Balloon aortic valvuloplasty (BAV) is frequently utilized for selected high-risk patients who cannot be immediate candidates for transcatheter aortic valve replacement. We describe a case of high-risk retrograde BAV performed safely with a newly invented Inoue balloon with stable fixation and multistage inflation characteristics, without any rapid ventricular pacing requirements.
In this research study, fuzzy fractional differential equations in presence of the Atangana-Baleanu-Caputo differential operators are analytically and numerically treated using extended reproducing Kernel Hilbert space technique. With the utilization of a fuzzy strongly generalized differentiability form, a new fuzzy characterization theorem beside two fuzzy fractional solutions is constructed and computed. To besetment the attitude of fuzzy fractional numerical solutions; analysis of convergence and conduct of error beyond the reproducing kernel theory are explored and debated. In this tendency, three computational algorithms and modern trends in terms of analytic and numerical solutions are propagated. Meanwhile, the dynamical characteristics and mechanical features of these fuzzy fractional solutions are demonstrated and studied during two applications via three-dimensional graphs and tabulated numerical values. In the end, highlights and future suggested research work are eluded.
Peptides that bind to and are presented on the cell surface by Human Leukocyte Antigens (HLA) molecules play a critical role in adaptive immunity. For a long time, it was believed all of the HLA bound peptides were generated through simple proteolysis of linear sequences of cellular proteins, and therefore, are templated in the genome and proteome. However, evidence for untemplated peptide ligands of HLA molecules has accumulated over the last two decades, with a recent global analysis of HLA-bound peptides suggesting that a considerable proportion of HLA bound peptides are potentially generated through splicing/fusion of discontinuous peptide segments from one or two distinct proteins. In this review, we will review recent discoveries and debates on the contribution of spliced peptides to the HLA class I immunopeptidome, consider biochemical rules for splicing, and the potential role of these spliced peptides in immune recognition.
Background Claims of influenza vaccination increasing COVID-19 risk are circulating. Within the I-MOVE-COVID-19 primary care multicentre study, we measured the association between 2019–20 influenza vaccination and COVID-19. Methods We conducted a multicentre test-negative case-control study at primary care level, in study sites in five European countries, from March–August 2020. Patients presenting with acute respiratory infection were swabbed, with demographic, 2019–20 influenza vaccination and clinical information documented. Using logistic regression we measured the adjusted odds ratio (aOR), adjusting for study site and age, sex, calendar time, presence of chronic conditions. The main analysis included patients swabbed ≤7 days after onset from the three countries with <15% of missing influenza vaccination. In secondary analyses, we included five countries, using multiple imputation with chained equations to account for missing data. Results We included 257 COVID-19 cases and 1631 controls in the main analysis (three countries). The overall aOR between influenza vaccination and COVID-19 was 0.93 (95% CI: 0.66–1.32). The aOR was 0.92 (95% CI: 0.58–1.46) and 0.92 (95%CI: 0.51–1.67) among those aged 20–59 and ≥60 years, respectively. In secondary analyses, we included 6457 cases and 69272 controls. The imputed aOR was 0.87 (95% CI: 0.79–0.95) among all ages and any delay between swab and symptom onset. Conclusions There was no evidence that COVID-19 cases were more likely to be vaccinated against influenza than controls. Influenza vaccination should be encouraged among target groups for vaccination. I-MOVE-COVID-19 will continue documenting influenza vaccination status in 2020-21, in order to learn about effects of recent influenza vaccination.
The role of isolation of left posterior wall in patients with persistent atrial fibrillation on top of pulmonary vein isolation is still debatable. There are still technical issues for achieving complete left posterior wall isolation and durability of the lesions is probably the main limiting factor for promoting a successful clinical outcome
Non-A non-B aortic dissections are an infrequent occurrence and represent a small proportion of aortic dissections. Treating this life-threatening medical emergency often requires surgeons to undertake some one of the most challenging surgical or endovascular cases in medicine. This literature review aims to define and classify non-A non-B dissections, describe their epidemiology as well as their pathology. This review also aims to discuss the range of surgical techniques employed in their treatment and management and to investigate the patient outcomes associated with each technique.
Our analysis as described in this research letter highlights the fact that age outweighs many other factors in people with T2DM in relation to mortality from SARS-CoV-2 virus, once infected. This fact should be taken into account in relation to the vaccination programme against coronavirus-19 in people with T2DM in the UK and elsewhere.
Following the emergency use authorization of the vaccine mRNA-1273 on 18th December 2020 in the US and the vaccine BNT162b2 one week earlier, two mRNA vaccines are in currently used for the prevention of coronavirus disease 2019 (COVID-19). Phase 3 pivotal trials on both vaccines excluded individuals with a history of allergy to vaccine components. Immediately after the initiation of vaccination in the United Kingdom, Canada, and in the US, anaphylactic reactions have been reported. While the culprit trigger requires investigation, initial reports suggested the excipient polyethylene glycol 2000 (PEG-2000), which is contained in both vaccines as PEG-micellar carrier system as the potential culprit. Surface PEG chains form a hydrate shell to increase stability and prevent opsonization. Allergic reactions to such PEG-ylated lipids are rarely IgE-mediated, but may result from complement activation-related pseudoallergy (CARPA) that has been described to similar liposomes. In addition, mRNA-1273 also contains tromethamine (trometamol), which has been reported to cause anaphylaxis to e.g. gadolinium-based or iodinated contrast media. Skin prick-, intradermal-, epicutaneous- tests, in vitro sIgE assessment, evaluation of sIgG/IgM, as well as basophil activation test are in use to demonstrate allergic reactions to various components of the vaccines.
Invasion in cardiac surgery is maximum when cardiopulmonary bypass(CPB) is used. The period is of no consequence as all complications such as Bleeding, Cerebral. Renal , vascular and Inflammatory responses are initiated when CPB is used. The term minimally invasive is therefore most inappropriate when CPB is used irrespective of the type of operation, incision, cosmesis, and use of sophisticated technology.This editorial highlights the misuse of the term Minimally invasive cardiac surgery.
BOOK REVIEW: Technical Aspects of Modern Coronary Artery BypassRobert F Tranbaugh, MDDepartment of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NYData Availability: NAFunding: NoneConflict of Interest: NoneInternational Review Board: NAInformed Consent: NACorresponding author:Robert F Tranbaugh, MDDepartment of Cardiothoracic SurgeryWeill Cornell Medicine505 East 68th StreetNew York, NY 10065Rft9008@med.cornell.eduWord Count: 484After recently purging most of my reference textbooks (many from the 1970’s and 1980’s and including the big names from the “Golden Age” of cardiac surgery—Glenn, Sabiston and Kirklin), I wondered if the era of the well-recognized, authoritative textbook was over. I actually cannot remember the last textbook I purchased. While a resident at UCSF, textbooks were critically important as the library closed at midnight. I grew up with the “red book”, Dunphy and Way’s “currentSurgical Diagnosis and Treatment”. This paperback nicely covered the basics of surgery and, importantly, was readily available for residents well before Google. Primarily for sentimental reasons, I kept my 1983 edition.So, why a surgical textbook in 2021? What is the appeal, attraction and need?Gaudino’s “Technical Aspects of Modern Coronary Artery Bypass Grafting” has enormous appeal. For one, it is beautifully illustrated with very useful drawings along with attractive and detailed operative photos. At times, I felt like I was visiting the author-surgeon in his or her operating room. The world’s leading experts have provided detailed step by step technical instructions, which are clear, concise and very helpful. For cardiac surgeons considering starting a multiple arterial grafting (MAG) program, this textbook is a needed and wonderful resource.The attractions of Gaudino’s testbook are many. First, “Technical Aspects” clearly reflects Gaudino’s stellar and highly productive career as an investigator and practitioner of MAG. He has systematically addressed the details of MAG. Conduit selection, harvest and utilization are all outlined in exquisite step by step detail. Complex grafting techniques are reviewed and beautifully illustrated. I especially enjoyed Chapter 12 by Rocha and his colleagues on their nicely done essay on the proximal anastomosis, or what I consider to be “the forgotten anastomosis”. The authors review the many important technical details and critical issues impacting the patency of a bypass graft.All of the chapters are well written, beautifully illustrated, highly practical and very helpful for residents in training, for early career surgeons and for well-established cardiac surgeons interested in coronary artery bypass. Gaudino should also be commended for the addition of Chapter 23 by Fremes and Tatoulis on the management of perioperative ischemia and Chapter 24 by Lazar on optimizing medical therapy. These are incredibly important chapters on “non-technical” yet critical issues with excellent recommendations.Gaudino’s “Technical Aspects” is a clearly needed and a highly authoritative textbook which will serve as an excellent roadmap for surgeons interested in starting a MAG program. It hopefully will allow surgeons to move from the “house special” CABG (one internal mammary and veins) mentioned by Girardi in his thoughtful Foreward to more arterial grafting performed with greater confidence and commitment. “Technical Aspects” will also serve as an important resource for surgeons at all levels of training and expertise. I currently have lots of room on my near empty book shelf. “Technical Aspects” will be on my book shelf and belongs on yours!
Mitral valve (MV) repair for mitral regurgitation (MR) due to posterior leaflet (PL) prolapse is achieved nowadays with a great success rate and a good survival, similar, in certain subgroups. In this paper, Sakaguchi et al describe their results in two groups of patients with PL prolapse. Some patients underwent resection (resection group) and others chordal replacement with/out limited resection (respect group). Results were similar in terms of survival and MR recurrence. Our goal is to eliminate, as much as possible, MR when a patient with degenerative MR is operated on. Reduction of the mitral orifice and consequently an increase of the transmitral gradient is the rule. MV repair for degenerative MR provides great results, but there is not a single surgical technique. A close evaluation of the anatomical findings will allow us to choose the best strategy for the individual patient. An open mind is the most important characteristic that a surgeon should have to repair a prolapsing PL without residual regurgitation and dangerous gradients.
Large studies demonstrated that moderate or severe patient-prosthesis mismatch (PPM) occurs in 44.2% to 65% of patients undergoing aortic valve replacement. If there is general agreement that patients with PPM have worse outcome than patients without, it is difficult to understand how to prevent this dangerous complication. The formula used to calculate the effective orifice area (EOA) of an implanted aortic prosthesis has many weak points that produce inconsistent results using the same prosthetic valve (type and size). The observed EOA (3 to 6 months postoperatively) of a #23 biological prosthesis can range from 0.9 to 3.5 cm², making PPM prevention impossible using projected EOA, where only the mean value is reported (1.83 cm² for the same #23 biological prosthesis). An EACTS-STS-AATS Valve Labelling Task Force has been established to suggest the manufacturers to present essential information on valvular prosthesis characteristics in standardized Valve Charts. For valves used in the aortic position, Valve Charts should include a standardized PPM chart to assess the probability of PPM after implantation. This will not solve completely the conundrum of prevention, but most likely it will be a step ahead.
Background: Hepatic metastasis from retinoblastoma (RB) is rare. We evaluated clinical features, imaging manifestations, treatment, and prognosis in these patients. Procedure: Clinical data of five patients diagnosed with hepatic metastases of RB at the Department of Pediatrics in Beijing Tongren Hospital between January 2009 and January 2019 were analyzed retrospectively. Results: Two patients had bilateral lesions, while three had unilateral lesions. Among the seven eyes with lesions, six and one were classified as stage E and C, respectively (International Integrated Reporting Council staging). On computed tomography (CT), low-density foci were observed (three, multiple foci and two, single foci). After chemotherapy, tumor regression was observed in four patients, while there was no response in one patient. Three patients who underwent enucleation were at high risk for extensive choroidal invasion. All patients had severe disease with multiple system involvement, including central nervous system (CNS) and bone metastases. Neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels were significantly elevated in all patients; after treatment, they decreased in four patients and remained unchanged in one patient with end-stage disease. Two patients died, with survival durations of 1 and 3 months following the diagnosis of hepatic metastasis. Three patients survived and continued treatment. Conclusion: Hepatic metastasis from RB is rare and usually occurs with CNS and bone metastases. On CT, hepatic foci could be indicated by low-density lesions with calcification. Chemotherapy could be effective for hepatic metastases. The prognosis of these patients is poor; however, hepatic metastasis is not a direct cause of death.
Cryptococcosis is one of the common mycological conditions leading to morbidity and mortality in patients with AIDS. We are presenting a case of disseminated cryptococcosis in a patient infected with human immunodeficiency virus (HIV-1), which were both diagnosed postmortem using Minimally Invasive Tissue Sampling Method.
Lorlatinib is a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) designed to penetrate the blood brain barrier. We report 2 cases of patients with ALK-rearrangement non-small cell carcinoma associated with severe symptomatic CNS metastases and poor performance status. Treatment with lorlatinib improved their neurological condition and performance status.
We presented an unusual case of iatrogenic esophageal perforation(EP) following trans-esophageal echocardiography(TEE) in a patient with COVID-19.Force applied during the intubation on an inflammatory and fragile wall caused by COVID-19 probably represented the underlying condition that contributed to the EP.Early diagnosis and urgent treatment are essential for a favorable prognosis