Clinical Features of Cardiac Calcified Amorphous Tumor: A Narrative Review.

A cardiac calcified amorphous tumor (CAT) is a non-neoplastic cardiac mass composed of calcified nodules surrounded by amorphous fibrous tissue in a context of degeneration and chronic inflammation. Although CAT cases are increasingly reported, its clinical manifestation remains unclear. We aimed to conduct a narrative review of CAT and identify its clinical characteristics. We conducted a comprehensive literature search using PubMed, with the keyword "Cardiac Calcified Amorphous Tumor" to identify relevant articles. A total of 113 articles published between 1997 and 2022 were retrieved. The clinical features allowing for assess patient background, differences with and without end-stage renal disease (ESRD), symptom-related factors, risk factors for embolism caused by CAT, and features of CAT, such as shape, location, mobility, pathology, and treatment, were statistically analyzed in 106 criteria-matched cases. The mean patient age was 60.2 ± 18.6 years, with 45 men and 61 women. Of the data collected from 21 countries, 52 patients were from Japan. Mobile CAT was more common in the chronic renal failure group. Linear, club-shaped, and spindle-shaped CAT tended to be mobile and more common in the ESRD group as well as located in the mitral valve region. The shape, mobility, location, and underlying mechanism of CAT depended on the presence or absence of ESRD. The risk of embolism was considered high because mobile CAT was more common in the ESRD group, and CAT originated in the mitral valve region. Hence, early diagnosis based on periodic examination in patients with ESRD and aggressive surgical treatment are necessary.

Correction: Comparison of short-term clinical outcomes between low-dose prasugrel and clopidogrel as part of triple antithrombotic therapy in patients requiring oral anticoagulant therapy and percutaneous coronary intervention.

[This corrects the article DOI: 10.1371/journal.pone.0272140.].

Comparison of short-term clinical outcomes between low-dose prasugrel and clopidogrel as part of triple antithrombotic therapy in patients requiring oral anticoagulant therapy and percutaneous coronary intervention.

BACKGROUND: Triple antithrombotic therapy, including dual antiplatelet therapy and oral anticoagulant (OAC), is recommended for a short-term period after percutaneous coronary intervention (PCI) in patients requiring anticoagulation therapy. The purpose of this study was to compare in-hospital clinical outcomes between low-dose prasugrel (3.75 mg/day) and clopidogrel, as part of triple antithrombotic therapy, using a large database in Japan. METHODS: Patients with ischemic heart disease who underwent PCI between January 2015 and December 2019, and were prescribed triple therapy with aspirin, a P2Y12 inhibitor (clopidogrel or low-dose prasugrel), and OAC (direct oral anticoagulant: DOAC or vitamin K antagonist: VKA), were selected from the Diagnosis Procedure Combination database. The primary outcome was in-hospital mortality. The secondary outcomes were myocardial infarction, ischemic stroke, bleeding stroke, gastrointestinal bleeding, and blood transfusion. RESULTS: Overall, 5,777 patients were eligible in this analysis. The patients were divided into 4 subgroups according to the type of P2Y12 inhibitor and OAC: clopidogrel/DOAC (n = 1,628), clopidogrel/VKA (n = 1,334), prasugrel/DOAC (n = 1,607), and prasugrel/VKA (n = 1,208). There was no significant difference in the incidence of death and gastrointestinal bleeding among the 4 subgroups. The prasugrel/DOAC group had significantly lower incidence of MI (OR 0.566, 95% CI 0.348-0.921). The incidence of ischemic stroke was significantly lower in the prasugrel/DOAC group (OR 0.701, 95% CI 0.502-0.979), and significantly higher in the clopidogrel/VKA group (OR 1.680, 95% CI 1.273-2.216). Need for blood transfusion was less frequent in the prasugrel/DOAC group (OR 0.729, 95% CI 0.598-0.890), and more frequent in both the clopidogrel/VKA group (OR 1.424, 95% CI 1.187-1.708) and the prasugrel/VKA group (OR 1.633, 95% CI 1.367-1.950). CONCLUSIONS: Combination of low-dose prasugrel and DOAC was associated with lower incidence of MI, ischemic stroke, and blood transfusion. Low-dose prasugrel may be feasible as part of triple therapy in patients undergoing PCI.

