Gastrointestinal Basidiomycosis: An Unusual Fungal Disease?

Background: Basidiobolus ranarum is a fungus that usually causes subcutaneous infection. Medical literature rarely report gastrointestinal involvement, especially in tropical climate areas.Case Report: Here we report a case of gastrointestinal basidiomycosis in an immunocompetent 43-year-old man from south of Iran who presented with abdominal pain, loss of appetite, and nausea. He had history of previous laparotomy 10 years ago, because of perforated peptic ulcer. He underwent an exploratory laparotomy. We found a mass in ascending colon; so, right hemicolectomy were done. Histologic founding were amazing. Eosinophilic sheath surrounding hyphae-like structures was seen. The diagnosis of basidiomycosis was established, so we prescribed antifungal agents for the patient. He expired 6 months later according to disseminated disease.Conclusions: Gastrointestinal basidiomycosis is a rare and invasive fungal infection that imitates malignant tumors, inflammatory bowel disease, or even phlegmon of appendicitis. Diagnosis of gastrointestinal basidiomycosis needs a high index of suspicion. The physicians should be aware of this disease as differential diagnosis in tropical areas. Surgical resection and prolonged antifungal therapy is recommended, but in some cases, the disease may spread and cause death

Evaluation of left ventricular systolic and diastolic regional function after enhanced external counter pulsation therapy using strain rate imaging

Aims Enhanced external counter pulsation (EECP) is a non-invasive and non-pharmacological therapy for patients with symptomatic coronary artery disease (CAD). There are, however, insufficient data to support the effectiveness of EECP in improving the myocardial mechanical properties of patients with refractory stable angina. We aimed to assess the effects of EECP on myocardial mechanical properties and cardiac functions in CAD patients not eligible for surgical or percutaneous revascularization procedures. Methods and results Twenty patients in New York Heart Association (NYHA) functional Class III and IV angina were evaluated. The mean age of the patients was 63+9 years, and 65% were male. A comprehensive echocardiographic study including an evaluation of the tissue Doppler-based parameters of systolic and diastolic functions was performed before and after the termination of the protocol. EECP was carried out 1 h per day, 5 days per week, for 7 weeks. EECP resulted in a significant increase in peak late diastolic transmitral inflow velocity (0.75+0.14 vs. 0.83+0.20 m/s, P , 0.05), propagation velocity (42.35+6.25 vs. 46.00+5.68 cm/s, P , 0.05), peak early diastolic velocity of mitral annulus (5.35+1.79 vs. 5.95+1.10 cm/s, P , 0.05), peak systolic velocity (2.51+0.28 vs. 2.67+ 0.26, P , 0.05), and early diastolic velocity (3.24+0.18 vs. 3.52+0.26 cm/s, P , 0.01) of all middle segments, peak late diastolic velocity of all basal (4.48+0.58 vs. 4.75+0.70 cm/s, P , 0.05) and middle segments (2.82+0.66 vs. 3.25+0.46 cm/s, P , 0.01), peak systolic strain rate of all basal (0.76+0.07 vs. 0.99+0.08 1/s, P ¼ 0.001) and middle segments (0.75+0.09 vs. 0.94+0.09 1/s, P , 0.001), peak systolic strain of basal (11.64+1.51 vs. 13.97+1.52%, P , 0.01) and middle segments (11.81+1.15 vs.13.73+1.57%, P , 0.001), and left ventricular (LV) ejection fraction (40.25+ 12.72 vs. 46.25+12.97%, P , 0.001).There was also a significant decrease in the ratios of transmitral E/A (0.92+ 0.41 vs. 1.08+ 0.46, P , 0.05) and E/Ea (12.61+4.22 vs. 15.44+6.96, P , 0.05) after EECP therapy. A significant reduction in NYHA angina class ( 1 angina class) was seen in the patients, who completed treatment. Conclusion EECP therapy seemed to improve both regional and global LV systolic and diastolic functions in patients with chronic angina pectoris

