Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: A transesophageal echocardiographics tudy

AbstractObjectives. The objective of this study was to determine the frequency of left atrial thrombus in patients with acute atrial fibrillation.Background. It is commonly assumed but unproved that left atrial thrombus in patients with atrial fibrillation begins to form after the onset of atrial fibrillation and that it requires ≥3 days to form. Thus, patients with acute atrial fibrillation (i.e., <3 days) frequently undergo cardioversion without anticoagulation prophylaxis.Methods. Three hundred seventeen patients (250 men, 67 women; mean [±SD] age 64 ± 12 years) with acute (n = 143) or chronic (n = 174) atrial fibrillation were studied by two-dimensional transesophageal echocardiography.Results. Left atrial appendage thrombus was present in 20 patients (14%) with acute and 47 patients (27%, p < 0.01) with chronic atrial fibrillation. In patients with a recent embolic event, the frequency of left atrial appendage thrombus did not differ between those with acute (5 [21%] of 24) and those with chronic (12 [23%] of 52, p = NS) atrial fibrillation. Patients with acute versus chronic atrial fibrillation, respectively, did not differ (p = NS) in mean age (64 ± 13 vs. 65 ± 11 years), frequency of concentric left ventricular hypertrophy (32% vs. 26%), hypertension (32% vs. 41%), coronary artery disease (35% vs. 39%), congestive heart failure (43% vs. 48%), mitral stenosis (4% vs. 7%) or mitral valve replacement (1.4% vs. 6%). The minimally detectable difference in proportions between patients with acute and chronic atrial fibrillation based on a power of 0.80 and base proportion of 0.20 was 14%.Conclusions. Left atrial thrombus does occur in patients with acute atrial fibrillation <3 days in duration. The frequency of left atrial thrombus in patients with recent emboli is comparable between those with acute and chronic atrial fibrillation. These data suggest that patients with acute atrial fibrillation for <3 days require anticoagulation prophylaxis or evaluation by transesophageal echocardiography before cardioversion and should not be assumed to be free of left atrial thrombus

Habitat Standardization of CPUE Indices: Research Needs

Habitat standardization for billfish CPUE offers a potentially useful alternative to the statistical procedures used in the past. However, most of the assumptions of the current habitatstandardization methodology remain untested and some are not consistent with current knowledge about the behavior of billfish. This paper outlines research required to ensure the methods for habitat standardization produce robust estimates of CPUE

2-But­oxy-N-[2-(diethyl­amino)­eth­yl]quinoline-4-carboxamide (dibucaine)

The mol­ecular conformation of the title compound, C20H29N3O2, is stabilized by an intra­molecular C—H⋯O hydrogen bond. The orientation of the amide group to the ring system is characterized by a C—C—C—O dihedral angle of 137.5 (3)°. In the crystal, inter­molecular N—H⋯O hydrogen bonds between the amide groups form C(4) chains running parallel to the a axis

TP53 Gene Status in the Presence of Allicin in NNK Induced Pancreatic Cancer Albino Rats

Pancreatic cancer (PC) is the fourth most lethal form of cancer in Western society, with mortalities closely mirroring incidence and an overall 5-year survival of less than 7%. Traditional medicine which involves the use of herbs has been used to treat various types of cancer and this has been found to be effective with minimal or no side effects. This ressearch was aimed at evaluating the chemo preventive effect of extract of the active ingredients of garlic (Allicine)on Nitrosamines induced pancreatic cancer in rat. Allicine was extracted from garlic by crushing the garlic in an ethanol and inject  into the HPLC column. Agarose gel electrophoresis was used to analyze deoxyribonuleic acid (DNAs) extracted from the pancreatic tissue of the experimental mice while haematoxylin and eosin staining was used for histological assay.There was a significant reduction in the weight of the experimental animals that were administered with NNK. The animals administered with extract (allicin) also show a reduction in weight. Normal control animals were seen to have gained weight. DNA bands obtained from agarose gel electrophoresis suggested a possible NNK induced damage which was prevented to a certain degree owing to the effect of the allicin. Histological assay revealed the presence of neoplastic hyperplasia which is more prominent in the histological sections of the pancreatic tissue of the rats which were not treated with allicin. This study has shown that allicin could be used as a treatment against NNK induced pancreatic cancer in white albino rats at the right concentration

The Surgical Infection Society revised guidelines on the management of intra-abdominal infection

Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. Results: This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. Summary: The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin