Septal Pouch in the Left Atrium A New Anatomical Entity With Potential for Embolic Complications

ObjectivesThe purpose of this study was to develop a better understanding of the pathophysiology of the condition, we studied the patterns by which the septum primum (SP) and septum secundum (SS) fuse.BackgroundA patent foramen ovale (PFO) is a communication across the interatrial septum between a nonadherent SP and SS and is considered to be a risk factor for serious clinical syndromes.MethodsWe examined the interatrial septum in 94 randomly selected autopsied hearts, with a focus on the SP and SS and the patterns by which the 2 structures fuse.ResultsOf the 94 specimens that were suitable for analysis, 26 (27.66%) had a PFO. Of the remaining 68 hearts, complete fusion of the SP and SS along the entire zone of overlap was seen in 27 (28.7%) hearts. In the remaining 41 hearts (60.29%), a PFO was absent, but incomplete fusion of the SP and SS was seen. Of 41 hearts, 37 (90%) had a septal pouch that opened into the left atrial (LA) cavity. Four hearts (10%) had a pouch accessible from the right atrium. Hearts with left-sided pouches tended to be younger (50 ± 18 years of age) than hearts where there was complete fusion (age 63 ± 23 years) (p = 0.06).ConclusionsOur data suggest that when a foramen ovale closes spontaneously, the SP and SS fuse initially at the caudal limit of the zone of overlap of the 2 structures. This incomplete fusion results in a pouch that, in the majority of instances, communicates with the LA cavity

Violent Hiccups: An Infrequent Cause of Bradyarrhythmias

A hiccup, or singultus, results from a sudden, simultaneous, vigorous contraction of the diaphragm and inspiratory muscles, accompanied by closure of the glottis. Hiccups can be associated with bradyarrhythmias. The mechanism of this phenomenon is likely hiccup-induced Valsalva maneuver and increased parasympathetic tone. We present a case of a patient with violent hiccups producing a bradyarrhythmia

Anatomical Basis for the Mobility of the Esophagus: Implications for Catheter Ablation of Atrial Fibrillation

We present autopsy data from a patient that illustrates the anatomical factors that allow the esophagus to be a mobile structure, especially with respect to the posterior left atrial wall

Prolongation of the QTc Interval Is Seen Uniformly During Early Transmural Ischemia

ObjectivesIn order to more clearly understand the electrocardiographic manifestations of early transmural ischemia, we studied electrocardiograms (ECGs) in patients undergoing balloon angioplasty.BackgroundDecisions regarding reperfusion strategies in patients with acute myocardial infarction rely largely on the presence of ST-segment elevation (STE) in the ECG, consequently with significant limitations. Studies of the “ischemic cascade” show that ST-segment changes occur well after the onset of wall motion abnormalities.MethodsWe prospectively analyzed ECGs obtained at 20-s intervals in 74 patients undergoing elective balloon angioplasty. The ECGs were analyzed using 3 methodologies. In 74 patients, the ST-segment, the T-wave, and the QT-interval were analyzed using the MUSE (General Electric HC, Menomonee Falls, Wisconsin) automated system (MUSE). Fifty patients were also analyzed using the Interval Editor automated system (IE; General Electric HC). In 20 patients, measurements were made manually.ResultsTransmural ischemia prolonged the QTc interval (using the Bazett’s formula) in 100% of patients. In all 74 patients analyzed with MUSE, QTc interval prolonged from 423 ± 25 ms to 455 ± 34 ms (p < 0.001). In the 50 patients analyzed with IE, QTc interval prolonged in 50 of 50 (100%) patients (from 424 ± 27 ms to 458 ± 33 ms [p < 0.001]). Mean time to maximal QTc interval prolongation, changes in T-wave polarity, ≥1 mm STE, and ST-segment depression (STD) were 22, 24, 29, and 35 s, respectively. Although QTc interval prolonged in 100% of patients, T-wave changes, STE, and STD (≥1 mm) occurred in 7%, 15%, and 7%, respectively.ConclusionsThe QTc interval prolongs in 100% of patients with early transmural ischemia. When compared with clinically accepted indexes of transmural ischemia (i.e., STD and STE [≥1 mm]) it is the earliest ECG abnormality

