Spontaneous avulsion of left internal mammary artery graft a complication of coronary artery bypass surgery: case report and review of the literature.

BACKGROUND: Coronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade. CASE PRESENTATION: We hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient's critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection. CONCLUSION: Avulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.

Expression and molecular insights of lima1 in cholangiocarcinoma.

Lim Domain and Actin Binding protein1 (lima1) influence cancer cell function. Thus far, functional role of lima1 in cholangiocarcinoma remains unknown. We used public databases, in vitro experiments, and multi-omics analysis to investigate the Lima1 in cholangiocarcinoma. Our results showed that lima1 expression is significantly upregulated and high levels of lima1 are significantly associated with vascular invasion in cholangiocarcinoma. Furthermore, lima1 knocking out inhibits the RBE cell invasion. Multi-omics data suggest that lima1 affect a broad spectrum of cancer related pathways, promoting tumor progression and metastatic ability in cholangiocarcinoma. This study provides insights into molecular associations of lima1 with tumorigenesist and establishes a preliminary picture of the correlation network in cholangiocarcinoma.

Minimally invasive off-pump bypass grafting-positioning the right posterior descending coronary artery.

Minimally invasive coronary surgery offers benefits to the patient. Besides the anterior wall, the lateral and inferior walls can be reached through a small thoracotomy with off-pump techniques. Thoracoscopic coronary identification can be very useful in these multivessel procedures. Positioning the heart without cardiopulmonary bypass can be challenging. We describe our technique for off-pump positioning and for grafting the right posterior descending coronary artery.

Physiological and genetic responses of the benthic dinoflagellate Prorocentrum lima to polystyrene microplastics.

Microplastics are well known as contaminants in marine environments. With the development of biofilms, most microplastics will eventually sink and deposit in benthic environment. However, little research has been done on benthic toxic dinoflagellates, and the effects of microplastics on benthic dinoflagellates are unknown. Prorocentrum lima is a cosmopolitan toxic benthic dinoflagellate, which can produce a range of polyether metabolites, such as diarrhetic shellfish poisoning (DSP) toxins. In order to explore the impact of microplastics on marine benthic dinoflagellates, in this paper, we studied the effects of polystyrene (PS) on the growth and toxin production of P. lima. The molecular response of P. lima to microplastic stress was analyzed by transcriptomics. We selected 100 nm, 10 µm and 100 µm PS, and set three concentrations of 1 mg L-1, 10 mg L-1 and 100 mg L-1. The results showed that PS exposure had limited effects on cell growth, but increased the OA and extracellular polysaccharide content at high concentrations. After exposure to PS MPs, genes associated with DSP toxins synthesis, carbohydrate synthesis and energy metabolism, such as glycolysis, TCA cycle and pyruvate metabolism, were significantly up-regulated. We speculated that after exposure to microplastics, P. lima may increase the synthesis of DSP toxins and extracellular polysaccharides, improve the level of energy metabolism and gene expression of ABC transporter, thereby protecting algal cells from damage. Our findings provide new insights into the effects of microplastics on toxic benthic dinoflagellates.

Internal Mammary Artery-saphenous Vein Y Anastomosis in Coronary Artery Bypass Grafting - Is there a Possibility of Coronary Steal?

Recent advances in coronary revascularization include total arterial grafting, however, in a few cases, harvesting the right internal thoracic artery (RITA) is not possible due to various reasons. In such cases, where the aorta is also calcified, few surgeons perform Y anastomosis configuration with the left internal thoracic artery(LITA) and saphenous vein which can have disastrous complications. Our patient is a 65-year-old man who was diagnosed with multivessel coronary disease and presented with a coronary steal during coronary artery bypass grafting surgery. The RITA was not harvested due to osteoporosis sternum. LITA-saphenous vein Y anastomosis configuration was done as the aorta was calcified. The anastomosis was done between the LITA to the left anterior descending (LAD) artery and the Y arm saphenous vein was anastomosed to an obtuse marginal (OM)branch. He developed coronary steal following anastomosis of the Y graft to the OM branch. The patient had ischemic changes inside the operation theatre in LAD territory, hence grafts were revised following which the patient became stable. There is a high possibility of a coronary steal when the caliber of the Y arm does not match with the LITA. LITA-saphenous vein Y anastomosis can cause more complications as the saphenous vein is much bigger in caliber compared to the LITA.

