A case of short QT-interval postventricular arrhythmia arrest from Torsade De Pointes, a new phenotype, or the result of tachycardia-mediated imbalance.

INTRODUCTION: We report the case of an 18-year-old female with recurrent syncope that was discovered to have congenital long QT syndrome (LQTS) and episodes of a transiently short QT interval after spontaneous termination of polymorphic ventricular tachycardia. METHODS & RESULTS: A cardiac event monitor revealed a long QT interval and initiation of polymorphic ventricular tachycardia by a premature ventricular complex on the preceding T-wave. After 1 minute of ventricular fibrillation, her arrhythmia spontaneously terminated with evidence of a short QT interval. CONCLUSIONS: A transient, potentially artificial, short QT interval following Torsades de Pointes can occur in patients with LQTS.

Case Report of Novel, Automatic Shocking Vector Adjustment Algorithm: A Life-Saving Feature of a Modern Defibrillator.

BACKGROUND: Failed delivery of appropriate shocks against fatal dysrhythmias can be the result of low impedance on high-voltage leads. This malfunction might be missed on routine interrogation. We describe the case of a 66-year-old man with a high-voltage lead short circuit who was successfully rescued with the use of an overcurrent detection and automatic shocking vector adjustment algorithm. CASE REPORT: A 66-year-old man with severe nonischemic cardiomyopathy was admitted after receiving 2 shocks from his cardiac resynchronization therapy cardioverter-defibrillator. Interrogation of his defibrillator confirmed 2 consecutive episodes of ventricular fibrillation. For each episode, the initial shock therapy was aborted due to low impedance (<10 ohms) detected on the default shocking configuration: right ventricle to superior vena cava/implantable cardioverter generator. As a result, the device algorithm excluded the superior vena cava coil and immediately delivered a shock of 40 joules between the right ventricular coil and the cardiac resynchronization therapy cardioverter-defibrillator implantable cardioverter generator. This successfully terminated the ventricular fibrillation. All other lead measurements were normal. CONCLUSION: High-voltage lead malfunctions can lead to failed therapy of life-threatening dysrhythmias. Malfunctions like a low impedance of high-voltage leads may not be detected on routine interrogation. Fortunately, the overcurrent detection algorithm recognized the low impedance, and another shocking configuration was selected and successfully terminated the ventricular dysrhythmias. With these algorithms, overcurrent detection and automatic shocking vector adjustment, this patient was rescued. We suggest this feature be considered in all modern defibrillators.

Beyond Ejection Fraction: Novel Clinical Approaches Towards Sudden Cardiac Death Risk Stratification in Patients with Dilated Cardiomyopathy.

Implantable Cardioverter-Defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death due to ventricular tachyarrhythmia. The most commonly used risk stratification algorithms use Left Ventricular Ejection Fraction (LVEF) to determine which patients qualify for ICD therapy, even though LVEF is a better marker of total mortality than ventricular tachyarrhythmias mortality. This review evaluates imaging tools and novel biomarkers proposed for better risk stratifying arrhythmic substrate, thereby identifying optimal ICD therapy candidates.

Biological Management of Banana Fusarium Wilt Caused by Fusarium oxysporum f. sp. cubense Tropical Race 4 Using Antagonistic Fungal Isolate CSR-T-3 (Trichoderma reesei).

Fusarium wilt in bananas is one of the most devastating diseases that poses a serious threat to the banana industry globally. With no effective control measures available to date, biological control has been explored to restrict the spread and manage the outbreak. We studied the effective biological control potential of different Trichoderma spp. in the management of Fusarium oxysporum f. sp. cubense tropical race 4 (Foc TR4). Expression of the defense related genes and metabolites in banana plants inoculated with Foc TR4 and treated with effective Trichoderma sp interactions were also studied. The in vitro growth inhibition of Foc TR4 by Trichoderma reesei isolate CSR-T-3 was 85.19% indicating a higher antagonistic potential than other Trichoderma isolates used in the study. Further, in in vivo assays, the banana plants treated with the isolate CSR-T-3 T. reesei had a significant reduction in the disease severity index (0.75) and also had increased phenological indices with respect to Foc TR4 treated plants. Enhanced activity of defense enzymes, such as ß-1, 3-glucanase, peroxidase, chitinase, polyphenol oxidase, and phenylalanine ammonia lyase with higher phenol contents were found in the Trichoderma isolate CSR-T-3 treated banana plants challenge-inoculated with Foc TR4. Fusarium toxins, such as fusaristatin A, fusarin C, chlamydosporal, and beauveric acid were identified by LC-MS in Foc TR4-infected banana plants while high intensity production of antifungal compounds, such as ß-caryophyllene, catechin-o-gallate, soyasapogenol rhamnosyl glucoronide, peptaibols, fenigycin, iturin C19, anthocyanin, and gallocatechin-o-gallate were detected in T. reesei isolate CSR-T-3 treated plants previously inoculated with Foc TR4. Gene expression analysis indicated the upregulation of TrCBH1/TrCBH2, TrXYL1, TrEGL1, TrTMK1, TrTGA1, and TrVEL1 genes in CSR-T-3 treatment. LC-MS and gene expression analysis could ascertain the upregulation of genes involved in mycoparasitism and the signal transduction pathway leading to secondary metabolite production under CSR-T-3 treatment. The plants in the field study showed a reduced disease severity index (1.14) with high phenological growth and yield indices when treated with T. reesei isolate CSR-T-3 formulation. We report here an effective biocontrol-based management technological transformation from lab to the field for successful control of Fusarium wilt disease caused by Foc TR4 in bananas.

Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: A systematic review.

BACKGROUND: Coronary occlusion (CO) is a rare but serious complication following transcatheter aortic valve replacement (TAVR) with limited published data. We sought to evaluate the immediate and short-term outcomes of CO complicating TAVR. METHODS: Studies, including case reports, case series and original articles published from 2002 to 2016 describing CO following TAVR were identified with a systematic electronic search using the PRISMA Statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. RESULTS: A total of 40 publications describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean age was 83±7years and most (81%) were females. The mean logistic EuroSCORE and STS score was 23.5±14.6% and 9.1±3.2% respectively. TAVR access site was transfemoral in 73% and a balloon expandable valve was used in 78%. Among those with LCA occlusion, the mean LCA ostium height was 10.1±1.8mm while the mean RCA ostium height was 10.4±2.0mm among those with RCA occlusion. CO frequently involved the left main coronary artery (80%) and the most common mechanism was displacement of native valve leaflet (60%), and most cases occurred within 1-hour post-implantation (88%). Percutaneous coronary intervention was attempted in 82 patients and successful in 89%. Procedural death was 10.4%. CO following TAVR in native aortic valve stenosis was associated with a 30-day mortality rate of 35.3%. CONCLUSIONS: CO following TAVR is associated with a high procedural and 30-day mortality rate despite aggressive resuscitative measures including percutaneous coronary intervention.

Opaque16, a high lysine and tryptophan mutant, does not influence the key physico-biochemical characteristics in maize kernel.

The enhancement of lysine and tryptophan in maize is so far basedon opaque2(o2) mutant, that along with the endosperm-modifiersled to development of Quality Protein Maize[QPM]. Though many mutants improving the endospermic protein quality were discovered, they could not be successfully deployed. Recently discovered opaque16 (o16)mutant enhances the lysine and tryptophan content in maize endosperm. In the present study, the influence of o16 on the endosperm modification was analyzed in four F2 populations, two each segregating for o16 allele alone and in combination with o2. The recessive o16o16 seed endosperm was found to be vitreousphenotypically similar to wild-O16O16. The mutant did not influence the degree of kernel opaqueness in o2o2 genetic background as opaqueness in o2o2/O16O16 and o2o2/o16o16 was similar. Grain hardness of o16o16 was comparable with the normal and QPM maize. The pattern of microscopic organization of proteinaceous matrix and starch granules, and zein profiling of the storage protein in o16o16 were found to be similar with normal maize endosperm, but distinct from the o2o2-soft genotype. The pattern in o2o2/o16o16 was unique and different from o2o2 and o16o16 as well. Here we demonstrated the effects of o16 on physico-biochemical characteristics of endosperm and report of o16 possessing negligible influence on kernel modification and hardness, which holds a great significance in maize quality breeding programme.

Bilateral Large Pneumothoraxes Following Implantable Cardioverter-Defibrillator Generator Change: A Case Report of an Uncommon Event Complicating a Common Procedure.

INTRODUCTION: A bilateral large spontaneous pneumothorax to our knowledge has never been reported after a device implantation. We report an unusual case of a patient developing spontaneous bilateral large pneumothoraxes after an implantable cardioverter-defibrillator generator and lead revision without evidence of any obvious traumatic cardiac injury. CASE PRESENTATION: A 79-year-old white man was scheduled for implantable cardioverter-defibrillator generator change and addition of an atrial lead. Approximately one hour after the procedure, he suddenly went into respiratory distress with profuse sweating, and pallor with falling oxygen saturation and blood pressure. Chest x-ray showed bilateral large pneumothoraxes. DISCUSSION: In our literature search, we found no reports of large bilateral pneumothorax in the absence of any traumatic cardiac or lung injury. Rupture of bilateral pleura during subclavian access or presence of pleuropleural communication or a right atrial microperforation could be possible causes.

