Defective mitochondria remodelling in B cells leads to an aged immune response.

The B cell response in the germinal centre (GC) reaction requires a unique bioenergetic supply. Although mitochondria are remodelled upon antigen-mediated B cell receptor stimulation, mitochondrial function in B cells is still poorly understood. To gain a better understanding of the role of mitochondria in B cell function, here we generate mice with B cell-specific deficiency in Tfam, a transcription factor necessary for mitochondrial biogenesis. Tfam conditional knock-out (KO) mice display a blockage of the GC reaction and a bias of B cell differentiation towards memory B cells and aged-related B cells, hallmarks of an aged immune response. Unexpectedly, blocked GC reaction in Tfam KO mice is not caused by defects in the bioenergetic supply but is associated with a defect in the remodelling of the lysosomal compartment in B cells. Our results may thus describe a mitochondrial function for lysosome regulation and the downstream antigen presentation in B cells during the GC reaction, the dysruption of which is manifested as an aged immune response.

An alternative valve for mitral valve replacement in young children: using an NO-REACT® INJECTABLE BIOPULMONIC™ prosthesis as a mitral valve replacement in a 14-month-old child.

Mitral valve replacement in infants is challenging and there are limited alternative valves available. Since the Boston group published their first report on alternative valves for mitral valve replacement in infants, there has been a growth in the literature on the topic, mostly based on the use of a stented bovine jugular vein graft (Melody® valve). The challenges of the Melody valve are firstly in its length of 28 mm unexpanded, which has the potential to cause left ventricular outflow tract obstruction, and secondly, the valve needs mechanical dilatation, which is laborious. A modified No-React® Injectable Biopulmonic™ Prosthesis (Bio Integral Surgical, Inc., Mississauga, ON, Canada) which is shorter (19 mm) and simpler in that it is self-expanding was implanted in a 14-month-old child to replace her mitral valve. The operation was successful and the short-term function of the prosthesis is good.

Analysis of a Cooperation and Interventional Model in Humanitarian Medicine.

Background: Every year, around 15 million children, in developing countries, die or develop life-long disabilities because of congenital cardiac diseases. In this report we measure the effect of a pediatric cardiac surgery humanitarian project on the health of the individual and on the potential influence this has on the countries economy and its growing health services. Methods: We collected and analyzed data from the Italian NGO, Mission Bambini's database, including all congenital cardiac missions undertaken in Cambodia between 2012 and 2019. DALY's (Disability Adjusted Life Years) saved by the humanitarian mission were estimated and used to reflect on the impact this had on the populations economy. Progression in the local medical teams skills emulated the advancements made in the health sector of the region. Results: Between 2012 and 2019, 128 patients underwent a congenital cardiac operation at Angkor Hospital for Children at Siem Reap, Cambodia. The median age was 6 years. The majority of the pathologies included VSD, TOF, ASD. The mean Aristotle's Complexity Score was 6. Post-operative mortality was 0.8% (1/128). The cost-effectiveness analysis identified 5.360 DALY's saved by surgery. The competency of the local team was progressive with them being able to handle more complex cases on subsequent missions. Conclusion: In developing Countries, performing congenital cardiac surgery cases can be carried out successfully with improvement in both the economy and the health system of the country by increasing the years and the quality of life of the working population and developing the expertise of the regional team.

Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve.

OBJECTIVES: Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS: From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS: Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months-12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS: An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study.