Prevalence of left internal mammary artery disease in patients undergoing coronary angiography for suspected coronary artery disease: A meta-analysis and meta-regression study.

Left internal mammary artery (LIMA) to bypass left anterior descending artery has demonstrated to improve survival in multivessel coronary artery disease, but its routine angiography during index coronary angiography is seldom performed as LIMA is rarely diseased. A systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases selecting the studies reporting prevalence of LIMA disease among patients undergoing coronary angiography and considered for CABG. Meta-regression analysis was performed to evaluate the prevalence of LIMA disease and the relative predictive value of canonical risk factors. After scrimmage, 9 studies for a total of 1365 patients were included. LIMA disease prevalence was 1.8 % (95 % CI; 1.2 %-2.8 %) in the entire cohort, whereas we reported a rate of subclavian artery disease of 7.6 % (95 % CI, 6-9.9 %). At univariate meta-regression analysis, only age (p = 0.031) and smoking habit (p = 0.035) were directly correlated with LIMA disease. In conclusion, LIMA angiographic assessment might be considered in selected patients that could undergo CABG, during index coronary angiography. However, prospective studies are needed to better evaluate the safety of routine selective LIMA angiography prior to CABG and whether the practice is associated with improved clinical outcomes among those individuals.

Exploring the Enigma: The Role of the Epithelial Protein Lost in Neoplasm in Normal Physiology and Cancer Pathogenesis.

The cytoskeleton plays a pivotal role in maintaining the epithelial phenotype and is vital to several hallmark processes of cancer. Over the past decades, researchers have identified the epithelial protein lost in neoplasm (EPLIN, also known as LIMA1) as a key regulator of cytoskeletal dynamics, cytoskeletal organization, motility, as well as cell growth and metabolism. Dysregulation of EPLIN is implicated in various aspects of cancer progression, such as tumor growth, invasion, metastasis, and therapeutic resistance. Its altered expression levels or activity can disrupt cytoskeletal dynamics, leading to aberrant cell motility and invasiveness characteristic of malignant cells. Moreover, the involvement of EPLIN in cell growth and metabolism underscores its significance in orchestrating key processes essential for cancer cell survival and proliferation. This review provides a comprehensive exploration of the intricate roles of EPLIN across diverse cellular processes in both normal physiology and cancer pathogenesis. Additionally, this review discusses the possibility of EPLIN as a potential target for anticancer therapy in future studies.

Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease - A propensity matched analysis.

OBJECTIVE: This study compared perioperative outcomes after off-pump revascularization through a thoracoscopic-assisted (non-robotic) minimally invasive approach (Endo-CAB) or sternotomy approach (OPCAB) for patients with single vessel left anterior descending (LAD) disease. METHODS: In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. 'Textbook outcome' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome. RESULTS: Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001). CONCLUSIONS: Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.

Lipotoxic hepatocyte derived LIMA1 enriched small extracellular vesicles promote hepatic stellate cells activation via inhibiting mitophagy.

BACKGROUND: Hepatic stellate cells (HSCs) play a crucial role in the development of fibrosis in non-alcoholic fatty liver disease (NAFLD). Small extracellular vesicles (sEV) act as mediators for intercellular information transfer, delivering various fibrotic factors that impact the function of HSCs in liver fibrosis. In this study, we investigated the role of lipotoxic hepatocyte derived sEV (LTH-sEV) in HSCs activation and its intrinsic mechanisms. METHODS: High-fat diet (HFD) mice model was constructed to confirm the expression of LIMA1. The relationship between LIMA1-enriched LTH-sEV and LX2 activation was evaluated by measurement of fibrotic markers and related genes. Levels of mitophagy were detected using mt-keima lentivirus. The interaction between LIMA1 and PINK1 was discovered through database prediction and molecular docking. Finally, sEV was injected to investigate whether LIMA1 can accelerate HFD induced liver fibrosis in mice. RESULTS: LIMA1 expression was upregulated in lipotoxic hepatocytes and was found to be positively associated with the expression of the HSCs activation marker α-SMA. Lipotoxicity induced by OPA led to an increase in both the level of LIMA1 protein in LTH-sEV and the release of LTH-sEV. When HSCs were treated with LTH-sEV, LIMA1 was observed to hinder LX2 mitophagy while facilitating LX2 activation. Further investigation revealed that LIMA1 derived from LTH-sEV may inhibit PINK1-Parkin-mediated mitophagy, consequently promoting HSCs activation. Knocking down LIMA1 significantly attenuates the inhibitory effects of LTH-sEV on mitophagy and the promotion of HSCs activation. CONCLUSIONS: Lipotoxic hepatocyte-derived LIMA1-enriched sEVs play a crucial role in promoting HSCs activation in NAFLD-related liver fibrosis by negatively regulating PINK1 mediated mitophagy. These findings provide new insights into the pathological mechanisms involved in the development of fibrosis in NAFLD.

Development of a Rapid Detection Method to Prorocentrum lima by Loop-Mediated Isothermal Amplification with Hydroxy Naphthol Blue.

Prorocentrum lima, a widely distributed dinoflagellate known for its production of harmful biotoxins, poses a significant threat to humans, aquaculture, and marine ecosystems. As a result, the detection of this toxic alga in coastal waters has become an urgent research focus. In this study, a rapid, sensitive, and cost-effective detection method based on loop-mediated isothermal amplification (LAMP) was developed to identify P. lima. In this method, cell extracts of P. lima were diluted and used directly as templates for amplification, eliminating the need for nucleic acid purification and simplifying the detection process. Hydroxy naphthol blue (HNB) was incorporated into the reaction mix to facilitate result interpretation, enabling visual determination of the amplification outcome with the naked eye. The entire detection process, from DNA extraction to template amplification and product detection, could be completed within 80 min using a simple constant temperature-control device. This LAMP-based detection method demonstrated excellent reliability, specificity, and a low detection limit of 5.87 cells/mL for DNA crude extract. The assay offered an efficient alternative to PCR for rapid detection of P. lima. By streamlining the detection process and offering a visual readout, this technique holds promise for efficient and routine monitoring of harmful algal species, benefitting both research efforts and environmental management strategies.

Temporal variation of the PM2.5/PM10 ratio and its association with meteorological factors in a South American megacity: Metropolitan Area of Lima-Callao, Peru.

The Metropolitan Area of Lima-Callao (MALC) is a South American megacity that has suffered a serious deterioration in air quality due to high levels of particulate matter (PM2.5 and PM10). Studies on the behavior of the PM2.5/PM10 ratio and its temporal variability in relation to meteorological parameters are still very limited. The objective of this study was to analyze the temporal trends of the PM2.5/PM10 ratio, its temporal variability, and its association with meteorological variables over a period of 5 years (2015-2019). For this, the Theil-Sen estimator, bivariate polar plots, and correlation analysis were used. The regions of highest mean concentrations of PM2.5 and PM10 were identified at eastern Lima (ATE station-41.2 µg/m3) and southern Lima (VMT station-126.7 µg/m3), respectively. The lowest concentrations were recorded in downtown Lima (CDM station-16.8 µg/m3 and 34.0 µg/m3, respectively). The highest average PM2.5/PM10 ratio was found at the CDM station (0.55) and the lowest at the VMT station (0.27), indicating a predominance of emissions from the vehicular fleet within central Lima and a greater emission of coarse particles by resuspension in southern Lima. The temporal progression of the ratio of PM2.5/PM10 showed positive and highly significant trends in northern and central Lima with values of 0.03 and 0.1 units of PM2.5/PM10 per year, respectively. In the southern region of Lima, the trend was also significant, showcasing a value of 0.02 units of PM2.5/PM10 per year. At the hourly and monthly level, the PM2.5/PM10 ratio presented a negative and significant correlation with wind speed and air temperature, and a positive and significant correlation with relative humidity. These findings offer insights into identifying the sources of PM pollution and are useful for implementing regulations to reduce air emissions considering both anthropogenic sources and meteorological dispersion patterns.

