Confirmation of the stereochemistry of spiroviolene

We confirm the previously revised stereochemistry of spiroviolene by X-ray crystallographically characterizing a hydrazone derivative of 9-oxospiroviolane, which is synthesized by hydroboration/oxidation of spiroviolene followed by oxidation of the resultant hydroxy group. An unexpected thermal boron migration occurred during the hydroboration process of spiroviolene that resulted in the production of a mixture of 1α-hydroxyspiroviolane, 9α- and 9β-hydroxyspiroviolane after oxidation. The assertion of the cis-orientation of the 19- and 20-methyl groups provided further support for the revised cyclization mechanism of spiroviolene.

Enantioselective Synthesis of the 1,3-Dienyl-5-Alkyl-6-Oxy Motif: Method Development and Total Synthesis

The 1,3-dienyl-5-alkyl-6-oxy motif is widely found in various types of bioactive natural products. However, present synthesis is mainly non-asymmetric which relied upon different olefination or transition metal-catalyzed cross-coupling reactions using enantioenriched precursors. Herein, based upon a newly developed enantioselective α-alkylation of conjugated polyenoic acids, a variety of 1,3-dienyl-5-alkyl-6-oxy motif (with E-configured internal olefin) was generated as the corresponding α-adducts in a highly enantioselective and diastereoselective manner. Utilizing 1,3-dienyl-5-alkyl-6-oxy motif as key intermediates, we further demonstrated their synthetic potential by expedient total syntheses of three types of natural products (glutarimide antibiotics, α-pyrone polyketides and Lupin alkaloids) within 4-7 steps.

Enantioselective Divergent Syntheses of Diterpenoid Pyrones

Capitalizing a synergy between late-stage C(sp3)-H alkynylation and a series of transition metal-catalyzed alkyne functionalization reactions, we reported herein enantioselective divergent synthesis of 10 diterpenoid pyrones within 14-16 steps starting from chiral pool enoxolone, including the first enantioselective synthesis of higginsianins A, B, D, E, and metarhizin C. Our synthesis also highlights an unprecedented biomimetic oxidative rearrangement of α-pyrone into 3(2H)-furanone, as well as applications of Echavarren C(sp3)-H alkynylation reaction and Toste chiral counterion-mediated Au-catalyzed intramolecular allene hydroalkoxylation in natural product synthesis.

Evidence for Chiral Wobbler in Nuclei

Three ΔI=1 bands with the πg_{9/2}⊗νg_{9/2} configuration have been identified in _{35}^{74}Br_{39}. Angular distribution, linear polarization, and lifetime measurements were performed to determine the multipolarity, type, mixing ratio, and absolute transition probability of the transitions. By comparing these experimental observations with the corresponding fingerprints and the quantum particle rotor model calculations, the second and third lowest bands are, respectively, suggested as the chiral partner and one-phonon wobbling excitation built on the yrast band. The evidence indicates the first chiral wobbler in nuclei.

Prognostic Significance of Serum Lipids in Patients with Non-Small Cell Lung Cancer Treated with Radiotherapy: A Multicenter Prospective Study

PURPOSE/OBJECTIVE(S)

Although lipids have been assessed for their possible roles in cancer survival prediction, studies on the association between serum lipids levels and the prognosis of non-small cell lung cancer (NSCLC) patients are limited. This study aimed to evaluate whether serum lipids are associated with outcomes in patients with NSCLC treated with radiotherapy.

MATERIALS/METHODS

We conducted a multicenter prospective study on patients diagnosed with NSCLC between January 2018 and February 2021. Participants received thoracic radiotherapy of 60ཞ80 Gy to the primary lung tumor and positive lymph node metastases. We measured patients' serum lipids levels (serum triglyceride, TGs; total cholesterol, TC, high density lipoprotein cholesterol, HDL-C; low density lipoprotein cholesterol, LDL-C) before radiotherapy. The association between serum lipids levels and overall survival (OS) was evaluated using hazard ratios. We sought to determine a threshold point using optimal stratification. Survival analysis was performed using Kaplan-Meier curves.

RESULTS

Of the 300 participants diagnosed with NSCLC treated with radiotherapy, 165 (55.0%) were men. Median follow-up time was 24.4 months (range 1.0- 101.9 months). Using univariate and multivariate Cox proportional hazard analysis, among those serum lipids, only serum TG was shown to be independent prognostic factors for OS (hazard ratio: 1.203, 95% confidence interval: 1.038 - 1.393, p = 0.014). The cut-off for TG associated with OS was 2.04 mmol/L. Based on the TG cut-off value, 55 NSCLC patients were categorized into the high TG group (>2.04 mmol/L) and 245 in the low TG group (<2.04 mmol/L). The NSCLC patients in the low TG group exhibited higher OS than the high group (median OS, not reach vs 41.4 months, p = 0.025).

CONCLUSION

TG levels were found to be a significant negative prognostic biomarker for OS in NSCLC patients treated with radiotherapy.

Targeted Isolation of Dolabellane Diterpenoids from the Soft Coral Clavularia viridis Using Molecular Networking

LC-MS/MS-based molecular networking annotation coupled ¹H NMR detection allowed the depiction of the soft coral Clavularia viridis to produce a profile of dolabellane-type diterpenoids. Chromatographic separation of the EtOAc fraction resulted in the isolation of 12 undescribed dolabellane-type diterpenoids, namely, clavirolides J-U (1-12). Their structures were characterized by the extensive analysis of the spectroscopic data, including the calculated ECD and X-ray diffraction for the configurational assignments. Clavirolides J-K are characterized by a 1,11- and 5,9-fused tricyclic tetradecane scaffold fused with a α,β-unsaturated-δ-lactone, and clavirolide L possesses a 1,11- and 3,5-fused tricyclic tetradecane scaffold, which extend the dolabellane-type scaffolds. Clavirolides L and G showed significant inhibition against HIV-1 without RT enzyme inhibition, providing additional non-nucleosides with different mechanisms from efavirenz.

MGF360-12L of ASFV-SY18 is an immune-evasion protein that inhibits host type I IFN, NF-κB, and JAK/STAT pathways

African swine fever virus (ASFV) causes feverous and hemorrhagic disease of domestic pigs and European wild boars with high mortality, yet no commercial vaccine is currently available. Several ASFV strains with natural deletion or gene-targeted knockout of multiple MGF360 and MGF505 genes are attenuated in vitro and in vivo, and can offer full protection against homologous challenge. However, the mechanisms underlying the protection are not fully understood. This study aims to investigate the effects of MGF360-12L of ASFV-SY18 on the cGAS-STING signaling pathway and explore the potential mechanisms. We identified that ASFV-SY18 MGF360-12L could inhibit cGAS-STING, TBK1, or IRF3-5D-stimulated IFN-β expression and ISRE activation. Specifically, MGF360-12L inhibits both the activation of PRD(III-I) in a dose-dependent manner, and suppresses the exogenous expression of TBK1 and IRF3-5D. MGF360-12L could block NF-κB activation induced by overexpression of cGAS-STING, TBK1, IKKβ. Downstream of the IFN-β signaling, MGF360-12L blocks the ISRE promoter activation by reducing total protein level of IRF9. Moreover, MGF360-12L protein can inhibit IFN-β-mediated antiviral effects. In conclusion, our findings suggest that MGF360-12L is a multifunctional immune-evasion protein that inhibits both the expression and effect of IFN-β, which could partially explain the attenuation of relevant gene-deleted ASFV strains, and shed light on the development of efficient ASFV live attenuated vaccines in the future.

Effects of Beta-Hydroxy-Beta-Methylbutyrate Supplementation on Older Adults with Sarcopenia: A Randomized, Double-Blind, Placebo-Controlled Study

OBJECTIVES

Sarcopenia is recognized as a major public health concern because of its association with several adverse health events. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation reportedly delays the loss of muscle mass and function; however, the effect of HMB on sarcopenia remains inconclusive. We aimed to evaluate the impact of HMB intervention on muscle strength, physical performance, body compositions, and inflammatory factors in older adults with sarcopenia.

DESIGN

Randomized, double-blind, placebo-controlled trial.

SETTING AND PARTICIPANTS

This study included subjects aged ≥60 years with sarcopenia which were assigned to the HMB group (HMBG, n=18) and the placebo group (PG, n=16).

INTERVENTION

The HMBG and PG were supplied with HMB and placebo products twice daily for 12 weeks, and both received resistance exercise training twice a week in 12 weeks.

MEASUREMENTS

Hand grip strength was selected as the primary outcome; gait speed, five-time chair stand test, body composition and inflammatory indicators were selected as the secondary outcomes. The differences in changes from baseline between the two groups were analyzed using the analysis of covariance(ANCOVA).

RESULTS

After the 12-week intervention, the HMBG demonstrated significantly greater improvements in handgrip strength (4.61(95%CI:2.93,6.28) kg, P<0.001), gait speed (0.11(95%CI:0.02,0.20)m/s, P=0.014), five-time chair stand test (-3.65 (95%CI:-5.72, -1.58)s, P=0.001), muscle quality (2.47(95%CI:1.15,3.80),kg.kg-1 P=0.001) and tumor necrosis factor-like weak inducer of apoptosis (-15.23(95%CI:-29.80,-0.66)pmol/mL, P=0.041) compared with the PG; no significant differences in skeletal muscle mass, skeletal muscle index, and other body composition parameters were found between the two groups.

CONCLUSION

In older adults with sarcopenia, HMB significantly enhance the effect of resistance exercise training on muscle strength, physical performance, muscle quality, and reduced inflammatory factors. Therefore, HMB supplementation could be an effective treatment for sarcorpenia. The trial protocol was registered at http://www.chictr.org.cn/showproj.aspx?proj=47571 as ChiCTR2000028778.

[Differential diagnosis and management of hemangioma at geniculate ganglion]

Objective: To investigate the clinical characteristics, differential diagnosis, treatments and prognosis of facial nerve hemangioma and schwannoma at genicular ganglion, so as to provide reference for clinical diagnosis and treatments of facial nerve tumor at genicular ganglion. Methods: Clinical data of 13 patients with facial nerve tumors at genicular ganglion confirmed by postoperative pathology in the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine from March 2018 to April 2020 were retrospectively analyzed, including seven cases of hemangioma and six cases of schwannoma. There were eight males and five females. Their ages ranged from 20 to 65, with an average age of 40. The course of disease ranged from 3 to 118 months, with an average of 52 months. All the patients underwent preoperative HRCT of the temporal bone and facial nerve dynamic contrast-enhanced(DCE) MRI examinations. All the patients had detailed surgical procedures and at least one-year postoperative follow-up. Results: On HRCT of the temporal bone, (4/7) hemangioma at geniculate ganglion showed characteristic honeycomb appearance, while 6/6 schwannoma and 3/7 hemangiomas showed expansive bone changes. On DCE-MRI, geniculate ganglion hemangioma (7/7) showed characteristic "point-to-surface" enhancement, and schwannoma (6/6) showed characteristic "face-to-surface" enhancement. For five hemangioma-patients with HB-Ⅱ-Ⅳ before surgery, the facial nerve anatomy was completely preserved through transcanal endoscopic approach(TEA), and the facial nerve function improved one year after surgery (two cases of HB-I, two cases of HB-Ⅱ, and one case of HB-Ⅲ). For two patients, with preoperative facial nerve function HB-Ⅴ-Ⅵ, since their tumors was inseparable from the nerves, they were performed with facial nerve anastomosis during the surgery, and the facial nerve function was improved to HB-Ⅳ level one year after surgery. For six patients with meningioma whose facial nerve function was greater than or equal to HB-Ⅲ, based on the preoperative hearing level, the involved segments, and duration of facial paralysis, three of them were conducted surgeries through middle cranial fossa approach, one by translabyrinthine approach, and one via mastoid approach. Two patients among them with complete facial paralysis over three years preoperatively were not performed facial nerve anastomosis after total resections of the tumors, and there was no improvement in facial nerve function one year after surgery. Three patients underwent facial nerve anastomosis after total tumor resections, and their facial nerve function was HB-Ⅲ in one patient, HB-Ⅳ in two patients one year after surgery. One patient (preoperative HB-Ⅲ) had a normal hearing level preoperatively, and the tumor involved the labyrinth segment. To protect the hearing, partial tumor was resected through the middle cranial fossa approach, and facial nerve function improved to HB-Ⅱ one year after surgery. Conclusions: Temporal bone HRCT combined with DCE-MRI are useful for the differential diagnosis of hemangioma and schwannoma at geniculate ganglion and provide references for preoperative clinical decision makings. It is extremely necessary to select the appropriate surgical approach based on the patient's hearing and involved segments. For geniculate ganglion hemangioma, early surgery can improve the possibilities of anatomical integrity of facial nerve, thereby improving facial nerve function postoperatively.TEA is a kind of surgical method worth consideration, with the characteristics of minimally invasive, favorable postoperative features, and so on. For schwannoma, one-stage functional reconstruction of the facial nerve is recommended during the resection of the tumors because of the inevitable damage to the anatomical integrity of the facial nerve.

