Inflammatory myofibroblastic tumor: A rare entity with a complex diagnosis.

Inflammatory myofibroblastic tumor is a neoplasm with uncertain behavior. We describe a case in a 66-year-old female who underwent resection of a left atrial tumor suspected to be a cardiac myxoma which was subsequently diagnosed as an inflammatory myofibroblastic tumor. After three years' follow-up the patient underwent a second operation to remove tumoral occurrence in the right atrium, diagnosed as an intimal sarcoma. It cannot be confirmed whether the tumoral recurrence with a different diagnosis (intimal sarcoma) was a progression from the primary tumor or the metachronous appearance of a spontaneous sarcoma.

Complications After Heart Transplantation According to the Type of Pretransplant Circulatory/Ventricular Support.

BACKGROUND: The purpose of the study was to analyze postcardiac transplant complications in patients who received transplants with short-term mechanical ventricular assist devices and to compare complications according to the type of device. METHODS: Ambispective and consecutive study of urgent heart transplants from 2015 to 2019. Pediatric transplants, retransplants, and combined transplants were excluded. A total of 45 patients were analyzed in 4 groups: (1) venoarterial extracorporeal membrane oxygenation (ECMO) implanted <10 days before heart transplant (HTx) (n = 17); (2) ECMO implanted for more than 10 days (n = 8); (3) Levitronix Centrimag implanted in INTERMACS 2 to 3 patients (n = 13); and (4) Levitronix Centrimag implanted in INTERMACS 2 patients (n = 7). ECMO assistance was in INTERMACS 2 and severe right ventricular dysfunction. Levitronix Centrimag was implanted in patients with preserved right ventricular function. RESULTS: Primary graft failure associated with the need for ECMO was more frequent in patients with ECMO than with Levitronix (P < .05). When comparing the 2 groups with ECMO, an implant more than 10 days before HTx was associated, after transplant, with a longer stay in the critical care unit (P = .02), higher mortality (P = .03), and an increase in complications in general. When comparing the 2 groups with Levitronix, all the parameters studied were much better when the Levitronix was implanted in INTERMACS 2-3 (P < .05). On the other hand, all cases of deep vein thrombosis and pulmonary thromboembolism occurred in patients who were assisted with ECMO. CONCLUSIONS: HTx with mechanical assist devices is associated with significant complications. ECMO produces more complications than the Levitronix Centrimag, although they are related to the days of implantation. The best group are patients implanted with a Levitronix in INTERMACS 2-3.

Analysis of the Intrahospital and Long-Term Survival of Heart Transplant Patients With a Short-Term Mechanical Assistance Device.

BACKGROUND: The purpose of this study was to compare early and late survival among patients who have undergone heart transplantation (HTx) with a short-term mechanical assist device. METHODS: This was an ambispective, single-center, consecutive study of patients undergoing urgent HTx for 5 years. Pediatric transplants, retransplants, and combined transplants were excluded. Forty-five patients were included. Four groups were analyzed: those with venoarterial extracorporeal membrane oxygenation (ECMO) implanted <10 days before HTx; those with ECMO implanted for >10 days; patients classified as INTERMACS 2 to 3 with Levitronix Centrimag implanted; and those classified as INTERMACS 2 with Levitronix Centrimag implanted. Survival and the influence of orotracheal intubation (OI) at the time of transplantation were compared. RESULTS: There were differences in in-hospital mortality (P = .03) and total mortality (P = .06). The groups with the highest risk for mortality were those who carried ECMO for >10 days before transplantation or those classified as INTERMACS 2 with Levitronix Centrimag implanted. In these groups, the need for posttransplant circulatory support was also greater (P = .04) as was the length of stay in critical care (P = .02). The need for OI during the days of care and until transplantation had a negative effect on survival in all groups (P < .1). CONCLUSIONS: There are different risk subgroups among patients who are transplanted with a circulatory/ventricular assist device. The lowest mortality occurs when the days of ECMO implantation are <10 and when the implanted device is a Levitronix Centrimag in INTERMACS 2 to 3 profile, particularly when the patient reaches the HTx without requiring OI.

Risk factors associated with testing positive for tuberculosis in high-yielding Holstein cows.

Tuberculosis remains a significant infectious disease of farm animals and humans worldwide. The objective of this study was to assess various risk factors associated with testing positive for bovine tuberculosis (bTB) in high-yielding Holstein cows in an intensive dry-lot dairy operation. In a retrospective observational study, 9312 records from Holstein cows from a large dairy herd in northern Mexico were used. The incidence rate of lactating cows reactor to bTB was 7.3 cases/100 cow years (95% CI = 6.7-7.9%). Multiple logistic regression models indicated that cows with total milk yield during the first lactation >10,200 kg were 1.3 times (95% confidence intervals (CI) for odds ratio (OR) = 1.2-1.6) more likely to be detected as bTB reactors than cows with total milk yield <10,200 kg (8.2 vs. 6.4%; P < 0.01). The risk of being reactor to bTB increased with x̅ total milk yield/lactation >11,500 kg (OR=2.7, 95% CI = 2.3-3.3; 10.4 vs. 4.2%) compared with cows with x̅ total milk yield/lactation <11,500 kg. Cows with >10,200 kg 305-day milk yield in the last lactation was associated (P < 0.01) with 1.3 times higher odds (95% CI for OR = 1.1-1.5) of being classed as reactors than cows with <10,200 kg. Cows with peak milk yield >48 kg were 1.9 times (95% CI for OR = 1.6-2.2) more likely to be reactor to bTB than cows with peak milk yield <48 kg (9.2 vs. 5.1%; P < 0.01). Cows with either puerperal metritis (OR = 0.07, 95% CI = 0.5-0.9) or carrying twins (OR = 0.05, 95% CI = 0.01-0.19) had a protective role for being reactor to bTB. This study showed that increased milk production was associated with a higher risk of becoming positive to tuberculin skin test in high-yielding Holstein cows.

Use of Alternative Wood for the Ageing of Brandy de Jerez.

The use of alternative types of wood has arisen for the aging of the Brandy de Jerez, on a pilot plant level. In particular, besides the use of American oak, two more types of oak have been studied, French oak and Spanish oak, allowed by the Technical File for the ID Brandy de Jerez, and chestnut, which, though it is not officially allowed, is a type of wood which had been traditionally used in the area for the aging of wines and distillates. All of them have been studied with different toasting levels: Intense toasting and medium toasting. The study of the total phenolic composition (TPI), chromatic characteristics, organic acids, and sensory analysis have proven that chestnut leads to distillates with a higher amount of phenolic compounds and coloring intensity than oak. This behavior is the opposite as regards the toasting of the wood. Among the different types of oak, Spanish oak produces aged distillates with a higher phenolic composition and a higher color intensity. Regarding tasting, the best-assessed samples were those aged with chestnut, French oak, and American oak, and the assessors preferred those who had used a medium toasting level to those with an intense level.

Effect of the type of wood used for ageing on the volatile composition of Pedro Ximénez sweet wine.

BACKGROUND: The present study investigated the volatile composition of a Pedro Ximénez sweet wine that had been aged in barrels made of different types of wood (Spanish oak, French oak, American oak and chestnut) and subjected to different degrees of toasting (medium toasting and intense toasting). The analyses were carried out using stir bar sorptive extraction gas chromatography-mass spectrometry after validation of the matrix in this case. RESULTS: Good values of linearity, precision, limits of detection and limits of quantification were obtained for the 36 compounds studied, six of which were identified for the first time in Pedro Ximénez (propyl acetate, cis-3-hexenyl acetate, benzyl acetate, guaiacol, trans-whiskeylactone and 4-ethylguaiacol). The volatile composition of the samples varied as the ageing process progressed, and higher volatile concentrations were obtained in samples aged in barrels that had been intensely toasted compared to in those with medium toasting. A multivariate statistical study allowed the samples to be correctly classified according to ageing time, wood toasting and the type of wood used for ageing. CONCLUSION: The organoleptic analysis performed on the Pedro Ximénez sweet wine samples resulted in differences between the wines aged in the different types of wood during the early weeks of ageing, and scarce differences towards the end of the study period. At the end of the process, all of the wines were better valued and wines aged in medium toasted barrels were the best rated by the panel of judges for all four woods under investigation. This fact could indicate the suitability of alternative woods for the ageing of Pedro Ximénez sweet wines. © 2020 Society of Chemical Industry.

Dissected aberrant right subclavian artery with Kommerell diverticulum.

Aberrant right subclavian artery is the most frequent anomaly of the aortic arch, and in 60% of cases is associated with Kommerell diverticulum. It is usually asymptomatic but may present with dysphagia or asthma due to esophageal and tracheal compression. Indications for surgical repair have not been established; however, when Kommerell diverticulum is complicated by aortic dissection the treatment is surgery. We present the case of a 54-year-old man with thoracic pain due to dissection of an aberrant right subclavian artery associated with Kommerell diverticulum. Elective surgical treatment was performed.

Páncreas heterotópico. Obstrucción intestinal por invaginación del yeyuno / Heterotopic Pancreas. Intestinal Obstruction Caused by a Yeyunal Intussuception

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Mitral Ring Extraction due to Nickel Allergy.

The incidence of allergic reactions due to mechanical prosthesis or rings is not well established. We report the case of a 56-year-old man who presented a persistent urticarial rash and anaphylactic shock after a mitral valve repair operation. Prick skin tests were positive for nickel. After the nucleus from the mitral annulus was removed, the urticarial rash disappeared.

Electronically tunable anion-π interactions in pyrylium complexes: experimental and theoretical studies.

Noncovalent interactions of anions with electron-deficient aromatic rings that have been studied so far involve non-heteroaromatic or nitrogen-based heteroaromatic systems. Here we report the first case of an organic oxygenated aromatic system, in particular the tri-aryl-pyrylium tetrafluoroborate system, for which noncovalent anion-π interactions of the pyrylium cation with the tetrafluoroborate anion have been experimentally detected and demonstrated by means of (19)F NMR spectroscopy in solution. A series of pyrylium tetrafluoroborate salts were synthesized in the presence of BF3·Et2O, by direct reaction of 4-substituted benzaldehydes with 4-substituted acetophenones or via the previously obtained chalcone of the less reactive ketone. Correlations of (19)F NMR chemical shifts of tetrafluoroborate anion for most of the synthesized tri-arylpyrylium tetrafluoroborate complexes with both the pyrylium cation molecular weight and the standard substituent Hammett constants, demonstrate anion-π(+) interaction to act between the polyatomic anion BF4(-) and the pyrylium aromatic system. DFT calculations reveal that an additional (C-H)(+)-anion hydrogen bond involving the H(5) of pyrylium ring exists for these fluorescent dyes that show a tunable cup-to-cap shape cavity. The strong fluorescence emission observed for some representative pyrylium tetrafluoroborates described herein, makes them a promising class of tunable emission wavelength dyes for laser technology applications.

Experience, outcomes and impact of delayed indication for video-assisted wide septal myectomy in 69 consecutive patients with hypertrophic cardiomyopathy.

OBJECTIVES: The aim of this study was to evaluate outcomes in our department after surgery for obstructive hypertrophic cardiomyopathy and to establish the impact of a delay on the indication for surgery. METHODS: From January 1998 to February 2011, 69 patients with obstructive hypertrophic cardiomyopathy and left ventricular outflow tract obstruction at rest were operated on by the same team, and followed up for at least 1 year. We retrospectively analysed clinical data, echocardiography and ambulatory Holter electrocardiogram findings before surgery, early after surgery, at 3 months and annually at follow-up, to detect possible prognostic determinants. RESULTS: We performed isolated septal myectomy in 59 patients and a combined procedure in 10 patients. Mean outflow tract gradient decreased by 72.2 mmHg (SD 37.3) and there was a mean reduction in thickness of 8.2 mm (SD 5.8) in the interventricular septum. Functional capacity, measured as New York Heart Association class, and angina of effort improved significantly after surgery (P < 0.0001). In-hospital mortality rate was 1.44% for isolated myectomy and 4.35% for combined procedures. Global actuarial survival at 5-year follow-up was 87.4%, but if those patients who were in functional class II or less at the time of surgery were considered, survival rose to 100%. However, 43 patients (62.3%) with functional class III or higher were operated upon. CONCLUSIONS: Clinical, haemodynamic and mortality outcomes after surgery were excellent, especially in those patients with mild or few symptoms. However, in our location, surgery is still undertaken at an advanced stage of the natural history of the disease, which may adversely affect prognosis.

Synthesis of cyclically constrained sugar derived α/ß- and α/γ-peptides.

A general approach to enantiopure conformationally constrained sugar derived α/ß- and α/γ-peptides has been established. Five-membered ring α/ß-peptides were synthesized via formyl C-glycofuranosides, easy available from hexose-derived azido-2-equatorial-OH-glycopyranosides by DAST-promoted ring contraction. By means of a regioselective oxidation with TEMPO at C-6 of hexose-derived 3-azido glycopyranosides as the key step, two- and three-residue α/γ-peptides having a six-membered ring were obtained in good yields and under very simple experimental conditions.

Impact of demographic trends on future development patterns and the loss of open space in the California Mojave Desert.

During the post-World War II era, the Mojave Desert Region of San Bernardino County, California, has experienced rapid levels of population growth. Over the past several decades, growth has accelerated, accompanied by significant shifts in ethnic composition, most notably from predominantly White non-Hispanic to Hispanic. This study explores the impacts of changing ethnicity on future development and the loss of open space by modeling ethnic propensities regarding family size and settlement preferences reflected by U.S. Census Bureau data. Demographic trends and land conversion data were obtained for seven Mojave Desert communities for the period between 1990 and 2001. Using a spatially explicit, logistic regression-based urban growth model, these data and trends were used to project community-specific future growth patterns from 2000 to 2020 under three future settlement scenarios: (1) an "historic" scenario reported in earlier research that uses a Mojave-wide average settlement density of 3.76 persons/ha; (2) an "existing" scenario based on community-specific settlement densities as of 2001; and (3) a "demographic futures" scenario based on community-specific settlement densities that explicitly model the Region's changing ethnicity. Results found that under the demographic futures scenario, by 2020 roughly 53% of within-community open space would remain, under the existing scenario only 40% would remain, and under the historic scenario model the communities would have what amounts to a deficit of open space. Differences in the loss of open space across the scenarios demonstrate the importance of considering demographic trends that are reflective of the residential needs and preferences of projected future populations.