OBJECTIVES: Repair of Tetralogy of Fallot (TOF) has currently excellent results with either transventricular or transatrial approach. However, it is unclear as to which has better late outcomes and what role of residual pulmonary valve (PV) regurgitation in the long term is. We report on late clinical outcomes after repair in a large series of patients with TOF, focusing on the type of surgical technique. METHODS: This analysis is a retrospective multicentre study on patients undergoing TOF repair in infancy. The exclusion criteria of the study were TOF with pulmonary atresia or absent PV. RESULTS: We selected 720 patients who had undergone TOF repair (median age 5.7 months, interquartile range 3.7-11.7). Preoperative cyanotic spells occurred in 18%. A transatrial repair was performed in 433 (60.1%) patients. The PV was preserved in 249 (35%) patients, while the right ventricular outflow tract was reconstructed with a transannular patch (60.4%) or a conduit (4.6%) in the rest of the patients. At a median follow-up of 4 years (range 1-21, 86% complete), 10 (1.6%) patients died, while 39 (6.3%) patients required surgical reoperation and 72 (11.7%) patients required an interventional procedure. The propensity match analysis showed that the incidence of postoperative complications and adverse events at follow-up were significantly increased in patients undergoing transventricular approach repair with transannular patch (P = 0.006) and PV preservation was a significant protective factor against postoperative complications (P = 0.009, odds ratio 0.5) and late adverse events (P = 0.022). CONCLUSIONS: Surgical repair of TOF in infancy is a safe procedure, with good late clinical outcomes. However, transatrial approach and PV preservation at repair are associated with lower early and late morbidity.

Modelling the combined effect of chlorine, benzyl isothiocyanate, exposure time and cut size on the reduction of Salmonella in fresh-cut lettuce during washing process.

This work aimed to study the effect of the combination of Sodium hypochlorite, the most used disinfectant by the vegetable industry, with a natural antimicrobial, benzyl-isothiocyanate (BITC), considering cutting surface and contact time, on the reduction of Salmonella in fresh-cut produce in washing operations under typical industrial conditions. Overall, the combinations of disinfectant and process parameters resulted in a mean reduction of Salmonella of 2.5 log CFU/g. According to statistical analysis, free chlorine and BITC concentrations, contact time and cut size exerted a significant effect on the Salmonella reduction (p ≤ 0.05). The optimum combination of process parameter values yielding the highest Salmonella reduction was a lettuce cut size of 15 cm2 washed for 110 s in industrial water containing 160 mg/L free chlorine and 40 mg/L BITC. A predictive model was also derived, which, as illustrated, could be applied to optimize industrial disinfection and develop probabilistic Exposure Assessments considering the effect of washing process parameters on the levels of Salmonella contamination in leafy green products. The present study demonstrated the efficacy of chlorine to reduce Salmonella populations in fresh-cut lettuce while highlighting the importance of controlling the washing process parameters, such as, contact time, cut size and concentration of the disinfectant to increase disinfectant efficacy and improve food safety.

Epicardial cardioverter-defibrillator implantation in a 4-month-old infant bridged to heart transplantation.

Implantable cardioverter-defibrillator (ICD) is the gold standard therapy for the prevention of sudden cardiac death. Nevertheless, ICD placement in the paediatric population is still limited because of several technical difficulties. Several implantation techniques have been proposed but experience in infants with very low weight and less than 6 months is very limited. We herein describe a case of a minimally invasive ICD epicardial implantation in a 4-month-old infant weighing 5 kg. A diagnosis of arrhythmic cardiomyopathy with left ventricular non-compaction disease with ventricular tachycardia storms, QT prolongation and Wolff-Parkinson-White pattern was made. Antiarrhythmic drugs, radiofrequency ablation and sympathetic denervation were not effective. ICD implantation was successful allowing the infant to survive and bridging to heart transplantation.

Proposta de atuação da Fonoaudiologia nos Cuidados Paliativos em pacientes oncológicos hospitalizados / Proposal of Speech-Language Pathology activities in Palliative Care in hospitalized oncology patients / Propuesta de acción fonoaudiologica para Cuidados Paliativos en pacientes oncológicos hospitalizados

O objetivo deste trabalho é apresentar uma proposta de atuação fonoaudiológica para os aspectos de segurança da deglutição e facilitação comunicativa em pacientes oncológicos internados em ambiente hospitalar e em cuidados paliativos. Diariamente, os pacientes caracterizados como em Cuidados Paliativos hospitalizados recebem a visita fonoaudiológica e passam por avaliação profissional, sobretudo se observados sinais preditores de risco para broncoaspiração ou queixas que lhes ofereçam desconforto no processo de alimentação. Após a avaliação fonoaudiológica completa, se inferida a Disfagia orofaríngea, os pacientes são acompanhados pelo Fonoaudiólogo com condutas que visem à reabilitação e/ou a minimização dos riscos de broncoaspiração, de acordo com o quadro clínico, das necessidades e desejos tanto do paciente quanto da família, da evolução em que se encontra e a possibilidade de antever e prevenir desconfortos relacionados à alimentação e/ou comunicação desse paciente. Assim, conclui-se que o Fonoaudiólogo pode contribuir ativamente dentro da equipe multiprofissional de cuidados paliativos ao paciente oncológico internado em ambiente hospitalar, avaliando, prevenindo, reabilitando e mantendo uma deglutição de forma segura e prazerosa ao indivíduo, quando possível, gerenciando os riscos de broncoaspiração e melhorando sua qualidade de vida relacionada à alimentação via oral e comunicativa.

The aim of this paper is to present a Speech-Language Pathology ­ SLP proposal to guarantee the security aspects of swallowing and facilitate the communication of palliative care patients with cancer admitted at a hospital. Everyday, patients characterized as palliative care in the hospital receive a SLP visit and undergo professional assessment specially if it is observed predictors of aspiration risk or complaints of discomfort while feeding. After the clinical assessment, if oropharyngeal dysphagia is inferred, patients are accompanied by the SLP. The treatment aim's rehabilitation and/or minimization of the aspiration risk, according to the clinical status and desires of the patient and the family. The patient evaluation is always considered and the SLP seeks to avoid any discomforts related to feeding and/or communication disorders. Thus, it was concluded that the SLP can contribute actively within the multidisciplinary team of palliative care patients with cancer admitted at a hospital, assessing, preventing, rehabilitating and maintaining, when possible, the swallowing safe and pleasurable by managing the risk of aspiration and improving the patient quality of life related to the oral feeding and communication.

El objetivo de este trabajo es presentar una propuesta de atuación fonoaudiológica para los aspectos de seguridad de la deglución y la facilitación de la comunicación en pacientes oncológicos internados en ambiente hospitalar y que reciben cuidados paliativos. Diariamente, los pacientes que reciben cuidados paliativos, hospitalizados, reciben visita fonoaudiológica y pasan por evaluación profesional especialmente si se observan señales de riesgo para la aspiración bronquial, o quejas que ofrescan molestias en el proceso de alimentación. Después de la evaluación fonoaudiológica completa, si se infiere la existencia de disfagia orofaríngea, los pacientes son acompañados por fonoaudiólogo con conductas orientadas a la rehabilitación y / o minimización del riesgo de aspiración, de acuerdo con el cuadro clínico, con las necesidades y deseos del paciente y de la familia, con la evolución del cuadro y con la capacidad de antever y prevenir malestares relacionados con la alimentación y / o comunicación de ese paciente. De eso se concluye que el fonoaudiólogo puede contribuir de manera activa dentro del equipo multidisciplinar de cuidados paliativos al pacientes oncológico internado em ambiente hospitalar, evaluando, preveniendo, rehabilitando y manteniendo una deglución segura y placentera para el individuo, siempre que sea posible, administrando los riesgos de aspiración bronquial y mejorando su calidad de vida relacionada con la alimentación oral y la comunicación.

Off-pump Kommerell's diverticulum resection and descending aorta replacement.

We report the case of an unusual variation of a Kommerell's diverticulum in a left aortic arch with an aberrant left subclavian artery, associated with dilatation of the distal aortic arch, surgically treated without the use of extracorporeal circulation.

Hormonal State Comparison (Progesterone, Estradiol, and Leptin) of Body Fat and Body Mass Indices in Mexican Women as a Risk Factor for Neonatal Physiologic Condition.

