Site Of Infarction Research Articles

Abstract 10483: Dose Of Outpatient Cardiac Rehabilitation After Acute Coronary Syndrome

Introduction: Cardiac rehabilitation (CR) is an effective intervention associated with a reduction in mortality and re-hospitalization for patients with acute coronary syndrome (ACS), but CR programs have not been fully implemented and doses are varied across patients. Hypothesis: This study aims to reveal the current practice of outpatient CR, and investigate the association between dose and long-term mortality for patients with ACS in real-world settings. Methods: We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with ACS underwent percutaneous coronary intervention between April 2014 and March 2018 and outpatient CR within 180 days after admission were included. Results: Of all 202,320 patients underwent percutaneous coronary intervention for ACS, a total of 20,444 (10%) patients underwent outpatient CR. The median (IQR) number of total CR sessions was 9 (3-17) times, and the median (IQR) duration per session was 3.0 (2.1-3.0) units. Patients were divided into four groups according to the total session number (≤9 or 10≤ times) and duration per session (≤40 or 60≤ minutes). Of 20,444 patients, 3,845 patients were assigned in low-number/short-duration, 6,976 patients in low-number/long-duration, 1,874 patients in high-number/short-duration, and 7,749 patients in high-number/long-duration group, respectively. After adjustment for age, sex, infarction site, comorbidities, and treatments during hospitalization, the adjusted HR for all-cause mortality was 1.01 (95% CI: 0.80-1.26, p=0.95) in low-number/long-duration group, 0.62 (95% CI: 0.45-0.86, p=0.004) in high-number/short-duration group, 0.74 (95% CI: 0.59-0.92, p=0.007) in high-number/long-duration group, compared with low-number/short-duration group. Conclusions: The participation rate of outpatient CR after ACS was low and the doses of sessions were varied in real-world settings. Higher number of total sessions in outpatient CR was associated with a better prognosis despite the session duration.

Abstract 14092: Arachidonate 5 Lipoxygenase Deficiency Drives Age-Related Obesity, Macrophage Dysfunction in Cardiac Repair, and Omnipresence of Inflammation

Introduction: Age-related inflammation is the primary hallmark of heart failure with reduced and preserved ejection fraction; however, the fundamental source of inflammation is unclear. Arachidonate 5 lipoxygenase (ALOX5) is known to direct the biosynthesis of leukotrienes and proinflammatory mediators (PIMs) that orchestrate the initiation of inflammation following myocardial infarction (MI). Hypothesis: Thus, we set out to test the role of ALOX5 to understand inflammation-resolution signaling in acute HF in aging. Methods: Male C57Bl/6J and ALOX5 -/- mice were divided into two groups: 1) young (2-4 months) and 2) aging (18 months). Mice were subjected to MI surgery that develops acute heart failure maintaining no-MI as naïve controls. Cellular and molecular mechanisms are detemined. Results: The absence of ALOX5 leads to age-related obesity with series of metabolic defects, including fatty liver. Next-gen sequencing analysis revealed that immune regulating pathways of infarcted myocardium were dysregulated in young and aging ALOX5 -/- mice compared to respective age-matched controls. In response to cardiac injury, ALOX5 -/- mice fail to initiate an inflammatory response with reduced leukotrienes B 4 and PIMs, with marked obesity-related chronic inflammation in immune defense hubs: spleen bone marrow and LV infarcted site. At the molecular level, ALOX5 deletion also reduced resolution mediators (specialized proresolving mediators; SPMs), thereby making macrophage dysfunctional with the decrease in SIRP-α. Aging superimposed on ALOX5 deficiency triggers macrophage dysfunction with the increase in proinflammatory phenotype (Ly6C hi ) and notable upregulation of CXCR4 and downregulation of resolution receptor formyl peptide receptor 2; in infarcted heart post-MI. Conclusions: Presented age-related outcome provides translational insight that ALOX5 serves as a connector for initiating PIM (turn-on) and SPMs (turn-off) essential for macrophage function and cardiac repair processes. Thus, future research is warranted to validate the role of ALOX5 in cardiometabolic defects, PIMs, and resolution mediators (SPMs) in heart failure with reduced and preserved ejection fraction.

Collagen-Binding Nanoparticles: A Scoping Review of Methods and Outcomes

(1) Background: Collagen is the main component of the connective tissue, playing an important role in the histological architecture and function of living organisms. Targeted therapy and improved imaging diagnosis can be obtained through collagen-binding nanoparticles that concentrate in the extracellular matrix. (2) Methods: We performed a scoping review of studies that analyzed the binding capacity of collagen-targeting nanoparticles. The search algorithm and inclusion criteria were based on PRISMA and ARRIVE guidelines. (3) Results: Fourteen studies matched all the inclusion criteria. All studies analyzed the distribution of nanoparticles in the collagen matrix, either by using collagen-targeting nanoparticles or by using unmodified ones. Most studies used collagen-binding nanoparticles for vascular research to target sites of endothelial injury, atherosclerotic plaques, or myocardial infarction. Two studies targeted the exposed collagen in models of liver fibrosis. (4) Conclusions: Our review summarizes the current literature on the methods and outcomes of using nanoparticles to target collagen. The studies reveal that there is high applicability for collagen-binding nanoparticles in cardiac or hepatic pathology and they could prove useful for targeted therapy of neoplastic lesions, which show an abundance of stromal collagen.

A fluid-powered refillable origami heart pouch for minimally invasive delivery of cell therapies in rats and pigs

Cardiac repair after heart injury remains a big challenge and current drug delivery to the heart is suboptimal. Repeated dosing of therapeutics is difficult due to the invasive nature of such procedures. We developed a fluid-driven heart pouch with a memory-shaped microfabricated lattice structure inspired by origami. The origami structure allowed minimally invasive delivery of the pouch to the heart with two small incisions and can be refilled multiple times with the therapeutic of choice. We tested the pouch's ability to deliver mesenchymal stem cells (MSCs) in a rodent model of acute myocardial infarction and demonstrated the feasibility of minimally invasive delivery in a swine model. The pouch's semi-permeable membrane successfully protected delivered cells from their surroundings, maintaining their viability while releasing paracrine factors to the infarcted site for cardiac repair. In summary, we developed a fluid-driven heart pouch with a memory-shaped microfabricated lattice structure inspired by origami. The origami structure allowed minimally invasive delivery of the pouch to the heart with two small incisions and can be refilled with the therapeutic of choice.

Structural Magnetic Resonance Imaging Correlated with Motor Function of Upper Extremity in Patients with Chronic Stroke

Abstract Background Ischemic cerebrovascular stroke is defined as an acute neurological dysfunction caused by focal cerebral infarction after decrease in the blood supply of the brain either by stenosis or occlusion leading to gross physical impairment or disability lasting more than 24 hours. Objective To assess correlation between site of infarction and upper extremity ( UE) function in chronic stroke patients. Methodology A cross sectional study with (30) Patients with chronic ischemic stroke ( >3 months) suffering from persistent UE motor function impairment, MRI brain done to assess the site of infarction. UE motor function assessment using the Fugl Meyer Assessment (FMA-UE) Scale. Results The current study found that no significant correlation between the site of infarction and UE motor function. Conclusion We concluded that the site of infarction not correlated with UE motor function in chronic stroke patients.

DECOMPRESSIVE CRANIOTOMY IN MANAGEMENT OF ACUTE CEREBRAL ISCHEMIA

Background: Ischemic stroke is a medical emergency and the most common affection of the central nervous system (CNS). This is the second-leading cause of death worldwide and the first causes of morbidity. Ischemic stroke correspond to 85% of all strokes with a mortality of 10-50%. Large space-occupying infarction accounts for 1-10% of all supratentorial infarction with signs of elevated intracranial pressure (ICP) and brain herniation usually in the second to the fifth day leading to a mortality rate of 53% to 89%. Objective: To evaluate the clinical and radiological outcome of decompressive surgery in the setting of cerebral infarctions, and to study its effect in reducing the overall mortality rates of this fatal condition. Patients and methods: This study is descriptive and analytic clinical trial study for evaluating the clinical and functional outcomes of surgical cases with massive cerebral infarction. Over one year, Between January 2018 and January 2019, at Dar Alshifa Hospital, and Al-Azhar University Hospitals in Cairo. Results: Twenty cases with cerebral infarctions were included in this. In our study, there was 12 males (60%) and 8 females (40%) male: female ratio 1.5:1.The age of the cases ranged from 37 to 77 years. The mean age was 57.65 years. Four cases were less than 50 years (20%), 6 cases between 50 and 60 years (30%), 8 cases between 60 and 70 years (40%), and 2 cases above 70 years (10%). Eighteen cases had middle cerebral artery (MCA) infarctions (90/%), while 2 cases had both MCA and anterior cerebral artery (ACA) infarctions. eleven cases were right sided while 9 cases were having left-sided infarctions. Conclusion: The preoperative clinical condition , higher GCS score at presentation were strongly related to a favorable clinical outcome .Some ICU related complications such as contra lateral infarction, hemorrhagic infarction, pulmonary embolism, pneumonia can worse the patient outcome .Other complication related to the surgery such as CSF leak, wound infection did not effect on patient prognosis. Factors like patients’ age, sex, site of infarction, and preoperative midline shift did not affect the final outcome. A study with larger sample size and longer follow-up is recommended for better confirmation of these facts.

Diffusion Tensor Imaging (DTI) and Fractional Anisotropy (FA) for Arcuate Fasciculus in Predicting Post-Stroke Aphasia Outcome

Background: In certain regions of the brain, aphasia arises from a lack of understanding and regulating language following damage. About 35–40 percent of the people receiving hospitalization after stroke are identified with aphasia. The recently developed imaging methods for the analysis of the impact of brain lesion sites and sizes on aphasia are the Diffusion Tensor Imaging (DTI) and Fractional Anisotropy (FA). In order to reflect micro-structural integrity DTI may give data on the damage level of the white matter of the brain and subcortical neural structure. Objective: We examined the relationship between arcuate fasciculus (AF) and the prognosis of aphasia outcome after ischemic stroke utilizing DTI, and FA. Patients and Methods: In this study, which included 34 patients with post stroke aphasia, we investigated DTI and FA of arcuate fasciculus in predicting post-stroke aphasia outcome. Results: There was no significant association between the sex and Aphasia Handicap Scale (AHS) (P>0.05), while the age was significantly correlate with AHS (P<0.05). The vascular risk factors (hypertension, diabetes mellitus, smoking, dyslipidemia) were associated with poor aphasia outcome. In our study, we found that lesion size had significant effect on aphasia outcome. Also, the site of ischemic infarction site was important factor in determining aphasia outcome. In the Broca and Wernicke regions, AHS was greater than in the cortical injury, and in the insula and cortical injuries (1.92 ± 1.26) were the least common in patients. Conclusion: The site and the size of ischemic infarction significantly predicted s aphasia outcome, also the extent and mechanism of AF injury, which can be detected in DTI and FA, stood as a significant indicator on aphasia severity for patients with ischemic stroke.

Recent Advances in Cardiac Tissue Engineering for the Management of Myocardium Infarction.

Myocardium Infarction (MI) is one of the foremost cardiovascular diseases (CVDs) causing death worldwide, and its case numbers are expected to continuously increase in the coming years. Pharmacological interventions have not been at the forefront in ameliorating MI-related morbidity and mortality. Stem cell-based tissue engineering approaches have been extensively explored for their regenerative potential in the infarcted myocardium. Recent studies on microfluidic devices employing stem cells under laboratory set-up have revealed meticulous events pertaining to the pathophysiology of MI occurring at the infarcted site. This discovery also underpins the appropriate conditions in the niche for differentiating stem cells into mature cardiomyocyte-like cells and leads to engineering of the scaffold via mimicking of native cardiac physiological conditions. However, the mode of stem cell-loaded engineered scaffolds delivered to the site of infarction is still a challenging mission, and yet to be translated to the clinical setting. In this review, we have elucidated the various strategies developed using a hydrogel-based system both as encapsulated stem cells and as biocompatible patches loaded with cells and applied at the site of infarction.

Epicardial Transplantation of Autologous Cardiac Micrografts During Coronary Artery Bypass Surgery.

