Analysis of the Genome Sequence of Strain GiC-126 of Gloeostereum incarnatum with Genetic Linkage Map

Gloeostereum incarnatum has edible and medicinal value and was first cultivated and domesticated in China. We sequenced the G. incarnatum monokaryotic strain GiC-126 on an Illumina HiSeq X Ten system and obtained a 34.52-Mb genome assembly sequence that encoded 16,895 predicted genes. We combined the GiC-126 genome with the published genome of G. incarnatum strain CCMJ2665 to construct a genetic linkage map (GiC-126 genome) that had 10 linkage groups (LGs), and the 15 assembly sequences of CCMJ2665 were integrated into 8 LGs. We identified 1912 simple sequence repeat (SSR) loci and detected 700 genes containing 768 SSRs in the genome; 65 and 100 of them were annotated with gene ontology (GO) terms and KEGG pathways, respectively. Carbohydrate-active enzymes (CAZymes) were identified in 20 fungal genomes and annotated; among them, 144 CAZymes were annotated in the GiC-126 genome. The A mating-type locus (MAT-A) of G. incarnatum was located on scaffold885 at 38.9 cM of LG1 and was flanked by two homeodomain (HD1) genes, mip and beta-fg. Fourteen segregation distortion markers were detected in the genetic linkage map, all of which were skewed toward the parent GiC-126. They formed three segregation distortion regions (SDR1–SDR3), and 22 predictive genes were found in scaffold1920 where three segregation distortion markers were located in SDR1. In this study, we corrected and updated the genomic information of G. incarnatum. Our results will provide a theoretical basis for fine gene mapping, functional gene cloning, and genetic breeding the follow-up of G. incarnatum.

Analysis of the Genome Sequence of Strain GiC-126 of Gloeostereum incarnatum with Genetic Linkage Map

Gloeostereum incarnatum has edible and medicinal value and was first cultivated and domesticated in China. We sequenced the G. incarnatum monokaryotic strain GiC-126 on an Illumina HiSeq X Ten system and obtained a 34.52-Mb genome assembly sequence that encoded 16,895 predicted genes. We combined the GiC-126 genome with the published genome of G. incarnatum strain CCMJ2665 to construct a genetic linkage map (GiC-126 genome) that had 10 linkage groups (LGs), and the 15 assembly sequences of CCMJ2665 were integrated into 8 LGs. We identified 1912 simple sequence repeat (SSR) loci and detected 700 genes containing 768 SSRs in the genome; 65 and 100 of them were annotated with gene ontology (GO) terms and KEGG pathways, respectively. Carbohydrate-active enzymes (CAZymes) were identified in 20 fungal genomes and annotated; among them, 144 CAZymes were annotated in the GiC-126 genome. The A mating-type locus (MAT-A) of G. incarnatum was located on scaffold885 at 38.9 cM of LG1 and was flanked by two homeodomain (HD1) genes, mip and beta-fg. Fourteen segregation distortion markers were detected in the genetic linkage map, all of which were skewed toward the parent GiC-126. They formed three segregation distortion regions (SDR1–SDR3), and 22 predictive genes were found in scaffold1920 where three segregation distortion markers were located in SDR1. In this study, we corrected and updated the genomic information of G. incarnatum. Our results will provide a theoretical basis for fine gene mapping, functional gene cloning, and genetic breeding the follow-up of G. incarnatum.

Aortic aneurysm: a rare cause of Ortner's syndrome

A young man presented with hoarseness of voice and was found to have left vocal cord paralysis and a large opacity on chest X-ray in the left upper zone. CT angiography showed a giant aneurysm of the aortic arch involving the left subclavian artery. Using a dual perfusion system, with the femoral bypass circuit taking care of the spinal protection and the aortic bypass circuit providing the cerebral protection, the aneurysm was excised and a 16 mm Dacron [registered] graft was anastomosed to the aortic arch and the left subclavian artery was anastomosed to the interposition graft. He had a smooth postoperative course and his hoarseness subsided in next 6 months.

