Endocarditis Associated With Coronary Cameral Fistula Presenting With Intracranial Hemorrhage.

Coronary cameral fistulas are rare anomalous connections between coronary circulation and cardiac chambers. Coronary cameral fistulas are often asymptomatic but may cause volume overload on impacted chambers, and also create high velocity turbulent diastolic flow which may predispose patients to endocarditis. This paper presents a unique case of infective endocarditis revealed by intracerebral hemorrhage with a mycotic aneurysm in a patient who was found to have a nonvalvular infective endocarditis located on the mitral anterolateral papillary muscle, at the ventricular site of entrance of a large coronary cameral fistula.

Exercise-Induced Shear Stress Drives mRNA Translation In Vitro.

The vascular endothelium is the first line of defense to prevent cardiovascular disease. Its optimal functioning and health are maintained by the interaction of the proteins-endothelial nitric oxide synthase (eNOS), sirtuin 1 (SIRT1), and endothelin 1 (ET1)-and the genes that encode them-NOS3, SIRT1, and EDN1, respectively. Aerobic exercise improves endothelial function by allegedly increasing endothelial shear stress (ESS). However, there are no current data exploring the acute effects of specific exercise-induced ESS intensities on these regulatory proteins and genes that are associated with endothelial function. The purpose of this study was to assess the acute changes in endothelial proteins and gene expression after exposure to low-, moderate-, and high-intensity exercise-induced ESS. Human umbilical vein endothelial cells (HUVECs) were exposed to resting ESS (18 dynes/cm2, 60 pulses per minute (PPM)), low ESS (35 dynes/cm2, 100 PPM), moderate ESS (50 dynes/cm2, 120 PPM), and high ESS (70 dynes/cm2, 150 PPM). Protein and gene expression were quantified by fluorescent Western blot and RTqPCR, respectively. All exercise conditions showed an increase in eNOS and SIRT1 expression and a decrease in NOS3 and SIRT1 gene expression when compared to resting conditions. In addition, there was no expression of ET1 and an increase in EDN1 gene expression when compared to resting conditions. These results show that (1) exercise-induced ESS increases the expressions of vascular protective proteins and (2) there is an inverse relationship between the proteins and their encoding genes immediately after exercise-induced ESS, suggesting that exercise has a previously unexplored translational role catalyzing mRNA to proteins.

Effectiveness of Virtual Reality for Managing Pain, Fear, and Anxiety in Children and Adolescents Undergoing Needle-Related Procedures: Systematic Review with Meta-Analysis.

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = -1.83; 95% CI -2.93 to -0.72; WBFSparents p = 0.0002; MD = -2.61; 95% CI -4.00 to -1.23; WBFSnurses p = 0.0001; MD = -2.71; 95% CI -2.82 to -2.60; VAS/NRS p = 0.001, MD = -0.71; 95% CI -1.13 to -0.28), anxiety (CAMpatient p = 0.02, MD = -2.92; 95% CI -5.45 to -0.38; CAMparents p = 0.01, MD = -3.87; 95% CI -6.99 to -0.75) and fear (CFSpatients p = 0.0005, MD = -1.27; 95% CI -1.99 to -0.56; CFSparents p = 0.0005, MD = -1.33; 95% CI -2.08 to -0.58; and CFSnurses p = 0.04, MD = -1.13; 95% CI -2.24 to -0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Effect of non-thermal acidic and alkaline modifications on the structural, pasting, rheological, and functional properties of cassava (Manihot esculenta) starch.

This study aimed to investigate the effects of acid or alkali modification of isolated cassava starch (ICS) on its physicochemical properties. Acetic acid concentrations of 5%, 10%, and 20% v/v (0.87, 1.73, and 3.46 M, respectively) and calcium hydroxide concentrations of 0.15%, 0.20%, and 0.30% w/w (0.02, 0.025, and 0.04 M, respectively) were tested independently and compared with untreated isolated starch. The scanning electron microscope (SEM) shows starches with polyhedral and semispherical shapes; these modifications do not change the surface of the starch granules. Nanocrystals with orthorhombic crystal structure were extracted from ICS. Transmission electron microscopy (TEM) shows crystallites with a size (two-dimensional) of 20 ± 5 nm in length and 10 ± 2 nm in width and reveals that this starch contains nanocrystals with orthorhombic crystal structure. The X-ray patterns show that these nanocrystals are unaffected by acidic or alkaline treatments. The Ca+2 and CH3COO- ions do not interact with these nanocrystals. The alkaline treatment only affects the gelatinization temperature at a Ca(OH)2 concentration of 0.30%. Low concentrations of acidic and alkaline treatments affect the ability of cassava starch to absorb water and reduce the peak and final viscosity. The infrared spectra show that the modifications lead to C-H and C═C bond formations. ICS-B 0.30 can modify the amorphous regions of the starch, and the acid treatment leads to acetylation, which was confirmed by the presence of an IR band at 1740 cm-1.

Expression patterns of folate metabolism-related enzymes in the bovine oviduct: estrous cycle-dependent modulation and responsiveness to folic acid.

Folate metabolism is required for important biochemical processes that regulate cell functioning, but its role in female reproductive physiology in cattle during peri- and post-conceptional periods has not been thoroughly explored. Previous studies have shown the presence of folate in bovine oviductal fluid, as well as finely regulated gene expression of folate receptors and transporters in bovine oviduct epithelial cells (BOECs). Additionally, extracellular folic acid (FA) affects the transcriptional levels of genes important for the functioning of BOECs. However, it remains unknown whether the anatomical and cyclic features inherent to the oviduct affect regulation of folate metabolism. The present study aimed to characterize the gene expression pattern of folate cycle enzymes in BOECs from different anatomical regions during the estrous cycle and to determine the transcriptional response of these genes to increasing concentrations of exogenous FA. A first PCR screening showed the presence of transcripts encoding dihydrofolate reductase (DHFR), methylenetetrahydrofolate reductase (MTHFR), and methionine synthase (MTR) in bovine reproductive tissues (ovary, oviduct and uterus), with expression levels in oviductal tissues comparable to, or even higher than, those detected in ovarian and uterine tissues. Moreover, expression analysis through RT-qPCR in BOECs from the ampulla and isthmus during different stages of the estrous cycle demonstrated that folate metabolism-related enzymes exhibited cycle-dependent variations. In both anatomical regions, DHFR was upregulated during the preovulatory stage, while MTHFR and MTR exhibited increased expression levels during the postovulatory stage. Under in vitro culture conditions, ampullary and isthmic cells were cultured in the presence of 10, 50, and 100 µM FA for 24 h. Under these conditions, isthmus epithelial cells exhibited a unique transcriptional response to exogenous FA, showing a pronounced increase in MTR expression levels. Our results suggest that the expression of folate metabolism-related genes in BOECs is differentially regulated during the estrous cycle and may respond to exogenous levels of folate. This offers a new perspective on the transcriptional regulation of genes associated with the folate cycle in oviductal cells and provides groundwork for future studies on their functional and epigenetic implications within the oviductal microenvironment.

Genome sequences of 70 multidrug-resistant Gram-negative isolates in high-risk neonates in the Northeast of Mexico.

Infections by multidrug-resistant pathogens are steadily increasing worldwide. A considerable proportion of neonatal intensive care admissions have a bacterial infection with multidrug-resistant bacteria during their hospital stay. In this work, we report draft genome sequences of 70 selected isolates from high-risk neonates in the Northeast of Mexico.

Extraction and Physicochemical Characterization of Hydroxyapatites From Horse Humerus Bones of Different Ages (1, 3, 6, and 8 Years old) Calcined at Low Temperature.

The aim of this work is to investigate the changes in the physicochemical properties of hydroxyapatite (HAp) extracted from horse humerus bones of different ages (1, 3, 6, and 8 years) subjected to low temperature calcination (600°C). Thermal analysis revealed significant mass loss due to water, collagen, organic compounds, carbonates, and age-related magnesium out-diffusion. Higher fat content in older bones contributed to increased mass loss. Phosphorus content remained constant across age groups, while calcium and sodium showed age-related fluctuations. Magnesium levels decreased with age, emphasizing its importance for early bone development. The Ca/P ratio deviated from the stoichiometric values due to additional ions from biogenic sources. Infrared spectroscopy identified functional groups in carbonated HAp, with changes observed before and after calcination. The full width at half maximum (FWHM) of the 961 cm-1 band decreased with age, indicating improved crystalline quality. The molar absorption coefficients provided information on the changes in molecular concentration and emphasized the differences between the age groups. X-ray analysis revealed nanocrystalline HAp in all samples, with crystallite size increasing with age. Rietveld analysis showed that the lattice parameters were affected by the presence of organic material, but the lattice constants remained stable, confirming high crystallinity independent of age. TEM analysis confirmed nanocrystalline structures, with crystallite size increasing with age. SEM images showed the characteristic porosity of calcined HAp, with particle size correlating positively with age. Calcination at 600°C preserved the nanoscale properties and microcrystal formation. Raman spectroscopy confirmed the identity of HAp, with FWHM variations indicating age-related changes in crystalline quality. EHAp1 showed increased FWHM, indicating lower crystalline quality and increased trace element content.

Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery.

The role of antithrombotic therapy in the prevention of ischemic stroke after non-cardiac surgery is unclear. In this study, we tested the hypothesis that the association of new-onset postoperative atrial fibrillation (POAF) on ischemic stroke can be mitigated by postoperative oral anticoagulation therapy. Of 251,837 adult patients (155,111 female (61.6%) and 96,726 male (38.4%)) who underwent non-cardiac surgical procedures at two sites, POAF was detected in 4,538 (1.8%) patients. The occurrence of POAF was associated with increased 1-year ischemic stroke risk (3.6% versus 2.3%; adjusted risk ratio (RRadj) = 1.60 (95% confidence interval (CI): 1.37-1.87), P < 0.001). In patients with POAF, the risk of developing stroke attributable to POAF was 1.81 (95% CI: 1.44-2.28; P < 0.001) without oral anticoagulation, whereas, in patients treated with anticoagulation, no significant association was observed between POAF and stroke (RRadj = 1.04 (95% CI: 0.71-1.51), P = 0.847, P for interaction = 0.013). Furthermore, we derived and validated a computational model for the prediction of POAF after non-cardiac surgery based on demographics, comorbidities and procedural risk. These findings suggest that POAF is predictable and associated with an increased risk of postoperative ischemic stroke in patients who do not receive postoperative anticoagulation.

Rapidly progressive coronary atherosclerosis in a young male: a retrospective advanced CCT phenotype analysis.

We present a real-life case of a very young man with multiple risk factors who progressed rapidly from minimally obstructive non-calcified plaque on computed tomography angiography (CCTA) to severe three-vessel coronary disease presenting with STEMI. It questions the reliability of zero coronary calcium in high-risk subgroups like familial hypercholesterolemia, high Lp(a), and the young. While CCTA can accurately visualize non-calcified plaque, its interpretation requires expertise and clinical judgment should consider both imaging and clinical risk factors for management. Advanced plaque quantification, peri-coronary (PCAT), and epicardial (EAT) adipose tissue could help better-stratified patients but the evidence-based clinical application remains unknown.

Effect of ultrasonically stimulated potato germination during soaking on the physicochemical properties of starch and its use in edible films.

