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Cardiac complications are the leading cause of morbidity and mortality in recipients of liver transplant (LT). Previous guidelines recommended stress testing to exclude coronary artery disease (CAD), although recent guidelines recommend coronary computed tomography angiography (CCTA). We aimed to assess the prevalence and predictors of CAD on CCTA and compare CCTA with stress testing in consecutive adult candidates for LT who underwent CAD noninvasive assessment between 2020 and 2023. Patients who underwent a stress test between January and December 2020 formed the stress cohort, and patients who underwent CCTA between January 2021 and September 2023 formed the CCTA cohort. There were 141 patients in the stress test cohort and 269 patients in the CCTA cohort. Stress test results were nondiagnostic or inconclusive in 18 patients (12.8%) whereas CCTA was nondiagnostic in 6 patients (2.2%). In patients evaluated with CCTA, mean coronary artery calcium (CAC) score was 332 ± 716 AU, with moderate or greater (>50%) stenosis in 33 patients (12.3%). New CAD was diagnosed in 158 patients (58.7%) using CCTA and in 5 patients (3.5%) using stress tests. Clinically actionable CAD (coronary artery calcium >100) on CCTA was present in 96 patients (35.7%). The number of CAD risk factors was associated with the presence of CAD on CCTA. In conclusion, there was a great burden of CAD, mainly nonobstructive, in a large cohort of candidates for LT who underwent CAD testing over a 4-year period. The current recommended risk-based evaluation of candidates for LT using CCTA as a first-line test was feasible and effective. Diagnosis of clinically actionable CAD on CCTA provides a vast opportunity for optimizing cardiac care in candidates for and recipients of LT., Competing Interests: Declaration of competing interest The authors have no competing interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose of Review: This review synthesizes recent research on the efficacy, optimal design, and delivery methods of cardiac rehabilitation tailored to heart failure patients. Despite established benefits, cardiac rehabilitation referral and access disparities persist, necessitating elucidation of limitations and solutions., Recent Findings: Exercise-based cardiac rehabilitation improves long-term mortality and hospitalization rates but not short-term mortality. cardiac rehabilitation further enhances quality of life and medical therapy adherence. However, cardiac rehabilitation relies on in-person delivery, presenting access barriers exacerbated during COVID-19. Significant geographic disparities exist, with analyses indicating current capacity only serves 45% of eligible US adults even if fully utilized. Referral rates also lag, disproportionately affecting women and minority groups. Research increasingly focuses on home-based and digital therapeutics modalities to expand reach, with evidence demonstrating comparable improvements across settings. Protocols and research center on heart failure with reduced ejection fraction (HFrEF), despite growing heart failure with preserved ejection fraction (HFpEF) prevalence., Summary: Increasing referrals through standardized procedures and addressing multifactorial geographic, economic, and capacity limitations are imperative to ensure equitable cardiac rehabilitation access. Broadening HFpEF rehabilitation research and care standards also constitutes a critical practice gap requiring alignment with projected epidemiologic shifts. Advancing patient-centered, evidence-based solutions can promote rehabilitation as essential secondary prevention for wider cardiac populations., Video Abstract: http://links.lww.com/HCO/A97., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Purulent pericarditis (PP)- a purulent infection involving the pericardial space-requires a high index of suspicion for diagnosis as it often lacks characteristic signs of pericarditis and carries a mortality rate as high as 40% even with treatment. Common risk factors include immunosuppression, diabetes mellitus, thoracic surgery, malignancy, and uremia. Most reported cases of PP occur in individuals with predisposing risk factors, such as immunosuppression, and result from more commonly observed preceding infections, such as pneumonia, osteomyelitis, and meningitis. We report a case of PP due to asymptomatic bacteriuria in a previously immunocompetent individual on a short course of high-dose steroids., Case Presentation: An 81-year-old male presented for severe epigastric pain that worsened with inspiration. He had been on high-dose prednisone for presumed inflammatory hip pain. History was notable for urinary retention requiring intermittent self-catheterization and asymptomatic bacteriuria and urinary tract infections due to methicillin-sensitive Staphylococcus aureus (MSSA). During the index admission he was found to have a moderate pericardial effusion. Pericardial fluid cultures grew MSSA that had an identical antibiogram to that of the urine cultures. A diagnosis of purulent pericarditis was made., Conclusion: PP requires a high index of suspicion, especially in hosts with atypical risk factors. This is the second case of PP occurring as a result of asymptomatic MSSA bacteriuria. Through reporting this case we hope to highlight the importance of early recognition of PP and the clinical implications of asymptomatic MSSA bacteriuria in the setting of urinary instrumentation and steroid use., (© 2024. The Author(s).)

Background A total of 40% of patients with severe aortic stenosis (AS) have low-gradient AS, raising uncertainty about AS severity. Aortic valve calcification, measured by computed tomography (CT), is guideline-endorsed to aid in such cases. The performance of different CT-derived aortic valve areas (AVAs) is less well studied. Methods and Results Consecutive adult patients with presumed moderate and severe AS based on echocardiography (AVA measured by continuity equation on echocardiography <1.5 cm 2 ) who underwent cardiac CT were identified retrospectively. AVAs, measured by direct planimetry on CT (AVA CT ) and by a hybrid approach (AVA measured in a hybrid manner with echocardiography and CT [AVA Hybrid ]), were measured. Sex-specific aortic valve calcification thresholds (≥1200 Agatston units in women and ≥2000 Agatston units in men) were applied to adjudicate severe or nonsevere AS. A total of 215 patients (38.0% women; mean±SD age, 78±8 years) were included: normal flow, 59.5%; and low flow, 40.5%. Among the different thresholds for AVA CT and AVA Hybrid , diagnostic performance was the best for AVA CT <1.2 cm 2 (sensitivity, 85%; specificity, 26%; and accuracy, 72%), with no significant difference by flow status. The percentage of patients with correctly classified AS severity (correctly classified severe AS+correctly classified moderate AS) was as follows; AVA measured by continuity equation on echocardiography <1.0 cm 2 , 77%; AVA CT <1.2 cm 2 , 73%; AVA CT <1.0 cm 2 , 58%; AVA Hybrid <1.2 cm 2 , 59%; and AVA Hybrid <1.0 cm 2 , 45%. AVA CT cut points of 1.52 cm 2 for normal flow and 1.56 cm 2 for low flow, provided 95% specificity for excluding severe AS. Conclusions CT-derived AVAs have poor discrimination for AS severity. Using an AVA CT <1.2-cm 2 threshold to define severe AS can produce significant error. Larger AVA CT thresholds improve specificity.

Human retinal organoid transplantation could potentially be a treatment for degenerative retinal diseases. How the recipient retina regulates the survival, maturation, and proliferation of transplanted organoid cells is unknown. We transplanted human retinal organoid-derived cells into photoreceptor-deficient mice and conducted histology and single-cell RNA sequencing alongside time-matched cultured retinal organoids. Unexpectedly, we observed human cells that migrated into all recipient retinal layers and traveled long distances. Using an unbiased approach, we identified these cells as astrocytes and brain/spinal cord-like neural precursors that were absent or rare in stage-matched cultured organoids. In contrast, retinal progenitor-derived rods and cones remained in the subretinal space, maturing more rapidly than those in the cultured controls. These data suggest that recipient microenvironment promotes the maturation of transplanted photoreceptors while inducing or facilitating the survival of migratory cell populations that are not normally derived from retinal progenitors. These findings have important implications for potential cell-based treatments of retinal diseases., Competing Interests: Conflict of interests M.S.S. is/was a paid advisor to Revision Therapeutics, Johnson & Johnson, Third Rock Ventures, Bayer Healthcare, Novartis Pharmaceuticals, W. L. Gore & Associates, Deerfield, Trinity Partners, Kala Pharmaceuticals, Janssen, and Acucela. M.S.S. has received sponsored research support from Bayer for other research. S.B. receives research support from Genentech, is a co-founder and shareholder in CDI Labs, LLC, and is/was a consultant for Third Rock Ventures and Tenpoint Therapeutics. M.S.S. and R.J.J are co-founders and shareholders in Agnos Therapeutics. These arrangements have been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. M.S.S., S.B., J.Q., R.J.J., Y.V.L., C.P.S., M.V.C.-S., M.F.-B., S.A.-D., and K.V.L. are named as inventors on patents or patent applications assigned to their respective universities., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Cone photoreceptor transplantation is a potential treatment for macular diseases. The optimal conditions for cone transplantation are poorly understood, partly because of the scarcity of cones in donor mice. To facilitate allogeneic cone photoreceptor transplantation studies in mice, we aimed to create and characterize a donor mouse model containing a cone-rich retina with a cone-specific enhanced green fluorescent protein (EGFP) reporter., Methods: We generated OPN1LW-EGFP/NRL -/- mice by crossing NRL -/- and OPN1LW-EGFP mice. We characterized the anatomical phenotype of OPN1LW-EGFP/NRL -/- mice using multimodal confocal scanning laser ophthalmoscopy (cSLO) imaging, immunohistology, and transmission electron microscopy. We evaluated retinal function using electroretinography (ERG), including 465 and 525 nm chromatic stimuli. Retinal sheets and cell suspensions from OPN1LW-EGFP/NRL -/- mice were transplanted subretinally into immunodeficient Rd1 mice., Results: OPN1LW-EGFP/NRL -/- retinas were enriched with OPN1LW-EGFP + and S-opsin + cone photoreceptors in a dorsal-ventral distribution gradient. Cone photoreceptors co-expressing OPNL1W-EGFP and S-opsin significantly increased in OPN1LW-EGFP/NRL -/- compared to OPN1LW-EGFP mice. Temporal dynamics of rosette formation in the OPN1LW-EGFP/NRL -/- were similar as the NRL -/- with peak formation at P15. Rosettes formed preferentially in the ventral retina. The outer retina in P35 OPN1LW-EGFP/NRL -/- was thinner than NRL -/- controls. The OPN1LW-EGFP/NRL -/- ERG response amplitudes to 465 nm stimulation were similar to, but to 535 nm stimulation were lower than, NRL -/- controls. Three months after transplantation, the suspension grafts showed greater macroscopic degradation than sheet grafts. Retinal sheet grafts from OPN1LW-EGFP/NRL -/- mice showed greater S-opsin  +  cone survival than suspension grafts from the same strain., Conclusions: OPN1LW-EGFP/NRL -/- retinae were enriched with S-opsin + photoreceptors. Sustained expression of EGFP facilitated the longitudinal tracking of transplanted donor cells. Transplantation of cone-rich retinal grafts harvested prior to peak rosette formation survived and differentiated into cone photoreceptor subtypes. Photoreceptor sheet transplantation may promote greater macroscopic graft integrity and S-opsin + cone survival than cell suspension transplantation, although the mechanism underlying this observation is unclear at present. This novel cone-rich reporter mouse strain may be useful to study the influence of graft structure on cone survival., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Short-term improvements in retinal anatomy are known to occur in preclinical models of photoreceptor transplantation. However, correlative changes over the long term are poorly understood. We aimed to develop a quantifiable imaging biomarker grading scheme, using noninvasive multimodal confocal scanning laser ophthalmoscopy (cSLO) imaging, to enable serial evaluation of photoreceptor transplantation over the long term., Methods: Photoreceptor cell suspensions or sheets from rhodopsin-green fluorescent protein mice were transplanted subretinally, into either NOD.CB17-Prkdc scid /J or C3H/HeJ-Pde6b rd1 mice. Multimodal cSLO imaging was performed serially for up to three months after transplantation. Imaging biomarkers were scored, and a grade was defined for each eye by integrating the scores. Image grades were correlated with immunohistochemistry (IHC) data., Results: Multimodal imaging enabled the extraction of quantitative imaging biomarkers including graft size, GFP intensity, graft length, on-target graft placement, intra-graft lamination, hemorrhage, retinal atrophy, and periretinal proliferation. Migration of transplanted material was observed. Changes in biomarker scores and grades were detected in 14/16 and 7/16 eyes, respectively. A high correlation was found between image grades and IHC parameters., Conclusions: Serial evaluation of multiple imaging biomarkers, when integrated into a per-eye grading scheme, enabled comprehensive tracking of longitudinal changes in photoreceptor cell grafts over time. The application of systematic multimodal in vivo imaging could be useful in increasing the efficiency of preclinical retinal cell transplantation studies in rodents and other animal models., Translational Relevance: By allowing longitudinal evaluation of the same animal over time, and providing quantifiable biomarkers, non-invasive multimodal imaging improves the efficiency of retinal transplantation studies in animal models. Such assays will facilitate the development of cell therapy for retinal diseases., Competing Interests: Disclosure: Y.V. Liu, None; S.K. Sodhi, None; G. Xue, None; D. Teng, None; D. Agakishiev, None; M.M. McNally, None; S. Harris-Bookman, None; C. McBride, None; G.J. Konar, None; M.S. Singh, None, (Copyright 2020 The Authors.)

Experimental multiple epicutaneous exposure of guinea pigs to furfural and D-11 mineral oil distillate and their combinations in various concentrations has resulted in structural changes of the skin and viscera. These changes were dose-dependent. Combined exposure to both agents resulted in more grave disorders than isolated exposures in the same doses.

A total of 2820 oilmen regularly exposed to industrial oil were examined. Folliculites were detected in 151, furuncles in 63, hydradenitis in 58, phlegmons in 35, panaritium in 30 subjects. The number of invalidity days due to pyogenic dermatoses was 2-3 times higher among the workers exposed to deep oils than among those handling surface oils; this difference is explained by chemical composition and physicochemical characteristics of the extracted oil.

Animal experiments have revealed manifest skin resorptive effect of furfural. Acute experiments have demonstrated manifest toxic action of furfural when applied to intact animal skin. Subacute action of mineral oil induced poorly manifest toxic effect manifesting as nonspecific visceral changes.

Acute rabbit experiments have revealed furfural photodynamic characteristics. Photoprotective cream used to protect the skin from UV exposure could to a certain measure reduce the level of the photodynamic reaction developing in combined exposure to furfural and UV light. These data are recommended to be borne in mind when designing prophylactic measures.

Blood serum IgG1, IgG2, IgA, and IgM were assayed by radial immunodiffusion after exposure of guinea pig skin to oil refinery products, mineral oil distillate D-11 (MOD) and furfurol (F), applied both separately and together. Application of MOD, F, and MOD + F subthreshold concentrations was found to be associated with a tendency to a reduction of IgG1 level; isolated applications of the agents in threshold concentrations involved statistically significant lowering of IgG1 (in exposure to MOD) and imbalanced levels of IgG1, IgG2, IgA, and IgM (in exposure to F). Combined application of both agents induced immunity shifts of other type as against isolated exposure.

This condition was described by Haxthausen in 1934 for the first time; it is one of the diseases explained by hyperkeratosis of the palms and soles. This disease is difficult to diagnose, and patients often complain of such conditions; therefore the authors consider it useful to regularly publish descriptions of clinical cases. Besides involvement of the palms and soles, manifesting by hyperkeratotic layers, painful fissures and itching, the patients with climacteric keratoderma develop metabolic endocrine, neurovegetative, and psychoemotional disorders. When choosing the treatment strategy, the physician should bear in mind specific features of the pathogenesis and clinical picture. Earlier therapy and its efficacy are of importance, as are the presence of allergies or drug intolerance and particulars of the climacteric period course in the first- and second-degree relatives.

Experimental data demonstrate a manifest skin irritating action of D-11 mineral oil distillate and furfural used in oil processing. The minimal effective concentrations of these chemicals have been defined. The irritating effects are enhanced in exposure to their combination. These data are recommended to be used when developing prophylactic measures.

Examinations of 518 refinery workers have revealed photodermatoses in 106. The disease ran a benign course: chronic or subacute one, eventuating in hyperpigmentation and vascular maculae in the workers exposed to oil and oil products. The patients suffering from occupational photodermatoses develop immunologic shifts, i.e. reduced levels of T-cells, T-suppressors, elevated counts of B-cells and of serum immunoglobulins G and M.

Allergenic and photosensitizing effects of organophosphorus pesticides (OPP) have been detected, as well as their destructive effect on the skin cell ultrastructure, on the body metabolism and enzymic systems, and the inhibitory effect on cholinesterase activity. Pesticide-induced changes in polyunsaturated fatty acids (PUFA) are significant in the mechanism of dermatoses development. The complex of treatment-and-prophylaxis measures includes regular dermatologic check-ups and limitation of the number of subjects handling OPP. Subjects in whom premorbid shifts have been detected, should be followed up. The therapy and prevention of the dermatoses developing as a result of exposure to pesticides may be effectively carried out with antioxidants, amino acids, vitamins, etc.; diets with the optimal PUFA-tocopherol ratio are advisable. Overalls with multiple protective physicochemical characteristics, filtering respirators and such are recommended.

Examinations of 518 refinery workers have helped define the dermatologic morbidity structure. Immunologic examinations have been carried out in 82 workers. 70 of these have developed skin abnormalities (toxicoderma, eczema, itching, hyperkeratosis, vascular spots, abnormal pigmentation, etc.). The studies have revealed reduced levels of the cell-mediated immunity parameters: T-lymphocytes, T-theophylline-sensitive lymphocytes, and decreased functional activities thereof); this has been parallelled by activation of the humoral immunity.