ACE and ACE2 Gene Variants Are Associated With Severe Outcomes of COVID-19 in Men.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current coronavirus disease 2019 (COVID-19) pandemic, affecting more than 219 countries and causing the death of more than 5 million people worldwide. The genetic background represents a factor that predisposes the way the host responds to SARS-CoV-2 infection. In this sense, genetic variants of ACE and ACE2 could explain the observed interindividual variability to COVID-19 outcomes. In order to improve the understanding of how genetic variants of ACE and ACE2 are involved in the severity of COVID-19, we included a total of 481 individuals who showed clinical manifestations of COVID-19 and were diagnosed by reverse transcription PCR (RT-PCR). Genomic DNA was extracted from peripheral blood and saliva samples. ACE insertion/deletion polymorphism was evaluated by the high-resolution melting method; ACE single-nucleotide polymorphism (SNP) (rs4344) and ACE2 SNPs (rs2285666 and rs2074192) were genotyped using TaqMan probes. We assessed the association of ACE and ACE2 polymorphisms with disease severity using logistic regression analysis adjusted by age, sex, hypertension, type 2 diabetes, and obesity. The severity of the illness in our study population was divided as 31% mild, 26% severe, and 43% critical illness; additionally, 18% of individuals died, of whom 54% were male. Our results showed in the codominant model a contribution of ACE2 gene rs2285666 T/T genotype to critical outcome [odds ratio (OR) = 1.83; 95%CI = 1.01-3.29; p = 0.04] and to require oxygen supplementation (OR = 1.76; 95%CI = 1.01-3.04; p = 0.04), in addition to a strong association of the T allele of this variant to develop critical illness in male individuals (OR = 1.81; 95%CI = 1.10-2.98; p = 0.02). We suggest that the T allele of rs2285666 represents a risk factor for severe and critical outcomes of COVID-19, especially for men, regardless of age, hypertension, obesity, and type 2 diabetes.

Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery.

OBJECTIVES: Single-dose del Nido cardioplegia has been used in the pediatric population for many years. Only a small amount of data exists about its use in adult cardiac surgery. We sought to compare the outcomes of all patients undergoing coronary artery bypass, using our 4:1 blood cardioplegia versus single-dose 1:4 del Nido cardioplegia, at our institution. METHODS: Data were retrospectively reviewed from all patients during 2 consecutive years (2013-2014). We switched our cardioplegia protocol from 4:1 blood cardioplegia to exclusively 1:4 single-dose del Nido cardioplegia in early 2014. A total of 408 patients were evaluated. Two hundred and forty-nine consecutive patients underwent coronary artery bypass using blood cardioplegia and 159 using del Nido Cardioplegia. RESULTS: Cardiopulmonary bypass time, cross-clamp time, in-hospital mortality and length of stay were similar (p>0.05): 63 ± 23 vs. 65 ± 21 min, 50 ± 20 vs. 52 ± 20 min, 0.8% vs. 0.6% and 6.4 ± 3 vs. 5.8 ± 3 days, respectively. For secondary outcomes: patients requiring defibrillation was 105/249 (42%) vs. 13/159 (8%) (p<0.0001), blood transfusion was required in 96/249 (38%) vs. 48/159 (30%) (p<0.085), total volume administered was 1139mL vs. 813 mL per case (p<0.0001), hematocrit change was 11.6% vs. 10.9% (p<0.04) and the mean cost per dose was $157.54 vs $5.74. CONCLUSIONS: Single-dose del Nido cardioplegia is an effective and economic cardioplegia and can be used with good outcomes in coronary surgery. Most patients have spontaneous return of sinus rhythm and there is a trend towards decreased transfusion rate.

Primary high-grade neuroendocrine carcinoma of the heart.

We report the successful resection of a solitary, apparently primary, high-grade neuroendocrine carcinoma of the heart, in a 70-year-old man who had presented with progressive dyspnea. The tumor occupied the right atrium and almost completely obstructed the superior and inferior venae cavae; it also involved the aortic root and the interatrial septum. To postpone the patient's impending cardiac failure, we resected the gross tumor except in the region of the aortic root and the trigone, which we debulked. We completely reconstructed the right atrium with pericardium and the interatrial septum with a pericardial patch. The patient recovered uneventfully; 18 months postoperatively, he had experienced only local recurrence in the tumor bed. This case shows that the palliative resection of large neuroendocrine tumors of the heart can yield good outcomes and prolong patient survival. To our knowledge, ours is the only report of a high-grade neuroendocrine cardiac tumor of apparently primary origin to have been resected with good palliative results.

