Epicardial Research Articles

Isolation and molecular characterization of fowl adenovirus from inclusion body hepatitis cases in Western India during 2019-2021.

Inclusion body hepatitis (IBH) resulted in a substantial economic loss in Western India during 2019 to 2021. The study aimed to characterize fowl adenovirus (FAdV) from field outbreaks. The study was conducted on 290 liver samples from 66 poultry flocks. The samples were subjected to histopathology and molecular detection, followed by phylogenetic typing of the partial hexon gene of the virus. Spiking mortality (14%) was recorded from day 21 to day 35 with peak mortality at the 28th day of age. The necropsy showed a pale and enlarged liver with hemorrhagic and yellowish necrotic foci, accumulation of straw-colored transudate in the pericardial sac which resulted in a flabby appearance of the heart, heart enlargement, and hemorrhages on the spleen, enlarged and congested kidneys. The virus inoculation resulted in stunting and poor feathering with hepatomegaly, hemorrhages and yellowish necrotic foci on the liver as well as greenish discoloration, and kidney swelling in SPF embryonated chicken eggs. Out of 29, 16 liver samples yielded 1219 bp amplicons specific to hexon gene fragments. The sequence and phylogenetic analysis identified 14 isolates as FAdV species E serotype 11 and two as species D serotype 8b. Conclusion: The results indicated that FAdV-8b and FAdV-11 strains are involved in disease outbreaks in western India.

Pericardial Effusion

Background: Pericardial effusion is defined as the accumulation of fluid in the pericardial sac, this can lead to life-threatening cardiac complications if not promptly diagnosed and managed effectively. This radiographic case study aims to demonstrate the crucial role of imaging techniques in diagnosing pericardial effusion, providing valuable insights into its characteristics, and guiding appropriate clinical interventions.
 Methods: This is a case study of a 37yr old patient with suspected cardiac failure who underwent diagnostic imaging, including chest X-rays and echocardiography. The imaging findings were analyzed to assess the extent and severity of the disease and to help in the treatment decisions.
 Results: The radiographic evaluation revealed a moderate pericardial effusion with characteristic findings on chest X-rays and echocardiography. The size, location, and hemodynamic impact of the effusion were assessed, informing the clinical team's decision to proceed with pericardiocentesis for therapeutic relief.
 Conclusion: This case study underscores the pivotal role of radiographic imaging, particularly echocardiography and chest X-rays, in diagnosing and characterizing pericardial effusion. Timely and accurate diagnosis is essential for appropriate management and the prevention of life-threatening complications. Radiographic imaging serves as an indispensable tool in guiding clinical decisions and improving patient outcomes.

Aneurisma biventricular em um cão

ABSTRACT: An aneurysm is defined as a localized dilation of a blood vessel or heart. It may have either a congenital or an acquired origin and occurs in both humans and animals. Cardiac aneurysms are rare, and are characterized by sacculations of the cardiac wall. The present case report describes the macroscopic and microscopic findings of an aneurysm affecting both ventricles of the heart in a dog. A 7-year-old mixed-breed female dog with osteosarcoma on the left pelvic limb was euthanized and submitted to the veterinary pathology laboratory for necropsy. Macroscopically, besides the lesions in the link, the pericardial sac was adhered to the pericardial surface of the heart and there were two sacculations in both ventricles which communicated widely with the respective ventricle. Microscopically, fibrous tissue adhered to the pericardium, atrophy and necrosis of the cardiomyocytes with replacement by adipocytes were observed in addition to hyperplasia of the tunica media of arterioles and thrombosis. A diagnosis of acquired biventricular cardiac aneurysm was made based on the necropsy findings and microscopic lesions in the heart. We emphasize the importance of performing a necropsy and examining tissues histologically for the diagnosis of this rare condition. Ventricular aneurysms should be included in the differential diagnosis of cardiovascular disease in dogs.

A Study on Variations in Size and Shape of Left Atrial Appendage from Formalin-fixed Cadavers

Introduction: Atrial appendages were once considered vestigial structures with no significant role in atrial function. However, they are now recognized as significantly impacting various pathophysiological conditions, including cardiac thromboembolism and arrhythmias. The left atrial appendage (LAA), in particular, has been found to have significant variations in shape and size, and its relationship with nearby structures, such as the pulmonary veins (PVs), is crucial in planning interventional and surgical procedures in and around the LAA. Although most studies examining variations in the LAA are image-based, few have focused on anatomical studies. Materials and Methods: In this study, we examined heart specimens from 54 cadavers for anatomical dissection at a tertiary care teaching hospital. After removing the heart from the pericardial cavity, we opened the left atrium and examined its interior. Observations were made regarding the LAA orifice and PV orifices, and measurements were taken. Subsequently, we removed the LAA along with a portion of the left atrial wall, observed its shape and number of lobes, and took measurements. To classify the shape, we used a system proposed by Wang et al. based on resemblance to familiar objects. Categorical variables were expressed as percentages and continuous as mean and standard deviation. The institutional research committee and the institutional ethics committee approved the study. Results: The most common shape variant observed was the Chicken Wing type, followed closely by the Windsock type. Specimens with Cauliflower or Cactus morphology were rare, with the Cactus variant being the least common. The LAA orifice was round or oval shaped in most cases. In most cases, the LAA orifice was at the same or lower level as the left superior PV orifice, with a prominent ridge between the two orifices in most patients. We observed most of the appendages to be trilobed, with considerable variations in length and diameter. We found two specimens with unusual morphologies but no specimens with accessory appendages. Conclusions: Based on our study, there are significant differences in findings compared to some of the previous studies reporting the shape variations of LAA. However, our findings are matching with those of some other earlier studies. The variations in the shape and size of LAA orifices and their relationship to PV orifices are similar to those reported in earlier studies. The distribution of variations in the size of LAA was also similar to those reported in earlier studies. Conducting larger studies to explore these variations could aid in designing and developing therapeutic interventions in the LAA.

Epidemiological characteristics, etiological spectrum, and outcomes of adult patients with pericardial effusion at a Teaching Hospital in Somalia.

Pericardial effusion (PE) is an abnormal fluid volume in the pericardial space and is a common clinical entity. The incidence of PE is estimated diversely and depends on risk factors, etiologies, and geographic locations. This study aimed to assess the clinical characteristics, etiologic spectrum, echocardiographic features, and outcomes among patients with different types of PE. This retrospective observational study included 93 patients with confirmed PE. Their medical records were reviewed in the hospital information system of Mogadishu Somali Turkish Training and Research Hospital between April 2022 and September 2022. Patient demographics, clinical characteristics, chest X-rays, echocardiography, laboratory findings, management approaches, and outcome reports were reviewed and recorded. Out of the 3000 participants, 3.1% (n = 93/3000) met the definition of definitive PE. In this study, we included 51 females and 42 males. Among the patients, 86% (n = 80) had at least one comorbidity, with diabetes (38.7%) and hypertension (37.6%) being the most common. The most frequently reported clinical presentation findings were shortness of breath (67.7%), chest pain (49.4%), cough (47.3%), and palpitations (47.3%). Cardiac tamponade developed in 9.7% (n = 9) of the patients. Pericardial taps were performed in 64.5% of the cases. Our analysis showed that the most common cause of PE was cardiac disease (n = 33, 35.4%), followed by tuberculosis (TB) (n = 25, 26.8%), uremic pericarditis (n = 24, 25.8%), and hypothyroidism (n = 10, 10.7%). Regarding the severity of PE based on echocardiographic findings, nearly half of the patients (n = 46, 49.4%) had mild PE, whereas 26.8% (n = 25) had moderate PE, and 23.6% (n = 22) had severe PE. Two-thirds of the cases (66.6%) were managed with furosemide, 48 (51.6%) patients were treated with an anti-inflammatory, hemodialysis was performed in 24 (25.8%) patients and antituberculous medications were administered to 7 (7.5%) patients. Out of the 93 patients, 24 (25.8%) died during the hospital stay. It was determined that the mortality risk of patients with renal failure was 7.518 times higher than those without (p = 0.004), and the risk for those with TB was 5.554 times higher than those without (p = 0.011). Other variables were not influential on mortality (p > 0.050). Our study results demonstrate the epidemiological profile of PE in Somalia. The leading causes of PE were cardiac diseases, uremic pericarditis, TB, and hypothyroidism. PE is a significant cause of morbidity and mortality in Somalia, especially in individuals with renal failure and TB infection.

Chest Tube Clearance Strategies Versus Conventional Chest Tubes After Cardiac Surgery

Standard chest tubes (CTs) used to drain retained blood can become occluded from blood clots, leading to ineffective drainage and postoperative complications such as cardiac tamponade. Chest tube clearance strategies (CTCSs) were developed to improve CT patency. Our meta‐analysis compared the safety and efficacy of CTCS versus CT following cardiac surgery. The PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were searched from 1946 to 2023 for studies that compared CTCS to CT. Two investigators independently reviewed, screened, extracted, and assessed the data prior to performing a random effects meta‐analysis using R. The primary outcome was re‐exploration and the secondary outcomes were retained blood syndrome, mortality, blood products, stroke, cardiac arrest, atrial fibrillation, ventilation time, intensive care unit (ICU) time, hospital length of stay, and chest drainage. Five studies (2288 patients) were included. There were two clinical trials (n = 620) and three observational studies (1668 patients). Compared to CT, CTCS had a significant reduction of postoperative atrial fibrillation (risk ratio (RR) 0.80, 95% CI 0.70 to 0.92, I2 = 17%, p < 0.01). There was no significant difference in re‐exploration, retained blood syndrome, hospital length of stay, and ICU length of stay. However, with the addition of four unmatched studies (n = 2583), CTCS was associated with a significant reduction in re‐exploration (RR 0.52, 95% CI 0.37 to 0.73, I2 = 34%, p < 0.01), retained blood syndrome (RR 0.71, 95% CI 0.53 to 0.95, I2 = 72%, p = 0.02), hospital length of stay (mean difference (MD) −0.40, 95% CI −0.78 to −0.01, I2 = 49%, p = 0.04), and chest drainage (MD 0.80, 95% CI 0.70 to 0.92, I2 = 17%, p < 0.01). Drawing from results including the unmatched studies, CTCSs are associated with fewer postoperative complications compared to CT. This was achieved without major differences in chest drainage, supporting the important role of preventing even small accumulations of blood in the pericardial space.

Lečenje pneumoperikardijuma kod uznapredovalog karcinoma pluća - prikaz slučaja i pregled literature

Introduction: Pneumopericardium, though rare, can lead to severe complications such as cardiac tamponade, particularly in patients with ma-lignancies. This case-based review examines the incidence , management, and outcomes of pneumopericardium in a patient with advanced lung cancer. Case Report: We present a comprehensive literature review and a detailed analysis of a 57-year-old male with metastatic squamous cell carcinoma of the lung, who developed pneumopericardium. The pa-tient's clinical presentation, diagnostic challenges, and management strategies were documented and compared with similar cases. He presented with cough and dyspnea, and imaging revealed pneumopericardi-um, likely due to tumor invasion into the pericardial space. Management involved conservative measures, including antibiotics and close monitoring. A literature review revealed that management strategies for pneumopericardium vary based on hemodynamic stability, ranging from conservative treatments to invasive procedures. Recurrence is common, and survival times post-diagnosis are highly variable. Conclusion: Pneumopericardium in cancer patients requires a tailored management approach, with a multidisciplinary team essential for optimizing patient outcomes. This case underscores the need for heightened awareness and prompt, individualized treatment plans for managing such complex conditions.

Study on the underlying mechanism of Poria in intervention of arrhythmia zebrafish by integrating metabolomics and network pharmacology.

Poria is an herb with both medicinal and dietary application. It has been used in various traditional Chinese patent medicines and medicinal decoctions for the treatment of arrhythmia. However, the specific mechanisms involved in the antiarrhythmic effects of Poria have, until now, remained unknown. This present study sought to explore the potential compounds and mechanisms by which Poria ameliorates BaCl2-induced arrhythmia. We initiated by using network pharmacology to predict probable components, targets, and associated signaling pathways before optimizing the extraction process of Poria. We then applied Poria extract to a zebrafish model of BaCl2-induced arrhythmia. We combined network pharmacology and untargeted metabolomic analysis to predict the likely signaling and metabolic pathways governed by Poria. Finally, we verified putative mRNA and metabolite targets of Poria involved in the intervention of arrhythmia by PCR, molecular docking, enzymatic inhibition and targeted metabolomics. We found that triterpenoids may be the main components of Poria responsible for its effects on arrhythmia, and that the optimal extraction process for its water extract is 9 volumes of water with the 7.5h first extraction period, and the second extraction period of 1.5h. Through experimentation, we have found that the water extract of Poria can interfere with BaCl2 induced arrhythmia in zebrafish by significantly increasing the heart rate, reducing the SV-BA distance, and pericardial area, and the degree of cardiomyocyte apoptosis in zebrafish. In addition, PCR validation revealed that Poria can regulate the calcium signaling pathway by upregulating the gene expression levels of ADRB1, HTR7, CALMB1, and PPP3CA. Meanwhile, through molecular docking and enzyme activity inhibition, it was found that the compounds in Poria can bind to ADRB1, HTR7, CALMB1, and PPP3CA, respectively. Targeted metabolism confirmed that Poria can downregulate the synthesis of cAMP in the calcium signaling pathway, as well as the synthesis of valine and isoleucine in valine, leucine, and isoleucine biosynthesis. Overall, our study indicates that Poria exerts its antiarrhythmic effect through regulating the calcium signaling pathway and valine, leucine, and isoleucine biosynthesis. Our findings not only establish a mechanistic framework for elucidating the antiarrhythmic effects of Chinese patent medicine containing Poria, but also provide a medicinal basis for the study of its dual use as medicine and food.

Genetic and Pathogenic Characteristics of an Emerging Highly Virulent Recombinant Lineage Korean Clade C PRRSV Strain

A strain of porcine reproductive and respiratory syndrome virus (PRRSV) was isolated from lung tissue of a pig showing severe respiratory clinical signs from a farm in Gyeongsang province of South Korea. This PRRSV strain, designated as SNUVR220803, was classified within the lineage Korean clade C (LKC) based on a phylogenetic analysis of the ORF5 gene. A whole‐genome analysis was conducted on the SNUVR220803 strain, which appears to be a recombinant between the PRRSV strains K07‐2273 (part of LKC lineage) and Ingelvac MLV (part of Lineage 5). The Nsp2 amino acid sequence of this strain features a deletion of four additional amino acids, setting it apart from the typical Korean clades A, B, and C lineages. An animal inoculation experiment was conducted with 24 pigs divided into three groups: 12 pigs in the inoculated group, six in the sentinel group, and six in the negative control group. Inoculated pigs exhibited persisting hyperthermia (≥40.3°C) for 5 days, palpebral edema, and cyanosis. Subsequently, these pigs suffered from severe respiratory distress and cachexia, leading to a mortality rate of 58.3% (7 out of 12 pigs) at 14 days postinoculation (dpi). Body weight decreased post‐SNUVR220803 strain infection in both the inoculated and sentinel groups. Gross pathology revealed noncollapsed lungs and serous effusion in the pericardial and peritoneal cavities. Microscopic analysis revealed severe interstitial pneumonia, while immunohistochemistry confirmed the presence of PRRSV antigen in the lungs, lymph nodes, thymus, kidneys, and the heart. Additionally, the levels of cytokines such as tumor necrosis factor‐α (TNF‐α), interferon‐α (IFN‐α), and IL‐10 were significantly elevated in the plasma of infected pigs. These observations indicate that the LKC recombinant strain, combined with Lineage 5, possesses high virulence and infectivity as characterized by distinctive exudative lesions.

Prevention and treatment of pericardial tamponade in the electrophysiology laboratory: a European Heart Rhythm Association survey.

Pericardial tamponade (PT) is the most frequent severe complication during electrophysiology (EP) procedures and requires immediate, co-ordinated, and effective treatment. However, multiple aspects of PT treatment are either not standardized or are under ongoing debate. An online questionnaire consisting of 26 multiple-choice questions was sent out to the European Heart Rhythm (EHRA) Research Network and also distributed via social media outputs. The EHRA survey was conducted between May and June 2023. A total of 213 replies were received from European (87%) and non-European countries. Ninety per cent of all participants perform interventions in dedicated EP labs equipped with different ablation platforms. In case of PT, most participants use X-ray as the main imaging modality guiding pericardial puncture, predominantly aiming for an anterior puncture site. Sheaths of different sizes are introduced into the pericardial space (84.3%), followed by a pigtail catheter. Application of protamine is an established but variable step in the majority (84.6%). Novel oral anticoagulants (NOAC) antidotes are not used by 73.3% of participants, while 15.2% routinely apply them. Re-transfusion of aspirated blood is performed by 72.1% [before protamine administration (18.2%), after protamine administration (13.5%), if pericardial effusion cannot be controlled (40.4%)]. A total of 72.4% re-transfuse without blood filter systems. A decision for surgical intervention is mostly taken if bleeding continues despite all interventional measures. The current survey demonstrates that the management of PT is heterogeneous among centres. The findings of this survey may help to guide operators in their treatment and decisions in the setting of PT.

Myocardial Infiltration in Primary Mediastinal B-Cell Lymphoma Detected by Cardiac Magnetic Resonance Imaging

Introduction: Cardiac involvement, particularly myocardial infiltration in primary mediastinal lymphoma, is a rare occurrence with an incidence of only 9% in known cases of primary malignancy. Neoplasm infiltration into the myocardium manifests through direct invasion, hematogenous spread, transvenous invasion through the great veins, or lymphangitic spreading in the mediastinal. Myocardial infiltration in lymphoma presents a grim prognosis and its treatment may be associated with specific risks, such as myocardial rupture. Various imaging modalities may detect cardiac involvement, with cardiac magnetic resonance (CMR) imaging considered the gold standard. CMR enables clear delineation of myocardial infiltration, making it valuable for local staging, pretreatment planning, and evaluating treatment response. Case Presentation: : A 37-year-old woman patient was diagnosed with primary mediastinal large B-cell lymphoma. Mild chest discomfort and shortness of breath were observed 3 months before hospital admission. A thorax CT scan showed a heterogeneous contrast-enhancing mass with a central necrotic area in the anterior mediastinum. Following thoracotomy and tumor debulking, the patient complained of severe crushing chest pain radiating to her back, accompanied by new T wave inversion on ECG and elevated cardiac troponin levels a week after surgery. Coronary angiogram results showed a normal coronary artery. Subsequent cardiac MRI showed tumor infiltration into the anterior pericardial space, as well as the myocardium of the left and right ventricles. Chemotherapy was promptly initiated, resulting in a gradual improvement of symptoms. Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like IMRT. However, with careful planning, we can still obtain optimum tumor dose, minimize OAR dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on reirradiation, especially in OAR dose tolerance guidelines.

A 64 Years Old Man with a Rare and Serious Cardiac Complication of Lung Cancer

A 64 years old man with prior history of lung cancer presented with increased shortness of breath. Echocardiography showed small bright echogenic spots in the pericardial sac. Thoracic CT scan found a pneumopericardium of 24 mm and the patient was successfully managed by an urgent drainage.

Fractured sternal wire causing a cardiac laceration

BackgroundHemopericardium is a serious complication that can occur after cardiac surgery. While most post-operative causes are due to inflammation and bleeding, patients with broken sternal wires and an unstable sternum may develop hemopericardium from penetrating trauma.Case presentationWe present the case of a 62-year-old male who underwent triple coronary bypass surgery and presented five months later with sudden anterior chest wall pain. Chest computed tomography revealed hemopericardium with an associated broken sternal wire that had penetrated into the pericardial space. The patient underwent a redo-sternotomy which revealed a 3.5 cm bleeding, jagged right ventricular laceration that correlated to the imaging findings of a fractured sternal wire projecting in the pericardial space. The laceration was repaired using interrupted 4 − 0 polypropylene sutures in horizontal mattress fashion between strips of bovine pericardium. The patient’s recovery was uneventful and he was discharged on post-operative day four without complications.ConclusionPatients with broken sternal wires and an unstable sternum require careful evaluation and management as these may have potentially life-threatening complications if left untreated.

Therapeutic effect of adipose-derived stem cells injected into pericardial cavity in rat heart failure.

There are few studies on the treatment of heart failure by injecting stem cells into the pericardial cavity. Can the cells injected into the pericardial cavity migrate through the epicardium to the myocardial tissue? Whether there is therapeutic effect and the mechanism of therapeutic effect are still unclear. This study investigated the therapeutic efficacy and evidence of cell migration of adipose-derived stem cells (ADSCs) injected into the pericardial cavity in rat heart failure. The aim of this study is to demonstrate the effectiveness and mechanism of treating heart failure by injecting stem cells into the pericardial cavity, laying an experimental foundation for a new approach to stem cell therapy for heart disease in clinical practice. The inguinal adipose tissue of male SD rats aged 4-6weeks was taken, ADSCs were isolated and cultured, and their stem cell surface markers were identified. Forty rats aged 6-8weeks were divided into sham operation group, heart failure group, and treatment group; there were 15 rats in the heart failure group and 15 rats in the treatment group. The heart failure model was established by intraperitoneal injection of adriamycin hydrochloride. The heart function of the three groups was detected by small animal ultrasound. The model was successful if the left ventricular ejection fraction<50%. The identified ADSCs were injected into the pericardial cavity of rats in the treatment group. The retention of transplanted cells in pericardial cavity was detected by small animal in vivo imaging instrument, and the migration of transplanted cells into myocardial tissue was observed by tissue section and immunofluorescence. Western blotting and immunohistochemical staining were used to detect brain natriuretic peptide (BNP), α-smooth muscle actin (α-SMA), and C-reactive protein (CRP). ADSCs express CD29, CD44, and CD73. On the fourth day after injection of ADSCs into pericardial cavity, they migrated to myocardial tissue through epicardium and gradually diffused to deep myocardium. The cell density in the pericardial cavity remains at a high level for 10days after injection and gradually decreases after 10days. Compared with the heart failure group, the expression of BNP and α-SMA decreased (P<0.05 and P<0.001, respectively), and the expression of CRP in the treatment group was higher than that in the heart failure group (P<0.0001). A small amount of BNP, α-SMA, and CRP was expressed in the myocardium of the sham operation group. After injection of ADSCs, interleukin-6 in myocardial tissue was significantly lower than that in heart failure myocardium (P<0.01). After treatment, vascular endothelial growth factor A was significantly higher than that of heart failure (P<0.01). Pericardial cavity injected ADSCs can penetrate the epicardium, migrate into the myocardium, and have a therapeutic effect on heart failure. Their mechanism of action is to exert therapeutic effects through anti-inflammatory, anti-fibrosis, and increased angiogenesis.

Bovine thoracic Ectopia cordis in southeastern Rio Grande do Sul, Brazil

This study describes and illustrates a case of thoracic ectopia cordis (EC) in a cross-bred calf in the southeastern region of Rio Grande do Sul, Brazil. A cow suffering from dystocia due to fetal static gave birth to a calf with the heart and pericardial sac outside the thoracic cavity and respiratory distress. The animal survived for 40 min after giving birth. EC is defined as the complete or partial displacement of the heart out of the thoracic cavity. It is a rare birth defect in the fusion of the anterior chest wall, which results in the extrathoracic location of the heart. Three possible theories for the development of this condition have been described in animals: the first is related to a primary failure in the descent of the heart and fusion of the midline of the body, the second is associated with rupture of the amnion, and the third is associated with amniotic band syndrome. Toxic plants, inbreeding, and some pharmacological compounds have been associated with the development of the anomaly. However, in most cases, the precise cause of the appearance of the malformation is unknown. This animal was considered a sporadic case of EC. EC has been described more frequently in cattle, although there are reports in other species, such as dogs, cats, and sheep. Treatment can be surgical, but this procedure is rarely an option.

Deleterious effects of benzotriazoles on zebrafish development and neurotransmission: 5-Chloro-benzotriazole versus 1H-benzotriazole

Benzotriazoles are heterocyclic compounds typically presenting a benzene ring fused with a triazole molecule. The industry uses these compounds as anti-corrosion agents and recently, they have been employed in the pharmaceutical industry and in detergent formulations. Benzotriazoles persist in the environment, and water treatment plants cannot degrade them completely. Consequently, these compounds have been detected in rivers, lakes, and drinking water, which makes assessing their safety for the human and aquatic animal populations crucial. Here, we have evaluated and compared how exposure to 1H-benzotriazole or 5-chloro-benzotriazole affect the zebrafish embryo-larval stages. We have determined the acute toxicity, morphometric alterations, and acetylcholinesterase activity on zebrafish embryos, as well as behavioral endpoints using the tail coiling assay. The estimated LC50 of 5-chloro-benzotriazole was 19 mg/L, whereas 1H-benzotriazole caused no mortality. The zebrafish embryos exposed to 20 and 25 mg/L 5-chloro-benzotriazole had decreased hatching rate and exhibited pericardial and yolk sac edemas. Furthermore, the embryo length and eye area were decreased, in contrast with an increased yolk sac after exposure to 20 mg/L 5-chloro-benzotriazole. In turn, 1H-benzotriazole also decreased the eye area of zebrafish embryos, but no other significant morphological alterations were observed. The tail coiling assay showed that the zebrafish embryos increased the percentage of time moving and the number of embryonic movements per minute after exposure to 1H-benzotriazole (15 mg/L) or 5-chloro-benzotriazole (20 and 25 mg/L), indicating that these compounds were potentially neurotoxic. However, acetylcholinesterase activity was not significantly altered in embryos exposed to 1H-benzotriazole, but significantly decreased when exposed to 0.05 mg/L 5-chloro benzotriazole confirming its neurotoxicity at a much lower concentration. Our findings showed that 5-chloro-benzotriazole seems to induce more harmful alterations to zebrafish embryos than 1H-benzotriazole. Nevertheless, 1H-benzotriazole seems to induce a direct effect on eye development for concentrations lower than the ones of 5-chloro-benzotriazole affecting zebrafish embryos.

Fluid-Overload Associated Large B-Cell Lymphoma Clinicopathologic Features and Determinants of Outcomes: Analysis of a Pooled Database

Background: Fluid overload-associated large B-cell lymphoma (FOLBCL) is a new WHO lymphoma entity previously known as PEL-like lymphoma or HHV8-unrelated PEL-like lymphoma. It is a rare lymphoma that arises within fluid-filled body cavities without a solid component. FOLBCL occurs in the absence of immunodeficiency and is commonly associated with conditions associated with fluid overload. It expresses mature B-cell phenotype and occasional EBV infection markers. We conducted this study to delineate key clinicopathological characteristics, prognostic indicators, and treatment modalities that affect outcomes in this rare and newly-defined lymphoma subtype. Methods: To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 115 cases that fit the diagnostic criteria for FOLBCL. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: A total of 115 patients with confirmed FOLBCL were identified. The median age was 74, with a peak incidence between 72 and 82 years. There was a male preponderance with M:F of 2. The pleural, pericardial, and peritoneal cavities were involved in 75%, 34%, and 27%, respectively. The median duration of symptoms before diagnosis was 1 month. Patients presented with constitutional symptoms and hepatosplenomegaly in 13% and 1%, respectively-no patients presented with lymph node and bone marrow involvement. The median OS of the whole group was 16 months. Patients younger than 70 had better median OS than 70 and older (24 vs. 10 months, p=0.008). The presence of any malignant peritoneal effusion was associated with worse OS when compared to effusion limited to the thoracic cavity (7 vs. 24 months, p=0.005). LDH≥500 was also associated with worse OS (p=0.02). Sex, the presence of fluid overload-causing conditions, and serum IL2R levels did not seem to impact OS. Compared to no treatment, chemotherapy had a numerically superior OS but did not reach statistical significance (19 vs. 10 months, p=0.11). However, patients that attained CR as their best response had a superior median OS (p&amp;lt;0.0001). Conclusions: This study presents updated clinicopathologic data from a pooled cohort of patients with FOLBCL. It identifies the age, the primary location of cavitary disease, LDH, active therapy, and quality of response to treatment as key determinants of OS.

