Symmetric Inversion Research Articles

Isokinetic Ankle Inversion and Eversion Muscle Strength in Korean Men’s Professional Basketball Players

PURPOSE: In this study, the isokinetic strength of ankle inversion and eversion in Korean professional basketball players (KBL) was assessed, distinguishing between their dominant and non-dominant legs, as well as across different positions.METHODS: A meticulously designed study was conducted involving 25 KBL players (12 guards, 11 forwards, and 2 centers) with an average age of 27.8 ± 5.3 years. The CSMI Norm isokinetic dynamometer, a highly accurate instrument, was used to measure bilateral isokinetic concentric strength at 60°·s-¹ and 150°·s-¹. The study measured peak torque (Nm), body mass normalized peak torque (Nm·kg-¹), bilateral strength asymmetry, and the eversion-to-inversion strength ratio in both dominant and non-dominant legs.RESULTS: Peak torques, normalized peak torques, and eversion-to-inversion strength ratios were not significantly different between the dominant and non-dominant legs at the two angular speeds. There was also less than a 10% asymmetry in strength between the two legs. However, a position-specific analysis revealed that guards had a significantly higher normalized peak torque (0.35 vs. 0.30 Nm·kg-1, p = .048) for ankle inversion of the dominant leg at 150°·s-¹ compared to forwards.CONCLUSIONS: The results suggest that healthy KBL players exhibit symmetrical ankle inversion and eversion muscle strength between their dominant and non-dominant sides, with possible positional differences in strength. These findings serve as a reference for the assessment of inversion and eversion strength in basketball players.

Left anterior descending coronary T-wave inversion pattern (Wellens’ syndrome) associated with myopericarditis and a normal left coronary artery

Background: Wellens’ syndrome is characterised by a history of chest pain with an abnormal electrocardiogram (EKG), demonstrating biphasic or deeply inverted T waves in leads V2–3 (may extend to involve all precordial and lateral limb leads – the type B Wellens’ pattern). A Wellens’ EKG pattern is considered highly specific for critical stenosis involving the ostial/proximal left anterior descending artery (LAD). However, there are no reported cases of an association of a Wellens’ EKG pattern with myopericarditis. Here, we present such a rare case. Case description: A thirty-one-year-old female with known essential hypertension and psoriatic arthritis presented with a constant, central chest pain radiating to the shoulders and back. The patient’s physical examination was unremarkable at presentation other than elevated blood pressure at 170/68 mmHg. An EKG at presentation demonstrated deep symmetric T-wave inversions in anterolateral leads with elevated high-sensitivity troponin, and an elevated erythrocyte sedimentation rate. The patient was referred to the cardiac catheterisation laboratory for concerns of a Wellens’ EKG pattern; however, invasive angiography demonstrated only obtuse marginal branch disease – no LAD disease was noted. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis of myopericarditis and absence of myocardial infarction. The patient was medically managed and discharged home in a stable condition. Conclusion: In literature and established clinical practice, the Wellens’ EKG pattern is considered highly concerning for critical ostial/proximal LAD stenosis. However, we now propose that myopericarditis may be considered in a differential diagnosis for this EKG pattern.

Insights on the pulsed-DC powder-pack boriding process: The role of the electric charge on the growth of the boride layer and the semiconductor behavior of the boriding media

In pursuit of innovating the conventional powder-pack boriding (CPB) process by introducing an electrical driving force, novel findings regarding the kinetics growth of boride layers produced on an AISI 8620 steel through the pulsed-DC powder-pack boriding process (PDCPB) were obtained. The PDCPB accelerates B diffusion on the surface of the specimen, resulting in an augmentation of the growth kinetics around 12 % and 15 % for FeB and Fe2B, respectively, compared to those observed in the CPB process. Additionally, the effect of polarity inversion half-cycles on the growth of the FeB-Fe2B layer during the PDCPB was studied. The experiments were conducted at temperatures of 850 °C, 900 °C, and 950 °C, with different exposure times, and polarity inversion half-cycles of 30 s and 50 s, maintaining a constant current density of around 177 mA cm−2. An estimation of the electric charge (q) using a transfer function considering minimal and maximum temperatures was achieved. It was confirmed that, with a symmetrical inversion, q was similar for both 30 s and 50 s polarity inversion half-cycles, indicating no influence on the growth kinetics of the boride layers.