Background: Cardio-regenerative cell therapies offer additional biologic support to coronary artery bypass surgery (CABG) and are aimed at functionally repairing the myocardium that suffers from or is damaged by ischemia. This non-randomized open-label study assessed the safety and feasibility of epicardial transplantation of atrial appendage micrografts (AAMs) in patients undergoing CABG surgery.Methods: Twelve consecutive patients destined for CABG surgery were included in the study. Six patients received AAMs during their operation and six patients were CABG-operated without AAMs transplantation. Data from 30 elective CABG patients was collected for a center- and time-matched control group. The AAMs were processed during the operation from a biopsy collected from the right atrial appendage. They were delivered epicardially onto the infarct scar site identified in preoperative late gadolinium enhancement cardiac magnetic resonance imaging (CMRI). The primary outcome measures at the 6-month follow-up were (i) patient safety in terms of hemodynamic and cardiac function over time and (ii) feasibility of therapy administration in a clinical setting. Secondary outcome measures were left ventricular wall thickness, change in myocardial scar tissue volume, changes in left ventricular ejection fraction, plasma concentrations of N-terminal pro-B-type natriuretic peptide levels, NYHA class, number of days in hospital and changes in the quality of life.Results: Epicardial transplantation of AAMs was safe and feasible to be performed during CABG surgery. CMRI demonstrated an increase in viable cardiac tissue at the infarct site in patients receiving AAMs treatment.Conclusions and Relevance: Transplantation of AAMs shows good clinical applicability as performed during cardiac surgery, shows initial therapeutic effect on the myocardium and has the potential to serve as a delivery platform for cardiac gene therapies.Trial Registration:ClinicalTrials.gov, identifier: NCT02672163.

Comparison of Efficacy and Safety of Recombinant Human Prourokinase and Alteplase in the Treatment of STEMI and Analysis of Influencing Factors of Efficacy.

Objective To compare the efficacy and safety of recombinant human prourokinase (rhPro-UK) and alteplase for thrombolytic therapy in acute ST-segment elevation myocardial infarction (STEMI) and to analyze the related factors affecting efficacy. Methods From January 2017 to December 2019, 100 patients diagnosed with STEMI were selected and randomly divided into the control group (n = 50) and the observation group (n = 50). Based on conventional treatments, the control group was treated with alteplase, and the observation group was treated with rhPro-UK, and both were treated for 7 days. After treatment, the vascular recanalization, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were compared. The bleeding and major adverse cardiovascular events (MACE) were recorded in both groups. According to the patient's vascular recanalization, it was divided into two subgroups: recanalization group and occlusion group. Multiple logistic regression models were used to analyze the related factors that affect the efficacy. Results The recanalization rate of the observation group (96.00%) was higher than that of the control group (84.00%) (P < 0.05). After treatment, LVDs and LVEDD in both groups were lower than those before treatment, and LVEF was higher than that before treatment. The LVDs and LVEDD in the observation group were lower than those in the control group, and the LVEF was higher than that in the control group (P < 0.05). The incidence of bleeding in the observation group (2.00%) was lower than that in the control group (12.00%), and the incidence of MACE (4.00%) was lower than that in the control group (16.00%) (P < 0.05). Univariate analysis showed that age, smoking history, diabetes history, myocardial infarction history, infarct location, and intravenous thrombolysis time were related to the efficacy after treatment (P < 0.05). Multivariate logistic analysis showed that age, history of diabetes, vascular infarction site, and venous thrombolysis time were independent influencing factors after treatment (P < 0.05). Conclusion Both rhPro-UK and alteplase thrombolytic therapy can effectively recanalize blood vessels and improve the cardiac function of patients with STEMI. However, rhPro-UK has better effect than alteplase and is safer and worth promoting. The curative effect is related to age, diabetes history, vascular infarction site, and venous thrombolysis time.

Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report

BackgroundAlthough M. pneumoniae (M. pneumoniae) infections have been associated with various extrapulmonary manifestations, there have been very few documented cases of thrombotic events in pediatrics, and none to our knowledge with such extensive involvement as the patient described here. We aim to contribute to the urgency of discovering the mechanism of the coagulopathy associated with M. pneumoniae infections.Case presentationThis 10-year-old boy was admitted after 2 weeks of fever, sore throat, worsening cough, and progressive neck and back pain. During hospitalization, he developed clots in several different organs: bilateral pulmonary emboli, cardiac vegetations, multiple splenic infarcts, and deep venous thromboses in three of four extremities. He was treated with long-term antibiotics and anticoagulation, and fully recovered.ConclusionsThis is the first case known to us of a child with an extensive number of thrombotic events in multiple anatomic sites associated with M. pneumoniae infection. The mechanism by which M. pneumoniae infection is related to thrombotic events is not fully understood, but there is evidence that the interplay between the coagulation pathways and the complement cascade may be significant. This patient underwent extensive investigation, and was found to have significant coagulopathy, but minimal complement abnormalities. By better understanding the mechanisms involved in complications of M. pneumoniae infection, the clinician can more effectively investigate the progression of this disease saving time, money, morbidity, and mortality.

Intrinsically Conductive Polymers for Striated Cardiac Muscle Repair.

One of the most important features of striated cardiac muscle is the excitability that turns on the excitation-contraction coupling cycle, resulting in the heart blood pumping function. The function of the heart pump may be impaired by events such as myocardial infarction, the consequence of coronary artery thrombosis due to blood clots or plaques. This results in the death of billions of cardiomyocytes, the formation of scar tissue, and consequently impaired contractility. A whole heart transplant remains the gold standard so far and the current pharmacological approaches tend to stop further myocardium deterioration, but this is not a long-term solution. Electrically conductive, scaffold-based cardiac tissue engineering provides a promising solution to repair the injured myocardium. The non-conductive component of the scaffold provides a biocompatible microenvironment to the cultured cells while the conductive component improves intercellular coupling as well as electrical signal propagation through the scar tissue when implanted at the infarcted site. The in vivo electrical coupling of the cells leads to a better regeneration of the infarcted myocardium, reducing arrhythmias, QRS/QT intervals, and scar size and promoting cardiac cell maturation. This review presents the emerging applications of intrinsically conductive polymers in cardiac tissue engineering to repair post-ischemic myocardial insult.

Implantation and repair of 3D printed myocardial patch in rabbit model of myocardial infarction

In this study, BMSCs were induced to differentiate into cardiomyocytes by 5-azacytidine, and combined with sodium alginate and gelatin to construct myocardial patch in vitro by 3D bio-printing, then it was attached to the myocardial infarction site of rabbit myocardial infarction model. Cytokines such as brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) in peripheral blood were detected by ELISA after operation. The results showed that the absolute value of cTnI in each group was more than 0.04 ng/ml after surgery, and there was no significant difference in the data at four time points in each group. As time went by, cTn-I did not decrease. BNP in both the control group and the experimental group was significantly higher than the blank group. However, BNP in the experimental group fell after the 2 nd week, but it was still higher than that in the blank group. Histological examination showed that there was no cardiomyocyte formation around the patch, only fibrous tissue and many small blood vessels and microvessels were found. And the patch could decrease the collagen fibers to some extent. These results suggested that the myocardial patch did not repair the injured myocardial cells by forming new myocardial cells in the myocardial infarction site of animals, but it could promote the local vascular proliferation, improve the blood supply to the myocardial infarction site, decrease the collagen fibers and thus improve the cardiac function.

Outcomes of Cerebral Venous Thrombosis in Al-Yarmook Teaching Hospital

Background: Cerebral venous thrombosis (CVT) is a disease with multiple causes and has a low incidence rate. Seizure is one of the most common complications of CVT. The rate at which seizure occurs following CVT and the risk factors associated with that occurrence is a debated issue. Objectives: The aim of this study was to evaluate the incidence of seizure and its associated and risk factors for patients with CVT. Subjects and Methods: This was an observational study that included a total of 30 adult patients with CVT. Data, including age, sex, clinical manifestations such as fever, headache, vomiting, altered consciousness, and focal neurologic signs, such as sensory disturbances, were collected. Imaging findings that included hemorrhagic lesion, infarction, and thrombus site were also reported. Patients were followed up for 6 months from the initial diagnosis to recognize the development of seizures. Results: Within 6 months of follow-up, 13 (43.3%) patients developed generalized seizures, which was the most common type of CVT. The superior sagittal sinus (SSS) occlusion was recognized in 84.62% of patients with seizures and 48.06.5% in patients without seizures. Similarly, the right lateral sinus was occluded in 84.62% of patients with seizures as compared with 41.18% among those without seizures. Contraceptive use was reported in 61.54%of patients with seizures versus 17.65% in those without seizures with a significant difference. Conclusion: The involvement of SSS and lateral right sinus occlusion and use of contraceptives could be warning signs and a risk factor for the development of seizures in patients with CVT.

Comparison of Ischemic and Hemorrhagic Stroke in the Medical Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study.

