Best of JACC: Case Reports From ACC.23.

This dedicated issue of JACC: Case Reports highlights the top ranked Complex Clinical Cases from the ACC 2023 Scientific Sessions. These cases were reviewed and selected by a committee of peers in the months leading up to the annual meeting. These reviewers were ACC members with no affiliation to the JACC: Case Reports Editorial Board. While the cases were presented at the meeting and included in the formal Abstract Book from ACC, they have not been published elsewhere. These cases illustrate how the ACC can be a place for cardiovascular professionals to come together to learn, grow, and share knowledge in order to transform cardiovascular care and improve heart health for all.

Taxonomy and Molecular Phylogenetics of Ensiculiferaceae, fam. nov. (Peridiniales, Dinophyceae), with Consideration of their Life-history.

In the current circumscription, the Thoracosphaeraceae comprise all dinophytes exhibiting calcified coccoid cells produced during their life-history. Species hitherto assigned to Ensiculifera and Pentapharsodinium are mostly based on the monadoid stage of life-history, while the link to the coccoid stage (occasionally treated taxonomically distinct) is not always resolved. We investigated the different life-history stages and DNA sequence data of Ensiculifera mexicana and other species occurring in samples collected from all over the world. Based on concatenated ribosomal RNA gene sequences Ensiculiferaceae represented a distinct peridinalean branch, which showed a distant relationship to other calcareous dinophytes. Both molecular and morphological data (particularly of the coccoid stage) revealed the presence of three distinct clades within Ensiculiferaceae, which may include other dinophytes exhibiting a parasitic life-history stage. At a higher taxonomic level, Ensiculiferaceae showed relationships to parasites and endosymbionts (i.e., Blastodinium and Zooxanthella) as well as to dinophytes harbouring diatoms instead of chloroplasts. These unexpected phylogenetic relationships are corroborated by the presence of five cingular plates in all such taxa, which differs from the six cingular plates of most other Thoracosphaeraceae. We herein describe Ensiculiferaceae, emend the descriptions of Ensiculifera and Pentapharsodinium, erect Matsuokaea and provide several new combinations at the species level.

Development of Electronic Chemotherapy Roadmaps for Pediatric Oncology Patients.

A chemotherapy roadmap is a summary of the chemotherapy plan for a pediatric oncology patient. Chemotherapy roadmaps exist as paper documents for most, if not all, pediatric oncology programs. Paper chemotherapy roadmaps are associated with risks that can negatively affect the safety of the chemotherapy process. This institution explored the feasibility of converting paper chemotherapy roadmaps into an electronic form. The pediatric information systems team developed an innovative computer application that can generate electronic chemotherapy roadmaps, and the pediatric oncology program established a novel workflow that can operationalize them. Electronic chemotherapy roadmaps have been produced for 36 treatment protocols, and 369 electronic chemotherapy roadmaps have been used for 352 pediatric oncology patients. They have functioned as designed and have not had any unintended effects. In the 5 years after their implementation, the average proportion of patient safety events involving paper or electronic chemotherapy roadmaps decreased by 78.7%. This report is the first to demonstrate the feasibility of creating and implementing electronic chemotherapy roadmaps. Continued expansion of the current library will be necessary to formally test the hypothesis that electronic chemotherapy roadmaps can decrease the risks associated with their paper counterparts and increase the safety of the chemotherapy process.

Effect of nutrient pollution on dinoflagellate cyst assemblages across estuaries of the NW Atlantic.

We analyzed surface sediments from 23 northeast USA estuaries, from Maine to Delaware, and nine estuaries from Prince Edward Island (PEI, Canada), to determine how dinoflagellate cyst assemblages varied with nutrient loading. Overall the abundance of cysts of heterotrophic dinoflagellates correlates with modeled nitrogen loading, but there were also regional signals. On PEI cysts of Gymnodinium microreticulatum characterized estuaries with high nitrogen loading while the sediments of eutrophic Boston Harbor were characterized by high abundances of Spiniferites spp. In Delaware Bay and the Delaware Inland Bays Polysphaeridium zoharyi correlated with higher temperatures and nutrient loading. This is the first study to document the dinoflagellate cyst eutrophication signal at such a large geographic scale in estuaries, thus confirming their value as indicators of water quality change and anthropogenic impact.

Biogeography of dinoflagellate cysts in northwest Atlantic estuaries.

Few biogeographic studies of dinoflagellate cysts include the near-shore estuarine environment. We determine the effect of estuary type, biogeography, and water quality on the spatial distribution of organic-walled dinoflagellate cysts from the Northeast USA (Maine to Delaware) and Canada (Prince Edward Island). A total of 69 surface sediment samples were collected from 27 estuaries, from sites with surface salinities >20. Dinoflagellate cysts were examined microscopically and compared to environmental parameters using multivariate ordination techniques. The spatial distribution of cyst taxa reflects biogeographic provinces established by other marine organisms, with Cape Cod separating the northern Acadian Province from the southern Virginian Province. Species such as Lingulodinium machaerophorum and Polysphaeridinium zoharyi were found almost exclusively in the Virginian Province, while others such as Dubridinium spp. and Islandinium? cezare were more abundant in the Acadian Province. Tidal range, sea surface temperature (SST), and sea surface salinity (SSS) are statistically significant parameters influencing cyst assemblages. Samples from the same type of estuary cluster together in canonical correspondence analysis when the estuaries are within the same biogeographic province. The large geographic extent of this study, encompassing four main estuary types (riverine, lagoon, coastal embayment, and fjord), allowed us to determine that the type of estuary has an important influence on cyst assemblages. Due to greater seasonal variations in SSTs and SSSs in estuaries compared to the open ocean, cyst assemblages show distinct latitudinal trends. The estuarine context is important for understanding present-day species distribution, the factors controlling them, and to better predict how they may change in the future.