Update on blunt thoracic aortic injury: fifteen-year single-institution experience.

OBJECTIVES: Despite improvements in the management of blunt thoracic aortic injury, mortality remains high. We report our experience with blunt thoracic aortic injury at a level 1 trauma center over the past 15 years. METHODS: Between January 1, 1997, and January 1, 2012, data on 338 patients who presented with suspected blunt thoracic aortic injury were entered into the University of Texas Medical School at Houston Trauma Center Registry. A total of 175 patients (52%) underwent thoracic aortic repair; 29 (17%) had open repair with aortic crossclamping, 77 (44%) had open repair with distal aortic perfusion, and 69 (39%) had thoracic endovascular aortic repair. Outcomes were determined, including early mortality, morbidity, length of stay, and late survival. Multiple logistic regression analysis was used to compute adjusted estimates for the effects of the operative technique. RESULTS: The early mortality for all patients with blunt thoracic aortic injury was 41% (139/338). Early mortality was 17% (27/175) for operative aortic interventions, 4% (3/69) for thoracic endovascular aortic repairs, 31% (11/29) for open repairs with aortic crossclamping, and 14% (11/77) for open repairs with distal aortic perfusion. Survival for thoracic endovascular aortic repair at 1 year and 5 years was 92% and 87%, respectively. Survival for open repair at 1, 5, 10, and 15 years was 76%, 75%, 72%, and 68%, respectively. CONCLUSIONS: Blunt thoracic aortic injury remains associated with significant early mortality. Delayed selective management, when applied with open repair with distal aortic perfusion and the use of thoracic endovascular aortic repair, has been associated with improved early outcomes. The long-term durability of thoracic endovascular aortic repair is unknown, necessitating close radiographic follow-up.

The use of intraoperative cholangiogram during laparoscopic double cholecystectomy.

Double gallbladder is a rare finding in patients with symptomatic cholelithiasis or acute cholecystitis. The incidence has been described as 1 in every 4000-5000 patients during autopsy. To identify the gallbladder (GB) duplication prior to surgical removal of the GB is of upmost importance. It is not unusual to identify this diagnosis intraoperatively, but by using US, ERCP or MRCP more than 50% of the cases are diagnosed preoperatively. The use of intraoperative cholangiogram helps to identify the anatomy and confirm the diagnosis during laparoscopic cholecystectomy in patients with gallbladder duplication.

Prevalence of nonalcoholic fatty liver disease (NAFLD) and utility of FIBROspect II to detect liver fibrosis in morbidly obese Hispano-American patients undergoing gastric bypass.

BACKGROUND: Our study describes the prevalence of nonalcoholic steatohepatitis (NASH) and liver fibrosis in Hispano-American morbidly obese patients and the utility of different serum markers to predict significant liver fibrosis in this population. METHODS: We perform a retrospective chart review of all patients undergoing Roux-en-Y gastric bypass with routine liver biopsy performed at Valley Baptist medical center during a 24-month period (2005-2006). RESULTS: Of 129 liver biopsies, only 25.7% had some degree of steatosis, but about 55% had NASH, and 30.9% had liver fibrosis. Of those patients with liver fibrosis, only 6.9% had moderate to severe fibrosis (stages 2-4), and only one patient had cirrhosis (0.7%). Of the 129 patients, only 92 had a FIBROspect score II in their chart, and they ranged from 9 to 95, with a mean of 28.3. Of these patients, 36 had a score less than 20, and none had significant fibrosis in their biopsy. FIBROspect II® score (cutoff <20) had a negative predictive value (NPV) of 100% (confidence interval (CI) 95%, 0.9035-1) positive predictive value (PPV) of 15% (CI 95%, 0.0838-0.2693), sensitivity of 100%, and specificity of 42% to predict stage 2 fibrosis or higher. CONCLUSIONS: NASH and liver fibrosis are present in a high percentage of morbidly obese patients. Liver function tests and ultrasound are not reliable tests to diagnose or rule out advance liver fibrosis. The use of FIBROspect II® score in the preoperative evaluation of morbidly obese patients can rule out significant liver fibrosis (stages 2-4) and avoid the morbidities related to liver biopsy.

Black bean extract ameliorates liver fibrosis in rats with CCl4-induced injury.

UNLABELLED: We assessed the anti-fibrotic effects of methanolic black bean extract antioxidants in a carbon tetrachloride (CCl4) liver injury model in rats. Experimentally intoxicated animals received CCl4 for eight weeks, the reference and test groups received daily intragastric quercetin or daily intragastric black bean extract. Liver fibrosis was assessed and quantified using morphometric analysis. Expression of fibrosis related genes was measured by real time RT-PCR. Qualitative and quantitative histological analysis showed that administration of 70 mg/kg b.w. of black bean extract reduced hepatic fibrosis index by 18% compared to positive controls (P 0.006), as a result of a decrease in type I (44.3% less, P 0.03) and type IV (68.9% less, P 0.049) collagen gene expression compared to CCl4-injured and Quercetin treated rats. In conclusion, we provide evidence that this methanol black bean extract ameliorates liver fibrosis and types I and IV collagen gene expression, in the animal model used. PRACTICAL APPLICATIONS: The compounds contained in this black bean extract exhibited strong antifibrotic effects in the CCl4 chronic liver injury model used; considering that this compounds are contained in a leguminous that has been used in human diet for a long time, their toxic potential should be very low, and this characteristic should favor their potential use in some other chronic or degenerative states that include an increase in inflammation and oxidative burst in their pathogenesis. Another possible application of this kind of extract could be its use as an antimicrobial or even antiparasitic therapeutic agent, although it is purely speculative.

Predictors of weight loss and effectiveness of Roux-en-Y gastric bypass in the morbidly obese Hispano-American population.

BACKGROUND: Co-morbidities and the metabolic response to intervention in morbid obesity have been reported to vary among different ethnic groups. We compared the rate of weight loss, effectiveness of gastric bypass surgery, and variables influencing success after gastric bypass in Hispanics compared to Caucasians. METHODS: Morbidly obese adult (>18 years old) patients (body mass index [BMI] 40 or above) evaluated by our bariatric group from 2005 to 2006 who underwent Roux-en-Y gastric bypass (RYGBP) were studied. Every patient was evaluated for height, weight, BMI, percent body fat, fat mass, serum metabolic analysis (SMA) 12, lipid profile, complete blood count (CBC), iron, ferritin, Vitamins A, D, and B1, complete urinalysis and Fibrospect score II. Weight loss was evaluated at 1, 3, 6, and 12 months. RESULTS: Seventy-five patients underwent successful open RYGBP with no mortality. Regardless of the significant difference in age and co-morbidities, the mean percentage of total weight loss after 1 year of follow-up was 32% for Hispanics and 30% for Caucasians with no significant difference (p > .5). When comparing the percentage of excess weight lost (% EWL) at 1, 3, 6, and 12 months, there was no significant difference between both groups. Using multiple regression analysis, we found that high-density lipoprotein (HDL) and systolic blood pressure (SBP) significantly predicted EWL at 12 months in Caucasians and Fibrospect predicted significantly EWL at 1 year. CONCLUSION: At 1 year after RYGBP, both ethnic groups lost approximately 77-80% of their EWL and BMI. All Caucasians and 95.7% of Hispanics achieved successful weight loss (>50% EWL).

Effects of bone marrow cell transplant on thyroid function in an I131-induced low T4 and elevated TSH rat model.

BACKGROUND: We developed a study using low dose radioactive iodine creating an animal model of transient elevation of thyroid stimulating hormone (TSH). Male derived bone marrow cells were transplanted to asses their effect on thyroid function and their capability to repair the thyroid parenchyma. RESULTS: At 40 an 80 days after I131 treatment, the study groups TSH and T4 serum values both increased and decreased significantly respectively compared to the negative control group. Eight weeks after cell transplantation, neither TSH nor T4 showed a significant difference in any group. The mean number of SRY gene copies found in group I (Left Intracardiac Transplant) was 523.3 and those in group II (Intrathyroid Transplant) were only 73. Group III (No Transplant) and IV had no copies. Group I presented a partial restore of the histological pattern of rat thyroid with approximately 20%-30% of normal-sized follicles. Group II did not show any histological differences compared to group III (Positive control). CONCLUSION: Both a significant increase of TSH and decrease of T4 can be induced as early as day 40 after a low dose of I131 in rats. Restore of normal thyroid function can be spontaneously achieved after using a low dose RAI in a rat model. The use of BM derived cells did not affect the re-establishment of thyroid function and might help restore the normal architecture after treatment with RAI.