Background Distinguishing the category of stroke plays a vital role in planning patient care. Simple clinical findings help distinguish the type of stroke. However, there is a need for diagnostic imaging. In Ethiopia, stroke is the most common neurological condition in patients admitted to hospitals. Yet, there are limited data on comparisons of stroke subtypes. Thus, this study was designed to determine the prevalence of stroke and to compare ischemic and hemorrhagic strokes. Methods A retrospective cross-sectional study design was employed. Medical records containing complete information and confirmed diagnosis using imaging techniques were included. The data were entered into SPSS version 24.0 for analysis. Results with a P value of <0.05 were considered statistically significant. Results From a total of 312 stroke patients, 204 (65.4%) patients were admitted due to ischemic stroke. More females, 59 (18.9%), were admitted for hemorrhagic stroke than males. In both ischemic, 175 (56.1%) and hemorrhagic, 91 (29.2%) stroke cases, most of the patients were 45 years and above. Middle cerebral artery territory was the most common site of arterial territory infarctions in ischemic stroke, 158 (50.7%). Middle cerebral artery territory also was the most common site of hematoma in hemorrhagic stroke, 91 (29.2%). Infarctions in more than one lobe of the cerebrum (16.4%) and intracerebral hemorrhage in multiple areas of the cerebrum (7.4%) were observed in ischemic as well as hemorrhagic stroke cases. Most of the ischemic, 124 (39.8%), and hemorrhagic, 39 (12.5%), stroke patients presented loss of sensation and weakness of body parts. Hypertension was observed in 124 (39.8%) ischemic and 73 (23.4%) hemorrhagic stroke patients. The mortality rate of ischemic stroke, 47 (15.3%), was two times higher than hemorrhagic stroke, 20 (6.5%). Hypertension was the most common predictor of death in both ischemic and hemorrhagic stroke cases. Conclusions Ischemic stroke is a common type of stroke in the medical ward of the study hospital. More females were affected by hemorrhagic stroke than males. Middle cerebral artery territory was the most affected area of the brain in both ischemic and hemorrhagic strokes. Most ischemic and hemorrhagic stroke patients were admitted due to loss of sensation and weakness of body parts. Hypertension was the most common risk factor of stroke as well as a predictor of stroke-related deaths. Identification of the stroke subtypes may be important in the management of stroke. Thus, health professionals, government officials, community leaders, and the population at large could be involved in creating awareness about antecedent risk factors and clinical presentations of stroke subtypes.

Novel factors that activate and deactivate cardiac fibroblasts: A new perspective for treatment of cardiac fibrosis.

Heart disease with attendant cardiac fibrosis kills more patients in developed countries than any other disease, including cancer. We highlight the recent literature on factors that activate and also deactivate cardiac fibroblasts. Activation of cardiac fibroblasts results in myofibroblasts phenotype which incorporates aSMA to stress fibres, express ED-A fibronectin, elevated PDGFRα and are hypersecretory ECM components. These cells facilitate both acute wound healing (infarct site) and chronic cardiac fibrosis. Quiescent fibroblasts are associated with normal myocardial tissue and provide relatively slow turnover of the ECM. Deactivation of activated myofibroblasts is a much less studied phenomenon. In this context, SKI is a known negative regulator of TGFb1 /Smad signalling, and thus may share functional similarity to PPARγ activation. The discovery of SKI's potent anti-fibrotic role, and its ability to deactivate and/or myofibroblasts is featured and contrasted with PPARγ. While myofibroblasts are typically recruited from pools of potential precursor cells in a variety of organs, the importance of activation of resident cardiac fibroblasts has been recently emphasised. Myofibroblasts deposit ECM components at an elevated rate and contribute to both systolic and diastolic dysfunction with attendant cardiac fibrosis. A major knowledge gap exists as to specific proteins that may signal for fibroblast deactivation. As SKI may be a functionally pluripotent protein, we suggest that it serves as a scaffold to proteins other than R-Smads and associated Smad signal proteins, and thus its anti-fibrotic effects may extend beyond binding R-Smads. While cardiac fibrosis is causal to heart failure, the treatment of cardiac fibrosis is hampered by the lack of availability of effective pharmacological anti-fibrotic agents. The current review will provide an overview of work highlighting novel factors which cause fibroblast activation and deactivation to underscore putative therapeutic avenues for improving disease outcomes in cardiac patients with fibrosed hearts.