Hydrogen sulphide regulates the growth of tomato root cells by affecting cell wall biosynthesis under CuO NPs stress

Copper oxide nanoparticles (CuO NPs) show strong nano-toxic effects on organisms. Hydrogen sulphide (H₂ S) plays a pivotal role in plant response to abiotic stress. In this study, we examine the crucial role of the cell wall as regulated by H₂ S in response to CuO NPs stress. The digestion method was employed to determine Cu content using atomic absorption spectrometry. The TraKine pro-tubulin staining kit was used to investigate the microtubule cytoskeleton using confocal laser-scanning microscopy. Cell wall component analysis utilized the ICS-3000 HPLC system. Application of H₂ S reduced growth inhibition caused by CuO NPs. Furthermore, most of the CuO NPs accumulates in roots, indicating a low transfer rate, and H₂ S significantly decreased CuO NPs content in roots, leaves and stems. Subcellular distribution analysis implied most Cu accumulated in root cell walls, and that H₂ S reduced the content of Cu in root cell walls. Cortical microtubules in the plasma membrane, guide cell wall biosynthesis. H₂ S obviously alleviated microtubule cytoskeleton disorders caused by CuO NPs. In addition, the content of cellulose, hemicellulose, pectin and other monosaccharides in root cell walls was reduced by CuO NPs treatment. H₂ S enhanced the monosaccharide and polysaccharide contents compared with that after CuO NPs treatment. In conclusion, H₂ S regulates cell wall development in response to CuO NPs stress by stabilizing microtubules. H₂ S affected Cu distribution and alleviated growth inhibition of tomato seedlings. The research results provide a theoretical basis for further study of nano-toxicity regulation in plants.

Sclerotiamides C-H, Notoamides from a Marine Gorgonian-Derived Fungus with Cytotoxic Activities

Bioassay-guided fractionation in association with LC-MS and NMR detection led to the isolation of six new alkaloids, sclerotiamides C-H (1-6), from the marine gorgonian-derived fungus Aspergillus sclerotiorum LZDX-33-4. Their structures were determined from extensive spectroscopic data, including ECD data and single-crystal X-ray diffraction analysis for configurational assignments. Sclerotiamides C (1) and D (2) are notoamide-type alkaloids with the incorporation of a unique 2,2-diaminopropane unit, and sclerotiamides E (3) and F (4) are unprecedented notoamide hybrids with a new coumarin unit. Sclerotiamide H (6) represents a new highly oxidized notoamide scaffold. Sclerotiamides C and F showed significant inhibition against a panel of tumor cell lines with IC₅₀ values ranging from 1.6 to 7.9 μM. Sclerotiamide C induces apoptosis in HeLa cells by arresting the cell cycle, activating ROS production, and regulating apoptosis-related proteins in the MAPK signaling pathway. The present study extends the scaffold diversity of the notoamides and provides a potential lead for the development of a cytotoxic agent.

Comparison of the Diagnostic Value of SARC-F and Its Three Modified Versions for Screening Sarcopenia in Chinese Community-Dwelling Older Adults

OBJECTIVES

Sarcopenia refers to age-related loss of skeletal muscle mass. SARC-F is a screening tool for sarcopenia with high specificity and relatively good overall diagnostic accuracy but with low sensitivity. This study evaluated the diagnostic utility of SARC-F and its three modified versions (SARC-CalF, SARC-F+AC, and SARC-CalF+AC) for screening sarcopenia in community-dwelling older adults.

DESIGN

Diagnostic accuracy study.

SETTINGS AND PARTICIPANTS

We screened sarcopenia of older adults (age ≥ 60 years) in three communities in 2020. The participants' information and anthropometric measurements were collected, respectively.

METHODS

The updated consensuses of AWGS2019 and the EWGSOP2 were applied as the reference standards. we performed sensitivity/specificity analyses and estimated the areas under the receiver operating characteristic curves (AUCs) of the four scales.

RESULTS

The prevalence of sarcopenia was 26.4% and 12.5% based on the AWGS2019 and EWGSOP2 criteria, respectively. The sensitivities/specificities of SARC-F, SARC-CalF, SARC-F+AC, and SARC-CalF+AC were 12.26%/95.59%, 47.17%/91.53%, 82.08%/68.47%, and 75.47%/83.73%, respectively, using the AWGS2019 criteria. Further, the corresponding AUCs of SARC-F, SARC-CalF, SARC-F+AC, and SARC-CalF+AC were 0.650 (95% confidence interval [CI]: 0.601-0.697), 0.811 (95% CI: 0.769-0.848), 0.801 (95% CI: 0.759-0.839), and 0.848 (95% CI: 0.809-0.881), respectively. Using the EWGSOP2 criteria, the sensitivities/specificities of SARC-F, SARC-CalF, SARC-F+AC, and SARC-CalF+AC were 20.00%/95.44%, 56.00%/86.61%, 70.00%/81.20%, and 80.00%/74.93%, respectively. The AUCs of SARC-F, SARC-CalF, SARC-F+AC, and SARC-CalF+AC were 0.706 (95% CI: 0.659-0.750), 0.799 (95% CI: 0.756-0.837), 0.815 (95% CI: 0.774-0.852), and 0.834 (95% CI: 0.794-0.869), respectively.

