Galectin-7 downregulation in lesional keratinocytes contributes to enhanced IL-17A signaling and skin pathology in psoriasis.

Psoriasis is a chronic inflammatory skin disease characterized by inflammatory cell infiltration, as well as hyperproliferation of keratinocytes in skin lesions, and is considered a metabolic syndrome. We found that the expression of galectin-7 is reduced in skin lesions of patients with psoriasis. IL-17A and TNF-α, 2 cytokines intimately involved in the development of psoriatic lesions, suppressed galectin-7 expression in human primary keratinocytes (HEKn cells) and the immortalized human keratinocyte cell line HaCaT. A galectin-7 knockdown in these cells elevated the production of IL-6 and IL-8 and enhanced ERK signaling when the cells were stimulated with IL-17A. Galectin-7 attenuated IL-17A-induced production of inflammatory mediators by keratinocytes via the microRNA-146a/ERK pathway. Moreover, galectin-7-deficient mice showed enhanced epidermal hyperplasia and skin inflammation in response to intradermal IL-23 injection. We identified fluvastatin as an inducer of galectin-7 expression by connectivity map analysis, confirmed this effect in keratinocytes, and demonstrated that fluvastatin attenuated IL-6 and IL-8 production induced by IL-17A. Thus, we validate a role of galectin-7 in the pathogenesis of psoriasis, in both epidermal hyperplasia and keratinocyte-mediated inflammatory responses, and formulate a rationale for the use of statins in the treatment of psoriasis.

An Efficient ECG Classification System Using Resource-Saving Architecture and Random Forest.

This paper presents a resource-saving system to extract a few important features of electrocardiogram (ECG) signals. In addition, real-time classifiers are proposed as well to classify different types of arrhythmias via these features. The proposed feature extraction system is based on two delta-sigma modulators adopting 250 Hz sampling rate and three wave detection algorithms to analyze outputs of the modulators. It extracts essential details of each heartbeat, and the details are encoded into 68 bits data that is only 1.48% of the other comparable methods. To evaluate our classification, we use a novel patient-specific training protocol in conjunction with the MIT-BIH database and the recommendation of the AAMI to train the classifiers. The classifiers are random forests that are designed to recognize two major types of arrhythmias. They are supraventricular ectopic beats (SVEB) and ventricular ectopic beats (VEB). The performance of the arrhythmia classification reaches to the F1 scores of 81.05% for SVEB and 97.07% for VEB, which are also comparable to the state-of-the-art methods. The method provides a reliable and accurate approach to analyze ECG signals. Additionally, it also possesses time-efficient, low-complexity, and low-memory-usage advantages. Benefiting from these advantages, the method can be applied to practical ECG applications, especially wearable healthcare devices and implanted medical devices, for wave detection and arrhythmia classification.

A modified frozen elephant trunk technique for acute Stanford type A aortic dissection.

BACKGROUND: Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. METHODS: From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. RESULTS: Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. CONCLUSIONS: The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

Design, Synthesis, and Biological Evaluation of Itaconic Acid Derivatives as Potential Anti-Influenza Agents.

Influenza A viruses (IAVs) have caused worldwide epidemics and pandemics by reassortment and generation of drug-resistant mutants, which render antivirals and current vaccinations no longer usable. In this study, an itaconic acid derivative 1 was identified from a chemical library of 20 000 compounds, by performing a cell-based screening assay, as a lead agent exhibiting anti-influenza A activity. Accordingly, a series of itaconic acid derivatives were designed and synthesized by adopting a rational design strategy to obtain more potent anti-influenza agents. The results of an in vitro pharmacological study showed that compounds 4 and 8 exhibited the most potent anti-IAV effect with half-maximal effective concentration values of 0.14 and 0.11 µM, respectively, in Madin-Darby canine kidney cells. The mechanism of action studies showed that lead agents 1 and 4 reduced virus replication by directly targeting IAV nucleoproteins and disrupting virus ribonucleoprotein export from the nucleus to the cytosol. On the basis of its high potential as an anti-IAV agent and its selectivity index >785, compound 4 was found to be a promising candidate for further development against IAVs.

Suture knot embolism--a rare complication of percutaneous arterial closure device.

Percutaneous closure devices used after percutaneous endovascular procedures have become more popular over the past decade. Occlusive vascular complication of the device is rare but always leads to limb-threatening consequence. We report a case of arterial occlusion caused by distal embolization of the suture material in the percutaneous closure device.

