Journal articles: 'Renal appendages'

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Crick, R. E., B. Burkart, J. A. Chamberlain, and K. O. Mann. "Chemistry of Calcified Portions of Nautilus Pompilius." Journal of the Marine Biological Association of the United Kingdom 65, no. 2 (May 1985): 415–20. http://dx.doi.org/10.1017/s0025315400050517.

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The Sr, Mg, and Ca chemistry and mineralogy of the shell, beaks, and inorganic compounds of the renal appendages of Nautilus pompilius Linné 1758 reveal a complex physiochemical system of biomineralization. The chemistry of the shell and septal aragonite is similar, and establish that N. pompilius discriminates against the concentration of Sr and Mg in sea water by 78% and more than 99% respectively. Beaks consist of high-Mg calcite (4.4% MgCO3). Renal appendages contain either aggregates of crystals (uroliths) of Mg-oxalate dihydrate with nuclei of hydroxyapatite or disassociated particles of hydroxyapatite or both. There is no evidence that uroliths or hydroxyapatite particles serve as temporary reservoirs of Ca during calcification of septa.

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Peuler, J. D., K. P. Patel, D. A. Morgan, C. A. Whiteis, D. D. Lund, B. J. Pardini, and P. G. Schmid. "Altered peripheral noradrenergic activity in intact and sinoaortic denervated Dahl rats." Canadian Journal of Physiology and Pharmacology 67, no. 5 (May 1, 1989): 442–49. http://dx.doi.org/10.1139/y89-071.

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Development of salt-induced hypertension in Dahl salt-sensitive (S) rats is dependent on sympathetic overactivity which may be partially related to arterial baroreflex dysfunction and, therefore, is regionally selective. Our first experiment was designed to determine which regions have elevated sympathetic activity in Dahl S compared with Dahl salt-resistant (R) rats. Weanling (4-week-old) female Dahl R and S rats were fed low or high salt diets (0.13% and 8% NaCl) until 10 weeks of age. Norepinephrine (NE) synthesis was blocked with α-methyl-p-tyrosine, and the fractional decline of NE concentration was measured in various tissues. Dahl S rats with increases in both arterial pressure and left ventricular weight demonstrated increased NE turnover in the sinoatrial node, the atrial appendages, the cardiac ventricles, and the renal cortex. In all of these tissues except the cardiac ventricle, increases were associated with high salt intake. Our second experiment was designed to test if arterial baroreflex dysfunction could account for regional increases in sympathetic activity. Separate groups of Dahl R and S rats fed high salt were subjected to either sham surgery or sinoaortic baroreceptor denervation 1 week prior to turnover determinations. Sinoaortic baroreceptor denervation abolished differences in NE turnover between salt-fed Dahl R and S rats in the cardiac sinoatrial node and the atrial appendages, but not in the cardiac ventricles and the renal cortex. Sinoaortic baroreceptor denervation also abolished differences between salt-fed Dahl S and R rats in the spleen but not the duodenum. Thus in awake, undisturbed Dahl S rats, sympathetic activity may be increased in the cardiac ventricles, regardless of salt intake. High salt intake may induce elevated sympathetic activity in the renal cortex and in the cardiac atria and sinoatrial node of Dahl S but not R rats. Sinoaortic baroreflex dysfunction in Dahl S rats may contribute to some, but not all, regional increases in sympathetic activity.Key words: high salt intake, hypertension, cardiac hypertrophy, norepinephrine turnover, sympathetic activity, sinoaortic denervation.

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Beuerlein, Knut, Bettina Westermann, Peter Ruth, Robert Schimmelpfennig, and Rudolf Schipp. "Hemocyanin re-uptake in the renal and branchial heart appendages of the coleoid cephalopod Sepia officinalis." Cell and Tissue Research 301, no. 3 (July 14, 2000): 413–21. http://dx.doi.org/10.1007/s004410000254.

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Benjamin, B. A., C. H. Metzler, and T. V. Peterson. "Chronic atrial appendectomy alters sodium excretion in conscious monkeys." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 254, no. 4 (April 1, 1988): R699—R705. http://dx.doi.org/10.1152/ajpregu.1988.254.4.r699.

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The purpose of this study is to determine whether chronic removal of atrial appendages alters renal response to volume expansion in the conscious monkey. Chronic bilateral atrial appendectomy (ATX) was performed in six animals. Six additional animals served as sham-operated controls. Monkeys were studied 1-2 wk after chronic surgery. The protocol consisted of three consecutive 10-min urine collections followed by 20% ischemic blood volume expansion (VE) and 120 min of post-VE measurements. In sham animals, VE caused an increase in plasma atrial natriuretic peptide (ANP) levels (48 +/- 7 pg/ml to a peak of 108 +/- 34 pg/ml). Urine flow increased from 0.43 +/- 0.07 to 1.07 +/- 0.24 ml/min, sodium excretion increased from 17.9 +/- 2.6 to 74.9 +/- 12.0 mu eq/min, and fractional sodium excretion increased from 0.67 +/- 0.10 to 2.43 +/- 0.28%. ATX attenuated the increase in ANP (34 +/- 8 pg/ml to a peak of 38 +/- 9 pg/ml) in four of six animals. In these animals, renal response to VE was significantly attenuated. Urine flow increased from 0.21 +/- 0.05 to 0.30 +/- 0.01 ml/min, sodium excretion increased from 19.3 +/- 6.02 to 37.8 +/- 5.05 mu eq/min, and fractional sodium excretion increased from 0.79 +/- 0.08 to 1.43 +/- 0.17%. Renal response of two ATX animals with normal increases in atrial natriuretic factor was similar to the sham group. Effect of volume expansion on mean arterial pressure, central venous pressure, and renal hemodynamics was not altered by ATX. These findings demonstrate that bilateral atrial appendectomy in the monkey attenuates the increase in ANP and reduces renal response to VE.

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Cowley, A. W., P. R. Anderas, and M. M. Skelton. "Acute saline loading in normal and bilaterally atrial-resected conscious dogs." American Journal of Physiology-Heart and Circulatory Physiology 255, no. 1 (July 1, 1988): H144—H152. http://dx.doi.org/10.1152/ajpheart.1988.255.1.h144.

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Acute isotonic saline volume loads (400 ml) were intravenously administered to conscious, renal-denervated dogs before and after bilateral removal of the atrial free walls and atrial appendages to determine the role of atrial-mediated hormonal factors in the renal excretory response. In one group of dogs (n = 11), the volume was given in 10 min; in another group (n = 5), the volume was given in 30 min while arginine vasopressin (AVP) was infused to maintain plasma AVP at a fixed, normal level (3 pg/ml). Sodium and water excretion, mean arterial pressure, and plasma hormone levels were determined before and for 5 h after volume loads. Atrial resection resulted in a 40-50% reduction of sodium and water excretion in both groups during the first 2 h after volume expansion. The blunted renal excretory responses could not be explained by differences in arterial pressure, renal sympathetic nerve activity, or by hormonal differences of plasma immunoreactive atrial natriuretic factor (iANP), plasma AVP, plasma renin activity, or plasma aldosterone. Plasma iANP was not significantly increased by the volume load in either the normal or atrial-resected state. Atrial-resected dogs exhibited normal plasma levels of iANP. The data indicate the presence of an unidentified diuretic and natriuretic substance, which is released with volume expansion from either the cardiac atria or via the central nervous system, and that the release of this factor is removed by atrial resection.

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Barysheva, Olga Yu, Ruslan N. Simanov, and Andrej V. Bukalev. "Malacoplakia of the urinary bladder. Clinical case report." Urology reports (St. - Petersburg) 12, no. 1 (April 26, 2022): 91–98. http://dx.doi.org/10.17816/uroved96740.

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A clinical case of bladder malacoplakia in a 33-year-old woman, clinically manifested by dysuria and gross hematuria, is presented. Malacoplakia is a rare tumor-like granulomatous-inflammatory disease with a predominant lesion of the bladder mucosa. The literature describes extravesical forms of malacoplakia with involvement of the ureters, renal pelvis and calyces, prostate, testicles and their appendages, intestines and other organs. In women, the disease occurs 4 times more often than in men. The reasons for the development of malacoplakia are not fully understood. The main importance in its pathogenesis is attached to the infectious factor and immunosuppression. Diagnosis is based on histological examination of bladder biopsy specimens and the detection of Hansemann cells and Michaelis Gutman bodies. Treatment of patients with malacoplakia consists of resection of the affected areas of the bladder and antibiotic therapy.

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Barysheva, Olga Yu, Ruslan N. Simanov, and Andrej V. Bukalev. "Malacoplakia of the urinary bladder. Clinical case report." Urology reports (St. - Petersburg) 12, no. 1 (April 26, 2022): 91–98. http://dx.doi.org/10.17816/uroved96740.

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A clinical case of bladder malacoplakia in a 33-year-old woman, clinically manifested by dysuria and gross hematuria, is presented. Malacoplakia is a rare tumor-like granulomatous-inflammatory disease with a predominant lesion of the bladder mucosa. The literature describes extravesical forms of malacoplakia with involvement of the ureters, renal pelvis and calyces, prostate, testicles and their appendages, intestines and other organs. In women, the disease occurs 4 times more often than in men. The reasons for the development of malacoplakia are not fully understood. The main importance in its pathogenesis is attached to the infectious factor and immunosuppression. Diagnosis is based on histological examination of bladder biopsy specimens and the detection of Hansemann cells and Michaelis Gutman bodies. Treatment of patients with malacoplakia consists of resection of the affected areas of the bladder and antibiotic therapy.

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Benjamin, B. A., C. H. Metzler, and T. V. Peterson. "Renal response to volume expansion in atrial-appendectomized dogs." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 253, no. 5 (November 1, 1987): R786—R793. http://dx.doi.org/10.1152/ajpregu.1987.253.5.r786.

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The purpose of this study was to determine whether chronic removal of the atrial appendages alters the renal response to volume expansion (VE) in anesthetized dogs. Chronic bilateral atrial appendectomy (ATX) was performed in 10 animals. Six animals served as sham-operated controls (S). The animals were studied 10-14 days after chronic surgery. The protocol consisted of a 20-min control period followed by isochemic VE (20%) and 120 min of post-VE measurements. The dogs were studied a second time, 2 wk later, after acute bilateral cervical vagotomy. Results from the vagi-intact study showed that VE caused a diuresis, natriuresis, and increase in fractional sodium excretion in ATX that did not differ from the response observed in S. VE also caused equivalent increases in central venous and mean arterial pressures in S and ATX. Atrial appendectomy, however, failed to significantly attenuate the increase in atrial natriuretic factor (ANF) after VE. Plasma ANF increased from 27.2 +/- 4.8 to 47.0 +/- 7.3 pg/ml in ATX and from 27.2 +/- 7.8 to 59.0 +/- 17.9 pg/ml in S. After vagotomy, VE caused transient increases in urine flow and sodium excretion. The changes in central venous and mean arterial pressures were not different from the vagi-intact study and vagotomy did not affect the increase in ANF after VE. Circulating ANF levels increased from 26.4 +/- 5.5 to 75.0 +/- 14.0 pg/ml in ATX and from 28.1 +/- 5.7 to 73.0 +/- 22.6 pg/ml in S. These results demonstrate that, in the dog, bilateral ATX does not alter the renal response to volume expansion or attenuate the increase in ANF. In addition, these results show that vagal pathways are not required for the release of ANF and that vagotomy fails to uncover any effect of atrial appendectomy on renal function.

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Mansour, Fatma, Felix J. Boivin, Iman B. Shaheed, Markus Schueler, and Kai M. Schmidt-Ott. "The Role of Centrosome Distal Appendage Proteins (DAPs) in Nephronophthisis and Ciliogenesis." International Journal of Molecular Sciences 22, no. 22 (November 12, 2021): 12253. http://dx.doi.org/10.3390/ijms222212253.

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The primary cilium is found in most mammalian cells and plays a functional role in tissue homeostasis and organ development by modulating key signaling pathways. Ciliopathies are a group of genetically heterogeneous disorders resulting from defects in cilia development and function. Patients with ciliopathic disorders exhibit a range of phenotypes that include nephronophthisis (NPHP), a progressive tubulointerstitial kidney disease that commonly results in end-stage renal disease (ESRD). In recent years, distal appendages (DAPs), which radially project from the distal end of the mother centriole, have been shown to play a vital role in primary ciliary vesicle docking and the initiation of ciliogenesis. Mutations in the genes encoding these proteins can result in either a complete loss of the primary cilium, abnormal ciliary formation, or defective ciliary signaling. DAPs deficiency in humans or mice commonly results in NPHP. In this review, we outline recent advances in our understanding of the molecular functions of DAPs and how they participate in nephronophthisis development.

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Nakanishi, Yukihiro, Preeti Behl, Abida Kadi, and Byron Crawford. "Epidermoid Cyst in the Intrapancreatic Accessory Spleen: A Case Report and Review of the Literature." American Journal of Clinical Pathology 152, Supplement_1 (September 11, 2019): S119. http://dx.doi.org/10.1093/ajcp/aqz122.005.

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Abstract Epidermoid cyst in the intrapancreatic accessory spleen (ECIAS) is an exceedingly rare nonneoplastic entity. It generally does not require therapeutic intervention, but it is often misdiagnosed preoperatively as a cystic tumor, such as a mucinous cystic neoplasm or a cystic degeneration in a solid pancreatic neuroendocrine tumor or solid pseudopapillary neoplasm. We herein report a rare case of ECIAS in a 33-year-old African American man with a history of end-stage renal disease secondary to IgA nephropathy, congestive heart failure, and sickle cell trait who was referred to our facility for a renal transplant workup. A contrast-enhanced abdominal computed tomography during the workup revealed a bilobed low attenuating mass (3.4 × 3.4 × 2.5 cm) in the tail of the pancreas. Because malignancy could not be excluded, the patient underwent a distal pancreatectomy and splenectomy. Gross examination of the surgical specimen revealed a smooth-walled, multiloculated cyst (3.7 × 2.7 × 2.0 cm), containing serous fluid within the pancreatic parenchyma. Microscopically, the cyst was lined by nonkeratinizing stratified squamous epithelium without skin appendages, surrounded by benign splenic tissue in the pancreatic parenchyma. No dysplasia or malignancy was seen. Immunohistochemically, the lining epithelium was positive for p63, CK5/6, and CEA and negative for CA19-9, which supports the above diagnosis. The postoperative course was uneventful. In conclusion, ECIAS is a rare benign entity that can mimic malignant conditions and should be considered in the differential diagnosis of cystic lesions in the tail of pancreas.

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CATALANO, SARAH R. "A review of the families, genera and species of Dicyemida Van Beneden, 1876." Zootaxa 3479, no. 1 (September 12, 2012): 1. http://dx.doi.org/10.11646/zootaxa.3479.1.1.

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The classification of the species in the phylum Dicyemida Van Beneden, 1876, a group of small organisms whichparasitise the renal appendages of benthic cephalopods, is reviewed. While dicyemid parasites have simple multicellularmorphology, their lifecycle is complex and it is uncertain whether their affinities are with the protozoans or metazoans.Hence they are commonly given an intermediate ‘mesozoan’ status. Although 112 species are described, confusion existsfor 20% of the taxa over the validity of certain families, genera and species, which has been attributed to incomplete andinformation-poor descriptions, loss of type specimens, errors in taxonomy and conceptual differences. The history ofdicyemids dating from the first known reference by Filippo Calvolini of Italy in 1787 is presented, along with thecharacteristics which are commonly used to classify genera and species. All species described to date are listed withreference to the original published records and the validity of ambiguous records is explored. A way forward usingalternative technologies such as molecular genetic methods based on next generation sequencing platforms is suggested,which may help to address unresolved systematic and life history questions surrounding this parasite group. This review aims to assist taxonomists to help unravel the confusion surrounding the poorly studied and little understood Dicyemida.

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Frost, Jodie H., and Atul Bagul. "A Brief Recap of Tips and Surgical Manoeuvres to Enhance Optimal Outcome of Surgically Placed Peritoneal Dialysis Catheters." International Journal of Nephrology 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/251584.

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Background. Peritoneal dialysis (PD) is an effective option of renal replacement therapy for ESRF, offering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement.Methods. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuffs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic fixing, omentopexy, omentectomy, the “Y”-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases.Findings. The complications of catheterrelated dysfunction can be reduced with advanced planning of access placement, immaculate surgery, and attention to catheter insertion techniques.Conclusion. The success of a peritoneal dialysis programme depends upon functional and durable long term access to the peritoneal cavity; this depends on placement techniques and competent surgeons and psychosocial support to the patient. The various technical tips and manoeuvres elaborated here should be considered options carried out to improve outcome and reduce catheter dysfunction.

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Brown, Carla, Megan Baber, and Gwenevere White. "A Unique Presentation of Amniotic Band Syndrome: A Newborn With a Tail." Global Pediatric Health 9 (January 2022): 2333794X2211275. http://dx.doi.org/10.1177/2333794x221127545.

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A 1-day-old late preterm, small-for-gestational-age female presented with a caudal appendage—a rare finding—and abnormalities in all 4 limbs most consistent with amniotic band syndrome. The caudal appendage was lateral to midline, measured 3 cm × 0.5 cm, and had no bony abnormalities or spinal cord tethering. Limb abnormalities consisted of brachydactyly, oligodactyly, and syndactyly. Renal and head ultrasounds and an echocardiogram were normal. Chromosomal microarray showed deletion of EPHA3, which is not associated with a known phenotype. The multidisciplinary approach of managing this infant with the rare finding of a caudal appendage and limb abnormalities is presented.

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Omran, Heyder. "Cardiac Computed Tomography versus 3D-Transesophageal Echocardiography in Preprocedural Planning of Left Atrial Appendage Closure." Clinical Cardiology and Cardiovascular Interventions 04, no. 06 (March 18, 2021): 01–09. http://dx.doi.org/10.31579/2641-0419/145.

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Aim: Preprocedural imaging of the left atrial appendage (LAA) plays a crucial role in the process of LAA closure (LAAC). This study aimed to compare the influence of preprocedural planning of the LAAC with 3D-transesophageal echocardiography (TEE) and cardiac computed tomography (CCT) versus 3D-TEE alone in patients who underwent LAAC with an Amplatzer Cardiac Plug or Amulet. Materials and Methods: In a retrospective study, 176 patients received a preprocedural 3D-TEE and CCT and 167 patients a 3D-TEE only. Both groups had similar patient characteristics and indications for LAAC. Results: There was no difference in terms of procedural success, procedure time, amount of contrast medium, fluoroscopy time, or radiation dose. Patients with CCT/3D-TEE had a longer hospital stay on average. Besides, there was a different incidence of renal diseases (49% for 3D-TEE versus 27% for CCT/3D-TEE; p < 0.001). The number of periprocedural adverse events was comparable. A device-related thrombus occurred three times in each group, and the peri-device leaks reported were similar. Conclusion: A preprocedural CCT does not decrease major adverse events or improve outcome in patients undergoing LAAC.

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Volmar, Keith E., Thomas J. Cummings, Wei Hua Wang, Andrew J. Creager, Douglas S. Tyler, and H. Bill Xie. "Clear Cell Hidradenoma: A Mimic of Metastatic Clear Cell Tumors." Archives of Pathology & Laboratory Medicine 129, no. 5 (May 1, 2005): e113-e116. http://dx.doi.org/10.5858/2005-129-e113-cchamo.

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Abstract Clear cell hidradenoma is a benign skin appendage tumor that may mimic conventional-type renal cell carcinoma. Histologically, clear cell hidradenoma contains small ductular lumens, focal apocrine and squamoid change, and a less prominent vascular pattern than renal cell carcinoma. Furthermore, immunohistochemical studies can aid in distinguishing the 2 tumors. Knowing the cytologic features of primary skin adnexal neoplasms helps distinguish them from cutaneous metastases, which are more commonly referred for fine-needle aspiration biopsy evaluation. Detailed clinical history, physical findings, and ancillary studies are essential for correct diagnosis and categorization of these tumors. We report the rare case of a patient with renal cell carcinoma who underwent excision of an axillary clear cell hidradenoma, which was clinically suggestive of cutaneous metastatic disease.

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Udompanich, Siriorn, Kumutnart Chanprapaph, and Natta Rajatanavin. "Phototoxic Reaction Induced by Pazopanib." Case Reports in Dermatology 10, no. 3 (November 21, 2018): 251–56. http://dx.doi.org/10.1159/000494611.

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Multikinase inhibitors (MKIs) are a novel target therapy that offers promising long-term survival for patients with advanced-stage cancer. However, they cause a wide range of adverse reactions, skin and skin appendage being the most prevalent. Photosensitivity reactions are well-recognized effects from certain MKIs such as sunitinib and vandetanib. However, phototoxic reaction induced by pazopanib has never been reported. We present here the first case of pazopanib-induced phototoxic drug reaction in a patient with renal cell carcinoma.

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Subramaniam, Kathirvel, Andrea Ibarra, and Michael L. Boisen. "Echocardiographic Guidance of AMPLATZER Amulet Left Atrial Appendage Occlusion Device Placement." Seminars in Cardiothoracic and Vascular Anesthesia 23, no. 2 (February 27, 2018): 248–55. http://dx.doi.org/10.1177/1089253218758463.

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In this report, we provided details of periprocedural echocardiographic guidance for patients undergoing Amplatzer-Amulet device left atrial closure. Familiarity with left atrial appendage (LAA) occlusion devices and the required left atrial examination and measurements are key before device placement. Device placement is assisted by transesophageal echocardiography (TEE) and fluoroscopy, but TEE will be the main guide for patients with renal insufficiency in whom contrast dye use needs to be minimal. TEE is also used to confirm LAA occlusion with the device and finally detect complications throughout the procedure and into the postoperative period.

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Diener, Hans-Christoph, and Ulf Landmesser. "Percutaneous left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation." Future Neurology 15, no. 3 (August 2020): FNL48. http://dx.doi.org/10.2217/fnl-2020-0001.

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Patients with atrial fibrillation (AF) have a fivefold higher risk of stroke than persons in sinus rhythm. Effective stroke prevention is achieved with oral anticoagulants such as vitamin K antagonists or nonvitamin K oral anticoagulants. An alternative for stroke prevention in patients with AF is the closure of the left atrial appendage (LAA) with a percutaneously applied closure system. The two large randomized studies PROTECT-AF and PREVAIL failed to show superiority of LAA closure over anticoagulation in patients with AF. Meta-analyses of studies and registries, however, suggest that LAA closure has particular advantages with regard to the reduction of severe bleeding complications. Currently, several prospective randomized studies are being conducted in different patient populations to evaluate the benefit of LAA closure in comparison to standard of care. Currently, LAA closure is recommended in patients after intracranial hemorrhage, with advanced renal failure, after severe gastrointestinal bleeding, in patients with a high risk of recurrent ischemic stroke and elderly patients with high risk of bleeding and falling.

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Qavi, Ahmed Hassaan, and Abdul Mannan Khan Minhas. "LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH RENAL FAILURE - INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE." Journal of the American College of Cardiology 77, no. 18 (May 2021): 431. http://dx.doi.org/10.1016/s0735-1097(21)01790-3.

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Nishimura, Masato, Tetsuya Hashimoto, Hiroyuku Kobayashi, Toyofumi Fukuda, Koji Okino, Noriyuki Yamamoto, and Toshihiko Ono. "High incidence of left atrial appendage thrombus in end-stage renal disease patients receiving maintenance hemodialysis." Journal of the American College of Cardiology 41, no. 6 (March 2003): 224–25. http://dx.doi.org/10.1016/s0735-1097(03)81627-3.

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Stöllberger, Claudia, Josef Finsterer, and Birke Schneider. "Is left atrial appendage closure useful for stroke prevention in atrial fibrillation patients with renal failure?" International Journal of Cardiology 216 (August 2016): 186–87. http://dx.doi.org/10.1016/j.ijcard.2016.04.102.

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Ronco, Federico, Patrizio Mazzone, Leila Hosseinian, and Simonetta Genovesi. "Recent Advances in Stroke Prevention in Patients with Atrial Fibrillation and End-Stage Renal Disease." Cardiorenal Medicine 7, no. 3 (2017): 207–17. http://dx.doi.org/10.1159/000470856.

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Background: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain. Summary: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA. Limited data from post hoc analyses of controlled clinical trials suggest the safe and effective use of NOACs in patients with moderate renal impairment (i.e., estimated glomerular filtration rate, eGFR, between 30 and 50 mL/min). The question still remains whether NOACs can be used in patients with an eGFR <30 mL/min, since there are no studies addressing this subject. In fact, patients with CKD stage 4 and 5 were excluded from controlled clinical trials on anticoagulation therapy for stroke prevention in AF. Left atrial appendage (LAA) occlusion represents a nonpharmacological alternative for stroke prevention in patients with AF who are difficult to manage medically. Preliminary data indicate a similar efficacy and safety profile in patients with CKD compared to patients with normal renal function. Key Messages: Stroke prevention in patients with ESRD and AF represents a clinical challenge with poor evidence. LAA occlusion may become the standard of care for stroke prevention in patients with ESRD and AF.

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Meier, Pascal, Olaf Franzen, and Alexandra J. Lansky. "Almanac 2013: novel non-coronary cardiac interventions." Seminars in Cardiovascular Medicine 19, no. 2 (December 1, 2013): 60–71. http://dx.doi.org/10.2478/semcard-2013-0008.

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Summary Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them.

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Esra ??nal, E., Canan T??rkyilmaz, Yldz Atalay, and Nurullah Okumu?? "Tubular skin appendage, renal agenesis and popliteal web: a further example of the human homologue of disorganization (Ds)." Clinical Dysmorphology 14, no. 2 (April 2005): 89–91. http://dx.doi.org/10.1097/00019605-200504000-00007.

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Kapto, A. A. "Reno-iliac intrasystem anastomoses of the inferior vena cava." Andrology and Genital Surgery 21, no. 2 (July 5, 2020): 51–57. http://dx.doi.org/10.17650/2070-9781-2020-21-2-51-57.

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The study objective is to describe the anastomoses between the left renal and iliac veins in the inferior vena cava system and to classify these anastomoses.Materials and methods. From 2015 to 2020, 340 men with varicose veins of the pelvic organs and bilateral varicocele were examined. Delayed imaging for 10–30 s with phlebotesticulography of 157 patients allowed us to study in more detail the vascular venous x-ray anatomy of the scrotum and various options for collateral circulation.Results. The data obtained by us during phlebography allowed us to offer our own classification of anastomoses between the left renal vein and the common iliac vein in the inferior vena cava system (reno-iliac intrasystemic anastomoses of the inferior vena cava): 1) through the vein of the vas deferens (v. ductus deferens), 2) through the cremasteric vein (v. cremasterica), 3) through the external testicular vein (v. testicularis externa). In addition to the classification, the terms for specific types of anastomoses are also proposed by us for the first time and do not have a name in the medical scientific literature. A new definition of the term “venous anastomotic node (nodus venarum anastomoticus) of the testis and its appendage” is proposed, which describes the anatomical relationship between the 4 veins: the internal testicular vein, external testicular vein, vena cremasterica and veins of the vas deferens. A new term is proposed “pseudo-varicocele” that defines the compensatory expansion of the internal testicular vein during normal antegrade blood flow through it.Conclusion. In this work, we give an X-ray anatomical description of the development of various types of collateral circulation in the system of the inferior vena cava between the left renal vein and iliac vessels in various types of arteriovenous conflicts of both the upper (nutcracker syndrome, posterior nutcracker syndrome) and the lower level (May–Thurner syndrome).

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Kapłon-Cieślicka, Agnieszka, Monika Budnik, Monika Gawałko, Michał Peller, Iwona Gorczyca, Anna Michalska, Aldona Babiarz, et al. "Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus." Heart 105, no. 17 (April 30, 2019): 1310–15. http://dx.doi.org/10.1136/heartjnl-2018-314492.

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ObjectiveWe aimed to identify predictors of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and to enhance the prognostic value of the CHA2DS2-VASc score.MethodsDerivation cohort included 1033 consecutive AF patients referred for catheter ablation or direct current cardioversion, in whom transoesophageal echocardiography (TOE) was performed prior to the procedure. Logistic regression analysis was used to identify predictors of LAA thrombus on TOE. Receiver operating characteristic (ROC) curves were constructed to compare the newly developed score with the CHA2DS2 and CHA2DS2-VASc scores in the derivation and the validation (n=320) cohort.ResultsOn TOE, LAA thrombus was present in 59 (5.7%) patients in the derivation cohort. Aside from variables encompassed by the CHA2DS2-VASc score, LAA thrombus predictors included AF type (persistent/’permanent’ vs paroxysmal) and renal dysfunction. These predictors were incorporated into the CHA2DS2-VASc score. In ROC analysis, area under the curve (AUC) for the new score (CHA2DS2-VASc-RAF score) was significantly higher (0.81) than those for the CHA2DS2 and CHA2DS2-VASc scores (0.71 and 0.70, respectively). In the validation cohort, the CHA2DS2-VASc-RAF score also performed significantly better (AUC of 0.88) than the CHA2DS2 and CHA2DS2-VASc scores (AUC of 0.63 and 0.60, respectively).ConclusionIn real-world AF patients with majority on oral anticoagulation, LAA thrombus was found in approximately 6%. Two variables not included in the CHA2DS2-VASc score (AF type and renal dysfunction) proved strong, independent predictors of LAA thrombus and might improve thromboembolic risk stratification.

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Mirahmadi, Seyed-Mohamad-Sadegh, Kimia Saleh Anaraki, and Azadeh Goodarzi. "Common mucocutaneous manifestations of patients with End Stage Renal Disease: A comprehensive review study." Pakistan Journal of Medical and Health Sciences 15, no. 6 (June 30, 2021): 1970–74. http://dx.doi.org/10.53350/pjmhs211561970.

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One of the notable points in ESRD patients is the multiplicity of skin manifestations which can include a wide range. It can also affect the living standards of patients due to its many types and severity. Careful study, as well as intense follow-up of these manifestations, can help physicians in timely diagnosis and their control or treatment. In this study, we tried to study the common mucocutaneous manifestations that occur in these patients. All references can be searched from PubMed. Sources of this study have been studied for clinical manifestations, pathophysiology, and treatment of skin manifestations in ESRD patients. In this study, xerosis, pruritus, pigmentation disorders, half and half nails, perforating disorder, and skin infections as well as appendageal disorders (hair and nail) in ESRD patients have been studied. These can be associated with other diseases and increase by disease severity. For better results and more help to patients with this disease, it seems that more and more comprehensive studies are needed. Key words: End stage renal disease, ESRD, mucucutaneous, skin, dermatology, xerosis, pigmentation disorders, infection, perforating disorder, half and half nails

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López-Mínguez, José Ramón, Juan Manuel Nogales-Asensio, Eduardo Infante De Oliveira, Lino Santos, Rafael Ruiz-Salmerón, Dabit Arzamendi-Aizpurua, Marco Costa, et al. "Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II." Journal of Clinical Medicine 9, no. 7 (July 19, 2020): 2295. http://dx.doi.org/10.3390/jcm9072295.

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Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age ≥75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or ≥75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 ± 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 ± 1.2; p = 0.029). Conclusions: In this high-risk population, GIB history and age ≥75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients.

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Walsh, K. P., T. D. Williams, R. Canepa-Anson, E. Pitts, S. L. Lightman, and R. Sutton. "Effects of endogenous atrial natriuretic peptide released by rapid atrial pacing in dogs." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 253, no. 4 (October 1, 1987): R599—R604. http://dx.doi.org/10.1152/ajpregu.1987.253.4.r599.

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The relationships between the hemodynamic, renal, and endocrine changes induced by rapid atrial pacing were studied in seven chloralose-anesthetized greyhounds paced from the right atrial appendage for 60 min at 250 beats/min. Pacing increased mean pulmonary wedge pressure, decreased cardiac output, and decreased mean arterial pressure. Systemic vascular resistance did not change significantly. Coronary sinus atrial natriuretic peptide (ANP) concentrations rose maximally within 5 min of commencing pacing. The corresponding increase in arterial ANP concentrations during this time was only 44% of its maximum value after 30 min of pacing. Plasma concentrations of arginine vasopressin were unchanged. Plasma renin activity decreased during pacing and showed a marked rebound increase at 60 min postpacing. Plasma norepinephrine levels did not change significantly during pacing. Urine flow increased during the latter 30 min of pacing. There was no significant change in sodium clearance despite high sustained concentrations of ANP. The lack of significant natriuretic and systemic vasodilator effects in association with high arterial plasma concentrations of endogenous ANP, in the absence of antagonistic mechanisms, suggests that the natriuretic and vascular effects of ANP may not be its major physiological actions.

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Jamal, Shakeel, Ehizogie Edigin, Asim Kichloo, Zulfiqar Qutrio Baloch, Sardar Hassan Ijaz, Abdul Mannan Khan Minhas, Sandeep Banga, Abbas Ali, and George Abela. "B-PO05-059 LEFT ATRIAL APPENDAGE OCCLUSION (LAAO) USING WATCHMAN DEVICE IN END STAGE RENAL DISEASE: ANALYSIS FROM NATIONAL INPATIENT SAMPLE." Heart Rhythm 18, no. 8 (August 2021): S395—S396. http://dx.doi.org/10.1016/j.hrthm.2021.06.979.

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Streb, Witold, Katarzyna Mitręga, Stanisław Morawski, Wiktoria Kowalska, and Zbigniew Kalarus. "The Extended Utility of CHA2DS2VASc and HAS-BLED Scores in the Selection for Transcutaneous Left Atrial Appendage Closure." Journal of Clinical Medicine 9, no. 11 (October 26, 2020): 3438. http://dx.doi.org/10.3390/jcm9113438.

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Background and purpose: Left atrial appendage closure (LAAC) is an option for stroke prevention in atrial fibrillation patients. Randomized studies have demonstrated the effectiveness and safety of LAAC but included patients with an average risk of stroke and bleeding complications. The current study aimed to assess the extended utility of CHA2DS2VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) and HAS-BLED (hypertension; abnormal renal/liver function; stroke; bleeding history or predisposition; labile INR, elderly, drugs/alcohol concomitantly) scores for qualification and prognosis after LAAC. Methods: The study population comprised 270 patients aged 72.8 ± 8.78 years. The occluders used were the Amplatzer Amulet (N = 205), Amplatzer Cardiac Plug (N = 53), and Watchman device (N = 12). The prognosis after LAAC was analyzed for different cohorts of patients distinguished based on different CHA2DS2VASc and HAS-BLED scores. The mean duration of follow-up was 21.6 ± 10.3 months. Results: The observed rates of ischemic stroke and bleeding were much lower than that expected (2.2% vs. 5.6%, and 0.76% vs. 6.05%, respectively). The mortality rate did not differ concerning the CHA2DS2CVASc score. It was significantly lower (8.3%) for HAS-BLED < 3, and it raised to 17.9% for HAS-BLED = 3 and to 25.9% for HAS-BLED > 3. Significant differences (p = 0.003) occurred for Kaplan–Meier curves for extreme HAS-BLED subgroups. A composite endpoint was most often found in high/very high risk of bleeding patients. Conclusions: HAS-BLED, but not CHA2DS2CVASc score, may be a useful tool to predict the prognosis of patients after LAAC. Qualification for LAAC based on the risk of stroke should not differ from qualification for anticoagulation. Despite the worse prognosis of patients with the highest bleeding risk, this group is likely to experience the greatest benefit from reducing the bleeding risk from LAAC.

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Genovesi, Simonetta, Giorgio Slaviero, Luca Porcu, Gavino Casu, Silvio Bertoli, Antonio Sagone, Federico Pieruzzi, et al. "Implant success and safety of left atrial appendage occlusion in end stage renal disease patients: Peri-procedural outcomes from an Italian dialysis population." International Journal of Cardiology 262 (July 2018): 38–42. http://dx.doi.org/10.1016/j.ijcard.2018.03.083.

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Munir, Muhammad Bilal, Muhammad Zia Khan, Douglas Darden, Deepak Kumar Pasupula, Sudarshan Balla, Frederick T. Han, Ryan Reeves, and Jonathan C. Hsu. "B-PO03-156 PROCEDURAL COMPLICATIONS AND IN-HOSPITAL OUTCOMES FROM LEFT ATRIAL APPENDAGE OCCLUSION DEVICE IMPLANTATION IN PATIENTS WITH CHRONIC AND END STAGE RENAL DISEASE." Heart Rhythm 18, no. 8 (August 2021): S252—S253. http://dx.doi.org/10.1016/j.hrthm.2021.06.629.

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Chang, Sheng-Nan, Chin-Feng Tsai, Jung-Cheng Hsu, Hsiao-Liang Cheng, Li-Ting Ho, Pang-Shuo Huang, Jien-jiun Chen, Yi-Chih Wang, Juey-Jen Hwang, and Chia-Ti Tsai. "LONG-TERM OUTCOMES ON SAFETY AND EFFICACY OF LEFT ATRIAL APPENDAGE OCCLUSION IN END STAGE RENAL DISEASE PATIENTS UNDERGOING DIALYSIS- THE FIRST MULTICENTER ASIAN EXPERIENCE." Journal of the American College of Cardiology 79, no. 9 (March 2022): 199. http://dx.doi.org/10.1016/s0735-1097(22)01190-1.

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Bauer, Sebastian, Yukiharu Sugimura, Artur Lichtenberg, and Payam Akhyari. "Minimally invasive repair of the mitral valve partially affected by an in situ left atrial appendage occluder in a patient with end-stage renal disease." Interactive CardioVascular and Thoracic Surgery 31, no. 4 (August 9, 2020): 585. http://dx.doi.org/10.1093/icvts/ivaa138.

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Yaffee, David W., Didier F. Loulmet, Lauren A. Kelly, Alison F. Ward, Patricia A. Ursomanno, Annette E. Rabinovich, Peter J. Neuburger, Sandeep Krishnan, Frederick T. Hill, and Eugene A. Grossi. "Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited?" Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 1 (January 2014): 43–48. http://dx.doi.org/10.1097/imi.0000000000000039.

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Objective A concern with the initiation of totally endoscopic robotic mitral valve repair (TERMR) programs has been the risk for the learning curve. To minimize this risk, we initiated a TERMR program with a defined team and structured learning approach before clinical implementation. Methods A dedicated team (two surgeons, one cardiac anesthesiologist, one perfusionist, and two nurses) was trained with clinical scenarios, simulations, wet laboratories, and “expert” observation for 3 months. This team then performed a series of TERMRs of varying complexity. Results Thirty-two isolated TERMRs were performed during the first programmatic year. All operations included mitral valve repair, left atrial appendage exclusion, and annuloplasty device implantation. Additional procedures included leaflet resection, neochordae insertion, atrial ablation, and papillary muscle shortening. Longer clamp times were associated with number of neochordae ( P < 0.01), papillary muscle procedures ( P < 0.01), and leaflet resection ( P = 0.06). Sequential case number had no impact on cross-clamp time ( P = 0.3). Analysis of nonclamp time demonstrated a 71.3% learning percentage ( P < 0.01; ie, 28.7% reduction in nonclamp time with each doubling of case number). There were no hospital deaths or incidences of stroke, myocardial infarction, unplanned reoperation, respiratory failure, or renal failure. Median length of stay was 4 days. All patients were discharged home. Conclusions Totally endoscopic robotic mitral valve repair can be safely performed after a pretraining regimen with emphasis on experts’ current practice and team training. After a pretraining regimen, cross-clamp times were not subject to learning curve phenomena but were dependent on procedural complexity. Nonclamp times were associated with a short learning curve.

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Xipell, Marc, Eduardo Flores‐Umanzor, Raquel Ojeda, Marta Arias, Pedro L. Cepas‐Guillén, Ander Regueiro, Xavier Freixa, Aleix Cases, and Francisco Maduell. "Percutaneous left atrial appendage closure, a safe alternative to anticoagulation for patients with nonvalvular atrial fibrillation and end‐stage renal disease on hemodialysis: A single center experience." Artificial Organs 44, no. 5 (December 22, 2019): 513–21. http://dx.doi.org/10.1111/aor.13603.

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Ye, Cong, Xuesong Han, Yiming Chen, Fei Liu, Hao Ma, Yu Yang, Yang Liu, et al. "Stroke prevention of thoracoscopic left atrial appendage clipping in patients with non-valvular atrial fibrillation at high risk of stroke and bleeding: study protocol for a non-randomised controlled clinical trial." BMJ Open 12, no. 10 (October 2022): e063931. http://dx.doi.org/10.1136/bmjopen-2022-063931.

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IntroductionNon-valvular atrial fibrillation (NVAF) is a high-risk factor for ischaemic stroke. The 2016 European Society of Cardiology Atrial Fibrillation Management guidelines recommend oral anticoagulants (OACs) to prevent stroke in men with CHA2DS2-VASc scores ≥2 and women ≥3. However, in patients with a high risk of stroke and a high risk of bleeding (HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) score≥3), OAC had a higher risk of bleeding. Left atrial appendage closure (LAAC) is non-inferior to OAC as a means of preventing stroke in several studies. As a minimally invasive intervention to prevent stroke, transthoracic LAAC (TS-LAAC) has a high successful closure rate, but there is a lack of literature reports directly comparing it with OAC. Our research compares TS-LAAC with novel oral anticoagulants (NOACs) and provides an appropriate programme for stroke prevention in a specific population.Methods and analysisThis is a non-randomised controlled trial study protocol, and we will conduct this study from April 2022 to April 2025. The study included 186 patients with confirmed NVAF, 93 of whom completed thoracoscopic LAAC, and the control group treated with NOACs. The primary outcome was the incidence of stroke and systemic embolism, as well as the composite endpoint events (stroke, systemic embolism, myocardial infarction, bleeding, cardiovascular death, etc). Secondary outcomes were ischaemic stroke, haemorrhagic stroke, any bleeding events, death from cardiovascular causes, death from all causes, residual root rate in the surgery group, device-related thrombosis in the surgery group, changes in blood pressure, cardiac chamber size changes, etc. Each subject completed at least 1 year of follow-up.Ethics and disseminationThe study has been approved by the Medical Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, China (approval number: KY2022-013-02). The results from this study will be disseminated through manuscript publications and national/international conferences.Trial registration numberChiCTR2200058109.

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Gellert, George, and Peter Bramlage. "Use of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience." Heart Surgery Forum 21, no. 6 (November 14, 2018): E476—E483. http://dx.doi.org/10.1532/hsf.2177.

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During interventional and structural cardiology procedures, such as mitral valve (MitraClip, BMV), aortic valve (TAVR, BAV), tricuspid valve (MitraClip), left atrial appendage (Watchman, Lariat), atrial septum (ASD/PFO closure), and coronary artery intervention (high-risk PCI), among others, patients are at a high risk of hemodynamic instability and require continuous monitoring. This is conventionally achieved through arterial catheterization and transpulmonary thermodilution. However, such invasive techniques are time-consuming and have been associated with steep learning curves, vascular complications, and increased risk of infection. In line with the ongoing simplification and improvement of the catheter-based valve intervention, it is logical to investigate the effectiveness of continuous noninvasive hemodynamic monitoring in this setting. Over the last 2 years, our team has performed over 400 valve procedures with continuous hemodynamic monitoring via the noninvasive ClearSight system. This system is based on a finger-cuff and automated volume-clamp technology integrated into a simplified clinical platform (EV1000 NI). Although current evidence suggests that the technology results in slight differences in arterial pressure (AP) and cardiac output (CO) relative to the current, commercially available, invasive approaches, we have found the bias to be acceptable. Both the noninvasive and the invasive approaches have the same percentage of error when compared to the true CO and provide beat-by-beat detection of acute changes facilitating shorter response times. In addition to AP and CO, the system provides up-to-date information on stroke volume (SV), stroke volume variation (SVV), and systemic vascular resistance, which can be useful in aiding decision-making and provide better postoperative outcomes, such as shorter length of stay (LOS), decreased postoperative infection, decreased postoperative arrhythmia, decreased postoperative renal failure, decreased postoperative congestive heart failure (CHF), and decreased readmission. Additionally, the simplicity of the system setup has translated into a time saving of up to 3 hours per day, allowing one team to perform an additional 2 to 3 valve interventions without moving rooms. Moving forward, a formal study comparing patient outcomes and cost-effectiveness between invasive and noninvasive hemodynamic monitoring techniques in valve replacement would be insightful.

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Marcano, Juan, Karla Campos, Victor Rodriguez, Kelly Handy, M. Alan Brewer, and William E. Cohn. "Intrapericardial Delivery of Amiodarone Rapidly Achieves Therapeutic Levels in the Atrium." Heart Surgery Forum 16, no. 5 (November 15, 2013): E279—E286. http://dx.doi.org/10.1532/hsf98.2013188.

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Background: Amiodarone is widely used worldwide as an important drug for managing supraventricular arrhythmias, regardless of its association with potentially severe side effects due to systemic toxicity. Amiodarone reduces the incidence of atrial fibrillation after cardiac surgery, but oral therapy requires a presurgery loading period, lasting from 1 to 4 weeks. In this study, we showed that it is possible to rapidly obtain therapeutic cardiac tissue levels of the drug by infusing aqueous amiodarone intrapericardially, without appreciable systemic exposure. We also examined the long-term histologic safety of intrapericardial infusion.Methods: In this observational study, 9 adult sheep, randomized into 3 groups of 3 animals each, were given low (2.5-mg/h), medium (10-mg/h), or high (50-mg/h) dosages of amiodarone by continuous infusion intrapericardially for 72 hours. An intrapericardial drain prevented tamponade from fluid build-up. Levels of amiodarone and its active metabolite, desethylamiodarone (DEA), were assessed both in plasma and in transmural biopsy specimens taken from the left atrial appendage and left and right ventricular myocardium. Cardiac, hepatic, and renal functions were also assessed. Humane euthanization was performed after 3 months, and cardiac and thoracic tissues were assessed for evidence of epicarditis, severe fibrotic changes, or other adverse effects potentially caused by the local amiodarone administration.Results: Pericardial infusion resulted in rapid uptake and high concentrations of amiodarone and DEA in the myocardial tissues, without an appreciable systemic presence of either drug. The highest and lowest levels of these agents were observed in the left atrium and left ventricle, respectively. Drug concentrations in all cardiac biopsy specimens were similar to, or higher than, those reportedly observed in patients taking long-term oral amiodarone. At 90 days, postmortem microscopic, biochemical, and hematologic evaluation of end-organ tissues from the 8 surviving sheep showed no adverse effects. Excessive inflammation or fibrotic changes were not observed in these 8 sheep. The ninth sheep died prematurely, and its death was deemed not to be related to this study.Conclusions: Short-term intrapericardial delivery of amiodarone is a safe method for rapidly obtaining therapeutic atrial-tissue drug levels. When begun perioperatively, this method may prevent postoperative atrial fibrillation similarly to oral or intravenous amiodarone therapy. However, we have shown that pericardial administration avoids systemic drug distribution and thus may greatly decrease the systemic complications resulting from this drug.

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Moldovan, Horașiu. "CARDIAC SURGERY AT A CROSS-POINT." Journal of Surgical Sciences 2, no. 2 (April 1, 2015): 59–62. http://dx.doi.org/10.33695/jss.v2i2.106.

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The cardiac surgery is the youngest surgical specialty that has emerged in the early period of the 20th century. Surprisingly, however, it is also the first surgical specialty that seems to be the first to disappear in a way or another in the second half of the 21st century. Even if the optimists consider this will never happen, it is expected that cardiac surgery will suffer a radical metamorphosis, which makes the realists say that this field of surgery will actually disappear.Before the beginning of the 20th century, the surgeons around the world have been convinced that human heart is untouchable. Remarkable surgeons of the 19th century like Theodor Billroth – the founder of the Viennese school of surgery- said in 1863 that “ Any surgeon that dares to perform surgery on the heart will fail and will lose the appreciation of his colleagues” [1]. This statement reveals the general opinion of that time, that the human heart is the center of the soul, of life itself and therefore it should never be touched. Considering this, Sharman stated in 1902 in „The American Journal of Medical Association” : “even though the heart lies at a few centimeters beneath the skin, it took 2400 years for surgery to reach this distance” [2].Ironically, the same year that English surgeon Stephan Paget stated that “probably the human heart is boundary that nature set for any kind of surgery -1896- was also the year when Ludwig Rehn, a German surgeon from Frankfurt, managed to successfully repair a right ventricular wound, signing the birth certificate of the cardiac surgery [3]. Since then the myth that the human heart can’t be touched by surgeons vanished and the sacred center of the heart has been opened…Two distinct periods of cardiac surgery can be identified over the next 100 years. The first period is the so called “surgery on a closed heart”, before the invention of extracorporeal circulation. In this heroic period, the first interventions that involved the pericardium were performed.In the first years of the 20th century, Alexis Carell imagined the experimental basis of cardio-vascular surgery. He invented the vascular sutures, demonstrated the possibility of organ transplantation and imagined coronary surgery. As recognition of his fundamental work he received the Nobel prize for medicine and physiology in 1912. Although he never performed surgery on humans, Alexis Carell remains to this day the first surgeon in history that was awarded with this prestigious prize [4].Surgery of the pericardium started in 1920 with Ludwig Rehn and Ferdinand Sauerbruch [5]. The first surgical approach of the aortic valve was realized by Theodor Tyffier in Paris in 1912 [6]. He succeeded to enlarge an aortic stenosis through a purse on the anterior wall of the aorta. In 1923, in Boston, USA, Elliot Cuttler realized the first instrumental mitral valve valvulotomy on a 12 year old girl [7]. Using a specially modified forceps, and the apex of the left ventricle as the initial approach, he managed to successfully open the mitral valve commissures and then to close the incision on the left ventricle. The first digital mitral valve commissurotomy through the left appendage was performed in 1925 by Sir Henry Soutar[8]. Catastrophic results ( 90% mortality) lead surgeons to abandon this procedure for the next 25 years. In 1948, Charles P. Bailey (Philadelphia), Dwight E. Harken (Boston) and Russell Brock (London) realized the first successful mitral valve commissurotomy [9,10].The first ligature of patent arterial duct was performed by Robert Edward Gross. This procedure took place at Harvard Medical School and Children’s Hospital from Boston, Massachusetts, in 1938 [11].Palliative treatment of the Fallot tetralogy started with the first systemic-pulmonary shunt,realized by Alfred Blalock in 1944 at John Hopkins Hospital [12]. The idea of subclavio-pulmonaryanastomosis was born with the contribution of Hellen Taussig, founder of pediatric cardiology.Treatment of aortic coarctation was independently realized by Edward Gross and Clarance Crafoord in 1945. Both surgeons managed to excised the diseased segment of the aorta and then performed an end to end anastomosis of the aorta [13].Sir Thomas Holmes-Sellors in 1947 and Russel Brock in 1948 realized the first pulmonary valvevalvulotomy [10].In our country, professor Nicolae Hortolomei was the first to perform surgery on the heart atColtea Hospital. He legated a patent arterial duct, excised an aortic coarctation and successfullyrealized in 1953 a digitally mitral valve commissurotomy [14].The second period of cardiac surgery began with the developing of the extracorporeal circulation.This technology allowed stopping the heart and keeping the patient alive, using a device thatmanage to circulate and oxygenate the blood. This ensemble composed of a pomp and anoxygenator was called “the extracorporeal circulation machine” and made possible the future development of “open cardiac surgery”.In 1946 Wilfred G. Bigelow (Toronto, Canada ), demonstrated the role of hypothermia inincreasing the tissue resistance to hypoxemia. This concept is fundamental in the development of extracorporeal circulation [15]. The first procedure on an open heart was realized by John Lewis from University of Minnesota, Mineapolis USA, on 2 september 1952. He used profund hypotermia and occlusion of the caval veins, without using extracorporeal circulation. Using this technique he closed an interatrial septal defect in a 6 year old boy. Time was his biggest limitation, because the heart could not be stoped for more than 8-10 minutes.On 6 may 1953, John H. Gibbon realised the first open heart surgery using an extracorporealcirculation machine [16]. He succesfully closed and interatrial septal deffect on an 18 years old girl.Unfortunatly he lost the following 4 patients, and he decided to abandon this king of surgery after20 years of research.A year later, on the 26th of March 1954 at „University of Minesotta” from Mineapolis USA, C.Walton Lillehei closed an inteventricluar septal defect on a child using the so called “crossedcirculation technique”. In this procedure, he connected the patient’s circulaton to his fathercirculation, trying to repoduce the fetal circulation [17]. Using this technique he operated 45patients, being the first surgeon that closed ventricular septal defects, corrected the commonatrioventricular canal and treated the Fallot tetralogy. Finding a compatible match for the “cross circulation” was the biggest limit of this technique. This method was untill the developement of liver and renal transplant, the only kind of surgery that could reach 200% mortality rate and was abandoned later due to ethical considerations.Starting from 1955, John Kirkling (Mayo Clinic), used the extracorporeal circulation machine(pomp - oxigenator) [18]. He used the Mayo-Gibbon-IBM type, and this technology began to beused all over the world.In Romania, the first surgical procedure on the heart using an extracorporeal circulation machinewas realized in 1961 at Fundeni Hospital (Bucharest). A remarkable team composed of professor Voinea Marinescu and professor Dan Setlacec, closed an atrial septal defect on an 18 years old boy.The extracorporeal machine was handled by Marian Ionescu, and the anesthesia was managed by professor George Litarczek. The patient is still living.Surgery of the cardiac valves started in 1960 when Albert Starr realized the first mitral valvereplacement [19].Without a doubt coronary artery bypass grafting is the most widly spread type of cardiac surgery.Initially introduced by Michael DeBakey and later perfected by Renee Favaloro in 1960, thisprocedure remains one of the most frequent and best studied type of surgery in medicine [20].A crucial moment in the history of cardiac surgery is represented by the first cardiac transplanton human performed by Christian Barnard in 1967[21]. This achievement consecrate cardiacsurgery as a high performace field and made the cardiac surgen a public figure. In this moment, thelove story between cardiac surgery and media started. Most probably the majority of active cardiac surgeons of this generation owe Christiaan Barnard their option for choosing this field and this medical specialty her huge succes.It is considered that the maximum moment of cardiac surgery is the year 1986 when worldwide over 2000 procedures on the open heart were performed daily.But new discoveries started to appear in the cardiovascular field. In the 70s percutaneous procedures were invented. Andreas Gruntzig realized in 1977 the first coronary angioplasty and coronary stents were implanted in 1986 by Puel and Sigwart. Development on interventional cardiology was exponential and nowadays at the European Association of Cardiothoracic Surgery simposium about the future of cardiac surgery, 90% of the cardiac surgeons stated that they would prefer the coronary stent over coronar artery bypass grafting surgery if they would have to choose as patients.Starting with 2003 when was realised the first transcatheter aortic valve implantation (TAVI), the exclusive field of cardiac valve surgery is partialy claimed by interventional cardiology [23].The field of aortic anevrisms and acute dissections falls from cardiac surgery also to interventional cardiology after the developement of endoaortic stent grafts [24,25].As a consequence the number of coronary artery bypass grating procedures falls 28% between 1997 and 2004 in the USA. Meanwhile coronary percutaneos procedures rises with 121% [24,28]. Also it is possible that for the first time in history, the number of cardiac surgeons will decrease untill 2020 [24.28].But cardiac surgery extends in to new fields in order to survive. For exemple, one of the future aspect is the treatment of cardiac insuffiency. It is estimated that over 5 milion americans have cardiac insuffiency [26] and cardiac transplantation is the solution for these patients. Unfortunately, the number of donors falls, and this is no longer an effective solution. Multiple devices are designed in order to help the heart, ranging from univentricular asist devices to artificial hearts. This devices can act as a bridge to cardiac transplantation or they can be the solution for patients that are not eligible for cardiac transplantation.Surgical treatment of atrial fibrilation remains a solid options for patients with this disease which have a high risk of emboly or progression to cardiac insufficiency [27].The field of corection of congenital cardiac malformations lessens because of early diagnostic and possibility to end the pregnancy. But there are surgical treatments for children that are born with complex congenital heart malformations with optimal results.The development of minimally invasive techniques, robotics and hybrid ones represents the response of cardiac surgery to interventional cardiology.Apparently, cardiac surgery and interventional cardiology are merging. More and more patients are heald in hybrind operating rooms, using hybrid techniques. The concept of “heart teams” emerges- a team made of cardiologists, cardiac surgeons and cardiac anesthesiologists. Probably, in the future will exist only a cardiologist-cardiac surgeon or a cardiac surgeon-cardiologist, either way a specialist in cardiovascular medicine.The conclusion isn’t pessimistic. As long as there will be patients, doctors will be needed. It remains to be seen if they will be surgeons, interventional cardiologists or just cardiologists.Certainly, general anesthesia, opeaning the mediastinum through median sternotomy using an electic saw and circulating the patients blood through the extracorporeal circulation machine, not to mention stopping the heart, isn’t the future.But introducing needls in arteries, wires in the aorta and pen sprins into the coronary isn’t also the future.Without a doubt, the future belongs to physicians that will cure cardiovascular disease with pills or even better just with advices...

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Kanar, B., RM Hamdy, A. Lindholm, L. Puga, A. Zaroui, L. Groenningsaeter, R. Sorrentino, et al. "P1113Relationship between left atrium and hypertensive retinopathy in patients with systemic hypertension: a real-time three-dimensional echocardiography-based studyP1114Detection of early left ventricular systolic dysfunction in hypertensive patients with preserved ejection fraction using deformation imagingP1115Left ventricular strain in systemic sclerosis with and without pulmonary hypertension; a cardiac magnetic resonance studyP1116End-stage chronic kidney disease and routine annual transthoracic echocardiograpyP1117arrhythmogenic right ventricular cardiomyopathy or athlete's heart adaptations ?P1118Reduced left ventricular function in long term follow-up in women with previous severe preeclampsiaP1119Preload dependent changes of left ventricular twisting and torsion during pregnancy: a three-dimensional strain studyP1120Pre-procedural renal resistive index predicts contrast-induced acute kidney injury following coronary angiographyP1121Simplified 10 point ultrasound in diagnosis of pulmonary congestion in heart failureP1122Pulmonary and systemic vascular resistance during graded exercise in patients with ventricular septal defect repair versus healthy controlsP1123Effect of percutaneous stent implantation on arterial hypertension and aortic flow dynamics in patients with aortic coarctation: identification of responders and non respondersP1124The use of vitamin k antagonists is associated with increased levels of vascular calcification in low-risk patients with atrial fibrillationP1125Stress echo positivity predicts cancer deathP1126Assessment of the agreement between instantaneous wave-free ratio (iFR) and dobutamine stress echo in real world stable angina patientsP1127Impact of AVAproj on severity reclassification of LFLG AS with persistent area - gradient discordanceP1128 The prognostic value of rest and exercise- induced B-lines in heart failure patientsP1129Stress-induced worsening of left ventricular diastolic function as a new marker of myocardial ischemia: a retrospective observational studyP1130Prediction and management of stable angina in senior populationP1131Risk assessment of coronary heart desease in men before revascularization of non-coronary arteriesP1132Relation of elevated C - reactive protien level to left atrial size and left atrial thrombus in patients with valvular and non-valvular atrial fibrillationP1133Transesophageal echocardiographic assessment of left atrial appendage function as a cardioembolic source in atrial fibrillationP1134Correlations of three-dimensional mitral valve geometry with chronic ischemic mitral regurgitation severity in compliance with tethering phenotypesP1135Aortic root physiology in patients with aortic valvulopathyP1136Comparison of layer-specific strain to other contemporary deformation parameters for coronary artery disease prediction in patients with non-ST-segment elevation acute coronary syndromeP1137Machine-learning based diagnosis of heart failure with preserved ejection fraction: how much do we agree with the guidelines?" European Heart Journal – Cardiovascular Imaging 17, suppl 2 (December 2016): ii234—ii241. http://dx.doi.org/10.1093/ehjci/jew262.002.

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Widya, A., A. Jalaludinsyah, D. G. Widyawati, E. Hindoro, E. Supriadi, G. Adi, G. R. T. Ryanto, et al. "Case ReportsClinical effect of ivabradine in patient with congestive heart failure with cardiogenic shock condition: A case reportAcute mesenteric ischemia on extensive anterior STEMI with paroxysmal atrial fibrilation: A rare complicationAcute fulminant myocarditis mimicking ST-elevation myocardial infarctionFractional flow reserve: Nurturing a functional perspective in angioplasty (Case Report)The role of invasive fractional flow reserve (FFR) in multivessel diseaseFibrinolytic followed by early angiography in cardiac arrest survivor patients with ST elevation ACS: A pharmaco-invasive in non-primary PCI capable hospitalEarly accelerated idioventricular rhythm followed by premature ventricular complexes as a marker for successful reperfusion in ST-elevation myocardial infarct patientInferior ST-elevation myocardial infarction complicated by unstable total atrioventricular block and diabetic ketoacidosis in end stage renal failure patientOutlflow tract ventricular arrythmia 3D ablation in LV summit Area: A case reportIntravascular hemolysis complication after transcatheter PDA closure with ADO device: A case reportA very rare case: A patient with extreme levocardia without remarkable symptomTransradial primary percutaneous coronary intervention on a patient with ST-Elevation myocardial infarction with comorbid peripheral artery disease and severe partial obstruction in the abdominal aortaAcute coronary syndrome with ventricular stormCardio-cerebral infaction: A rare case of concomitant acute right ventricular infarction and ischemic strokeTypical ECG pattern of acute pulmonary embolism in a 45 years old dyspneic and chest pain male patient: A case reportPersistent high degree AV block after early invasive strategy in acute decompensated heart failure caused by NSTEMI: A case reportAdult patent ductus arteriosus complicated by pulmonary artery endarteritis and pneumoniaRoutine thrombus aspiration in primary percutaneous coronary intervention: Is it still necessary? (Case Report)Curable severe tachycardiomyopathy due to typical atrial flutter by radiofrequency catheter ablationSinus node dysfunction in right heart failure: A rare caseLipomatous hypertrophy of the interatrial expanding into left atrial appendage mimicking thrombus: A very rare case reportConservative approach for patient in acute heart failure with cor triatriatum dexter and atrial fibrillation: A rare case reportAcute rheumatic fever in juvenile complicated by complete heart block: A case reportA nineteen years old young woman with idiopathic hypertrophic subaortic stenosis: A case reportRecurrent acute coronary syndrome – a manifestation of clopidogrel resistance: A case reportSubarterial doubly committed ventricularseptal defectcomplicated with right-sided fungalinfective endocarditisCase report: The hemodynamic effect of non invasive ventilation in atrial septal defect with severe pulmonary hypertension and respiratory failureEchocardiography-guided percutaneus transvenous mitral commissurotomy in a pregnant woman with severe mitral stenosisThe correlation between endothelial function parameter flow mediated vasodilatation with the complexity of coronary artery disease based on Syntax ScoreRuptured sinuses of valsalva aneurysms: Report of five casesParacetamol as alternative for patent ductus arteriosus (PDA) management." European Heart Journal Supplements 18, suppl B (April 8, 2016): B51—B57. http://dx.doi.org/10.1093/eurheartj/suw024.

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Craciunescu, I., N. Ngiam, BJ Sun, S. Prado Diaz, AE Vijiiac, M. Tomaszewski, JE Yi, et al. "P235Relation between myocardial deformation by three-dimensional speckle tracking analysis , control of the hypertension and functional capacity in patients with systemic hypertensionP236Obstructive sleep apnoea is often under-recognised in patients with acute myocardial infarction, but commonly contributes to left ventricular diastolic dysfunctionP237Intrinsic left ventricular dysfunction in Behcet disease in comparison with systemic disease activity: insights from speckle tracking echocardiographyP238Echocardiography changes during singleton and twin pregnancyP239Proposal of two new echocardiographic parameters for the differentiation of pre-capillary from post-capillary pulmonary hypertensionP240The coincidence of implanted device and number of electrodes with the presence of residual fibrotic tissue after transvenous leads extraction assessed in echocardiographic examP241Hemoglobin is an independent predictor of left ventricular hypertrophy in postmenopausal women but not in premenopausal womenP242Left ventricular longitudinal deformation impairment in patients with psoriasis is linked with immunologic activationP243Impaired diastolic functions and left atrial mechanical functions in patients with vitamin-D deficiencyP244Modification of cardiac and vascular function secondary to insulin resistanceP245Impaired right ventricular function is not related to serum galectin-3 concentration in patients with repaired tetralogy of fallotP246Age-adjusted indices of right ventricular (RV) longitudinal function do not adequately reflect the global RV contraction in children with repaired congenital heart defects and RV volume overloadP247Relationship between fractional flow reserve and dobutamine stress echocardiography in coronary artery diseaseP248A retrospective observational comparative study on the negative predictive value of nuclear testing vs. stress echo in pre-operative assessment for patients undergoing solid organ transplantionP249The detection of viable myocardium by dobutamine stress speckle tracking echocardiography in patients with coronary artery diseaseP250VO2 flattening during exercise in heart failure: evidence for a combined low cardiac output and inefficient O2 extractionP251 The dynamic assessment of alveolar-capillary barrier during exercise-echocardiography in heart failure patients with reduced ejection fractionP252The effect of exercise training on cardiac function during exercise stress echo in patients with type 2 diabetes and diastolic dysfunctionP253Age-related maximal exercise O2 extraction differences in a population of apparently healthy subjects at cardiovascular riskP254Difference in the changes of functional mitral regurgitation between semisupine ergometer and handgrip exerciseP255Correlation of annulus size assessed by echo 2d, 3d and multidetector computed tomography in patients undergoing transcatheter aortic valve implantationP256Mitral annulus dynamics: from normal to extensive mixomatous disease-a three-dimensional transoesophageal studyP257Left atrial appendage closure: an echo point of view of 55 casesP258Effect of catheter-based renal denervation on left ventricular function, mass and (un)twist with two-dimensional speckle tracking echocardiographyP259Associations of microRNAs gene expression in peripheral blood mononuclear cells and left ventricular global longitudinal peak strain in patients with essential hypertension." European Heart Journal – Cardiovascular Imaging 17, suppl 2 (December 2016): ii37—ii45. http://dx.doi.org/10.1093/ehjci/jew236.002.

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Colunga Blanco, S., C. Gonzalez Matos, A. Angelis, P. G. Dinis, M. Chinali, A. Toth, M. G. Andreassi, et al. "Poster session 5The imaging examinationP1097Correlation between visual and quantitative assessment of left ventricle: intra- and inter-observer agreementP1099Incremental prognostic value of late gadolinium-enhanced by cardiac magnetic resonance in patients with heart failureAnatomy and physiology of the heart and great vesselsP1100Left ventricular geometry and diastolic performance in erectile dysfunction patients; a topic of differential arterial stiffness influenceAssessment of diameters, volumes and massP1101Impact of the percutaneous closure of atrial septal defect on the right heart "remodeling"P1102Left Ventricular Mass Indexation in Infants, Children and Adolescents: a Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical PracticeP1103Impact of trabecules while quantifying cardiac magnetic resonance exams in patients with systemic right ventricleP1104Detection of subclinical atherosclerosis by carotid intima-media thickness: correlation with leukocytes telomere shorteningAssessments of haemodynamicsP1105Flow redirection towards the left ventricular outflow tract: vortex formation is not affected by variations in atrio-ventricular delayAssessment of systolic functionP1106Reproducibility and feasibility of cardiac MRI feature tracking in Fabry diseaseP1107Normal left ventricular strain values by two-dimensional strain echocardiography; result of normal (normal echocardiographic dimensions and functions in korean people) studyP1108Test-retest repeatability of global strain following st-elevation myocardial infarction - a comparison of tagging and feature trackingP1109Cardiotoxicity induced by tyrosine kinase inhibitors in patients with gastrointestinal stromal tumors (GIST)P1110Finite strain ellipses for the analysis of left ventricular principal strain directions using 3d speckle tracking echocardiographyP1111Antihypertensive therapy reduces time to peak longitudinal strainP1112Right ventricular systolic function as a marker of prognosis after inferior myocardial infarction - 5-year follow-upP1113Is artery pulmonary dilatation related with right but also early left ventricle dysfunction in pulmonary artery hypertension?P1114Right ventricular mechanics changes according to pressure overload increasing, a 2D-speckle tracking echocardiographic evaluationAssessment of diastolic functionP1115Paired comparison of left atrial strain from P-wave to P-wave and R-wave to R-waveP1116Diagnostic role of Tissue Doppler Imaging echocardiographic criteria in obese heart failure with preserved ejection fraction patientsP1117Evaluation of diastolic function of right ventricle in idiopathic pulmonary arterial hypertensionP1118Severity and predictors of diastolic dysfunction in a non-hypertensive non-ischemic cohort of Egyptian patients with documented systemic autoimmune disease; pilot reportP1119correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarctionIschemic heart diseaseP1120Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)P1121Utility of transmural myocardial mechanic for early infarct size prediction after primary percutaneous coronary intervention in STEMI patientsP1122Progressive Improvements of the echocardiographic deformation parameters in ST Elevation Myocardial Infarction after five years follow-upP1123Long-term prognostic value of left ventricular dyssynchrony as assessed by cardiac magnetic resonance feature-tracking imaging after a first st-segment elevation myocardial infarctionP1124Differences in mitral annulus remodeling in acute anterior ST elevation and acute inferior ST elevation myocardial infarctionP1125Reduction of microvascular injury using a novel theragnostic ultrasound strategy: a first in men feasibility and safety studyP1126Impact of focused echocardiography in clinical decision of patient presented with st elevation myocardial infarction underwent primary angioplastyHeart valve DiseasesP1127Aortic valve area calculation in aortic stenosis: a comparison among conventional and 3D-transesophageal echocardiography and computed tomographyP1128Myocardial fibrosis and microRNA-21 expression in patients with severe aortic valve stenosis and preserved ejection fraction: a 2D speckle tracking echocardiography, tissutal and plasmatic studyP1129Quantification of calcium amount in a new experimental model: a comparison between calibrated integrated backscatter of ultrasound and computed tomographyP1130Altered diffusion capacity in aortic stenosis: role of the right heartP1131Osteoprotegerin predicts all-cause mortality in calcific aortic stenosis patients with preserved left ventricle ejection fraction in long term observationP1132Mitral regurgitation as a risk factor for pulmonary hypertension in patients with aortic stenosisP1133The relationship between the level of plasma B-type natriuretic peptide and mitral stenosisP1134Aortic regurgitation, left ventricle mechanics and vascular load: a single centre 2d derived-speckle tracking studyP1135Feasibility and reproducibility issues limit the usefulness of quantitative colour Doppler parameters in the assessment of chronic aortic and mitral regurgitation severityP1136Predictors of postoperative outcome in degenerative mitral regurgitationP1137Left ventricular mechanical dyssynchrony in patients with severe mitral regurgitation of rheumatic etiology; three dimensional echocardiography studyP1138Functional mitral regurgitation and left atrial dysfunction concur in determining pulmonary hypertension and functional status in subjects with left ventricular systolic dysfunctionP11393D echocardiography allows more effective quantitative assessment of the severity of functional tricuspid regurgitation than conventional 2D/Doppler echocardiographyP1140Prosthetic valve thrombosis: still a severe disease? 10-years experience in a university hospitalP1141Validity of echocardiography in the hospital course of patients with feverP1142Do baseline 3DTEE characteristics of mitral valve apparatus predict long term result in patients undergoing percutaneous valve repair for degenerative regurgitation?P1143Influence of baseline aortic regurgitation on mitral regurgitation change after transcatheter aortic valve replacement for aortic stenosisP1144Prevalence of echocardiography detected significant valvular regurge in subclinical rheumatic carditis in assiut childrenCardiomyopathiesP1145Can we early detect left ventricular systolic dysfunction in patients with Duchenne muscular dystrophy using global longitudinal strain assessment?P1146Prevalence of isolated papillary muscle hypertrophy in young competitive athletesP1147Troponin release after exercise in patients with hypertrophic cardiomyopathy: associations with clinical and mr imaging characteristicsP1148Atrial fibrillation in hypertrophic cardiomyopathy: can we score the risk?P1149Impact of hypertrophy on multiple layer longitudinal deformation in hypertrophy cardiomyopathy and cardiac amyloidosis compared to controlsP1150Functional evaluation in hypertrophic cardiomyopathy combining cardiopulmonary exercise testing combined with exercise-echocardiographyP1151Refinement of the old diagnostic criteria of left ventricular noncompaction cardiomyopathy (LVNC) based on cardiac magnetic resonance (CMR)P1152Differences of clinical characteristics and outcomes between acute myocarditis with preserved and reduced left ventricular systolic functionP1153Value of longitudinal strain for distinguishing left ventricular non-compaction from idiopathic dilated cardiomyopathyP1154Speed of recovery of left ventricular function is not related to the prognosis of Takotsubo cardiomyopathy. A Portuguese multicentre studyP1155Predictors of in-hospital left ventricular systolic function recovery after admission with takotsubo cardiomyopathy. Portuguese multicentre studyP1156Mid-ventricular takotsubo detected by initial echocardiogram associates with recurrence of takotsubo cardiomyopathy - a portuguese multicentre studySystemic diseases and other conditionsP1157Relations between left ventricle remodelling and expression of angiotensin 2 AT2R1 geneP1158Impact of renal denervation on long-term blood pressure variability and surrogate markers of target organ damage in individuals with drug-resistant arterial hypertensionP1159Greater improvement of coronary artery function, left ventricular deformation and twisting by IL12/23 compared to TNF-a inhibition in psoriasisP1160Advanced glycation end products play a role in adverse LV remodeling following MIP1161Incidence of subclinical myocardial dysfunction in patients with systemic sclerosis and normal left ventricular systolic and diastolic functionP1162Left atrial remodeling and dysfunction occur early in patients with systemic sclerosis and normal left ventricular functionP1163Intrinsic vortex formation : a unique performance indicatorP1164P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletesP1165Usefulness of transthoracic echocardiography in diagnosis of young patients with ischemic strokeP1166Primary cardiac lymphoma: role of echocardiography in the clinical managementP1167Abnormal echocardiographic findings in cancer patients before chemotherapyMasses, tumors and sources of embolismP1168Three-dimensional transesophageal echocardiography of the left atrial appendage reduces rate of postpone electrical cardioversionP1169Detection of ventricular thrombus by cmr after reperfused st-segment elevation myocardial infarction correlated with echocardiographyP1170Clinical and transthoracic echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillationStress echocardiographyP1171Pharmacological stress echocardiography complications: a 4-year single center experienceP1172Myocardial functional and perfusion reserve in type I diabetesP1173Feasibility of incorporating 3D Dobutamine stress echocardiography into routine clinical practiceP1174Right ventricular isovolumic acceleration at rest and during exercise in children after heart transplantP1175Right ventricular systolic and diastolic response to exercise in children after heart transplant -a bicycle exercise studyP1176Determinants of functional capacity in heart failure patients with reduced ejection fractionP1177Handgrip stress echocardiography with emotional component compared to conventional isometric exercise in coronary artery disease diagnosisP1178The relationship between resting transthoracic echocardiography and exercise capacity in patients with paroxysmal atrial fibrillationP1179Correlation between NT-proBNP and selected echocardiography parameters at rest and after exercise in patients with functional ischemic mitral regurgitation qualified for cardiosurgical treatmentReal-time three-dimensional TEEP1180Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A study based on transesophageal 3D colour Doppler in 419 patientsP1181Proximal flow convergence by 3D echocardiography in the evaluation of mitral valve area in rheumatic mitral stenosisP1182Quantification of valve dimensions by transesophageal 3D echocardiography in patients with functional and degenerative mitral regurgitationTissue Doppler and speckle trackingP1183Automatic calculation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reductionP1184Effect of the mitral valve repairs on the left ventricular blood flow formationP1185Quantification of left atrial strain using cardiovascular magnetic resonance. a comparison between hypertrophic cardiomyopathy and healthy controlsP1186The role of early systolic lengthening in patients with non-ST elevation acute coronary syndrome and its relation to syntax scoreP1187Different standard two dimensional strain methods to quantity left ventricular mechanicsP1188Atrial function and electrocardiography caracteristics in sportsmen with or without paroxysmal atrial fibrillationP1189Right ventricular outflow premature contractions induce regional left ventricular dysfunctionP1190Ultrasound guided venous access for pacemaker and defibrillators. Randomized TrialP1191Atrial function analysis correlates with symptoms and quality of life of heart failure patientsP1192The use of tissue doppler echocardiography in myocardial iron overload in patients with thalassaemia majorP1193Independent association between pulse pressure and left ventricular global longitudinal strainP1194Global and regional longitudinal strain identifies the presence of coronary artery disease in patients with suspected reduction of coronary flow reserve and absence of wall motion abnormalitiesP1195Prognostic value of invasive and noninvasive parameters of right ventricular function in patients with pulmonary arterial hypertension receiving specific vasodilator therapyP1196Myocardial deformation analysis to improve arrhythmic risk stratificationP1197Quantitative assessment of regional systolic and diastolic function parameters for detecting prior transient ischemia in normokinetic segmentsP1198Left atrial function in patients with corrected tetralogy of Fallot - a three-dimensional speckle-tracking echocardiographic studyP1199Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiographyP1200Acute angulation of the aortic arch late after the arterial switch operation for transposition of the great arteries: impact on cardiac mechanicsP1201Circumferential deformation of the ascending thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiographyCardiac Magnetic ResonanceP1202The incremental value of cardiac magnetic resonance on diagnosis myocardial infarction and non-obstructed coronary arteriesP1204Reference ranges of global and regional myocardial T1 values derived from MOLLI and shMOLLI at 3TComputed Tomography & Nuclear CardiologyP1205Deformation of the left atrial appendage after percutaneous closure with the Amplatzer cardiac plugP1206Prognostic impact of non-obstructive coronary artery disease on coronary computed tomographic angiography: A single-center study." European Heart Journal – Cardiovascular Imaging 16, suppl 2 (December 2015): S183—S209. http://dx.doi.org/10.1093/ehjci/jev275.

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Winter, R., A. Fazlinezhad, S. Martins Fernandes, M. Pellegrino, X. Iriart, S. Moustafa, D. Stolfo, et al. "Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography." European Heart Journal – Cardiovascular Imaging 16, suppl 2 (December 2015): S102—S129. http://dx.doi.org/10.1093/ehjci/jev277.

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Catalano, Sarah, Ian Whittington, Stephen Donnellan, and Bronwyn Gillanders. "Using the giant Australian cuttlefish (Sepia apama) mass breeding aggregation to explore the life cycle of dicyemid parasites." Acta Parasitologica 58, no. 4 (January 1, 2013). http://dx.doi.org/10.2478/s11686-013-0186-y.

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AbstractDicyemid mesozoan parasites, microscopic organisms found with high intensities in the renal appendages of benthic cephalopods, have a complex, partially unknown life cycle. It is uncertain at which host life cycle stage (i.e. eggs, juvenile, adult) new infection by the dispersive infusoriform embryo occurs. As adult cephalopods have a short lifespan and die shortly after reproducing only once, and juveniles are fast-moving, we hypothesize that the eggs are the life cycle stage where new infection occurs. Eggs are abundant and sessile, allowing a huge number of new individuals to be infected with low energy costs, and they also provide dicyemids with the maximum amount of time for survival compared with infection of juvenile and adult stages. In our study we collected giant Australian cuttlefish (Sepia apama) eggs at different stages of development and filtered seawater samples from the S. apama mass breeding aggregation area in South Australia, Australia, and tested these samples for the presence of dicyemid DNA. We did not recover dicyemid parasite cytochrome c oxidase subunit I (COI) nucleotide sequences from any of the samples, suggesting eggs are not the stage where new infection occurs. To resolve this unknown in the dicyemid life cycle, we believe experimental infection is needed.

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Sadouski, Denis, Aleh Kalachyk, Alexadr Nosik, Aliaksei Narbin, Anna Startsava, Yuliya Kuzmenka-Maskvina, and Anna Dolgolikova. "MO065DIAGNOSTIC CRITERIA OF HUMORAL REJECTION IN RENAL TRANSPLANT RECIPIENTS WITH PRE-EXISTING ANTI-HLA ANTIBODIES BASED ON SENTINEL SKIN FLAP BIOPSY." Nephrology Dialysis Transplantation 36, Supplement_1 (May 1, 2021). http://dx.doi.org/10.1093/ndt/gfab078.001.

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Abstract Background and Aims Twenty years of transplantation of composite vascularised allografts have revealed the high immunogenicity of the constituent parts, especially the skin.Several researchers have proposed the use of vascular stalk flaps, which allow to performe skin biopsy and diagnose rejection without biopsy of the transplanted solid organ.Pre-existing anti-HLA antibodies represent a serious immunological barrier to successful kidney transplantation.We are not aware of any studies on the diagnosis of antibody-associated acute kidney allograft rejection from deceased donors in recipients with pre-existing antibodies, based on morphological examination of a sentinel skin flap on a vascular stalk. The Aim: To determine the morphological features of humoral rejection in renal transplant recipients with pre-existing anti-HLA antibodies based on sentinel skin flap biopsy. Method Three skin-kidney allografts recipients underwent skin flap biopsy on 2nd day after transplantation. A kidney allograft biopsy was performed on day 7, 30, 60, 90.The results of morphological studies are presented using the Banff classification of renal allograft and skin allograft pathology. All recipients were female; 35, 44, and 57 years old. Two patients were re-transplanted and the main cause of CKD was chronic glomerulonephritis. The third patient, with congenital abnormality of the urinary tract, received her first graft.Pre-existing anti-HLA antibody levels before transplantation were 50%, 60%, 80%, respectively. Results All recipients showed signs of humoral rejection of the skin flap with thrombosis of the feeding vascular bundle, phlebitis, predominantly intimal arteritis with median necrosis, detachment and areactive necrosis of epidermis and epithelium of skin appendages. Clinical rejection, similar to the algorithm proposed by Etra J.W. et al. to assess preclinical skin rejection in an animal model (2019), was interpreted as G2 in two cases and G3 in one case. The Banff classification of the skin flap offers a qualitative assessment of certain biopsy parameters, while the kidney graft has qualitative-quantitative criteria for assessing rejection. When comparing the two classifications, a quantitative gradation of pathological changes in the skin flap according to the parameter of intimal arteritis (v) and immunoreactivity of the C4d marker similar to renal rejection was possible. In histological examination of skin flap biopsies, the degree of vasculitis was assessed in a large feeding artery: in all three cases this parameter was equal to v3. C4d expression was analyzed in the endothelium of microcirculatory blood vessels of the dermis and hypodermis: C4d1 in one case and C4d3 in the other two. The analysis of renal allograft biopsies revealed signs of humoral rejection (v1) only at day 30 in two recipients whose C4d expression in the skin and hypodermis was strong (C4d3). Conclusion Antibody-mediated rejection of a vascularized sentinel skin flap in recipients with combined skin-kidney transplantation is characterized by vasculitis affecting a core vascular bundle in the form of endarteritis with necrosis of media,phlebitis and associated thrombosis.Further studies are required to determine the feasibility of using a vascular stalked skin flap in the diagnosis of humoral rejection after renal transplantation.

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Sanjoy, Shubrandu S., Yun‐Hee Choi, Robert T. Sparrow, Hani Jneid, J. Dawn Abbott, Luis Nombela‐Franco, Lorenzo Azzalini, et al. "Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure." Journal of the American Heart Association, September 24, 2021. http://dx.doi.org/10.1161/jaha.121.021973.

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Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in‐hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in‐hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P =0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P =0.09) and death (0.3% versus 0.1%, P =0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in‐hospital MAE were observed in women (1.61‐fold), and those with preprocedural congestive heart failure (≈2‐fold), diabetes (≈1.5‐fold), renal disease (≈2.6‐fold), anemia (≈2.7‐fold), and dementia (≈5‐fold). In patients <80 years old, a higher risk of in‐hospital MAE was encountered among women (≈1.4‐fold) and those with diabetes (≈1.3‐fold), renal disease (≈2.6‐fold), anemia (≈2‐fold), and dyslipidemia (≈1.2‐fold). Conclusions Patients ≥80 years old had higher rates of in‐hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in‐hospital MAE among both groups.

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Finnegan, Daniel K., Michael J. Murray, Samuel Young, Michael M. Garner, and Elise E. B. LaDouceur. "Histologic lesions of cestodiasis in octopuses." Veterinary Pathology, October 15, 2022, 030098582211289. http://dx.doi.org/10.1177/03009858221128915.

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Parasitism of cephalopods is common, including infection with Aggregata spp., Ichthyobodo spp., dicyemids, cestodes of the orders Tetraphyllidea and Trypanorhynchidea, and various crustaceans. Cestodiasis in octopuses is reported, although a full histologic description of lesions has not been previously described. Cestodiasis was identified in 10 octopuses of 4 different species, which included 4 common octopuses ( Octopus vulgaris), 3 Caribbean reef octopuses ( Octopus briareus), 2 two-spot octopuses ( Octopus bimaculoides), and 1 giant Pacific octopus ( Enteroctopus dofleini). Larval cestodes were present in the cecum ( n = 5), intestines ( n = 4), digestive gland ( n = 3), chitinous alimentary tract ( n = 2), renal appendage ( n = 1), and salivary duct ( n = 1). In 5 cases, larval cestodes invaded tissue and were associated with hemocytic inflammation and tracts of necrotic tissue in the intestines ( n = 3), digestive gland ( n = 3), and/or renal appendage ( n = 1). When present in the chitinous alimentary tract (esophagus, stomach) or cecum, larval cestodes were in the central lumen and not associated with lesions. One adult cestode was identified in the mantle cavity and was not associated with lesions. Other common concurrent parasitic infections included enteric Aggregata spp. infection, branchial Rickettsia-like organism infection, enteric nematodiasis, and an arthropod-associated branchitis.

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Journal articles on the topic 'Renal appendages'

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