Saltwater- and freshwater environments have opposing physiological challenges, yet, there are fish species that are able to enter both habitats during short time-spans, and as individuals they must therefore adjust quickly to osmoregulatory contrasts. In this study, we conducted an experiment to test for plastic responses to abrupt sainity changes in two poplulations of threespine stickleback, Gasterosteus aculeatus, representing two ecotypes (freshwater and ancestral saltwater). We exposed both ecotypes to abrupt native (control treatment) and non-native salinities (0 and 30‰) and sampled gill-tissue for transcriptomic analyses after six hours exposure. To investigate genomic responses to salinity, we analysed four different comparisons; one for each ecotype (in their control and exposure salinity; 1 and 2), one between ecotypes in their control salinity (3), and the fourth comparison included all transcripts identified in (3) that did not show any expressional changes within ecotype in either the control or the exposed salinity (4). Abrupt salinity transfer affected the expression of 10 and 1530 transcripts for the saltwater and freshwater ecotype, respectively, and 1314 were differentially expressed between the controls, including 502 that were not affected by salinity within ecotype (fixed expression). In total, these results indicate that factors other than genomic expressional plasticity are important for osmoregulation in stickleback, due to the need for opposite physiological pathways to survive the abrupt change in salinity.
Title Page:Title : Letter To the Editor: Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic DissectionArticle Type : Letter To The EditorCorrespondence : 1. Sandhya KumariContact no: +92-3321346164 Email: email@example.comInstitute: Ziauddin University KarachiAddress: Bungalow Number 7/2, 26th Street, Tauheed Commercial Area, Phase 5 Defence Karachi.ORCID: 0000-0001-8842-8738Co-Author : 2. Roomi RajaContact No: +92-3342946940 Email: Romirajagoindani@yahoo.comInstitution: Ziauddin University KarachiAddress: Hemilton Courts Block G-1 Flat 408 Near Teen Talwar Clifton KarachiORCID: 0000-0001-9104-3644Word Count : 340Conflict of interest : NoneAcknowledgement : NoneDeclaration : NoneDisclosure : NoneFunding : NoneDear Editor,We have, in recent times, read with great interest the article entitled “ Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic Dissection” by Xuan Jiang MD et al.1 We highly appreciate the author’s efforts towards this highly sensitive topic and it needs to be applauded by the readers.We acknowledge the primary conclusion of the article that patients receiving antiplatelet therapy before having surgery for acute type A aortic dissection is associated with increased mortality and increased need for blood transfusions. However, some concerns appear, disturbing the validity of the study.Even though the authors have highlighted the use of multiple different antiplatelet drugs before the surgery such as ticagrelor, clopidogrel and aspirin, there remains some factors that made an impact on the findings. Firstly, the authors should have considered the patients who are on Dual antiplatelet therapy because mortality and blood transfusion rate in patients using dual antiplatelet therapy is higher as compared to a single antiplatelet drug user.2 Secondly, the authors should have widened their inclusion criteria and could have included patients with preoperative characteristic such as cardiac tamponade and lower systolic blood pressure, like the study of 2014 included these two as variables and found increased prevalence of mortality associated with these variables.3Thirdly, the authors should have classified the patients using Debakey class 1,2 and Penn class A,B,C classifications. For example, a study in 2019 stated that the patients who experienced major bleeding were associated with Debakey class 1 and higher Penn class.4 Lastly, the authors should have taken into consideration some measures while transferring a patient to the ICU to minimize the mortality rate. For example, a study of 2022 stated that patients on new oral anticoagulants required norepinephrine and other inotropic agents while transferring to ICU as compared to patients taking warfarin (Coumadin).5In last, additional new studies should be conducted on patients receiving antiplatelet therapy before undergoing mitral valve surgery so that incidents leading to mortality goes down and prognosis becomes better.References:1- Jiang X, Khan F, Shi E, Fan R, Qian X, Zhang H, Gu T. Outcomes of preoperativeantiplatelet therapy in patients with acute type A aortic dissection. J Card Surg. 2022Jan;37(1):53-61. doi: 10.1111/jocs.16080. Epub 2021 Oct 17. PMID: 34657299.2- Chemtob RA, Moeller-Soerensen H, Holmvang L, Olsen PS, Ravn HB. OutcomeAfter Surgery for Acute Aortic Dissection: Influence of Preoperative AntiplateletTherapy on Prognosis. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):569-574. doi:10.1053/j.jvca.2016.10.007. Epub 2016 Oct 11. PMID: 28017673.3- Hansson EC, Dellborg M, Lepore V, Jeppsson A. Prevalence, indications andappropriateness of antiplatelet therapy in patients operated for acute aortic dissection:associations with bleeding complications and mortality. Heart. 2013 Jan;99(2):116-21. doi: 10.1136/heartjnl-2012-302717. Epub 2012 Oct 9. PMID: 23048167.4- Hansson EC, Geirsson A, Hjortdal V, Mennander A, Olsson C, Gunn J, et al.Preoperative dual antiplatelet therapy increases bleeding and transfusions but notmortality in acute aortic dissection type a repair [Internet]. OUP Academic. OxfordUniversity Press; 2019: doi: org/10.1093/ejctz/ezy469. Epub 2019 january 16.5- Sromicki J, Van Hemelrijck M, Schmiady MO, Krüger B, Morjan M, Bettex D, VogtPR, Carrel TP, Mestres CA. Prior intake of new oral anticoagulants adversely affectsoutcome following surgery for acute type A aortic dissection. Interact CardiovascThorac Surg. 2022 Jun 15;35(1):ivac037. doi: 10.1093/icvts/ivac037. PMID:35258082; PMCID: PMC9252133.
Geobacter species have great application potential in remediation processes and electrobiotechnology. In all applications, understanding the metabolism will enable target-oriented optimization of the processes. The typical electron donor and carbon source of the Geobacter species is acetate, while fumarate is the usual electron acceptor. Here, we could show that depending on the donor/acceptor ratio in batch cultivation of G. sulfurreducens different product patterns occur. With a donor/acceptor ratio of 1:2.5 malate accumulated as an intermediate product but was metabolized to succinate subsequently. At the end of the cultivation, the ratio of fumarate consumed and succinate produced was approximately 1:1. When fumarate was added in excess, malate accumulated in the fermentation broth without further metabolization. After the addition of acetate to stationary cells, malate concentration decreased immediately and additional succinate was synthesized. Finally, it was shown that also resting cells of G. sulfurreducens could efficiently convert fumarate to malate without an additional electron donor. Overall, it was demonstrated that by altering the donor/acceptor ratio, targeted optimization of the metabolite conversion by G. sulfurreducens can be realized.
Over the last few years cardiac changed radically and so has the average age of the heart disease population progressively increased. Mitral valve surgery has a significant margin for progress in conservative vs replacement strategy. Mitral disease due to insufficiency in the elderly population has historically suffered from lower repair rates but deficiency alone should not limit repair operations in a specialized environment ensuring good survival.
Background: The management of aortic arch pathologies represents a great challenge and is associated with high rates of mortality and morbidity. A superior endovascular approach via thoracic endovascular aortic repair (TEVAR) has been introduced to treat arch pathologies with specifically designed endografts. This approach was shown to benefit patients who are deemed ‘high risk’ for undergoing OSR as it is a greatly less invasiveness option and thus, yields lower rates of morbidity and mortality. Aims: This commentary aims to discuss the recent study by Tan et al. which reports original data on the neurological outcomes after endovascular repair of the aortic arch using the RELAY™ Branched device. Methods: We carried out a literature search on multiple electronic databases including PubMed, Ovid, Google Scholar, Scopus and EMBASE in order to collate research evidence on the neurological outcomes of endovascular aortic arch repair with TEVAR. Results: Tan and colleagues showed through their original clinical data that the RELAY™ Branched device has a high rate of technical success and favourable neurological outcomes. There were no reported neurological deficits in patients who received the triple-branched RELAY™ Branched device. Conclusion: The RELAY™ Branched endograft is well-established for candidates for aortic arch endovascular repair with favourable neurological outcomes. Multiple considerations can help control the incidence of stroke following endovascular repair. These include optimization of the supra-aortic vessels’ revascularization, weighting the embolic risk in patients with atheromatous disease, and careful preoperative assessment to select the best candidates for arch endovascular repair
Coronavirus disease is a viral infection affecting different organs with various morbidities and mortality. Vaccines are used to control the disease. COVID-19 vaccines have brought many benefits but their adverse effects should not be ignored. Here, we report a case of Guillain-Barré Syndrome Following Sinopharm COVID-19 Vaccine.
Background: Type A aortic dissection (TAAD) involves a tear in the intimal layer of the thoracic aorta proximal to the left subclavian artery, and hence, carries a high risk of mortality and morbidity and requires urgent intervention. This dissection can extend into the main coronary arteries. Coronary artery involvement in TAAD can either be due to retrograde extension of the dissection flap into the coronaries or compression and/or blockage of these vessels by the dissection flap, possibly causing myocardial ischaemia. Due to the emergent nature of TAAD, coronary involvement is often missed during diagnosis, thereby delaying the required intervention. Aims: The main scope of this review is to summarise the literature on the incidence, mechanism, diagnosis, and treatment of coronary artery involvement in TAAD. Methods: A comprehensive literature search was performed using multiple electronic databases, including PubMed, Ovid, Scopus and Embase, to identify and extract relevant studies. Results: Incidence of coronary artery involvement in TAAD was seldom reported in the literature, however, some studies have described patients diagnosed either preoperatively, intraoperatively following aortic clamping, or even during autopsy. Among the few studies that reported on this matter, the treatment choice for coronary involvement in TAAD was varied, with the majority revascularizing the coronary arteries using coronary artery bypass grafting or direct local repair of the vessels. It is well-established that coronary artery involvement in TAAD adds to the already high mortality and morbidity associated with this disease. Lastly, the right main coronary artery was often more implicated than the left. Conclusion: This review reiterates the significance of an accurate diagnosis and timely and effective interventions to improve prognosis. Finally, further large cohort studies and longer trials are needed to reach a definitive consensus on the best approach for coronary involvement in TAAD.
Despite advances in technologies and clinical experience, conduction disorders, after TAVR or SAVR, represent the weak point of these procedures, requiring permanent pacemaker implantation (PPI) till 37.7% of patients in TAVR recipients. The role of PPI in TAVR and SAVR remains controversial in mid- and long-term outcomes. Indeed, many studies have been published with contradictory results, leaving doubts rather than certainties.
A previously healthy 68-year-old woman presented to the outpatient clinic with a 2-month history of palpitation. Physical examination and laboratory findings were unremarkable. Her electrocardiogram showed sinus tachycardia with a heart rate of 115 beats/m. Transthoracic echocardiography (TTE) showed a normal ejection fraction with a huge mass in the left atrium (Figure 1a). Transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (MRI) were performed for further evaluation. TEE revealed a hyperechogenic, well-demarcated mass in the left atrium, that was attached to the interatrial septum and adjacent to the left pulmonary veins (Figure 1b, 1c,1d). Cardiac MRI revealed a heterogeneous left atrial mass located on the fossa ovalis, 58x52x54 mm in size and markedly hyperintense on a STIR sequence (Figure 1e). These findings were suggestive of a benign cardiac tumour such as myxoma or hemangioma. A decision for surgery was made and coronary angiography was performed which showed that the branch of the circumflex artery supplied and surrounded the mass in the form of a net (Figure 1e). The patient underwent complete excision of the mass (Figure 2a, 2b). Histopathological examination revealed a nested architecture of epitelioid cells, the nests are round or oval in shape and invested by an fibrovascular stroma. Tumor cells had centrally and eccentrically located round nuclei and cytoplasm ranging from finely granular to eosiniphilic. At immunohistochemical staining, the nests were positive for chromogranin A, negative for cytokeratin (Figure 2c, 2d, 2e, 2f). A diagnosis of paraganglioma was made. After an uneventful postoperative course, she was discharged home on postoperative day 6. Cardiac paraganglioma is a very rare neuroendocrine tumour and accounts for less than 1% of primary cardiac tumours (1,2). Approximately 10% of paragangliomas may be malignant, complete surgical resection remains the first-line treatment (3).
A larger use of mitral valve repair is recommended in case of mitral regurgitation. Anterior leaflet repair is generally more difficult than posterior. Presence of atrial fibrillation or dysfunction of left ventricle appears to be independent preoperative factors of failure in case of involvement of the anterior leaflet. In experienced hands anterior leaflet repair can be effective and safe and should theoretically not limit a conservative technique instead of a replacement. This would therefore lead to being more aggressive in the treatment of this pathological condition in the earlier stages of the disease.
Background: Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality. Methods: We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/18 and 2019/20 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24h were included. IAPA was diagnosed according to previously published clinical, radiological and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome which was a composite of in-hospital mortality, ICU length of stay ≥7d, mechanical ventilation ≥7d or extracorporeal membrane oxygenation. Results: 158 patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, p=0.05). Asthma (OR 12.0 (95% CI 2.1-67.2)) and days of mechanical ventilation (OR 1.1 (1.1 – 1.2)) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, p=0.001) and vasoactive support (75% vs. 45%, p=0.03) and had more complications including ARDS (53% vs. 26%, p=0.04), respiratory bacterial infections (65% vs. 37%, p=0.04) and higher ICU-mortality (35% vs. 16.4%, p=0.05). IAPA (OR 28.8 (3.3–253.4)), influenza A (OR 3.3 (1.4-7.8)) and higher SAPS II score (OR 1.07 (1.05—1.10)) were independent predictors of poor outcome. Interpretation: High clinical suspicion, early diagnostics and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.
Studies of natural hybrid zones can provide documentation of range shifts in response to climate change and identify loci important to reproductive isolation. Using a deep temporal (36-38 years) comparison of the black-capped (Poecile atricapillus) and Carolina (P. carolinensis) chickadee hybrid zone, we investigated movement of the western portion of the zone (western Missouri) and assessed whether loci and pathways underpinning reproductive isolation were similar to those in the eastern portion of the hybrid zone. Using 92 birds sampled along the hybrid zone transect in 2016 and 68 birds sampled between 1978 and 1980, we generated 11,669 SNPs via ddRADseq. These SNPs were used to assess movement of the hybrid zone through time and to evaluate variation in introgression among loci. We demonstrate that the interface has moved ~5 km to the northwest over the last 36-38 years, i.e., at only one-fifth the rate at which the eastern portion (e.g., Pennsylvania, Ohio) of the hybrid zone has moved. Temperature trends over the last 38 years reveal that eastern areas have warmed 50% more than western areas in terms of annual mean temperature, possibly providing an explanation for the slower movement of the hybrid zone in Missouri. Our results suggest hybrid zone movement in broadly distributed species, such as chickadees, will vary between areas in response to local differences in the impacts of climate change.
Heart failure and atrial fibrillation are often associated. Both conditions share pathophysiology and risk factor; as an example, atrial fibrillation may be regarded as either the ‘cause’ or the ‘consequence’ of heart failure. If coexistent, they are associated to very poor outcome. With this in mind, finding effective therapy for patients presenting with both heart failure and atrial fibrillation remains of paramount importance. There are also little evidence of the role and benefit of surgical atrial fibrillation ablation concomitant to heart surgery (i.e., coronary or valve surgery).
BJOG-22-0382.R1: Implementing Effective Investigations for Cause of StillbirthElizabeth M McClure, PhDRobert L Goldenberg, MDRTI International, Durham, NCColumbia University, New York, NYStillbirth is one of the most common adverse pregnancy outcomes in low and middle-income countries (LMICs), with rates in the range of 40 to 50 per thousand births in some regions . International goals aim for no country to have a rate of >10 per thousand births by 2035 [Hug L, et al. Lancet. 2021;398(10302):772-85]. To achieve this, a better understanding of stillbirth causes often requiring additional investigations is critical. For several reasons, including low prioritization, inadequate resources, and hesitancy by families and providers, investigations on stillbirth causes in LMICs have been limited to date.Bedwell et al used a grounded theory approach to explore the views of women, partners, families, health workers and community leaders in Malawi, Tanzania, and Zambia regarding investigations to determine the cause(s) of stillbirth [Bedwell et al, BJOG (in press)]. While most would like more information regarding the stillbirth, the authors noted cultural and religious obstacles to performing the investigations, including preferences for quick burial, reluctance to disfigure the deceased fetus, concerns about blame, as well as costs.One test to inform cause of stillbirths is minimally invasive tissue sampling (MITS), using needle biopsies to obtain internal organ tissue for histological evaluation and microbial analyses. For a study on causes of stillbirth in Pakistan and India, we explored the acceptability of MITS among parents, relatives, religious leaders, and government officials [Feroz A, et al. Reprod Health.2019;16(1):53]. The perceived benefits included knowing the cause of death, and both personal and societal benefits in preventing subsequent stillbirths. Concerns regarded rapid burial and reluctance to disfigure the stillborn. In Pakistan, with some caveats, religious leaders approved, and, when MITS was undertaken, in both Pakistan and India, approximately 50% of the parents consented for the MITS procedure.Because obstacles to testing in general and to MITS specifically relate to time, cost, and disfigurement, we have considered which examinations feasible in LMICs provide the most information at minimal cost. Page et al., in a similar exercise in a US study, noted that the most useful test was placental histology (65%) followed by full autopsy (42%) [Page JM, Obstet Gynecol 2017;129(4):699-706.]. No other tests were useful for >12% of cases. Similar studies have rarely been performed in LMICs. The prevalence of the causes relates to the frequency of tests’ usefulness. In high-income countries where birth asphyxia and infection have been reduced, congenital and genetic anomalies have assumed a larger proportion of stillbirths, and testing for those conditions using karyotyping and other genetic tests become proportionately more important. However, in many LMICs, birth asphyxia remains the major cause of stillbirth and genetic issues play a smaller proportional role.To develop the most effective methodology to determine cause of stillbirth, the prevalent conditions, and the tests’ usefulness to diagnose those conditions should be considered together. Importantly, the community and other stakeholder’s perceived benefits and obstacles to various tests as described in the Bedwell, et al must be considered to ultimately be successful in implementing the necessary investigations.For LMICs, given that asphyxia and infection appear to be major causes of stillbirth, tests to diagnose these conditions will likely be important to implement, including the obstetric history and histological placental evaluation for diagnosing asphyxia and infection. Of potential information gained from MITS, histology of the fetal lung, and bacteriological assessment of the fetal blood and brain/CSF may be the most useful. Thus, by considering the prevalence of the causes of stillbirth, the usefulness of tests to diagnose the prevalent conditions, and importantly addressing the community’s sense of benefit and obstacles, an effective approach to stillbirth cause of death investigation can be developed.Declaration of Interest: The authors declare no conflicts of interest.
A new fractional difference equation 2D-TFCDM based on Caputo derivative is proposed. Using the bifurcation diagram, the maximum Lyapunov exponent and the phase diagram, the numerical solutions of the fractional difference equations are obtained, and the chaotic behavior is observed numerically. After encrypting the key with elliptic curve cryptosystem, the fractional map is developed as an encryption algorithm and applied to color image encryption. Finally, the proposed encryption system is systematically analyzed from five main aspects, and the results show that the proposed encryption system has a good encryption effect. In respective of application, we apply the proposed discrete fractional map into color image encryption with the secret keys ciphered by Menezes-Vanstone Elliptic Curve Cryptosystem (MVECC). Finally, the image encryption algorithm is analysed in 4 aspects that indicates the proposed algorithm is superior to others.