The effect of body size and composition on lumbar spine trabecular bone score in morphologically diverse subjects

AIM

The trabecular bone score (TBS) is a tool for assessing bone quality and health. Current TBS algorithm corrects for body mass index (BMI), as a proxy of regional tissue thickness. However, this approach fails to consider BMI inaccuracies due to individual differences in body stature, composition and somatotype. This study investigated the relationship between TBS and body size and composition in subjects with a normal BMI, but with large morphological diversity in body fatness and height.

METHODS

Young male subjects (n = 97; age 17.2±1.0 years), including ski jumpers (n = 25), volleyball players (n = 48) and non-athletes (controls n = 39), were recruited. The TBS was determined from L1-L4 dual-energy X-ray absorptiometry (DXA) scans using TBSiNsight software.

RESULTS

TBS correlated negatively with height and tissue thickness in the L1-L4 area in ski jumpers (r = -0.516 and r = -0.529), volleyball players (r = -0.525 and r = -0.436), and the total group (r = -0.559 and r = -0.463), respectively. Multiple regression analyses revealed that height, L1-L4 soft tissue thickness, fat mass and muscle mass were significant determinants of TBS (R2 = 0.587, p<0.001). L1-L4 soft tissue thickness explained 27% and height 14% of the TBS variance.

CONCLUSION

The negative association of TBS and both features suggests that a very low L1-L4 tissue thickness may lead to overestimation of the TBS, while tall stature may have the opposite effect. It seems that the utility of the TBS as a skeletal assessment tool in lean and/or tall young male subjects could be improved if tissues thickness in the lumbar spine area and stature instead of BMI were considered in the algorithm.

Removal of Perfluorooctanoic Acid from Water Using a Hydrophobic Ionic Liquid Selected Using the Conductor-like Screening Model for Realistic Solvents

The conductor-like screening model for realistic solvents was used to identify ionic liquids (ILs) to efficiently extract perfluorooctanoic acid (PFOA). The infinite dilution chemical potentials of PFOA in 14 000 ILs were calculated and used as descriptors of the chemical affinities between the ILs and PFOA. Trihexyltetradecylphosphonium pivalate ([P6,6,6,14][Piv]) was found to be a good IL for extracting PFOA because it gave a well-balanced combination of a strong chemical attraction for PFOA and useful physicochemical properties. The results of experiments indicated that [P6,6,6,14][Piv] could remove >99.9% of the PFOA in an aqueous solution. However, problematic emulsification of IL in the aqueous phase occurred at PFOA/IL molar ratios <1.9-2.1, and this limited the PFOA removal rate to 80-91%. The ability of the used IL to extract PFOA was found to be partially regenerated by washing the IL with 1% NaOH, and the IL could be reused to extract PFOA with a removal rate decreased by ∼10% in each cycle.

3D reactive inkjet printing of aliphatic polyureas using in-air coalescence technique

An in-flight coalescence reactive inkjet printer has been developed to facilitate the in-air collision of two reactive microdroplets. This way precise volumes of reactive inks can be mixed and subsequently deposited on the substrate to produce the desired product by polymer synthesis and patterning in a single step. In this work, we validate the printer capabilities by fabrication of a series of 3D structures using an aliphatic polyurea system (isophorone diisocyanate IPDI and poly(propylene glycol) bis(2-aminopropyl ether) PEA-400). The influence of temperature and ink ratio on the material properties has been investigated. An increase in both IPDI and temperature facilitates the production of materials with higher Young's Modulus E and higher ultimate strength U. The possibility of printing different materials i.e. ductile (U = 2 MPa, ε_B = 450%), quasi-brittle (U = 14 MPa, ε_B = 350%), and brittle (U = 10 MPa, ε_B = 11%) by varying the printing process parameters using one set of inks has been presented. The anisotropy of the material properties arising from different printing directions is at the 20% level.

In flight coalescence of polyurea inks in different volume ratios produces materials with varied degrees of elasticity.