STUDY OBJECTIVE: Describe the impact of teen pregnancy on later ovarian activity and metabolic hormones considering the concentration of current levels of ovarian steroids and leptin in a sample of Mexican females. DESIGN: Cross-sectional study in the maternity of the General Hospital of Atlacomulco and campus of the Autonomous University of the State of Mexico. PARTICIPANTS: 71 women between the ages of 18 and 24, and 160 neonates seen between March 2010 and June 2012. MAIN OUTCOME MEASURES: The measurements obtained included anthropometric body composition (bioelectrical impedance), serum hormone quantification of ovarian steroids and leptin (immunoassays), and the Apgar scores, height, and weight in neonates. Statistical analysis included ANOVA, Student, and chi-square for P < .05. RESULTS: Adolescent mothers showed significantly lower concentrations of estradiol (P = .001) and progesterone (P = .001). However, higher levels of leptin in adolescent mothers were not statistically different compared with older mothers (P = .84). Also, leptin was correlated with all measures of adiposity. The mean birth weights (P = .001) and Apgar scores (P = .001) were lower in neonates of adolescent mothers than in neonates of adult mothers. There was no association between maternal age with the anthropometric variables studied. CONCLUSIONS: Early reproduction represents a metabolic stress condition that modifies the long term ovarian activity and metabolic hormones, and impacts the morbidity-mortality of the mother and offspring in a later vital life cycle stage.

Field efficacy and safety of a combination of moxidectin and imidacloprid for the prevention of feline heartworm (Dirofilaria immitis) infection.

Throughout the end of March to beginning of May 2006, 212 owned cats and 608 owned dogs from a heavy endemic area for canine heartworm (HW) disease in northern Italy have been examined to assess HW infection prevalence. Both cats and dogs were clinically examined and blood samples were taken from each animal to be examined for HW antibody (Ab). Ab-positive cats were further examined for circulating microfilariae, HW antigens (Ag) and by echocardiography (ECHO) to assess the presence of adult worms. Dogs were clinically examined and blood samples taken from each animal were examined for circulating microfilariae and for HW Ag. Ten cats (4.7%) were found Ab positive. Of these, 6 cats were Ag positive (2.6%) and in 4 (1.8%) the worms were visualized by ECHO. HW prevalence in dogs was 36% (221/608). One hundred and seventy-six (29%) were both microfilaraemic and Ag positive, 40 (7%) had occult infections (no circulating microfilariae) and 7 (1%) were microfilaraemic but Ag negative. Upon owners' consent, 132 cats (including cats Ab and/or Ag and ECHO positive) were prophylactically treated against HW disease with an imidacloprid/moxidectin spot-on combination (10% imidacloprid/1% moxidectin) monthly administered for 6 months. Cats were re-examined for HW infection in November, 1 month after the last drug administration, and in May-June 2007, 7-8 months after the last treatment. All 122 cats found HW negative before treatment, were found negative at the two examinations at the end of study. The 4 cats Ab positive, 2 cats Ab and Ag positive and 1 Ab, Ag and ECHO positive at the beginning of treatment were found negative. Throughout the treatment, transitory hypersalivation and generic signs of annoyance were reported by owners in 6 cats (4.5%). All signs regressed spontaneously.

Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome.

