Native arbuscular mycorrhizal fungi drive ecophysiology through phenotypic integration and functional plasticity under the Sonoran desert conditions.

Knowledge is scarce to what extent environmental drivers and native symbiotic fungi in soil induce abrupt (short-term), systemic (multiple traits), or specific (a subset of traits) shifts in C3 plants' ecophysiological/mycorrhizal responses. We cultivated an emblematic native C3 species (Capsicum annuum var. glabriusculum, "Chiltepín") to look at how the extreme heat of the Sonoran desert, sunlight regimes (low = 2, intermediate = 15, high = 46 mol m2 d-1) and density of native arbuscular mycorrhizal fungi in soil (low AMF = 1% v/v, high AMF = 100% v/v), drive shifts on mycorrhizal responses through multiple functional traits (106 traits). The warming thresholds were relentlessly harsh even under intensive shade (e.g. superheat maximum thresholds reached ranged between 47-63°C), and several pivotal traits were synergistically driven by AMF (e.g. photosynthetic capacity, biomass gain/allometry, and mycorrhizal colonization traits); whereas concurrently, sunlight regimes promoted most (76%) alterations in functional acclimation traits in the short-term and opposite directions (e.g. survival, phenology, photosynthetic, carbon/nitrogen economy). Multidimensional reduction analysis suggests that the AMF promotes a synergistic impact on plants' phenotypic integration and functional plasticity in response to sunlight regimes; however, complex relationships among traits suggest that phenotypic variation determines the robustness degree of ecophysiological/mycorrhizal phenotypes between/within environments. Photosynthetic canopy surface expansion, Rubisco activity, photosynthetic nitrogen allocation, carbon gain, and differential colonization traits could be central to plants' overall ecophysiological/mycorrhizal fitness strengthening. In conclusion, we found evidence that a strong combined effect among environmental factors in which AMF are key effectors could drive important trade-offs on plants' ecophysiological/mycorrhizal fitness in the short term.

Functional plasticity of Capsicum annuum var. glabriusculum through multiple traits.

The diversity of functional traits still has not been studied enough in model plant species, even less so in little-known species. This experiment was carried out under the extreme heat of Sonoran Desert, using shading nets and under conditions where the availability of water and nutrients was not a stress factor. We evaluated how the low, intermediate and high sunlight regimes impact survival and promote multiple alterations on phenological and ecophysiological response of cultivated Capsicum annuum var. glabriusculum plants. Extremely warm temperatures promoted a high heat sum in degrees days throughout plants development. Most plants grown in high sunlight regimes did not survive; under intermediate sunlight regimes survival was high and plants developed vegetative and reproductively; but under low sunlight regimes plants survival was high; however, they developed just vegetatively. Photosynthetic response to light suggests that plants are physiologically acclimated to low and intermediate irradiance, whereas the CO2 assimilation curves suggest contrasting photosynthetic capacity traits. Under the intermediate sunlight regimes, plants strengthened their performance through multiple functional traits (e.g. CO2 and water diffusion traits, photosynthetic capacity, respiration, among others). Consequently, their biomass gain was faster and proportionally higher by 76 % with an investment of 14 % in fruits development. The principal components analysis extracted the main explanatory functional traits: photosynthetic nitrogen allocation, stomatal limitation, mesophyll conductance, Rubisco maximum carboxylation velocity, among others. In conclusion, phenological response and multiple functional traits determine plants acclimation to sunlight regimes and extremely warm temperatures in short term.

Single Ventricle and Valve-in-Valve, An Impediment or a New Horizon for TAVR?

We present a case of a 30-year-old patient with Fontan physiology and prior bioprosthetic valve replacement who developed severe bioprosthetic aortic valve stenosis. We describe the challenges and planning involved to successfully perform a transcatheter aortic valve-in-valve procedure in this especially complex subset of patients. (Level of Difficulty: Advanced.).

Stress-Induced Cardiomyopathy in Cancer Patients.

