A hybrid open-top light-sheet microscope for versatile multi-scale imaging of cleared tissues.

Light-sheet microscopy has emerged as the preferred means for high-throughput volumetric imaging of cleared tissues. However, there is a need for a flexible system that can address imaging applications with varied requirements in terms of resolution, sample size, tissue-clearing protocol, and transparent sample-holder material. Here, we present a 'hybrid' system that combines a unique non-orthogonal dual-objective and conventional (orthogonal) open-top light-sheet (OTLS) architecture for versatile multi-scale volumetric imaging. We demonstrate efficient screening and targeted sub-micrometer imaging of sparse axons within an intact, cleared mouse brain. The same system enables high-throughput automated imaging of multiple specimens, as spotlighted by a quantitative multi-scale analysis of brain metastases. Compared with existing academic and commercial light-sheet microscopy systems, our hybrid OTLS system provides a unique combination of versatility and performance necessary to satisfy the diverse requirements of a growing number of cleared-tissue imaging applications.

Three-dimensional residual channel attention networks denoise and sharpen fluorescence microscopy image volumes.

We demonstrate residual channel attention networks (RCAN) for the restoration and enhancement of volumetric time-lapse (four-dimensional) fluorescence microscopy data. First we modify RCAN to handle image volumes, showing that our network enables denoising competitive with three other state-of-the-art neural networks. We use RCAN to restore noisy four-dimensional super-resolution data, enabling image capture of over tens of thousands of images (thousands of volumes) without apparent photobleaching. Second, using simulations we show that RCAN enables resolution enhancement equivalent to, or better than, other networks. Third, we exploit RCAN for denoising and resolution improvement in confocal microscopy, enabling ~2.5-fold lateral resolution enhancement using stimulated emission depletion microscopy ground truth. Fourth, we develop methods to improve spatial resolution in structured illumination microscopy using expansion microscopy data as ground truth, achieving improvements of ~1.9-fold laterally and ~3.6-fold axially. Finally, we characterize the limits of denoising and resolution enhancement, suggesting practical benchmarks for evaluation and further enhancement of network performance.

Dyslipidemia in adults with congenital heart disease: A systematic review and meta-analysis.

AIMS: Several particular characteristics of patients with congenital heart disease could affect lipid levels. The objectives of this study were: a) to analyze the prevalence of dyslipidemia in congenital heart disease patients; 2) to compare lipid levels between congenital heart disease patients and a control group. DATA SYNTHESIS: This systematic review and meta-analysis was performed according to PRISMA guidelines (PROSPERO CRD42023432041). A literature search was performed to detect studies that have reported lipid levels or the prevalence of dyslipidemia in congenital heart disease patients. We performed a qualitative analysis (studies that reported dyslipidemia prevalence) and quantitative analysis (studies that compared lipid values between congenital heart disease patients and controls). In total, 29 observational studies involving 22,914 patients with congenital heart disease and 641,086 controls were eligible for this review. The reported presence of "hyperlipidemia" or "dyslipidemia" ranged from 14.3% to 69.9%. When studies analyzed lipid variables dichotomously between congenital heart disease patients and controls, the results were conflicting. The quantitative analysis showed that patients with congenital heart disease have lower levels of total cholesterol (MD: -18.9 [95% CI: -22.2 to -15.7]; I2 = 93%), LDL-C (MD: -10.7 [95% CI: -13.1 to -8.3]; I2 = 90%) and HDL-C (MD: -6.3 [95% CI: -7.7 to -4.9]; I2 = 95%) compared to controls. CONCLUSIONS: The qualitative analysis showed some concerns, but the quantitative analysis indicates that congenital heart disease patients showed lower levels of total cholesterol, LDL-C, and HDL-C compared to controls. New research should be developed to clarify this relevant topic.

[Fulminant myocarditis in a patient with a history of autoimmune hepatitis]. / Miocarditis fulminante en paciente con antecedente de hepatitis autoinmune.

Myocarditis is an inflammatory disease of the cardiac tissue of variable etiology, both infectious and non-infectious. Its presentation can range from asymptomatic to fulminant forms. We present the case of a 24-year-old male patient with a history of autoimmune hepatitis in compensated cirrhotic phase. He consulted for dyspnea of 15 days evolution. He had presented gastrointestinal symptoms one month prior to the consultation. Physical examination revealed signs of heart failure. Laboratory examination showed elevated cardiac biomarkers and acute on chronic hepatic insufficiency. A transthoracic echocardiogram showed severe global biventricular dysfunction. The diagnostic hypotheses were cardiac involvement due to reactivation of autoimmune disease versus viral myocarditis. An MRI was performed which confirmed very severe ventricular dysfunction and late gadolinium enhancement suggestive of myocarditis. It was indicated treatment with methylprednisolone pulses. On the first day of hospitalization he evolved with clear signs of cardiogenic shock and ventricular arrhythmia refractory to medical treatment. After an exhaustive multidisciplinary evaluation, which was difficult due to his clinical condition, the possibility of a heart transplant was considered. Extracorporeal membrane oxygenation (ECMO) support was established as a bridge to transplantation. On the seventh day after ECMO, and after great improvement of the hepatogram parameters, the patient received a heart transplant. He had good postoperative evolution. However, he died two months after the transplant due to an opportunistic infection. The results of the biopsy of the explanted organ confirmed the diagnosis of lymphocytic myocarditis.

La miocarditis es una enfermedad inflamatoria del tejido cardíaco de etiología variable, infecciosa o no infecciosa. Su presentación va desde formas asintomáticas hasta fulminantes. Se presenta el caso de un varón de 24 años, con antecedente de hepatitis autoinmune, en fase cirrótica compensada. Consultó por disnea de 15 días de evolución. Presentó cuadro gastrointestinal un mes previo a la consulta. El examen físico reveló signos de sobrecarga hídrica. El laboratorio informó elevación de biomarcadores cardiacos, insuficiencia hepática aguda sobre crónica y graves trastornos de coagulación. Se realizó un ecocardiograma transtorácico que evidenció disfunción biventricular grave global, con adelgazamiento de las paredes. Las hipótesis diagnósticas fueron compromiso cardíaco por reactivación de enfermedad autoinmune versus miocarditis viral. Se realizó una resonancia magnética que confirmó la disfunción ventricular grave en la que se observó realce tardío de gadolinio sugestivo de miocarditis. Se indicó tratamiento con pulsos de metilprednisolona. El primer día de la internación evolucionó con signos de shock cardiogénico y arritmia ventricular refractaria al tratamiento. Posteriormente a una evaluación multidisciplinaria exhaustiva y dificultosa por el estado clínico, se planteó la posibilidad de un trasplante cardiaco. Se instauró soporte con membrana de oxigenación extracorpórea (ECMO) como puente al trasplante. Al séptimo día de colocado el ECMO, y luego de gran mejoría de los parámetros del hepatograma, recibió un trasplante cardíaco. Tuvo buena evolución postoperatoria, sin embargo, a los dos meses falleció por una infección oportunista. Los resultados de la biopsia del órgano explantado confirmaron el diagnóstico de miocarditis linfocítica.

Postmenopausal Hyperandrogenism due to Ovarian Hyperthecosis.

Ovarian hyperthecosis or ovarian stromal hyperplasia is a non-neoplastic functional disorder resulting from the presence of luteinized thecal cells within a hyperplastic ovarian stroma. The condition is more common in postmenopausal women than in those of reproductive age and leads to substantial clinical and laboratory alterations, principally androgenetic alopecia, progressive hirsutism, and elevated testosterone levels. Investigation should include clinical evaluation, laboratory tests, and imaging tests to differentiate between the principal diagnostic hypotheses. The gold standard for diagnosis is histopathology of the ovarian tissue. The present case report describes a woman being followed up as an outpatient at the Santa Casa de Misericórdia Hospital in Vitória, Brazil. The objective in publishing this case report is to add to available data on ovarian hyperthecosis, thus contributing towards improving timely diagnosis and treatment. Early diagnosis and treatment would ensure better quality of life for patients with this condition and better physical and mental health. Moreover, these data should be useful both for the medical community and for future research into this disease.

Down the Dimensionality Lane: Thermal Conductivity Enhancement in Carbon-Based Liquid Dispersions.

Carbon allotropes of different dimensionality, i.e., 1D-carbon nanotubes, 2D-graphene nanoplatelets, and 3D-graphite, possess high thermal conductivity (TC > 2000 W/m K). They are, therefore, excellent candidates for filler material aiming at increasing the TC of composites used for thermal management. However, preparing aqueous dispersions of these materials is challenging due to their strong van der Waals attraction, leading to aggregation and subsequent precipitation. Reported dispersion methodologies have failed to disperse large microscale fillers, which are essential for efficient thermal management. In this work, we suggest to "kinetically arrest" the dispersion by using sepiolite, a fiberlike clay, that effectively disperses all three carbon dimensionalities. We explore the effect of filler dimensionality and properties (lateral size, thickness, defect density) on the dispersion TC enhancement. Modeling the TC by the effective medium approach allows lumping all the intrinsic properties of the filler into a single parameter termed "effective TC", providing an accurate prediction of the experimentally measured TC. We show that, by judicious choice of filler, the TC of both water and a water-ethylene glycol mixture can be enhanced by 31% using graphene nanoplatelets of 15 µm in lateral size. We believe that the guidelines obtained in this work provide a useful tool for designing future liquid composites with enhanced thermal properties.

[Takotsubo syndrome and multivessel coronary disease]. / Síndrome de Takotsubo y enfermedad multivaso.

Takotsubo syndrome is a generally reversible cardiomyopathy often related to a stressor trigger, either physical or emotional. It is estimated that this entity represents between 1 and 6% of the cases of suspected acute coronary syndrome without ST segment elevation in women. Coexistence with coronary artery disease has been a matter of long controversy. On this matter, we present the clinical case of a 79-year-old hypertensive and dyslipidemic female with smocking history, who was referred to our institution presenting an episode of chest pain with anginal characteristics. During the conducted interrogation, she reported having been overpassing a stressfull moment in her private life. The electrocardiogram showed deep and diffuse negative T waves with prolonged QT interval. Laboratory findings revealed dissociation of biomarkers (troponin/ProBNP), and the transthoracic Doppler echocardiogram showed left ventricular dysfunction with apical ballooning. Given the differential diagnoses of acute coronary syndrome and TakoTsubo syndrome, a coronary angiography was performed, which revealed multiple epicardial coronary disease. However, due to the strong suspicion of stress cardiomyopathy, a cardiac magnetic resonance imaging with gadolinium was performed, which showed an improvement in the ejection fraction prior to revascularization with the presence of myocardial edema and absence of late gadolinium enhancement. The aforementioned characteristics led to the diagnosis of Takotsubo syndrome. The final decision of revascularization was based on the fact that the patient's principal complaint was typical anginal symptoms.

El síndrome de Takotsubo es una miocardiopatía generalmente reversible y con frecuencia relacionada a un desencadenante estresor ya sea físico o emocional. Se estima que esta entidad representa entre el 1 y 6% de los cuadros de sospecha de síndrome coronario agudo sin elevación del segmento ST en mujeres. La coexistencia con enfermedad coronaria ha sido objetivo de debate durante mucho tiempo. Se presenta el caso clínico de una mujer de 79 años, hipertensa, dislipémica y ex tabaquista que consulta a la guardia por presentar un episodio de dolor precordial con características anginosas. En el interrogatorio refirió situación estresante en su entorno familiar los días previos. El electrocardiograma mostró ondas T negativas profundas y difusas con prolongación del intervalo QT. En el laboratorio se observó disociación de marcadores (troponina/ ProBNP). En el ecocardiograma Doppler transtorácico se evidenció deterioro de la función ventricular con balonamiento apical. Ante los diagnósticos diferenciales de síndrome coronario agudo y síndrome de Takotsubo se realizó una cinecoronariografía en la cual se evidenció compromiso de las tres arterias coronarias epicárdicas. Pese a esto, por la fuerte sospecha de miocardiopatía por estrés se realizó una resonancia magnética cardíaca con gadolinio, la cual demostró mejoría de fracción de eyección previa a la revascularización con presencia de edema miocárdico y sin realce tardío de gadolinio. Las características mencionadas condujeron al diagnóstico de síndrome de Takotsubo. La decisión de revascularización, estuvo fundamentada en el hecho de que la consulta fue motivada por síntomas anginosos típicos con el esfuerzo.

Trapped and Alone: Clay-Assisted Aqueous Graphene Dispersions.

Dispersing graphene sheets in liquids, in particular water, could enhance the transport properties (like thermal conductivity) of the dispersion. Yet, such dispersions are difficult to achieve since graphene sheets are prone to aggregate and subsequently precipitate due to their strong van der Waals interactions. Conventional dispersion approaches, such as surface treatment of the sheets either by surfactant adsorption or by chemical modification, may prevent aggregation. Unfortunately, surfactant-assisted graphene dispersions are typically of low concentration (<0.2 wt %) with relatively small sheets (<1 µm lateral size) while chemical modification is punished by increased defect density within the sheets. We investigate here a new approach in which the concentration of dispersed graphene in water is enhanced by the addition of a fibrous clay mineral, sepiolite. As we demonstrate, the clay particles in water form a kinetically arrested particle network within which the graphene sheets are effectively trapped. This mechanism keeps graphene sheets of high lateral size (∼4 µm) dispersed at high concentrations (∼1 wt %). We demonstrate the application of such dispersions as cooling liquids for thermal management solutions, where a 26% enhancement in the thermal conductivity is achieved as compared to that in a filler-free fluid.

Prognostic value of NT-proBNP, and echocardiographic indices of diastolic function, in hospitalized patients with acute heart failure and preserved left ventricular ejection fraction.

BACKGROUND: Several parameters have proven useful in assessing prognosis in outpatients with heart failure with preserved ejection fraction (HFpEF). In contrast, prognostic determinants in HFpEF hospitalized for an acute event are poorly investìgated. AIM: To determine the predictive value of NT-proBNP, and diastolic function (assessed by E/e'), in patients with HFpEF hospitalized for acute heart failure. METHODS AND RESULTS: We evaluated 205 consecutive HFpEF patients admitted for acute heart failure (median age: 76[53,81], 36% male, median EF: 61 [54,77]). We assessed clinical, echocardiographic, and NT-proBNP values, on admission and at discharge. Primary end-point was the composite of all-cause death and/or HF rehospitalization. After a mean follow up of 28±10 months, 82 patients met the primary end-point; there were 30 deaths (14.6%), and 72 patients (35%) were rehospitalized for HF. By multivariable analysis, predictors of the composite end-point were: discharge E/e´ ≥14 (HR: 4.63 CI 95%: 2.71-18.2, p<0.0001), discharge NT-proBNP ≥1500 pg/ml (HR: 5.23, CI 95%: 2.87-17.8, p < 0.0001), ≥50% NT-proBNP decrease between admission and discharge (HR: 0.62, CI 95%: 0.25-0.79, p = 0.019). Combining E/e´ and NT-proBNP values at discharge further and significantly improved discrimination power compared to each variable analyzed separately (AUC, NT-proBNP at discharge: 0.80; E/e´ at discharge: 0.77; E/e´ + NT-proBNP: 0.88; p < 0.01). CONCLUSIONS: In HFpEF patients hospitalized with acute heart failure, assessment of E/e´ ratio and NT-proBNP at discharge provides prognostic information on top of other variables, and allows to easily identify a population at higher risk of subsequent death or rehospitalization for heart failure, during a medium-term follow up.

3D Particle Tracking for Noninvasive In Vivo Analysis of Synaptic Microtubule Dynamics in Dendrites and Neuromuscular Junctions of Drosophila.

Microtubules (MTs) play critical roles in neuronal development, but many questions remain about the molecular mechanisms of their regulation and function. Furthermore, despite progress in understanding postsynaptic MTs, much less is known about the contributions of presynaptic MTs to neuronal morphogenesis. In particular, studies of in vivo MT dynamics in Drosophila sensory dendrites yielded significant insights into polymer-level behavior. However, the technical and analytical challenges associated with live imaging of the fly neuromuscular junction (NMJ) have limited comparable studies of presynaptic MT dynamics. Moreover, while there are many highly effective software strategies for automated analysis of MT dynamics in vitro and ex vivo, in vivo data often necessitate significant operator input or entirely manual analysis due to inherently inferior signal-to-noise ratio in images and complex cellular morphology.  To address this, this study optimized a new software platform for automated and unbiased in vivo particle detection. Multiparametric analysis of live time-lapse confocal images of EB1-GFP labeled MTs was performed in both dendrites and the NMJ of Drosophila larvae and found striking differences in MT behaviors. MT dynamics were furthermore analyzed following knockdown of the MT-associated protein (MAP) dTACC, a key regulator of Drosophila synapse development, and identified statistically significant changes in MT dynamics compared to wild type. These results demonstrate that this novel strategy for the automated multiparametric analysis of both pre- and postsynaptic MT dynamics at the polymer-level significantly reduces human-in-the-loop criteria. The study furthermore shows the utility of this method in detecting distinct MT behaviors upon dTACC-knockdown, indicating a possible future application for functional screens of factors that regulate MT dynamics in vivo. Future applications of this method may also focus on elucidating cell type and/or compartment-specific MT behaviors, and multicolor correlative imaging of EB1-GFP with other cellular and subcellular markers of interest.

Dataset supporting the estimation and analysis of high spatial resolution inventories of atmospheric emissions from several sectors in Argentina.

This data article provides an extensive and complete description of the high spatial resolution inventory (HSRI) estimation shown in the article "High resolution inventory of atmospheric emissions from livestock production, agriculture, and biomass burning sectors of Argentina" Puliafito et al. [1], and its comparison with several sectors in Argentina. The dataset provided are high-resolution inventories (0.025° × 0.025° lat/long) for CO2, CH4, N2O and another 8 species from livestock, biomass burning, agriculture and another 12 sectors (based on 2016 year). In addition, we also provide the database for 2014 using the same methodology. The dataset presented are necessary to improve input inventories for air quality models. Also, they are better to inform and guide the stakeholders, in making decisions related to environmental protection and health promotion, as well as assessing the environmental performance in terms of atmospheric emissions of an activity, sector or region in Argentina.

Miocarditis fulminante en paciente con antecedente de hepatitis autoinmune / Fulminant myocarditis in a patient with a history of autoimmune hepatitis

Resumen La miocarditis es una enfermedad inflamatoria del tejido cardíaco de etiología variable, infecciosa o no in fecciosa. Su presentación va desde formas asintomáticas hasta fulminantes. Se presenta el caso de un varón de 24 años, con antecedente de hepatitis autoinmune, en fase cirrótica compensada. Consultó por disnea de 15 días de evolu ción. Presentó cuadro gastrointestinal un mes previo a la consulta. El examen físico reveló signos de sobrecarga hídrica. El laboratorio informó elevación de biomar cadores cardiacos, insuficiencia hepática aguda sobre crónica y graves trastornos de coagulación. Se realizó un ecocardiograma transtorácico que evidenció disfunción biventricular grave global, con adelgazamiento de las paredes. Las hipótesis diagnósticas fueron compromiso cardíaco por reactivación de enfermedad autoinmu ne versus miocarditis viral. Se realizó una resonancia magnética que confirmó la disfunción ventricular grave en la que se observó realce tardío de gadolinio suges tivo de miocarditis. Se indicó tratamiento con pulsos de metilprednisolona. El primer día de la internación evolucionó con signos de shock cardiogénico y arritmia ventricular refractaria al tratamiento. Posteriormente a una evaluación multidisciplinaria exhaustiva y dificulto sa por el estado clínico, se planteó la posibilidad de un trasplante cardiaco. Se instauró soporte con membrana de oxigenación extracorpórea (ECMO) como puente al trasplante. Al séptimo día de colocado el ECMO, y luego de gran mejoría de los parámetros del hepatograma, recibió un trasplante cardíaco. Tuvo buena evolución postoperatoria, sin embargo, a los dos meses falleció por una infección oportunista. Los resultados de la biopsia del órgano explantado confirmaron el diagnóstico de miocarditis linfocítica.

Abstract Myocarditis is an inflammatory disease of the cardiac tissue of variable etiology, both infectious and non-in fectious. Its presentation can range from asymptomatic to fulminant forms. We present the case of a 24-year-old male patient with a history of autoimmune hepatitis in compensated cirrhotic phase. He consulted for dyspnea of 15 days evolution. He had presented gastrointestinal symptoms one month prior to the consultation. Physical examina tion revealed signs of heart failure. Laboratory examina tion showed elevated cardiac biomarkers and acute on chronic hepatic insufficiency. A transthoracic echocar diogram showed severe global biventricular dysfunction. The diagnostic hypotheses were cardiac involvement due to reactivation of autoimmune disease versus viral myocarditis. An MRI was performed which confirmed very severe ventricular dysfunction and late gadolinium enhancement suggestive of myocarditis. It was indicated treatment with methylprednisolone pulses. On the first day of hospitalization he evolved with clear signs of car diogenic shock and ventricular arrhythmia refractory to medical treatment. After an exhaustive multidisciplinary evaluation, which was difficult due to his clinical condi tion, the possibility of a heart transplant was considered. Extracorporeal membrane oxygenation (ECMO) support was established as a bridge to transplantation. On the seventh day after ECMO, and after great improvement of the hepatogram parameters, the patient received a heart transplant. He had good postoperative evolution. However, he died two months after the transplant due to an opportunistic infection. The results of the biopsy of the explanted organ confirmed the diagnosis of lym phocytic myocarditis.

Experimental and theoretical modelling of blind-ended vessels within a developing angiogenic plexus.

Angiogenic sprouts at the leading edge of an expanding vascular plexus are recognised as major regulators of the structure of the developing network. Early in sprout development, a vascular lumen is often evident which communicates with the parent vessel while the distal tip is blind-ended. Here we describe the temporal evolution of blind-ended vessels (BEVs) in a small wound made in the panniculus carnosus muscle of a mouse viewed in a dorsal skin-fold window-chamber model with intra-vital microscopy during the most active period of angiogenesis (days 5-8 after injury). Although these structures have been mentioned anecdotally in previous studies, we observed BEVs to be frequent, albeit transient, features of plexus formation. Plasma leakage into the surrounding extracellular matrix occurring from these immature conduits could play an important role in preparing hypoxic tissue for vascular invasion. Although sprout growth is likely to be regulated by its flow environment, the parameters regulating flow into and through BEVs have not been characterised in situ. Longitudinal data from individual animals show that the number of BEVs filled with plasma alone peaks at day 7, when they can exceed 150 microm in length. Additionally, BEVs greater than 40 microm in length are more likely to be filled with stationary erythrocytes than with plasma alone. Using a mathematical model, we show how the flux of 150 kD fluorinated (FITC-) dextran through an individual plasma-filled BEV is related to its geometry being determined primarily by its surface area; by fitting theoretical intensity values to experimental data we assess the permeability of the vessel to FITC-dextran. Plasma skimming provides a mechanistic explanation for the observation that BEVs with larger surface area are more likely to recruit erythrocytes.