Formation and dynamics of van der Waals molecules in buffer-gas traps

We show that weakly bound He-containing van der Waals molecules can be produced and magnetically trapped in buffer-gas cooling experiments, and provide a general model for the formation and dynamics of these molecules. Our analysis shows that, at typical experimental parameters, thermodynamics favors the formation of van der Waals complexes composed of a helium atom bound to most open-shell atoms and molecules, and that complex formation occurs quickly enough to ensure chemical equilibrium. For molecular pairs composed of a He atom and an S-state atom, the molecular spin is stable during formation, dissociation, and collisions, and thus these molecules can be magnetically trapped. Collisional spin relaxations are too slow to affect trap lifetimes. However, helium-3-containing complexes can change spin due to adiabatic crossings between trapped and untrapped Zeeman states, mediated by the anisotropic hyperfine interaction, causing trap loss. We provide a detailed model for Ag3He molecules, using ab initio calculation of Ag-He interaction potentials and spin interactions, quantum scattering theory, and direct Monte Carlo simulations to describe formation and spin relaxation in this system. The calculated rate of spin-change agrees quantitatively with experimental observations, providing indirect evidence for molecular formation in buffer-gas-cooled magnetic traps.Comment: 20 pages, 13 figure

Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

<p>Abstract</p> <p>Objectives</p> <p>We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR).</p> <p>Background</p> <p>Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined.</p> <p>Methods</p> <p>136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained.</p> <p>Results</p> <p>There was significant association between MR severity and echocardiogarphic indices (all p values < 0.001). Severe MR occurred more frequently in dilated cardiomyopathy (DCM) patients compared to ischemic patients, (p < 0.001). Based on the model, only Mitral valve tenting distance (TnD) (OR = 22.11, CI 95%: 14.18 – 36.86, p < 0.001) and Interpapillary muscle distance (IPMD), (OR = 6.53, CI 95%: 2.10 – 10.23, p = 0.001) had significant associations with MR severity.</p> <p>Mitral annular dimensions and area, C-septal distance and sphericity index, although greater in patients with severe regurgitation, did not significantly contribute to FMR severity.</p> <p>Conclusion</p> <p>Degree of LV enlargement and dysfunction were not primary determinants of FMR severity, therefore local LV remodeling and mitral valve apparatus deformation are the strongest predictors of functional MR severity.</p

Insight to the influence of Ti addition on the strain-induced martensitic transformation in a high (about 7 wt.%) Mn stainless steel

Tiivistelmä The kinetics of strain-induced martensite (SIM) formation in a Ti-bearing 201L stainless steel were evaluated and compared to the existing results of two conventional stainless steel grades; i.e., 201L and 304L AISI. The effects of strain rate and rolling pass reduction on the kinetics of SIM formation during cold rolling were investigated. The Ti-microalloying was found to be intensifying the transformation due to lowering the stacking fault energy. It was seen that decreasing the rolling pass reduction strongly affected the variation of SIM volume fraction. Furthermore, a close correlation between the hardness and strain-induced transformation was found arising from microstructural evolution during the cold rolling process. Three stages in the hardening behavior were detected associated with lath-type martensite formation, transition stage of martensite laths break up and formation of dislocation-cell-type martensite

Evaluation of the Ventricular Mechanical Dyssynchrony in Patients with Atrial Septal Defect