Fluctuation-induced excess conductivity in the compounds CaREBaCu<SUB>3</SUB>O<SUB>7-y</SUB> (RE=La and Sm)

The compounds CaREBaCu3O7-y (RE=La and Sm) are tetragonal at room temperature with Tc between 60 and 70 K. The single-phase compounds were prepared by solid-state reaction. The resistivity was measured by a four-probe technique in a continuous flow cryostat with the temperature being controlled to an accuracy of 10 mK. The resistivity vs temperature showed a break in slope around 180 K in CaLaBaCu3O7-y and around 220 K in CaSmBaCu3O7-y . The results were analysed for fluctuation conductivity from 180 K downwards. A plot of dp/dT vs T showed a sharp peak at Tm =69.69 K for La compound and 66.00 K for the Sm compound. Detailed analysis of the resistivity in the region Ton to 180 K was carried out using the procedure due to Veira and Vidal. The results are discussed in this paper

Targeting the programmed cell death 1: programmed cell death ligand 1 pathway reverses T cell exhaustion in patients with sepsis

INTRODUCTION: A major pathophysiologic mechanism in sepsis is impaired host immunity which results in failure to eradicate invading pathogens and increased susceptibility to secondary infections. Although many immunosuppressive mechanisms exist, increased expression of the inhibitory receptor programmed cell death 1 (PD-1) and its ligand (PD-L1) are thought to play key roles. The newly recognized phenomenon of T cell exhaustion is mediated in part by PD-1 effects on T cells. This study tested the ability of anti-PD-1 and anti-PD-L1 antibodies to prevent apoptosis and improve lymphocyte function in septic patients. METHODS: Blood was obtained from 43 septic and 15 non-septic critically-ill patients. Effects of anti-PD-1, anti-PD-L1, or isotype-control antibody on lymphocyte apoptosis and interferon gamma (IFN-γ) and interleukin-2 (IL-2) production were quantitated by flow cytometry. RESULTS: Lymphocytes from septic patients produced decreased IFN-γ and IL-2 and had increased CD8 T cell expression of PD-1 and decreased PD-L1 expression compared to non-septic patients (P<0.05). Monocytes from septic patients had increased PD-L1 and decreased HLA-DR expression compared to non-septic patients (P<0.01). CD8 T cell expression of PD-1 increased over time in ICU as PD-L1, IFN-γ, and IL2 decreased. In addition, donors with the highest CD8 PD-1 expression together with the lowest CD8 PD-L1 expression also had lower levels of HLA-DR expression in monocytes, and an increased rate of secondary infections, suggestive of a more immune exhausted phenotype. Treatment of cells from septic patients with anti-PD-1 or anti-PD-L1 antibody decreased apoptosis and increased IFN-γ and IL-2 production in septic patients; (P<0.01). The percentage of CD4 T cells that were PD-1 positive correlated with the degree of cellular apoptosis (P<0.01). CONCLUSIONS: In vitro blockade of the PD-1:PD-L1 pathway decreases apoptosis and improves immune cell function in septic patients. The current results together with multiple positive studies of anti-PD-1 and anti-PD-L1 in animal models of bacterial and fungal infections and the relative safety profile of anti-PD-1/anti-PD-L1 in human oncology trials to date strongly support the initiation of clinical trials testing these antibodies in sepsis, a disorder with a high mortality

Tackling alcoholism and domestic violence in fisheries - a new opportunity to improve wellbeing for the most vulnerable people in global fisheries

The UN Sustainable Development Goals (SDGs) principle of ‘Leaving no one behind’ focusses global attention on the poorest and most vulnerable people. As different sectors grapple to engage meaningfully with this principle, we posit that greater consideration of social problems in fishing-dependent communities, such as alcoholism and domestic violence, presents an opportunity for fisheries governors to contribute to the SDGs mandate. We further argue that governing marine resources in ignorance of these problems can risk harming some of the most vulnerable people in fisheries. Using subjective wellbeing data from women living in two small-scale fishing communities in India and Sri Lanka, we demonstrate the prevalence and impact of alcoholism and domestic violence in fishing households. We further highlight how policies which restrict access to marine resources can undermine important coping strategies, in particular the ability of women to act as independent income-earners, exacerbating harm to already vulnerable women. A scoping review of the literature reveals that alcoholism and domestic violence are reported in certain fisheries around the world, and we theorise how this may relate to the nature of fishing life, and growing stresses regarding the future of fishing. Tackling the burdens of alcoholism and domestic violence in fisheries, where it is an issue, is an opportunity to improve wellbeing for men, women and their families. The paper concludes with tangible actions which marine resource governors could adopt to contribute to the ‘leave no one behind’ ethos