CONCLUSIONS

The modified versions of SARC-F+AC and SARC-CalF+AC, which have superior sensitivity, can be used to screen sarcopenia in community-dwelling older adults. SARC-CalF+AC had the highest overall diagnostic accuracy for screening sarcopenia among community-dwelling older adults.

Study on Lubrication Characteristics of Novel Forced Wave Generator of Harmonic Drive without Flexible Bearing

In contrast to the conventional forced wave generator which consists of cam and flexible bearing in harmonic drive, the novel forced wave generator retains cam but cancels flexible bearing. In this article, the lubrication characteristics of the novel forced wave generator in harmonic drive is studied. First, an elliptical sliding bearing (ESB) model of simplified structure between the novel forced wave generator and the flex spline is established. Further, the computational fluid dynamics (CFD) method is employed to study the effect of some factors on the lubrication characteristics of the ESB model including elliptical gap ratio, width, and rotational speed. According to the analysis, the elliptical gap ratio has a great impact and its optimal value is 3, which is used in the design of the novel forced wave generator. Last, the practical design of the novel forced wave generator in harmonic drive is given, which can provide a basis for design and optimization of a forced wave generator without flexible bearing of the harmonic drive.

Impact of nodular calcification on the outcomes of patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI)

Background

Calcified plaque is thought to adversely impact clinical outcomes but the impact of nodular calcification after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear.

Purpose

This study sought to explore the impact of nodular calcification on the outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes.

Methods

Five-hundred culprit plaque with calcification were analysed from 495 ACS patients in whom PCI was performed. Plaques were divided into nodular calcification group (n=238) and non-nodular calcification group (n=262). Calcification is defined as an area with low back-scattering signal and a sharp border. Nodular calcification was defined as a protruding mass with an irregular surface, high backscattering, and signal attenuation on optical coherence tomography (OCT).

Results

Patients with nodular calcification were older (p&lt;0.001) and had lower left ventricular ejection fraction (p=0.006) compared to patients with non-nodular calcification. Lesion length (31 (25.2, 38.5) vs. 29 (22.8, 34.1), p&lt;0.001) was longer in plaques with nodular calcification. A higher prevalence of superficial calcium (p&lt;0.001) was observed in plaques with nodular calcification compared with non-nodular calcification group. Minimum stent area (MSA) (5.0 (3.9, 6.3) vs. 5.4 (4.2, 6.7), p=0.011) and stent expansion (70 (62.7, 81.8) vs. 75 (65.2, 86.6), p=0.004) were significantly smaller in the nodular calcification group than in the non-nodular calcification group. Independent predictors of nodular calcification were age (p&lt;0.001) lesion length (p=0.002) and calcium depth (p&lt;0.001).

Conclusion

This study demonstrated that the presence of nodular calcification is associated with unfavourable outcomes with smaller minimum stent area and higher incidence of stent under expansion in patients with ACS treated with primary PCI.

Funding Acknowledgement

Type of funding sources: None.

Frequency and predictors of thin-cap fibroatheroma progression: a comprehensive and dynamic in-vivo OCT study

Purpose

To assess the evolution of thin-cap fibroatheroma (TCFA) and to explore predictors for its progression by using optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS).

Methods

We enrolled ACS patients with non-culprit TCFA at baseline and corresponding OCT images at follow-up of 9 to 15 months. Clinical, angiographic and OCT data were collected and analyzed according to established methods. TCFA was defined as a lipid plaque with maximum lipid arc &gt;90° and fibrous cap thickness &lt;65μm. Considering the resolution of OCT, the regression of TCFA was defined as an increase of fibrous cap thickness &gt;10μm. Inversely, TCFA progression was defined as a decrease, constant or ≤10μm increase of fibrous cap thickness.

Results

41 patients with 55 non-culprit TCFAs were taken into final analysis. 17 patients (41.5%) had patient-level progression and 22 TCFAs (40.0%) progressed at plaque-level with a median follow-up duration of 371 days. 11 (20.0%) of the 55 TCFAs happened subclinical rupture at follow-up, including 10 with the formation a new layer and 1 without the detection of the new layer. Besides, another patient suffered re-myocardial infarction because of the rupture of TCFA induced acute thrombosis and lumen occlusion during follow-up. The baseline clinical and angiographic characteristics were similar between the two cohorts. The progression group had a significantly higher prevalence of macrophage infiltration and vasa vasorum at baseline than the non-progression group (Figure 1). Multivariate analysis identified macrophage infiltration (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 1.01 to 27.91; p=0.049]) as the independent predictor of TCFA progression. When it came to the evolution of lesion morphology and lipid components, the progression cohort had a higher percent change of lumen stenosis and lipid length (Figure 2).

Conclusions

About 40% of non-culprit TCFAs in ACS patients progressed in fibrous cap thickness at a median interval of 1 year. Macrophage infiltration was the independent predictor of non-culprit TCFA progression. The progression of fibrous cap thickness was usually accompanied with an aggressive evolution of other lesion characteristics.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): the National Key R&D Program of China Baseline OCT characteristicsPercent change of lesion morphology

Prevalence, predictors, and clinical prognosis of macrophage infiltrates in patients with ST-segment elevation myocardial infarction caused by plaque erosion as assessed by OCT

Background

Autopsy series showed that one of most common plaque phenotypes underlying coronary thrombi was plaque erosion. Identification of erosion may permit a less invasive management. Chronic inflammation is a common process in atherosclerosis. The severity of plaque inflammation can be assessed by optical coherence tomography (OCT) defined macrophages density. The impact of macrophage infiltrates (MØI) in ST-segment elevation myocardial infarction (STEMI) patients caused by plaque erosion was still unknown.

Purpose

The aim of this study was to evaluate plaque morphology and clinical prognosis associated with MØI as assessed by optical coherence tomography in STEMI patients caused by plaque erosion.

Methods

From October 2014 to December 2017, 1561 STEMI with OCT imaging before percutaneous coronary intervention were enrolled in this study. Finally, 312 STEMI patients caused by plaque erosion were split into two group according to the presence of MØI in culprit eroded plaques.

