Multiple thrombi mimicking metastases in the right atrium of patients with non-Hodgkin's lymphoma diagnosed by multimodal cardiac imaging: one case report.

BACKGROUND: Right-side heart mass can be found incidentally on routine transthoracic echocardiography (TTE). Accurate diagnosis of cardiac mass often requires more than one imaging method. We present a mid-age woman with non-Hodgkin lymphoma who was found to have multiple right atrial masses mimicking metastases on routine TTE, which were finally diagnosed as thrombi by multimodal cardiac imaging. CASE PRESENTATION: A 52-year-old woman was diagnosed with primary mediastinal diffuse large B cell lymphoma (DLBCL) almost six months prior. The TTE revealed multiple masses in the right atrium with normal cardiac function when she was being evaluated for the next chemotherapy. On arrival, she was hemodynamically stable and asymptomatic. Physical examination was no remarkable. Laboratory findings showed leukocytosis of 17,900 cells/mm3, hemoglobin of 7.5 mg/dL, and a normal D-dimer level. The suspicious diagnosis of right atrial metastasis was made by TEE. However, the diagnosis of right atrial thrombi was made by contrast CMR. Finally, the 18 F-FDG PET-CT demonstrated no metabolic activity in the right atrium, which further supported the diagnosis of thrombi. Eventually, the masses were removed by cardiopulmonary bypass thoracotomy because of a high risk of pulmonary embolism. Histopathology confirmed the diagnosis of thrombi. CONCLUSIONS: This case highlights the importance of multimodality cardiac imaging in the appropriate diagnosis of a RA masses in patient of lymphoma. Diagnosis of RA masses can be made using multimodal cardiac imaging like TTE, TEE and CMR, even PET. Echocardiography is the most commonly used on multimodal imaging in cardiac thrombus. CMR has high specificity in differentiating a tumor from thrombus, while 18 F-FDG PET has good sensitivity to determine the nature of the masses.

Promotion of High-Speed Copper-Filling Performance for Interconnections with Increasing Aspect-Ratio Using Compound Additives.

Interconnections are essential for integrating the packaging substrate, and defect-free copper-filling can further improve the reliability in through holes (THs). The coating properties and filling processes are mainly dominated by the interplays among additives in the direct current electroplating. The acidic copper sulfate electroplating solution contained three typical convection-dependent additives and chloride ions (Cl-). The THs with aspect ratios (ARs) of 6.25, 5, and 4.17 (thickness of 500 µm) were selected as the study subjects. The effects of Cl- and ARs on the interactions among the additives were investigated in detail using electrochemical measurements, which were verified by the THs filling experiments. The additive compounds present a convection enhanced inhibition effect and cathodic polarization, leading to a copper filling capacity increase with ARs and the amelioration of copper compactness and corrosion resistance. The defect-free copper filling of THs and a uniform mirror bright surface circuit can be achieved simultaneously using compound additives at a relatively high speed.

Effects of Bonding Materials on Optical-Thermal Performances and High-Temperature Reliability of High-Power LED.

The die-bonding layer between chips and substrate determinates the heat conduction efficiency of high-power LED. Sn-based solder, AuSn20 eutectic, and nano-Ag paste were widely applied to LED interconnection. In this paper, the optical-thermal performances and high-temperature reliability of LED with these bonding materials have systematically compared and studied. The thermal conductivity, electrical resistivity, and mechanical property of these bonding materials were characterized. The LED module packaged with nano-Ag has a minimum working temperature of 21.5 °C. The total thermal resistance of LED packaged with nano-Ag, Au80Sn20, and SAC305 is 4.82, 7.84, and 8.75 K/W, respectively, which is 4.72, 6.14, and 7.84 K/W higher after aging for 500 h. Meanwhile, the junction temperature change of these LEDs increases from 2.33, 3.76, and 4.25 °C to 4.34, 4.81, and 6.41 °C after aging, respectively. The thermal resistance of the nano-Ag, Au80Sn20 and SAC305 layer after aging is 1.5%, 65.7%, and 151.5% higher than before aging, respectively. After aging, the LED bonded with nano-Ag has the better optical performances in spectral intensity and light output power, which indicates its excellent heat dissipation can improve the light efficiency. These results demonstrate the nano-Ag bonding material could enhance the optical-thermal performances and high-temperature reliability of high-power LED.

