Clinical Images - An Incidental EKG

A routine employment stress test reveals Brugada syndrome, a rare abnormality

An Unusual Migration of A Stent: A Case Report

Stent dislodgment and embolization is a rare complication of coronary stenting. There are reports of intra-coronary stent entrapment, stripping, and dislodgement during percutaneous coronary interventions causing potentially life threatening complications, including intra-coronary or systemic embolization. Reports of dislodgment and migration of previously placed drug eluting intra-coronary stent several months after deployment are very limited in the literature. We describe a drug eluting stent dislodgment and migration in an 88 year-old male 10 months after its deployment

Outcomes of Transcutaneous Aortic Valve Replacement among high risk WV sample population.

Introduction:Transcatheter aortic valve replacement (TAVR) is a relatively new strategy for replacing the aortic valve. We elected to review our early experience to see if we could identify clinical characteristics at baseline or immediately following the procedure that would predict death within one year. Methods:Charts for all patients assigned to receive TAVR procedure at St Mary’s medical center, Huntington, West Virginia between April, 2013 till November, 2016 were identified and reviewed. A total of seventy-two (72) cases were included. Results: All cause mortality rate at index hospitalization, 30 days, and 12 months was 5.6%(N=4), 6.9%(N=5), 19.4%(N=14) respectively. Stroke rate at index hospitalization, 30 days, and 12 months was 2.8%(N=2), 2.8%(N=2), 8.3%(N=6) respectively. Major predictors of death were post procedure GFR, Contrast volume, and number of antiplatelet agents therapy (AUC= 0.638, 0.632, 0.637 respectively). Conclusion: We found that post procedure GFR, less number of antiplatelet agents post procedure, and contrast volume may predict mortality within first 12 months post TAVR. Further studies focused on the above factors may be warranted

Acetaminophen Combinations Protect Against Iron-Induced Cardiac Damage in Gerbils

This study tested if acetaminophen, N-methyl-D-glucamine dithiocarbamate (NMGDTC), deferoxamine, and combinations of these agents reduce excess iron content, prevent iron-induced pathology, reduce cardiac arrhythmias, and reduce mortality in iron-overloaded gerbils. Eight groups of 16 gerbils received iron dextran injections (ferric hydroxide dextran complex, 120 mg/kg, ip) or saline solution (controls) twice/wk for 8 wk. The 8 groups were treated every Monday, Wednesday, and Friday with one of the following: saline control, acetaminophen, 150 mg/kg, ip), acetaminophen (150 mg/kg, po), deferoxamine, 83 mg/kg, ip), NMGDTC (200 mg/kg, ip), or combinations of acetaminophen (75 mg/kg) with deferoxamine (42 mg/kg, each ip, separately) or acetaminophen (75 mg/kg) with NMGDTC (100 mg/kg, each ip, separately). The treatments were given 4 hr after each iron injection on days when both iron administration and treatment occurred during iron overloading (8 wk) and were continued 4 wk thereafter. Echocardiography (ECHO) was used to evaluate iron-induced cardiac changes and detect arrhythmias. Acetaminophen and NMGDTC, or combinations thereof, reduced cardiac and hepatic excess iron content as measured by inductively coupled plasma atomic emission spectrometry (ICP-AES). Acetaminophen was effective whether administered po or ip. Acetaminophen treatment had a positive inotropic effect on cardiac function. Acetaminophen-deferoxamine combination conferred equal cardioprotection as acetaminophen or deferoxamine alone, was equally able to remove hepatic iron, and was superior to either acetaminophen or deferoxamine in removing cardiac iron from iron-overloaded gerbils. Acetaminophen-NMGDTC combination was also effective in removing cardiac and hepatic iron and protecting against iron-induced cardiac damage. ECHO evaluation of iron-overloaded, untreated gerbils demonstrated a high incidence of cardiac arrhythmias, usually PVCs (10/16 = 63%), and mortality prior to completion of the experiment (4/16 = 25%). All treatments except deferoxamine, alone, reduced the incidence of cardiac arrhythmias and deaths. All treatments reduced iron-induced increases in hepatic and cardiac weights. This study demonstrates injection alternates that are equally or more effective than deferoxamine injections and shows oral acetaminophen to be effective in treatment of iron-overload and associated cardiac complications

Age-Associated Changes in Hearts of Male Fischer 344/Brown Norway F1 Rats

Aging is associated with left ventricular hypertrophy, dilatation, and fibrosis of the heart. The Fischer 344/Brown Norway F1 (F344/BNF1) rat is recommended for age-related studies by the National Institutes on Aging because this hybrid rat lives longer and has a lower rate of pathological conditions than inbred rats. However, little is known about age-associated changes in cardiac and aortic function and structure in this model. This study evaluated age-related cardiac changes in male F344/BNF1 rats using ECHO, gross, and microscopic examinations. Rats aged 6-, 30-, and 36-mo were anesthetized and two-dimensional ECHO measurements, two-dimensional guided M-mode, Doppler M-mode, and other recordings from parasternal long- and short-axis views were obtained using a Phillips 5500 ECHO system with a 12 megahertz transducer. Hearts and aortas from sacrificed rats were evaluated grossly and microscopically. The ECHO studies revealed persistent cardiac arrhythmias (chiefly PVCs) in 72% (13/18) of 36-mo rats, 10% (1/10) of 30-mo rats, and none in 6-mo rats (0/16). Gross and microscopic studies showed left ventricular (LV) dilatation, borderline to mild hypertrophy, and areas of fibrosis that were common in 36-mo rats, less evident in 30-mo rats, and absent in 6-mo rats. Aging was associated with mild to moderate decreases of LV diastolic and systolic function. Thus, male F344/BN F1 rats demonstrated progressive age-related (a) decline in cardiac function (diastolic and systolic indices), (b) LV structural changes (chamber dimensions, volumes, and wall thicknesses), and (c) persistent arrhythmias. These changes are consistent with those in humans. The noninvasive ECHO technique offers a means to monitor serial age-related cardiac failure and therapeutic responses in the same rats over designated time intervals