Left Ventricular Noncompaction Cardiomyopathy and Recurrent Polymorphic Ventricular Tachycardia: A Case Report and Literature Review.

INTRODUCTION: Noncompaction cardiomyopathy is a rare phenotype of cardiomyopathy associated with severe cardiac arrhythmia and thromboembolic complications. CASE PRESENTATION: A 55-year-old woman presented with frank pulmonary edema and received a diagnosis of noncompaction cardiomyopathy. DISCUSSION: Left ventricular noncompaction cardiomyopathy is increasingly being diagnosed because of advances in imaging modalities. It is important to differentiate this new phenotype of cardiomyopathy from others because its diagnosis, management, and prognosis differ. We reviewed the literature and summarized the diagnostic criteria, associated complications, initial and long-term management, and the recommendation for family screening.

Ivabradine: A Review of Labeled and Off-Label Uses.

Ivabradine is a unique medication recently approved in the USA for the treatment of select heart failure patients. It was first approved for use in several countries around the world over a decade ago as an anti-anginal agent, with subsequent approval for use in heart failure patients. Since ivabradine has selective activity blocking the I f currents in the sinus node, it can reduce heart rate without appreciable effects on blood pressure. Given this heart-rate-specific effect, it has been investigated in many off-label indications as an alternative to traditional heart-rate-reducing medications such as beta blockers and calcium channel blockers. We conducted searches of PubMed and Google Scholar for ivabradine, heart failure, HFrEF, HFpEF, angina, coronary artery disease, inappropriate sinus tachycardia, postural orthostatic hypotension, coronary computed tomography angiography and atrial fibrillation. We reviewed and included studies, case reports, and case series published between 1980 and June 2016 if they provided information relevant to the practicing clinician. In many cases, larger clinical trials are needed to solidify the benefit of ivabradine, although studies indicate benefit in most therapeutic areas explored to date. The purpose of this paper is to review the current labeled and off-label uses of ivabradine, with a focus on clinical trial data.

A quick responding quartz crystal microbalance sensor array based on molecular imprinted polyacrylic acids coating for selective identification of aldehydes in body odor.

In present work, a novel quartz crystal microbalance (QCM) sensor array has been developed for prompt identification of primary aldehydes in human body odor. Molecularly imprinted polymers (MIP) are prepared using the polyacrylic acid (PAA) polymer matrix and three organic acids (propenoic acid, hexanoic acid and octanoic acid) as template molecules, and utilized as QCM surface coating layer. The performance of MIP films is characterized by 4-element QCM sensor array (three coated with MIP layers and one with pure PAA for reference) dynamic and static responses to target aldehydes: hexanal, heptanal, and nonanal in single, binary, and tertiary mixtures at distinct concentrations. The target aldehydes were selected subsequent to characterization of body odor samples with solid phase-micro extraction gas chromatography mass spectrometer (SPME-GC-MS). The hexanoic acid and octanoic acid imprinted PAA exhibit fast response, and better sensitivity, selectivity and reproducibility than the propenoic acid, and non-imprinted PAA in array. The response time and recovery time for hexanoic acid imprinted PAA are obtained as 5 s and 12 s respectively to typical concentrations of binary and tertiary mixtures of aldehydes using the static response. Dynamic sensor array response matrix has been processed with principal component analysis (PCA) for visual, and support vector machine (SVM) classifier for quantitative identification of target odors. Aldehyde odors were identified successfully in principal component (PC) space. SVM classifier results maximum recognition rate 79% for three classes of binary odors and 83% including single, binary, and tertiary odor classes in 3-fold cross validation.

Complete heart block and asystole following blunt cardiac trauma.

Cardiac contusion is a well-recognized complication of blunt chest trauma. Various conduction system disorders have been reported in association with this condition, the most common being right bundle branch block. Complete heart block (CHB) is seen rarely. Most cases of CHB are transient. We present the case of an 80-year-old woman who developed CHB and asystole following blunt cardiac trauma. Malignant cardiac arrhythmias such as CHB can be associated with blunt cardiac trauma. In most cases, CHB is transient resolving in days to weeks. In rare cases, however, CHB leads to asystole. Close monitoring and prompt intervention is thus required.