Abstract 13261: Global T Wave Inversion: Incidence and Implications in Critically Ill Patients

Background: Symmetric global T-wave inversion (GTWI) occurs in 0.3% of general hospital admits. As reported by Walder and Spodick, GTWI exhibited a 4:1 female preponderance and was often associated with ACS or central nervous system (CNS) disorders; in-hospital mortality was not affected. Anecdotally we have observed this ECG pattern in critically-ill medical ICU (MICU) patients. We hypothesized that GTWI is more prevalent among MICU patients and may be associated with adverse outcomes. Methods: We reviewed the ECGs, demographic, clinical, and physiological data of 1652 consecutive patients admitted to 2 medical ICUs. Those admitted to CCU and Neuro ICU were excluded as were MICU patients with a primary diagnosis of ACS, acute CNS syndrome, LBBB, ventricular pacing, pre-excitation, and uninterpretable ECG. ECGs performed within 48 hours of ICU admit were reviewed by 2 blinded readers. GTWI was defined by the criteria of Walder and Spodick. The GTWI group was compared to 95 matched patients without GTWI. Results: See Table. GTWI occurred in 75 patients (4.5%); 56% of whom were female. Significant differences between GTWI vs control included history of CAD (p=0.03), cardiomyopathy (p=0.035), CKD (p=0.046), and prior EP procedure (p=0.023). In addition, QT-interval (p<0.0001), QTc (p<0.0001) and BNP (1433±1725 vs 750±978 pg/mL; p=0.032) were greater in the GTWI group. LVEF (52.7±16.2% vs 55.6±14.1%) and cTnI (1.35±2.52 vs 1.25±4.15 pg/mL) were similar. MICU days and APACHE II score were greater in those with GTWI. Total length of stay and in-hospital mortality were similar. Conclusions: In this critically-ill MICU cohort, GTWI was more prevalent compared to previously reported general hospital admits. A distinct female preponderance was not found. This ECG pattern was associated with underlying cardiac disease, greater length of MICU stay and higher illness severity, but was not associated with higher in-hospital morality.

Wellens pattern as the debut of acute pulmonary embolism: A case report

The Wellens pattern is an electrocardiographic finding seen in patients with chest pain and atherosclerotic coronary artery disease and is described as a symmetrical T-wave inversion or biphasic T-wave inversion in precordial leads. The deep inversion of the precordial T wave is a sign associated with various etiologies, including left ventricular hypertrophy, vasospasm, and pulmonary embolism. We present the case of a patient who debuts with chest pain and electrocardiographic findings consistent with the Wellens and McGinn-White patterns, who was subsequently diagnosed with intermediate-risk pulmonary embolism after ruling out obstructive coronary artery disease. We discussed the differential diagnostic approach to T-wave inversion as a sign associated with high-risk conditions.

Acute hearing and visual loss caused by thiamine deficiency

BackgroundWernicke encephalopathy (WE) is a devastating acute or subacute neurological disorder caused by thiamine deficiency. Wernicke encephalopathy is characterized by the triad of ocular signs, cerebellar dysfunction, and confusion. Visual loss and hearing loss are less common findings in WE. Here, we report a case of Wernicke encephalopathy in a nonalcoholic liver cirrhosis patient who presented with acute bilateral deafness and bilateral blindness.Case presentationA 60-year-old Chinese man presented with a history of bilateral blindness and bilateral hypoacousia for 3 days. He had a history of liver cirrhosis and chronic hepatitis C virus infection and did not have a habit of alcohol consumption. Ophthalmologic and otologic examinations showed no obvious abnormalities. MRI findings revealed symmetric fluid-attenuated inversion recovery (FLAIR) hyperintensities in the bilateral medial dorsal thalamus, periventricular region around the third ventricle and tectum, and dorsal medulla oblongata. One day after hospitalization, the patient developed a mild coma. Based on the laboratory and neuroimaging findings, we diagnosed the patient with Wernicke encephalopathy. He soon regained consciousness after administration of thiamine. Both his visual acuity and his hearing function improved gradually.ConclusionsWe suggest that Wernicke encephalopathy can present with bilateral blindness and bilateral deafness.

A case report on : Wellens syndrome- The widow maker

Wellens syndrome refers to typical clinical electrophysiological presentation in patient with critical LAD stenosis . This rare entity is often missed if unrecognized and has considerable implications due to critical stenosis associated with it. It is also knwon as “The Widow Maker”. It is further divided into Type A and B, type A is recognized by biphasic T-waves in leads V2 and V3, while Type B is characterized by deeply symmetrical T-wave inversions in leads V2 and V3, often including leads V1 and V4 and sometimes leads V5 and V6 . It is important to recognize this as symptoms are intermittent and often do not correlate with clinical severity. PCI is the management of choice. Here we present a case of Wellens syndrome who presented in our Institute with typical history found associated with it.