The aim of this work was to investigate the effects of ultrasonic treatment during soaking of potatoes on the physicochemical properties of starches obtained after 16 weeks of germination. The ultrasonic treatment showed a direct correlation between sprout length and ultrasonic time. The protein content decreased from 0.63 to 0.38 % and the fat content decreased significantly from 0.31 to 0.01 % after germination. The amylose content changed depending on the ultrasonic treatment, and increased from 36.27 to 40.92 % after 16 weeks of germination, which was related to the amylopectin debranching and the duration of the ultrasonic treatment. X-ray diffraction showed that the nanocrystals with hexagonal structure were not affected by the germination and the duration of ultrasonic treatment. Scanning electron microscopy showed that the surface of the starch granules was not affected by the enzymatic treatment. The sprouted potato starch resulted in films with better tensile strength and lower water vapor permeability (WVP) compared to the native potato starch films. In addition, the films produced with ultrasound stimulated potato starch exhibited better properties (high strength and low permeability), which is desirable when it comes to controlling moisture exchange between a food product and the surrounding atmosphere.

Systemic Lupus Erythematosus Causing Rapid Progression of Mitral Valve Disease.

A 33-year-old woman with systemic lupus erythematosus presented with rapid progression of mitral valve disease within a 5-year period, highlighting concerns regarding routine surveillance guidelines for mild to moderate valvular disease.

Relationship between epicardial adipose tissue and coronary atherosclerosis by CCTA in young adults (18-45).

Objective: Epicardial adipose tissue (EAT) is implicated in the pathogenesis and progression of coronary artery disease (CAD). Limited data exists on the interplay between EAT and atherosclerosis in young individuals. Our study aims to explore the relationship between EAT and CAD in a young cohort. Methods: All young (18-45 years) patients without prior CAD, referred for coronary computed tomography angiography (CCTA) from 2016 to 2022 were included. EAT volume and coronary artery calcium (CAC) were calculated from dedicated non-contrast scans. Coronary plaque presence, extent, and volume were quantified from CCTA. Multivariable logistic regression models for the presence of CAD, defined as any coronary atherosclerosis, were performed. Results: Overall, 712 patients (39±4.8 years, 54 % female) with 45 % Hispanic, and 21 % non-Hispanic Black were included. Patients with CAD had higher EAT volume than those without (80.80 mL ± 36.00 vs 55.16 mL ± 27.92; P < 0.001). In those with CAC=0, higher EAT was associated with the presence of CAD compared to lower EAT volume (P < 0.001). An EAT volume >76 mL was associated with higher CAC (P < 0.001), segment involvement score (P < 0.001), and quantitative total, non-calcified, and low-attenuation plaque volumes (P < 0.002). At multivariable analysis, EAT volume (per 10 mL, OR: 1.21; 95 %CI: 1.12-1.30; P < 0.0001) was independently associated with the presence of CAD. Conclusion: In a diverse cohort of young adults without history of CAD and undergoing a clinically indicated CCTA, EAT volume was independently associated with the presence of CAD. Our findings highlight EAT potential as a novel marker for CAD risk-assessment and a potential therapeutic target in young patients.

Preventing bisphosphonate induced osteonecrosis of the jaw with a polyguanidine conjugate (GuaDex): A promising new approach.