Synovial sarcoma of the heart

A young male presented with dyspnoea and was found to have a diastolic murmur at the left lower sternal edge. Transthoracic and transoesophageal echocardiograms found a large mass attached to the tricuspid valve, which was projecting into the right atrium and the right ventricle. The mass was causing significant obstruction of the right ventricular inflow. Emergency surgery had to be performed because the patient developed severe vomiting [of unknown cause] leading to haemodynamic compromise. This condition was not responding to fluid resuscitation as there was obstruction to right ventricular inflow. Intraoperatively the mass was removed and the tricuspid valve was repaired. The histological and immunohistochemical examination of the excised tissue confirmed the rare diagnosis of synovial sarcoma of the heart. Postsurgical imaging showed no metastases. The patient received postoperative radio therapy and chemotherapy. The tumour recurred after 6 months and the patient succumbed to his illness and expired

Predictive value of euroscopre in Pakistani cardiac surgical patients

To evaluate the predictive value of European System for Cardiac Operative Risk Evaluation [EuroSCORE] of early mortality in Pakistani cardiac surgical population in a single cardiac center. A prospective, single institution, observational cohort study. Department of Cardiac Surgery AFIC Rawalpindi from 1st January, 2009 to 31st December 2009. A total of 1064 consecutive adult patients undergoing cardiac surgical intervention at department of adult cardiac surgery from 1st January 2009 to 31st December 2009 were included in the study. The logistic EuroSCORE score was estimated for all the patients and compared with the observed 30 day mortality. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model and the area under the receiver operating characteristic [ROC] curve was measured to analyse the EuroSCORE discriminative power on individual death prediction. Expected mortality was compared to observed or actual mortality. Mortality was defined as death from any cause within 30 days of operation or within the same hospital admission. The Hosmer-Lemeshow test revealed a good calibration power [p = 0.73] and the area under the ROC curve was 0.753, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients [18.18%] was very high as compared to predicted mortality [8.14%]. EuroSCORE is a reasonably good relevant predictor of immediate post-operative mortality in low and intermediate risk groups after cardiac surgery in Pakistani population, but is less predictive for high-risk patients

Double flap patch closure of VSD with elevated pulmonary vascular resistance: an experience at AFIC/NIHD

To determine the 30 days outcome measured in terms of morbidity and mortality in cases of ventricular septal defect [VSD] with increased pulmonary vascular resistance [PVR] managed with double flap patch closure. Case series. Armed Forces Institute of Cardiology [AFIC/NIHD], Rawalpindi, from December 2005 to December 2008. Forty patients with VSD having PVR 9.58 + 4.33 wood units underwent double flap patch closure. The patch was fenestrated as one half of the expected aortic annulus diameter. A separate flap patch 5 mm larger than fenestration was attached to superior upper one third margins of fenestration. The patch was placed with flap to open towards the left ventricular apex. Modified ultra filtration [MUF] was employed in every case and sildenafil was given postoperatively. The age of patients ranged from 1 to 28 years with a mean of 6.66 + 5.70 years. There were 22 males and 18 females. All patients were weaned off from inotropic and ventilatory support as earlier as possible postoperatively with intensive care unit [ICU] stay of 77.15 + 54.56 hours. Postoperative pulmonary artery pressures were reduced to 42.63 + 10.86 mmHg as compared to pre-operative pulmonary artery pressures of 88.3 + 15.2 mmHg. Postoperatively 11 patients with suprasystemic pulmonary artery pressures and desaturation went into pulmonary hypertensive crisis in which immediate 2D echo evidenced the functioning flap valve with right to left shunt. There was only one death [early] out of 40 patients with an overall mortality of 2.5% along with limited morbidity. Double flap patch is an inexpensive, easy to construct technique with low morbidity and mortality in cases of VSD with raised PVR