Multiple primary pulmonary meningioma: A case report and literature review.

Lung cancer has become a leading cause of cancer-related deaths. With the conventional use of low-dose spiral computed tomography (CT) in physical examinations, an increasing number of small pulmonary nodules are screened. However, primary pulmonary meningiomas (PPMs) are rarely reported. Here, we report the case of a 64-year-old woman who had a CT scan during physical examination, which revealed three ground-glass-like opacity pulmonary nodules in both lungs. The patient underwent video-assisted thoracoscopic wedge resection of the right upper and lower lobes. Paraffin sections revealed pulmonary meningothelial-like and collagenous nodules in the right upper and lower lobes which stained as follows: EMA+, VIM+, SMA-, S-100-, CD34-, STAT6-, Ki-67+ (2%), and CgA-. Primary pulmonary meningiomas (PPMs) were finally diagnosed. PPM is a kind of rare and benign tumor. Surgery can provide a precise pathological examination, and patients can achieve an excellent prognosis after surgical resection.

Pulmonary valve perforation with multiple cardiac anomalies: a case report.

BACKGROUND: Large pulmonary valve perforation, which is rarely seen with infective endocarditis, general atrophy, or congenital fenestration, often leads to potentially fatal outcomes, including heart failure. CASE PRESENTATION: Transthoracic and transesophageal echocardiographic evaluation of a 69-year-old woman revealed a severely eccentric pulmonary regurgitation with concomitant pulmonary valve stenosis, patent ductus arteriosus, patent foramen ovale, and pulmonary artery aneurysm. In the operation, a large perforation was found in the pulmonary valve leaflet. She underwent complicated surgery that involved closure of the congenital heart defects and replacement of a pulmonary valve with successful results. But the cause of her pulmonary valve perforation remained undetermined. CONCLUSION: This case highlights two important points: the need for timely management of congenital heart disease and being aware of the possibility of pulmonary valve perforation, which in this case was indicated by an eccentric pulmonary regurgitant jet seen on echocardiography.

The lipid components of high-density lipoproteins (HDL) are essential for the binding and transportation of antimicrobial peptides in human serum.

Antimicrobial peptides (AMPs) have been developed for the treatment of bacterial infections, but their applications are limited to topical infections since they are sequestered and inhibited in serum. Here we have discovered that the inhibition of AMPs by human serum was mediated through high-density lipoproteins (HDL) which are known to remove cholesterol from peripheral tissues. The susceptibility of AMPs to HDL varied depending on the degree of hydrophobicity of AMPs and their binding affinities to HDL. The phospholipids, such as phosphatidylcholine, of HDL were essential for AMP-binding. The dynamic binding interactions between AMPs and HDL were mediated through the hydrophobic interactions rather than by ionic strength. Interestingly, some AMPs, such as SMAP29, dissociated from the AMP-HDL complex and translocated to bacteria upon contact, while some AMPs, such as LL37, remained in complex with HDL. These results suggest that HDL binds AMPs and facilitates the translocation of them to the bacteria.

Sarcopenia and sarcopenic obesity after cholecystectomy: A population-based study.

OBJECTIVE: The present study aimed to investigate the associations of cholecystectomy with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity. METHODS: This population-based study included data from 4,909 participants aged 18 to 80 years. History of cholecystectomy was diagnosed using abdominal ultrasonography. Muscle mass was evaluated using a dual-energy x-ray absorptiometry scan, and muscle strength was evaluated using an electronic hand dynamometer. Sarcopenia was defined as the presence of both low muscle mass and low muscle strength. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Multivariable logistic regression models were performed to investigate the associations of cholecystectomy with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity. RESULTS: Participants with history of cholecystectomy were more likely than those without to have low muscle mass, low muscle strength, and sarcopenia. Furthermore, compared with cholecystectomy that occurred within 7 years (7 years is the median interval between cholecystectomy and the physical examination), participants with cholecystectomy that occurred more than 7 years ago had higher odds of sarcopenia. Finally, whether obesity was defined by BMI or body fat percentage, cholecystectomy was positively associated with sarcopenic obesity. CONCLUSIONS: Cholecystectomy is associated with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity.

Cilengitide Inhibits Neovascularization in a Rabbit Abdominal Aortic Plaque Model by Impairing the VEGF Signaling.

BACKGROUND: Cilengitide is a selective α v ß 3 and α v ß 5 integrin inhibitor. We sought to investigate the effect of cilengitide on the neovascularization of abdominal aortic plaques in rabbits and explore its underlying antiangiogenic mechanism on human umbilical vein endothelial cells (HUVECs). MATERIALS AND METHODS: For the in vivo experiment, the abdominal aortic plaque model of rabbits was established and injected with different doses of cilengitide or saline for 14 consecutive days. Conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) were applied to measure the vascular structure and blood flow parameters. CD31 immunofluorescence staining was performed for examining neovascularization. Relative expressions of vascular endothelial growth factor (VEGF) and integrin of the plaque were determined. For in vitro experiments, HUVECs were tested for proliferation, migration, apoptosis, and tube formation in the presence of different doses of cilengitide. Relative expressions of VEGF, integrin, and Ras/ERK/AKT signaling pathways were determined for the exploration of underlying mechanism. RESULTS: CEUS showed modestly increased size and eccentricity index (EI) of plaques in the control group. Different degrees of reduced size and EI of plaques were observed in two cilengitide treatment groups. The expressions of VEGF and integrin in the plaque were inhibited after 14 days of cilengitide treatment. The neovascularization and apoptosis of the abdominal aorta were also significantly alleviated by cilengitide treatment. For in vitro experiments, cilengitide treatment was found to inhibit the proliferation, migration, and tube formation of HUVECs. However, cilengitide did not induce the apoptosis of HUVECs. A higher dose of cilengitide inhibited the mRNA expression of VEGF-A, ß 3, and ß 5, but not α V. Lastly, cilengitide treatment significantly inhibited the Ras/ERK/AKT pathway in the HUVECs. Conclusions. This study showed that cilengitide effectively inhibited the growth of plaque size by inhibiting the angiogenesis of the abdominal aortic plaques and blocking the VEGF-mediated angiogenic effect on HUVECs.

Aortic Chordae Tendineae Strands with Significant Aortic Regurgitation.

The aortic chordae tendineae strands are suggested to be embryonic remnants of the cusp formation process. We herein describe a 70-year-old male who was admitted to our hospital for shortness of breath and chest tightness. During echocardiographic examination, severe aortic regurgitation with a ruptured fibrous strand was detected. Moreover, another fibrous strand was found by three-dimensional transesophageal echocardiography (TEE). To our knowledge, this is the first literature review of aortic chordae tendineae strands, including diagnosis, management, and mechanisms of aortic regurgitation due to such informal strands.

Caseous calcification of the mitral annulus mimicking benign cardiac tumour of the mitral valve.

Caseous calcification of the mitral annulus (CCMA) is a rare subtype of mitral annular calcification. It usually appears as a large, round, mass-like calcification with an echolucent core, which may be misdiagnosed as an intracardiac mass, cyst, thrombus or abscess of the mitral valve. We present a case report of CCMA that was misdiagnosed by echocardiography as a benign tumour due to its atypical imaging. The mitral valve mass was resected and it was pathologically confirmed to be a myxoid change with calcification. Echocardiography is the preferred initial diagnostic tool. Myocardial contrast echocardiography (MCE) is used to evaluate the vascularity of intracardiac masses or mass-like lesions, but neither echocardiography nor MCE is reliable for identifying atypical lesions. Cardiac computed tomography is helpful in establishing a diagnosis by showing dense calcifications, while cardiac magnetic resonance imaging is used primarily as a credible tool. We therefore recommend that a diagnosis should be made based on various imaging modalities, if necessary, and operators should be skilled to avoid misdiagnosis.

Peri-operative echocardiography for lung transplantation in a critical patient with COVID-19.

Critical patients with coronavirus disease 2019 (COVID-19) suffer from severe illness and have a high mortality rate. Lung transplantation may be the final option for a subset of these patients. Herein we report the important role of peri-operative echocardiography in a COVID-19 patient who underwent bilateral lung transplantation because of severe respiratory failure. The precise evaluation provided by echocardiography enabled the prevention of anastomotic complications and the successful management of haemodynamic instability. Echocardiographers should be familiar with the complications of lung transplantation and the haemodynamics under extracorporeal membrane oxygenation support to achieve a more accurate interpretation of cardiac parameters.

Targeting Phosphotyrosine in Native Proteins with Conditional, Bispecific Antibody Traps.

Engineering sequence-specific antibodies (Abs) against phosphotyrosine (pY) motifs embedded in folded polypeptides remains highly challenging because of the stringent requirement for simultaneous recognition of the pY motif and the surrounding folded protein epitope. Here, we present a method named phosphotyrosine Targeting by Recombinant Ab Pair, or pY-TRAP, for in vitro engineering of binders for native pY proteins. Specifically, we create the pY protein by unnatural amino acid misincorporation, mutagenize a universal pY-binding Ab to create a first binder B1 for the pY motif on the pY protein, and then select against the B1-pY protein complex for a second binder B2 that recognizes the composite epitope of B1 and the pY-containing protein complex. We applied pY-TRAP to create highly specific binders to folded Ub-pY59, a rarely studied Ub phosphoform exclusively observed in cancerous tissues, and ZAP70-pY248, a kinase phosphoform regulated in feedback signaling pathways in T cells. The pY-TRAPs do not have detectable binding to wild-type proteins or to other pY peptides or proteins tested. This pY-TRAP approach serves as a generalizable method for engineering sequence-specific Ab binders to native pY proteins.

Tricuspid valve vegetation related to leaflet injury: a unique problem of catheter malposition.

The use of peripherally inserted central catheters (PICCs) has expanded substantially for drug delivery in clinical practice in recent years. However, PICC lines expose patients to potential complications associated with an increasing incidence of infective endocarditis. We herein report a case of a 57-year-old woman who was diagnosed with tricuspid valve endocarditis by echocardiography. The most probable cause was direct injury to the tricuspid valve by the tip of a PICC line with excessive length in the right heart. The vegetation disappeared with conservative treatment after removal of the PICC line. Clinicians must maintain vigilance against any suspected PICC-related infection in febrile patients with a PICC line. For echocardiographers, precise evaluation of the position of the PICC tip and the detection of endocarditis is important to devise the optimal clinical strategy.

Overexpression of FNTB and the activation of Ras induce hypertrophy and promote apoptosis and autophagic cell death in cardiomyocytes.

Farnesyltransferase (FTase) is an important enzyme that catalyses the modification of protein isoprene downstream of the mevalonate pathway. Previous studies have shown that the tissue of the heart in the suprarenal abdominal aortic coarctation (AAC) group showed overexpression of FTaseß (FNTB) and the activation of the downstream protein Ras was enhanced. FTase inhibitor (FTI) can alleviate myocardial fibrosis and partly improve cardiac remodelling in spontaneously hypertensive rats. However, the exact role and mechanism of FTase in myocardial hypertrophy and remodelling are not fully understood. Here, we used recombinant adenovirus to transfect neonatal rat ventricular cardiomyocytes to study the effect of FNTB overexpression on myocardial remodelling and explore potential mechanisms. The results showed that overexpression of FNTB induces neonatal rat ventricular myocyte hypertrophy and reduces the survival rate of cardiomyocytes. FNTB overexpression induced a decrease in mitochondrial membrane potential and increased apoptosis in cardiomyocytes. FNTB overexpression also promotes autophagosome formation and the accumulation of autophagy substrate protein, LC3II. Transmission electron microscopy (TEM) and mCherry-GFP tandem fluorescent-tagged LC3 (tfLC3) showed that FNTB overexpression can activate autophagy flux by enhancing autophagosome conversion to autophagolysosome. Overactivated autophagy flux can be blocked by bafilomycin A1. In addition, salirasib (a Ras farnesylcysteine mimetic) can alleviate the hypertrophic phenotype of cardiomyocytes and inhibit the up-regulation of apoptosis and autophagy flux induced by FNTB overexpression. These results suggest that FTase may have a potential role in future treatment strategies to limit the adverse consequences of cardiac hypertrophy, cardiac dysfunction and heart failure.

