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Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare, potentially life-threatening complication of immunotherapy. We report a case of a 60-year-old female with a history of colorectal cancer treated with nivolumab immunotherapy who presented with new cardiomyopathy complicated by cardiogenic shock and ventricular arrhythmias. Treatment of ICI-associated myocarditis requires aggressive immunosuppression and supportive therapy. In this case, the patient required advanced mechanical circulatory support as a bridge to recovery. This case highlights the complexity of diagnosis, haemodynamic management, and treatment of fulminant ICI myocarditis.

The ability of humans to sense chemical signals in ingested substances is implicit in the ability to detect the five basic tastes; sweet, sour, bitter, salty, and umami. Of these, sweet, bitter, and umami tastes are detected by lingual G-protein-coupled receptors (GPCRs). Recently, these receptors were also localized to the gut mucosa. In this review, we will emphasize recent advances in the understanding of the mechanisms and consequences of foregut luminal chemosensing, with special emphasis on cell surface GPCRs such as the sweet and proteinaceous taste receptors (TASRs), short- and long-chain fatty acid (FA) receptors, and bile acid receptors. The majority of these luminal chemosensors are expressed on enteroendocrine cells (EECs), which are specialized endocrine cells in the intestine and pancreas that release gut hormones with ligand activation. These gut hormones are responsible for a wide variety of physiologic and homeostatic mechanisms, including glycemic control, appetite stimulation and suppression, regulation of gastric emptying, and trophic effects on the intestinal epithelium. Released from the EECs, the gut peptides have paracrine, autocrine, and endocrine effects. Additionally, EECs have unique direct connections to the enteric nervous system enabling precise transmission of sensory data to and communication with the central nervous system. We will also describe how gut sensors are implicated in gut hormone release, followed by examples of how altered gut chemosensing has been implicated in pathological conditions such as metabolic diseases including diabetes and obesity, functional dyspepsia, helminthic infections, colitis, gastric bypass surgery, and gastric inflammation and cancer.

The carotenoids have low-lying triplet excited statesand can self-assemblein some solvents to form weakly or strongly coupled aggregates. Thesequalities make carotenoid aggregates useful for studies of singletfission, where an outstanding goal is the correlation of interchromophoriccoupling to the dynamics and yield of triplet excited states froma parent singlet excited state. Three aggregates of zeaxanthin, twoweakly coupled and one strongly coupled, are characterized by steady-statespectroscopic methods including temperature-dependent absorption,fluorescence, and resonance Raman spectroscopy. The absorption spectrafor each type of aggregate are distinct; however, an analysis of bandpositions reveals some important shared characteristics and suggeststhat the strongly coupled H-aggregate contains a subpopulation ofweakly coupled constituents. Temperature-dependent absorption spectroscopyindicates that one of the weakly coupled aggregates can be convertedto the other upon heating. The emission spectra of the three aggregateshave similar profiles that are overall red-shifted by more than 1000cm–1relative to the monomer. The emission quantumyields of the aggregates are 5 to 30 times less than that of the monomer,with the lowest yield for the strongly coupled aggregate. The vibrationalspectra of the chromophores support only slight perturbations fromthe structure of solvated monomers. Our findings support the conclusionthat all three aggregates are best characterized as H-aggregates,in agreement with a prior theoretical study of lutein aggregates. [ABSTRACT FROM AUTHOR]

Introduction: While outcomes and risk factors for pediatric and adult heart transplantation have been well studied, little is known regarding the risk factors of adolescent or young adult patients undergoing heart transplantation. The child-to-adult transition is associated with poorly understood challenges and risk factors that may contribute to increased risk after transplant. Methods: The United Network of Organ Sharing (UNOS) database was used to identify heart transplants performed between 1987 and 2015. The 50267 patients identified were stratified by age: pediatric (<13 years, N=4729), transitional (13-24 years, N=3102), and adult (>24 years, N=42436). Patients receiving re-transplantation were excluded from analysis. Outcomes are reported by age and analyzed using the chi-squared test or ANOVA. Survival analysis with a multivariate Cox proportional hazards regression model using demographic, diagnostic, comorbidity, and biomarker variables was performed and analyzed during the early (<12 months) and constant (>12 months) phase after transplant. Results: Within the follow-up period, transitional patients suffered greater rates of cardiovascular death, re-transplantation, graft failure, and acute rejection than pediatric or adult patients. During the early phase older age was associated with greater risk of death or re-transplantation. However, transitional age was a risk factor during the constant phase relative to pediatric (HR=0.57) or adult (HR=0.67) age. Other early phase risk factors included advanced mechanical support and renal replacement therapy. Race and insurance status were important risk factors during the constant phase. Conclusions: The transitional age is associated with an increased risk of mortality or re-transplantation during the constant phase (>12 months) post-transplant. Further research is needed to assess and address the challenges that face transitional age patients after transplantation. [ABSTRACT FROM AUTHOR]