Aorto-atrial fistula formation and therapy

Aorta-atrial fistulas (AAF) are a rare but complex pathological condition. These fistulas are characterised by aberrant blood flow between the aorta and either atrium. In the present manuscript, we present a comprehensive overview of the clinical characteristics, formation and treatment of this condition. A literature review was conducted using PubMed. Aorta-Atrial Fistula was used as the primary search term. The clinical presentation of AAF encompasses a wide range of signs and symptoms of heart failure including dyspnoea, chest pain, palpitations, fatigue, weakness coughing or oedema. Causes of fistulas can be congenital or acquired, whilst diagnosis is normally achieved via echocardiography or MRI. Due to the low incidence of AAF, no clinical trials have been performed in AAF patients and treatment strategies are based on expert opinion and consensus amongst the treating physicians. Uncorrected AAF may continue to impose a risk of progression to overt heart failure. The repair of an AAF can either be surgical or percutaneous. AAF is a relatively rare but very serious condition. Clinicians should consider the possibility of AAF, when a new continuous cardiac murmur occurs, especially in patients with a history of cardiac surgery or with signs of heart failure. Closure of the AAF fistula tract is generally recommended. Further studies are required to define optimal therapeutic strategies, but these are hindered by the rarity of the occurrence of this disorde

Aorto-atrial fistula formation and closure: a systematic review

Blood flow between the aorta and atrium is a rare but complex pathological condition, also known as aorto-atrial fistula (AAF). The exact incidence of this condition is unknown, as are the major precipitating factors and best treatment options. We carried out a systematic review of the available case report literature reporting AAF. We systematically reviewed literature on AAF formation and closure. Separate Medline (PubMed), EMBASE, and Cochrane database queries were performed. The following MESH headings were used: atrium, ventricle, fistula, cardiac, shunts, aortic, aorto-atrial tunnels and coronary cameral fistula. All papers were considered for analysis irrespective of their quality, or the journal in which they were published. Fistula formation from the ascending aorta to the atria occurred more often in the right atrium compared to the left. Endocarditis was the major cause of AAF formation, whilst congenital causes were responsible for nearly 12%. In a number of cases fistula formation occurred secondary to cardiac surgery, whilst chest traumas were a relatively rare cause of AAF. Correction via an open surgical approach occurred in 73.5% of cases, whilst percutaneous intervention was utilised in 10% of patients. In 74.3% of all studied cases the fistula repair was successful and patients survived the procedures. In 14.7% of the cases patients did not survive. Similar outcomes were observed between percutaneous and surgical interventions. Data from larger populations with AAF is lacking, meaning that specific data regarding incidence and prevalence does currently not exist

Interspecies and intraspecies transmission of triple reassortant H3N2 influenza A viruses

The triple reassortant H3N2 viruses were isolated for the first time from pigs in 1998 and are known to be endemic in swine and turkey populations in the United States. In 2004, we isolated two H3N2 triple reassortant viruses from two turkey breeder flocks in Ohio and Illinois. Infected hens showed no clinical signs, but experienced a complete cessation of egg production. In this study, we evaluated three triple reassortant H3N2 isolates of turkey origin and one isolate of swine origin for their transmission between swine and turkeys. Although all 4 viruses tested share high genetic similarity in all 8 genes, only the Ohio strain (A/turkey/Ohio/313053/04) was shown to transmit efficiently both ways between swine and turkeys. One isolate, A/turkey/North Carolina/03, was able to transmit from pigs to turkeys but not vice versa. Neither of the other two viruses transmitted either way. Sequence analysis of the HA1 gene of the Ohio strain showed one amino acid change (D to A) at residue 190 of the receptor binding domain upon transmission from turkeys to pigs. The Ohio virus was then tested for intraspecies transmission in three different avian species. The virus was shown to replicate and transmit among turkeys, replicate but does not transmit among chickens, and did not replicate in ducks. Identifying viruses with varying inter- and intra-species transmission potential should be useful for further studies on the molecular basis of interspecies transmission

Docetaxel Induced Toxic Erythema of Chemotherapy: A Case Report

Toxic erythema of chemotherapy (TEC) refers to a group of chemotherapy-induced cutaneous toxicities. It is important to raise awareness of TEC clinical presentation to prevent misdiagnosis and treat them promptly. We present a patient diagnosed with invasive ductal carcinoma of the left breast who had undergone mastectomy with axillary dissection who developed TEC after docetaxel chemotherapy infusion

Open repair of type Ia endoleak in the aortic arch: three tailored approaches

Endoleaks are an important complication following hybrid thoracic endovascular aortic repair (TEVAR) with an incidence ranging from 20% to 25%. There are five different types of endoleaks, which are classified based on the source of vessels that cause the inflow into the aneurysm sac. Type I endoleaks (EL-I) occur at either the proximal (Ia) or distal (Ib) attachment sites and can be seen during insertion of the initial stent graft or during a follow-up surveillance imaging exam. EL-I may be secondary to incomplete dilatation or inaccurate sizing of the stent graft, diseased aortic wall or aortic tortuosity with angulations, leading to higher chances of rupture. However, EL-I represent a technical failure of endovascular repair that should be corrected promptly. However, endovascular EL-I repair at the level of aortic arch is not always possible due to an improper landing zone in the ascending aorta making it technically challenging. In the present paper, we describe three cases of EL-Ia following TEVAR and we address different repair techniques. Written informed consents were obtained from the patients for publication of the article and any accompanying images

