A Wolf in Sheep's Clothing: A Case of Dilated Cardiomyopathy Presenting with Nonspecific Digestive Symptoms: Insights into Nonocclusive Mesenteric Ischemia

We report on a 32-year-old male patient who presented to the emergency room for abdominal pain associated with nausea and vomiting. The patient experienced these symptoms for the last 3 months and was taken in charge on an outpatient basis. Assessment in the emergency room showed hemodynamic collapse, there were no signs of acute surgical abdomen. Emergent cardiac echogram showed severely dilated hypokinetic cardiomyopathy. The diagnosis of acute heart failure associated with nonocclusive mesenteric ischemia was retained. A review of the pertinent literature is presented

The Apparent and the Effective PR Interval, Insights for Cardiac Pacing

A 75-year-old-male patient with dual chamber pacemaker presented with a bizarre EKG showing a unique spike within the QRS complex. Apparent PR interval was 160 ms and effective atrio-right ventricular delay was 210 ms due to right bundle branch block. Sensed AV delay was set at 180 ms causing pseudofusions. Insights regarding cardiac pacing are presented

Assessment of Ventricular Pacing in the Setting of an Institutional Improvement Program: Insights into Physiological Pacing

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Electrocardiographic Characteristics of Ventricular Arrhythmia Originating from the Left Coronary Cusp

Aortic cusps originating arrhythmias are rare; they have special electrocardiogram features that help to locate the site of origin. We report on a 20-year-old male patient without structural heart disease presenting with accelerated idioventricular rhythm; electrocardiogram analysis was typical of left coronary cusp origin

CXCR2 Inhibition Combined with Sorafenib Improved Antitumor and Antiangiogenic Response in Preclinical Models of Ovarian Cancer

The authors thank Drs. Kar-Ming Fung and Muralidharan Jayaraman, and Ms. Sheeja Aravindan for their help with the IHC experiments. The authors also thank the OUHSC Histology and Molecular Imaging Cores for their service and technical assistance.Antiangiogenic therapy is important for the treatment of gynecological cancer. However, the therapeutic benefit derived from these treatments is transient, predominantly due to the selective activation of compensatory proangiogenic pathways that lead to rapid development of resistance. We aimed to identify and target potential alternative signaling to anti-vascular endothelial growth factor (VEGF) therapy, with a view toward developing a combination of antiangiogenic agents to provide extended therapeutic benefits. We developed a preclinical in vivo phenotypic resistance model of ovarian cancer resistant to antiangiogenic therapy. We measured dynamic changes in secreted chemokines and angiogenic signaling in tumors and plasma in response to anti-VEGF treatment, as tumors advanced from the initial responsive phase to progressive disease. In tumors that progressed following sorafenib treatment, gene and protein expression levels of proangiogenic CXC chemokines and their receptors were significantly elevated, compared with responsive tumors. The chemokine (C-X-C motif) ligand 8 (CXCL8), also known as interleukin-8 (IL-8) increase was time-dependent and coincided with the dynamics of tumor progression. We used SB225002, a pharmacological inhibitor of chemokine (C-X-C motif) receptor 2 (CXCR2), to disrupt the CXC chemokine-mediated functions of ovarian cancer cells in in vitro assays of cell growth inhibition, spheroid formation, and cell migration. The combination of CXCR2 inhibitor with sorafenib led to a synergistic inhibition of cell growth in vitro, and further stabilized tumor progression following sorafenib in vivo. Our results suggest that CXCR2-mediated chemokines may represent an important compensatory pathway that promotes resistance to antiangiogenic therapy in ovarian cancer. Thus, simultaneous blockage of this proangiogenic cytokine pathway using CXCR2 inhibitors and the VEGF receptor (VEGFR) pathway could improve the outcomes of antiangiogenic therapy.Yeshttp://www.plosone.org/static/editorial#pee

Predictors of Undiagnosed and Uncontrolled Hypertension in the Local Community of Byblos, Lebanon

Objective: This study aimed to determine the prevalence and predictors of undiagnosed and uncontrolled hypertension (HTN) in a local community in Lebanon. Design and methods: In this cross-sectional study, we interviewed 911 adults in the local community of Byblos, Lebanon, and 691 were enrolled in the study. Blood pressure (BP), height, and weight were measured. The diagnosis of HTN was based on the 2013 European Society of Hypertension (ESH)/ European Society of Cardiology (ESC) guidelines (systolic BP ⩾140 mm Hg and/or diastolic BP ⩾90 mm Hg). The data collected were analyzed using “Statistical Package for the Social Sciences” software (SPSS). Results: A total of 260 participants were found to be hypertensive, either previously diagnosed or undiagnosed, yielding an overall prevalence of HTN of 37.62%. Of these participants, 149 (57.31%) were previously diagnosed and had controlled BP, and 111 (42.69%) had undiagnosed or uncontrolled HTN. Of these 111 participants, 44 had undiagnosed HTN and 67 were previously documented as hypertensive but had uncontrolled BP. Younger age and the absence of associated cardiovascular comorbidities were found to be associated with undiagnosed HTN, whereas high body mass index, smoking, and nonadherence to therapy were found to be associated with uncontrolled HTN. Conclusion and implications: This study revealed a relatively high prevalence of HTN in the studied population, along with a high prevalence of undiagnosed and uncontrolled HTN. These findings emphasize the need for wider and more efficient screening strategies to better diagnose and control HTN in the general population

Conservative Management of Skin Fistula Occurring After Internal Cardioverter Defibrillator Replacement

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Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the "Right Way" to Explore the Forgotten Chamber

Background The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber. Objective We sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography. Methods A MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed. Results A RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S′) 45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography. Conclusion Accurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy