Ethical implications of heart transplantation in elderly patients

AbstractJ Thorac Cardiovasc Surg 2001;121:434-

Imaging in-stent restenosis: an inexpensive, reliable, and rapid preclinical model.

Preclinical models of restenosis are essential to unravel the pathophysiological processes that lead to in-stent restenosis and to optimize existing and future drug-eluting stents. A variety of antibodies and transgenic and knockout strains are available in rats. Consequently, a model for in-stent restenosis in the rat would be convenient for pathobiological and pathophysiological studies. In this video, we present the full procedure and pit-falls of a rat stent model suitable for high throughput stent research. We will show the surgical procedure of stent deployment, and the assessment of in-stent restenosis using the most elegant technique of OCT (Optical Coherence Tomography). This technique provides high accuracy in assessing plaque CSAs (cross section areas) and correlates well with histological sections, which require special and time consuming embedding and sectioning techniques. OCT imaging further allows longitudinal monitoring of the development of in-stent restenosis within the same animal compared to one-time snapshots using histology

Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy

AbstractA retrospective analysis of patients with hypertrophic obstructive cardiomyopathy treated by left ventricular myotomy and myectomy from 1972 to 1994 is reported. There were 158 patients (81 male and 77 female) with a mean age of 50.2 (±17.2) years (range 12 to 80 years). One hundred nine patients (69%) were 60 years of age or younger, and 49 patients (31%) were older than 60 years. The overall mean follow-up period was 6.1 (±4.8) years (range 0.1 to 19.3 years) and was 94% complete with a cumulative total of 956 patient-years. Preoperative exertional dyspnea was present in 84%, chest pain in 70%, presyncope in 54%, syncope in 31%, and cardiac arrest in 5% of patients. Preoperative cardiac catheterization was done in 150 patients, with mitral regurgitation detected in 104 patients (67%). The average maximal provocable left ventricular outflow tract gradient was 118 (±46) mm Hg (range 25 to 250 mm Hg). The average preoperative echocardiographic gradient at rest was 64 mm Hg, 20 mm Hg in the early postoperative period and 10 mm Hg in the late postoperative period. The mean septal thickness was 2.2 (±0.6) cm, 1.9 (±0.7) cm in the early postoperative period (p < 0.05 vs preoperative) and 1.7 (±0.5) cm in the late postoperative period (p < 0.05 vs preoperative). The overall 30-day operative mortality rate was 3.2% (5/158), and 0% for 109 patients 60 years of age or younger. Causes of death included myocardial infarction and left ventricular free wall rupture, myocardial failure from septal perforation, sepsis, cerebrovascular accident caused by thromboembolism, and delayed cardiac tamponade in one patient each. Concomitant coronary artery bypass grafting was performed in 22 patients (19.3% of patients ≥40 years of age) and mitral valve replacement in 5 patients (3.2%). One hundred nine patients (69%) are alive, 10 patients (6.3%) were lost to follow-up, and 39 patients died (24.7%, including operative deaths). Actuarial survivals at 1, 5, 10, and 15 years were 92.4% ±2.2%, 85.4% ±3.1%, 71.5% ±4.6%, and 46% ±9%, respectively. The overall linearized death rate for discharged patients was 1.9%/pt-yr, and for cardiac related deaths it was 1.7%/pt-yr. Thirty-nine (36%) of the 109 survivors received β-adrenergic blockers, and 30 (28%) received calcium channel blockers. Ninety-four patients had improvement in New York Heart Association functional class, 10 had improvement in symptoms but not in functional class, and 5 had no improvement in functional class or symptoms. Neither preoperative hemodynamic values nor routine echocardiographic measurements significantly correlated with quality of postoperative results. Left ventricular myotomy and myectomy is a safe and reproducibly effective operative treatment for medically refractory hypertrophic obstructive cardiomyopathy, especially for patients 60 years of age or younger. Improvement in functional class and symptoms can be expected in nearly all patients. The results of myotomy and myectomy serve as a standard for comparison with other interventions for medically refractory cardiomyopathy. (J THORAC CARDIOVASC SURG 1996;111:586-94

Successful repair of blunt injury of aortic arch branches in the setting of bovine arch

Intrathoracic great vessels injuries are usually fatal and represent a special surgical challenge. We report a successful surgical repair for blunt disruption of the three aortic arch branches in the setting of bovine arch anatomy. The repair was achieved without the use of cardiopulmonary bypass or arterial shunts. There was no clinical or radiologic evidence of neurologic abnormality after the repair

Advances in biodiversity: metagenomics and the unveiling of biological dark matter

BACKGROUND: Efforts to harmonize genomic data standards used by the biodiversity and metagenomic research communities have shown that prokaryotic data cannot be understood or represented in a traditional, classical biological context for conceptual reasons, not technical ones. RESULTS: Biology, like physics, has a fundamental duality—the classical macroscale eukaryotic realm vs. the quantum microscale microbial realm—with the two realms differing profoundly, and counter-intuitively, from one another. Just as classical physics is emergent from and cannot explain the microscale realm of quantum physics, so classical biology is emergent from and cannot explain the microscale realm of prokaryotic life. Classical biology describes the familiar, macroscale realm of multi-cellular eukaryotic organisms, which constitute a highly derived and constrained evolutionary subset of the biosphere, unrepresentative of the vast, mostly unseen, microbial world of prokaryotic life that comprises at least half of the planet’s biomass and most of its genetic diversity. The two realms occupy fundamentally different mega-niches: eukaryotes interact primarily mechanically with the environment, prokaryotes primarily physiologically. Further, many foundational tenets of classical biology simply do not apply to prokaryotic biology. CONCLUSION: Classical genetics one held that genes, arranged on chromosomes like beads on a string, were the fundamental units of mutation, recombination, and heredity. Then, molecular analysis showed that there were no fundamental units, no beads, no string. Similarly, classical biology asserts that individual organisms and species are fundamental units of ecology, evolution, and biodiversity, composing an evolutionary history of objectively real, lineage-defined groups in a single-rooted tree of life. Now, metagenomic tools are forcing a recognition that there are no completely objective individuals, no unique lineages, and no one true tree. The newly revealed biosphere of microbial dark matter cannot be understood merely by extending the concepts and methods of eukaryotic macrobiology. The unveiling of biological dark matter is allowing us to see, for the first time, the diversity of the entire biosphere and, to paraphrase Darwin, is providing a new view of life. Advancing and understanding that view will require major revisions to some of the most fundamental concepts and theories in biology

A segmented and clawed male foreleg in a newly described genus and species of eumaeine butterfly (Lepidoptera: Lycaenidae)

Grishinata Robbins and Busby, new genus (Lepidoptera: Lycaenidae: Eumaeini), possesses a five-segmented foretarsus with a clawed pretarsus, a trait that differentiates it from all eumaeine genera except Theclopsis Godman and Salvin. Grishinata penny Busby, Hall, and Robbins, new species, differs from all species of Theclopsis (and most Eumaeini) in lacking male secondary sexual organs on the wings or in the abdomen. It is recorded from the eastern slope of the Andes in Ecuador and Peru. We cannot place Grishinata penny in an existing Eumaeini genus based upon its wing pattern, male foreleg structure, lack of male second­ary sexual organs, and male genitalic morphology. We propose names for the genus and species to document its leg morphology and to provide a name for a genome sequencing project, which will allow us to place the genus in the eumaeine Linnaean hierarchy. There are two morphological types of male forelegs in the lepidopteran butterfly family Lycaenidae, each of which is functionally and structurally different from male forelegs in other diurnal butterfly families. The first male foreleg type is superficially similar to that of Nymphalidae and Riodinidae in that the tarsus is unsegmented, lacks a pretarsus, and is not used to groom the antennae (Robbins 1988, 1990). It differs functionally from these families in that it is used for walking. It differs morphologically in that it possesses tarsal alpha and beta trichoid sensilla (terminology from Chun and Schoonhoven 1973), which are lacking in Nymphalidae and Riodinidae with few exceptions (Robbins 1988). This male foreleg type occurs in more than 98% of lycaenid species (Mattoni and Fiedler 1991). The second lycaenid male foreleg type is superficially similar to that of Hesperiidae, Papilionidae, and Pieridae in that the foretarsus is segmented with a clawed pretarsus. It differs functionally from these families in that it is not used to groom the antennae (Jander 1966; Robbins 1990). It differs morphologically in that it lacks the tibial epiphysis of Hesperiidae and Papilionidae or the vestigial remnant of an epiphysis that occurs in some Pieridae (Robbins 1990). Within Eumaeini, this male foreleg type is restricted to some species of Theclopsis Godman and Salvin, 1887 (Godman and Salvin 1887; Robbins 2004). We discovered a species (Fig. 1) belonging to the Eumaeini with a male foreleg that has a clawed pretarsus and a five-segmented tarsus (Fig. 2), but the male genitalia, secondary sexual characters, and wing pattern (Fig. 1, 3) are dissimilar from those of Theclopsis. The males lack secondary sexual organs on the wings or in the abdomen (Fig. 1, 3), which is highly unusual in Eumaeini (Valencia-Montoya et al. 2021). The male genitalia (Fig. 3) lack structures that would be useful in determining its closest phylogenetic relatives. More generally, we find no clear-cut morphological evidence to place this species in an available eumaeine genus. The purpose of this paper is to propose new generic and specific names for this newly discovered taxon. One reason is that we need a name to document its unusual leg morphology. Another is that we are currently sequencing its genome for a phylogenetic project. Phylogenetic analysis of the sequence data will allow us to place the genus in the eumaeine Linnaean hierarchy. We predict that it will show, in accord with the findings of Mattoni and Fiedler (1991), that its male foreleg with a clawed pretarsus and five-segmented tarsus evolved from a tarsus that was fused without a pretarsus

Using Xenon as a Heavy Atom for Determining Phases in Sperm Whale Metmyoglobin

Xenon gas can be used as a heavy atom for determining phases in a protein. We demonstrate that an interpretable electron density map can be obtained for sperm whale metmyoglobin from a single xenon derivative using iterative single isomorphous replacement with the anomalous scattering method

Using Xenon as a Heavy Atom for Determining Phases in Sperm Whale Metmyoglobin

Xenon gas can be used as a heavy atom for determining phases in a protein. We demonstrate that an interpretable electron density map can be obtained for sperm whale metmyoglobin from a single xenon derivative using iterative single isomorphous replacement with the anomalous scattering method

Hepatic Arterial Therapy with Drug-Eluting Beads in the Management of Metastatic Bronchogenic Carcinoma to the Liver: A Multi-Institutional Registry

Introduction. There has been limited information reported on the use of hepatic arterial therapy in liver dominant hepatic metastases arising from lung cancer. The aim of this study was to evaluate the safety and efficacy of hepatic arterial therapy in the treatment of liver dominant hepatic metastases arising from lung cancer. Methods. Thirteen patients underwent a total of 30 treatment sessions with Drug-Eluting Beads. Eight of the thirteen received only doxorubicin DEB (17 of the total treatments), and four patients received Irinotecan DEB (7 of the total treatments). Results. The planned preprocedural dosage was a median of 75 mg (range 19–200), with total hepatic dose exposure being a median of 150 mg (range 0–458), with a technical success rate of 97% in all 29 treatments. There were 4 adverse events related to treatment, but no evidence of hepatic insufficiency. Overall 6-month and 12-month response rates were 50%. After a median followup of 24 months, the median overall survival in this cohort was 14 months (range 7–48 months). Conclusion. Drug-eluting beads loaded with doxorubicin (DEBDOX) or irinotecan (DEBIRI) can be safely and effectively used in treatment of patients with liver predominant metastatic disease from lung cancer