Outcomes of Transcutaneous Aortic Valve Replacement among high risk WV sample population

Introduction:Transcatheter aortic valve replacement (TAVR) is a relatively new strategy for replacing the aortic valve. We elected to review our early experience to see if we could identify clinical characteristics at baseline or immediately following the procedure that would predict death within one year. Methods:Charts for all patients assigned to receive TAVR procedure at St Mary’s medical center, Huntington, West Virginia between April, 2013 till November, 2016 were identified and reviewed. A total of seventy-two (72) cases were included. Results: All cause mortality rate at index hospitalization, 30 days, and 12 months was 5.6%(N=4), 6.9%(N=5), 19.4%(N=14) respectively. Stroke rate at index hospitalization, 30 days, and 12 months was 2.8%(N=2), 2.8%(N=2), 8.3%(N=6) respectively. Major predictors of death were post procedure GFR, Contrast volume, and number of antiplatelet agents therapy (AUC= 0.638, 0.632, 0.637 respectively). Conclusion: We found that post procedure GFR, less number of antiplatelet agents post procedure, and contrast volume may predict mortality within first 12 months post TAVR. Further studies focused on the above factors may be warranted

Trans-radial coronary intervention (TCI) using 5-Fr versus 6-Fr guiding catheters in the setting of acute coronary syndrome (ACS)

Background: As in any vascular access the size of guiding catheter is an operator preference. Although multiple studies showed the use of 5-Fr versus 6-Fr guiding catheters for Transradial coronary intervention (TCI) have similar vascular safety profile and can be performed safely and successfully with both of them, the data comparing the 5-Fr vs 6-Fr guiding catheters for TCI in terms of fluoroscopy time, procedure time and contrast amount in the setting of ACS is limited. We conducted this study to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the settings of ACS. Method: Our study is a single center, retrospective cohort study designed to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the setting of ACS. In the period between July 2014 and July 2015, all patients who had previously undergone PCI with at least one stent being placed, utilizing a radial access, and using a 5Fr or 6Fr guiding catheter were included. No exclusion criteria were applied. The study was approved by Marshall University’s institutional review board. Results: There was a significant reduction in the volume of contrast medium used with the 5 Fr group compared to the 6 Fr group (130.66 +/- 3.46 ml vs. 166.25 +/- 10.05 ml in the 5 and 6 Fr groups, respectively; p < 0.001), fluoroscopy time (12.62 +/- 0.50 min vs. 16.61 +/- 1.28 min in the 5 and 6 Fr groups, respectively; p = 0.005) and there was also significant reduction in the procedure time in the 5 Fr group (38.74 +/- 1.27 min vs. 46.03 +/- 2.86 min in the 5 and 6 Fr groups, respectively; p = 0.023). Conclusion: TCI in the settings of ACS is safe and feasible, whether using 5 Fr or 6 Fr catheters. Our study concluded that using 5 Fr catheters for TCI could be preferred for patients presenting with ACS due to lower amount of contrast medium used and less fluoroscopy and procedure time. However, this is a single center retrospective study, so we suggest that large randomized controlled studies are needed

Telomeric DNA induces apoptosis and senescence of human breast carcinoma cells

INTRODUCTION: Cancer is a leading cause of death in Americans. We have identified an inducible cancer avoidance mechanism in cells that reduces mutation rate, reduces and delays carcinogenesis after carcinogen exposure, and induces apoptosis and/or senescence of already transformed cells by simultaneously activating multiple overlapping and redundant DNA damage response pathways. METHODS: The human breast carcinoma cell line MCF-7, the adriamycin-resistant MCF-7 (Adr/MCF-7) cell line, as well as normal human mammary epithelial (NME) cells were treated with DNA oligonucleotides homologous to the telomere 3' overhang (T-oligos). SCID mice received intravenous injections of MCF-7 cells followed by intravenous administration of T-oligos. RESULTS: Acting through ataxia telangiectasia mutated (ATM) and its downstream effectors, T-oligos induced apoptosis and senescence of MCF-7 cells but not NME cells, in which these signaling pathways were induced to a far lesser extent. In MCF-7 cells, experimental telomere loop disruption caused identical responses, consistent with the hypothesis that T-oligos act by mimicking telomere overhang exposure. In vivo, T-oligos greatly prolonged survival of SCID mice following intravenous injection of human breast carcinoma cells. CONCLUSION: By inducing DNA damage-like responses in MCF-7 cells, T-oligos provide insight into innate cancer avoidance mechanisms and may offer a novel approach to treatment of breast cancer and other malignancies

Quantifying temporal change in biodiversity : challenges and opportunities

Growing concern about biodiversity loss underscores the need to quantify and understand temporal change. Here, we review the opportunities presented by biodiversity time series, and address three related issues: (i) recognizing the characteristics of temporal data; (ii) selecting appropriate statistical procedures for analysing temporal data; and (iii) inferring and forecasting biodiversity change. With regard to the first issue, we draw attention to defining characteristics of biodiversity time series—lack of physical boundaries, uni-dimensionality, autocorrelation and directionality—that inform the choice of analytic methods. Second, we explore methods of quantifying change in biodiversity at different timescales, noting that autocorrelation can be viewed as a feature that sheds light on the underlying structure of temporal change. Finally, we address the transition from inferring to forecasting biodiversity change, highlighting potential pitfalls associated with phase-shifts and novel conditions.Publisher PDFPeer reviewe