The heart is a very complex conglomeration of organized interactions between various different cell types that all aid in facilitating myocardial function through contractility, sufficient perfusion, and cell-to-cell reception. In order to make sure all features of the heart work effectively, it is imperative to have a well-controlled communication system among the different types of cells. One of the most important ways the heart regulates itself is by the use of extracellular vesicles, more specifically, exosomes. Exosomes are types of nano-vesicles, naturally released from living cells. They are believed to play a critical role in intercellular communication through the means of certain mechanisms including direct cell-to-cell contact, long-range signals as well as electrical and extracellular chemical molecules. Exosomes contain many unique features like surface proteins/receptors, lipids, mRNAs, microRNAs, transcription factors and other proteins. Recent studies indicate that the exosomal contents are highly regulated by various stress and disease conditions, in turn reflective of the parent cell status. At present, exosomes are well appreciated to be involved in the process of tumor and infection disease. However, the research on cardiac exosomes is just emerging. In this review, we summarize recent findings on the pathologic effects of exosomes on cardiac remodeling under stress and disease conditions, including cardiac hypertrophy, peripartum cardiomyopathy, diabetic cardiomyopathy and sepsis-induced cardiovascular dysfunction. In addition, the cardio-protective effects of stress-preconditioned exosomes and stem cell-derived exosomes are also summarized. Finally, we discuss how to epigenetically reprogram exosome contents in host cells which makes them beneficial for the heart.
IntroductionUltrasound is a rapidly expanding imaging modality that many medical schools are incorporating into a structured curriculum. Learning both anatomy and ultrasound imaging simultaneously is intuitively challenging. This double-blinded, randomized control study examined the effect of utilizing threedimensional (3d) cardiac models within an ultrasound video tutorial in order to achieve improved cardiac ultrasound anatomy education.
MethodsThirty-nine (39) first-and second-year medical students at a single medical school voluntarily participated. The control group watched a video tutorial on cardiac ultrasound anatomy while the experimental group watched a similar video tutorial that also included a 3d cardiac model. The effect was measured with a multiple-choice test that included a sub-analysis of ultrasound principles. The test was unique in that no text or context clues were provided on the reference images, further challenging anatomic identification.
ResultsThe findings of the study included a p-value of 0.73 for the ultrasound principles section and a p-value of 0.77 for the cardiac anatomy. There was no statistical difference in the primary outcome or in the subgroup analysis. Post-hoc analysis demonstrated the study was underpowered.
ConclusionsThis study is the first of its kind to utilize an innovative testing method that holds promise for future research in regards to utilizing 3d models with ultrasound education. The study was underpowered, therefore no definitive conclusions about the utility of 3d cardiac models in the educational process can be ascertained.
This case report discusses a diagnosis of arteria lusoria in a man with a history of transthyretin cardiac amyloidosis who presented for evaluation of dysphagia and transcatheter aortic valve replacement.
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