nitrophenyl (pNP)-acetate, with moderate butyrylcholinesterase activity, whereas Est4L showed the highest activity with pNP-decanoate and had broad specificity. Significant effects were not observed in Est2L from Co2+ and Zn2+, although Est2L contains the domain CzcD. Est2L and Est4L showed high stabilities in 30% methanol and 1% Triton X-100. These enzymes could be used for a variety of applications, such as detergent and mining processing under alkaline conditions.

Transcriptome Analysis Reveals MFGE8-HAPLN3 Fusion as a Novel Biomarker in Triple-Negative Breast Cancer

BackgroundTriple-negative breast cancer (TNBC) is a highly aggressive cancer with poor prognosis. The lack of effective targeted therapies for TNBC remains a profound clinical challenge. Fusion transcripts play critical roles in carcinogenesis and serve as valuable diagnostic and therapeutic targets in cancer. The present study aimed to identify novel fusion transcripts in TNBC.MethodsWe analyzed the RNA sequencing data of 360 TNBC samples to identify and filter fusion candidates through SOAPfuse and ChimeraScan analysis. The characteristics, including recurrence, fusion type, chromosomal localization, TNBC subgroup distribution, and clinicopathological correlations, were analyzed in all candidates. Furthermore, we selected the promising fusion transcript and predicted its fusion type and protein coding capacity.ResultsUsing the RNA sequencing data, we identified 189 fusion transcripts in TNBC, among which 22 were recurrent fusions. Compared to para-tumor tissues, TNBC tumor tissues accumulated more fusion events, especially in high-grade tumors. Interestingly, these events were enriched at specific chromosomal loci, and the distribution pattern varied in different TNBC subtypes. The vast majority of fusion partners were discovered on chromosomes 1p, 11q, 19p, and 19q. Besides, fusion events mainly clustered on chromosome 11 in the immunomodulatory subtype and chromosome 19 in the luminal androgen receptor subtype of TNBC. Considering the tumor specificity and frameshift mutation, we selected MFGE8-HAPLN3 as a novel biomarker and further validated it in TNBC samples using PCR and Sanger sequencing. Further, we successfully identified three types of MFGE8-HAPLN3 (E6-E2, E5-E3, and E6-E3) and predicted the ORF of E6-E2, which could encode a protein of 712 amino acids, suggesting its critical role in TNBC.ConclusionsImproved bioinformatic stratification and comprehensive analysis identified the fusion transcript MFGE8-HAPLN3 as a novel biomarker with promising clinical application in the future.

Drivers of Cost in Primary Single-Level Lumbar Fusion Surgery

Study Design: Retrospective cohort. Objectives: Allocating cost is challenging with traditional hospital accounting. Time-driven activity-based costing (TDABC) is an efficient method to accurately assign cost. We sought to characterize the variation in direct total hospital cost (THC) among both lumbar fusion approaches and surgeons. Methods: Patients were treated with single-level anterior interbody (ALIF), lateral interbody (LLIF), transforaminal interbody (TLIF), instrumented posterolateral (PLF) or in-situ fusion (ISF) for degenerative disease. Process maps were developed for preoperative, intraoperative and postoperative care. THC was composed of implant, medication, other supply, and personnel costs. Linear regression and descriptive statistics were used to analyze THC variation. Results: A total of 696 patients underwent surgery by 8 surgeons. Approximately 50% of THC variation was associated with procedure choice while patient characteristics explained 10%. Implants (including biologics) accounted for 45% of cost. With reference to PLF, THC ranged from 0.6x (ISF) to 1.7x (LLIF). Implant cost ranged from 2.5x reference (LLIF) to 0.1x (ISF). There was a 1.7x difference between the highest THC surgeon and the lowest. The fusion type with the highest THC variation was TLIF. The surgeon with the highest TLIF THC was 1.5x more expensive than the surgeon with the lowest. Conclusions: Surgeon-based choices have the greatest effect on THC variation and represent the largest opportunities for cost savings. Primary single-level lumbar fusion THC is driven primarily by fusion type. Implants, including biologics, account for nearly half this cost. Future work should incorporate outcomes data to characterize the differential value conferred by higher THC fusions.

