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The number of peaks of a random permutation is known to be asymptotically normal. We give a new proof of this and prove a central limit theorem for the distribution of peaks in a fixed conjugacy class of the symmetric group. Our technique is to apply analytic combinatorics to study a complicated but exact generating function for peaks in a given conjugacy class. [ABSTRACT FROM AUTHOR]

Lesion detectability (LD) quantifies how easily a lesion or target can be distinguished from the background. LD is commonly used to assess the performance of new ultrasound imaging methods. The contrast-to-noise ratio (CNR) is the most popular measure of LD; however, recent work has exposed its vulnerability to manipulations of dynamic range. The generalized CNR (gCNR) has been proposed as a robust histogram-based alternative that is invariant to such manipulations. Here, we identify key shortcomings of CNR and strengths of gCNR as LD metrics for modern beamformers. Using the measure theory, we pose LD as a distance between empirical probability measures (i.e., histograms) and prove that: 1) gCNR is equal to the total variation distance between probability measures and 2) gCNR is one minus the error rate of the ideal observer. We then explore several consequences of measure-theoretic LD in simulation studies. We find that histogram distances depend on bin selection that LD must be considered in the context of spatial resolution and that many histogram distances are invariant under measure-preserving isomorphisms of the sample space (e.g., dynamic range transformations). Finally, we provide a mathematical interpretation for why quantitative values such as contrast ratio (CR), CNR, and signal-to-noise ratio should not be compared between images with different dynamic ranges or underlying units and demonstrate how histogram matching can be used to reenable such quantitative comparisons. [ABSTRACT FROM AUTHOR]

The Tsetlin library is a well-studied Markov chain on the symmetric group S n. It has stationary distribution π (σ) the Luce model, a nonuniform distribution on S n , which appears in psychology, horse race betting, and tournament poker. Simple enumerative questions, such as "what is the distribution of the top k cards?" or "what is the distribution of the bottom k cards?" are long open. We settle these questions and draw attention to a host of parallel questions on the extension to the chambers of a hyperplane arrangement. [ABSTRACT FROM AUTHOR]

Given a poset (P,≤), an antichain is a subset of pairwise incomparable elements of P. Let (P,w) be a graded, weighted poset. If the maximum weight of an antichain of P is equal to the weight of the largest rank of P, then P is said to be Sperner. In 1967, Rota conjectured that the poset of partitions, ordered by refinement of blocks, is Sperner; this conjecture was later disproved by Canfield. In this paper, we consider a generalization of Rota's conjecture and show that Sn, partially ordered by refinement of cycles, is strongly Sperner. [ABSTRACT FROM AUTHOR]

A bedside echocardiogram showed normal left ventricle (LV) cavity size, visual LV ejection fraction of 25% with global dysfunction, and a mildly dilated right ventricle (RV) with moderately reduced function. b The pulmonary artery pulsatility index (pulmonary artery systolic pressure - pulmonary artery diastolic pressure/right atrial pressure) of 0.95 and right atrial pressure/pulmonary capillary wedge pressure ratio of 0.76 objectively suggest severe RV dysfunction out of proportion to LV dysfunction. 2 Cooper LT Jr, Hare JM, Tazelaar HD, Edwards WD, Starling RC, Deng MC, Menon S, Mullen GM, Jaski B, Bailey KR, Giant Cell Myocarditis Treatment Trial Investigators Usefulness of immunosuppression for giant cell myocarditis. [Extracted from the article]

Interferon gamma release assay for tuberculosis was positive, but his chest x-ray was negative, consistent with his history of treated tuberculosis. Dear Editor, Sarcoidosis is a chronic, inflammatory disease of unclear etiology, classically characterized by an infiltration of noncaseating granulomas.1 It may affect any tissue or organ, but the most commonly affected are the lungs, the lymphatic system, and the skin. For localized disease, intralesional or topical corticosteroid therapy is the preferred first-line treatment.3 Particularly for thicker or nodular lesions, intralesional therapy may penetrate the skin better and yield better results. [Extracted from the article]

Nonmelanoma melanocytic nests with lichenoid inflammation have been reported to be Melan-A-, SOX-10-, or MITF-positive but PRAME-negative.[4] In our case, the melanocytes were also PRAME-negative. All 3 excision pathology specimens were interpreted by the dermatopathologist as residual LM extending to the excision margins, and the patient was referred to us for MMS. Although immunostains such as Melan-A and SOX-10 can be useful in confirming the diagnosis of melanoma, these stains can be misleading without appropriate clinical correlation. [Extracted from the article]

