Recurrent short-to-shield phenomenon requiring LVAD exchange: a rare complication.

Left ventricular assist device (LVAD) therapy is a common alternative approach for a patient with end-stage heart failure with HeartMate II (HM II) being one of the most common LVAD implants. The short-to-shield (STS) phenomenon is an uncommon drive-line (DL) dysfunction resulted from broken insulator causing an underlying wire to contact a metallic shield in a DL. This leads to a short circuit and a pump stoppage. We reported a case of 66-year-old man status post-implantation of HM II who presented with STS phenomenon. A tear at the distal end of the DL was found, and the patient underwent replacement of the extracorporeal part of DL twice. After the second repair, the pump functioned normally when tested in the hospital but the STS occurred again at home. The patient then underwent LVAD replacement surgery and insulation breach was found at one of the wires in intracorporeal part of the DL. After the surgery, the patient sustained recurrent episodes of STS and had to undergo a third extracorporeal DL repair surgery. Analysis of the removed DL confirmed an insulation breach. The STS has been resolved since then. Our case is unique as it is very rare to sustain another episode of STS shortly after a pump exchange. It also shows that the occurrence of STS can be intermittent and the area of insulation breach can be different from the area of the visualized tear. As a result, closed monitoring after DL repair must be strictly implemented.

The UAE healthy future study: a pilot for a prospective cohort study of 20,000 United Arab Emirates nationals.

BACKGROUND: The United Arab Emirates (UAE) is faced with a rapidly increasing burden of non-communicable diseases including obesity, diabetes, and cardiovascular disease. The UAE Healthy Future study is a prospective cohort designed to identify associations between risk factors and these diseases amongst Emiratis. The study will enroll 20,000 UAE nationals aged ≥18 years. Environmental and genetic risk factors will be characterized and participants will be followed for future disease events. As this was the first time a prospective cohort study was being planned in the UAE, a pilot study was conducted in 2015 with the primary aim of establishing the feasibility of conducting the study. Other objectives were to evaluate the implementation of the main study protocols, and to build adequate capacity to conduct advanced clinical laboratory analyses. METHODS: Seven hundred sixty nine UAE nationals aged ≥18 years were invited to participate voluntarily in the pilot study. Participants signed an informed consent, completed a detailed questionnaire, provided random blood, urine, and mouthwash samples and were assessed for a series of clinical measures. All specimens were transported to the New York University Abu Dhabi laboratories where samples were processed and analyzed for routine chemistry and hematology. Plasma, serum, and a small whole blood sample for DNA extraction were aliquoted and stored at -80 °C for future analyses. RESULTS: Overall, 517 Emirati men and women agreed to participate (68% response rate). Of the total participants, 495 (95.0%), 430 (82.2%), and 492 (94.4%), completed the questionnaire, physical measurements, and provided biological samples, respectively. CONCLUSIONS: The pilot study demonstrated the feasibility of recruitment and completion of the study protocols for the first large-scale cohort study designed to identify emerging risk factors for the major non-communicable diseases in the region.

Fatal Intramyocardial Hemorrhage After Pericardiotomy in a Patient With von Willebrand Disease.

Patients with large pericardial effusions and possible tamponade undergoing general anesthesia for pericardial drainage are generally thought to be at a highest risk of cardiovascular collapse before drainage of the effusion. Here, we report a case of extensive and fatal intramyocardial hemorrhage after drainage of a pericardial effusion in a patient with von Willebrand disease.

Pseudallescheria boydii keratitis.

A case of Pseudallescheria boydii keratitis is presented. The patient was successfully treated with topical natamycin and systemic itraconazole in conjunction with penetrating keratoplasty, leading to visual acuity of 20/40.

Differences in polyadenylation site choice between somatic and male germ cells.

BACKGROUND: We have previously noted that there were differences in somatic and male germ cell polyadenylation site choices. First, male germ cells showed a lower incidence of the sequence AAUAAA (an important element for somatic polyadenylation site choice) near the polyadenylation site choice. Second, the polyadenylation sites chosen in male germ cells tended to be nearer the 5' end of the mRNA than those chosen in somatic cells. Finally, a number of mRNAs used a different polyadenylation site in male germ cells than in somatic cells. These differences suggested that male germ cell-specific polyadenylation sites may be poor substrates for polyadenylation in somatic cells. We therefore hypothesized that male germ cell-specific polyadenylation sites would be inefficiently used in somatic cells. RESULTS: We tested whether pre-mRNA sequences surrounding male germ cell-specific polyadenylation sites (polyadenylation cassettes) could be used to direct polyadenylation efficiently in somatic cells. To do this, we developed a luciferase reporter system in which luciferase activity correlated with polyadenylation efficiency. We showed that in somatic cells, somatic polyadenylation cassettes were efficiently polyadenylated, while male germ cell-specific polyadenylation cassettes were not. We also developed a sensitive, 3' RACE-based assay to analyze polyadenylation site choice. Using this assay, we demonstrated that male germ cell-specific polyadenylation cassettes were not polyadenylated at the expected site in somatic cells, but rather at aberrant sites upstream of the sites used in male germ cells. Finally, mutation of the male germ cell-specific poly(A) signal to a somatic poly(A) signal resulted in more efficient polyadenylation in somatic cells. CONCLUSION: These data suggest that regulated polyadenylation site choice of male germ cell-specific polyadenylation sites requires one or more factors that are absent from somatic cells.