Síndrome de Takotsubo y enfermedad multivaso / Takotsubo syndrome and multivessel coronary disease

Resumen El síndrome de Takotsubo es una miocardiopatía generalmente reversible y con frecuencia relacionada a un desencadenante estresor ya sea físico o emocional. Se estima que esta entidad representa entre el 1 y 6% de los cuadros de sospecha de síndrome coronario agudo sin elevación del segmento ST en mujeres. La coexistencia con enfermedad coronaria ha sido objetivo de debate durante mucho tiempo. Se pre senta el caso clínico de una mujer de 79 años, hipertensa, dislipémica y ex tabaquista que consulta a la guardia por presentar un episodio de dolor precordial con características anginosas. En el interrogatorio refirió situación estresante en su entorno familiar los días previos. El electrocardiograma mostró ondas T negativas profundas y difusas con prolongación del intervalo QT. En el laboratorio se observó disociación de marcadores (troponina/ ProBNP). En el ecocardiograma Doppler transtorácico se evidenció deterioro de la función ventricular con balo namiento apical. Ante los diagnósticos diferenciales de síndrome coronario agudo y síndrome de Takotsubo se realizó una cinecoronariografía en la cual se evidenció compromiso de las tres arterias coronarias epicárdicas. Pese a esto, por la fuerte sospecha de miocardiopatía por estrés se realizó una resonancia magnética cardíaca con gadolinio, la cual demostró mejoría de fracción de eyección previa a la revascularización con presencia de edema miocárdico y sin realce tardío de gadolinio. Las características mencionadas condujeron al diagnóstico de síndrome de Takotsubo. La decisión de revascularización, estuvo fundamentada en el hecho de que la consulta fue motivada por síntomas anginosos típicos con el esfuerzo.

Abstract Takotsubo syndrome is a generally reversible cardiomyopathy often related to a stressor trigger, either physical or emotional. It is esti mated that this entity represents between 1 and 6% of the cases of suspected acute coronary syndrome without ST segment elevation in women. Coexistence with coronary artery disease has been a matter of long controversy. On this matter, we present the clinical case of a 79-year-old hypertensive and dyslipidemic female with smocking history, who was referred to our institution presenting an episode of chest pain with anginal characteristics. During the conducted interrogation, she reported having been overpassing a stressfull moment in her private life. The electrocardiogram showed deep and diffuse negative T waves with prolonged QT interval. Laboratory findings revealed dissociation of biomarkers (troponin/ProBNP), and the transthoracic Doppler echocardiogram showed left ventricular dysfunction with apical ballooning. Given the differential diagnoses of acute coronary syndrome and TakoTsubo syndrome, a coronary angiography was performed, which revealed multiple epicardial coronary disease. However, due to the strong suspicion of stress cardiomyopathy, a cardiac magnetic resonance imaging with gadolinium was performed, which showed an improvement in the ejection fraction prior to revasculariza tion with the presence of myocardial edema and absence of late gadolinium enhancement. The aforementioned characteristics led to the diagnosis of Takotsubo syndrome. The final decision of revascularization was based on the fact that the patient's principal complaint was typical anginal symptoms.

[Plasmatic pattern and clinical outcomes of lactic acid in heart transplantation]. / Comportamiento plasmático y clínico del ácido láctico en el trasplante cardíaco.