Detection of Drugs in Postmortem Specimens of Blood, Vitreous Humor and Bone Marrow Aspirate

In case of basic biological materials (blood, urine, vitreous humor) being unavailable, bone marrow can be used for toxicological tests. The aim of the study was to assess the concentration of various xenobiotics in the bone marrow, as well as in the blood and the vitreous humor. The analysis was performed in the biological material originating from the autopsy (n = 120), using the LC-MS method and with liquid/liquid extraction at pH = 9. As many as 46 different xenobiotics were detected in the biological material, strong correlations between the concentration of a given xenobiotic in blood and bone marrow, as well as in the vitreous humor and bone marrow, were noted for most of them, with the exception of diazepam and 7-aminoclonazepam. The obtained results indicate the possibility of using bone marrow to determine the concentration of numerous xenobiotics in the situation of basic biological materials being unavailable, as well as using the results obtained in the future to better understand the pharmacokinetic processes and the effect of postmortem redistribution on medication and drug concentrations in the body of a deceased person.

Vapor Pressure and Physicochemical Properties of {LiBr + IL-Based Additive + Water} Mixtures: Experimental Data and COSMO-RS Predictions

In recent years, many compounds have been proposed as additives to conventional working fluids to improve the performance of the absorption refrigeration system. The main aim of this research is to show the influence of ionic liquid based additives on thermodynamic and physicochemical properties of {LiBr + water} solutions. The following additives: 3-(1-methyl-morpholinium)propane-1-sulfonate, N,N-di(2-hydroxyethyl)-N,N-dimethylammonium bromide, and N,N,N-tri(2-hydroxy-ethyl)-N-methylammonium bromide have been added to aqueous lithium bromide solutions (IL to LiBr mass fraction, w2 = 0.3). The physicochemical and thermodynamic properties of {LiBr (1) + additive (2) + water (3)} and {LiBr + water} systems including (vapor + liquid) phase equilibria (VLE), density (ρ) and dynamic viscosity (η) were determined over wide temperature and composition ranges. The conductor-like screening model for real solvents (COSMO-RS) was used for the VLE data prediction. For the density and dynamic viscosity correlations, empirical equations were applied. A comparison of experimental data for {LiBr + additive + water} with those for {LiBr + water} systems shows the influence of using the additives proposed in this work. The data presented are complementary to the current state of knowledge in this area and provide directions for future research.

THU0186 CLINICAL EVALUATION OF THE IMMUNOGENICITY TO CT-P13 FOR SUBCUTANEOUS USE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: 1-YEAR CLINICAL RESULTS FROM A MULTICENTER, RANDOMIZED CONTROLLED PIVOTAL TRIAL

Background:

Novel subcutaneous infliximab (CT-P13 SC) was developed to augment the flexibility in therapeutic use of infliximab and noninferiority (NI) of CT-P13 SC versus CT-P13 intravenous (IV) was demonstrated for efficacy in patients with rheumatoid arthritis (RA) [1]. CT-P13 SC 120mg biweekly showed consistent higher therapeutic trough levels during the treatment period, which helps in maintaining efficacy over time. Since immunogenicity has clinical importance in patients using anti-TNF alpha agents and there is a general presumption that SC route is more immunogenic than IV route, this needs careful assessment.

Objectives:

Immunogenicity assessment of CT-P13 SC with further impact analysis has been performed on the pivotal data set [1] to determine whether there was any correlation between the magnitude of anti-drug antibody (ADA) positivity and clinical outcomes in RA patients.

Methods:

The immune response against CT-P13 in human serum was detected using an electrochemiluminescence (ECL) platform with an Affinity Capture Elution (ACE) step. An ADA ECL ACE assay showed ability to detect ADA at low levels in all samples regardless of residual drug in serum (25 ng/mL ADA in the presence of 80 μg/mL of CT-P13 in RA serum). To investigate the impact of ADA titer on PK, efficacy and safety, key clinical parameters were assessed by visit based ADA titer quartile. All patients who had ‘Positive’ ADA status result at each visit were included in the analysis and categorized into 4 groups using the 25th, 50th, 75th percentiles of ADA titer result, respectively.