Coronary endarterectomy for severe diffuse coronary artery disease

To determine the outcome of Coronary Endarterectomy [CE] in patients undergoing Coronary Artery Bypass Graft [CABG] surgery for diffuse Coronary Artery Disease [CAD], in terms of postoperative mortality and morbidity, relief from angina and survival at one year. A case series. Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2003 to November 2005. Included in the study were all patients with such diffuse CAD that conventional bypass grafting was not possible. Those with the diseased coronary artery supplying an akinetic myocardium and a fixed perfusion defect on perfusion scan, or with poor left ventricular function [ejection fraction < 30%] in association with severe chronic hepatic disease and deranged liver function tests, permanent severe immune deficiency state, or poor results at lung function tests were excluded. Cardiopulmonary Bypass [CPB] was used in all patients. All patients were followed up for a mean time of one year, for assessment of postoperative mortality and morbidity, relief from angina and survival. Fifty five patients [3.2%] underwent CE of at least one major coronary artery for severe diffuse atheromatous disease. The mean age was 53.9 +/- 9.5 years. Twenty six [47.3%] had previous Myocardial Infarction [Ml], 16 [29.1%] had unstable angina, 12 [21.8%] had poor Left Ventricular [LV] function, 5 [9.1%] underwent emergency CABG surgery for impending infarction, 39 [70.9%] had angina Canadian Cardiovascular Society [CCS] class II/III, 11 [20%] had critical left main stem disease and 12 [21.8%] required Intra-Aortic Balloon Pump [IABP] for hemodynamic support. There were 2 [3.6%] early deaths and 2 [3.6%] cases of non-fatal infarctions. Three [5.4%] patients had low Cardiac Output [CO] after operation. At one year follow-up, there were no late deaths and 43 patients [91.5% of those reporting for follow-up] did not have angina. CE acted as an adjunct to CABG surgery with acceptable operative risks and satisfactory results at one year in terms of mortality and angina relief

Surgical experience with cardiac myxomas

Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period. This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients [19 males, 15 females] underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months. Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium [LA] [79%] followed by the right atrium [RA] [14%]. Only one patient had myxoma in the right ventricle [RV]. Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study. Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity

Modified Ultrafiltration: Role in adult cardiac surgical haemostasis

During cardiac surgery, cardiopulmonary bypass [CPB] leads to haemodilutional anaemia and activation of inflammatory mediators, affecting haemostasis. Modified Ultrafiltration [MUF] is being increasingly favoured for haemoconcentration without blood transfusion and reducing post operative bleeding. Aim of this study was to record the impact of modified ultrafiltration on haemoconcentration and postoperative bleeding during adult cardiac surgery. This randomized control trial included 100 patients, divided into 2 groups; MUF and control group. Serial blood samples were drawn to evaluate haematological indices. Postoperative chest drainage was recorded for 24 hours. Results were expressed in terms of percentages, means and p value [p < 0.05 was taken as significant]. Four patients were excluded and 96 patients were analyzed [MUF n=50, control n=46]. According to American society of anaesthetist [ASA] classification, MUF group was higher risk group [p=0.02] with longer extracorporeal perfusion time [p < 0.001]. Haemoconcentration was successfully achieved in MUF group [final haemoglobin=10.7 +/- 1.25, haematocrit=33 +/- 3.64%, p < 0.001] with lower blood loss [MUF=395 +/- 153 ml, control=755 +/- 435 ml, p < 0.001] and transfusion requirement [p < 0.001]. Re-exploration rate was 4% and 6.5% in MUF and control group respectively [p=0.57]. Mortality in both groups was comparable [MUF=4%, control=4.3%, p=0.94]. Modified ultrafiltration is a safe procedure which successfully achieves haemoconcentration, lowers blood loss and transfusion requirement after cardiac surgery in adult population

Ventricular septal defect in infants and children with increased pulmonary vascular resistance and pulmonary hypertension - surgical management leaving an atrial level communication