Osteonecrosis of the jaw (ONJ) is a relatively rare side effect after prolonged use of bisphosphonates, which are drugs used to treat bone resorption in osteoporosis and certain cancers. This study introduces a novel ONJ model in rats by combining exposure to bisphosphonates, oral surgery, and bacterial inoculation. Potential ONJ preventive effects of polyguanidine (GuaDex) or antibiotics were evaluated. The study consisted of twenty-four male Wistar rats were divided into four groups. Groups 1 to 3 were given weekly doses of i.v. Zoledronic acid (ZA), four weeks before and two weeks after an osteotomy procedure on their left mandibular first molar. Group 4 was a negative control. Streptococcus gordonii bacteria were introduced into the osteotomy pulp chamber and via the food for seven days. On day eight, the rats were given different treatments. Group 1 was given a GuaDex injection into the osteotomy socket, Group 2 was given an intramuscular (i.m.) injection of clindamycin, Group 3 (positive control) was given an i.m. injection of saline, and Group 4 was given an i.m. injection of saline. Blood samples were taken two weeks after the osteotomy procedure, after which the rats were euthanized. Bone healing, bone mineral density, histology, and blood status were analyzed. The results showed that Group 1 (GuaDex) had no ONJ, extensive ongoing bone regeneration, active healing activity, vascularization, and no presence of bacteria. Group 2 (clindamycin) showed early stages of ONJ, avascular areas, and bacteria. Group 3 showed stages of ONJ, inflammatory infiltrates, defective healing, and bacterial presence, and Group 4 had normal healing activity and no bacterial presence. Conclusion: ZA treatment and bacterial inoculation after tooth extraction inhibited bone remodeling/healing and induced ONJ characteristic lesions in the rats. Only GuaDex apparently prevented ONJ development, stimulated bone remodeling, and provided an antimicrobial effect.

Neutrophil-to-lymphocyte ratio may predict complications and patency in bile duct injury repair.

BACKGROUND: Bile duct injury (BDI) repair surgery is usually associated with morbidity/mortality. The neutrophil-to-lymphocyte ratio (NLR) easily assesses a patient's inflammatory status. The study aims to determine the possible relationship between preoperative NLR (pNLR) with postoperative outcomes in BDI repair surgery. METHODS: Approved Ethics/Research Committee retrospective study, in patients who had a Bismuth-Strasberg type E BDI repair (2008-2023). Data registered was: morbidity, mortality, and long-term outcomes (primary patency and loss of primary patency) (Kaplan-Meier). Group comparison (U Mann-Whitney), receiver operator characteristic (ROC): area under curve [AUC]; cut-off value, and Youden index [J], and logistic regression analysis were used for pNLR evaluation. RESULTS: Seventy-three patients were studied. Mean age was 44.4 years. E2 was the commonest BDI (38.4%). Perioperative morbidity/mortality was 31.5% and 1.4%. Primary patency was 95.9%. 8.2% have lost primary patency (3-year actuarial patency: 85.3%). Median pNLR was higher in patients who had any complication (4.84 vs. 2.89 p = 0.015), biliary complications (5.29 vs. 2.86 p = 0.01), and patients with loss of primary patency (5.22 vs. 3.1 p = 0.08). AUC's, cut-off values and (J) were: any complication (0.678, pNLR = 4.3, J = 0.38, p = 0.007), serious complication (0.667, pNLR = 4.3, J = 0.34, p = 0.04), biliary complications (0.712, pNLR = 3.64, J = 0.46, p = 0.001), and loss of primary patency (0.716, pNLR = 3.24, J = 0.52, p = 0.008). Logistic regression was significant in any complication (Exp [B]: 0.1, p = 0.002), serious complications (Exp [B]: 0.2, p = 0.03), and biliary complications (Exp [B]: 8.1, p = 0.003). CONCLUSIONS: pNLR is associated with complications in BDI repair with moderate to acceptable predictive capacity. pNLR could potentially predict patency of a BDI repair.

Hybrid Repair of Left Subclavian Artery Pseudoaneurysm With Vertebral Artery Revascularisation: A Solution for a Complex Case.

Introduction: Pseudoaneurysms of the subclavian artery are a rare complication. Surgical treatment is necessary to prevent potentially lethal complications. This needs adequate planning in cases that require vertebral artery revascularisation. Report: A 56 year old man with multiple systemic comorbidities underwent endovascular treatment using a balloon expandable bare metal stent for symptomatic subclavian Steal syndrome. During follow up, computed tomography angiography (CTA) revealed a pseudoaneurysm in the proximal segment of the left subclavian artery. The patient had criteria warranting left vertebral artery revascularisation. The patient underwent scheduled hybrid surgical treatment involving transposition of the vertebral artery to the common carotid artery, endarterectomy of the internal carotid artery, and endovascular therapy for pseudoaneurysm exclusion; all were performed on the left side. The post-operative period was without incident. After 12 months the patient remains asymptomatic, with adequate exclusion of the pseudoaneurysm, and patency of the procedures. Discussion: Hybrid surgery could offer a secure, feasible, and less invasive option for treating subclavian artery pseudoaneurysms that require vertebral artery revascularisation.

Geographic and Climatic Variation in Resin Components and Quality of Pinus oocarpa in Southern Mexico Provenances.

In Mexico, there is a deficit in the production of pine resin, because it relies on natural forests only. Therefore, it is necessary to select provenances and phenotypes of potential species such as P. oocarpa. The objective was to determine the difference between provenances and the variation in resin components and quality, as well as the effect of geographic and climatic factors. Resin from five provenances was collected from southern Mexico. The percentage of rosin, turpentine and water was obtained, as well as the acidity and saponification index. P. oocarpa resin had 80.94% rosin, 7.7% turpentine and 11.49% water. The saponification and acidity index was 125.47 and 117.49 mg KOH.g-1, respectively. All variables showed differences (p ≤ 0.0001) between provenances. The provenance contributed between 6.44 and 11.71% to the total variance, the error contributed between 88.29 and 93.56%. Geographic and climatic variables only had an effect on the percentage of turpentine; the correlation was negative with altitude and longitude, but positive with temperature and precipitation. The results allow defining seed collection sites for resin plantations and orienting the selection for a P. oocarpa improvement program.

Aortic Stenosis Management in Patients With Acute Hip Fracture.

The treatment of severe aortic stenosis (SAS) has evolved rapidly with the advent of minimally invasive structural heart interventions. Transcatheter aortic valve replacement has allowed patients to undergo definitive SAS treatment achieving faster recovery rates compared to valve surgery. Not infrequently, patients are admitted/diagnosed with SAS after a fall associated with a hip fracture (HFx). While urgent orthopedic surgery is key to reduce disability and mortality, untreated SAS increases the perioperative risk and precludes physical recovery. There is no consensus on what the best strategy is either hip correction under hemodynamic monitoring followed by valve replacement or preoperative balloon aortic valvuloplasty to allow HFx surgery followed by valve replacement. However, preoperative minimalist transcatheter aortic valve replacement may represent an attractive strategy for selected patients. We provide a management pathway that emphasizes an early multidisciplinary approach to optimize time for hip surgery to improve orthopedic and cardiovascular outcomes in patients presenting with HFx-SAS.

Differential nested patterns of Anaplasma marginale and Coxiella-like endosymbiont across Rhipicephalus microplus ontogeny.

Understanding the intricate ecological interactions within the microbiome of arthropod vectors is crucial for elucidating disease transmission dynamics and developing effective control strategies. In this study, we investigated the ecological roles of Coxiella-like endosymbiont (CLE) and Anaplasma marginale across larval, nymphal, and adult stages of Rhipicephalus microplus. We hypothesized that CLE would show a stable, nested pattern reflecting co-evolution with the tick host, while A. marginale would exhibit a more dynamic, non-nested pattern influenced by environmental factors and host immune responses. Our findings revealed a stable, nested pattern characteristic of co-evolutionary mutualism for CLE, occurring in all developmental stages of the tick. Conversely, A. marginale exhibited variable occurrence but exerted significant influence on microbial community structure, challenging our initial hypotheses of its non-nested dynamics. Furthermore, in silico removal of both microbes from the co-occurrence networks altered network topology, underscoring their central roles in the R. microplus microbiome. Notably, competitive interactions between CLE and A. marginale were observed in nymphal network, potentially reflecting the impact of CLE on the pathogen transstadial-transmission. These findings shed light on the complex ecological dynamics within tick microbiomes and have implications for disease management strategies.

Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium.

Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes.