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Reham Hammad,1 Hend G Kotb,2 Gehan Abdel-Rahman Eldesoky,3 Alshaimaa Mohamed Mosaad,4 Asmaa M El-Nasser,5 Fatma EL-Zahraa Abd El Hakam,6 Noha Abdel-Rahman Eldesoky,7 Alya Mashaal,8 Hesham Farhoud9 1Clinical Pathology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt; 2Internal Medicine Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt; 3Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt; 4Hepatogastroenterology and Infectious Diseases Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt; 5Medical Microbiology & Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt; 6Pharmacology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt; 7Biochemistry and Molecular Biology Department, Faculty of Pharmacy (for Girls), Al-Azhar University, Cairo, Egypt; 8Immunology, Zoology & Entomology Department, Faculty of Science (for Girls), Al-Azhar University, Cairo, Egypt; 9Orthopedic Surgery Department, Former Dean of Faculty of Medicine (for Girls), Al-Azhar University, Cairo, EgyptCorrespondence: Alya Mashaal, Immunology, Zoology & Entomology Department, Faculty of Science (for Girls), Al-Azhar University, Cairo, Egypt, Email alyamashaal@azhar.edu.egBackground: Dysregulated immunity is a hallmark of SARS-CoV-2 infection. Immune suppression is indicated by low monocyte expression of human leukocyte antigen D-related (mHLA-DR). T cells are important antiviral cells. We aimed to assess the role of mHLA-DR and T lymphocyte frequency in predicting COVID-19 severity.Patients and Methods: This cross-sectional study enrolled 97 SARS-CoV-2 positive patients, including mild to moderate (n = 49) and severe cases admitted to intensive care unit (ICU) (n = 48). These ICU cases were further subdivided into survivors (n = 35) and non-survivors (n = 13).Results: Severe cases had a significant decrease in the mHLA-DR mean fluorescence intensity (MFI) and T lymphocyte percentage compared to mild to moderate cases (P< 0.001). Non-survivors had a lower T lymphocyte percentage (P=0.004) than survivors. The mHLA-DR MFI and T lymphocyte percentage correlated with oxygen saturation (r=0.632, P< 0.001) and (r=0.669, P< 0.001), respectively. According to the ROC curves, mHLA-DR MFI, at a cutoff of 143 and an AUC of 0.9, is a reliable biomarker for distinguishing severe COVID-19 cases, with 89.6% sensitivity and 81.6% specificity, while T lymphocyte frequency had 81.3% sensitivity and 81.6% specificity at a cutoff of 54.4% and an AUC of 0.9. The T lymphocyte percentage as a predictor of ICU survival at a cutoff of 38.995% exhibited 100% sensitivity and 57.1% specificity. According to multivariate regression analysis, reduced mHLA-DR MFI and T lymphocyte percentage are independent predictors of COVID-19 severity (OR = 0.976, 95% CI: 0.955– 0.997, P = 0.025) and (OR = 0.849, 95% CI: 0.741– 0.972, P = 0.018), respectively.Conclusion: Reduced mHLA-DR expression and T-lymphocyte percentage are independent predictors of COVID-19 severity. Oxygen saturation percentage is correlated with mHLA-DR MFI and T lymphocyte frequency. The T lymphocyte frequency is a proposed predictor of COVID-19 survival in ICU admitted patients.Keywords: mHLA-DR, COVID-19 patients’ stratification, COVID-19 monitoring, COVID-19 severity discriminators, T cell lymphopenia

Two of the earliest Middle East respiratory syndrome (MERS) cases were men who had visited the Doha central animal market and adjoining slaughterhouse in Qatar. We show that a high proportion of camels presenting for slaughter in Qatar show evidence for nasal MERS-CoV shedding (62/105). Sequence analysis showed the circulation of at least five different virus strains at these premises, suggesting that this location is a driver of MERS-CoV circulation and a high-risk area for human exposure. No correlation between RNA loads and levels of neutralizing antibodies was observed, suggesting limited immune protection and potential for reinfection despite previous exposure.

MERS-CoV (Middle East respiratory syndrome corona virus) antibodies were detected in camels since 1983, but the first human case was only detected in 2012. This study sought to identify and quantify possible drivers for the MERS-CoV emergence and spillover to humans. A list of potential human, animal and environmental drivers for disease emergence were identified from literature. Trends in possible drivers were analyzed from national and international databases, and through structured interviews with experts in Qatar. The discovery and exploitation of oil and gas led to a 5-fold increase in Qatar GDP coupled with a 7-fold population growth in the past 30 years. The lifestyle gradually transformed from Bedouin life to urban sedentary life, along with a sharp increase in obesity and other comorbidities. Owing to substantial governmental support, camel husbandry and competitions flourished, exacerbating the already rapidly occurring desertification that forced banning of free grazing in 2005. Consequently, camels were housed in compact barns alongside their workers. The transition in husbandry leading to high density camel farming along with increased exposure to humans, combined with the increase of camel movement for the racing and breeding industry, have led to a convergence of factors driving spillover of MERS-CoV from camels to humans.

While the effectiveness of fog computing in Internet of Things (IoT) applications has been widely investigated in various studies, there is still a lack of techniques to efficiently utilize the computing resources in a fog platform to maximize Quality of Service (QoS) and Quality of Experience (QoE). This paper presents a resource management model for service placement of distributed multitasking applications in fog computing through mathematical modeling of such a platform. Our main design goal is to reduce communication between the candidate nodes hosting different task modules of an application by selecting a group of nodes near each other and as close to the source of the data as possible. We propose a method based on a greedy principle that demonstrates a highly scalable and near-optimal performance for resource mapping problems for multitasking applications in fog computing networks. Compared with the commercial Gurobi optimizer, our proposed algorithm provides a mapping solution that obtains 93% of the performance, attributed to a higher communication cost, while outperforming the reference method in terms of the computing speed, cutting the mapping execution time to less than 1% of that of the Gurobi optimizer.

One of the main challenges in studying brain signals is the large size of the data due to the use of many electrodes and the time-consuming sampling. Choosing the right dimensional reduction method can lead to a reduction in the data processing time. Evolutionary algorithms are one of the methods used to reduce the dimensions in the field of EEG brain signals, which have shown better performance than other common methods. In this article, (1) a new Bond Graph algorithm (BGA) is introduced that has demonstrated better performance on eight benchmark functions compared to genetic algorithm and particle swarm optimization. Our algorithm has fast convergence and does not get stuck in local optimums. (2) Reductions of features, electrodes, and the frequency range have been evaluated simultaneously for brain signals (left-handed and right-handed). BGA and other algorithms are used to reduce features. (3) Feature extraction and feature selection (with algorithms) for time domain, frequency domain, wavelet coefficients, and autoregression have been studied as well as electrode reduction and frequency interval reduction. (4) First, the features/properties (algorithms) are reduced, the electrodes are reduced, and the frequency range is reduced, which is followed by the construction of new signals based on the proposed formulas. Then, a Common Spatial Pattern is used to remove noise and feature extraction and is classified by a classifier. (5) A separate study with a deep sampling method has been implemented as feature selection in several layers with functions and different window sizes. This part is also associated with reducing the feature and reducing the frequency range. All items expressed in data set IIa from BCI competition IV (the left hand and right hand) have been evaluated between one and three channels, with better results for similar cases (in close proximity). Our method demonstrated an increased accuracy by 5 to 8% and an increased kappa by 5%.

MERS-CoV (Middle East respiratory syndrome corona virus) antibodies were detected in camels since 1983, but the first human case was only detected in 2012. This study sought to identify and quantify possible drivers for the MERS-CoV emergence and spillover to humans. A list of potential human, animal and environmental drivers for disease emergence were identified from literature. Trends in possible drivers were analyzed from national and international databases, and through structured interviews with experts in Qatar. The discovery and exploitation of oil and gas led to a 5-fold increase in Qatar GDP coupled with a 7-fold population growth in the past 30 years. The lifestyle gradually transformed from Bedouin life to urban sedentary life, along with a sharp increase in obesity and other comorbidities. Owing to substantial governmental support, camel husbandry and competitions flourished, exacerbating the already rapidly occurring desertification that forced banning of free grazing in 2005. Consequently, camels were housed in compact barns alongside their workers. The transition in husbandry leading to high density camel farming along with increased exposure to humans, combined with the increase of camel movement for the racing and breeding industry, have led to a convergence of factors driving spillover of MERS-CoV from camels to humans. [ABSTRACT FROM AUTHOR]

Hypersensitivity eosinophilic myocarditis is a rare histological finding. It has been previously described as an incidental finding, most commonly in the ex-planted hearts of patients who were on inotropic support. A 71-year-old man with ischemic cardiomyopathy ACC/AHA stage D heart failure was briefly on home dobutamine infusion as a bridge to left ventricular assist device (LVAD) placement. Prior to his surgery, the patient presented with worsening cardiogenic shock and recurrent episodes of ventricular tachycardia shortly after initiation of dobutamine. The multidisciplinary team decided to proceed with an emergent LVAD placement despite his presentation. The immediate post-operative course was complicated by vasoplegia and profound shock which eventually led to his death. The LV apical core biopsy obtained at the time of LVAD implant later revealed eosinophilic infiltration without necrosis, which is suggestive of hypersensitivity eosinophilic myocarditis (Image 1) likely due to dobutamine infusion. This case highlights that hypersensitivity eosinophilic myocarditis should be kept in the differentials for patients on dobutamine infusion with unexplained, rapidly progressive cardiogenic shock. [ABSTRACT FROM AUTHOR]

Over the last several years, the number of deaths from drug overdose has increased. Heart transplantation (HT) utilizing donor hearts from patients dying from drug overdose has expanded the donor pool. The current standard method of organ procurement includes the use of an ice cooler (ICE), which adds the risk of tissue freezing injury. The SherpaPak Cardiac Transport System (CTS) is a controlled hypothermic organ preservation technology that maintains donor heart temperatures between 4°C - 8°C, potentially mitigating this risk. The GUARDIAN Heart registry (October 2015-August 2022) includes 761 HT patients from 9 US centers in which donor hearts were procured using either CTS or ICE. Subgroup analysis of HTs using donors who died due to drug overdose, and whose total ischemic time was > 4 hours was performed. The outcomes were compared between HTs performed using CTS vs ICE. Summary statistics were used for comparison. Our cohort included 26 HTs in CTS and 12 in ICE group. The cohorts were well-matched aside from a few areas. Significantly fewer recipients in the CTS cohort had durable VAD at baseline. Additionally, while the ICE cohort had zero gender mismatches, the CTS cohort included 8 (30.8%) mismatches, with 5 (19.2%) female-to-male mismatches. The ICE cohort showed a trend of requiring new post-transplant mechanical circulatory support (MCS) at a rate more than double that of the CTS cohort (50.0% v 23.1%, p=0.10). The primary graft dysfunction (PGD) and survival between the cohorts were similar (details in Table 1). The 30-day survival was similar between the two groups. The use of CTS trends towards a lower need of post-transplant MCS in donors who died of drug overdose and had ischemic times > 4 hours. Utilizing donor hearts from drug overdose individuals and prolonged ischemic time appears to have trended toward favorable outcomes when utilizing CTS over ICE. [ABSTRACT FROM AUTHOR]

Mitigating cold ischemic myocardial injury during organ transport may increase cardiac function and improve patient outcomes post-transplant. SherpaPak (SP) is a storage and transportation device that maintains the donor heart at a constant, hypothermic temperature and may lower the risk of cold ischemic injury when compared to traditional heart transport on ice. We retrospectively analyzed adult patients who underwent isolated heart transplantation at the University of Kansas Medical Center from June 2020 to June 2022. Baseline characteristics were compared between patients that utilized SP and donor heart transport on ice. Outcomes were compared between groups using Wilcoxon tests for continuous, non-normal variables and Fisher's exact tests or chi-square tests, as appropriate, for categorical variables. Multivariable linear regression was used to analyze the association of length of stay with clinical predictors. A total of 85 patients were included in the study, 25 (29.4%) with donor hearts transported using SP and 60 (70.6%) transported on ice. No significant differences were noted in baseline characteristics between the groups. The SP group trended towards having a higher average donor age (32 yrs vs. 28 yrs; p = 0.052), total ischemic time (197 min vs. 177 min; p = 0.193), and total bypass time (136 min vs. 127 min; p = 0.194). Average total vasopressin dose was lower in the SP group (56 units vs. 146 units; p = 0.034). On multivariable regression analysis, SP use was associated with reduced length of stay (11 days vs 19 days; p = 0.006) after controlling for donor age, total ischemic time, total bypass time, total vasopressin dose, cause of cardiomyopathy, UNOS status at time of transplant, and gender matching. No difference in 30 days outcomes of transplant rejection, readmission and mortality was noted between the groups. Despite older donor age and longer total ischemic times, SP usage was associated with shorter length of stay post-transplant as compared to standard cold storage. [ABSTRACT FROM AUTHOR]

We performed a retrospective review comparing outcomes between traditional ice storage (ICE) with short ischemic times (<3 hours) to SherpaPak Cardiac Transport System (SCTS) with long ischemic times (>4 hours) using data from the GUARDIAN registry, a retrospective observational trial. To minimize baseline differences, propensity-matched (PSM) cohorts for site and era were performed. SherpaPak Cardiac Transport System travel distance was almost 10-fold greater than ICE (82 miles ICE vs. 765 miles SCTS). There was no significant difference in primary graft dysfunction (PGD) (20.8% vs. 18.2%, p = 0.58), length of stay (LOS) (24.7 vs. 24.8, p = 0.98), posttransplant mechanical circulatory support (MCS) (25.1% vs. 20.3%, p = 0.34), and 30 day survival (100% vs. 98.6%, p = 0.20). SherpaPak Cardiac Transport System showed statistically significant reduction in 24 hour inotrope scores (17.6 vs. 13.6, p = 0.007) and right ventricular (RV) dysfunction (31.1% vs. 15.7%, p = 0.002). Propensity-matched cohorts showed statistically similar rates of MCS utilization and PGD, but SCTS trended toward less RV dysfunction (26.0% vs. 16.2%, p = 0.11) and lower inotrope scores (16.5 vs. 12.9, p = 0.06) despite almost double the ischemic time. In conclusion, donor heart preservation with SCTS continues to be effective in prolonged ischemic times without sacrificing postheart transplantation clinical outcomes. This may aid in expanding donor organ geography., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)

Background: Data on long term outcomes in heart transplant recipients from Coronavirus disease 2019 (COVID-19) positive donors are limited., Methods and Results: We present a series of nine patients who underwent heart transplants from COVID-19 PCR-positive donors between November 2021 to August 2022 with mean follow-up of 12.12 ± 3 months. All the recipients received two doses of COVID-19 vaccine and had at least 6 months follow-up. Eight recipients had acceptable long-term outcomes; one patient died during index admission from primary graft dysfunction. Details regarding donor and recipient characteristics, management and outcomes are provided. Two patients developed deep vein thrombosis, and one patient underwent pacemaker implantation for sinus node dysfunction. Among the surviving eight patients, none developed COVID-19 infection during follow-up period. There was no significant difference in outcome parameters when compared to patients who received hearts from donors who tested negative for COVID-19 during the same time period at our center., Conclusion: Keeping in mind the significant waitlist mortality in patients awaiting heart transplantation, COVID-19-positive donors should be considered for heart transplantation to help expand the donor pool and potentially reduce waitlist mortality., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Rheumatoid arthritis (RA) is characterized by progressive joint destruction with subsequent serious disability. Objective biomarkers of RA course progression are lacking, which necessitates the discovery of activity indicators and predictors of the disease outcome. Musculoskeletal Ultrasound Seven-joint Score (MSUS7) is proposed as a reliable technique to evaluate radiographic RA progression. Homo sapiens-microRNA-21-5p (hsa-miR-21-5p) plays an important role during joint remodeling and the pro-inflammatory process driving RA progression. We aimed to evaluate plasma hsa-miR-21-5p as a noninvasive RA activity biomarker and to investigate if hsa-miR-21-5p is linked to MSUS7 components in the context of RA activity. This cross-sectional study included 71 RA patients classified into inactive (n = 36) and active (n = 35) groups according to the Disease Activity Score 28-joint count with ESR (DAS28-ESR). Joints were assessed by MSUS7. Gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) were used to rate the synovitis, tenosynovitis, and erosion in the joints. Plasma hsa-miR-21-5p expression was measured by real-time PCR. The absolute count of regulatory T cell (Treg) was calculated after Treg frequency was assessed by flow cytometry. Results: Hsa-miR-21 expression was significantly up-regulated in the active RA group with a median fold change of 51.6 in comparison to the inactive cases with a median fold change of 7.7 (p < 0.001). Hsa-miR-21-5p was positively correlated with DAS28-ESR, C reactive protein (CRP), and rheumatoid factor (r = 0.7, p < 0.001, r = 0. 0.6, p < 0.001, and r = 0.4, p = 0.002, respectively), while negatively correlated with Treg absolute count (r = -0.4, p < 0.001). Hsa-miR-21-5p levels were correlated with synovitis and tenosynovitis in GSUS (r = 0.4, p < 0.001, r = 0.3, p = 0.025, respectively) and in PDUS (r = 0.5, p < 0.001 and 0.4, p = 0.001, respectively). The hsa-miR-21-5p accurately distinguished RA activity [AUC 0.933, 94.3% sensitivity, and 86.1% specificity]. Logistic regression analysis revealed hsa-miR-21-5p as an independent predictor for RA flare (OR = 1.228, p = 0.004). Hsa-miR-21-5p was linked to synovitis and tenosynovitis components of the MSUS7. Up-regulated hsa-miR-21-5p can be utilized as a predictor for RA disease flare., Competing Interests: Declaration of Competing Interest Relevant declarations of interest have been made within the manuscript., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Background: There is a paucity of data regarding epidemiology, temporal trends, and outcomes of patients with cardiogenic shock (CS) and end-stage renal disease (chronic kidney disease stage V on hemodialysis)., Methods: This is a retrospective cohort study using the United States Renal Data System database from January 1, 2006 to December 31, 2019. We analyzed trends of CS, percutaneous mechanical support (intraaortic balloon pump, percutaneous ventricular assist device [Impella and Tandemheart], and extracorporeal membrane oxygenation) utilization, index mortality, 30-day mortality, and 1-year all-cause mortality in end-stage renal disease patients., Results: A total of 43 825 end-stage renal disease patients were hospitalized with CS (median age, 67.8 years [IQR, 59.4-75.8] and 59.1% men). From 2006 to 2019, the incidence of CS increased from 275 to 578 per 100 000 patients ( P trend <0.001). The index mortality rate declined from 54.1% in 2006 to 40.8% in 2019 ( P trend =0.44), and the 1-year all-cause mortality decreased from 63% in 2006 to 61.8% in 2018 ( P trend =0.73), but neither trend was statistically significant. There was a significantly decreased utilization of intra-aortic balloon pumps from 17 832 to 7992 ( P trend <0.001), increased utilization of percutaneous ventricular assist device from 137 to 5201 ( P trend <0.001) and increase in extracorporeal membrane oxygenation use from 69 to 904 per 100 000 patients ( P trend <0.001). After adjusting for covariates, there was no significant difference in index mortality between CS patients requiring percutaneous mechanical support versus those not requiring percutaneous mechanical support (odds ratio, 0.97 [CI, 0.91-1.02]; P =0.22). On multivariable regression analysis, older age, peripheral vascular disease, diabetes, and time on dialysis were independent predictors of higher index mortality., Conclusions: The incidence of CS in end-stage renal disease patients has doubled without significant change in the trend of index mortality despite the use of percutaneous mechanical support., Competing Interests: Disclosures None.

Aim: To investigate the change in a serum level of copeptin, a neuroendocrine biomarker, in differentiating grades of COVID-19 severity on admission time and to find its diagnostic potential. Materials & Methods: 160 COVID-19 patients were classified according to disease severity into 80 mild to moderate and 80 severe patients. Serum copeptin level was assessed by ELISA on their admission time. Besides, serum CRP, ferritin and D-dimer were estimated. Results: Severe COVID-19 patients showed higher serum copeptin level in comparison to mild to moderate cases, with diagnostic potential to distinguish disease severity with 93.33% sensitivity and 100% specificity at cutoff value >18.5 Pmol/l. Conclusion: Serum copeptin was remarkably increased with COVID-19 severity with reasonable differentiation potential for recently admitted patients.

MERS-CoV (Middle East respiratory syndrome corona virus) antibodies were detected in camels since 1983, but the first human case was only detected in 2012. This study sought to identify and quantify possible drivers for the MERS-CoV emergence and spillover to humans. A list of potential human, animal and environmental drivers for disease emergence were identified from literature. Trends in possible drivers were analyzed from national and international databases, and through structured interviews with experts in Qatar. The discovery and exploitation of oil and gas led to a 5-fold increase in Qatar GDP coupled with a 7-fold population growth in the past 30 years. The lifestyle gradually transformed from Bedouin life to urban sedentary life, along with a sharp increase in obesity and other comorbidities. Owing to substantial governmental support, camel husbandry and competitions flourished, exacerbating the already rapidly occurring desertification that forced banning of free grazing in 2005. Consequently, camels were housed in compact barns alongside their workers. The transition in husbandry leading to high density camel farming along with increased exposure to humans, combined with the increase of camel movement for the racing and breeding industry, have led to a convergence of factors driving spillover of MERS-CoV from camels to humans.

This paper focuses on the development of a passive, lightweight skin patch sensor that can measure fluid volume changes in the heart in a non-invasive, point-of-care setting. The wearable sensor is an electromagnetic, self-resonant sensor configured into a specific pattern to formulate its three passive elements (resistance, capacitance, and inductance). In an animal model, a bladder was inserted into the left ventricle (LV) of a bovine heart, and fluid was injected using a syringe to simulate stoke volume (SV). In a human study, to assess the dynamic fluid volume changes of the heart in real time, the sensor frequency response was obtained from a participant in a 30° head-up tilt (HUT), 10° HUT, supine, and 10° head-down tilt positions over time. In the animal model, an 80-mL fluid volume change in the LV resulted in a downward frequency shift of 80.16 kHz. In the human study, there was a patterned frequency shift over time which correlated with ventricular volume changes in the heart during the cardiac cycle. Statistical analysis showed a linear correlation [Formula: see text] and 0.87 between the frequency shifts and fluid volume changes in the LV of the bovine heart and human participant, respectively. In addition, the patch sensor detected heart rate in a continuous manner with a 0.179% relative error compared to electrocardiography. These results provide promising data regarding the ability of the patch sensor to be a potential technology for SV monitoring in a non-invasive, continuous, and non-clinical setting.

Peripheral artery disease (PAD) is a condition caused by atherosclerotic blockages in the arteries supplying the lower limbs and is characterized by ischemia of the leg, progressive myopathy, and increased risk of limb loss. The affected leg muscles undergo significant changes of their biochemistry and metabolism including variations in the levels of many key proteins, lipids, and nucleotides. The mechanisms behind these changes are poorly understood. The objective of this study was to correlate the severity of the PAD disease stage and associated hemodynamic limitation (determined by the ankle brachial index, ABI) in the legs of the patients with alterations in the biochemistry of chronically ischemic leg muscle as determined by ATR-Fourier transform infrared micro-spectroscopy. Muscle (gastrocnemius) biopsies were collected from 13 subjects including four control patients (ABI≥0.9), five claudicating patients (0.4 ≤ ABI<0.9), and four critical limb ischemia (CLI) patients (ABI<0.4). Slide mounted specimens were analyzed by ATR-Fourier transform infrared micro-spectroscopy. An analysis of variance and a partial least squares regression model were used to identify significant differences in spectral peaks and correlate them with the ABI The spectra revealed significant differences ( P  < 0.05) across control, claudicating, and CLI patients in the fingerprint and functional group regions. Infrared microspectroscopic probing of ischemic muscle biopsies demonstrates that PAD produces significant and unique changes to muscle biochemistry in comparison to control specimens. These distinctive biochemical profiles correlate with disease progression and may provide insight and direction for new targets in the diagnosis and therapy of muscle degeneration in PAD., (© 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)

Background. Posttransplant lymphoproliferative disorders (PTLDs) occur after solid organ transplantation. Treatment guidelines include reduction in immunosuppression (RIS), radiation, rituximab, chemotherapy, and immunological agents. We present a rare case of recurrent diffuse large B-cell lymphoma presenting as a PTLD in a heart transplant patient treated with autologous blood stem cell transplant (ASCT) after failure of conventional therapy. Case Presentation. A 66-year-old male presented with a neck mass. He has a history of Hodgkin's disease status after staging laparotomy with splenectomy and heart transplantation due to dilated nonischemic cardiomyopathy 8 years prior to the development of PTLD. His examination was remarkable for right submandibular swelling. An excisional biopsy confirmed the diagnosis of diffuse large B-cell NHL. Patient received RIS, rituximab, chemotherapy, and radiation therapy with a complete remission. His lymphoma relapsed and he subsequently was treated with RICE salvage chemotherapy and consolidative high-dose chemotherapy with BEAC regimen followed by ASCT resulting in a complete remission. Conclusion. Patients with PTLD present a difficult therapeutic challenge. In this case, the patient's prior history of Hodgkin's disease, splenectomy, and a heart transplant appear to be unique features, the significance of which is unclear. ASCT might be a promising therapy for patients with relapsed or refractory PTLD.