Householder Transformation-Based Temporal Knowledge Graph Reasoning

Knowledge graphs’ reasoning is of great significance for the further development of artificial intelligence and information retrieval, especially for reasoning over temporal knowledge graphs. The rotation-based method has been shown to be effective at modeling entities and relations on a knowledge graph. However, due to the lack of temporal information representation capability, existing approaches can only model partial relational patterns and they cannot handle temporal combination reasoning. In this regard, we propose HTTR: Householder Transformation-based Temporal knowledge graph Reasoning, which focuses on the characteristics of relations that evolve over time. HTTR first fuses the relation and temporal information in the knowledge graph, then uses the Householder transformation to obtain an orthogonal matrix about the fused information, and finally defines the orthogonal matrix as the rotation of the head-entity to the tail-entity and calculates the similarity between the rotated vector and the vector representation of the tail entity. In addition, we compare three methods for fusing relational and temporal information. We allow other fusion methods to replace the current one as long as the dimensionality satisfies the requirements. We show that HTTR is able to outperform state-of-the-art methods in temporal knowledge graph reasoning tasks and has the ability to learn and infer all of the four relational patterns over time: symmetric reasoning, antisymmetric reasoning, inversion reasoning, and temporal combination reasoning.

Algorithms for solving a class of real quasi-symmetric Toeplitz linear systems and its applications

<abstract><p>In this paper, fast numerical methods for solving the real quasi-symmetric Toeplitz linear system are studied in two stages. First, based on an order-reduction algorithm and the factorization of Toeplitz matrix inversion, a sequence of linear systems with a constant symmetric Toeplitz matrix are solved. Second, two new fast algorithms are employed to solve the real quasi-symmetric Toeplitz linear system. Furthermore, we show a fast algorithm for quasi-symmetric Toeplitz matrix-vector multiplication. In addition, the stability analysis of the splitting symmetric Toeplitz inversion is discussed. In mathematical or engineering problems, the proposed algorithms are extraordinarily effective for solving a sequence of linear systems with a constant symmetric Toeplitz matrix. Fast matrix-vector multiplication and a quasi-symmetric Toeplitz linear solver are proven to be suitable for image encryption and decryption.</p></abstract>

ЭКГ-признаки транзиторного синдрома Бругада у пациента после COVID-19

The article presents a description of a clinical case of the appearance of characteristic ECG signs of Brugada syndrome type 1 in the form of incomplete blockade of the right bundle branch block, «convex» ST elevation of 2 mm and negative symmetrical T-wave inversion in V1-V2 in a practically healthy patient after a new coronavirus infection (COVID-19). On the control ECG performed a week later, these signs reduced to a latent form. However, there is an assumption that the Brugada syndrome in a woman had existed in a latent form, and against the background of COVID-19, it transformed into its active variant. Unfortunately, we do not have data on how long these signs were present on the ECG, as the ECG was recorded a week after COVID-19. The clinical case we demonstrate shows a possible relationship between the transient nature of type 1 Brugada syndrome and COVID-19, which requires further study. The article also provides examples of other clinical cases of the appearance of signs of Brugada syndrome on the ECG in patients with COVID-19 according to various literature data.

Type A Wellens’ syndrome - A critical electrocardiographic sign

Wellens’ syndrome was first described in 1982[1] and classified into type A and type B. Type A Wellens’ syndrome is characterized by biphasic T-waves in leads V2 and V3, and type B is characterized by deep symmetrical T-wave inversions in the same leads. The study reported that Wellens’ syndrome electrocardiographic (ECG) finding related to left anterior descending (LAD) total or near-total occlusion, which is also described as one of the ST-segment elevation myocardial infarction (STEMI) equivalent signs.[2] Cardiology consultation for possible coronary angiography is necessary for evaluating patients.[3] A 29-year-old male without underlying medical diseases was admitted to our emergency department due to intermittent retrosternal chest tightness for 1 week. His chest pain usually occurs after exertion, accompanied by nausea and dizziness, and subsides 10–15 min after rest. He did not notice other exacerbating or relieving factors. Thus, he visited our emergency department for a consultation. The patient is a nonsmoker with no family history of acute coronary syndrome. In the emergency department, his chest pain had already subsided. He was vitally stable. On physical examination, his cardiac auscultation revealed a regular heartbeat with no murmurs. His ECG performed in the emergency department showed sinus rhythm with biphasic T-waves in leads V2 and V3 without precordial Q waves [Figure 1], which is compatible with type A Wellens’ syndrome. As for his blood examination, his troponin I level is 3.2 ng/mL (normal range < 0.02 ng/mL) and creatine kinase-myocardial band mass is 8.5 ng/mL (normal range <5 ng/mL). He also had thrombocytosis with a platelet count of 993,000/μL.Figure 1: Patient’s initial ECG. ECG: ElectrocardiographicThe patient received aspirin, ticagrelor, and heparin for the myocardial infarction. He received urgent coronary angiography and the examination showed an 85% stenosis of the proximal LAD artery [Figure 2] that was successfully opened through angioplasty. Two drug-eluted stents were placed. After angioplasty, his ECG showed sinus rhythm with no Wellens’ pattern. In addition, he did not experience any chest pain attack after angioplasty. On admission, the patient was diagnosed with essential thrombocythemia through positive JAK-2 V617F mutation test and bone marrow biopsy.Figure 2: Patient’s coronary angiography showed LAD stenosis. (Left) Before the intervention. (Right) After the intervention. LAD: Left anterior descendingWellens’ syndrome is one of the STEMI equivalent ECG signs that need to be treated as acute myocardial infraction in the emergency department.[2] A previous study[1] showed that 75% of the patients with Wellens’ syndrome developed extensive anterior wall myocardial infarction a few weeks after admission. T-wave findings of Wellens’ syndrome are classified into two patterns. In type B, which comprises approximately 75% of cases, the T-wave is deeply inverted and the inverted T-wave is symmetric in contour. In type A, which comprises 25% of cases, the T-wave is biphasic in leads V2 and V3. Other ECG criteria included no loss of R rave or precordial Q waves. Considering noncoronary causes of T-wave inversions, the left ventricular hypertrophy and bundle branch block patterns should be readily recognized by their significant coexistent findings.[3] The characteristic ECG pattern often develops when the patient is not experiencing angina.[3] Patients with ET may present with vasomotor symptoms such as myocardial infarction or stroke. However, in this case, the patient was young and without any risk factors for myocardial infarction before diagnosis. Prompt recognition of the ECG pattern and early cardiology consultation are essential to prevent missing the diagnosis of myocardial infarction. Declaration of patient consent The authors certify that they have obtained appropriate patient consent form. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Stereoinversion of tetrahedral p-block element hydrides.