To evaluate the surgical and medical efficacy of the patients operated for Ventricular Septal Defect [VSD] with Pulmonary Hypertension and Pulmonary Vascular Resistance [PVR]. Infants and children with elevated PVR and Pulmonary Hypertension are associated with significant mortality and morbidity after surgical closure. Circulatory assist devices and sophisticated medicines may not be available to help in the management of infants and children with elevated Pulmonary artery pressure and resistance. We left Patent Foramen Ovale [PFO] or made atrial communication to decrease the morbidity and mortality associated with the closure of large VSD in this risky group. Sixteen infants and children were operated with median age of 12 months, operated by the same surgeon [IU], from January' 2004 to December' 2005. They were with large VSD of elevated PVR [3.9+0.3] and underwent VSD closure leaving PFO or artificial ASD [5mm]. Surgical approach was through right atrium. Post operatively, all the patients were electively ventilated for 36 hours. They were given intravenous dilators [Glyceral Trinitrate + Phentolamine] and oral Sildenafil up to 1mg /Kg, six hourly. Five cases went into acute pulmonary hypertensive crisis postoperatively, and were rescued by Prostacycline Nebulization. Sixteen patients had VSD as the primary lesion that underwent operation. The overall early mortality was 6.25% [1/16]. There have been no late deaths. Closure of large VSD with elevated PVR can be performed, leaving PFO or artificial ASD, with acceptable mortality and morbidity

Vascularized bilateral pectoralis major muscle flaps as a primary procedure in patients with sternal necrosis and infection

The current study was conducted to analyze our experience of vascularized bilateral pectoralis major muscle flaps as a primary procedure in patients with sternal necrosis and infection in terms of mortality, functional results and chest stabilization. It is a case - review analytical study conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from 1st Jan 1994 to 31st Dec 2001. Patients developing sternal dehiscence subjected to primary repair with vascularized bilateral pectoralis major flaps were studied. Relevant information was retrieved from the medical records. The procedure entails generous excision of all visibly infected soft tissues and bone followed by covering with vascularized bilateral pectoralis major flaps, raised from medial to lateral side based on thoracoacromial vessels. Patients were followed for 01 year postoperatively for complications. Twenty six patients suffered from deep mediastinal wound infection and sternal necrosis requiring bilateral pectoralis major flaps. One patient presented late after three months and all others were fresh cases. Mean age was 57.23 +/- 8.92 and there were 24 males and 2 females. Twenty five patients had coronary artery bypass surgery and 01 had closure of ventricular septal defect [VSD] with aortic valve replacement and right ventricular outflow tract [RVOT] reconstruction. One [4%] patient had complete failure of the repair requiring omentoplasty, while 02 [8%] had partial wound dehiscence needing resuturing. Twenty two [84%] patients were discharged between 8 to 10 days while 01 [4%] patient died of septicemia and mutliorgan failure in the hospital. After one year, all were alive; none had chest instability, breathing difficulty or limitation of shoulder joint movement. Primary repair with bilateral pectoralis major muscle flaps in sternal infection requiring extensive resection gives good results, with early discharge from the hospital good cosmetic results

Outcome of ventricular septal defect closure

To identify the factors affecting the outcome, measured in terms of morbidity and mortality, after primary ventricular septal defect [VSD] closure. Design: Descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, from January 2002 to October 2003. Subjects and Children upto the age of 5 years who had primary VSD closure were studied. Patients were divided into two groups. Group-I included survivors and group-II included non-survivors. There was no difference in the conduct of operation among the two groups. A total of 53 patients were operated of whom 47 survived. Pulmonary hypertensive crisis [p < 0.001], pulmonary infections [p < 0.001] and pleural effusions [p < 0.003] were higher in non-survivor group. Patients in non survivor group were younger [0.75 + 0.34 years vs 2.24 + 1.16 years, p = 0.01] having less body weight [4.91 + 1.56 kg vs 7.94 + 3.35, p = 0.03] and high pulmonary artery to systemic pressure ratio at the time of coming off bypass [0.63 + 0.13 vs 0.43 + 0.09, p < 0.001]. Non survivors had higher association [66.6% vs 19.1%] of additional left to right shunts [p < 0.001]. Body weight less than 5 kg along with young age, high pulmonary artery to systemic pressure ratio at the time of coming off bypass and presence of additional left to right shunt are risk factors for adverse outcome

Microsporidial keratoconjunctivitis in an HIV-infected patient: case report and literature review

We describe an HIV-seropositive patient who presented with bilateral superficial epithelial keratitis due to protozoal infection by the microsporidia Encephalitozoon cuniculi. Diagnosis was made by clinical and cytological examination of conjunctival and corneal scrapings and was further confirmed by light and electron microscopy