Exposure to microplastics renders immunity of the thick-shell mussel more vulnerable to diarrhetic shellfish toxin-producing harmful algae.

Despite both microplastics (MPs) and harmful algae blooms (HABs) may pose a severe threat to the immunity of marine bivalves, the toxification mechanism underlying is far from being fully understood. In addition, owing to the prevalence and sudden occurrence characteristics of MPs and HABs, respectively, bivalves with MP-exposure experience may face acute challenge of harmful algae under realistic scenarios. However, little is known about the impacts and underlying mechanisms of MP-exposure experience on the susceptibility of immunity to HABs in bivalve mollusks. Taking polystyrene MPs and diarrhetic shellfish toxin-producing Prorocentrum lima as representatives, the impacts of MP-exposure on immunity vulnerability to HABs were investigated in the thick-shell mussel, Mytilus coruscus. Our results revealed evident immunotoxicity of MPs and P. lima to the mussel, as evidenced by significantly impaired total count, phagocytic activity, and cell viability of haemocytes, which may result from the induction of oxidative stress, aggravation of haemocyte apoptosis, and shortage in cellular energy supply. Moreover, marked disruptions of immunity, antioxidant system, apoptosis regulation, and metabolism upon MPs and P. lima exposure were illustrated by gene expression and comparative metabolomic analyses. Furthermore, the mussels that experienced MP-exposure were shown to be more vulnerable to P. lima, indicated by greater degree of deleterious effects on abovementioned parameters detected. In general, our findings emphasize the threat of MPs and HABs to bivalve species, which deserves close attention and more investigation.

Do the humeral radiographic changes at 5-year follow-up affect the clinical outcomes of press-fit humeral stems in primary reverse shoulder arthroplasties?

INTRODUCTION: The purposes of this study were to analyze and compare the functional outcomes and radiological changes around the press-fit humeral components in two contemporary medialized reverse total shoulder arthroplasty (RTSA) systems at a minimum of 5-year follow-up. MATERIALS AND METHODS: Between December 2003 and December 2015, 249 consecutive RTSAs were performed at our hospital. Of these, 68 primary uncemented RTSA met our inclusion criteria. The Constant-Murley score (CMS), the modified Constant score, a visual analog scale (VAS) and active shoulder range of motion (ROM) were measured pre- and postoperatively. Radiological assessment was performed by plain radiographs at a minimum of 5 years postoperatively. RESULTS: At a mean follow-up of 80.2 months, there was no significant difference (p = .59) between the postoperative functional scores and range of motion of the two groups (Delta Xtend and Lima SMR). Radiological data of stress-shielding were observed in 38 patients (55.9%) being slightly more frequent in the Lima SMR group (21 patients) than in the Delta Xtend group (17 patients) (p = .62). CONCLUSIONS: Our study shows that the good functional results are similar between the two uncemented RTSA systems used and that they do not depend on the presence of radiological changes (stress-shielding) in the humeral stem at a minimum 5-year follow-up.

Molecular Phylogeny, Morphology, Growth and Toxicity of Three Benthic Dinoflagellates Ostreopsis sp. 9, Prorocentrum lima and Coolia monotis Developing in Strait of Gibraltar, Southwestern Mediterranean.