Results:

The four subgroups categorized by quartiles at each visit from week 22 to week 54 were: 1st (ADA titer ≤ 3), 2nd (3 < ADA titer ≤ 9), 3rd (9 < ADA titer ≤ 27) and 4th (27 < ADA titer). There was a trend for pre-dose concentration to decrease as ADA titer increases for both CT-P13 SC and CT-P13 IV arms as expected (Figure 1). Patients in the 1st and 2nd subgroup maintained the sufficient therapeutic drug concentration level. Figure 2 shows the correlation between ADA titer and efficacy outcomes where the change from baseline of DAS28 (CRP) and the proportion of patients achieving ACR20 were lower in the 3rd and 4th subgroups. The ADA impact was especially apparent in the 4th subgroup where the mean pre-dose concentration of the patients was below the therapeutic drug concentration level (1 μg/mL), which led to worse efficacy outcomes in both arms, IV as well as SC. Nevertheless, no impact of ADA on safety profile in both arms was observed. A neutralizing antibody (NAb) method with enhanced drug tolerance but limited performance was also developed and clinical consequences of NAb titer in terms of PK, efficacy and safety were not different from the results with ADA.

Conclusion:

The analysis of both ADA positivity and titer is clinically meaningful in the prediction of PK profile and clinical response. CT-P13 SC administration did not result in a greater incidence of ADA compared to the CT-P13 IV and there were no clinical differences depending on the formulation.

References:

[1]Westhovens R, et al. Annals of the Rheumatic Diseases 2019;78:1158-1159.

Disclosure of Interests:

Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, DaeHyun Yoo Grant/research support from: Celltrion, Inc, Consultant of: Celltrion, Inc, Speakers bureau: Celltrion Healthcare, Inc, Piotr Wiland Grant/research support from: Celltrion, Inc, Speakers bureau: Novartis, Pfizer, Abbvie, Gedeon-Richter, Lilly, Roche, Sandoz, Marek Zawadzki Grant/research support from: Celltrion, Inc, Delina Ivanova Grant/research support from: Celltrion, Inc, Alfredo Berrocal Grant/research support from: Celltrion, Inc, Speakers bureau: Pfizer, Elias Chalouhi Grant/research support from: Celltrion, Inc, Éva Balázs Grant/research support from: Celltrion, Inc, Consultant of: Amgen, Sergii Shevchuk Grant/research support from: Celltrion, Inc, Sang Joon Lee Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc, Sung Hyun Kim Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc, JeeHye Suh Employee of: Celltrion, Inc, Chankyoung Hwang Employee of: Celltrion, Inc, Dae Seok Choi Shareholder of: Celltrion, Inc, Employee of: Celltrion, Inc

Dissociative electron attachment to benzoic acid (C7H6O2)

The dissociative electron attachment (DEA) to benzoic acid (C₆H₅COOH) has been studied using an experimental crossed beam setup of a quadrupole mass spectrometer and a trochoidal electron monochromator. Relative partial cross sections for the DEA to produce negative ion fragments show the main channels for dissociation. The comparison of the present results with the ultraviolet photoelectron spectrum of benzoic acid [J. Meeks, A. Wahlborg, and S. P. McGlynn, J. Electron Spectrosc. Relat. Phenom. 22, 43 (1981)] implies that most DEA bands in the high energy range are due to Feshbach resonances with double occupation of diffuse Rydberg-like orbitals. The measurements are supported by density functional theory calculations of the threshold energies.

Dissociative ionization dynamics of dielectric gas C3F7CN

Fluoronitrile C₃F₇CN is a promising candidate for the replacement of SF₆ dielectric gas in high-voltage insulation.

Electron attachment to hexafluoropropylene oxide (HFPO)

We probe the electron attachment in hexafluoropropylene oxide (HFPO), C₃F₆O, a gas widely used in plasma technologies. We determine the absolute electron attachment cross section using two completely different experimental approaches: (i) a crossed-beam experiment at single collision conditions (local pressures of 5 × 10^-4 mbar) and (ii) a pulsed Townsend experiment at pressures of 20-100 mbar. In the latter method, the cross sections are unfolded from the electron attachment rate coefficients. The cross sections derived independently by the two methods are in very good agreement. We additionally discuss the dissociative electron attachment fragmentation patterns and their role in the radical production in industrial HFPO plasmas.