Results

163 (52.2%) STEMI patients presented plaque erosion with MØI, whereas 149 (47.8%) patients had no evidence of MØI. MØI were more frequency appeared in older patients (p=0.015). The severity and vulnerability of culprit lesions were higher in patients with MØI characterized by more aggressive and vulnerable features. Patients with MØI had worse long-term prognosis, compared with patient without MØI, mainly driven by a higher rate of target lesion revascularization (p=0.046), especially in STEMI patients presented plaque erosion with intensive antiplatelet therapy (p=0.035).

Conclusions

In the present study, we demonstrated that macrophage infiltrates at the site of erode plaques were associated with severity and vulnerability of culprit lesions. The long-term prognosis in patients with MØI were poorer especially in patients without stent implantation.

Funding Acknowledgement

Type of funding sources: None. Study flow chartPredictors of plaque erosion with MØI

Gender-specific difference of clinical and plaque characteristics in myocardial infarction with non-obstructive artery (MINOCA): insights from optical coherence tomography

Background

To date, sparse data are available with regard to gender differences in coronary plaque morphology and composition as underlying mechanism of MINOCA.

Purpose

To assess the differences in coronary plaque morphology in culprit lesion between women and men with MINOCA using intravascular optical coherence tomography.

Methods

Totally, 7404 consecutives acute myocardial infarction patients who underwent emergency coronary angiography between 2016 and 2019 were screened. MINOCA were identified in 292 patients (mean age: 72.6% male, 54.1% with ST-segment elevation). Optical coherence tomography was performed in 190 patients (men, n=142).

Results

Women with MINOCA were older (62.5±10.6 vs. 54.0±11.5, P&lt;0.001) and more over 55 years (75.3% vs. 43.6%, P&lt;0.001). Although women with MINOCA more frequently presented with NSTEMI (56.8% vs. 41.7%, P=0.025) and prior coronary artery disease (CAD) (33.3% vs. 6.3%, P&lt;0.001), they were less likely smoker (27.2% vs. 58.8%, P&lt;0.001). There was no significant difference in incidence of plaque rupture, erosion and calcified nodule between men and women. However, women were more likely to have thin-cap fibroatheroma (TCFA) (39.6% vs. 22.5%, P=0.025).

Conclusion

Women with MINOCA were older, more frequently presented with NSTEMI and less smoking compared to men. Besides, more TCFA were observed in women.

Funding Acknowledgement

Type of funding sources: None. Clinical and OCT plaque profilesProportion of clinical and OCT profiles

Functional characterization and structural bases of two class I diterpene synthases in pimarane-type diterpene biosynthesis

Pimarane-type diterpenoids are widely distributed in all domains of life, but no structures or catalytic mechanisms of pimarane-type diterpene synthases (DTSs) have been characterized. Here, we report that two class I DTSs, Sat1646 and Stt4548, each accept copalyl diphosphate (CPP) as the substrate to produce isopimara-8,15-diene (1). Sat1646 can also accept syn-CPP and produce syn-isopimaradiene/pimaradiene analogues (2-7), among which 2 possesses a previously unreported "6/6/7" ring skeleton. We solve the crystal structures of Sat1646, Sat1646 complexed with magnesium ions, and Stt4548, thereby revealing the active sites of these pimarane-type DTSs. Substrate modeling and subsequent site-directed mutagenesis experiments demonstrate different structural bases of Sat1646 and Stt4548 for 1 production. Comparisons with previously reported DTSs reveal their distinct carbocation intermediate stabilization mechanisms, which control the conversion of a single substrate CPP into structurally diverse diterpene products. These results illustrate the structural bases for enzymatic catalyses of pimarane-type DTSs, potentially facilitating future DTS engineering and combinatorial biosynthesis.

[Effect of electrode array type and insertion technique on the insertion force: in vitro cochlear model study]

Objective: To investigate the effect of insertion technique and electrode array type on the insertion force of electrode array, and to provide a basis for further optimizing electrode design and facilitating mini-invasive electrode insertion. Methods: Three types of electrode array from Nurotron (Standard Electrode, Slim-medium Electrode, Slim-long Electrode) were studied. from July 2019 to December 2019. These electrode arrays were inserted into the phantom models of the cochlea, manually or robot-assisted(medium speed and low speed). The real-time force during electrode array insertion was recorded by ATI Nano 17 Ti sensors and was analyzed by accessory software. Origin 2020b software was used for statistical processing. Results: The insertion force of all electrode arrays progressively increased with the insertion depth. With the manual technique, the peak force of slim-medium electrode insertion was significantly smaller than that of the standard electrode insertion((71.0±16.6) mN vs (140.9±52.7) mN, Z=3.683, P<0.01), and the peak force of the slim-long electrode insertion was between the peak force of standard electrode and slim-medium electrode(P>0.05). No difference was found in the force variation of insertion among the three electrodes(P>0.05). With medium-speed and low-speed robotic assistance, the peak force characteristics of three electrodes were similar to those with the manual technique, but the force variation of standard electrode insertion ((83.9±9.7) mN/s) at medium speed was significantly larger than that of the slim-long electrode insertion ((69.2±4.0)mN/s), and the force variation of the standard electrode insertion at low speed was significantly greater than the other two electrodes. For the same electrode, robot-assisted insertion presented significantly lower peak force and force variation than manual insertion for each type of electrode array. But there was no difference in the peak force and force variation between two-speed levels of robot assistance (P>0.05). Conclusions: The insertion force of the electrode array will be lower when a slim electrode array or robot technique is applied. Long electrode array might make manual insertion difficult or less precise. Robot assistance has advantage on force control during electrode array insertion.