The distribution of descents in certain conjugacy classes of Sn has been previously studied, and it is shown that its moments have interesting properties. This paper provides a bijective proof of the symmetry of the descents and major indices of matchings (also known as fixed point free involutions) and uses a generating function approach to prove an asymptotic normality theorem for the number of descents in matchings. [ABSTRACT FROM AUTHOR]

Advances in medical and device therapies have demonstrated the capacity of the heart to reverse the failing phenotype. The development of normative changes to ventricular size and function led to the concept of reverse remodelling. Among heart failure therapies, durable mechanical circulatory support is most consistently associated with the largest degree of reverse remodelling. Accordingly, research to analyse human tissue after a period of mechanical circulatory support continues to yield a wealth of information. In this Review, we summarize the latest findings on reverse remodelling and myocardial recovery. Accumulating evidence shows that the molecular changes associated with heart failure, in particular in the transcriptome, metabalome, and extracellular matrix, persist in the reverse-remodelled myocardium despite apparent normalization of macrolevel properties. Therefore, reverse remodelling should be distinguished from true myocardial recovery, in which a failing heart regains both normal function and molecular makeup. These findings have implications for future research to develop therapies to repair fully the failing myocardium. Meanwhile, recognition by society guidelines of this new clinical phenotype, which is coming to be known as a state of heart failure remission, underscores the need to accurately define and identify reverse modelled myocardium for the establishment of appropriate therapies. [ABSTRACT FROM AUTHOR]

Arrhythmogenic cardiomyopathy (AC) is most commonly characterized as a disease of the intercalated disc that promotes abnormal cardiac conduction. Previously, arrhythmogenic cardiomyopathy was frequently referred to as arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D); however, genotype–phenotype studies have defined a broader phenotypic spectrum; with the identification of left-dominant and biventricular subtypes. Molecular insight into AC has primarily focused on mutations in desmosomal proteins and the downstream signaling pathways; however, desmosomal gene mutations can only be identified in approximately 50% of patients with AC. Animal and cellular studies have shown that in addition to abnormal biomechanical properties from changes in desmosome function, crosstalk from the desmosome to the nucleus, gap junctions, and ion channels are implicated in the pathobiology of AC. In this review, we highlight some of the newly identified genetic and epigenetic mechanisms that may lead to the development of AC including the role of the Hippo pathway and microRNAs. This article is part of a Special Issue entitled: Genetic and epigenetic control of heart failure - edited by Jun Ren & Megan Yingmei Zhang. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Mutations in the inner nuclear envelope protein emerin cause Emery-Dreifuss muscular dystrophy (EDMD), which is characterized by progressive skeletal muscle wasting, cardiac conduction defects, and tendon contractures. We previously showed that emerin binds directly to the transcription regulator Lmo7 and attenuates its activity to regulate the proper temporal expression of important myogenic differentiation genes. Methods: The skeletal muscle and cardiac phenotypes were analyzed in a newly generated Lmo7-null mouse using histological analysis, echocardiography, and various neuromuscular tests to determine if Lmo7 was important for skeletal muscle and cardiac function. Results: Lmo7-null mice had growth retardation, decreased fiber size, and impaired skeletal muscle and cardiac function. Lmo7-null mice also had lower levels of phosphorylated retinoblastoma (Rb), extracellular signal-regulated kinase, and c-Jun N-terminal kinase, which is consistent with altered Rb and mitogen-activated protein kinase signaling. Conclusions: These findings demonstrate that loss of Lmo7 in mice causes myopathic phenotypes similar to those seen in other EDMD mouse models. Muscle Nerve 51: 222-228, 2015 [ABSTRACT FROM AUTHOR]