Seismic Design and Performance Evaluation of Fusion-Type Polyethylene Pipeline

It is known that buried polyethylene (PE) pipes exhibit good seismic performance owing to their flexibility and ductility. The use of PE pipes as buried pipelines is gradually increasing, but currently, there are no seismic design or seismic performance evaluation procedures for domestic PE pipes in Korea. In this study, a seismic design and performance evaluation procedure for a domestic fusion-type PE pipe was developed based on the response displacement method, which is relatively easy to apply. The procedure was based on a method of examining whether the sum of the axial strain induced by both normal and seismic loading was within the allowable strain of the PE pipe. While calculating the axial strain of the ground, a coefficient was introduced to account for the heterogeneity of the ground. A seismic review method for ground deformation, i.e., ground liquefaction, was also introduced. The proposed procedure will provide a useful technical basis for evaluating the seismic design and performance of buried PE pipes in future studies.

Microautophagy – distinct molecular mechanisms handle cargoes of many sizes

ABSTRACTAutophagy is fundamental for cell and organismal health. Two types of autophagy are conserved in eukaryotes: macroautophagy and microautophagy. During macroautophagy, autophagosomes deliver cytoplasmic constituents to endosomes or lysosomes, whereas during microautophagy lytic organelles take up cytoplasm directly. While macroautophagy has been investigated extensively, microautophagy has received much less attention. Nonetheless, it has become clear that microautophagy has a broad range of functions in biosynthetic transport, metabolic adaptation, organelle remodeling and quality control. This Review discusses the selective and non-selective microautophagic processes known in yeast, plants and animals. Based on the molecular mechanisms for the uptake of microautophagic cargo into lytic organelles, I propose to distinguish between fission-type microautophagy, which depends on ESCRT proteins, and fusion-type microautophagy, which requires the core autophagy machinery and SNARE proteins. Many questions remain to be explored, but the functional versatility and mechanistic diversity of microautophagy are beginning to emerge.

Development of a Real-Time Tillage Depth Measurement System for Agricultural Tractors: Application to the Effect Analysis of Tillage Depth on Draft Force during Plow Tillage

The objectives of this study were to develop a real-time tillage depth measurement system for agricultural tractor performance analysis and then to validate these configured systems through soil non-penetration tests and field experiment during plow tillage. The real-time tillage depth measurement system was developed by using a sensor fusion method, consisting of a linear potentiometer, inclinometer, and optical distance sensor to measure the vertical penetration depth of the attached implement. In addition, a draft force measurement system was developed using six-component load cells, and an accuracy of 98.9% was verified through a static load test. As a result of the soil non-penetration tests, it was confirmed that sensor fusion type A, consisting of a linear potentiometer and inclinometer, was 6.34–11.76% more accurate than sensor fusion type B, consisting of an optical distance sensor and inclinometer. Therefore, sensor fusion type A was used during field testing as it was found to be more suitable for use in severe working environments. To verify the accuracy of the real-time tillage depth measurement system, a linear regression analysis was performed between the measured draft and the predicted values calculated using the American Society of Agricultural and Biological Engineers (ASABE) standards-based equation. Experimental data such as traveling speed and draft force showed that it was significantly affected by tillage depth, and the coefficient of determination value at M3–Low was 0.847, which is relatively higher than M3–High. In addition, the regression analysis of the integrated data showed an R-square value of 0.715, which is an improvement compared to the accuracy of the ASABE standard prediction formula. In conclusion, the effect of tillage depth on draft force of agricultural tractors during plow tillage was analyzed by the simultaneous operation of the proposed real-time tillage depth measurement system and draft force measurement system. In addition, system accuracy is higher than the predicted accuracy of ± 40% based on the ASABE standard equation, which is considered to be useful for various agricultural machinery research fields. In future studies, real-time tillage depth measurement systems can be used in tractor power train design and to ensure component reliability, in accordance with agricultural working conditions, by predicting draft force and axle loads depending on the tillage depth during tillage operations.