Background: There is some evidence indicating improvement in myocardial performance after atrial septal defect closure, either device closure or surgical, but ventricular dyssynchrony has not been evaluated before and after surgical closure. The aim of this study was to evaluate ventricular mechanical dyssynchrony in patients with atrial septal defect before and after surgical closure.Methods: Twenty patients (mean age: 23±11years) with isolated secundum or sinus venosus type atrial septal defect, unsuitable for device closure, were evaluated before and after successful surgical closure. Interventricular and intraventricular dyssynchrony (using 6 basal and 6 mid-segmental models) were determined.Results: A significant reduction in the right atrial and right ventricular dimensions and the tricuspid regurgitation peak gradient was noted after atrial septal defect closure (3.6±0.54 cm versus 4.2±0.7, P=0.009; 3.5±0.29 cm versus 4.3±0.41, P=0.02; and 20.4±10.5 mmHg versus 35.3±6.5, P<0.002; respectively).There was no significant difference in the maximum difference in time-to-peak systolic velocity and the standard deviation of time-to-peak systolic velocity of the l2 left ventricular myocardial segments in the patients with atrial septal defect before and after surgical closure in comparison with the normal subjects (normal: 26±10.64 ms versus before closure: 21.0±33.9 versus after closure: 27±29.5, both P=0.68) and the left ventricular asynchrony index after atrial septal defect closure (normal: 14.9±8.7 versus before closure: 11.46±8.5 versus after closure: 18.12±13.6, both P=0.2). There was a significant positive relation between the tricuspid regurgitation peak gradient and the left ventricular asynchrony index (r=0.67, P=0.03) and an insignificant negative relation between the left ventricular ejection fraction and the asynchrony index before atrial septal defect closure (r=−0.53, P=0.11). No significant relation was found between the total asynchrony index and the atrial septal defect size, the degree of left-to-right shunt, and the tricuspid regurgitation peak gradient.Conclusion: There was no significant ventricular dyssynchrony in the patients with atrial septal defect before and after surgical closure

Is the Peak-to-Mean Pressure Gradient Ratio Useful for Assessment of Aortic Valve Prosthesis Obstruction?

Background: The evaluation of prosthetic valves is very difficult with two-dimensional transthoracic echocardiography alone. Doppler and color flow imaging as well as transesophageal echocardiography are more reliable to detect prosthetic valve dysfunction. However, Doppler study sometimes tends to be misleading due to the load-depending characteristics of peak and mean pressure gradients. The peak-to-mean pressure decrease ratio is a load-independent measure, which was previously used for the detecting and grading of aortic valve stenosis. We assessed the usefulness of this method for the evaluation of aortic valve prosthesis obstruction.Methods: One hundred fifty-four patients with aortic valve prostheses were included in this study. Transthoracic and transesophageal echocardiographic examinations were performed in all the patients. Peak velocity and velocity time integral of the aortic valve and left ventricular outflow tract, peak and mean aortic valve pressure gradients, peak-to-mean pressure gradient ratio, and time velocity integral (TVI) index were measured.Results: There was a significant relation between the TVI index (p value < 0.001) and aortic prosthesis obstruction. A TVI index < 0.2 had a sensitivity of 71% and specificity of 100% for the detection of aortic valve prosthesis obstruction. However, no significant relation was found between the peak-to-mean pressure ratio and aortic valve prosthesis obstruction (p value = 0.09).Conclusion: Although the peak-to-mean pressure gradient (PG/MG) ratio is a simple, quick, and load-independent method which may be useful for the grading of aortic valve stenosis, it is poorly associated with aortic valve prosthesis obstruction.The TVI index is a useful measure for the detection of aortic prosthesis obstruction

Echocardiographic Characteristics Including Tissue Doppler Imaging After Enhanced External Counterpulsation Therapy