The uptake characteristics of Prussian-blue nanoparticles for rare metal ions for recycling of precious metals from nuclear and electronic wastes.

We have examined the uptake mechanisms of platinum-group-metals (PGMs) and molybdenum (Mo) ions into Prussian blue nanoparticles (PBNPs) in a nitric acid solution for 24-h sorption test, using inductively coupled plasma atomic emission spectroscopy, powder XRD, and UV-Vis-NIR spectroscopy in combination with first-principles calculations, and revealed that the Ru4+ and Pd2+ ions are incorporated into PBNPs by substitution with Fe3+ and Fe2+ ions of the PB framework, respectively, whereas the Rh3+ ion is incorporated into PBNPs by substitution mainly with Fe3+ and minorly with Fe2+ ion, and Mo6+ ion is incorporated into PBNPs by substitution with both Fe2+ and Fe3+ ions, with maintaining the crystal structure before and after the sorption test. Assuming that the amount of Fe elusion is equal to that of PGMs/Mo substitution, the substitution efficiency is estimated to be 39.0% for Ru, 47.8% for Rh, 87% for Pd, and 17.1% for Mo6+. This implies that 0.13 g of Ru, 0.16 g of Rh, 0.30 g of Pd, and 0.107 g of Mo can be recovered by using 1 g PBNPs with a chemical form of KFe(III)[Fe(II)(CN)6].

Removal of a frozen elephant trunk using a polyvinyl tube.

The increasing use of total arch replacement and frozen elephant trunk (FET) is expected to lead to an increase in the prevalence of graft infections requiring replacement involving an FET, which is generally a more invasive procedure than the initial surgery. Herein, we describe a novel method for FET removal using a polyvinyl tube as the storage device. The procedure is completed using the same median sternotomy approach as the initial surgery. We report on the outcomes for six patients. Our procedure is simple to perform and safe and caused no injury to the aorta in our case series.

Thoracoscopic infrared ablation to create a box lesion as a treatment for atrial fibrillation.

BACKGROUND: Creating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, it is still difficult to create a transmural lesion at unclampable sites because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF). CASE PRESENTATION: A 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events. CONCLUSIONS: The infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.

The uptake mechanism of palladium ions into Prussian-blue nanoparticles in a nitric acid solution toward application for the recycling of precious metals from electronic and nuclear wastes.

We have investigated the uptake mechanism of palladium (Pd: one of the most important elements in industry used as a catalyst) ions into Prussian-blue nanoparticles (PBNPs) in a nitric acid solution via high-resolution electron transmission microscopy, inductively coupled plasma atomic emission spectroscopy, powder X-ray diffraction, and ultraviolet-visible-near infrared spectroscopy in combination with first principles calculations. Comparison of the structural and electronic properties of PBNPs between before and after a 24 h sorption test reveals that the Pd2+ ions incorporated into PBNPs by the substitution of Fe2+ ions of the PB framework while maintaining the crystal structure, and the substitution efficiency is estimated to be 87% per PB unit cell. This implies that 0.30 g of Pd can be recovered by using 1 g of PB having the chemical formula KFe(iii)[Fe(ii)(CN)6]. The present finding suggests that PB (or its analogues) can be applied to recycle noble and rare metals from electronic and nuclear wastes.

Hydrothermal-treatment desorption of cesium from clay minerals: The roles of organic acids and implications for soil decontamination.

The adsorption and desorption of cesium (Cs) on clays of contaminated soil in a rhizosphere zone can be greatly affected by various biogeochemical processes, the timespans of which are usually months to years. Herein, we present several representative scenarios of the binding of Cs on diverse sites of vermiculitized biotite by controlled Cs adsorption to particles of different sizes. We investigated whether and how the fixed Cs in the different scenarios is desorbed by ambient and hydrothermal treatments with several low-molecular-weight organic acids (LMWOAs). The results showed that the sorbed Cs was discriminatively retained in the un-collapsed, partially collapsed, and thoroughly collapsed structures of vermiculites. The desorption of the sorbed Cs by hydrothermal LMWOAs extractions was easily realized in the un-collapsed structure, but was limited or minimal in the partially collapsed and thoroughly collapsed structures. The Cs desorption varied in accord with the LMWOA species applied and increased with the acid concentration, temperature, and number of treating cycles. The analysis of Cs-desorbed specimens confirmed their partial destruction and interlayer expansion, suggesting that the underlying mechanism of Cs removal by LMWOAs involves not only acid dissolution and complexation but also the accelerated weathering of clays within a short time under hydrothermal conditions. Our findings contribute novel insights into the mobility, bioavailability, and fate of Cs in contaminated soils and its removal from these soils for environmental restorations.

Arterial-bronchial fistula from ruptured immunoglobulin G4-related subclavian artery aneurysm.

Immunoglobulin G4 (IgG4)-related disease is a systemic chronic inflammatory disease caused by infiltration of IgG4-positive plasma cells into the systemic organs. IgG4-related arterial disease is relatively rare not only in the aorta but also in the small to medium-sized arteries. If IgG4-related vasculitis is suspected on the basis of the preoperative medical history and radiologic and serologic examination findings, a definitive diagnosis can be obtained by open repair and pathologic examination to determine the prognosis and need for additional treatment. Here, we report the successful treatment of arterial-bronchial fistula caused by a ruptured IgG4-related subclavian artery aneurysm.

Adult ALCAPA: from histological picture to clinical features.

BACKGROUND: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly that results in high mortality if left untreated. Our aim was to extend our knowledge of the histological, angiographic, and clinical characteristics of ALCAPA in order to deepen our understanding of this rare entity. CASE PRESENTATION: We were involved in the assessment, treatment, and pathological evaluation of two adult ALCAPA patients who were rescued from ventricular fibrillation and then surgically treated to establish a dual coronary artery system. Histological studies indicated various chronic ischemic changes in the myocardium, patchy fibrosis, and severely thickened arteriolar walls in both ventricles. The first patient is alive and well 11.5 years after surgical correction without any implantable cardioverter defibrillator (ICD) activations. The second patient required re-do surgery 9 months after the initial operation but subsequently died. Histologically, chronic ischemic alteration of the myocardium and thickened arteriolar walls persisted even after surgical correction, and coronary angiography (CAG) showed an extremely slow flow phenomenon even after surgical correction in both patients. The average postoperative opacification rate in the first case was 7.36 + 1.12 (n = 2) in the RCA, 3.81 + 0.51 (n = 3) in the left anterior descending (LAD) artery, and 4.08 + 0.27 (n = 4) in the left circumflex (LCx) artery. The slow flow phenomenon may represent persistent high arteriolar resistance in both ventricles. CONCLUSIONS: Seldom reported or new findings in adult ALCAPA were identified in two cases. More frequent diagnosis of adult ALCAPA can be expected because of the widespread availability of resuscitation and more advanced diagnostic modalities. Accumulation of pathological and clinical findings and confirmation of the long-term follow-up results after treatment may contribute to expanding our knowledge of this rare entity and establishing optimal treatment.

Effects of Diluents on the Separation of Minor Actinides from Lanthanides with Tetradodecyl-1,10-phenanthroline-2,9-diamide from Nitric Acid Medium.

To investigate the effective separation of actinides (Ans) from lanthanides (Lns), single-stage batch extraction experiments were performed with a novel extractant, tetradodecyl-1,10-phenanthroline-2,9-diamide (TDdPTDA) with various diluents such as 3-nitrobenzotrifluoride (F-3), nitrobenzene, and n-dodecane for Am, Cm, and Lns. The extraction kinetics with TDdPTDA was rapid enough to perform continuous extraction experiments using mixer-settler extractors. The slopes of the distribution ratio versus the TDdPTDA concentration and the distribution ratio versus the nitric acid concentration were similar for F-3 and nitrobenzene systems, but different from the n-dodecane system. These differences were attributed to the characteristics of the diluents. This study revealed high distribution ratios of Am (DAm) and Cm (DCm) for TDdPTDA, with the high separation factors (SFs) of Am from Lns enough for their separation.

Selective removal of radiocesium from micaceous clay for post-accident soil decontamination by temperature-controlled Mg-leaching in a column.

The effective and efficient removal of radioactive Cs from contaminated soil is highly urgent for the nuclear post-accident remediation. In present study, we achieved rapid Cs desorption from both a typical micaceous clay (i.e., vermiculitized biotite, VB) and actually contaminated soil by high-speed ion exchange through temperature-controlled continuous leaching with Mg-solutions in a column reactor. Cs-sorbed VB was firstly employed as a soil surrogate to explore the macro-Cs desorption process and micro-mechanism in detail. Results showed that VB sandwiched the adsorbed Cs to its interlayers within collapsed structure (10.7 Å) and prevent Cs release even by abundant extraction with H2O at 250 °C or Mg2+ at 25 °C. However, Mg2+-extracted Cs desorption boosted significantly with elevating temperatures and 100 % of sorbed-Cs was removed from Cs-VB leached above 150 °C. Further structural and composition analysis of the leached specimen ensured that solvated Mg2+ preferentially entered into Cs+-collapsed interlayers at 150 °C than K+-interlayers above 200 °C, leading to prior complete Cs removal over K from VB at lower temperatures. By contrast, the Cs-contaminated soil reduced by ∼39 % but ∼82 % of its initial radioactivity after equally leaching with same volumes of Mg2+-solution at 150 and 200 °C, respectively. These temperature-controlled Cs desorption validated that radioactive Cs in actual soil indeed be tightly trapped by micaceous clays nearly in the Cs-K co-collapsed interlayers, to which its extraction by other cations can conditionally occur above enough high leaching temperatures. These superior features would inspire new insights for the design of novel practical technologies for treatment and decontamination of the nuclear post-accident soils.

[How to Insert an Intraaortic Balloon Pumping(IABP)].

The Intra Aortic Balloon Pumping( IABP) is a circulatory assist device widely used in cardiovascular surgery area. The IABP increases coronary perfusion and (may increase?)intracranial blood flow through diastolic augmentation mechanism and it reduces afterload and myocardial oxygen consumption through systolic unloading mechanism. Safer insertion of the IABP is able to be accomplished with the assistance of radioscopy or a transesophageal echocardiography(TEE). Based on the experience in our institution, we describe the IABP insertion technique with a TEE guide.

Epicardial infrared ablation to create a linear conduction block on a beating right atrium.

BACKGROUND: It is still difficult to create a secure linear conduction block on a beating heart from the epicardial side. To overcome this drawback we developed an infrared coagulator equipped with a cuboid light-guiding quartz rod. This study was designed to electrophysiologically confirm the efficacy of a new ablation probe using infrared energy in a clinical case. METHODS: The infrared light from a lamp is focused into the newly developed cuboid quartz rod, which has a rectangular distal exit-plane that allows 30 mm × 10 mm linear photocoagulation. Two pairs of electrodes were attached to the right atrium of a patient who was undergoing surgery. Each pair of electrodes was placed 10 mm from an ablation line. The change in conduction time between the two pairs of electrodes was measured during ablation. The predicted conduction time delay ratio was 1.54. RESULTS: The actual conduction time after ablation was 1.38-1.43 times longer than the pre-ablation conduction time. CONCLUSIONS: The infrared ablation using a newly developed cuboid probe made it possible to create a linear conduction block on the beating right atrial free wall clinically.

Selective separation of cadmium(ii) from zinc(ii) by a novel hydrophobic ionic liquid including an N,N,N',N'-tetrakis(2-methylpyridyl)-1,2-phenylenediamine-4-amido structure: a hard-soft donor combined method.

A novel hydrophobic ionic liquid including an N,N,N',N'-tetrakis(2-methylpyridyl)-1,2-phenylenediamine-4-amido structure ((IL-1,2-tpbd)+NTf2-) was successfully synthesized. (IL-1,2-tpbd)+NTf2- combined one amido (O-hard donor) and four pyridine (N-soft donor) groups. Its Cd2+ and Zn2+ separation behavior in nitric acid solution was investigated as a function of the extraction time, effect of pH etc. by dissolving (IL-1,2-tpbd)+NTf2- in a room temperature ionic liquid, 1-hexyl-3-methylimidazolium bis(trifluoromethanesulfonyl)imide ((C6mim)+NTf2-). The extraction kinetics were fairly fast and could reach equilibrium within 4 h. When pHeq ≥ 1.8, the extraction percentage of Cd2+ and Zn2+ remained constant and the maximum separation factor was calculated as 12.78 at pHeq = 3.1; when pHeq < 1.8, the extraction percentage of Cd2+ and Zn2+ decreased drastically due to the protonation of the pyridine groups. Complete stripping of the extracted Cd2+ and Zn2+ from the ionic liquid phase into an aqueous phase was successfully achieved under highly acidic conditions ([HNO3] = 2 M) without adding any other metal complex forming agents. The extraction mechanism was summarized as a cation exchange due to the independence of nitrate ions in the extraction process. Additionally, the results of the slope analysis and UV-vis titration revealed the formation of a 1 : 2 complex. Furthermore, (IL-1,2-tpbd)+NTf2- showed a higher preference for Cd2+ even under the interference of various co-existing metal ions.

Off-pump hemostasis for left ventricular rupture after myocardial infarction with Hydrofit® and Surgicel®.

Left ventricular free wall rupture (LVFWR) is a catastrophic complication of myocardial infarction. In these cases, cardiopulmonary bypass (CPB) should be performed for left ventricular repair, but can impact hemodynamic stability. An 87-year-old man presented with acute shock. He was diagnosed with LVFWR after myocardial infarction. We describe a simple, effective, and reproducible technique to achieve hemostasis at the LVFWR site during emergency operation using Hydrofit® and Surgicel® surgical hemostatic agents. We simply placed and manually pressed the Hydrofit® and Surgicel® composite on the bleeding site. This technique provides complete hemostasis without CPB establishment.

Effects of NH4+, K+, Mg2+, and Ca2+ on the Cesium Adsorption/Desorption in Binding Sites of Vermiculitized Biotite.

The reversibility of cesium adsorption in contaminated soil is largely dependent on its interaction with micaceous minerals, which may be greatly influenced by various cations. Herein, we systematically investigated the effects of NH4+, K+, Mg2+, and Ca2+ on the adsorption/desorption of Cs+ into different binding sites of vermiculitized biotite (VB). Original VB was initially saturated by NH4+, K+, or Mg2+; we then evaluated the adsorption of Cs+ on three treated VBs, and the desorption by extraction with NH4+, K+, Mg2+, or Ca2+ was further evaluated. Our structural analysis and Cs+ extractability determinations showed that NH4+ and K+ both collapsed the interlayers of VB, resulting in the dominant adsorption of Cs+ to external surface sites on which Cs+ was readily extracted by NH4+, K+, Mg2+, or Ca2+ irrespective of their species, whereas Mg2+ maintained the VB with expanded interlayers, leading to the overwhelming adsorption of Cs+ in collapsed interlayer sites on which the Cs+ desorption was difficult and varied significantly by the cations used in extraction. The order of Cs+ extraction ability from the collapsed interlayers was K+ ≫ Mg2+ ≈ Ca2+ ≫ NH4+. These results could provide important insights into Cs migration in soil and its decontamination for soil remediation.