Primary myxosarcoma of the right inferior pulmonary vein presenting clinically as benign left atrial myxoma with a concurrent right lower lung tumor.

Primary sarcomas of the pulmonary vein are extremely rare. Although myxomas are the most common intracavitary tumor of the left atrium, some findings should alert the clinician to the probability of malignancy. A 28-year-old woman developed hemoptysis, night fever, generalized malaise, anorexia and weight loss for 2 months, with progressive dyspnea for 2 weeks. She was preoperatively diagnosed as left atrial myxoma with a concurrent right lower lung tumor.

Prevalence of symptomatic large pleural effusions first diagnosed more than 30 days after coronary artery bypass graft surgery.

BACKGROUND AND OBJECTIVE: Symptomatic large pleural effusions (>25% of hemithorax) are sometimes diagnosed after coronary artery bypass graft surgery (CABG). Their incidence and outcome have not been fully described. This study aims to discuss the prevalence and the clinical course in patients diagnosed with symptomatic newly developed large pleural effusions at least 30 days after CABG. METHODS: A retrospective study of 410 patients who underwent CABG over a three and a half year period was undertaken. The type of surgery, timing of occurrence of effusion after CABG, amount and characteristics of the pleural effusion, left ventricular dimension and ejection fraction were obtained from medical records and cardiac surgery databases. RESULTS: The records of 356 patients 1 month post CABG were available for evaluation. The initial diagnosis of a newly developed symptomatic large pleural effusions was made in 11 patients (3.1%) at least 30 days after CABG. Eight had a pleural effusion predominantly on the left side and three on the right. Patients were further divided into two groups: those who had effusions diagnosed between 30 and 90 days post CABG (group 1) and those diagnosed more than 90 days post-CABG (group 2). The pleural fluid LDH levels were higher in patients in group 1 (1262.0 +/- 921.3 U/L vs. 117.5 +/- 35.1 U/L, P = 0.02). Patients in group 2 had evidence of cardiac impairment compared with those in group 1, as evidenced by a lower ejection fraction (68.8 +/- 6.0% vs. 52.0 +/- 10.6% in groups 1 and 2, respectively, P = 0.01) and higher left ventricular end-diastolic dimension (45.2 +/- 6.0 mm vs. 55.3 +/- 8.4 mm in groups 1 and 2, respectively, P = 0.05). CONCLUSIONS: The incidence of symptomatic newly developed large pleural effusions first diagnosed at more than 30 days post CABG was 3.1%. Those who were diagnosed between 30 and 90 days post CABG tended to have exudative effusions, whereas those diagnosed more than 90 days post CABG often had left ventricular impairment and transudative effusions. Most of these effusions settled with conservative management and did not recur.

Acute fulminant myocarditis after diphtheria, polio, and tetanus vaccination.

We report an infant case of acute fulminant myocarditis which occurred after administration of a diphtheria, polio, and tetanus vaccination. Fever and dyspnea developed after the vaccination. Extracorporeal membrane oxygenation was used for intractable cardiogenic shock. The patient survived the extracorporeal support, but poor ventricular contractility recurred 2 months later and she died while waiting for heart transplantation.

Starfish-assisted off-pump obliteration of massive coronary arteriovenous fistulae.

Coronary arteriovenous fistula is a rare congenital heart disease. A 71-year-old woman suffered from heart failure due to massive coronary arteriovenous fistulae from the right coronary artery and left circumflex artery to the coronary sinus. Using the off-pump technique, we successfully performed Starfish-assisted obliteration of the fistulae. Intraoperative transesophageal echocardiography was used to confirm the complete elimination of the abnormal shunt flow.

Total descending thoracic and abdominal aorta grafting in type III aortic dissection with aneurysm.

Single-stage complete replacement of the descending thoracic aorta and the abdominal aorta is a surgical challenge. A 65-year-old man developed acute DeBakey type IIIB aortic dissection and was treated medically. The affected aorta dilated progressively, reaching a maximal diameter of 7 cm 2 years later. Computed tomography revealed a Crawford type II thoracoabdominal aortic aneurysm and an additional infrarenal abdominal aortic aneurysm below the dissected aorta. The descending thoracic aorta and the abdominal aorta were completely replaced with a Hemashield graft under deep hypothermic circulatory arrest. The postoperative course was complicated with transient left hemiparesis and upper gastrointestinal bleeding which were successfully treated by transarterial embolization. The results of this case indicate that complete replacement of the descending thoracic and abdominal aorta can adequately and safely treat type III aortic dissection.