Diagnosis of a primary pericardial mesothelioma by the combination of conventional echocardiography and contrast echocardiography.

Primary malignancies arising from the pericardium are rare, even more unusual for primary pericardial mesothelioma. The diagnosis is difficult and has no standard treatment. We herein present a case of a 65-year-old woman with primary pericardial mesothelioma associated with dyspnoea and palpitations. Transthoracic conventional echocardiography revealed mild pericardial effusion and a hypo-echogenic mass in the pericardium. Contrast echocardiography showed that the mass was hyper-enhanced with a radial enhancement pattern. The patient underwent open chest exploration and was diagnosed by pathological examination. She had no further treatment and died 2 years later. In conclusion, the combination of conventional echocardiography and contrast echocardiography plays a significant role in diagnosing primary pericardial mesothelioma. Comprehensive evaluation and accurately preoperative diagnosis are important to exclude certain tumours that do not require surgery.

Giant Right Coronary Artery Aneurysm Resembling Cardiac Tumor: A Case Report.

BACKGROUND: Coronary artery aneurysms are not uncommon vascular anomalies, but giant coronary artery aneurysms mimicking cardiac tumors are extremely rare and easily misdiagnosed as tumors. The management and prognosis are not well defined. CASE REPORT: We describe a case of a 50-year-old woman, who had a transthoracic echocardiogram that suggested a cardiac tumor in the right ventricle adjacent to the tricuspid valve and without ventricular wall akinesia. Her medical history was unremarkable, and she had no obvious symptoms. A transesophageal echocardiogram and computed tomography angiogram examination suggested the tumor-like structure was a giant coronary aneurysm, originating from the distal portion of right coronary artery. The patient underwent surgical intervention and recovered uneventfully. Histopathology of the excised aneurysm showed fibrous tissue hyperplasia with collagenization and calcification in the wall of the artery. CONCLUSION: Giant coronary artery aneurysms resembling heart tumors are extremely rare. Differentiating them from cardiac tumors can sometimes be difficult. This rare case emphasizes the importance of combining multiple imaging methods, which helps make accurate diagnosis. For treatment, surgical intervention may be the appropriate therapeutic strategy for the rare lesion.

Giant left ventricular pseudoaneurysm: a rare acute complication of radiofrequency catheter ablation for premature ventricular contraction.

BACKGROUND: Radiofrequency catheter ablation is approved effective therapy for premature ventricular contraction. However, the rare but serious complication such as pseudoaneurysm should be given more attention. It is life-threatening due to the high risk of rupture. Only few cases have been reported in the literature. We herein report a huge acute left ventricular pseudoaneurysm after catheter ablation therapy. CASE PRESENTATION: A 69-year-old man underwent radiofrequency catheter ablation for premature ventricular contraction at a local hospital. The patient developed shock the second day after ablation. A chest computed tomography (CT) scan showed pericardial effusion. Pericardiocentesis was performed, and the puncture fluid was a bloody pericardial effusion. The transthoracic echocardiogram revealed an 9- × 4-cm giant pseudoaneurysm with a cystic structure in the left ventricular inferior wall near the mitral annulus along the left atrium. The pseudoaneurysm was connected to the left ventricular cavity through a 8-mm neck, and the lumen was filled with systolic and diastolic blood flow. The patient underwent three-dimensional transesophageal echocardiography. The pseudoaneurysm and the tract was clearly visible. Emergency surgery was performed to resect the pseudoaneurysm. A bovine pericardial patch was placed on the neck of the pseudoaneurysm. Echocardiographic examination confirmed the absence of cardiac lesions after the operation. CONCLUSIONS: It is rare to see such a large pseudoaneurysm after radiofrequency catheter ablation. Clinicians should be allert to the potential risks to patients in the process of an effective treatment. Echocardiography plays an important role in the prompt diagnosis and prognosis of this disease. Emergency surgery is a better method for treatment of huge pseudoaneurysm.