Discovery of cyclohexadepsipeptides with anti-Zika virus activities and biosynthesis of the nonproteinogenic building block (3S)-methyl-l-proline

The fungal cyclohexadepsipeptides destruxins (DTXs), isaridins (ISDs), and isariins (ISRs) are nonribosomal peptides whose structures include a 19-membered ring composed of five amino acid residues and one α- or β-hydroxy acid residue. These cyclohexadepsipeptides contain unusual nonproteinogenic amino acid-building blocks and possess a range of antiviral, antibacterial, and other activities. The biosynthetic gene clusters for ISDs and ISRs have not been identified, and the biosynthesis of the nonproteinogenic (3S)-methyl-l-proline residue, which is found in DTXs, ISDs, and many other natural products, lacks full characterization. In an ongoing effort to identify compounds that can inhibit the Zika virus (ZIKV), we examined the extract of marine-derived fungus Beauveria felina SX-6-22 and discovered 30 DTXs, ISDs, and ISRs (1-30) including seven new compounds (1-7). The anti-ZIKV assays showed that 9-12 and 16-18 possess inhibitory activities against ZIKV RNA replication and NS5 (nonstructural protein 5) production in ZIKV-infected A549 cells. We sequenced the genome of B. felina SX-6-22 and identified three biosynthetic gene clusters detx, isd and isr, which are responsible for the biosynthesis of DTXs, ISDs, and ISRs, respectively. Comparative analyses of the three gene clusters clarified the biosynthetic relationships among these cyclohexadepsipeptides. Finally, we characterized the entire biosynthesis of nonproteinogenic building block (3S)-methyl-l-proline. The Δ1-pyrroline-5-carboxylate reductases (P5CRs), also used in the biosynthesis of l-proline, were demonstrated to catalyze the final reduction step in (3S)-methyl-l-proline formation, suggesting potential cross talk between primary and secondary metabolisms. These results provide opportunities for biosynthetic pathway engineering to generate new anti-ZIKV cyclohexadepsipeptides.

Identification of the pivotal differentially expressed genes and pathways involved in Staphylococcus aureus-induced infective endocarditis by using bioinformatics analysis

OBJECTIVE

Infective endocarditis (IE), particularly by Staphylococcus aureus, is an uncommon bacteremia-associated infection of the endocardium and cardiac valves. Herein, we evaluated predictive noninvasive biomarkers for IE caused by S. aureus through bioinformatics analysis.

MATERIALS AND METHODS

Staphylococcus aureus-associated and IE-associated differentially expressed genes (DEGs) were identified by bioinformatics analysis of the GSE6269 and GSE29161 Gene Expression Omnibus (GEO) datasets. The DEGs were analyzed with the LIMMA package, and the coregulated genes were chosen as the intersection of DEGs between the two datasets, called common differentially expressed genes (CDEGs). The enrichment study of CDEGs was subsequently performed with the DAVID and KOBAS web resources. Finally, protein-protein interaction (PPI) network, microRNA (miRNA)-transcription factor (TF)-mRNA (messenger RNA) regulatory network, and the network of drug-genes were identified.

RESULTS

From GSE6269 and GSE29161, respectively, a total of 201 and 741 DEGs were obtained. Gene Ontology (GO) analysis showed that CDEGs were primarily involved in innate immune response, extracellular exosome, as well as calcium ion binding, while the pathway analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) revealed that CDEGs were significantly enriched in the B-cell receptor, IL-17, and NF-kappa B signaling pathways. The hub genes in the PPI network included HP, S100A12, SPI1, CD14, CCR1, S100A9 and so on. In the miRNA-TF-mRNA regulatory network, SPI1 could target miR-361-5p, miR-155-5p, and miR-339-5p in the progression of IE.

CONCLUSIONS

Several pivotal genes and pathways were identified in the progression of S. aureus-induced IE, which may have the potential for early detection.

Enantioselective Total Synthesis of Berkeleyone A and Preaustinoids

Herein we report the first enantioselective total synthesis of 3,5-dimethylorsellinic acid-derived meroterpenoids (-)-berkeleyone A and its five congeners ((-)-preaustinoids A, A1, B, B1, and B2) in 12-15 steps, starting from commercially available 2,4,6-trihydroxybenzoic acid hydrate. Based upon the recognition of latent symmetry within D-ring, our convergent synthesis features two critical reactions: 1) a symmetry-breaking, diastereoselective dearomative alkylation to assemble the entire carbon core, and 2) a Sc(OTf)₃ -mediated sequential Krapcho dealkoxycarbonylation/carbonyl α-tert-alkylation to forge the intricate bicyclo[3.3.1]nonane framework. We also conducted our preliminary biomimetic investigations and uncovered a series of rearrangements (α-ketol, α-hydroxyl-β-diketone, etc.) responsible for the biomimetic diversification of (-)-berkeleyone A into its five preaustinoid congeners.

Crystal Structures of Fsa2 and Phm7 Catalyzing [4 + 2] Cycloaddition Reactions with Reverse Stereoselectivities in Equisetin and Phomasetin Biosynthesis

Fsa2 and Phm7 are a unique pair of pericyclases catalyzing [4 + 2] cycloaddition reactions with reverse stereoselectivities in the biosynthesis of equisetin and phomasetin, both of which are potent HIV-1 integrase inhibitors. We here solve the crystal structures of Fsa2 and Phm7, both of which possess unusual "two-β barrel" folds. Different residues are evident between the active sites of Fsa2 and Phm7, and modeling experiments provide key structural information determining the reverse stereoselectivities. These results provide a better understanding of how natural pericyclases control the catalytic stereoselectivities and benefit the protein engineering in future.

Excitation functions of proton induced reactions on titanium and copper

Excitation functions of the Tnati(p,x)S43,47c, V48 and Cnatu(p,x)⁶⁴Cu, Z62,65n reactions were measured in the energy range of 8.8-18.4 MeV by using the stacked-foil activation technique and off-line gamma spectroscopy. The irradiation was carried out at the superconducting linac of the Institute of Modern Physics, Chinese Academy of Sciences. Besides, the reliability and effectiveness of theoretical data from the TALYS code, recommended data of the International Atomic Energy Agency (IAEA) and evaluated nuclear data of the ENDF/B-VIII.0, JENDL-4.0/HE and PADF-2007 libraries were evaluated and verified by comparing with experimental data. Our experimental results agree with most of the available literature data. TALYS-1.95 code could not reproduce, in most cases, the experimental data. Evaluated nuclear data from the ENDF/B-VIII.0, JENDL-4.0/HE and PADF-2007 libraries are able to reproduce, in most cases, the experimental data trend. Recommended data of the IAEA are in good consistent with our work and most of the available literature data.