Introduction: It has been well documented that for heart transplant recipients (HTR), posttransplantation physical work capacity (PWC) normally does not exceed 60% of the value for healthy age-matched controls. Few, if any, studies have undertaken posttransplantation PWC measurements of well-conditioned individuals (i.e., PWC>300 W)., Case Summary: A 37-yr-old professionally trained male cyclist suffered an acute myocardial infarction (AMI) immediately after a road race and received a heart transplant (HT) 4 months after the AMI. The participant resumed training 1 month after surgery and underwent a maximal exercise test 6 months after surgery. Peak PWC (33.8 mL.kg(-1).min(-1), 250 W) was 92% of the age-predicted maximum, and peak heart rate (165 bpm) was 96% of his known maximum. These results were similar to the participants in a study who had been training regularly for 36+/-24 months before testing, and PWC evaluations occurred 43+/-12 months after HT., Conclusion: Results suggest that 1) lifestyle before HT may positively affect posttransplantation PWC, 2) exercise capacity was not limited by chronotropic incompetence, and 3) a more aggressive approach to HT recovery could be applied to HTR with similar activity histories.

Background: Cardiac transplantation has been successfully performed in patients with a history of presumably cured Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Though the risk of recurrence is a major concern, the long-term influence of prior cancer and cancer therapy on posttransplant outcome has not been previously investigated., Methods: Questionnaires were sent to 130 cardiac transplant centers in the United States registered with the United Network for Organ Sharing. Data collected included patient demographics; type, stage, and timing of HD/NHL; treatment for HD/NHL; posttransplant immunosuppressive regimen, rejection history, and outcomes; and Epstein-Barr virus status., Results: Thirty-four cardiac transplant recipients with a previous history of HD (n=16) or NHL (n=18) were identified. HD patients averaged 41+/-15 years of age, with a mean disease-free interval of 15+/-9 years at the time of transplantation. NHL patients averaged 42+/-17 years of age with a mean disease-free interval of 10+/-9 years at the time of transplantation. The mean follow-up for the entire group was 50 months (range, 2 days to 136 months), and mean follow-up for the survivors was 67 months (range, 23-136 months). The 1-, 3-, 5-, 7-, and 10-year actuarial survival estimates for the entire group are 77%, 64%, 64%, 64%, and 50%, respectively. Actuarial survival was lower in HD patients (P=0.04) and in patients who had previously undergone splenectomy (P=0.008). Cox regression analysis identified only prior splenectomy (P=0.02) as an independent risk factor for mortality after cardiac transplantation with an adjusted relative risk of 6.2 (1.7-21.9, 95% confidence intervals)., Conclusions: Although the numbers are small, these data strongly suggest that there is an increased mortality risk for cardiac transplant recipients with prior HD who have undergone splenectomy.

Infectious complications after heart transplantation remain a major cause of morbidity and mortality. While many viral, bacterial, and protozoal infections can be successfully treated, fungal infections continue to be challenging. Mucormycosis is a rare infection in heart transplant recipients; however, mortality is exceedingly high. We report a case of cavitary Rhizopus lung infection 2 months after cardiac transplantation. The infection was complicated by inadvertent exposure of the pleural cavity to the fungus during surgical resection. Therapy consisted of standard systemic amphotericin B, surgical excision, and for the first time, the use of adjuvant intrapleural amphotericin B. Cure was achieved with no clinical or radiological evidence of disease at 3 months follow-up. Rhizopus pulmonary infection is a rare complication of cardiac transplantation. Treatment consists of the triad of systemic anti-fungal therapy, surgical resection, and control of any underlying predisposing diseases. Adjuvant intrapleural amphotericin B use could also be considered in patients with fungal pneumonias and evidence of chest wall and/or pleural cavity involvement.