Few works have been carried out on benthic harmful algal blooms (BHAB) species in the southern Mediterranean and no data are available for the highly dynamic Strait of Gibraltar (western Mediterranean waters). For the first time, Ostreopsis sp. 9, Prorocentrum lima and Coolia monotis were isolated in this key region in terms of exchanges between the Atlantic Ocean and the Mediterranean and subject to intense maritime traffic. Ribotyping confirmed the morphological identification of these three dinoflagellates species. Monoclonal cultures were established and the maximum growth rate and cell yield were measured at a temperature of 24 °C and an irradiance of 90 µmol photons m-2 s-1, for each species: 0.26 ± 0.02 d-1 (8.75 × 103 cell mL-1 after 28 days) for Ostreopsis sp. 9, 0.21 ± 0.01 d-1 (49 × 103 cell mL-1 after 145 days) for P. lima and 0.21 ± 0.01 d-1 (10.02 × 103 cell mL-1 after 28 days) for C. monotis. Only P. lima was toxic with concentrations of okadaic acid and dinophysistoxin-1 measured in optimal growth conditions ranging from 6.4 pg cell-1 to 26.97 pg cell-1 and from 5.19 to 25.27 pg cell-1, respectively. The toxin content of this species varied in function of the growth phase. Temperature influenced the growth and toxin content of P. lima. Results suggest that future warming of Mediterranean coastal waters may lead to higher growth rates and to increases in cellular toxin levels in P. lima. Nitrate and ammonia affected the toxin content of P. lima but no clear trend was noted. In further studies, we have to isolate other BHAB species and strains from Strait of Gibraltar waters to obtain more insight into their diversity and toxicity.

Mortalidad por suicidio y sus características de comportamiento en la ciudad de Lima durante los años 2017-2022 / Suicide mortality and its behavioral characteristics in the city of Lima during the years 2017-2022

RESUMEN Describir la mortalidad por suicidio y sus principales características en Lima, Perú, durante el período 2017-2022. Materiales y métodos: Estudio descriptivo observacional que reporta características sociodemográficas y métodos de suicidio durante el período 2017-2022. Se estimaron también las tasas estandarizadas de mortalidad por año y por edad en Lima y sus distritos para cada año del período 2017-2021. Se registró un total de 559 muertes por suicidio durante el período 2017-2022 en Lima Metropolitana, con una razón hombre/mujer de 2,6 y edad mediana de 37. El 68,78% correspondía a personas solteras, el 44,54 % tenía educación secundaria, el 60,82 % de los suicidios ocurrieron en el hogar, y el ahorcamiento fue el método más frecuente (70,98 %). La mortalidad por suicidio alcanzó una proporción de 5,52 por cada 100 000 habitantes para Lima Metropolitana durante el período 2017-2021. Este indicador aumentó hasta un máximo en 2019 y ha disminuido desde entonces. Los distritos con mayor mortalidad fueron Pucusana, Barranco y San Bartolo. Conclusiones: La mortalidad por suicidio en Lima Metropolitana ha mostrado una tendencia decreciente desde el año 2019. Por otro lado, es imperativo mantener una vigilancia exhaustiva a largo plazo e implementar estrategias de prevención y atención en salud mental, particularmente en los distritos y grupos demográficos más afectados.

ABSTRACT To describe suicide mortality and its main characteristics in Lima, Peru during the period 2017-2022. Methods: A descriptive observational study that reports the main sociodemographic characteristics and methods of suicide, during the period 2017-2022 in Metropolitan Lima and its districts. Age-standardized mortality rates were also estimated annually and throughout the period 2017-2021. There were 559 deaths by suicide during 2017-2022 in Lima, with a male/female ratio of 2.6, and a median age of 37; 68,78% were single, 44,54% had secondary education, 60,82% occurred at home, and hanging was the main method (70,98%). Suicide-related mortality was 5.52 per 100 000 habitants for Lima during the period 2017-2021. It increased to a peak in 2019 and then decreased. The districts with the highest mortality were Pucusana, Barranco and San Bartolo. Suicide mortality has shown a decreasing trend since 2019 in Lima; it is imperative to maintain comprehensive long-term surveillance, and to implement prevention and mental health care strategies, particularly in the most affected districts and demographic groups.