Assessing the Impact of Neurogenic Claudication on Outcomes Following Decompression With Lumbar Interbody Fusions in Patients With Lumbar Spinal Stenosis

Study Design: Retrospective cohort study. Objectives: To conduct the first comprehensive national-level study examining specific risks, outcomes, and costs surrounding surgical treatment of lumar spinal stenosis (LSS) in patients with and without neurogenic claudication (NC). Methods: Data for patients with or without NC who underwent decompression with a lumbar interbody fusion approached anteriorly (ALIF), posteriorly (PLIF), or laterally (LLIF) for LSS was collected from the 2013-2014 National Inpatient Sample using International Classification of Disease codes. Results: A total of 121 025 LSS cases without NC and 20 095 cases with NC were included in this study. The most significant complications associated with NC status by organ system included renal ( P = .0030) and hematological complications ( P = .0003). Multivariate regression controlling for key demographic and comorbidity variables showed that patients with NC did not have significantly higher odds of complication, non-home discharge, or extended hospitalization compared to patients without NC regardless of fusion type. Interestingly, NC patients had comparatively lower total charges for their hospitalization following PLIFs ( P = .0001) and LLIFs ( P < .0001), but not ALIFs ( P = .6121). Conclusion: NC does not appear to significantly increase odds of adverse outcomes following fusion in LSS. Given the large prevalence of LSS and coincidental NC, these findings may carry important implications in managing this challenging patient population and justifies future prospective investigation of this topic.

P761 Clinical manifestation of bicuspid aortic valve in single center registry

INTRODUCTION Bicuspid aortic valve (BAV) is a congenital cardiac defect which may contribute to aortic stenosis (AS) and regurgitation (AR), aortopathy, endocarditis or in some group of patients remains without echocardiographic deviations. Prognosis of BAV population is hardly predictable. Nevertheless, the population of BAV requires regular medical control. PURPOSE The aim of our study was to assess the BAV appearance and characteristics in the Single Center Registry. METHODS All patients with recognition of BAV admitted to First Department of Cardiology at Medical University of Gdansk in years 2012-2018 were enrolled to analysis. Echocardiographic data were collected. Anthropometrics and comorbidities were recorded. Patents were categorized depending on BAV phenotype: coronary cusps fusion (Type 1), right-noncoronary cusps fusion (Type 2), left-noncornary cusps fusion (Type 3) and BAV without raphe (True Type). RESULTS 323 (25,7% female) patients were enrolled into the Registry. Average age of studied group was 55 ± 16.0. 190 (58.8%) patients were characterized by Type 1 BAV, 75 (23.2%) by Type 2 and 8 (2.4%) by Type 3. There were only 3 patients with True Type. In 14.5% of patients we were unable to clearly identify BAV phenotype. For the further analysis there were included Type 1 and Type 2 groups due to low prevalence of other types. Patients with Type 2 were slightly younger (51.3 ± 16.2 years vs 57.5 ± 13.4 years in Type 1 group; p &lt; 0.01). The aortopathy appeared in 221 patients (68.4% of studied group). Type 1 was associated with larger diameter of aortic root comparing with Type 2 (40.7 ± 6.0 mm vs 38.7 ± 10.6 mm, respectively; p &lt; 0.001), without significant difference in ascending aorta diameter (42.3 ± 7.1 mm in Type 1 and 40.9 ± 6.7 mm in Type 2; p = 0.19). In contrary, Type 2 was correlating with the higher prevalence of severe AR (16% vs 5.7% in Type 1; p &lt; 0.01). Prevalence of AS was similar in both groups (48.4% in Type 1 and 37.85 in Type 2; p = 0.1). In the subgroup with severe AS (75 patients), there was no significant differences in the hemodynamic profile of AS between Type 1 and Type 2 group (respectively; peak transvalvular velocity- 4.5 ± 0.5 m/s2 vs 4.3 ± 0.6 m/s2, p = 0.2; mean transvalvular pressure- 54.2 ± 13.6 mmHg vs 46.6 ± 13.8 mmHg, p = 0.08; aortic valve area- 0.7 ± 0.1 cm2 vs 0.8 ± 0.1 cm2, p = 0.5). 4.3% of studied group were hospitalized due to endocarditis. Average age in that subgroup was 42.3 ± 12.0 years. There was no correlation between BAV phenotype and endocarditis prevalence. CONCLUSION Despite higher prevalence of severe AR in patients with Type 2 BAV, Type 1 is more predisposing to aortic root abnormalities. That discrepancy may confirm complex pathophysiology of BAV complications. Prevalence of AS and hemodynamic profile of severe AS does not present correlation with the type of BAV phenotype.