A case of acute myocardial infarction during perioperative period of non-cardiac surgery in a patient with antiphospholipid syndrome and a history of coronary artery bypass surgery

AbstractA 65-year-old woman underwent coronary artery bypass surgery and was diagnosed with antiphospholipid syndrome (APS) at the same time in 1985. She was admitted to our hospital to undergo mastectomy for left breast cancer in 2012. She was put on intravenous infusion of heparin and stopped receiving both antiplatelet agents and warfarin. The operation was performed without complications, and antithrombotic therapy was restarted one day after the operation. On day 6 postoperative, she complained of sudden chest pain and on examination she was diagnosed with acute myocardial infarction. The culprit lesion was in a saphenous vein graft and coronary intervention was performed.<Learning objective: Antithrombotic therapy for patients with APS is complicated because of prolonged baseline activated partial thromboplastin time (aPTT). An effective perioperative antithrombotic therapy for APS patients who have a history of coronary artery disease and have undergone non-cardiac surgery has not yet been established. A safe strategy for such a therapy should therefore be discussed.

An Esophageal Ulcer Associated with a Thoracoabdominal Aortic Aneurysm

An aortoesophageal fistula, an abnormal anatomical communication between the aorta and the esophagus, is a rare cause of upper gastrointestinal bleeding. The mortality rate of patients with this condition is very high. A 77-year-old man, who had undergone endovascular aortic repair for a ruptured abdominal aortic aneurysm, developed melena. An upper gastrointestinal endoscopy was performed. This detected an esophageal ulcer, which had the potential to develop into an aortoesophageal fistula. Therefore, thoracic endovascular aortic repair was performed on the following day. Thereafter, the course was uneventful. We encountered a rare case of an esophageal ulcer associated with a thoracoabdominal aortic aneurysm before it developed into an aortoesophageal fistula

A Case of Gastroparesis after Cryoballoon Ablation followed by Medication-Induced Recovery within 6 Months

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and cryoballoon ablation was developed as a new treatment modality for symptomatic AF. Gastroparesis is rarely reported as a transient complication of ablation, and its frequency and risk are not clear. We experienced a rare case of gastroparesis after cryoballoon ablation followed by medication-induced recovery within 6 months

Detections of [C II] 158 μ\mum and [O III] 88 μ\mum in a Local Lyman Continuum Emitter, Mrk 54, and its Implications to High-redshift ALMA Studies

We present integral field, far-infrared (FIR) spectroscopy of Mrk 54, a local Lyman Continuum Emitter (LCE), obtained with FIFI-LS on the Stratospheric Observatory for Infrared Astronomy. This is only the second time, after Haro 11, that [C II] 158 $\mu$m and [O III] 88 $\mu$m spectroscopy of the known LCEs have been obtained. We find that Mrk 54 has a strong [C II] emission that accounts for $\sim1$% of the total FIR luminosity, whereas it has only moderate [O III] emission, resulting in the low [O III]/[C II] luminosity ratio of $0.22\pm0.06$. In order to investigate whether [O III]/[C II] is a useful tracer of $f_{\rm esc}$ (LyC escape fraction), we examine the correlations of [O III]/[C II] and (i) the optical line ratio of $\rm O_{32} \equiv$ [O III] 5007 \AA/[O II] 3727 \AA, (ii) specific star formation rate, (iii) [O III] 88 $\mu$m/[O I] 63 $\mu$m ratio, (iv) gas phase metallicity, and (v) dust temperature based on a combined sample of Mrk 54 and the literature data from the Herschel Dwarf Galaxy Survey and the LITTLE THINGS Survey. We find that galaxies with high [O III]/[C II] luminosity ratios could be the result of high ionization (traced by $\rm O_{32}$), bursty star formation, high ionized-to-neutral gas volume filling factors (traced by [O III] 88 $\mu$m/[O I] 63 $\mu$m), and low gas-phase metallicities, which is in agreement with theoretical predictions. We present an empirical relation between the [O III]/[C II] ratio and $f_{\rm esc}$ based on the combination of the [O III]/[C II] and $\rm O_{32}$ correlation, and the known relation between $\rm O_{32}$ and $f_{\rm esc}$. The relation implies that high-redshift galaxies with high [O III]/[C II] ratios revealed by ALMA may have $f_{\rm esc}\gtrsim0.1$, significantly contributing to the cosmic reionization.Comment: 14 pages, 5 figures, Accepted for publication in Ap

Taxanes and platinum derivatives impair Schwann cells via distinct mechanisms

Impairment of peripheral neurons by anti-cancer agents, including taxanes and platinum derivatives, has been considered to be a major cause of chemotherapy-induced peripheral neuropathy (CIPN), however, the precise underlying mechanisms are not fully understood. Here, we examined the direct effects of anti-cancer agents on Schwann cells. Exposure of primary cultured rat Schwann cells to paclitaxel (0.01 μM), cisplatin (1 μM), or oxaliplatin (3 μM) for 48 h induced cytotoxicity and reduced myelin basic protein expression at concentrations lower than those required to induce neurotoxicity in cultured rat dorsal root ganglion (DRG) neurons. Similarly, these anti-cancer drugs disrupted myelin formation in Schwann cell/DRG neuron co-cultures without affecting nerve axons. Cisplatin and oxaliplatin, but not paclitaxel, caused mitochondrial dysfunction in cultured Schwann cells. By contrast, paclitaxel led to dedifferentiation of Schwann cells into an immature state, characterized by increased expression of p75 and galectin-3. Consistent with in vitro findings, repeated injection of paclitaxel increased expression of p75 and galectin-3 in Schwann cells within the mouse sciatic nerve. These results suggest that taxanes and platinum derivatives impair Schwan cells by inducing dedifferentiation and mitochondrial dysfunction, respectively, which may be important in the development of CIPN in conjunction with their direct impairment in peripheral neurons

Activation of AMPK-Regulated CRH Neurons in the PVH is Sufficient and Necessary to Induce Dietary Preference for Carbohydrate over Fat

Food selection is essential for metabolic homeostasis and is influenced by nutritional state, food palatability, and social factors such as stress. However, the mechanism responsible for selection between a high-carbohydrate diet (HCD) and a high-fat diet (HFD) remains unknown. Here, we show that activation of a subset of corticotropin-releasing hormone (CRH)-positive neurons in the rostral region of the paraventricular hypothalamus (PVH) induces selection of an HCD over an HFD in mice during refeeding after fasting, resulting in a rapid recovery from the change in ketone metabolism. These neurons manifest activation of AMP-activated protein kinase (AMPK) during food deprivation, and this activation is necessary and sufficient for selection of an HCD over an HFD. Furthermore, this effect is mediated by carnitine palmitoyltransferase 1c (CPT1c). Thus, our results identify the specific neurons and intracellular signaling pathway responsible for regulation of the complex behavior of selection between an HCD and an HFD

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection