Massive Myocardial Infarction Research Articles

Complications After Open Skull Base Surgery for Brain Tumors: A 26-Year Experience.

Open skull base surgery carries the risk of significant complications. It is important to inform patients and family members clearly of the details of these complications. This study aimed to present the numerous complications encountered with open skull base surgery for brain tumors. This report analyzed the complications experienced by patients treated with open skull base surgery by a single skull base surgeon at a single tertiary center over 26 years. A retrospective study was performed using the University of Puerto Rico Neurosurgery database to identify patients who were managed using open skull base procedures from 1995 to 2020. The neurosurgical database for each patient had been prospectively recorded. Patients with skull basetumors under the author's care during the study period were includedin the investigation. Exclusions include patients with non-tumoral conditions and non-skull base tumors and those operated using a microscopic transsphenoidal route. Patients who experienced an intraoperative or postoperative complication within 30 days of the surgery were further analyzed. In the cohort, 141 patients with brain tumors underwent open skull base surgery. The cohort had a median age of 48 (range 3-79). It consisted of 101 (71.6%) females and 40 (28.4%) males, with a female-to-male ratio of 2.5:1. The approach most frequently used was an orbitofrontal craniotomy (with or without zygomatic osteotomy) in 79 patients (56%). A petrosal approach was utilized in 26 patients (18%). Forty-six patients (33%) developed an intraoperative or postoperative complication. Twenty-four percent of the complications occurred in the 30-day postoperative period. Five patients had more than one complication. The median age of the patients who experienced a complication was 44.5 (range 22-79), with a female-to-male ratio similar to the entire cohort. Cranial nerve injury was the most frequent complication. Worsening or loss of vision in the affected eye occurred in 5.7% of the patients. A cerebrospinal fluid leak occurred in 2% of the patients. Six patients died, two of them after a massive myocardial infarction. The results of this study showed that approximately one-third of the patients undergoing open skull base surgery can develop a complication. The most frequent complication was injury to a cranial nerve. A large number of complications occurred intraoperatively. The majority of the complications in patients with tumors in the posterior fossa were associated with injury to a cranial nerve. At the middle fossa, damage to the optic nerves is a noteworthy complication. Complications at the anterior fossainvolved worsening of vision ormyocardial infarction. Less aggressive surgery near the cavernous sinus and the petroclival region may reduce complications. Understanding the complications can help counsel patients and family members.

Sudden Death among Medical Professionals: How to Reverse this Trend?

During the past few years, the sudden death of young medical professionals in India shocked the entire medical fraternity. Recently, the sudden demise of several young doctors due to massive myocardial infarction came as shocking sad news for medical colleagues. Similarly, few young, highly skilled and talented doctors succumbed before age of 45 years. Sudden early deaths have frequently been reported among medical professionals during the past few years. This indicates an alarming trend of the sudden death of doctors and is also closely associated with stress/burnout, a sedentary lifestyle, long working hours, and socio-economic factors.

The autopsy is not dead: ongoing relevance of the autopsy

Autopsy requests have been trending downward for a variety of factors. There are differences between pre- and postmortem diagnoses. Autopsies remain a tool for education, public health research, quality control, and closure for families.We report two cases that illustrate the utility of autopsy for uncovering contributing factors in the death of these patients and highlight their ongoing importance.Clinical and autopsy investigation of two individuals and illustration of the importance of autopsy findings which, had they been diagnosed premortem, could have changed the outcome. Cases were evaluated using the Goldman criteria for discrepancies between premortem clinical diagnoses and postmortem autopsy findings.In the first case, the patient had been previously admitted due to a non-ST elevation myocardial infarction months before the fatal event. The autopsy showed an undiagnosed clear cell carcinoma of the ovary. She expired due to a massive myocardial infarction secondary to neoplasm induced hypercoagulable state. The degree of pre-mortem/postmortem diagnostic discrepancy makes this a Goldman Class I error.In the second case, the patient presented to the emergency department with symptoms of Guillain-Barré Syndrome (GBS), for which he was treated. Abdominal masses were discovered; however, the patient decompensated before workup was completed. A high-grade B-cell lymphoma was confirmed but would not have altered the outcome, making this a Goldman class II error.The autopsy remains a relevant and necessary tool for physicians and society. It assists in the establishment of diagnoses, measurement of treatment quality, the providence of public health metrics, and closure to the survivors.

ODP498 Myocardial Ischemia precipitating thyroid storm diagnosed during recovery through Wellen's wave: An ECG for an eye

Abstract Introduction: Thyroid storm is a major life-threatening condition in a patient of thyrotoxicosis which can accelerate the cardiovascular morbidity in forms of tachycardia, arrythmia and congestive heart failure. It can be precipitated by acute coronary syndrome. Most literatures have reported acute coronary syndromes during the presentation itself but here we shall describe an intriguing case where the diagnosis was possible after the resolution of the thyroid storm. Clinical case: A 55-year-old graves’ disease patient had presented with classical features of thyroid storm which was precipitated by discontinuation of the anti-thyroid drugs. His initial electrocardiogram (ECG) showed sinus tachycardia. He was promptly started on intravenous fluid, 80 mg of daily carbimazole along with lugol's iodine and intravenous dexamethasone. Within 48 hours of treatment, his vitals became normal with resolution of the thyroid storm. His thyroid hormone status also showed marked improvement (free T4 falls from 90.31 ng/dl to 2.31 ng/dl) (normal range: 0.7 ng/dl-1.7 ng/dl). Due to his persistent jaw pain, mild chest discomfort and hiccough, ECG recordings were done in regular intervals. Interestingly it showed dynamic changes consisted of biphasic T waves. This ECG changes were seen after the resolution of the thyroid storm features. The cardiac enzymes were within normal limits. We thought of wellen's syndrome and sought urgent cardiological consultation. Coronary angiography reveals left anterior descending artery (LAD) obstruction and patient promptly underwent percutaneous transluminal angioplasty. Patient's angina equivalent symptoms had resolved remarkably. He recovered satisfactorily and was discharged after 5 days. Clinical lesson: Ischemic heart disease is a well-known co-morbidity in a case of thyroid storm which can be identified at the initial presentation. But here the dynamic changes of ECG appeared after the resolution of the thyroid storm. It was classical of type A wellen's wave which is a harbinger of imminent massive anterior myocardial wall infarction due to near-complete blockage of LAD. Initial sinus tachycardia probably had hindered the appearance of typical wellen's wave in this case. But as soon as the thyroid storm resolved, typical dynamic changes appeared in the form of wellen's wave. Early suspicion due to following serial dynamic ECG changes has prevented a major catastrophe in this case. This case highlights the importance of tracking serial ECG changes in a patient of thyroid storm which can unmask any underlying ischemic cardiac disease even after apparent improvement of the clinical status. This clinical case also reports a unique association of thyroid storm and type A wellen's syndrome. Presentation: No date and time listed

Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice

Myocardial infarction (MI) is a cardiovascular disease with high morbidity and mortality. Clinically, rehabilitation after massive MI often has a poor prognosis. Therefore, it is necessary to explore the therapeutic methods of myocardial protection after MI. As a first-line treatment for type 2 diabetes, metformin has been found to have a certain protective effect on myocardial tissue. However, its pharmacological mechanism remains unclear. In this study, we investigated key factors that reduced MI with metformin. Through in vivo, in vitro, and in silico analyses, we identified HSF1 as a key target for metformin. HSF1 could up-regulate the transcriptional level of AMPKα2 through transcriptional activation and stimulate the activity of the downstream AMPK/mTOR signaling pathway. Metformin stimulated cardiomyocytes to form stress granules (SGs), and knockdown of HSF1 reversed this process. Furthermore, HSF1 exhibited better in vitro affinity for metformin than AMPK, suggesting that HSF1 may be a more sensitive target for metformin.

Peculiarity of Surgical Tactics for Management of Ischemic Heart Disease in patients with Left Main Coronary Artery Stenosis

The left main coronary artery disease has poor natural history. Sudden death, massive myocardial infarction, angina and poor quality of life indicate the ominous nature of the disease. Coronary artery bypass grafting remains the ultimate choice of its management. A relatively high mortality and morbidity of its surgical treatment described in literature leads to the actuality of this disease. This work is a part of our continuous effort for refinements in anesthetic and surgical techniques to reduce mortality and morbidity in such patients and is in the clinical practice at our institute for the last few years. During the period from February 1998 to October 2005, 74 patients underwent coronary artery bypass surgery for left main coronary artery stenosis, at Federal Postgraduate Medical Institute, Shaikh Zayed Hospital. Lahore. All patients presented with angina, unstable in 62.2%. An old myocardial Infarction was present in 52 (70.3%) patients. An emergent surgery was needed in 5(6.8%), urgent operation was performed in 45(60.8%) patients and elective procedure was done in 24(32.4%). Average stay in the hospital was 9.0±2.7 days. There were 2 hospital deaths and one late non cardiac death. The post-operative
 recovery was eventless in majority of the patients. The return of patients to their jobs improved significantly (P

New-onset inflammatory bowel diseases among IL-17 inhibitor-treated patients: results from the case-control MISSIL study.

To describe new-onset IBD (new IBD) in patients treated with IL-17 inhibitors (IL-17i), to assess their incidence and to identify their risk factors in real life. A French national registry (MISSIL) aimed to report all cases of new IBD in patients treated with IL-17i from January 2016 to December 2019. Using the estimated number of patients treated by IL-17 in France during the study period, the annual incidence rates of new IBD was reported in IL-17i-treated patients. A case-control study was performed with two controls per new IBD case matched by gender, age and underlying inflammatory disease. Thirty-one cases of new IBD under IL-17i were collected: 27 patients treated for spondyloarthritis and four patients for psoriasis. All were observed with secukinumab (SEK). The median time to onset of new IBD symptoms was 4.0 (1.5-7.5) months. SEK was discontinued in all patients. The evolution was favourable with complete resolution (17/31), improvement (7/31) or stabilization (5/31). Two patients died: one due to a massive myocardial infarction and one due to post-colectomy complications. The incidence of new IBD decreased from 0.69/100 patient-years [PY] (7/1010) in 2016 to 0.08/100 PY (6/7951) in 2019. No previous treatment with etanercept (odds ratio [OR] = 0.33, 95% CI: 0.14-0.80, P = 0.014) and low number of previous biologic therapies (OR = 0.67, 95% CI: 0.47, 0.94, P = 0.021) were significantly associated with new IBD. The incidence of new IBD was low and decreased from 2016 to 2019. The outcome was favourable in 24 out of 31 patients, but two patients died.

Use of Inner Branches During Physician-Modified Endografting for Complex Abdominal and Thoracoabdominal Aortic Aneurysms

Endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms have been performed widely in an increasing number of centers, utilizing custom-manufactured or physician-modified stent grafts containing fenestrations and side-arm branches for visceral and renal artery incorporation. Alternatively, inner branch configurations may be useful in complex anatomy, where application of fenestrations or side-arm branches can be challenging. Our study aims to evaluate the incidence of target vessel instability when incorporated with inner branch configurations, and report clinical outcomes of patients who underwent fenestrated/branched endovascular aortic repairs (F-BEVAR) containing one or more inner branches. We reviewed patients who underwent F-BEVAR with at least one inner branch configuration for complex abdominal or thoracoabdominal aortic aneurysms at Keck Hospital of University of Southern California from 2014 to 2020. Endpoints were mortality, major adverse events (MAE), technical success, and target vessel instability. Target vessel instability was assessed using follow-up computed tomography (CT) and duplex imaging. Out of the 175 patients who underwent F-BEVAR for complex abdominal and TAAA during the study period, 17 patients had at least one inner branch configuration. All were deemed high-risk for open repair with multiple cardiovascular and/or pulmonary comorbidities. Eight (47%) patients had extent I, II, III thoracoabdominal aortic aneurysms, and 10 (59%) had prior aortic repairs. A total of 68 target vessels were incorporated (mean=4 vessels/patient, range=1~6), of which 40% were inner branch configurations, most commonly for renal arteries. Technical success was 94.1%. There was one perioperative mortality due to massive myocardial infarction, as well as one patient who needed temporary hemodialysis. No device-related mortalities were observed. At 30 days, primary inner branch patency was 100% with no target vessel instability or reintervention. At mean follow-up of 5.8 months, the overall survival was 94% with one patient who expired from unknown cause. Overall primary inner branch patency was 96.3%, due to occlusion of a long lumbar artery branch with no clinical sequelae. Inner branch configurations can provide a safe alternative technique of branch incorporation during complex endovascular aortic repair.

Left ventricular free wall rupture as a result of delayed presentation of an inferior ST-elevation myocardial infarction due to fear of COVID-19: case report

BackgroundLeft ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs 1 to 4 days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR.Case presentationWe present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table.ConclusionsThe occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.

Across Two Bridges to a Heart Transplant

Introduction Cardiac Transplantation still remains the standard care for end stage heart failure. Availability of donor hearts often prolong the waiting period and the patients may succumb to the disease. This is a major problem in developing nations like India where the donor pool is quite low compared to the recipient pool. Extra Corporeal Membrane Oxygenator (ECMO) and Ventricular Assist Devices (VAD) are effective bridges to transplant in patients who can no longer be waiting with optimal medical therapy alone . We herein describe a patient who was successfully bridged using ECMO and BiVAD (Biventricular Assist Device) to a cardiac transplant. This was the first case in our state and probably in the country wherein a BiVAD was successfully used as a bridge to transplant. Case Report A 32 year old male who worked as a software engineer developed ischemic DCM (Dilated CardioMyopathy) following a massive anterior wall myocardial infarction in 2015. Progressive cardiac failure was followed by hepatic and renal dysfunction at which point he was referred for a heart transplant. He suffered a cardiac arrest with intractable ventricular tachycardias and necessitated insertion of an ECMO. A central ECMO with aortic and bi-atrial cannulas was instituted and he was enlisted for an urgent transplant. 5 days later, this was converted into a BiVAD with centrifugal full magnetic levitated system (CentriMag, Abott).The patient was maintained on BiVAD for 14 days with the cannulas exiting through subcutaneous tunnels and sternum approximated. He was extubated and mobilized in the intensive care room. A standard biatrial orthotopic heart transplant was performed and the BiVAD was successfully weaned off. The patient had a prolonged hospital stay due to multidrug resistant bugs that grew in urine and sputum.He is now 4 years post transplant and is doing well with no evidences of rejection and maintained on standard immunosuppression. Summary ECMO and VAD are useful tools in stabilizing and optimizing patients for heart transplant when they are no longer stable on maximal medical therapy. They are effective bridges to transplant although the cost is quite formidable in developing nations wherein cost of health care is still primarily borne by the patient.

Clinical Characteristics and Outcomes of Coronary Artery Disease among South Indian Women- A Retrospective Study

Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women and is the leading cause of death. Clinical presentation of CAD in women can widely vary from atypical chest pain, silent ischemia to massive myocardial infarction and death. Women have poor prognosis than men after myocardial infarction and are less likely to undergo revascularisation compared to men. Aim: To study the risk factors, clinical characteristics, severity of CAD and to evaluate the outcomes in women undergoing coronary angiogram. Materials and Methods: This retrospective study included 912 women who had undergone coronary angiogram in our hospital from January 2018 to December 2018. The patients were divided into three groups- Group A consisted of 230 (25%) women with age <50 years. Group B consisted of 591 (65%) women with age between 50 to 69 years. Group C consisted of 91 (10%) women with age >70 years. Continuous variables were analysed by paired t-test and categorical variables were analysed by chi-square test. Results: Most women were post menopausal (73.6%). Common risk factors were diabetes mellitus (63%) hypertension (56%), and hypothyroidism (16.8%). Out of the total study population, 51% (n=466) presented with a diagnosis of chronic stable angina, 34.7% (n=317) presented with acute coronary syndrome, and 7% (n=66) had atypical chest pain. Out of 500 patients with significant CAD, requiring revascularisation only 316 (63.2%) had undergone interventions out of which 193 (61%) had undergone percutaneous coronary intervention and 123 (39%) had undergone Coronary Artery Bypass Grafting (CABG) as the modality of revascularisation. conclusion: Clinical presentation of CAD in women varies widely from atypical chest pain to acute infarction. Diabetes and hypertension are the most common risk factors for CAD in our study. Chronic stable angina was the most common spectrum of presentation. Single vessel disease is the most common finding on coronary angiogram.

Massive Myocardial Infarction Due to Acute Left Main Coronary Artery Occlusion in a Young Organophosphorus Poisoning: Case Report

Massive Myocardial Infarction Due to Acute Left Main Coronary Artery Occlusion in a Young Organophosphorus Poisoning: Case Report

Inguinal Hernia - Is There Any Room Left for Classical Procedures?

Background: Nowadays, the repair of inguinal hernias is mostly achieved through a minimally invasive approach (TAPP or TEP) which has well-known advantages. However, the Lichtenstein mesh technique still has some particular indications. Methods: We reviewed 256 consecutive patients who underwent a Lichtenstein procedure during 5 years (2015-2019) in the Department of General Surgery of "Dr. I. Cantacuzino" Clinical Hospital. The vast majority of them - 180 (74%) were 60 or older and 105 (41%) were over 70. Severe cardiovascular diseases, diabetes mellitus and other significant co-morbidities were recorded in 128 patients (50%). Results: 240 patients had a favorable evolution, 12 experienced local complications, while in 4 we recorded severe cardiac post-operative events.1 patient died due to a massive myocardial infarction. Conclusions: The surgical treatment of inguinal hernias should be adapted to the age and biological status of the patient; surgical departments must be able to provide both a laparoscopic and an open-surgery approach.

Obituary for Gary D. James, Ph.D. 1954–2020

It is with considerable sadness that we announce the death of Professor Gary Douglas James who died unexpectedly on October 15, 2020 at the age of 65 of a massive myocardial infarction. Professor J...

Impella CP for treatment of left ventricular free-wall rupture after myocardial infarction: Report of a case

ABSTRACTUnloading of the left ventricle (LV) is essential for the treatment of LV free-wall rupture (LVFWR), and it is well-known that the LV can be optimally unloaded with the Impella system. However, there has been no report on applying the Impella system for the treatment of LVFWR. Here, we report a patient with FWR after massive myocardial infarction who was successfully treated with non-suture repair via median sternotomy and implantation of Impella CP (Abiomed, Danvers, MA).

Computed tomography examination of the screaming mummy \u201cUnknown-Woman-A\u201d

BackgroundThe Royal Cache at Deir el Bahari in Luxor, Egypt, contained the mummy of a princess named Meritamun of uncertain identity, who was consequently designated “Unknown-Woman-A.” The mummy has a widely opened mouth as if screaming, with the unusual posture of her head tilted to the right and partially flexed legs cross at the ankles. We postulated that computed tomography (CT) would help to provide insights on life and death of “Unknown-Woman-A.”ResultsCT findings indicate that “Unknown-Woman-A” died in her fifties (sixth decade of life) and suffered from advanced diffuse atherosclerosis. “Unknown-Woman-A” was well mummified and eviscerated, and her body cavity was filled with resin. The desiccated brain had shifted to the right inside her skull. We presume that “Unknown-Woman-A” died of a sudden and massive myocardial infarction. Death spasm induced her unusual posture, and the contracted body was apparently mummified before relaxing her postmortem position.ConclusionsThis CT study has provided useful information about the mummy designated “Unknown-Woman-A” including her mummification style, underlying advanced cardiovascular atherosclerosis disease, and her possible death circumstances.

Acute myocardial infarction with cardiogenic shock in a young physically active physician concurrently using the anabolic steroid sustanon: A case report.

The association between ischemic heart disease (IHD) and the concurrent use of anabolic androgenic steroids (AASs) is underestimated in clinical settings. The tendency of patients to not disclose AASs use may explain this underestimation. In the present case report, the clinical case of a 26-year-old physically active male, who was a physician, without any classical coronary risk factors, who presented with chest pain that was misdiagnosed by the peripheral care unit as skeletal muscle pain is described. Later, the patient was brought to our central hospital (King Abdullah University Hospital) suffering from a massive acute myocardial infarction with marked ECG changes and cardiogenic shock. Following stabilization of his condition, a detailed history of the patient was taken, during which the patient admitted that he was a chronic user of the anabolic steroid sustanon (250 mg, once/week for 6 months) and amino acid supplements (whey protein isolate, 6 tabs every day for 1 year). Specific cardiac markers were increased and the patient exhibited dynamic ischemic changes in his electrocardiogram. Notably, the coronary angiogram of the patient demonstrated ostial occlusion of the left anterior descending artery, which was associated with mid-right coronary artery embolic obstruction. Other than the anabolic steroids and protein supplementation use, the patient history, examination and lab evaluation were normal. During follow up, the patient continued to suffer heart failure with low ejection fraction. In addition, he developed apical thrombus 2 months after primary admission. The patient developed tachycardia in spite of optimal medical treatment and finally received an implantable cardioverter defibrillator. Physicians should always be aware of the possibility of AASs use in young physically active patients. IHD should always be suspected and investigated with typical chest pain in healthy young patients, even if regular risk factors are not present. Medical professionals should not be excluded as potential AASs users/abusers.

Human ARF Specifically Inhibits Epimorphic Regeneration in the Zebrafish Heart.

The Alternative Reading Frame (ARF) protein is a tumor suppressor encoded by the Cyclin Dependent Kinase Inhibitor 2A gene in mammals but not lower regenerative vertebrates, and has been previously implicated as a context-sensitive suppressor of regeneration in murine skeletal muscle and humanized ARF-expressing zebrafish fins. This study extends our investigation of the role of ARF in the regeneration of other solid tissues, including the zebrafish heart and the mammalian digit. Heart regeneration after cryoinjury was used to mimic massive myocardial infarction. ARF gene expression was upregulated during the cardiac regenerative process and slowed the rate of morphological recovery. ARF specifically impacts cardiomyocytes, neovascularization, and the endothelial-mesenchymal transition, while not affecting epicardial proliferation. This suggests that in the context of regeneration, ARF is specifically expressed in cells undergoing dedifferentiation. To investigate ARF as a suppressor of epimorphic regeneration in mammalian systems, we also tested whether the absence of ARF was permissive for murine digit regeneration, but found that ARF absence alone was insufficient to significantly alter digit restoration. These findings provide additional evidence that ARF suppresses epimorphic regeneration, but suggests that modulation of ARF alone is insufficient to permit regeneration.

Increase in PKCα Activity during Heart Failure Despite the Stimulation of PKCα Braking Mechanism.

Rationale: Heart failure (HF) is marked by dampened cardiac contractility. A mild therapeutic target that improves contractile function without desensitizing the β-adrenergic system during HF may improve cardiac contractility and potentially survival. Inhibiting protein kinase C α (PKCα) activity may fit the criteria of a therapeutic target with milder systemic effects that still boosts contractility in HF patients. PKCα activity has been observed to increase during HF. This increase in PKCα activity is perplexing because it is also accompanied by up-regulation of a molecular braking mechanism. Objective: I aim to explore how PKCα activity can be increased and maintained during HF despite the presence of a molecular braking mechanism. Methods and Results: Using a computational approach, I show that the local diacylglycerol (DAG) signaling is regulated through a two-compartment signaling system in cardiomyocytes. These results imply that after massive myocardial infarction (MI), local homeostasis of DAG signaling is disrupted. The loss of this balance leads to prolonged activation of PKCα, a key molecular target linked to LV remodeling and dysfunctional filling and ejection in the mammalian heart. This study also proposes an explanation for how DAG homeostasis is regulated during normal systolic and diastolic cardiac function. Conclusions: I developed a novel two-compartment computational model for regulating DAG homeostasis during Ang II-induced heart failure. This model provides a promising tool with which to study mechanisms of DAG signaling regulation during heart failure. The model can also aid in identification of novel therapeutic targets with the aim of improving the quality of life for heart failure patients.

Pathologic Evaluation of Influenza A H5N8 Infection Outbreaks in Mule Ducks in Bulgaria.

This article outlines pathomorphologic findings of a study involving commercial mule ducks with confirmed influenza A H5N8 infections after a series of outbreaks in Bulgaria. Examinations were carried out after performing necropsy on dead birds from three different age groups (up to 15, 20 to 30, and 40+ days of age) fattened on different farms. Among birds of all ages, gross lesions were present as lesions affecting the heart. Histologically, the myocardium exhibited severe intermyofibrillar edema, moderate to massive hemorrhages, and degenerative changes. All lesions resulted in single or multiple and small to massive myocardial infarctions. Other affected organs included the brain, lungs, liver, spleen, and pancreas. Nonpurulent lymphocytic encephalitis was found postmortem in ducks that had shown prior clinical nervous signs. Among ducks of all ages, a viral antigen in the cardiomyocytes and the epithelium of air capillaries was found through immunohistochemical detection methods. The results of the present study allowed us to conclude that the highly pathogenic avian influenza A H5N8 viral infection may manifest itself as a systemic illness in commercial mule ducks with septicemic lesions, resulting in high morbidity and mortality rates of up to 100%. Pathomorphologic lesions were somewhat different from those previously reported in wild waterfowl.