[Auditory brainstem implantation: current status and prospects]

Auditory brainstem implantation is a hearing restoration technique on the central auditory pathway, which directly stimulates neural tissues of cochlear nucleus by electrode array to produce hearing, so it will not be restricted by abnormalities of the cochlea and cochlear nerve. In the past 30 years since the birth of multi-channel ABI, its indications have expanded from patients with neurofibromatosis type 2 (NF2) to congenital deafness patients with severe inner ear and/or cochlear nerve malformations, and the age of recipients decreases from adults to young children. This article summarizes the principle, indications, surgical techniques, complications and auditory outcomes of ABI.

Impact of macrophage infiltration in patients with st-segment elevation myocardial infarction caused by plaque erosion: an in vivo optical coherence tomography study

Background

Chronic inflammatory infiltration is a common process for atherosclerosis development. However, autopsy studies reveal that incidence rate of inflammatory infiltrates are less abundant in plaque erosion compared with plaque rupture.

Purpose

Studies performed by optical coherence tomography (OCT) have allowed to establish the severity of plaque inflammation by assessing macrophage infiltration (MØI). In this study, we aimed at assessing the impaction of MØI in plaque erosion among patients with STEMI by using OCT.

Methods

A total of 1561 patients with ST-segment elevation myocardial infarctions (STEMI) who underwent OCT imaging were enrolled in this study. According to the exclusion criteria, 312 patients with STEMI exhibiting plaque erosion were classified as MØI or no MØI.

Results

163 (52.2%) patients had MØI at the site of plaque erosion, whereas 149 (47.8%) patients had no evidence of MØI and patients of MØI group were significantly older (P=0.015). The result of angiography showed the prevalence of multi-vessel disease appeared more frequency (P=0.021) and diameter stenosis% were higher (P=0.031) in MØI group. OCT results showed the minimum fibrous-cap thickness was thinner (P&lt;0.001) and the maximum lipid arc was larger (P=0.005) in MØI group. Some patients underwent imaging follow-up at 1 year. There was no significant difference in the culprit plaque morphology progress among two groups (Figure 1A-1D).

Conclusions

This study demonstrated that plaque inflammation can increase culprit lesion severity and plaque vulnerability in patients with STEMI caused by plaque erosion.

Figure 1

Funding Acknowledgement

Type of funding source: None

Aaptodines A-D, Spiro Naphthyridine-Furooxazoloquinoline Hybrid Alkaloids from the Sponge Aaptos suberitoides

LC-MS-oriented fractionation of the sponge Aaptos suberitoides resulted in the isolation of four heptacyclic alkaloids, aaptodines A-D (1-4), which contain 9,10-dihydrofuro[2,3-f][1,3]oxazolo[5,4-h]quinolone and 7,8-dihydrocyclopenta[de][1,6]naphthyridine subunits with a spiro carbon atom. The structures were determined on the basis of NMR spectroscopic and single-crystal X-ray diffraction data analysis aided by electronic circular dichroism calculations and Mosher's method. A biosynthetic pathway for the formation of aaptodines A-D is postulated. Aaptodine D exhibits potent inhibition against osteoclast formation.

(+)- and (-)-Corydecumbenines A and B, two pairs of novel quaternary protoberberine alkaloid cycloadduct enantiomers with anti-neuroinflammatory and neuroprotective activities from the rhizomes of Corydalis decumbens

Two novel Diels-Alder [4 + 2] cycloadducts of quaternary protoberberine alkaloids and fumaric acid monoanion, corydecumbenines A and B (1 and 2), and six known isoquinoline analogues (3-8) were isolated from the rhizomes of Corydalis decumbens. The planar structures of 1 and 2 were elucidated by extensive spectroscopic analysis including UV, IR, HRESIMS, 1D and 2D NMR. Chiral chromatography of 1 and 2 afforded two pairs of enantiomers (+)-corydecumbenine A (1a), (-)-corydecumbenine A (1b), (+)-corydecumbenine B (2a), and (-)-corydecumbenine B (2b), respectively, and their absolute configurations were determined by single-crystal X-ray crystallography and comparison of experimental and calculated electronic circular dichroism (ECD) spectra. Compounds 1b and 2b exhibited significant nitric oxide (NO) inhibitory activities in lipopolysaccharide (LPS)-stimulated BV-2 cells with IC₅₀ values of 11.6 and 16.2 μM, respectively, comparable to the positive control indomethacin (IC₅₀ = 10.3 μM), and they could also decrease the level of interleukin (IL)-1β in BV-2 cells in a dose-dependent manner. Most of the isolates showed neuroprotective effects against the injury of OGD/R-induced PC12 cells at 20 μM.

The probiotic Lactobacillus casei Shirota attenuates symptoms of vestibular migraine: a randomised placebo-controlled double-blind clinical trial

Vestibular migraine (VM) has emerged as one of the major vestibular syndromes. Although probiotics have exhibited beneficial effects on migraine headache, its effect on VM is not clear. This trial aimed to investigate the treatment efficacy of the probiotic Lactobacillus casei Shirota (LcS) on symptoms of VM. 247 VM patients were enrolled, of which 204 eligible patients receiving either LcS or placebo on a daily basis completed the 4 month study. They were re-visited at 2 and 4 months after study initiation to assess treatment outcomes. The primary endpoints were vestibular symptoms, evaluated by the number of vertiginous attacks during the past week, the Vertigo Severity Score (VSS), and Dizziness Handicap Inventory (DHI) scores. The secondary endpoints were anxiety and depressive symptoms, evaluated using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores. Efficacy of LcS over placebo was not obvious at 2 month follow-up. At 4 month follow-up, while both LcS and placebo groups of VM patients displayed alleviated symptoms, the extents of the improvements were significantly better in LcS group than those of placebo group, with regard to vestibular symptoms using DHI and VSS, as well as anxiety and depressive symptoms using BAI and BDI. Although placebo effect cannot be ignored in intervention for VM patients, the probiotic LcS still exhibits considerable efficacy against VM symptoms over a 4 month study period, supporting further clinical study of a larger and more diverse cohort.

