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1.
J Saudi Heart Assoc ; 33(2): 95-100, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34183904

RESUMEN

Heyde's syndrome (HS) is described as the association between recurrent bleeding from angiodysplasia of the gastrointestinal tract and aortic stenosis. Aortic valve replacement has been reported to stop the bleeding. In unfit patients, the options available are interventional or conservative management. We hereby report an elderly obese patient with severe comorbidity with complicated HS involving a narrow aortic root. She underwent left ventricular outlet myomectomy and aortic root replacement to promote better forward flow and prevent restenosis and recurrence of symptoms. She was discharged home symptom-free despite being on coumadin anticoagulants.

2.
J Saudi Heart Assoc ; 33(4): 317-320, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35083123

RESUMEN

Iatrogenic injuries with migrated interventional stents can sometimes be life-threatening. The interventional retrieval management is generally the treatment of choice, as surgical procedures carry a high mortality risk with only a few cases reported. We report a patient with two stents migrated into the right atrium from superior vena cava resulting in cardiac perforation. She was successfully treated using pericardiocentesis followed by surgical intervention with rapid post-operative resolution of symptoms. The technique presented here substantiates the steps for a safe and effective removal of these multiple displaced stents with minimal postprocedural complications.

3.
Asian Cardiovasc Thorac Ann ; 28(7): 444-447, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31533439

RESUMEN

An 8-year-old girl with severe mitral regurgitation presented with symptoms of heart failure. Clinical investigations did not raise suspicion of an absent left pericardium. Congenital defects of the pericardium are rare and frequently associated with other cardiac lesions. We describe a case of severe mitral regurgitation in a child in whom an absent left-sided pericardium with hypoplasia of left lung was found incidentally during surgery to repair the mitral valve. We believe such associations with other heart diseases is usually circumstantial but can influence the perioperative morbidity, length of hospital stay, and even alter the surgical management.


Asunto(s)
Anomalías Múltiples/diagnóstico , Cardiopatías Congénitas/diagnóstico , Hallazgos Incidentales , Enfermedades Pulmonares/diagnóstico , Pulmón/anomalías , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Pericardio/anomalías , Niño , Femenino , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/fisiopatología , Índice de Severidad de la Enfermedad
4.
Nat Food ; 1(12): 811-819, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37128067

RESUMEN

The global supply of vanilla extract is primarily sourced from the cured beans of the tropical orchid species Vanilla planifolia. Vanilla plants were collected from Mesoamerica, clonally propagated and globally distributed as part of the early spice trade. Today, the global food and beverage industry depends on descendants of these original plants that have not generally benefited from genetic improvement. As a result, vanilla growers and processors struggle to meet global demand for vanilla extract and are challenged by inefficient and unsustainable production practices. Here, we report a chromosome-scale, phased V. planifolia genome, which reveals sequence variants for genes that may impact the vanillin pathway and therefore influence bean quality. Resequencing of related vanilla species, including the minor commercial species Vanilla × tahitensis, identified genes that could impact productivity and post-harvest losses through pod dehiscence, flower anatomy and disease resistance. The vanilla genome reported in this study may enable accelerated breeding of vanilla to improve high-value traits.

5.
Cureus ; 11(10): e5993, 2019 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-31807381

RESUMEN

Coronary artery disease (CAD) is the most common killer disease, responsible for about one-third of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome.

7.
Asian Cardiovasc Thorac Ann ; 27(1): 42-44, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30789010

RESUMEN

In cardiac surgery, supplementation with recombinant factor VIIa is the treatment of choice for patients with factor VII deficiency, but overzealous administration can be associated with thromboembolic side-effects. A 53-year-old man with factor VII activity 15.2%, international normalized ratio 2.9, and acute thrombotic critical coronary anatomy, underwent coronary artery bypass surgery and a thoracotomy with decortication 5 months later. He was managed successfully without recombinant factor VIIa supplementation. This case demonstrates that current bedside and laboratory tests such as thromboelastography, prothrombin time or international normalized ratio, and factor VII activity may not predict replacement therapy in these patients.


Asunto(s)
Coagulación Sanguínea/efectos de los fármacos , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Deficiencia del Factor VII/tratamiento farmacológico , Factor VIIa/administración & dosificación , Hemostáticos/administración & dosificación , Espondilitis Anquilosante/cirugía , Toracotomía , Toma de Decisiones Clínicas , Puente de Arteria Coronaria/efectos adversos , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Esquema de Medicación , Monitoreo de Drogas/métodos , Deficiencia del Factor VII/sangre , Deficiencia del Factor VII/complicaciones , Deficiencia del Factor VII/diagnóstico , Factor VIIa/efectos adversos , Hemostáticos/efectos adversos , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/diagnóstico , Toracotomía/efectos adversos , Tromboelastografía , Resultado del Tratamiento
8.
Ann Card Anaesth ; 22(1): 30-34, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30648676

RESUMEN

The development of a myocardial infarction ventricular septal rupture is a rare fatal complication, and the surgical repair is the treatment of choice. In most of the scenarios, the operation will be done as an emergency procedure that carries high mortality. Prognosis of these patients depends on prompt echocardiographic diagnosis and the proactive medical and surgical therapy. More recently, various options have been put forward including the timing for surgery, percutaneous closure devices, and the improved outcome with initial stabilization with medical treatment including mechanical support. In this retrospective case series, we are presenting the management of these patients who presented us in different clinical scenarios and trying to identify the risks for the poor outcome and to formulate a strategy to improve the outcome.


Asunto(s)
Defectos del Tabique Interventricular/cirugía , Infarto del Miocardio/complicaciones , Atención Perioperativa , Defectos del Tabique Interventricular/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
9.
J Saudi Heart Assoc ; 30(3): 260-263, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29983501

RESUMEN

Guidelines recommend screening patients for carotid-artery stenosis, but unfortunately, measurement of baseline cerebral oximetry levels is still not a routine practice prior to cardiac surgery. We report a 41-year-old woman who presented with a normal carotid scan and unexpectedly low baseline cerebral oximetry levels. She had delayed postoperative recovery and discharge from hospital following her coronary-artery bypass surgery. This case report reiterates the prognostic significance of cerebral oximetry in the preoperative checkup and the association of low intraoperative values to postoperative cerebral impairment. It can also be identified as a comparatively better tool for preventing cognitive disturbances after cardiac surgery.

10.
Ann Card Anaesth ; 19(1): 59-62, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26750675

RESUMEN

BACKGROUND: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. MATERIALS AND METHODS: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. RESULTS: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc.,) were taken. CONCLUSION: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Estenosis Carotídea/metabolismo , Oxígeno/análisis , Anciano , Anciano de 80 o más Años , Química Encefálica , Dióxido de Carbono/metabolismo , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Consumo de Oxígeno , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Espectroscopía Infrarroja Corta , Accidente Cerebrovascular/prevención & control
11.
Asian Cardiovasc Thorac Ann ; 24(5): 473-6, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25829458

RESUMEN

Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome.


Asunto(s)
Anticoagulantes/administración & dosificación , Síndrome Antifosfolípido/tratamiento farmacológico , Coagulación Sanguínea/efectos de los fármacos , Anuloplastia de la Válvula Cardíaca , Sustitución de Medicamentos , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Heparina/administración & dosificación , Warfarina/administración & dosificación , Adulto , Algoritmos , Anticoagulantes/efectos adversos , Síndrome Antifosfolípido/sangre , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Pruebas de Coagulación Sanguínea , Anuloplastia de la Válvula Cardíaca/efectos adversos , Puente Cardiopulmonar , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Heparina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Warfarina/efectos adversos
12.
J Biol Chem ; 288(36): 25908-25914, 2013 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-23873930

RESUMEN

The genes encoding a family of proteins termed proline-rich γ-carboxyglutamic acid (PRRG) proteins were identified and characterized more than a decade ago, but their functions remain unknown. These novel membrane proteins have an extracellular γ-carboxyglutamic acid (Gla) protein domain and cytosolic WW binding motifs. We screened WW domain arrays for cytosolic binding partners for PRRG4 and identified novel protein-protein interactions for the protein. We also uncovered a new WW binding motif in PRRG4 that is essential for these newly found protein-protein interactions. Several of the PRRG-interacting proteins we identified are essential for a variety of physiologic processes. Our findings indicate possible novel and previously unidentified functions for PRRG proteins.


Asunto(s)
Proteínas de la Membrana/metabolismo , Secuencias de Aminoácidos , Células HEK293 , Humanos , Proteínas de la Membrana/genética , Unión Proteica , Estructura Terciaria de Proteína
13.
Nature ; 475(7355): 217-21, 2011 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-21706032

RESUMEN

Editing of the human genome to correct disease-causing mutations is a promising approach for the treatment of genetic disorders. Genome editing improves on simple gene-replacement strategies by effecting in situ correction of a mutant gene, thus restoring normal gene function under the control of endogenous regulatory elements and reducing risks associated with random insertion into the genome. Gene-specific targeting has historically been limited to mouse embryonic stem cells. The development of zinc finger nucleases (ZFNs) has permitted efficient genome editing in transformed and primary cells that were previously thought to be intractable to such genetic manipulation. In vitro, ZFNs have been shown to promote efficient genome editing via homology-directed repair by inducing a site-specific double-strand break (DSB) at a target locus, but it is unclear whether ZFNs can induce DSBs and stimulate genome editing at a clinically meaningful level in vivo. Here we show that ZFNs are able to induce DSBs efficiently when delivered directly to mouse liver and that, when co-delivered with an appropriately designed gene-targeting vector, they can stimulate gene replacement through both homology-directed and homology-independent targeted gene insertion at the ZFN-specified locus. The level of gene targeting achieved was sufficient to correct the prolonged clotting times in a mouse model of haemophilia B, and remained persistent after induced liver regeneration. Thus, ZFN-driven gene correction can be achieved in vivo, raising the possibility of genome editing as a viable strategy for the treatment of genetic disease.


Asunto(s)
Reparación del ADN/genética , Modelos Animales de Enfermedad , Marcación de Gen/métodos , Terapia Genética/métodos , Genoma/genética , Hemofilia B/genética , Hemostasis , Animales , Secuencia de Bases , Línea Celular Tumoral , Roturas del ADN de Doble Cadena , Endonucleasas/química , Endonucleasas/genética , Endonucleasas/metabolismo , Exones/genética , Factor IX/análisis , Factor IX/genética , Vectores Genéticos/genética , Células HEK293 , Hemofilia B/fisiopatología , Humanos , Intrones/genética , Hígado/metabolismo , Regeneración Hepática , Ratones , Ratones Endogámicos C57BL , Mutación/genética , Fenotipo , Homología de Secuencia , Dedos de Zinc
14.
Nanomedicine ; 5(4): 463-72, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19341819

RESUMEN

This study evaluated the efficiency of chitosan-encapsulated DNA-based respiratory syncytial virus (RSV) vaccine. Antigenic regions of RSV F, M2, and G genes were cloned into the human cytomegalovirus promoter-based constitutive expression vector, resulting in a DNA vaccine vector named DR-FM2G. This vector was used to formulate DNA-chitosan nanoparticles (DCNPs) using a complex coacervation process that yielded an encapsulation efficiency of 94.7%. The DCNP sizes ranged from 80 to 150 nm with uniform size distribution and spherical shape. DNA release was between 50% and 60% when DCNPs were incubated with similar gastrointestinal fluid (pH 2), whereas 21% to 25% of DNA was released from DCNPs in 30 minutes at pH 10. Differential scanning calorimetry showed DCNPs to be more stable than naked DNA or chitosan, offering protection from DNA degradation by nucleases. DCNPs were not toxic to cells when used at concentrations < or =400 microg/mL. Immunohistochemical and real-time polymerase chain reaction results showed a higher level of RSV protein expression in mouse tissues given when DCNPs were injected intravenously as compared with naked DNA. FROM THE CLINICAL EDITOR: This study evaluated the efficiency of chitosan-encapsulated DNA-based respiratory syncytial virus (RSV) vaccine, showing a higher level of RSV protein expression in mouse tissues given when DCNPs were injected intravenously as compared with naked DNA.


Asunto(s)
Técnicas de Transferencia de Gen , Vectores Genéticos/genética , Nanopartículas/administración & dosificación , Vacunas contra Virus Sincitial Respiratorio/inmunología , Virus Sincitiales Respiratorios/inmunología , Vacunas de ADN/administración & dosificación , Vacunas de ADN/genética , Animales , Células COS , Rastreo Diferencial de Calorimetría , Muerte Celular/efectos de los fármacos , Quitosano/administración & dosificación , Quitosano/farmacología , Chlorocebus aethiops , ADN Viral/administración & dosificación , ADN Viral/inmunología , Ensayo de Cambio de Movilidad Electroforética , Humanos , Inmunohistoquímica , Inyecciones Intravenosas , Ratones , Microscopía de Fuerza Atómica , Microscopía Electrónica de Transmisión , Nanopartículas/ultraestructura , Vacunas contra Virus Sincitial Respiratorio/administración & dosificación , Virus Sincitiales Respiratorios/efectos de los fármacos , Virus Sincitiales Respiratorios/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Propiedades de Superficie/efectos de los fármacos , Transfección , Vacunas de ADN/inmunología , Proteínas Virales/inmunología
15.
J Mol Biol ; 356(2): 288-99, 2006 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-16376379

RESUMEN

Mitochondrial genomes in higher plants are much larger and more complex as compared to animal mitochondrial genomes. There is growing evidence that plant mitochondrial genomes exist predominantly as a collection of linear and highly branched DNA molecules and replicate by a recombination-dependent mechanism. However, biochemical evidence of mitochondrial DNA (mtDNA) recombination activity in plants has previously been lacking. We provide the first report of strand-invasion activity in plant mitochondria. Similar to bacterial RecA, this activity from soybean is dependent on the presence of ATP and Mg(2+). Western blot analysis using an antibody against the Arabidopsis mitochondrial RecA protein shows cross-reaction with a soybean protein of about 44 kDa, indicating conservation of this protein in at least these two plant species. mtDNA structure was analyzed by electron microscopy of total soybean mtDNA and molecules recovered after field-inversion gel electrophoresis (FIGE). While most molecules were found to be linear, some molecules contained highly branched DNA structures and a small but reproducible proportion consisted of circular molecules (many with tails) similar to recombination intermediates. The presence of recombination intermediates in plant mitochondria preparations is further supported by analysis of mtDNA molecules by 2-D agarose gel electrophoresis, which indicated the presence of complex recombination structures along with a considerable amount of single-stranded DNA. These data collectively provide convincing evidence for the occurrence of homologous DNA recombination in plant mitochondria.


Asunto(s)
ADN/metabolismo , Glycine max , Mitocondrias/genética , Recombinación Genética , ADN/química , ADN/ultraestructura , Electroforesis/métodos , Conformación de Ácido Nucleico , Glycine max/citología , Glycine max/genética
16.
J Mol Biol ; 329(2): 311-22, 2003 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-12758078

RESUMEN

Hydrogen bonded histidine-aspartate (His-Asp) pairs are critical constituents in several key enzymatic reactions. To date, the role that these pairs play in catalysis is best understood in serine and trypsin-like proteases, where structural and biochemical NMR studies have revealed important pK(a) values and hydrogen bonding patterns within the catalytic pocket. However, the role of the His-Asp pair in metal-assisted catalysis is less clear. Here, we apply liquid-state NMR to investigate the role of a critical histidine residue of apurinic endonuclease 1 (Ape1), a human DNA repair enzyme that cleaves adjacent to abasic sites in DNA using one or more divalent cations and an active-site His-Asp pair. The results of these studies suggest that the Ape1 His-Asp pair does not function as either a general base catalyst or a metal ligand. Rather, the pair likely stabilizes the pentavalent transition state necessary for phospho-transfer.


Asunto(s)
Ácido Aspártico/metabolismo , Liasas de Carbono-Oxígeno/metabolismo , Exodesoxirribonucleasas/metabolismo , Histidina/metabolismo , Paladio/metabolismo , Sitios de Unión , Calcio/metabolismo , Liasas de Carbono-Oxígeno/química , Catálisis , ADN/genética , ADN/metabolismo , Reparación del ADN , ADN-(Sitio Apurínico o Apirimidínico) Liasa , Exodesoxirribonucleasas/química , Humanos , Hidrólisis , Cinética , Magnesio/metabolismo , Espectroscopía de Resonancia Magnética , Modelos Moleculares , Oxidación-Reducción , Unión Proteica , Proteínas Recombinantes/genética , Proteínas Recombinantes/aislamiento & purificación , Proteínas Recombinantes/metabolismo , Relación Estructura-Actividad
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