OBJECTIVE: To assess the outcome of 54 patients with obesity-hypoventilation syndrome (OHS) who were treated with nasal intermittent positive-pressure ventilation (NIPPV). DESIGN: Descriptive analysis of retrospectively collected clinical data. MATERIALS AND METHODS: From March 1995 to December 2002, OHS (defined as a body mass index [BMI] of > 30 kg/m2, a daytime Pa(CO2) of > or = 50 mm Hg, and a Pa(O2) of < 60 mm Hg in the absence of COPD) was diagnosed in 69 cases. Fifteen patients (21.7%) refused to be treated with NIPPV, and 20 patients were started on NIPPV therapy electively and 34 following an acute exacerbation. We employed daytime arterial blood gas values and overnight pulse oximetry to determine the initial NIPPV modes and settings. The outcome measures were survival, clinical status, and arterial blood gas levels. RESULTS: Among the 54 study patients (18 women), the mean (+/- SD) age was 56 +/- 13 years. The mean BMI was 44 +/- 8.8 kg/m2. Sleep apnea syndrome (apnea-hypopnea index, > 5) was present in 87% of the patients. At presentation, 22 of the 54 patients had experienced an acute hypercapnic respiratory failure (pH < 7.34). None of these patients required orotracheal intubation after NIPPV treatment. Initially, 2 patients were treated with volume-preset ventilation, 49 patients used pressure-preset equipment, and 3 patients employed continuous positive airway pressure (CPAP). Forty-seven patients required supplemental oxygen. At the end of the follow-up period (mean duration, 50 months), Pa(O2) had increased by 24 mm Hg from baseline (95% confidence interval [CI], 21 to 28 mm Hg; p < 0.0001) and Pa(CO2) had decreased by 17 mm Hg (95% CI, 13 to 20 mm Hg; p < 0.0001). NIPPV therapy improved subjective sleepiness (mean Epworth sleepiness scale score decrease, 16 +/- 5 to 6 +/- 2; p < 0.001), and dyspnea decreased in all but four patients. During follow-up, three patients died (one of them due to the progression of respiratory failure). NIPPV therapy could be withdrawn in 5 patients who had achieved a sufficient weight loss, and the conditions of 16 patients could be maintained without respiratory failure by the use of simple therapy with CPAP. CONCLUSIONS: NIPPV therapy is effective in the treatment of patients with OHS, providing a significant improvement in clinical status and gas exchange.

Subannular left ventricular aneurysm in a patient with bicuspid aortic valve stenosis.

The term "subannular" left ventricular aneurysm (LVA) implies that the aneurysm's origin is very close to the aorta. In the absence of an infective etiology, subannular LVAs are very rare among Caucasians. Only a few cases have been reported in the literature. We present the case of a patient with a subannular LVA who underwent surgery at our Institution.

[Cardiac myxoma: surgical results and 15-year clinical follow-up]. / Il mixoma cardiaco: risultati chirurgici e follow-up clinico a 15 anni.

BACKGROUND: Among cardiac tumors myxoma is the most common benign neoplasm. The aim of this study was to review our Institution's 15-year experience with intracardiac myxoma. METHODS: From 1985 through 2001, 38 patients (22 males, 16 females, mean age 57.06 +/- 11.1, range 32-74 years) underwent surgical resection of a cardiac myxoma at our Institution. The tumor was located in the left atrium in 29 patients (76.3%), in the right atrium in 8 patients (21%), and in the right ventricle in 1 patient (2.6%). The duration of symptoms prior to surgery ranged from 2 to 30 days. None of the patients had a familial myxoma. The surgical approach comprised complete wide excision in all patients. The incidence of delayed death, thromboembolic complications, valve degeneration, recurrence and reoperation were reviewed and the Kaplan-Meier survival curve was elaborated. RESULTS: There were no perioperative deaths. Three patients (7.9%) developed postoperative neurological sequelae: transient ischemic attacks in 2 patients (5.2%) and a stroke with persistent neurological deficit in 1 patient (2.6%). One patient (2.6%) required pacemaker implantation for complete atrioventricular block. An inferior myocardial infarction occurred in 1 patient (2.6%). During the follow-up, complete in 89.4% of the patients (34 out of 38 patients, mean 96.8 +/- 68.4 months, range 1-218 months), there were 2 (5.8%) non-cardiac related deaths. All the patients underwent clinical examination and echocardiography at regular intervals (1 year): no neurological event was observed during the follow-up and 29 patients (90.6%) are in NYHA functional class I. At 15 years the event-free rate is 85.2%. At 15 years the actuarial survival for the whole group is 92%. CONCLUSIONS: At present, the diagnosis of myxoma is easy to make and two-dimensional echocardiography plays a major role in this field. Surgery is the gold standard treatment and the clinical long-term results are excellent.

Successful resection of an epicardial cyst.

Cases of pericardial cyst have been reported by many authors, but the incidence of epicardial cyst originating directly from the epicardium in the pericardial cavity is extremely rare. A case of successful resection of epicardial cyst fortuitously discovered and diagnosed during cardiac operation is presented.