Expert consensus document on automated diagnosis of the electrocardiogram: The task force on automated diagnosis of the electrocardiogram in Japan. Part 1: Nomenclature for diagnosis and abnormal findings.

As these terms should accurately represent the abnormal findings and conditions as much as possible, we propose to unify these terms into terminologies that are not confusing and easy to understand for everyone.

Left ventricular free wall rupture: A real nightmare.

Left ventricular free wall rupture (LVFWR) is a rarest but often lethal mechanical complication of acute myocardial infarction (AMI). The mortality rate for LVFWR is described from 75% to 90% and it is the cause for 20% of in-hospital deaths after AMI. Death results essentially from the limited time available for emergent intervention after onset of symptoms. Emergency surgery is indicated and normally the rupture site is easily identified, but it may not be apparent macroscopically, corresponding to transmyocardial or subepicardial dissection with an external rupture far from the infarction site, or already thrombosed and contained. Repair of the ventricular wall is usually achieved either by suturing the edges of the tear or closing it with patches of artificial material or biological tissues, usually using some kind of biological glue. However, several cases of successful conservative management have been described. In this Editorial, I comment on the metanalysis conducted by Matteucci et al, published in this issue of the Journal, including 11 nonrandomized studies and enrolling a total of 363 patients, which brings a great deal of new knowledge that can help not only in the prevention but also in the management of this dreadful complication of AMI.

Biomaterials based cardiac patches for the treatment of myocardial infarction

• Biomaterials used for cardiac patches are classified according to their sources. • The required properties for the biomaterials to make cardiac patches are introduced. • The specific advantages and shortcomings of different types of cardiac patches are discussed. • The development tendency of biomaterials based cardiac patches is prospected. Myocardial infarction (MI) is one of the common cardiovascular diseases that occurs with a blockage in one or more of the coronary arteries to lead to the damage of the myocardium, resulting in a life-threatening condition. To repair the damaged myocardium in MI, researchers are looking forwards to new ways to postpone the progression of myocardial injury. Cardiac patches, the scaffolds layered on the heart surface, can provide mechanical support for the infarction site and improve cardiac function by delivering various bioactive factors or cells, showing considerable curative effect in the treatment of MI. Biomaterials with certain biocompatibility and mechanical properties have received widespread attention for the application in cardiac patches. In this review, we focus on the recent progress on these biomaterials-based cardiac patches, which could be categorized into two types according to the sources of materials including (ⅰ) natural materials and (ⅱ) synthetic materials. The major advantages and current challenges of each type are discussed and a brief perspective on the future research directions is presented.

Abdominal Computed Tomography Angiography and Venography in Evaluation of Hemorrhagic and Thrombotic lesions in Hospitalized COVID-19 patients

PurposeTo report imaging findings at computed tomography angiography (CTA) and venography (CTV) of the abdomen and pelvis in evaluation of hemorrhagic and thrombotic lesions in hospitalized patients with COVID-19. MethodsIn this retrospective observational study, patients admitted to a single tertiary care center from April 1 to July 20, 2020, who tested positive for SARS-CoV-2 and developed acute abdominal pain or decreasing hemoglobin levels over the course of hospitalization were included. Abdominal CTA/CTV imaging studies performed in these patients were reviewed, and acute hemorrhagic or thromboembolic findings were recorded. ResultsA total of 40 patients (mean age, 59.7 years; 20 men, 20 women) were evaluated. Twenty-five patients (62.5%) required intensive care unit (ICU) admission and 15 patients (37.5%) were treated in the medical ward. Hemorrhagic complications were detected in 19 patients (47.5%), the most common was intramuscular hematoma diagnosed in 17 patients; It involved the iliopsoas compartment unilaterally in 10 patients, bilaterally in 2 patients and the rectus sheath in 5 cases. Pelvic extraperitoneal hemorrhage was found in 3 patients, and mesenteric hematoma in one patient. Thromboembolic events were diagnosed in 8 patients (20%) including; arterial thrombosis (n = 2), venous thrombosis (n = 2), splenic infarct (n = 1), bowel ischemia (n = 1) and multiple sites of thromboembolism (n = 2). ConclusionOur study highlights that both hemorrhagic and thromboembolic complications can be seen in hospitalized patients with COVID-19. It is important that radiologists maintain a high index of suspicion for early diagnosis of these complications.