Purpose: To compare the change in keratometry (K), spherical equivalent (SE), and visual acuity after myopic laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Setting: Academic tertiary care center. Design: Retrospective review. Methods: The postoperative K, SE, and uncorrected and corrected distance visual acuities were measured 6 months, 9 months, 1 year, 2 years, 3 years, 4 to 5 years, 6 to 7 years, and 8+ years postoperatively. A difference (Δ) for each variable was calculated from its 6-month postoperative baseline. The rates of change were grouped based on the magnitude of myopic correction (0.00 to 2.99 diopters [D]; 3.00 to 5.99 D; 6.00 to 8.99 D), type of surgery (LASIK versus PRK), and age (<34 years; 34 to 45 years; >45 years). Results: Statistically significant differences were found in the rates of change between low and moderate corrections to high corrections for ΔKavg (P = .0472 and P = .0091, respectively) and ΔSE (both P < .0001). Statistically significant differences were found in the rate of change in ΔKavg between all 3 ages groups (P = .0330, P = .0051, and P <.0001) and in ΔSE between ages less than 34 years and 34 to 45 years to ages over 45 years (P = .0158 and P = .0015, respectively). There was no significant difference in the rate of change in ΔKavg and ΔSE between LASIK and PRK (P = .3599 and P = .9403, respectively). Conclusion: There was keratometric and refractive regression for myopic LASIK, with the rate of regression depending on treatment magnitude and age. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

In order to develop an efficient, reproducible, and well-tolerated protocol for assessing corneal innervation, 11 normal subjects underwent corneal confocal microscopy ( CCM) using a Heidelberg Retinal Tomography III microscope. Five standardized locations were sampled in the left eye and one centrally in the right. The protocol was repeated 1-4 weeks later. A blinded technician measured nerve fiber length ( NFL) and tortuosity coefficient ( TC). The relationship between image location and NFL and TC was assessed using one-way analysis of variance, and reproducibility determined using relative intertrial variability and intraclass correlation coefficients. NFL reproducibility was maximized by averaging four or more images from the left eye, or one central image from both eyes. TC was less reproducible. CCM is a rapid, well-tolerated, and reproducible method for assessing corneal innervation. [ABSTRACT FROM AUTHOR]

Purpose: Among irritable bowel syndrome (IBS) patients, breath methane producers overwhelmingly have constipation predominance (C-IBS). Although the most common methanogen in humans is Methanobrevibacter smithii, incidence and type of methanogenic bacteria in C-IBS patients are unknown. Methods: By use of a questionnaire and lactulose breath testing, subjects with Rome II C-IBS and methane (>3 ppm) were selected ( n = 9). The control group included subjects with IBS who had no breath methane ( n = 10). Presence of bacterial DNA was assessed in a stool sample of each subject by quantitative-PCR using universal 16S rDNA primer. M. smithii was quantified by use of a specific rpoB gene primer. Results: M. smithii was detected in both methane and non-methane subjects. However, counts and relative proportion of M. smithii were significantly higher for methane-positive than for methane-negative subjects (1.8 × 10 ± 3.0 × 10 vs 3.2 × 10 ± 7.6 × 10 copies/g wet stool, P < 0.001; and 7.1 ± 6.3 % vs 0.24 ± 0.47 %, P = 0.02 respectively). The minimum threshold of M. smithii resulting in positive lactulose breath testing for methane was 4.2 × 10 copies/g wet stool or 1.2 % of total stool bacteria. Finally, area-under-curve for breath methane correlated significantly with both absolute quantity and percentage of M. smithii in stool ( R = 0.76; P < 0.001 and R = 0.77; P < 0.001 respectively). Conclusions: M. smithii is the predominant methanogen in C-IBS patients with methane on breath testing. The number and proportion of M. smithii in stool correlate well with amount of breath methane. [ABSTRACT FROM AUTHOR]

Epidermolysis bullosa acquisita (EBA) is a rare and acquired autoimmune subepidermal bullous disease of skin and mucosa. EBA includes various distinct clinical manifestations resembling genetic dystrophic epidermolysis bullosa (DEB), Bullous pemphigus, Brunsting-Perry pemphigoid, or cicatricial pemphigoid. These patients have autoantibodies against type VII collagen (C7), an integral component of anchoring fibrils (AFs), which are responsible for attaching the dermis to the epidermis. Destruction or perturbation of the normal functioning AFs clinically results in skin fragility, blisters, erosions, scars, milia, and nail loss, all features reminiscent of genetic dystrophic epidermolysis bullosa. These anti-C7 antibodies are 'pathogenic' because when injected into a mouse, the mouse develops an EBA-like blistering disease. Currently, treatment is often unsatisfactory; however, some success has been achieved with colchicine, dapsone, photopheresis, plasmapheresis, infliximab, rituximab, and IVIG. [ABSTRACT FROM AUTHOR]

Background: Until recently, combined heart‐liver‐kidney transplantation was considered too complex or too high‐risk an option for patients with end‐stage heart failure who present with advanced liver and kidney failure as well. Aims: The objective of this paper is to present our institution's best practices for successfully executing this highly challenging operation. At our institution, referral patterns are most often initiated through the cardiac team. Results: Determinants of successful outcomes include diligent multidisciplinary patient selection, detailed perioperative planning, and choreographed care transition and coordination among all transplant teams. The surgery proceeds in three distinct phases with three different teams, linked seamlessly in planned handoffs. The selection and perioperative care are executed with determined collaboration of all of the invested care teams. Conclusions: Combined heart‐liver‐kidney transplantation can be successfully done by careful selection, coordination, and execution. [ABSTRACT FROM AUTHOR]

MicroRNAs are increasingly being recognized as regulators of embryonic development; however, relatively few microRNAs have been identified to regulate cardiac development. FOG-2 (also known as zfpm2) is a transcriptional co-factor that we have previously shown is critical for cardiac development. In this report, we demonstrate that FOG-2 expression is controlled at the translational level by microRNA-130a. We identified a conserved region in the FOG-2 39 untranslated region predicted to be a target for miR-130a. To test the functional significance of this site, we generated an expression construct containing the luciferase coding region fused with the 39 untranslated region of FOG-2 or a mutant version lacking this microRNA binding site. When these constructs were transfected into NIH 3T3 fibroblasts (which are known to express miR-130a), we observed a 3.3-fold increase in translational efficiency when the microRNA target site was disrupted. Moreover, knockdown of miR-130a in fibroblasts resulted in a 3.6-fold increase in translational efficiency. We also demonstrate that cardiomyocytes express miR-130a and can attenuate translation of mRNAs with a FOG-2 39 untranslated region. Finally, we generated transgenic mice with cardiomyocyte over-expression of miR-130a. In the hearts of these mice, FOG-2 protein levels were reduced by as much as 80%. Histological analysis of transgenic embryos revealed ventricular wall hypoplasia and ventricular septal defects, similar to that seen in FOG-2 deficient hearts. These results demonstrate the importance of miR-130a for the regulation of FOG-2 protein expression and suggest that miR-130a may also play a role in the regulation of cardiac development. [ABSTRACT FROM AUTHOR]

Gizzard shad (Dorosoma cepedianum) population characteristics vary with lake productivity, competing with and providing prey for sport fishes. Because age-0 gizzard shad (>30 mm total length) are facultative detritivores, they can link benthic energy, carbon, and nutrients to pelagic food webs. To determine how age-0 gizzard shad success varies along a detritus-quality gradient, we completed a 15-day laboratory experiment in which age-0 gizzard shad fed lake sediment and starved gizzard shad both suffered high mortality, whereas fish fed zooplankton grew and survived well. This suggested that detritus alone is insufficient to ensure gizzard shad growth and survival. When sediment quality was high in outdoor mesocosms, density-dependent factors led to rapid growth only at low fish density and high-quality sediments; however, survival generally increased with sediment quality, regardless of gizzard shad density. In four small reservoirs, annual growth of gizzard shad increased with sediment quality. Collectively, our findings suggest that detritus quality ultimately can contribute to regulation of community and ecosystem productivity, mediated by its influence on gizzard shad biomass available for trophic transfer to gape-limited predators (i.e., piscivorous fish). This role of gizzard shad can link higher trophic levels in aquatic food webs to allochthonous detritus subsidies from the surrounding watershed. [ABSTRACT FROM AUTHOR]