Long term survival following the detection of circulating tumour cells in head and neck squamous cell carcinoma

Background Techniques for detecting circulating tumor cells in the peripheral blood of patients with head and neck cancers may identify individuals likely to benefit from early systemic treatment. Methods Reconstruction experiments were used to optimise immunomagnetic enrichment and RT-PCR detection of circulating tumor cells using four markers (ELF3, CK19, EGFR and EphB4). This method was then tested in a pilot study using samples from 16 patients with advanced head and neck carcinomas. Results Seven patients were positive for circulating tumour cells both prior to and after surgery, 4 patients were positive prior to but not after surgery, 3 patients were positive after but not prior to surgery and 2 patients were negative. Two patients tested positive for circulating cells but there was no other evidence of tumor spread. Given this patient cohort had mostly advanced disease, as expected the detection of circulating tumour cells was not associated with significant differences in overall or disease free survival. Conclusion For the first time, we show that almost all patients with advanced head and neck cancers have circulating cells at the time of surgery. The clinical application of techniques for detection of spreading disease, such as the immunomagnetic enrichment RT-PCR analysis used in this study, should be explored further

Ecological–Health Risk of Antimony and Arsenic in Centella asiatica, Topsoils, and Mangrove Sediments: A Case Study of Peninsular Malaysia

The current study assessed the ecological–health risks of potentially toxic arsenic (As) and antimony (Sb) in the vegetable Centella asiatica, topsoils, and mangrove sediments sampled from Peninsular Malaysia. The As concentrations ranged from 0.21 to 4.33, 0.18 to 1.83, and 1.32 to 20.8 mg/kg dry weight, for the leaves, stems, and roots of the vegetable, respectively. The ranges of Sb concentrations were 0.31–0.62, 0.12–0.35, and 0.64–1.61 mg/kg dry weight, for leaves, stems, and roots of the vegetable, respectively. The children’s target hazard quotient (THQ) values indicated no non-carcinogenic risks of As and Sb in both leaves and stems, although children’s THQ values were higher than those in adults. The calculated values of estimated weekly intake were lower than established provisional tolerable weekly intake of As and Sb for both children and adult consumers. The carcinogenic risk (CR) values of As for children’s intake of leaves and stems of vegetables showed more public concern than those of adults. The levels of Sb and As in the topsoils were generally higher (although not significantly) than those in the mangrove sediments, resulting in a higher geoaccumulation index, contamination factor and ecological risk, hazard index, THQ, and CR values. This indicated that the anthropogenic sources of Sb and As originated from the land-based activities before reaching the mangrove near the coast. The CR of As signifies a dire need for comprehensive ecological–health risks exposure studies, as dietary intake involves more than just vegetable consumption. Therefore, risk management for As and Sb in Malaysia is highly recommended. The present findings of the ecological–health risks of As and Sb based on 2010–2012 samples can be used as an important baseline for future reference and comparison. Copyright © 2022 Yap, Tan, Cheng, Syazwan, Azrizal-Wahid, Krishnan, Go, Nulit, Ibrahim, Mustafa, Omar, Chew, Edward, Okamura, Al-Mutairi, Al-Shami, Sharifinia, Keshavarzifard, You, Bakhtiari, Bintal, Zakaly, Arai, Naji, Saleem, Abd Rahman, Ong, Subramaniam and Wong.Ministry of Higher Education, Malaysia, MOHEThe present study was supported financially by the Fundamental Research Grant Scheme (FRGS), (Vote No.: 5524953) and by the Ministry of Higher Education, Malaysia