High Initial Reversible Capacity and Long Life of Ternary SnO2-Co-carbon Nanocomposite Anodes for Lithium-Ion Batteries.

The two major limitations in the application of SnO2 for lithium-ion battery (LIB) anodes are the large volume variations of SnO2 during repeated lithiation/delithiation processes and a large irreversible capacity loss during the first cycle, which can lead to a rapid capacity fade and unsatisfactory initial Coulombic efficiency (ICE). To overcome these limitations, we developed composites of ultrafine SnO2 nanoparticles and in situ formed Co(CoSn) nanocrystals embedded in an N-doped carbon matrix using a Co-based metal-organic framework (ZIF-67). The formed Co additives and structural advantages of the carbon-confined SnO2/Co nanocomposite effectively inhibited Sn coarsening in the lithiated SnO2 and mitigated its structural degradation while facilitating fast electronic transport and facile ionic diffusion. As a result, the electrodes demonstrated high ICE (82.2%), outstanding rate capability (~ 800 mAh g-1 at a high current density of 5 A g-1), and long-term cycling stability (~ 760 mAh g-1 after 400 cycles at a current density of 0.5 A g-1). This study will be helpful in developing high-performance Si (Sn)-based oxide, Sn/Sb-based sulfide, or selenide electrodes for LIBs. In addition, some metal organic frameworks similar to ZIF-67 can also be used as composite templates.

Using response surface methodology optimize culture conditions for human lactoferrin production in desert Chlorella.

To optimize the expression conditions for human lactoferrin production, we have constructed the transgenic chlorella with human lactoferrin named as GTD8A1-HLF, the original chlorella was separated from Gurbantunggut Desert in Xinjiang China. To further improve the production of human lactoferrin, a sequential methodology was used to optimize human lactoferrin production by GTD8A1-HLF. First, a screening trial using a Plackett-Burman design was done, and variables with statistically significant effects on human lactoferrin bio-production were identified. These were further optimized by central composite design experiments and response surface methodology. Finally, we found that the maximum human lactoferrin production (52.70 mg/L) was achieved under the following optimized conditions: Initial pH 5.0, NaNO3 concentration of 0.600 mol/L, FeSO4 concentration of 0.006 mol/L, and a CuSO4 concentration of 0.002 mol/L, with the other medium components constituting the basal culture medium BBM. The yield of HLF protein under optimized culture conditions was approximately 4-fold higher than that obtained by using the basal culture medium BBM. The findings are significant for the potential industrial use of GTD8A1-HLF.

Multiphoton structured thin-plane imaging with a single optical path.

Optical sectioning has become an indispensable technique for high-speed volumetric imaging in the past decade. Here we present a novel optical-sectioning method that produces a thin plane of illumination by exploiting the spatial and temporal properties of multiphoton excitation. Critically, the illumination and detection share the same optical path, as in a conventional epi-fluorescence microscope configuration. Therefore, the imaged sample can be prepared as for standard fluorescence microscopy. Our method also leads to a laterally structured illumination pattern, and this feature can be utilized in structured illumination microscopy to further enhance the imaging performance. We show an example of such an approach, which achieves axial resolution finer than confocal microscopy. We also demonstrate the potential of the new method for biological applications by performing three-dimensional imaging of living Caenorhabditis elegans.