Cough-induced sudden acute chest pain and massive left hemothorax soon after pacemaker implantation.

A 74-year-old man who recently undergone a definitive pacemaker implantation with an apical septal active lead fixation presented to the emergency department because of a new-onset acute chest pain that began soon after cough episodes. Pacemaker interrogation reported an increased bipolar pacing threshold (3.25 V at 1 ms). Contrast-enhanced chest CT scan and percutaneous angiography revealed the sequential perforation of the right ventricular apex and the left internal mammary artery by the ventricular pacemaker lead. Successful percutaneous embolization of the LIMA, blood transfusion and thoracentesis were then performed, and the patient subsequently underwent a percutaneous ventricular lead extraction followed by re-implantation, with an uneventful follow-up after 2 years. This unique case report highlights a potential rare complication of the active fixation of the ventricular lead at the apical interventricular septum and should lead the clinicians to keep in mind right ventricular perforation, even without cardiac tamponade, in patients presenting for cardio-pulmonary symptoms soon after pacemaker implantation.

Lima bean (Phaseolus lunatus Linn.) protein isolate as a promising plant protein mixed with xanthan gum for stabilizing oil-in-water emulsions.

BACKGROUND: Lima bean protein isolate (LPI) is an underutilized plant protein. Similar to other plant proteins, it may display poor emulsification properties. In order to improve its emulsifying properties, one effective approach is using protein and polysaccharide mixtures. This work investigated the structural and emulsifying properties of LPI as well as the development of an LPI/xanthan gum (XG)-stabilized oil-in-water emulsion. RESULTS: The highest protein solubility (84.14%) of LPI was observed and the molecular weights (Mw ) of most LPI subunits were less than 35 kDa. The enhanced emulsifying activity index (15.97 m2 g-1 ) of LPI might be associated with its relatively high protein solubility and more low-Mw subunits (Mw < 35 kDa). The effects of oil volume fraction (ϕ) on droplet size, microstructure, rheological behavior and stability of emulsions were investigated. As ϕ increased from 0.2 to 0.8, the emulsion was arranged from spherical and dispersed oil droplets to polyhedral packing of oil droplets adjacent to each other, while the LPI/XG mixtures changed from particles (in the uncrowded interfacial layer) to lamellae (in the crowded interfacial layer). When ϕ was 0.6, the emulsion was in a transitional state with the coexistence of particles and lamellar structures on the oil droplet surface. The LPI/XG-stabilized emulsions with ϕ values of 0.6-0.8 showed the highest stability during a 14-day storage period. CONCLUSION: This study developed a promising plant-based protein resource, LPI, and demonstrates potential application of LPI/XG as an emulsifying stabilizer in foods. © 2023 Society of Chemical Industry.

Robot-Assisted Minimally Invasive Multivessel Coronary Bypass Guided by Computerized Tomography.

OBJECTIVE: Robot-assisted minimally invasive coronary bypass surgery is one of the least invasive approaches that offers multivessel revascularization and accelerated recovery. We investigated the benefits of computed tomography angiography (CTA) guidance in robotic coronary bypass (RCAB) by analyzing perioperative outcomes. METHODS: Between April 2022 and April 2023, 60 consecutive patients who underwent RCAB under preoperative CTA guidance were included. The intercostal space of the minithoractomy incision was determined based on the distance from the thoracotomy site to the midsection of the left anterior descending artery (LAD) on preoperative CTA. Peripheral vascular findings on preoperative CTA guided the decision for the cannulation site. Perioperative parameters and early outcomes were evaluated. RESULTS: The mean age of the patients was 62.3 ± 10.5 years, and 51 patients were male (85.0%). The mean number of revascularized vessels was 2.9 ± 1.1. Left thoracotomy guided by CTA measurements was performed in the fourth intercostal space in 37 patients (61.7%) and in the third intercostal space in the remaining patients. Axillary cannulation was performed in 28 (46.7%) patients because of prohibitive findings in the iliac vessels and aorta. All target coronary arteries with an indication for bypass were revascularized with CTA-guided RCAB. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 17 patients (28.3%). No operative mortality or cerebrovascular event was observed. One patient underwent reoperation due to bleeding. CONCLUSIONS: Robot-assisted minimally invasive multiple-vessel coronary bypass under preoperative CTA guidance is safe and can be performed with excellent results.