Background: The aim of this study was to echocardiographically assess the effects of EECP (Enhanced External Counterpulsation Therapy) therapy on systolic and diastolic cardiac function. Methods: LVEF (left ventricular ejection fraction), ESV (end-systolic volume), EDV (end-diastolic volume), Sm (myocardial systolic wave), Ea (myocardial early diastolic wave), Vp (propagation velocity), E/Ea (peak early diastolic transmitral flow velocity/Ea), E/Vp and diastolic function grade were studied in twenty-five patients before and after 35 hours of EECP. Results: EECP reduced ESV and EDV and increased EF significantly (p=0.018, 0.013, 0.002, respectively) in patients with baseline LVEF≤50%, but not in patients with baseline LVEF>50%. Patients with E/Ea≥14 had a significant reduction in EDV and ESV (p=0.038 and 0.32, respectively) and an increase in LVEF (p=0.007) after EECP, whereas patients with baseline E/Ea<14 had no significant change in these parameters. Similarly, EECP significantly improved ESV, EDV and LVEF (p=0.014, 0.032, 0.027 respectively) in patients with grades II and III of diastolic dysfunction (decreased compliance) at baseline, but not in patients with normal diastolic function or grade I diastolic dysfunction (impaired relaxation). Patients with Ea<7 cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after therapy (p=0.024, 0.015, 0.001), while patients with Ea ≥7cm/sec showed no significant change. Similarly, patients with Sm<7cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after EECP (p=0.016, 0.017, 0.006), while patients with Sm ≥7cm/sec did not. Conclusion: These results provide new insight into the hemodynamic effectiveness and potential clinical applications of EECP

Anti-zona pellucida antibodies in infertile patients in relation to multiple puncture of ovaries and unexplained infertility

Background:Auto antibodies to zona-pellucida (AZA) seem to be important autoantibodies implicated in reproduction, with substantial role in both endocrine and reproductive functions of the human ovary. There are some debates on the relation of AZA with infertility, repeated In Vitro Fertilization (IVF) attempts, and outcome of it. Objective: In this study, we assessed the presence of AZA in the follicular fluids (FFs) of women who underwent intra cytoplasmic sperm injection (ICSI), in relation to etiology of infertility and multiple puncture of ovaries. Materials and Methods: In this prospective study, follicular fluids were evaluated from 96 infertile women, (19-40 years old, 31.5±5.1), who were candidates for ICSI based on the etiology of infertility. From these 80 women had explained infertility whereas 16 had unexplained infertility. All FFs were evaluated for presence of AZA by ELISA test. Results:Twenty patients (20.8%)were positive for AZA in follicular fluid.In patients with unexplained infertility, AZA antibody in follicular fluid, was significantly higher than the group with proven etiology of infertility (p=0.001). In addition, 20.4 % of patients who had been punctured previously showed AZA in their FFs which is statistically similar to the patients who were punctured for the first time. Conclusions: The high incidence of AZA in infertile women, especially women with unexplained infertility has to be considered. Relation of the presence AZA and repeated puncture of ovaries is still debatable. Determinations of AZA are highly recommended in evaluation of infertile couples especially in patient with unexplained infertility

The Results of a 2-year Experience in Pediatric Heart Transplant in Rajaie Cardiovascular Medical and Research Center

Introduction: Heart transplantation is the ultimate treatment method for many infants and children with the diagnosis of cardiomyopathy or final stages of congenital heart failure. Purpose: This report provides the results of children's heart transplantation in Shahid Rajaie Heart Center during a 2-year period. Methods: Studying retrospective information of heart-transplanted children between 2012 and 2015. Results: Nineteen cases of pediatric heart transplantation were performed between 2012 and 2015 on children aged between 16 months and 14 years with an average age of 10 months. Among these, 14 (73.7%) cases were male and 5 (26.3%) cases were female. Among heart-transplanted cases, 10 (52.6%) cases were diagnosed with idiopathic dilated cardiomyopathy, 1 (5.3%) case was diagnosed with myocarditis, 7 (36.8%) cases were diagnosed with left ventricular (LV) noncompaction, and 1 (5.3%) case was diagnosed with myocarditis and LV noncompaction. After the heart transplantation, two cases suffered from pericardial effusion, three cases suffered from renal failure, three cases suffered from the right heart failure, three cases received extracorporeal membrane oxygenation, one case suffered from hypersensitivity to mycophenolate mofetil, and one case suffered from polyradiculopathy. Conclusion: Our short-term experience shows good results with low mortality rates and controlled complications of heart transplantation. Although we are in the early stages and are going through experiences, we expect to get better results given that there is an increase in the number of donors alongside improvements in immunosuppressive treatments and appropriate antibiotics