Background Both increases and decreases in the incidence of subsequent malignancies in melanoma patients have been reported. We examined the database of the Indiana University Cancer Center to determine whether there is an association between malignant melanoma and noncutaneous malignancies. Objective We searched for evidence of noncutaneous malignancies in a cohort of melanoma patients. Methods Patients with microscopically confirmed malignant melanoma diagnosed between January 1987 and March 2001 were analyzed. This cohort was investigated for noncutaneous malignancies occurring either before or after the diagnosis of melanoma. The standardized incidence ratios (SIR) were calculated as the ratio of the observed to the expected number of patients with second malignancies, and 95% confidence intervals (95% CI) around the SIR were estimated from the cumulative Poisson distribution. Results A total of 955 patients with melanoma (498 males and 457 females) were documented over the 14-year period. Sixty-nine noncutaneous malignancies were identified in 59 (6.2%) melanoma patients (39 males and 20 females). There was a higher risk of non-Hodgkin's lymphoma (SIR = 1.91; 95% CI, 0.88–3.62) in men and renal cell carcinoma (SIR = 2.41, 95% CI, 0.97–4.97) in men. In female patients, however, there was no higher risk of noncutaneous malignancies. Conclusions This study did not show a higher risk of prostate cancer, gastrointestinal cancer, leukemia, endometrial cancer, or cancer of the nerve and neuroendocrine systems in melanoma patients. No female patients incurred a higher risk of noncutaneous cancers. The increased risk of non-Hodgkin's lymphoma and renal cell carcinoma in men might be attributed to a mutual carcinogenic exposure, an aberration of cell-mediated immunity, a shared genetic susceptibility, increased medical surveillance among cancer patients, a post-therapy effect after cancer management, or factors not as yet clear. Close monitoring of melanoma patients for signs of second malignancy is warranted. [ABSTRACT FROM AUTHOR]

A 33-year-old woman with a prior history of small-incision lenticule extraction (SMILE) presented with gradual deterioration of vision in her right eye since the surgery. She had undergone bilateral SMILE for myopic correction ((7.00 diopters [D] in the right eye and (6.00 D in the left eye) 3 weeks prior. SMILE was performed with a Zeiss VisuMax femtosecond laser system, with a cap thickness of 120 µm, a cap diameter of 7.50 mm, and a lenticule diameter of 6.50 mm. At the completion of the surgery, loose epithelium was noted at the SMILE incision bilaterally, and bandage contact lenses were placed in both eyes. On the first postoperative day, the patient’s uncorrected distance visual acuity (UDVA) was 20/40 in both eyes. The bandage lenses were removed from both eyes, with the epithelium intact. At the first-week postoperative visit, her visual acuity was recorded as 20/30 in the right eye and 20/20 in the left eye. She noticed her vision in the right eye was not as sharp as that in her left eye. She denied experiencing any pain, redness, or ocular surface irritations. She was advised to return to the clinic for a 1-month postoperative visit and continue with aggressive lubrication in both eyes. However, a week later, the patient returned for an emergency visit, citing significant central visual distortion in the right eye and difficulty working on the computer. At this visit, her UDVA and corrected distance visual acuity (CDVA) was 20/50 in the right eye and 20/15 in the left eye at both near and far distances. A slitlamp examination revealed mild central changes in the right eye. She once again denied any pain, redness, or irritation. She was advised to continue with artificial tears and return to the office in 1 week for further observation of the central distortion in her right eye. Upon returning to the clinic at the third postoperative week, the patient still complained of central visual changes in the right eye, with a visual acuity of 20/70. Further slitlamp examination revealed a nonspecific central haze in the same eye, but there was no corneal staining or signs of epithelial defects. Anterior segment ocular coherence tomography (AS-OCT) and NIDEK topography were performed, showing the same central distortion in the right eye (Figures 1 and 2). Based on the examination and images provided, what is your working medical diagnosis? What other medical conditions are in your differential diagnosis? What medical and/or surgical interventions would you recommend, if any? [ABSTRACT FROM AUTHOR]

In this paper, we show that the joint distribution of descents and major indices in conjugacy class is asymptotically bivariate normal. This generalizes the authors' previous work on the asymptotical normality of descents in conjugacy classes, where the asymptotic parameters depended only on the density of fixed points. The result is achieved by two key ingredients; one is a variation of the continuity theorem in which the region of pointwise convergence of moment generating functions (m.g.f.s) can be chosen arbitrarily, and the other is a uniform estimate on the m.g.f.s of the descents/major-index pairs in conjugacy classes. As a byproduct, the authors obtain a generating function for the descents and major indices of a given conjugacy class. [ABSTRACT FROM AUTHOR]

Objectives: To present an index case and review the histologic and electron microscopic findings in chloroquine (CQ) and hydroxychloroquine (HCQ) myopathy, focusing primarily on cardiomyopathy. CQ and HCQ are antimalarial drugs with disease-modifying activity in rheumatic diseases (DMARD) and now are among the most widely used DMARDs. Although they are rare, severe adverse effects caused mainly by deposition of intracellular metabolites in both cardiac and skeletal muscle have been described. Currently, both CQ and HCQ have been proposed to have efficacy for patients with coronavirus disease 2019, and several large centers in the United States and other countries have started clinical trials.Methods: A case of HCQ cardiotoxicity diagnosed on an endomyocardial biopsy is presented. A review of the pathology archives was performed to identify additional cases of CQ or HCQ myopathy, and histologic changes were recorded. A brief literature review with an emphasis on pathologic findings in myopathies was performed.Results: Including the index case, 4 cases of CQ or HCQ myopathy were identified. Light microscopic findings included vacuolated myopathy, and electron microscopic findings included myeloid bodies and curvilinear inclusion bodies.Conclusion: CQ and HCQ myopathy can present following long-term administration of the drug. The pathologic findings are nonspecific and overlap with other vacuolated myopathies, necessitating careful correlation of the histologic changes with the patient's medical history. [ABSTRACT FROM AUTHOR]

Vemurafenib is an inhibitor of BRAF and is used to treat patients with metastatic melanoma who carry a V600E BRAF mutation. Recently, four patients have been described in the literature who developed a neutrophilic panniculitis following treatment with a BRAF inhibitor. We present an additional case and review the clinical findings of the cases reported to date. [ABSTRACT FROM AUTHOR]

Aortic insufficiency remains a difficult to treat and highly morbid condition even in the era of HeartMate 3 left ventricular assist devices (LVADs). The prognostic nature of the longitudinal progression of aortic insufficiency, however, remains unknown. We prospectively collected data on patients who received HeartMate 3 LVAD implantation, who had assessments of aortic insufficiency using a novel Doppler echocardiography obtained at outflow graft at three (baseline) and 6 months postimplant. Patients with moderate or greater aortic insufficiency at baseline were excluded. The risk of aortic insufficiency progression on 1‐year death and readmission for heart failure was investigated. In total, 41 patients (median 51 years old and 29 males) were included. All patients had less than moderate aortic insufficiency at baseline. Of them, 22 patients had worsening aortic insufficiency for 3 months following baseline assessments, which was associated with a significantly higher risk of 1‐year death or heart failure readmission rate (41% vs. 11%, P =.023) with a hazard ratio of 3.24 (95% confidence interval 1.02‐18.5, P =.038) adjusted for device speed at baseline and destination therapy indication. In patients with HeartMate 3 LVADs, progressive aortic insufficiency may be associated with a higher risk of 1‐year death or readmission for heart failure. Close monitoring of patients with baseline aortic insufficiency should be considered as a measure to risk‐stratify those for future adverse events. [ABSTRACT FROM AUTHOR]

The distribution of descents in fixed conjugacy classes of S n has been studied, and it is shown that its moments have interesting properties. Fulman proved that the descent numbers of permutations in conjugacy classes with large cycles are asymptotically normal, and Kim proved that the descent numbers of fixed point free involutions are also asymptotically normal. In this paper, we generalize these results to prove a central limit theorem for descent numbers of permutations in any conjugacy class of S n. [ABSTRACT FROM AUTHOR]

Background: Tricuspid regurgitation(TR) following heart transplantation could adversely affect clinical outcomes. In an effort to reduce the incidence of TR, prophylactic donor heart tricuspid valve annuloplasty has been performed during heart transplantation in our institution. We assessed early and long-term outcomes. Methods: Between August 2011 and August 2021, 349 patients who underwent prophylactic tricuspid valve annuloplasty were included. Tricuspid valve annuloplasty was performed using the DeVega annuloplasty technique. The clinical outcomes of the interests included complete atrioventricular block requiring pacemaker implantation, the occurrence of significant TR(defined as moderate or greater), and survival. Long-term survival was compared in patients with and without significant TR using the Kaplan-Meier method. The Cox proportional hazards regression with time-dependent covariate analysis was used to see if significant TR affected the long-term survival. Results: There was one patient(0.3%) who required pacemaker implantation for complete atrioventricular block. No patients developed tricuspid valve stenosis that required intervention. Significant TR developed in 31 patients(8.9%) during the follow-up period. The survival rate of patients who developed significant TR was significantly lower than that of those who did not(log rank < 0.01). Significant TR was associated with the long-term mortality(HR2.92, 95%CI 1.47–5.82, p < 0.01). Conclusions: Prophylactic donor heart tricuspid valve annuloplasty has the potential to reduce the occurrence of significant TR and can be performed safely. The significant TR that developed in patients with prophylactic annuloplasty negatively affected survival and was an independent predictor of long-term mortality. [ABSTRACT FROM AUTHOR]