Isolation and sequence analysis of the complete VP2 gene of canine parvovirus from Chinese domestic pets and determination of the pathogenesis of these circulating strains in beagles

Canine parvovirus (CPV) causes acute gastroenteritis in domestic dogs, cats, and several wild carnivore species. In this study, the full-length VP2 gene of 36 CPV isolates from dogs and cats infected between 2016 and 2017 in Beijing was sequenced and analyzed. The results showed that, in dogs, the new CPV-2a strain was the predominant variant (n = 18; 50%), followed by the new CPV-2b (n = 6; 16.7%) and CPV-2c (n = 3; 8.3%) strains, whereas, among cats, the predominant strain was still CPV-2 (n = 9; 25%). One new CPV-2a strain, 20170320-BJ-11, and two CPV-2c strains, 20160810-BJ-81 and 20170322-BJ-26, were isolated and used to perform experimental infections. Multiple organs of beagles that died tested PCR positive for CPV, and characteristic histopathological lesions were observed in organs, including the liver, spleen, lungs, kidneys, small intestines, and lymph nodes. Experimental infections showed that the isolates from the epidemic caused high morbidity in beagles, indicating their virulence in animals and suggesting the need to further monitor evolution of CPV in China.

pUC18-CpG stimulates RAW 264.7 via TBK1-mediated pathway and presents adjuvanticity in mice

Phosphorothioate CpG oligodeoxynucleotides (ODN) are reported to be recognized by the membrane-bound TLR9 and trigger the MyD88-dependent up-regulation of Type I interferons and pro-inflammatory cytokines. Whether plasmids containing multiple CpG motifs stimulate the same signaling pathway is yet to be determined. The present results show that the CpG motifs enrich plasmid pUC18-CpG stimulates RAW 264.7 in vitro, mainly through the TBK1-mediated signaling pathway, causing the up-regulation of IFN-β, and pro-inflammatory cytokines TNF-α and IL-6. When pUC18-CpG is co-administered with the recombinant Echinococcus granulosus antigen, the antigen-specific antibody titers are markedly increased compared to the Quil-A adju- vanted group. Antigen specific cytokine quantification shows that cytokine profiles from the pUC18-CpG adjuvanted-group are switched to a Th1-biased immune response.

Surgery of the lateral skull base: a 50-year endeavour

Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

Genotyping and pathogenic characterization of canine distemper virus based on mutations in the hemagglutinin gene in Chinese domestic dogs

Canine distemper virus (CDV) infects wild and domestic Canidae worldwide. The hemag- glutinin (H) gene has the highest genetic variation in the genome of this virus. Thus, the H gene is commonly used for lineage identification and genetic analyses. In order to study the genetic characteristics and pathogenicity of CDV strains prevalent in China, 132 samples were collected from domestic dogs with suspected CDV infection, 58 samples were confirmed to be positive, and the H gene was successfully amplified from 15 samples. The epidemic strain was identified as type Asia-1 and the novel mutations, A51T, V58I, R179K and D262N, were detected in this strain. Isolated strains, BJ16B53, BJ16B14, and BJ17B8, were used for an animal infection experiment in raccoon dogs. BJ16B53 and BJ16B14 were found to cause clinical symptoms, death, and exten- sive lesions in various organs. These results are expected to facilitate the development of effective strategies to monitor and control CDV infection in China.

P3390Relationship of thrombus healing to underlying plaque characteristics in ST-segment elevation myocardial infarction: an optical coherence tomography study

Background

Acute ST-segment elevation myocardial infarction (STEMI) is typically characterized by an occlusive coronary thrombus propagation on a disrupted or eroded atherosclerotic plaque. A variable period of plaque instability and thrombus formation occur days or weeks old in approximately 50% of patients with STEMI. Presence of late stage (older) thrombi in aspirated coronary material is an independent predictor of 1-year and long-term mortality in STEMI patients. However, the relationship between coronary thrombus healing to underlying plaque morphology and characteristics in vivo still remains largely unknown.

Purpose

Our objective was to assess differences in thrombus healing between ruptured and eroded plaques in vivo and evaluate the impact of underlying plaque characteristics on thrombus healing using optical coherence tomography (OCT).

Methods

Analyzable coronary material was obtained during primary percutaneous coronary intervention (PCI) from 135 patients with STEMI within 12h of symptom onset. Thrombi were morphologically classified as either early or late stage (lytic changes or organization). Of the 135 patients, 110 were eligible for culprit lesion evaluation using OCT. Quantitative and qualitative underlying plaque characteristics were assessed by OCT.

Results

Late-stage thrombi were found in 49 of 110 (44.5%) culprit plaques. Patients with eroded plaques more frequently had late-stage thrombi compared with ruptured plaques (59.0% vs. 36.6%, p<0.001). Subgroup analysis was performed between plaque rupture, identified in 71 patients (64.5%) and plaque erosion in 39 patients (35.5%). In plaque ruptures, patients with late-stage thrombi had larger lipid core length (12.4±3.3 vs. 14.5±3.8, p=0.020), larger rupture cavity length [1.5 (1.0, 2.0) vs. 1.9 (1.5, 2.8), p=0.034] and increased residual thrombus length [7.8 (6.3, 11.2) vs. 10.3 (7.8, 13.8), p=0.021] assessed by OCT compared with early thrombus group. However, in plaque erosions, late stage thrombi were associated with decreased residual thrombus burden compared with patients with early thrombus group [16.8 (12.8, 20.4) vs. 13.4 (10.7, 14.8), p=0.012]. No significant difference was found between thrombus healing with peak creatine kinase concentration or maximum NT-pro BNP in subgroup analysis.

Conclusions

Coronary thrombi in STEMI patients exhibited diverse phases of healing, depending on the etiology of the underlying culprit plaque in vivo. These observations indicate entirely distinct mechanisms of thrombus propagation, maturation and healing between plaque rupture and erosion, illustrating an opportunity for more tailored treatment in patients with different plaque type.