Resonances and Dissociative Electron Attachment in HNCO

In a combined experimental and theoretical study, we probe the dissociative electron attachment in isocyanic acid HNCO. The experimental absolute cross section for the NCO^{-} fragment shows a sharp onset and fine structures near the threshold. The autoionizing state responsible for the dissociative attachment is found in both the R-matrix calculation and using analytic continuation in the coupling constant. The involved A^{'} resonance has a mixed π^{*}/σ^{*} character along the dissociating bond and thus combines the effects of nonzero electron angular momentum and dipole-supported states. This leads to unusual behavior of its width at various geometries. Because the potential energy gradient of the autoionizing state points essentially in the direction of the N─H bond, nuclear dynamics can be described by a one-dimensional nonlocal model. The results agree with the experiment both quantitatively and qualitatively. The present system may be a prototype for interpretation of the dissociative electron attachment process in a number of other polyatomic systems.

Low energy differential elastic electron scattering from acetonitrile (CH3CN)

Measurements of elastic differential cross sections for electron scattering from acetonitrile (CH₃CN) have been performed utilizing a crossed electron-molecular beam experiment and with the relative flow method, for the incident electron energy range of 0.7 eV-30 eV and the scattering angle range of 10°-130°. These differential cross sections have been used to calculate the elastic integral and momentum-transfer cross sections, revealing a π ^* resonance located around 3 eV. The elastic differential cross sections are compared with available theoretical models using the R-matrix method and the Schwinger multichannel method.

The detection of capsaicin and dihydrocapsaicin in horse serum following long-term local administration

Background

Capsaicin and dihydrocapsaicin are alkaloids with analgesic effects in humans and animals. When used locally, both of them minimalise pain sensation by defunctionalising nerve endings. According to the Federation Equestrian International Prohibited Substances List, these are substance banned in horse competitions. The aim of the study was to determine the detection time of capsaicin in both plasma and serum after long-term use of a gel recommended for commercial use and applied as intended. The objective of the study was to select the best material for the detection of capsaicin as a doping substance in horses.

Methods

Nine healthy mature horses were administered 0.1% capsaicin topically in the form of a commercial analgesic gel (15 g of the gel per limb) to the front limbs every 24 hours for five days with a polar fleece bandage. Blood serum and plasma were collected prior to gel application and in the 12th, 18th, 24th, 36th, 42nd, 48th, 60th, 84th, 108th, 132nd, 156th hour after the gel application. Qualitative and quantitative analysis was performed using ultra-high performance liquid chromatography coupled with a triple quadrupole mass spectrometry (UHPLC-QqQ-MS/MS).

Results

The concentration of capsaicin in the serum samples did not exceed the lower limit of quantification. Capsaicin was not detected in the plasma samples during the entire study period. Dihydrocapsaicin was not detected in blood serum or plasma.

Conclusion

The presented results suggest that capsaicin is not detected in horse serum in the 24-hour-periodfollowing its last application according to the dosage regimen used by owners and veterinarians for therapy rather than doping, based on a five day gel application and a polar bandage.

Dissociative electron attachment and anion-induced dimerization in pyruvic acid

We report partial cross sections for the dissociative electron attachment to pyruvic acid. A rich fragmentation dynamics is observed. Electronic structure calculations facilitate the identification of complex rearrangement reactions that occur during the dissociation. Furthermore, a number of fragment anions produced at electron energies close to 0 eV are observed, that cannot originate from single electron-molecule collisions. We ascribe their production to secondary reactions of the transient anions with neutral molecules. Such reactions turn out to be unusually efficient; the most probable reason for this is that they proceed via the formation of a double-hydrogen-bonded complex followed by an ultrafast proton transfer between the reaction partners.

Ternary mixtures of ionic liquids for better salt solubility, conductivity and cation transference number improvement

We hereby present the new class of ionic liquid systems in which lithium salt is introduced into the solution as a lithium cation-glyme solvate. This modification leads to the reorganisation of solution structure, which entails release of free mobile lithium cation solvate and hence leads to the significant enhancement of ionic conductivity and lithium cation transference numbers. This new approach in composing electrolytes also enables even three-fold increase of salt concentration in ionic liquids.