INTRODUCTION: It is not well established the prognostic value of elevated lactic acid after heart transplantation. OBJECTIVE: To evaluate the plasmatic pattern and the prognostic value of elevated lactate after heart transplantation. METHODS: One-hundred and twenty seven patients were included between 2011 and 2014, 71 comprising the transplantation group and 56 the control group, represented by on pump coronary artery by-pass surgery patients. Lactic acid levels were compared between groups before, within and after surgery upon Coronary Care Unit admission, at 6, 12 and 24h. In addition, in the transplantation group univariate and bivariate analysis were performed between lactic acid levels and in-hospital mortality. RESULTS: The mean age of the entire cohort was 57 years. Among transplanted patients, lactic acid levels were significantly higher over control group: within the surgery; and after surgery (P<.001), but not before surgery (P=.143; unadjusted comparisons). In transplanted patients, lactic acid levels were significantly associated with in-hospital mortality during surgery, at admission, and thereafter but not before surgery. Lactic acid at admission was associated with in-hospital mortality after adjustment of postoperative cardiac output (P=.011),≥2 inotropic drug support within 24h (P=.033), glycemic level at admission (P=.004), age≥60 years (P=.015), on pump time (P=.027), and pH (P=.017). CONCLUSIONS: Acid lactic levels were higher in transplanted patients than in the control group and was associated to higher in-hospital mortality.

Consequences of the historical demography on the global population structure of two highly migratory cosmopolitan marine fishes: the yellowfin tuna (Thunnus albacares) and the skipjack tuna (Katsuwonus pelamis).

BACKGROUND: Yellowfin and skipjack tuna are globally distributed in the world's tropical and sub-tropical oceans. Since little, if any, migration of these fishes occurs between the Atlantic and Indo-Pacific Oceans, one might expect to see genetic differences between sub-populations in these ocean basins. However, yellowfin and skipjack tuna have extremely large population sizes. Thus, the rate of genetic drift should be slower than that observed for other tunas. RESULTS: Low levels of genetic differentiation were observed between Atlantic and Pacific samples of yellowfin tuna. In contrast, no genetic differentiation was observed between Atlantic and Pacific samples of skipjack tuna. CONCLUSION: Much lower levels of genetic differentiation were found among sub-populations of yellowfin tuna compared to those observed for other large tunas, probably due to the large population size of yellowfin tuna. Since skipjack tuna appear to have even larger population sizes, it is not surprising that no genetic differentiation was detected between Atlantic and Pacific samples of these fish.

Trasplante cardíaco en adultos con cardiopatías congénitas / Heart Transplantation in Adult Patients with Congenital Heart Disease

RESUMEN Introducción: En las últimas décadas los pacientes con cardiopatías congénitas (CC) han presentando nuevos desafíos en el manejo de las complicaciones, tanto de la patología originaria como de las cirugías correctoras que les han permitido llegar a la adultez. Objetivo: Comunicar los resultados y la evolución de los pacientes con CC que hayan sido evaluados para trasplante en un centro de alta complejidad. Se utilizó la base de datos institucional, y se analizaron los datos de 11 pacientes evaluados para trasplante con diversas patologías congénitas. Accedieron al trasplante 5 de ellos con una sobrevida a 1,6 años del 80%. Los pacientes que se hallaban en lista y no se trasplantaron tuvieron una mortalidad del 66%, y los descartados por comorbilidades presentaron una mortalidad del 35%. Conclusión: El trasplante cardíaco en adultos con CC tiene un riesgo periprocedimiento más elevado que para las cardiopatías adquiridas (CA). No obstante, los que sobreviven el primer año postrasplante tienen una excelente evolución a largo plazo.

ABSTRACT Background: Over recent decades, congenital heart disease (CHD) patients have posed new challenges in the management of complications, both of the original condition as of the corrective surgeries that have allowed them to reach adulthood. Objective: The aim of this study was to report the outcomes and evolution of CHD patients who had been evaluated for transplantation in a tertiary care center. Using the institutional database, data from 11 patients with different congenital diseases were evaluated for transplantation. A total of 5 patients underwent transplantation, with a 1.6-year survival rate of 80%. Mortality rate was 66% for patients who were on the waiting list but were not transplanted, and 35% for those who were ruled out due to comorbidities. Conclusion: Heart transplantation in CHD adult patients present a higher periprocedural risk than in patients with acquired heart diseases. However, those who survive the first post-transplant year have an excellent long-term outcome.