Successful subclavian transcatheter aortic valve replacement in a nonagenarian patient: Case report and review of literature.

RATIONALE: In super-aged patients with severe symptomatic aortic stenosis, transcatheter aortic valve replacement (TAVR) is a good treatment option, and the number of TAVR-eligible elderly patients is expected to grow exponentially. We present the case of a nonagenarian woman with severe aortic stenosis who underwent successful subclavian TAVR. PATIENT CONCERNS: A 90-year-old Korean woman was brought to our department with dyspnea. On physical examination, a grade IV systolic murmur was auscultated in both the upper sternal borders and the left lower sternal border. DIAGNOSIS: A transthoracic echocardiogram showed heavy calcification of the aortic valve with an increase in both peak velocity (4.36 m/s) and mean pressure (44.8 mm Hg), indicating severe symptomatic aortic stenosis. INTERVENTIONS: After a heart team conference involving interventional cardiologists, cardiac surgeons, and anesthesiologists, subclavian TAVR was performed. Using the left subclavian artery, we successfully deployed a self-expandable valve prosthesis (CoreValveTM Evolut RTM, Medtronic Inc., Minneapolis, MN). OUTCOMES: After TAVR, transthoracic echocardiogram showed a decline in both peak velocity (2.06-2.14 m/s) and mean pressure (7.42-7.95 mm Hg) with an increase in the aortic valve area (1.12 cm2). The patient's dyspnea symptoms improved dramatically. LESSONS: In addition to femoral TAVR, subclavian TAVR may be feasible and safe in super-aged patients.

Is Methionyl-tRNA Synthetase Applicable as a Diagnostic Marker for Lung Cancer in Bronchial Ultrasound-Guided Brushing Cells?

BACKGROUND AND OBJECTIVE: Methionyl-tRNA synthetase (MARS) and A variant of Aminoacyl-tRNA synthetase interacting multifunctional protein 2 (AIMP2) with an exon 2 deletion (AIMP2-DX2) are known to be overexpressed in lung cancer. However, their role as diagnostic markers in lung cancer has not been well established. Thus, we evaluated their diagnostic performance in brushed cells obtained from nodular lung lesions suspected of lung cancer. METHODS: Samples obtained by radial endobronchial ultrasound-guided brushing were processed for cytological examination with Papanicolaou (Pap) staining. Then, double IF staining with MARS and AIMP2-DX2 antibodies was measured in the cytology samples for peripheral lung nodules. The diagnostic performance was compared against biomarkers. RESULTS: MARS IF staining was the only independent staining method used for the prediction of malignant cells. The area under the curve (AUC) of conventional cytology, MARS IF, and MARS IF plus cytology was 0.64, 0.68, and 0.69, respectively. The diagnostic accuracy was increased in MARS IF plus conventional cytology compared with cytology alone (71% vs. 47%). CONCLUSIONS: The combination of MARS staining with conventional cytology showed increases in the diagnostic accuracy for diagnosing lung nodules suspected of lung cancer on chest-computed tomography scans.

Coronary Sinus Ostial Atresia Presenting as Infective Endocarditis in a Previously Healthy Young Woman.

Coronary sinus ostial atresia is a rare disease. Most patients are usually asymptomatic and diagnosed incidentally during surgery or at autopsy. We report a case of coronary sinus ostial atresia with unroofed coronary sinus syndrome in a previously healthy woman who presented with infective endocarditis.

MicroRNA-31 functions as a tumor suppressor by regulating cell cycle and epithelial-mesenchymal transition regulatory proteins in liver cancer.

MicroRNA-31 (miR-31) is among the most frequently altered microRNAs in human cancers and altered expression of miR-31 has been detected in a large variety of tumor types, but the functional role of miR-31 still hold both tumor suppressive and oncogenic roles in different tumor types. MiR-31 expression was down-regulated in a large cohort of hepatocellular carcinoma (HCC) patients, and low expression of miR-31 was significantly associated with poor prognosis of HCC patients. Ectopic expression of miR-31 mimics suppressed HCC cell growth by transcriptional deregulation of cell cycle proteins. Additional study evidenced miR-31 directly to suppress HDAC2 and CDK2 expression by inhibiting mRNA translation in HCC cells. We also found that ectopic expression of miR-31 mimics reduced metastatic potential of HCC cells by selectively regulating epithelial-mesenchymal transition (EMT) regulatory proteins such as N-cadherin, E-cadherin, vimentin and fibronectin. HCC tissues derived from chemical-induced rat liver cancer models validated that miR-31 expression is significantly down-regulated, and that those cell cycle- and EMT-regulatory proteins are deregulated in rat liver cancer. Overall, we suggest that miR-31 functions as a tumor suppressor by selectively regulating cell cycle and EMT regulatory proteins in human hepatocarcinogenesis providing a novel target for the molecular treatment of liver malignancies.

Tuberculosis of the lower lumbar spine with an atypical radiological presentation - a case mimicking a malignancy -.

A 65-year-old woman was treated for an atypical radiological presentation of spinal tuberculosis. Compared with previously reported cases, the following two different radiographic features were found. 1) Although there was multiple and skipped involvement of the vertebral body, the intervertebral disc was relatively preserved. 2) The presence of an epidural granuloma indicated an epidural extension of the lesion of the adjacent vertebral body. These findings strongly mimicked bone marrow infiltrative disease such as a malignancy. Tuberculosis was confirmed through an open biopsy and the patient was treated successfully with antitubercular chemotherapy. This case highlights the importance of being aware that spinal tuberculosis has many different radiographic features and can mimic a spinal malignancy.