The pandemic caused by SARS-CoV-2 has affected communities throughout the world. The global nature of health care disparities is exacerbated by COVID-19. Patients in Low-and Middle-Income Countries have limited health care resources and marginal support for the evaluation and treatment of cardiac rhythm disorders. Heart Rhythm Societies and their members need to advocate for increased subsidies and assistance for these patients.
We report implementation of a hierarchical equations of motion (HEOM) module within the open-source Libra software. It includes the standard and scaled HEOM algorithms for computing the dynamics of open quantum systems interacting with a harmonic bath. The module allows computing evolution of the reduced density matrix as well as spectral lineshapes. The truncation, filtering, and “update list” schemes as well as OpenMP parallelization allow for further computational saving. The package is written in a mix of C++ and Python languages, delivering the best compromise between user friendliness and efficiency. The Python layer of the package takes advantage of standard Python libraries, such as h5py which allows efficient storage and retrieval of the generated results. The package can be seamlessly used within Jupyter notebooks; its careful design shall provide the maximal convenience and intuitiveness to its users.
Congenital superior vena cava (SVC) stenosis is a very rare anomaly especially in pediatric population. Co-existence with obstructed supracardiac total anomalous pulmonary venous connection (TAPVC) has never been reported. Clinical examination should prompt detailed and focused evaluation for this treatable etiology. SVC stenosis, although causing SVC syndrome, may decrease the severity of pulmonary venous hypertension by limiting the amount of blood in obstructed common chamber. Pericardial patch augmentation can cure SVC stenosis, and may allow for growth potential as well. We describe a case of congenital SVC stenosis in a case of obstructed supra-cardiac TAPVC in a 3 month old infant, managed successfully.
We report a case of refractory life-threatening warm autoimmune hemolytic anemia (wAIHA) associated with chronic myelomonocytic leukemia (CMML) for which all conventional treatments had failed. The use of eculizumab allowed controlling hemolysis and resulted in transfusion independence. These data support the use of eculizumab in refractory wAIHA.
Background. We sought to determine the relationship between tricuspid right ventricular (RV) and tricuspid valve (TV) remodeling and late failure of tricuspid annuloplasty. Methods. From May 2009 to December 2015, 423 patients undergoing tricuspid annuloplasty (TA) for functional TR at a single were analyzed. Residual TR was defined TR moderate-or-more at discharge. Recurrent TR was defined TR-moderate-or-more at follow up. RV remodeling was defined RV dysfunction and/or dilatation. Results. Residual TR after TA was recorded in 54. Five-year freedom from TR recurrence was 86.3±2.3% for patients without residual TR vs 57.6±7.6% for patients with residual TR, p<0.001. Evaluating late results of 369 patients without residual TR, following risk factors were identified: preoperative pulmonary pressure, pre RV remodeling, pre TR and TV remodeling, functional mitral regurgitation. Conclusions. Prophylactic tricuspid annuloplasty should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.
Antigenic competition in the skin is a phenomenon in which the current dermatitis is distributed away from the area of previously existing dermatitis. We experienced antigenic competition-like phenomenon in bullous pemphigoid. Our case differs from typical presentations of antigenic competition, since the responsible antigen was the same.
Aims: To determine if the combination of exercise and statin could normalize postprandial triglyceridemia (PPTG) in hypercholesteraemic individuals. Mehods: Eight hypercholesteraemic (blood cholesterol 182±38 mg·dL-1; LDL-c 102±32 mg·dL-1) overweight (BMI 30±4 kg·m-2) individuals with metabolic syndrome (i.e., Met Synd) were compared to a group of eight metabolically healthy controls (i.e., MetH, blood cholesterol 149±23 mg·dL-1; LDL-c 77±23 mg·dL-1, and BMI 23±2 kg·m-2). Each group underwent two PPTG tests, either 14-h after a bout of intense exercise (EXER) or without previous exercise (REST). Additionally, Met Synd individuals were tested 96 h after withdrawal of their habitual statin medication (PLAC trials) to study medication effects. Results: A bout of exercise before the test meal did not reduce PPTG in Met Synd (P=0.347), but reduced PPTG by 46% in MetH (224±142 to 413±267 mg·dL-1·for 5 h iAUC; P=0.02). In both trials (i.e., REST and EXER) statin withdrawal in Met Synd greatly increased PPTG (average 65%; P<0.01), mean LDL-c (average 25%; P<0.01), total cholesterol (average 16%; P<0.01) and Apo B48 (24%; P<0.01), without interference from exercise. However, Apo B100 was not affected by statin withdrawal. Conclusions: Hypercholesteraemic Met Synd individuals (compared to metabolically healthy controls) are resistant to the effects of exercise on reducing PPTG. However, chronic statin medication blunts the elevations in TG after a fat meal (i.e., iAUC of PPTG) reducing their cardiovascular risk associated to their atherogenic dyslipidemia. Statin decreases PPTG by reducing the secretion or accelerating the catabolism of intestinal Apo B48.