A 3‐week‐old baby with hydrops fetalis, acute respiratory failure, and shock of unknown etiology developed a diffuse, pustular rash with worsening inflammatory markers and respiratory status despite antimicrobials. Whole exome sequencing revealed a de novo, frameshift mutation in the SAM9DL gene, leading to the diagnosis of SAMD9L‐associated autoinflammatory disease. [ABSTRACT FROM AUTHOR]

Introduction: In failing myocardium, cardiac tissue remodels and can result in changes in composition, structure, and function. Myocardial extracellular matrix (ECM) plays an important role in remodeling process, however, little is known about mechanical properties of cardiac ECM in shear. In this study, we apply established rheological techniques to measure the shear storage modulus (G') and shear loss modulus (G"), which are related to the elastic and viscous behavior of ECM, respectively. Methods: Fresh porcine whole hearts (n=3) were procured at slaughter house. Tissue sections 1-2 mm thickness were harvested in two locations of left ventricle: wall and apex. The tissue was decellularized with modified 3-step approach: Tris-EDTA, SDS, and PBS. The viscoelastic properties of ECM (G' and G") were measured using an oscillating disc rheometer fitted with an 8mm disc and employing a frequency sweep and constant shear strain (1.25%). A user-controlled compressive load is applied normal to the disc-shaped tissue, and the temperature was held constant (37°C). Samples were extracted with fibers perpendicular (cross) and aligned with the disc (parallel). Student t-test and three way ANOVA followed by the Holm-Sidak method were used to estimate statistical significance (p<0.05). Results: Porcine myocardium G' and G" moduli, and bulk modulus increased with increasing bulk compressive strain. Comparing values for the apex region or myocardium wall (Figure 1A) with the same fiber alignment, were statistically indistinguishable (162±69 Pa vs. 97±54 Pa, p=0.269) (Figure 1B). This implies apex properties are proxies of wall properties. Higher G', G" and bulk storage modulus are higher for the parallel vs the cross fiber alignment (Figure 1C). Tissue fiber alignment was a statistically significant factor in G' (p=0.005, Figure 1D). Conclusions: We have established a robust protocol to measure viscoelastic shear properties of ECM ex vivo with samples obtained from the apex and wall locations on the left ventricle. These properties depend on fiber orientation. This is a manifestation of myocardium anisotropy, which can be further exploited to understand of ECM role in myocardial physiology and disease prognosis, and could lead to advances in therapeutic development. [ABSTRACT FROM AUTHOR]

Background: Invasive hemodynamic variables obtained from right heart catheterization have been used for risk‐stratifying patients with advanced heart failure (HF). However, there is a paucity of data on the prognostic value of invasive hemodynamic variables in patients with left ventricular assist devices (LVAD). We hypothesized that cardiac power output (CPO), cardiac power efficiency (CPE), and left ventricular stroke work index (LVSWI) can serve as prognostic markers in patients with LVADs. Methods: Baseline hemodynamic data from patients who had LVAD ramp studies at our institution from 4/2014 to 7/2018 were prospectively collected, from which advanced hemodynamic variables (CPO, CPE, and LVSWI) were retrospectively analyzed. Univariate and multivariable analyses were performed for hemocompatibility‐related adverse events (HRAE), HF admissions, and mortality. Results: Ninety‐one participants (age 61 ± 11 years, 34% women, 40% Black or African American, and 38% ischemic cardiomyopathy) were analyzed. Low CPE was significantly associated with mortality (HR 2.42, 95% CI 1.02–5.74, p = 0.045) in univariate analysis and Kaplan–Meier analysis (p = 0.04). Low LVSWI was significantly associated with mortality (HR 2.13, 95% CI 1.09–4.17, p = 0.03) in univariate analysis and Kaplan–Meier analysis (p = 0.02). CPO was not associated with mortality. CPO, CPE, and LVSWI were not associated with HRAE or HF admissions. Conclusions: Advanced hemodynamic variables can serve as prognostic indicators for patients with LVADs. Low CPE and LVSWI are prognostic for higher mortality, but no variables were associated with HF admissions or HRAEs. [ABSTRACT FROM AUTHOR]