Peritoneopericardial hernia in dogs

AbstractCongenital diaphragmatic peritoneopericardial hernia in dogs is attributed to a failure in the development of the transverse septum and may cause clinical signs. Its diagnosis is usually made through chest radiographic examination, where it is possible to detect cardiomegaly and the presence of abdominal organs in the pericardial sac. The aim of this study was to report two cases of peritoneopericardial hernia in asymptomatic bitches. The patients presented a lack of appetite and vomiting for different reasons, which led the veterinarians to request abdominal ultrasounds, which, in both cases, were suggestive of diaphragmatic peritoneopericardial hernia. In Case 1, a Doppler echocardiogram was also performed, and in Case 2, a contrast‐enhanced chest x‐ray confirmed the diagnosis. Although surgical treatment can be used, in the reported cases it was unnecessary. Therefore, the treatment chosen was conservative, maintaining the clinical follow‐up and keeping the patient's quality of life without surgical interventions.

Surgically treated purulent pericarditis induced by ingested fish bone: a case report

BackgroundAspiration of fish bones is common, but perforation of the gastrointestinal tract is very rare. Once perforation occurs, fatal complications such as mediastinitis and cardiac tamponade can occur. Here, we present a case of acute pericarditis due to perforation of a fish bone.Case presentationA 66-year-old woman was referred to our hospital with shortness of breath. Blood tests showed high C-reactive protein, and contrast-enhanced computed tomography showed a large amount of pericardial fluid as well as a foreign body with high bone density in the pericardial sac. Upper gastrointestinal endoscopy showed no evidence of penetration of the esophageal or gastric mucosa. Emergency open chest surgery was performed, and the pericardial sac was filled with copious amounts of pus. The fish bone-like foreign body was found to penetrate the pericardial membrane from the diaphragmatic side. The foreign body was removed, a drainage tube was placed, and the chest was closed. After 2 weeks of postoperative antibiotics, the patient was discharged from the hospital in stable general condition. Three months after the surgery, the patient had no recurrence of pericarditis.ConclusionsWe reported a rare case of gastrointestinal perforation by a fish bone, resulting in pericardium, which was treated by surgical drainage.

Aortic annulus rupture after transcatheter aortic valve replacement: successful management of a dangerous complication

ObjectiveAortic annulus rupture remains one of the most fatal complications of TAVR. While attempts have been made to describe and predict this complication, the data remains insufficient without evidence-based guidelines for management of this rare complication.MethodsHere we describe a series of 3 aortic annulus ruptures after TAVR which were managed successfully to hospital discharge.ResultsPatient 1 suffered annulus rupture during balloon valvuloplasty prior to TAVR. The patient became hypotensive, and echocardiogram showed pericardial effusion. The patient underwent pericardiocentesis which transiently improved the blood pressure, but bleeding continued. The patient was transitioned to an open surgical aortic valve replacement due to ongoing hemorrhage. The chest was left open with delayed closure on post-op day 2. The patient was discharged on post-op day 15. Patient 2 was undergoing TAVR valve expansion. The patient became hypotensive. An echocardiogram revealed pericardial effusion. Pericardiocentesis yielded 200 mL of blood. SURGIFLO (Johnson & Johnson Wound Management, Somerville, NJ) was injected into the pericardial space. Aortic root angiography confirmed no further contrast extravasation. A pericardial drain was left in place for 2 days, and the patient was discharged on post-op day 7. Patient 3 received a TAVR valve and post-placement dilation due to paravalvular leak. The echocardiogram showed a pericardial effusion. Pericardiocentesis was performed, yielding 500 cc of blood. The patient’s healthcare proxy declined emergent surgery; thus, a pericardial drain was placed. No hemostatic agents were used, and drainage reduced over several hours. The drain was removed on post-op day 3, and the patient was discharged on post-op day 8.ConclusionsBased on the timelines in these three cases, and interventions used, the following steps may be employed in the event of annulus rupture: identification of hemodynamic instability, echocardiogram to confirm pericardial effusion, emergent pericardiocentesis, pericardial drain placement for evacuation of the pericardial space and use of hemostatic agents, repeat aortogram to rule out ongoing extravasation. If hemostasis is unable to be achieved and/or the patient becomes hemodynamically unstable at any point, rapid transition to emergent surgical management is necessary. This management strategy proved successful for this case series and warrants further investigation.