Lithium cation conducting TDI anion-based ionic liquids

In this paper we present the synthesis route and electrochemical properties of new class of ionic liquids (ILs) obtained from lithium derivate TDI (4,5-dicyano-2-(trifluoromethyl)imidazolium) anion. ILs synthesized by us were EMImTDI, PMImTDI and BMImTDI, i.e. TDI anion with 1-alkyl-3-methylimidazolium cations, where alkyl meant ethyl, propyl and butyl groups. TDI anion contains fewer fluorine atoms than LiPF6 and thanks to C-F instead of P-F bond, they are less prone to emit fluorine or hydrogen fluoride due to the rise in temperature. Use of IL results in non-flammability, which is making such electrolyte even safer for both application and environment. The thermal stability of synthesized compounds was tested by DSC and TGA and no signal of decomposition was observed up to 250 °C. The LiTDI salt was added to ILs to form complete electrolytes. The structures of tailored ILs with lithium salt were confirmed by X-ray diffraction patterns. The electrolytes showed excellent properties regarding their ionic conductivity (over 3 mS cm(-1) at room temperature after lithium salt addition), lithium cation transference number (over 0.1), low viscosity and broad electrochemical stability window. The ionic conductivity and viscosity measurements of pure ILs are reported for reference.

Should anastomotic assessment with flexible sigmoidoscopy be routine following laparoscopic restorative left colorectal resection?

AIM

The aim of the study was to evaluate the value of routine intra-operative flexible sigmoidoscopy (IOFS) for left-sided anastomotic integrity and to determine the safest step after a positive leak test.

METHOD

All consecutive patients undergoing left-sided colorectal resections for benign and malignant disease between August 2005 and April 2011 were included. Data regarding procedure, type of anastomosis and outcomes of IOFS were collected. A positive intra-operative leak test resulted in redoing the anastomosis and repeating the leak test.

RESULTS

A total of 415 consecutive patients underwent hand-assisted laparoscopic colorectal resection with a colorectal/ileoanal anastomosis. All patients underwent IOFS. Seventeen patients had abnormality on IOFS. Fifteen patients had a positive air leak test. One patient had anastomotic bleeding. There was one stapler misfiring. Fourteen anastomoses were redone without diversion. One patient required diversion to protect the ileoanal anastomosis and another had already been diverted. Minor bleeding from the staple line in one patient resolved without intervention; however, he had a postoperative anastomotic leak needing surgical intervention. None of the patients who had a takedown and refashioning of the anastomosis following a positive leak on IOFS had postoperative anastomotic leakage or bleeding. Our overall anastomotic leak rate was 2.1%.

CONCLUSIONS

Intra-operative flexible sigmoidoscopy for restorative colorectal resection is safe and reliable and should be performed routinely to assess anastomotic integrity and bleeding. Refashioning the anastomosis after formal takedown would obviate the risk of leakage and is our recommended method of managing intra-operative leaks.

Morphology of the Lingual and Buccal Papillae in Alpaca (Vicugna pacos) - Light and Scanning Electron Microscopy

The aim of this study was the description of the lingual and buccal papillae in adult alpaca (Vicugna pacos) by light and scanning electron microscopy (SEM). The tongue consisted of apex, body and root. Four types of lingual papillae (filiform, fungiform, conical and circumvallate) in addition to two types of buccal papillae were observed. The filiform papillae, some with secondary papillae, were distributed on both the corpus and apex of the tongue, with stratified epithelium, and layer of keratin coat were recognized. The short (small) cone papillae had pointed top, while bunoform papillae were wide with smooth apex. The much less numerous circumvallate papillae with pseudopapillae on the each rim of the caudal lingual body were present with weak layer of keratin and intra-epithelial taste buds. The small fungiform papillae were found on the dorsal lingual surface, while the large fungiform papillae were situated on the ventral surface of the tongue, especially, in rostral part and were round in shape with numerous gustatory pores and very thin keratin coat. Pseudopapillae were present on the buccal conical 'bunoform' papillae surface, while 'elongate' buccal papillae surface was rather softly folded with thin coat of keratin. Microridges were observed in the less keratinized parts of each type of papillae. The orientation of either lingual or buccal papillae into the throat side facilitates the emptying of oral cavity from nutrient and swallowing of food. In conclusion, the anatomical features of the alpaca tongue are an adaptation to the feeding habits.

Is hybrid robotic laparoscopic assistance the ideal approach for restorative rectal cancer dissection?

AIM

While the use of robotic assistance in the management of rectal cancer has gradually increased in popularity over the years, the optimal technique is still under debate. The authors' preferred technique is a robotic low anterior resection that requires a hybrid approach with laparoscopic hand-assisted mobilization of the left colon and robotic assistance for rectal dissection. The aim of this study was to determine the efficacy of this approach as it relates to intra-operative and short-term outcomes.