Aims: Left ventricular assist device (LVAD) therapy improves the haemodynamics of advanced heart failure patients. However, it is unknown whether haemodynamic optimization improves haemocompatibility-related adverse events (HRAEs). This study aimed to assess HRAEs in patients with optimized haemodynamics.Methods and Results: Eighty-three outpatients [aged 61 (53-67) years, 50 male] underwent a haemodynamic ramp test at 253 (95-652) days after LVAD implantation, and 51 (61%) had optimized haemodynamics (defined as central venous pressure < 12 mmHg, pulmonary artery wedge pressure < 18 mmHg, cardiac index > 2.2 L/min/m2 ) following LVAD speed adjustment. One-year survival free of any HRAEs (non-surgical bleeding, thromboembolic event, pump thrombosis, or neurological event) was achieved in 75% of the optimized group and in 44% of the non-optimized group (hazard ratio 0.36, 95% confidence interval 0.18-0.73, P = 0.003). The net haemocompatibility score, using four escalating tiers of hierarchal severity to derive a total score for events, was significantly lower in the optimized group than the non-optimized group (1.02 vs. 2.00 points/patient; incidence rate ratio 0.51, 95% confidence interval 0.29-0.90, P = 0.021).Conclusion: Left ventricular assist device patients in whom haemodynamics can be optimized had greater freedom from HRAEs compared to those without optimized haemodynamics. [ABSTRACT FROM AUTHOR]

Furthermore, the eruption may be an abortive variant of supravenous hyperpigmentation described with docetaxel previously.4 Interestingly, despite developing fixed erythrodysesthesia at peripheral intravenous insertion sites, our patient did not have the reaction when a central catheter was used. This report serves to alert clinicians to fixed erythrodysesthesia plaques, a rare cutaneous side effect seen in the peripheral intravenous administration of the chemotherapeutic agent docetaxel that potentially may be avoided by infusion via a central venous catheter. Given the ongoing rashes at intravenous insertion sites, an implantable indwelling central intravenous catheter was placed, and the patient did not experience any skin adverse effects after docetaxel infusion through the implanted catheter. [Extracted from the article]

Objectives: The purpose of this study is to investigate the early and late outcomes of axillary intra-aortic balloon pump (IABP) implantation as a bridge to heart transplantation, comparing the grafted technique with the percutaneous technique. Methods: Between July 2009 and January 2020, 163 patients underwent an axillary IABP insertion as a bridge to heart transplantation. Among them, 97 patients underwent axillary IABP implantation through a graft sutured onto the axillary artery (Group A) and 66 patients underwent percutaneously (Group B). Propensity matching identified 53 matched pairs for analysis (C-statistics 0.741). The primary outcomes of interest included IABP-related complications, success rate of a bridge to transplantation, in-hospital mortality, and late survival. Results: In the propensity-score matched cohort, there were no significant differences in the baseline characteristics between the two groups. The operation time was significantly longer in Group A than in Group B (141.5 ± 38.3 min vs 42.7 ± 19.3 min, p < 0.01). The complication rates including stroke, re-exploration for bleeding, and aortic event were not significantly different between Group A and B. However, Group A required more transfusion and re-exploration for bleeding. The success rate of a bridge to transplantation was similar between Group A (47/53, 88.7%) and Group B (47/53, 88.7%). There were no significant differences in in-hospital mortality and late survival between two groups. Conclusion: In the propensity score matching analysis, there were not any significant differences between the two groups in IABP-related complications, in-hospital mortality, and late survival. The percutaneous technique provided a shorter operation time and less requirement of transfusion and re-exploration for bleeding compared to the grafted technique. The percutaneous technique might be favorable when feasible. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 40-year-old woman with numerous ivory-colored papules in the axilla. Biopsy reveal follicular plugging with focal parakeratosis and slight spongiosis of the follicular infundibulum. The article discusses the Fox-Fordyce disease which affects the aprocrine-rich areas of the skin. It uses immunohistochemistry using antibodies against human milk fat globulin (HMFG) to evaluate the nature of the infiltrate and the observed foamy changes.