Variety of transversus thoracis muscle in relation to the internal thoracic artery: an autopsy study of 120 subjects

<p>Abstract</p> <p>Background</p> <p>The transversus thoracis muscle is a thin muscular layer on the inner surface of the anterior thoracic wall that is always in concern during harvesting of the internal thoracic artery. Because the muscle is poorly described in the surgical literature, the aim of the present study is to examine in details its variations.</p> <p>Methods</p> <p>The data was obtained at standard autopsies of 120 Caucasian subjects (Bulgarians) of both sexes (97 males and 23 females), ranging in age from 18 to 91 years (mean age 52.8 ± 17.8 years). The transversus thoracis morphology was thoroughly examined on the inner surface of the chest plates collected after routine incisions.</p> <p>Results</p> <p>An overall examination revealed that in majority of cases the transversus thoracis slips formed a complete muscular layer (left - 75.8%, right - 83.3%) or some of the slips (left - 22.5%, right - 15%) or all of them (left - 1.7%, right - 1.7%) were quite separated. Rarely (left - 3.3%, right - 5.8%), some fibrous slips of the transversus thoracis were noted. In 55.8% of the cases there was left/right muscle symmetry; 44.2% of the muscles were asymmetrical. Most commonly, the highest muscle attachment was to the second (left - 53.3%, right - 37.5%) or third rib (left - 29.2%, right - 46.7%). The sixth rib was the most common lowest attachment (left - 94.2%, right - 89.2%). Most frequently, the muscle was composed of four (left - 31.7%, right - 44.2%) or fifth slips (left - 53.3%, right - 40.8%).</p> <p>Conclusions</p> <p>This study provides detailed basic information on the variety of the transversus thoracic muscle. It also defines the range of the clearly visible, uncovered by the muscle part of the internal thoracic artery and the completeness of the muscular layer over it. The knowledge of these peculiar muscle-arterial relations would definitely be beneficial to cardiac surgeon in performing fast and safe arterial harvesting.</p

Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories

BACKGROUND & AIMS: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS: We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS: There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into

Chronic Obstructive Pulmonary Disease and Hepatitis C

Chronic obstructive pulmonary disease (COPD) is a preventable, treatable disease with significant extrapulmonary manifestations that could affect negatively its course in some patients. Hepatitis C virus infection (HCV), on the other hand, is associated with a number of extrahepatic manifestations. COPD patients have increased prevalence of HCV and patients with HCV, especially older ones, have increased prevalence and faster progression of COPD. HCV infection exerts long-term effects on lung tissue and is an additional risk factor for the development of COPD. The presence of HCV is associated with an accelerated loss of lung function in COPD patients, especially in current smokers. COPD could represent extrahepatic manifestation associated with HCV infection. The aim of this article was to review the literature on prevalence of HCV in COPD and vice versa, pathogenetic link and the consequences of their mutual existence

A comparative quantitative analysis of postnatal changes in cardiomyocites in normotensive and spontaneously hypertensive rats

Differences between the size of cardiomyocytes from normotensive and hypertensive hearts have been studied by a small number of authors and have been limited to measurements of the cellular diameter, length and cross-sec­tional area. The aim of the present study was to analyse a broader range of morphometric markers in order to as­sess the size of the cardiac muscle cells and to compare the obtained data between normotensive Wistar rats and spontaneously hypertensive rats. Results were obtained by studying the hearts of 15 male normotensive Wistar rats, distributed in five age groups: 2 weeks old, 1, 3, 6, and 12 months old, each group containing three animals, as well as 6 spontaneously hypertensive rats, distributed in two age groups: 1 month old (young) and 6 months old (adult), each group containing three animals. With the advance in age, the thickness of the free wall of the ven­tricles and the cross-sectional area of cardiomyocytes from both ventricles increased, as did the cross-section­al area of cardiomyocytic nuclei. Conversely, a decrease in the cardiomyocytic density was noted. These chang­es were more pronounced in the left ventricle of both normotensive and spontaneously hypertensive rats but oc­curred at an earlier age and were better expressed in the group of spontaneously hypertensive rats. The morpho­metric markers analysed in the present study represent a statistically significant assessment, which illustrates the differences between hypertrophy and remodelling of the myocardium induced by advancing age under normo­tensive conditions and those initiated by arterial hypertension

A Comparative Quantitative Analysis of the Postnatal Changes in the Myocardium of the Left and Right Ventricles in Rats

Background: The growth of the heart during the foetal and early postnatal development takes places mainly due to hyperplasia. The late postnatal development is characterised by cardiomyocytic hypertrophy in response to normal physiological mechanisms and increased load. To study the cell size most authors measure the diameter either directly or indirectly