Patterns of Reading Errors among Emirati Second Grade Students

The impact of morphological awareness on reading proficiency has been neglected and there has been much focus on researching the impact of phonological awareness on reading skills. The aim of this study was to examine reading errors among second-grade Emeriti students by mapping a threefold paradigm (i.e., difficulty level, lexical category, and reading error patterns). The study sample included 168 Emirati second grade students (87 males and 81 females). One hundred forty four words were randomly selected from the Arabic reading curriculum. Those words were classified into lexical categories as nouns (45%), verbs (34%), adjectives and adverbs (10%), and functional words (i.e., prepositions and conjunctions; 11%). Those words were classified into three levels of linguistic difficulty (i.e., easy, difficult, and very difficult) according to their morphological complexity. The results revealed that reading difficulties may be the result of a threefold interrelated paradigm: the difficulty level of the words (i.e., morphological complexity), the lexical category (i.e., nouns, verbs, adjective and adverbs, and prepositions and conjunctions), and the pattern of the reading error (e.g., omission of a letter or a syllable and reading the geminated letter as ingeminated). The results also indicated that identifying this paradigm in each student can be useful in early detection of reading difficulty and thus, may assist in constructing appropriate remedial programs

ARTICULAR PAIN IS CORRELATED WITH ULTRASOUND POWER DOPPLER FINDINGS?

Universidade Federal de São Paulo, Div Rheumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Radiol, São Paulo, BrazilUniv Politecn Marche, Div Rheumatol, Jesi, ItalyUniversidade Federal de São Paulo, Div Rheumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Radiol, São Paulo, BrazilWeb of Scienc

LC-MS metabolomics comparisons of cancer cell and macrophage responses to methotrexate and polymer- encapsulated methotrexate

Methotrexate (MTX) is a folate analogue antimetabolite widely used for the treatment of rheumatoid arthritis and cancer. A number of studies have shown that MTX delivered via nanoparticle carriers is more potent against cancer cells than free MTX, a phenomenon attributed to higher cellular uptake of the particles compared to the saturable folate receptor pathway. In this study, a cell-based global metabolic profiling approach was applied to study the effects of MTX in both free drug form and when encapsulated in-poly(lactide-co-glycolide) (PLGA) nanoparticles on a cancer cell line, A549, and also on human-like THP-1 macrophages. The results showed that MTX loaded nanoparticles had less impact on the macrophages than free MTX, and the effects on macrophages were limited to changes in nucleotide metabolism and suppression of the tricarboxylic acid cycle, whereas free MTX also led to a drop in glycolytic activity and impairment in redox homeostasis. In contrast, MTX loaded nanoparticles showed a greater impact on A549 cells than the free drug, which was in accord with studies in other cell lines in prior literature with MTX-carrier nanoparticles

Metabolic Signatures of Surface-Modified Poly(lactic- co-glycolic acid) Nanoparticles in Differentiated THP-1 Cells Derived with Liquid Chromatography-Mass Spectrometry-based Metabolomics

Polymeric nanoparticles (NPs) are widely used in preclinical drug delivery investigations, and some formulations are now in the clinic. However, the detailed effects of many NPs at the subcellular level have not been fully investigated. In this study, we used differentiated THP-1 macrophage cells, as a model, to investigate the metabolic changes associated with the use of poly (lactic-co-glycolic acid) (PLGA) NPs with different surface coating or conjugation chemistries. Liquid chromatography-mass spectrometry-based metabolic profiling was performed on the extracts (n = 6) of the differentiated THP-1 cells treated with plain, Pluronic (F-127, F-68, and P-85)-coated and PEG-PLGA NPs and control (no treatment). Principal component analysis and orthogonal partial least squares-discriminant analysis (OPLS-DA) in conjunction with univariate and pathway analyses were performed to identify significantly changed metabolites and pathways related to exposure of the cells to NPs. OPLS-DA of each class in the study compared to the control showed clear separation and clustering with cross-validation values of R2 and Q2 > 0.5. A total of 105 metabolites and lipids were found to be significantly altered in the differentiated THP-1 cell profiles due to the NP exposure, whereas more than 20 metabolic pathways were found to be affected. These pathways included glycerophospholipid, sphingolipid, linoleic acid, arginine and proline, and alpha-linolenic acid metabolisms. PLGA NPs were found to perturb some amino acid metabolic pathways and altered membrane lipids to a different degree. The metabolic effect of the PLGA NPs on the cells were comparable to those caused by silver oxide NPs and other inorganic nanomaterials. However, PEG-PLGA NPs demonstrated a reduced impact on the cellular metabolism compared to Pluronic copolymer-coated PLGA and plain PLGA NPs