Asymmetric focal pericardial thickening causing physiologically significant constrictive pericarditis

A 34‐year‐old woman presented with refractory ascites and edema. Echocardiography revealed normal left ventricular function with a restrictive diastolic filling pattern. Tissue Doppler velocities of the mitral annulus were normal. Cardiac magnetic resonance imaging (MRI) revealed a focal region of pericardial thickening anterior to the right ventricle and normal thickness pericardium in the other segments. However, abnormal delayed enhancement MRI (consistent with inflammation) was present in both the thickened and the normal pericardial segments. Invasive hemodynamics confirmed constrictive physiology and the patient underwent successful pericardiectomy. This case highlights the utility of multimodality imaging in the diagnosis of constrictive pericarditis and the underappreciated fact that the pericardium need not be globally thickened to cause hemodynamically significant constrictive physiology.© 2012 Wiley Periodicals, Inc.     

Prediction of Cardiovascular Mortality by Estimated Cardiorespiratory Fitness Independent of Traditional Risk Factors: The HUNT Study

Objective

To assess the predictive value of estimated cardiorespiratory fitness (eCRF) and evaluate the additional contribution of traditional risk factors in cardiovascular disease (CVD) mortality prediction.

Primary cutaneous mucinous carcinoma: presence of myoepithelial cells as a clue to the cutaneous origin

BACKGROUND: Primary cutaneous mucinous carcinoma (PCMC) is a rare malignancy with probable apocrine differentiation. It is important to differentiate it from metastatic mucinous carcinoma (MMC), especially from the breast. The histologic and immunohistochemical features overlap between PCMC and breast mucinous carcinomas. In this study, we introduce the presence of myoepithelial component in PCMC as a new morphologic parameter to distinguish it from MMC from either breast or sites elsewhere in the body. MATERIALS AND METHODS: We studied 7 cases of PCMC. The possible in situ component in the tumor was assessed by the presence of a peripheral myoepithelial cell layer. Myoepithelial cell differentiation was confirmed with immunohistochemical stains for p63, CK 5/6, calponin, smooth muscle actin (SMA), HHF-35, and CD10. Estrogen and progesterone receptor (ER/PR), gross cystic disease fluid protein (GCDFP 15), CK7, CK20, and S-100 immunostains were also performed. RESULTS: Histologically, multiple small monomorphic epithelial islands floating in multilocular pools of mucin characterized the tumor. Focally, epithelial islands were bordered by dermal connective tissue at the periphery of mucin pools. Secretory snouts were apparent in all cases providing evidence for apocrine differentiation. In 5 of the 7 cases, an in situ component was identified as epithelial islands being bounded by a myoepithelial layer, which was highlighted by p63, CK 5/6, calponin, SMA, and HHF-35. ER/PR and CK7 were positive in all the cases. GCDFP-15 and CD10 were focally positive in the tumor cells and myoepithelial cells, respectively. All 7 cases were negative for S-100 and CK 20. CONCLUSION: We conclude that an in situ component is frequently present in PCMC (5/7) and may help in distinguishing this entity from MMC, especially of breast origin. Furthermore, it may provide insight into the pathogenetic mechanism of mucinous carcinoma evolving from in situ carcinoma with luminal mucinous distention to cellular tumor with a little surrounding mucin.     

Sustained Physical Activity,Not Weight Loss,Associated With Improved Survival in Coronary Heart Disease

Background

Individuals with coronary heart disease (CHD) are recommended to be physically active and to maintain a healthy weight. There is a lack of data on how long-term changes in body mass index (BMI) and physical activity (PA) relate to mortality in this population.

Antioxidant and antiproliferative activities of anthocyanin/ellagitannin-enriched extracts from Syzygium cumini L. (Jamun, the Indian Blackberry)

Colored fruits, particularly berries, are highly chemoprotective because of their antioxidant, antiproliferative, and antiinflammatory activities. We report the cancer chemoprotective potential of Syzygium cumini L., commonly known as jamun or Indian blackberry. Anthocyanins and other polyphenolics were extracted with acidic ethanol and enriched by amberlite XAD7/HP20 (1:1). The pulp powder was found to contain 0.54% anthocyanins, 0.17% ellagic acid/ellagitannins, and 1.15% total polyphenolics. Jamun seed contained no detectable anthocyanins but had higher amounts of ellagic acid/ellagitannins (0.5%) and total polyphenolics (2.7%) than the pulp powder. Upon acid hydrolysis, the pulp extract yielded 5 anthocyanidins by HPLC: malvidin (44.4%), petunidin (24.2%), delphinidin (20.3%), cyanidin (6.6%), and peonidin (2.2%). Extracts of both jamun pulp (1,445 ± 64 μmol of trolox equivalent (TE)/g) and seeds (3,379 ± 151 μM of TE/g) showed high oxygen radical absorbance capacity. Their high antioxidant potential was also reflected by 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid)- and 2,2-diphenyl-1-picrylhydrazyl-scavenging and ferrous ion-chelating activities. We also analyzed antiproliferative activity of jamun extracts against human lung cancer A549 cells. The hydrolyzed pulp and seed extracts showed significant antiproliferative activity. However, unhydrolyzed extracts showed much less activity. These data showed that in addition to 5 anthocyanidins, jamun contains appreciable amounts of ellagic acid/ellagitannins, with high antioxidant and antiproliferative activities.     

Survival outcomes in liver transplant recipients with Model for End‐stage Liver Disease scores of 40 or higher: a decade‐long experience

BackgroundThe Model for End‐stage Liver Disease (MELD) has been used as a prognostic tool since 2002 to predict pre‐transplant mortality. Increasing proportions of transplant candidates with higher MELD scores, combined with improvements in transplant outcomes, mandate the need to study surgical outcomes in patients with MELD scores of ≥40.MethodsA retrospective longitudinal analysis of United Network for Organ Sharing (UNOS) data on all liver transplantations performed between February 2002 and June 2011 (n= 33 398) stratified by MELD score (<30, 30–39, ≥40) was conducted. The primary outcomes of interest were short‐ and longterm graft and patient survival. A Kaplan–Meier product limit method and Cox regression were used. A subanalysis using a futile population was performed to determine futility predictors.ResultsOf the 33 398 transplant recipients analysed, 74% scored <30, 18% scored 30–39, and 8% scored ≥40 at transplantation. Recipients with MELD scores of ≥40 were more likely to be younger (P < 0.001), non‐White and to have shorter waitlist times (P< 0.001). Overall patient survival correlated inversely with increasing MELD score; this trend was consistent for both short‐term (30 days and 90 days) and longterm (1, 3 and 5 years) graft and patient survival. In multivariate analysis, increasing age, African‐American ethnicity, donor obesity and diabetes were negative predictors of survival. Futility predictors included patient age of >60 years, obesity, peri‐transplantation intensive care unit hospitalization with ventilation, and multiple comorbidities.ConclusionsLiver transplantation in recipients with MELD scores of ≥40 offers acceptable longterm survival outcomes. Futility predictors indicate the need for prospective follow‐up studies to define the population to gain the highest benefit from this precious resource.     

Effect of porosity on the fluid flow characteristics and mechanical properties of tantalum scaffolds

In many cases of traumatic bone injury, bone grafting is required. The primary source of graft material is either autograft or allograft. The use of both material sources are well established, however, both suffer limitations. In response, many grafting alternatives are being explored. This article specifically focuses on a porous tantalum metal grafting material (Trabecular Metaltrade mark) marketed by Zimmer. Twenty-one cylindrical scaffolds were manufactured (66% to 88% porous) and tested for porosity, intrinsic permeability, tangent elastic modulus, and for yield stress and strain behavior. Scaffold microstructural geometries were also measured. Tantalum scaffold intrinsic permeability ranged from 2.1 x 10(-10) to 4.8 x 10(-10) m(2) and tangent elastic modulus ranged from 373 MPa to 2.2 GPa. Both intrinsic permeability and tangent elastic modulus closely matched porosity-matched cancellous bone specimens from a variety of species and anatomic locations. Scaffold yield stress ranged from 4 to 12.7 MPa and was comparable to bovine and human cancellous bone. Yield strain was unaffected by scaffold porosity (average = 0.010 mm/mm). Understanding these structure-function relationships will help complete the basic physical characterization of this new material and will aid in the development of realistic mathematical models, ultimately enhancing future implant designs utilizing this material.     

Identification of a Potent Combination of Key Plasmodium falciparum Merozoite Antigens That Elicit Strain-Transcending Parasite-Neutralizing Antibodies

Blood-stage malaria vaccines that target single Plasmodium falciparum antigens involved in erythrocyte invasion have not induced optimal protection in field trials. Blood-stage malaria vaccine development has faced two major hurdles, antigenic polymorphisms and molecular redundancy, which have led to an inability to demonstrate potent, strain-transcending, invasion-inhibitory antibodies. Vaccines that target multiple invasion-related parasite proteins may inhibit erythrocyte invasion more efficiently. Our approach is to develop a receptor-blocking blood-stage vaccine against P. falciparum that targets the erythrocyte binding domains of multiple parasite adhesins, blocking their interaction with their receptors and thus inhibiting erythrocyte invasion. However, with numerous invasion ligands, the challenge is to identify combinations that elicit potent strain-transcending invasion inhibition. We evaluated the invasion-inhibitory activities of 20 different triple combinations of antibodies mixed in vitro against a diverse set of six key merozoite ligands, including the novel ligands P. falciparum apical asparagine-rich protein (PfAARP), EBA-175 (PfF2), P. falciparum reticulocyte binding-like homologous protein 1 (PfRH1), PfRH2, PfRH4, and Plasmodium thrombospondin apical merozoite protein (PTRAMP), which are localized in different apical organelles and are translocated to the merozoite surface at different time points during invasion. They bind erythrocytes with different specificities and are thus involved in distinct invasion pathways. The antibody combination of EBA-175 (PfF2), PfRH2, and PfAARP produced the most efficacious strain-transcending inhibition of erythrocyte invasion against diverse P. falciparum clones. This potent antigen combination was selected for coimmunization as a mixture that induced balanced antibody responses against each antigen and inhibited erythrocyte invasion efficiently. We have thus demonstrated a novel two-step screening approach to identify a potent antigen combination that elicits strong strain-transcending invasion inhibition, supporting its development as a receptor-blocking malaria vaccine.