A 53 year old man presented with symptomatic severe pulmonary valve regurgitation. He underwent a diagnostic catheterization. A heavily calcified pericardium and the pressure tracings illustrate typical features of constrictive pericarditis physiology. This condition is important to recognize given the progressive nature and poor prognosis when left untreated.
Ranaviruses can infect both captive and wild cold-blooded vertebrates, leading to significant economic and environmental losses. With the cases of ranavirus infection increasing, many ranavirus genomic sequences were published, but little is known about ranavirus taxonomy on a whole genome level. In this study, 44 ranaviruses core genes were identified in 32 ranaviruses genome suquences by using PanX. The Neighbor joining phylogenetic trees (NJ-tree) based on 44 ranaviruses core genes and 24 iridoviridae core genes and composition vector phylogenetic tree (CV-Tree) based on whole genome were constructed. The three of phylogenetic trees showed that 32 ranavirus isolates can be divided to 4 different subspecies including GIV-like, EHNV-like, FV3-like and CMTV-like, and subspecies taxonomic position of three phylogenetic trees were consistent. However, the phylogenetic position of ToRV could not be determined if it belongs to FV3-like or CMTV-like group. Subsequently, we carried out dot plot analysis and confirmed that ToRV should belong to CMTV-like group. Based on dot plot analysis and phylogenetic trees, taxonomic classification of ranaviruses were confirmed. Finally, 4 genes which are suitable for the construction of phylogenetic tree were selected from ranavirus core genes by recombination analysis, substitution saturation analysis and single-gene phylogenetic analysis. Phylogenetic tree based on concatenated sequences of the 4 selected genes showed that classification of subspecies was identical with 3 of the phylogenetic trees. Conclusion: our results confirmed taxonomic identification of ranaviruses, the 4 selected genes used in phylogenic analysis will make taxonomic identification more convenient and accurate.
ABSTRACT Purpose In our study, we aimed to evaluate the sleep disorders, sleep quality of the patients who applied to family health centers, to determine the situations that might be related with insomnia and to determine the insomnia rates of the general population in primary care. Methods This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Center policlinics. The study population consisted of all patients over 18 years of age who were admitted to the family health centers for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality index and insomnia severity scales were collected by the researchers from October to December 2017 using face-to-face interview method. Results 299 people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Scale, it was found that 27.1% of the participants’ sleep quality was good and 72.9% of them were poor; according to the Berlin sleep questionnaire, 27.4% had high OSAS risk and 72.2% had a low OSAS risk. According to total Insomnia Severity Index, 27.1% had insomnia lower threshold, 15.4% had moderate insomnia, 3.7% severe insomnia was detected. Conclusions In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary health care institutions and the other patients to be delivered to the related upper levels.
Extra Corporeal Membrane Oxygenation (ECMO) is a supportive therapy used to provide cardiac support with or without respiratory support in the event of cardiopulmonary failure. The two main types of ECMO are Veno-arterial ECMO (VA-ECMO) and Veno-venous ECMO (VV-ECMO). The use of ECMO in cardiac surgery has been established in cases of post-cardiotomy cardiogenic shock which is refractory to conventional therapy with inotropes and intra-aortic balloon pulsation support. Survival for this, otherwise, fatal condition has been shown to be improving through the use of ECMO. However, the decision and timing to initiate ECMO therapy remains selective and is dependent on a range of factors such as patient factor, clinician’s judgement, meaning there is no consistent and solid ground regarding the timing of ECMO initiation. This article will provide an extensive review of ECMO indications, contraindications, complications and outcomes to analyse the survival benefit of ECMO following cardiac surgery.
Filippos-Paschalis R et al1 described a very interesting and unique case of ectopic hepatocellular carcinoma (HCC) in the adrenal gland with inferior vena cava thrombosis and right atrial extension. The patient developed respiratory failure and required an urgent operation. The right adrenal gland was removed through the abdominal approach, but cardiopulmonary bypass (CBP) was needed in removing the right atrium extension. The ascending aorta, superior vena cava, and the right femoral vein were cannulated for arterial and venous access, respectively. They achieved systemic hypothermia (250 C), and antegrade cold cardioplegia was administered. The aorta was cross-clamped, and another vascular clamp was placed between the left common carotid artery and left subclavian artery. The adrenal gland, the right atrium tumor, and IVC tumor thrombus were removed successfully. During the placement of the venous cannulas, the authors were very careful to avoid dislodging the tumor thrombus. The surgery was meticulously planned, and the patient had an uneventful post-operative course.Ectopic hepatocellular carcinoma in the adrenal gland is a very rare tumor, but all adrenal tumors can extend into the IVC and even into the right atrium.2,3 Of note, renal cell carcinoma (RCC) can have the same behavior of vascular extension into the IVC and right atrium.4 Once these tumors extend into the IVC and go into the chest, hepatic veins can be obstructed, causing Budd-Chiari syndrome (BCS).5 Figure 1 showed that hepatic veins and IVC were dilated and obstructed; thus, the patient probably had BCS in this situation. Under such condition, the use of CPB is a must in order to remove the tumor from the hepatic vein and to avoid liver congestion. Also, the patient presented to the emergency department with signs and symptoms of pulmonary emboli (PE). Some of these patients can present with PE, which is a tumor thrombus that embolizes into the pulmonary arteries. In some cases the PEs also need to be removed if it is safe for the patient.6The use of CPB is indicated in cases like the one described by Filippos-Paschalis et al.1 The tumor was probably too bulky to be removed without the use of CBP; otherwise, the risk of … developing with the use of CBP may be unacceptably high. There are select cases of RCC and adrenal HCC with tumor thrombus extension which can be removed safely from the right atrium and IVC without the use of CPB.2,7,8 It is important to remember that these tumors do not cause thrombosis of the IVC, as the tumor thrombus (different from thrombosis) extends into the IVC. Tumor thrombus can cause blood thrombosis below its location,9 making it difficult to be able to place a cannula in the femoral veins.These complex extreme surgeries usually require a multidisciplinary team or a transplant surgeon who specializes in approaching these types of cases.
The polysaccharidic mucilage is a widespread plant trait with diverse features, often present around plant structures in contact with the environment, providing numerous functions including protection and adhesion. In myxodiasporous species, a mucilage is released upon the imbibition of the seed (myxospermy) or the fruit (myxocarpy), and therefore can play roles in the early seedling stages. It is unclear whether myxodiaspory has one or multiple evolutionary origins and why it disappeared in several species. Here, we summarize the recent advances on (i) the mucilage and mucilage secretory cell diversity, (ii) the evolution of the molecular actors involved in myxospermy underlying the observed inter- and intra-species natural diversity and (iii) the recently identified ecological functions. At the intra-species level, a high polymorphism was detected for a few genes in relation to the observed morphological diversity. Well characterized transcriptions factors interact in master regulatory complexes to balance carbon partitioning in Arabidopsis thaliana seeds. These transcription factors were sequentially recruited during seed plant evolution to control diverse traits including myxospermy, and their functions in seeds seem to be conserved across Rosids. Historically, the ecological functions of seed mucilage were mostly related to germination and seed dissemination but recently some exosystemic functions were uncovered such as soil micro-organism control and plant establishment support.
Ataxia-telangiectasia (A-T) is a multi-system disorder, resulted from the mutation in the ATM gene. Its mortality is largely related to some other disorders. Therefore, the management of its complications significantly improves patient quality of life. We studied a pediatric patient with A-T who one of his relatives had A-T.
Background and Aim Endoscopic radial artery (RA) harvest (ERAH) is an alternative to open RA harvest (ORAH) technique. Our aim was to compare clinical outcome, patent satisfaction and 1-year angiographic patency rates after ERAH and ORAH. Patients and methods 50 patients undergoing multivessel CABG were prospectively randomized to two groups. In the ERAH group (25 patients) the RA was harvested endoscopically and in the ORAH group (25 patients) openly. Results There were not differences between the groups in preoperative characteristics. Length of skin incision was shorter in ERAH (p<0.001) but there were not differences in the length of RA, harvest time, blood flow and pulsatility index after ERAH and ORAH. Wound healing was uniformly smooth in ERAH and there were 2 haematomas and 1 infection in ORAH. Postoperatively, major neuralgias were present in 5 patients in ORAH and none in ERAH (p=0.05) and minor neuralgias in 11 and 3 patients (p=0.02) respectively. Twenty-four patients in ERAH and 4 in ORAH graded their experience as excellent (p<00001). One-year angiographic RA patency was 90% without intergroup difference. Target vessel stenosis < 90% adversely affected RA patency (p<0.0001). Conclusions In expert center, ERAH has no negative impact on time harvest, length and quality of RA conduit. Moreover, ERAH may provide better wound healing, and is associated with less neuralgias, excellent cosmetic result and better patient satisfaction. RA graft patency is unaffected by the harvesting technique and is excellent when placed to a target coronary artery vessel with stenosis > 90%.
The coronavirus disease 2019 (COVID-19) is an infectious disease which has rapidly evolved into a pandemic. Though it has affected all disciplines of medical sciences but it has some serious implications pertaining to cardiovascular sciences which have presented unique challenges in front of cardiac surgeons in particular. To flatten the curve of this pandemic, routine cardiac surgeries are being deferred indefinitely resulting in the pool of sick cardiac patients rising day by day. A different perspective is presented on this global catastrophe from the viewpoint of a cardiac surgeon.
Device embolization is a rare major complication of atrial septal defect percutaneous closures that requires surgical management if non-invasive retrieval fails. We report a symptomatic delayed embolization of an Amplatzer septal occluder device into the left ventricle outflow tract tangled with the mitral valve, complicated with ventricular arrhythmias and cardiac tamponade during percutaneous retrieval attempt. Emergent surgical treatment was performed, requiring combined approach through the right atrium and the aorta for surgical removal.