Assessing the Seasonal and Spatial Dynamics of Zooplankton through DNA Metabarcoding in a Temperate Estuary.

Zooplankton are key components of estuarine trophic networks. However, routine monitoring is hindered by the difficulty of morphology-based identification. DNA-based methods allow us to circumvent some of these hurdles, providing precise species identifications regardless of the taxonomic expertise of the investigator or the developmental stage of the specimens. However, the process is dependent on the completeness of the reference libraries. In this study, we sought to evaluate the potential of DNA metabarcoding to assess the seasonal (summer, autumn, and early spring) and spatial dynamics of zooplankton (four locations spanning ca. 6 km) in the Lima estuary (NW Portugal). Two genetic markers were used: the cytochrome c oxidase subunit I and the V4 hypervariable region of the ribosomal 18S rRNA genes. Overall, 327 species were recovered, and both markers displayed minute overlap (7% were detected with both markers). Species richness, composition, and taxonomic distinctness were majorly influenced by the season, with a declining tendency from summer (highest number of exclusive species, n = 74) to spring. Second to season, the taxa composition was influenced by spatial variation where the most downstream site displayed the highest number of exclusive species, n = 53. A total of 16 non-indigenous species were detected using metabarcoding, but only one (Austrominus modestus) has been documented out in the estuary. In conclusion, both the seasonal and spatial gradients influenced the recovered richness, composition, and taxonomic distinctness, confirming the great aptitude of DNA metabarcoding for providing higher density monitoring and shedding new light on the composition and dynamics of complex zooplankton communities.

Transcriptomic Analysis of the Response of the Toxic Dinoflagellate Prorocentrum lima to Phosphorous Limitation.

Some dinoflagellates cause harmful algal blooms, releasing toxic secondary metabolites, to the detriment of marine ecosystems and human health. Phosphorus (P) is a limiting macronutrient for dinoflagellate growth in the ocean. Previous studies have been focused on the physiological response of dinoflagellates to ambient P changes. However, the whole-genome's molecular mechanisms are poorly understood. In this study, RNA-Seq was utilized to compare the global gene expression patterns of a marine diarrheic shellfish poisoning (DSP) toxin-producing dinoflagellate, Prorocentrum lima, grown in inorganic P-replete and P-deficient conditions. A total of 148 unigenes were significantly up-regulated, and 30 unigenes were down-regulated under 1/4 P-limited conditions, while 2708 unigenes were significantly up-regulated, and 284 unigenes were down-regulated under 1/16 P-limited conditions. KEGG enrichment analysis of the differentially expressed genes shows that genes related to ribosomal proteins, glycolysis, fatty acid biosynthesis, phagosome formation, and ubiquitin-mediated proteolysis are found to be up-regulated, while most of the genes related to photosynthesis are down-regulated. Further analysis shows that genes encoding P transporters, organic P utilization, and endocytosis are significantly up-regulated in the P-limited cells, indicating a strong ability of P. lima to utilize dissolved inorganic P as well as intracellular organic P. These transcriptomic data are further corroborated by biochemical and physiological analyses, which reveals that under P deficiency, cellular contents of starch, lipid, and toxin increase, while photosynthetic efficiency declines. Our results indicate that has P. lima evolved diverse strategies to acclimatize to low P environments. The accumulation of carbon sources and DSP toxins could provide protection for P. lima to cope with adverse environmental conditions.