METHOD

Between August 2005 and July 2011, consecutive patients undergoing rectal dissection for cancer via the hybrid robotic technique were included in our study. Demographics, margin positivity, intra-operative and short-term outcomes were evaluated.

RESULTS

The preferred approach was performed in 77 patients with rectal adenocarcinoma. Of these, 68 underwent low anterior resection and nine had a coloanal pull-through procedure (mean age 60.1 years; mean body mass index 28.0 kg/m(2) ; mean operative time 327 min; conversion rate 3.9%). Three patients (3.9%) had positive resection margins (one circumferential, two distal). Five patients had an anastomotic leak (6.4%). No robot-specific complications were observed.

CONCLUSION

The hybrid approach involving hand-assisted left colon mobilization and robotic rectal dissection is a safe and feasible technique for minimally invasive low anterior resection. This approach can be considered an viable option for surgeons new to robotic rectal dissection.

Structural and optical properties of nano-sized K3Nd(PO4)2:Yb3+ orthophosphate

Nanocrystals of tripotassium neodymium bis-phosphate(V) doped with ytterbium ions, K3Nd(PO4)2: Yb3+, were synthesized by Pechini method. The obtained grains, having an average size of about 40 nm, were characterised by X-ray, electron microscopic, electron absorption, luminescence and IR studies. Moreover, fluorescence decay studies were carried out at room temperature. The energy transfer from the Nd3+ to Yb3+ was described and discussed. The results were compared to those of the K3Nd(PO4)2 bulk crystal.

Melatonin decreases homocysteine level in blood of rats

Elevated plasma homocysteine level promotes atherosclerosis in blood vessels due to, among others, generation of reactive oxygen species and reduction of nitric oxide bioavailability. The aim of this study was to investigate whether melatonin administration reduces plasma homocysteine level in rats consuming increased doses of methionine in the diet. The trial lasted for two months. The rats were divided into a few groups - 2 groups consisted of animals fed a standard diet, 2 groups consisted of animals fed a diet rich in methionine for one and two months, a group which had methionine removed from the diet in the second month, a group which had methionine removed from the diet and melatonin administered in the second month, a group still fed a diet rich in methonine in the second month and also given melatonin, and a group of animals on a diet rich in methionine for two months and given melatonin at the same time. Hcy, lipid peroxidation markers (MDA+4HNE) and nitric oxide metabolite (NO(2)(-)/NO(3)(-)) concentrations were determined in the plasma of all the rats. As a result of the tests it was found that plasma Hcy concentration increases in the first month of a methionine-rich diet but then decreases in the second month. MDA+4HNE changes are similar. Melatonin significantly intensifies the effects. The changes of NO(2)(-)/NO(3)(-) concentrations were noticed especially in the groups receiving melatonin. Elimination of methionine from the feed does not change the value of NO(2)(-)/NO(3)(-). NO production increases only after administration of melatonin. On the basis of received results it might be stated that melatonin administration together with a methionine-rich diet significantly decreases Hcy concentration, the level of oxidative stress and increases NO production. It might have some practical implications, especially when the level of endogenous melatonin decreases e.g. in elderly people or people with hyperhomocysteinemia.

Endoscopic study of the morphology of Vieussens valve

Vieussens valve (Vv) is the ostial valve of the great cardiac vein located near the beginning of the coronary sinus. Knowledge of its anatomy is important for several trans-sinus cardiologic procedures. The frequency of its presence is reported to vary from 65-87%. We documented the post mortem morphology of Vieussens valve in 50 unfixed, intact human coronary sinuses using endoscopy. We believe this is the first study of the anatomy of the coronary sinus and the adjacent venous ostia to employ this technique. Vieussens valve was observed in 78% of specimens. Special attention was given to the shape of the valve leaflets. Five morphological types of Vv were distinguished: single leaflet, flat (16%); single leaflet, concave (20%); double leaflet, flat (8%); double leaflet, concave (32%); and triple leaflet, concave (2%). We found post mortem endoscopy of the coronary sinus to be a good and reliable method of visualizing Vieussens valve.