Takotsubo syndrome, also known as stress-induced cardiomyopathy (SC), is underrecognized in cancer patients. This study aims to investigate the incidence, natural history, and triggers of SC in cancer patients and its impact on cancer therapy and overall survival. A total of 30 subjects fulfilled the diagnostic criteria for SC at MD Anderson Cancer Center over a 6-year period. Clinical presentation, electrocardiogram, laboratory data, and transthoracic echocardiogram results registered during the acute phase and follow-up were collected. All patients underwent coronary angiography. The most frequent presenting symptoms were chest pain in 63.3% of the patients and shortness of breath/dyspnea on exertion in 27% of the patients. T-wave inversion was a more common electrocardiographic presentation (60%) than ST elevation (13.3%). The median and interquartile range of peak creatine kinase MB fraction, troponin I, and brain natriuretic peptide were creatine kinase MB fraction 8.9, 4.6 to 21.1; troponin I 1.31, 0.7 to 3.3; and brain natriuretic peptide 1,124, 453.5 to 2,369.5. The most common complication of SC was cardiogenic shock requiring inotropic agents (20%). Of the 21 patients who required ongoing cancer treatment, 16 were able to resume chemotherapy, 5 underwent surgery, and 4 received radiation treatment. Median time to resume cancer treatment was 20 days after SC. None of the patients experienced recurrence of SC and other cardiac events. In conclusion, SC should be considered in the differential diagnosis of cancer patients who present with chest pain and ECG findings characteristic of acute coronary syndrome. Most of these patients normalize ejection fraction and may resume cancer therapy early.

Metástasis intraabdominal por melanoma: presentación de un caso / Melamoma intraabdominal metastasis: presentation of a case

El melanoma maligno muestra una inusual predilección en producir metástasis a nivel del intestino delgado. El diagnóstico de metástasis en el intestino delgado por melanoma debe sospecharse en aquellos pacientes, con historia previa de melanoma, que presenten síntomas gastrointestinales o pérdida crónica de sangre. En el siguiente informe se presenta a un paciente masculino de 40 años de edad, con antecedentes de melanoma en la comisura labial, resecado 6 años antes, quien presenta dolor de aparición insidiosa, localizado en hipogastrio de moderada intensidad, aumento progresivo de volumen en hipogastrio, asociado a tenesmo rectal, y pérdida de peso importante de tres meses de evolución. El paciente presenta signos de abdomen agudo quirúrgico por lo que se práctico una laparotomía exploradora evidenciando un extenso tumor abdominopélvico perforado que infiltraba asas delgadas, mesenterio yeyunoileal, con adherencias al colon sigmoides, fuertemente adherido al sacro, a los vasos ilíacos y a la pared posterior de la vejiga. Se realizó una resección, lo más amplia posible, del tumor. El paciente fallece en el posoperatorio mediato por sepsis. El reporte histopatológico reporto melanoma metastásico. El tratamiento quirúrgico es paliativo, y aumenta la sobrevida del paciente si la enfermedad metastásica involucra sólo el intestino delgado; lo que no se observa para aquella enfermedad metastásica simúltanea del intestino delgado y otros organos

Infecciones post-operatorias en pacientes con abdomen agudo H.U.C. profilaxis antibioticoterapia precoz / Post-operative infections in acute-abdominal patients of the H.U.C. antimicrobial prophylaxis precocious

El análisis costo-beneficio de diferentes regimenes de antibióticos en esquema de profilaxis y terapéutica precoz fue estudiado en 88 pacientes intervenidos por abdomen agudo quirúrgico. No se encontró entre la presencia de infección pre-operatoria y la elevación de temperatura o del recuento de leococitos. La infección post-operatoria fue más frecuente en heridas contaminadas tales como: apendicitis, colecistitis y heridas traumáticas con ruptura de vícera hueca. El uso profiláctico de atibióticos disminuyó la frecuencia de infecciones de 16,33%a 40,55%. La estancia hospitalaria fue mayor en un promedio de 11 días en pacientes infectados

Torsión de la trompa debido a la presencia de un quiste para-tubario / Tube torsion due to the presence of a para-tubal cyst

Se presenta un caso de torsión de la trompa de Falopio debida a la presencia de un quiste para-tubario. Se comentan las dificultades del diagnóstico diferencial y se hace hincapié en el valor de la laparoscopia en el diagnóstico precoz de la situación