Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study.

Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a 'pre-vaccination' cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and 'vaccinated' and 'unvaccinated' cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4. Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.

The predictive accuracy of cardiovascular risk prediction tools in inflammatory arthritis and psoriasis: an observational validation study using the Clinical Practice Research Datalink.

OBJECTIVES: Cardiovascular risk prediction tools developed for the general population often underperform for individuals with rheumatoid arthritis (RA), and their predictive accuracy are unclear for other inflammatory conditions that also have increased cardiovascular risk. We investigated performance of QRISK-3, Framingham Risk Score (FRS) and Reynolds Risk Score (RRS) in RA, psoriatic disease (psoriatic arthritis (PsA) and psoriasis) and ankylosing spondylitis (AS). We considered osteoarthritis as a non-inflammatory comparator. METHODS: We utilised primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database to identify individuals with each condition and calculated 10-year cardiovascular risk using each prediction tool. Discrimination and calibration of each tool in each disease was assessed. RESULTS: Time-dependent AUC for QRISK3 was 0.752 for RA (95% CI 0.734-0.777), 0.794 for AS (95% CI 0.764-0.812), 0.764 for PsA (95% CI 0.741-0.791),0.815 for psoriasis (95% CI 0.789-0.835), and 0.698 for osteoarthritis (95% CI 0.670-0.717) indicating reasonably good predictive performance. AUC for FRS were similar, and slightly lower for RRS. FRS was reasonably well calibrated for each condition but underpredicted risk for patients with RA. RRS tended to underpredict CVD risk, whilst QRISK3 overpredicted CVD risk, especially for the most high-risk individuals. CONCLUSIONS: CVD risk for individuals with RA, AS and psoriatic disease were generally less accurately predicted using each of the 3 CVD risk prediction tools than reported accuracies in the original publications. Individuals with osteoarthritis also had less accurate predictions suggesting inflammation is not the sole reason for underperformance. Disease specific risk prediction tools may be required.

Outer membrane vesicles from Piscirickettsia salmonis induce the expression of inflammatory genes and production of IgM in Atlantic salmon Salmo salar.

Piscirickettsiosis outbreaks due to Piscirickettsia salmonis occur globally in the Chilean salmon aquaculture generating significant monetary losses in the industry. P. salmonis secretes outer membrane vesicles (OMVs) which are naturally non-replicating and highly immunogenic spherical nanoparticles. P. salmonis OMVs has been shown to induce immune response in zebrafish; however, the immune response induced by these vesicles in salmonids has not been evaluated. In this study, we inoculated Atlantic salmon with 10 and 30 µg doses of P. salmonis OMVs and took samples for 12 days. qPCR analysis indicated an inflammatory response. Thus, the inflammatory genes evaluated were up- or down-regulated at several times in liver, head kidney and spleen. In addition, the liver was the organ most immune-induced, mainly in the 30 µg-dose. Interestingly, co-expression of pro- and anti-inflammatory cytokines was evidenced by the prominent expression of il-10 at day 1 in spleen and also in head kidney on days 3, 6 and 12, while il-10 and tgf-ß were up-regulated on days 3, 6 and 12 in liver. Importantly, we detected the production of IgM against proteins of P. salmonis in the serum collected from immunized fish after 14 days. Thus, 40 and 400 µg OMVs induced the production of highest IgM levels; however, no statistical difference in the immunoglobulin levels produced by these OMVs doses were detected. The current study provides evidence that OMVs released by P. salmonis induced a pro-inflammatory responses and IgM production in S. salar, while regulatory genes were induced in order to regulate their effects and achieve the balance of the inflammatory response.

Live and inactivated Piscirickettsia salmonis activated nutritional immunity in Atlantic salmon (Salmo salar).

Nutritional immunity regulates the homeostasis of micronutrients such as iron, manganese, and zinc at the systemic and cellular levels, preventing the invading microorganisms from gaining access and thereby limiting their growth. Therefore, the objective of this study was to evaluate the activation of nutritional immunity in specimens of Atlantic salmon (Salmo salar) that are intraperitoneally stimulated with both live and inactivated Piscirickettsia salmonis. The study used liver tissue and blood/plasma samples on days 3, 7, and 14 post-injections (dpi) for the analysis. Genetic material (DNA) of P. salmonis was detected in the liver tissue of fish stimulated with both live and inactivated P. salmonis at 14 dpi. Additionally, the hematocrit percentage decreased at 3 and 7 dpi in fish stimulated with live P. salmonis, unchanged in fish challenged with inactivated P. salmonis. On the other hand, plasma iron content decreased during the experimental course in fish stimulated with both live and inactivated P. salmonis, although this decrease was statistically significant only at 3 dpi. Regarding the immune-nutritional markers such as tfr1, dmt1, and ireg1 were modulated in the two experimental conditions, compared to zip8, ft-h, and hamp, which were down-regulated in fish stimulated with live and inactivated P. salmonis during the course experimental. Finally, the intracellular iron content in the liver increased at 7 and 14 dpi in fish stimulated with live and inactivated P. salmonis, while the zinc content decreased at 14 dpi under both experimental conditions. However, stimulation with live and inactivated P. salmonis did not alter the manganese content in the fish. The results suggest that nutritional immunity does not distinguish between live and inactivated P. salmonis and elicits a similar immune response. Probably, this immune mechanism would be self-activated with the detection of PAMPs, instead of a sequestration and/or competition of micronutrients by the living microorganism.

PAMPs of Piscirickettsia salmonis Trigger the Transcription of Genes Involved in Nutritional Immunity in a Salmon Macrophage-Like Cell Line.

The innate immune system can limit the growth of invading pathogens by depleting micronutrients at a cellular and tissue level. However, it is not known whether nutrient depletion mechanisms discriminate between living pathogens (which require nutrients) and pathogen-associated molecular patterns (PAMPs) (which do not). We stimulated SHK-1 cells with different PAMPs (outer membrane vesicles of Piscirickettsia salmonis "OMVs", protein extract of P. salmonis "TP" and lipopolysaccharides of P. salmonis "LPS") isolated from P. salmonis and evaluated transcriptional changes in nutritional immunity associated genes. Our experimental treatments were: Control (SHK-1 stimulated with bacterial culture medium), OMVs (SHK-1 stimulated with 1µg of outer membrane vesicles), TP (SHK-1 stimulated with 1µg of total protein extract) and LPS (SHK-1 stimulated with 1µg of lipopolysaccharides). Cells were sampled at 15-, 30-, 60- and 120-minutes post-stimulation. We detected increased transcription of zip8, zip14, irp1, irp2 and tfr1 in all three experimental conditions and increased transcription of dmt1 in cells stimulated with OMVs and TP, but not LPS. Additionally, we observed generally increased transcription of ireg-1, il-6, hamp, irp1, ft-h and ft-m in all three experimental conditions, but we also detected decreased transcription of these markers in cells stimulated with TP and LPS at specific time points. Our results demonstrate that SHK-1 cells stimulated with P. salmonis PAMPs increase transcription of markers involved in the transport, uptake, storage and regulation of micronutrients such as iron, manganese and zinc.

Fertility and Iron Bioaccumulation in Drosophila melanogaster Fed with Magnetite Nanoparticles Using a Validated Method.

Research on nanomaterial exposure-related health risks is still quite limited; this includes standardizing methods for measuring metals in living organisms. Thus, this study validated an atomic absorption spectrophotometry method to determine fertility and bioaccumulated iron content in Drosophila melanogaster flies after feeding them magnetite nanoparticles (Fe3O4NPs) dosed in a culture medium (100, 250, 500, and 1000 mg kg-1). Some NPs were also coated with chitosan to compare iron assimilation. Considering both accuracy and precision, results showed the method was optimal for concentrations greater than 20 mg L-1. Recovery values were considered optimum within the 95-105% range. Regarding fertility, offspring for each coated and non-coated NPs concentration decreased in relation to the control group. Flies exposed to 100 mg L-1 of coated NPs presented the lowest fertility level and highest bioaccumulation factor. Despite an association between iron bioaccumulation and NPs concentration, the 500 mg L-1 dose of coated and non-coated NPs showed similar iron concentrations to those of the control group. Thus, Drosophila flies' fertility decreased after NPs exposure, while iron bioaccumulation was related to NPs concentration and coating. We determined this method can overcome sample limitations and biological matrix-associated heterogeneity, thus allowing for bioaccumulated iron detection regardless of exposure to coated or non-coated magnetite NPs, meaning this protocol could be applicable with any type of iron NPs.

Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation.

BACKGROUND: Endovascular treatment (EVT) by percutaneous transluminal angioplasty (PTA) or stent is the first-line treatment for hepatic artery stenosis (HAS) after liver transplantation, but there are no guidelines to help choose between PTA and stent. METHODS: Retrospective review of HAS EVT after liver transplantation, between 1999 and 2017. HAS was treated by PTA or stent. We report EVT primary effectiveness, arterial patency after 1 year of follow-up, complications, HAS recurrence rate; comparing PTA to stent. RESULTS: Fifty-two HAS were diagnosed in 42 patients. We performed 51 EVT; 34 PTA (66.7%) and 16 stents (31.4%). Global primary EVT effectiveness was 86.3%: 82.3% after PTA and 100% after stent (P = 1.00 after propensity score matching). Recurrent HAS was found in 22.0% of cases: 29.4% after PTA and 6.2% after stenting, (P = .053 after propensity score matching). Patency rate without recurrent HAS or HAT at 12 months was 73.5% with PTA and 93.8% with stent (P = .09), and globally this was 92.8%. There were 7.8% complications: 2.9% after PTA, 12.5% after stenting (P = .23). CONCLUSION: Primary effectiveness was the same for PTA and stenting. There was a strong trend toward more HAS recurrence after PTA than after stenting suggesting that HAS should benefit from primary stenting.

Efectos del cambio a café filtrado sobre los niveles séricos de colesterol / A reversal study on the effects of change to filtered coffee on serum cholesterol levels

No disponible

Unfiltered coffee consumption has been associated to the increase in serum cholesterol levels. The aim of this population study was to verify if the change in the type of coffee consumed from unfiltered to filtered produces effects on the serum cholesterol levels of the participants. The sample was formed of 30 volunteers (9 men) with no health problems (age range= 18-47; average= 28.2; SD= 8.8). The study was structured according to an A-B-A reversible design with simultaneous replications between subjects. During the Baseline and Reversion phases (A), participants consumed unfiltered coffee in their usual way, while in the Intervention Phase (B) they consumed only filtered coffee. Participants were divided into two subgroups according to their serum level of cholesterol LDL at Baseline Phase (resulting in a subgroup formed by 16 participants with LDL <115 mg/dL, and a subgroup formed by 14 participants with LDL ≥115 mg/dL). Results indicated that 90% of participants showed decrease in their serum cholesterol LDL level at the end of the Intervention Phase contingent to coffee change with an increase in their serum cholesterol LDL level at the end of the Reversion Phase when they returned to consuming unfiltered coffee. Also a change in serum cholesterol HDL level was shown by 93% of participants, with an increase in serum cholesterol HDL level contingent on the change to filtered coffee and a decrease when they return to consume unfiltered coffee. The implications of these findings and the limitations of the study are discussed

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career.

Although associations between work stressors and stress-related biomarkers have been reported in cross-sectional studies, the use of single time measurements of work stressors could be one of the reasons for inconsistent associations. This study examines whether repeated reports of work stress towards the end of the working career predicts allostatic load, a measure of chronic stress related physiological processes. Data from waves 2 to 6 of the English Longitudinal Study of Ageing (ELSA) were analysed, with a main analytical sample of 2663 older adults (aged 50+) who had at least one measurement of effort-reward imbalance between waves 2-6 and a measurement of allostatic load at wave 6. Cumulative work stress over waves 2-6 were measured by the effort-reward imbalance model. ELSA respondents who had reported two or more occasions of imbalance had a higher (0.3) estimate of the allostatic load index than those who did not report any imbalance, controlling for a range of health and socio-demographic factors, as well as allostatic load at baseline. More recent reports of imbalance were significantly associated with a higher allostatic load index, whereas reports of imbalance from earlier waves of ELSA were not. The accumulation of work related stressors could have adverse effects on chronic stress biological processes.

Detection of precancerous lesions in the cervix and HPV infection in women in the region of Maniapure, Bolivar State.

Human papillomavirus (HPV) is the causative agent of cervical cancer (CC), the second most common cause of cancer deaths in Venezuela. Early detection and prompt treatment of precancerous lesions prevent up to 80% of CC cases. In Venezuela, difficult access to CC screening means that the disease is detected at advanced stages, especially in more vulnerable indigenous populations. The aim of the study was to detect precancerous cervical lesions and HPV infection in 60 women who attended the gynaecology service at the Maniapure Outpatient Clinic in Bolivar State, Venezuela. The study was carried out to detect precancerous cervical lesions using visual inspection with acetic acid (VIA), the Schiller test and conventional cytology (Pap testing). HPV detection and typing were carried out using the polymerase chain reaction. 58.3% of the women in the study belonged to the Eñepa indigenous community and 41.7% were white Creole women. The Schiller test showed irregularities in the staining of the exocervical epithelium in 8.33% of the patients, suggesting HPV infection. VIA was positive for 10.0% of the women. In the cytopathology report, 81.67% tested negative for intraepithelial lesions. The overall frequency of HPV detection was 35.0%. HPV infection was detected in 45.71% of the Eñepa women and 20.0% of the Creole women. 71.43% of the women had a high-risk single HPV infection. The percentage of viral infection was lower in the Creole patients than in the indigenous population; therefore, CC screening programmes in the latter population need to be improved.

Retroperitoneal epithelioid sarcoma: A case report.

Epithelioid sarcoma (ES), a mesenchymatous malign neoformation, is often diagnosed in later stages and associated with high recurrence index, metastasis and mortality. We report a case of a 65 years old male, with history of abdominal pain and upper gastrointestinal bleeding. Endoscopy demonstrated a posterior duodenal wall perforation communicating with a solid retroperitoneal neoformation. Endoscopic biopsy was performed, with a final report of ES. The patient was submitted for surgical palliation due to the tumor's unresectability. Retroperitoneal ES is an extremely rare condition with limited reports in the literature where guidelines for its optimal treatment are not well established.

Disfunción de prótesis mitral en paciente con síndrome de Bland-White-Garland / Dysfunction protesis mitral in a patient with white garland syndrome Bland-White-Garland

Las anomalías coronarias tienen una incidencia en la población general de 0.2 a 1.2%; de ellas la más frecuente es el origen anómalo de la coronaria izquierda del tronco de la arteria pulmonar, conocido como ALCAPA (anomalous left coronary artery from pulmonary artery). Ésta es una rara anomalía que representa el 0.25 a 0.5% del total de cardiopatías. La implantación de la arteria coronaria izquierda desde el tronco de la arteria pulmonar también conocida como síndrome de Bland-White-Garland (BWG) es la anomalía coronaria más frecuente. Reporte de caso: Se presenta caso de mujer de 51 años de edad, quien ingresó de forma electiva para cateterismo cardiaco como protocolo prequirúrgico de recambio valvular por disfunción de prótesis mitral donde como hallazgo se encontró inmovilidad de uno de los discos; la paciente tenía antecedente de sustitución valvular mitral a los 15 años por prolapso congénito. Durante el cateterismo cardiaco se evidencia el implante anómalo de la coronaria izquierda, situación que no había sido detectada en el primer evento quirúrgico, presentada en sesión médico-quirúrgica y siendo aceptada para recambio valvular más reconexión coronaria, llevándose procedimiento sin complicaciones. Conclusiones: Aunque el síndrome BWG es una enfermedad con rara presentación en la edad adulta, el conocimiento de esta anomalía congénita es importante, ya que el diagnóstico precoz y el tratamiento pueden prevenir daños irreversibles al miocardio.

Coronary anomalies have an incidence in the general population of 0.2 to 1.2 %, of which the most common is the anomalous origin of the left coronary artery from the main pulmonary artery, known as ALCAPA (anomalous left coronary artery from pulmonary artery). It is a rare anomaly representing 0.25 to 0.5 % of all heart disease. The implementation of the left coronary artery from the main pulmonary artery also known as Bland-White-Garland syndrome is the most common coronary anomaly. Case Report: Female 51-year-old show, who electively income for preoperative cardiac catheterization and Protocol were valve replacement for mitral prosthesis dysfunction where was found immobility of a disk. Immobility was found, patient had a history of mitral valve replacement for 15 years for congenital prolapse, during cardiac catheterization of anomalous left coronary implant situation that had not been detected in the first surgical event, presented in medical and surgical session and being accepted for coronary valve replacement reconnection is more evidence, taking procedure without complications. Conclusions: Although BWG syndrome is a rare disease presenting in adulthood, knowledge of this congenital anomaly is important because early diagnosis and treatment can prevent irreversible damage to the myocardium.

Hábitos y creencias de salud en médicos y estudiantes de Medicina / Health habits, and health beliefs among physicians and medical students

Los datos sobre hábitos y creencias de salud de la población médica española son escasos.Este estudio tiene como objetivo explorar, en una muestra de médicos y estudiantesde Medicina, los hábitos de salud (consumo de tabaco y alcohol) y los conocimientos ycreencias sobre los mismos. La muestra se compuso por 147 participantes de distintoshospitales de España. Se utilizó un cuestionario diseñado para recabar información sobrelas variables estudiadas. Los resultados indicaron que el 47,6% eran fumadores y el71,7% consumidores de alcohol, encontrándose una relación positiva entre edad y frecuenciade consumo en ambos casos. Los participantes mostgraron un adecuado nivel deconocimientos y creencias respecto a los riesgos para la salud del consumo de tabaco yalcohol, que contrasta claramente con sus hábitos de consumo. Los hábitos de salud enla muestra no difieren de los encontrados en la población general, si bien el nivel deconocimientos y creencias es más preciso. Destaca la falta de correspondencia entrecreencias y conocimientos en salud y los hábitos de salud

Data availableon health habits and health beliefs in Spanish medical population is scarce. The objectiveof this study was to explore some health habits (i.e., tobacco and alcohol consume) aswell as the knowledge and beliefs regarding those habits among physicians and medicalstudents. The sample was 147 participants from various hospitals in Spain. A questionnairespecifically designed for this study was used to obtain data about the target variables.Results show that 47,6% of participants are smokers, and 71,7% inform to be alcoholconsumers. A positive relation between age and frequency of consumption was found inboth habits. Participants demonstrate to have an adequate level of knowledge and beliefsin relation to the risks for health that the use of tobacco and alcohol entails, contrastingclearly with their consumption patterns. The health habits of this sample do not differfrom those founded in the general population, even though participants show a correctlevel of knowledge and beliefs on these habits, thus emphasizing the lack of correspondencebetween health knowledge, beliefs and health habits

Células dendríticas: respuesta inmunitaria y señales de peligro / Dendritic cells: immunitary response and danger signals

Las células dendríticas, representan una familia heterogénea de células muy móviles y de forma irregular. Poseen gran plasticidad ontogénica y funcional, por lo que se observan diferencias en su origen ontogénico, fenotipo, localización y función. Es una célula presentadora de antígeno con propiedad para activar o tolerizar a los linfocitos T. Estos conocimientos han puesto en evidencia, las debilidades de la teoría de selección clonal, y apuntalado otras como la teoría del peligro. Por tal motivo, el dogma central de la inmunología: la discriminación de "lo propio" de "lo extraño", ha sido sustituido por la idea según la cual el sistema inmunitario responde a "señales de alarma o peligro" inde-pendientemente del orígen del antígeno. Las células dendríticas captan estas señales de peligro o alarma y en función de su maduración, características fenotípicas, y de su localización se comportará como una célula inmunogénica o tolerogénica. Para ello expresa moléculas, que le permiten adecuar su respuesta en función del tipo de señal que recibe: si la misma es de "peligro" o "alarma" la resúesta será de resistencia. Si la señal no es de "peligro" la respuesta será de tolerancia. Reportes de nuestro grupo de trabajo, y de otros grupos, demuestran que, incluso durante el período neonatal, normalmente concebido como un período crítico para la tolerancia inmunitaria, las células dendríticas pueden ser inmunogénicas. Esto ha permitido el desarrollo de ensayos clínicos en enfermedades como las autoinmunitarias, infecciosas, alérgicas y tumorales, con el objeto de prevenirlas o tratarlas, o de establecer nuevos esquemas de vacunación desde etapas muy tempranas de la vida

Efectos del consumo de café para la salud cardiovascular, la diabetes y el desarrollo de cáncer / Effects of coffee consume on cardiovascular health, diabetes and cancer

Se revisan y analizan las relaciones entre consumo de café y riesgo para la salud en los tres grupos de trastornos primeras causas de muerte prematura: trastornos cardiovasculares, diabetes y cáncer. Se revisan los estudios epidemiológicos y experimentales existentes, y aquellos que han explorado los agentes o mecanismos responsables del efecto de riesgo o protector para la salud del consumo de café. Los resultados indican que existen evidencias de aumento del riesgo de trastornos cardiovasculares por consumo de café, mientras que los datos no son concluyentes respecto a las relaciones entre riesgo de diabetes y consumo. Las relaciones entre consumo de café y riesgo de cáncer parecen probables en el caso de los cánceres de páncreas y de ovario, mientras que el consumo de café se muestra como un factor protector del cáncer de colon y recto y los datos no son concluyentes para el cáncer de vejiga. En todos los casos se indican las hipótesis disponibles sobre mecanismos responsables del efecto y se señalan posibles formas de consumo saludable que reduzcan los riesgos (AU)

This paper presents a revision of the relationships between coffee consumption and health across the three groups of diseases that are the first causes of premature death: cardiovascular diseases, diabetes and cancer. Epidemiological and experimental studies show relative evidences of increasing cardiovascular risk correlated to coffee consumption while no clear relationship is found concerning diabetes. Relationships between coffee consumption and cancer risk are likely in the case of pancreas and ovarian cancers while coffee consumption appears as a protector factor in colorectal cancer with no concluding data in the case of bladder cancer. This paper also presents the available hypotheses concerning the mechanisms that might be responsible of coffee consumption as a risk or protector factor for the diseases revised, and healthy forms of coffee consumption that minimize risk are indicated (AU)

Cork taint of wines: role of the filamentous fungi isolated from cork in the formation of 2,4,6-trichloroanisole by o methylation of 2,4,6-trichlorophenol.

Cork taint is a musty or moldy off-odor in wine mainly caused by 2,4,6-trichloroanisole (2,4,6-TCA). We examined the role of 14 fungal strains isolated from cork samples in the production of 2,4,6-TCA by O methylation of 2,4,6-trichlorophenol (2,4,6-TCP). The fungal strains isolated belong to the genera Penicillium (four isolates); Trichoderma (two isolates); and Acremonium, Chrysonilia, Cladosporium, Fusarium, Mortierella, Mucor, Paecilomyces, and Verticillium (one isolate each). Eleven of these strains could produce 2,4,6-TCA when they were grown directly on cork in the presence of 2,4,6-TCP. The highest levels of bioconversion were carried out by the Trichoderma and Fusarium strains. One strain of Trichoderma longibrachiatum could also efficiently produce 2,4,6-TCA in liquid medium. However, no detectable levels of 2,4,6-TCA production by this strain could be detected on cork when putative precursors other than 2,4,6-TCP, including several anisoles, dichlorophenols, trichlorophenols, or other highly chlorinated compounds, were tested. Time course expression studies with liquid cultures showed that the formation of 2,4,6-TCA was not affected by a high concentration of glucose (2% or 111 mM) or by ammonium salts at concentrations up to 60 mM. In T. longibrachiatum the O methylation of 2,4,6-TCP was catalyzed by a mycelium-associated S-adenosyl-L-methionine (SAM)-dependent methyltransferase that was strongly induced by 2,4,6-TCP. The reaction was inhibited by S-adenosyl-L-homocysteine, an inhibitor of SAM-dependent methylation, suggesting that SAM is the natural methyl donor. These findings increase our understanding of the mechanism underlying the origin of 2,4,6-TCA on cork, which is poorly understood despite its great economic importance for the wine industry, and they could also help us improve our knowledge about the biodegradation and detoxification processes associated with chlorinated phenols.

Bicaval anastomosis in a heart transplant recipient with left superior vena cava.

We describe the surgical procedure of orthotopic heart transplantation (OHT) in a recipient with persistent left superior vena cava (LSVC) and isolated noncompaction of the left ventricle. The bicaval anastomosis technique was performed using and isolating his native coronary sinus to let the left superior vena cava drain into his own inferior vena cava through the native coronary sinus.