The potential energy surfaces of 15 tetrahedral p-block element hydrides were screened on the multireference level. It was addressed whether stereoinversion competes against other reactions, such as reductive H2-elimination or hydride loss, and if so, along which pathway the stereomutation occurs. Importantly, stereoinversion transition structures for the ammonium cation (C4v) and the tetrahydridoborate anion (Cs) were identified for the first time. Revisiting methane's Cs symmetric inversion transition structure with the mHEAT+ protocol revealed an activation enthalpy for stereoinversion, in contrast to all earlier studies, which is 5 kJ mol-1 below the C-H bond dissociation enthalpy. Square planar structures were identified lowest in energy only for the inversion of AlH4 -, but a novel stepwise Cs-inversion was discovered for SiH4 or PH4 +. Overall, the present contribution delineates essentials of the potential energy surfaces of p-block element hydrides, while structure-energy relations offer design principles for the synthetically emerging field of structurally constrained compounds.

Arrhythmogenic Right Ventricular Dysplasia Diagnosed in a Patient with Long-term Undiagnosed Syncope

Arrhythmogenic Right Ventricular Dysplasia (ARVD) is an inherited cardiomyopathy which represents progressive replacement of right ventricular myocardium with fibrofatty tissue. In the present case, a 42-year-old male presented to the hospital as he fell down, due to syncope. He had a history of recurrent syncopal in past 4-5 years. His chest radiogram revealed cardiomegaly (CT ratio 0.64), repeat electrocardiogram showed symmetric T-wave inversions and epsilon waves in right precordial V1, V2 and V3 leads, and echocardiogram revealed mild left ventricular dysfunction (ejection fraction - 45%) and dilated right atrium and ventricle. Cardiac Magnetic Resonance Imaging (MRI) confirmed the diagnosis of ARVD.The patient was advised for the placement of an Automatic Implantable Cardioverter Defibrillator (AICD), but he denied for this treatment. Thus, he was managed with anti-arrhythmic drugs and was advised for regular follow-up. The patient was followed-up for six months where episodes of syncope had significantly reduced to one in six months but need of AICD implantation was still there to avoid sudden cardiac death.

Bilateral symmetry of linear streptomycete chromosomes.

Here, we characterize an uncommon set of telomeres from Streptomyces rimosus ATCC 10970, the parental strain of a lineage of one of the earliest-discovered antibiotic producers. Following the closure of its genome sequence, we compared unusual telomeres from this organism with the other five classes of replicon ends found amongst streptomycetes. Closed replicons of streptomycete chromosomes were organized with respect to their phylogeny and physical orientation, which demonstrated that different telomeres were not associated with particular clades and are likely shared amongst different strains by plasmid-driven horizontal gene transfer. Furthermore, we identified a ~50 kb origin island with conserved synteny that is located at the core of all streptomycete chromosomes and forms an axis around which symmetrical chromosome inversions can take place. Despite this chromosomal bilateral symmetry, a bias in parS sites to the right of oriC is maintained across the family Streptomycetaceae and suggests that the formation of ParB/parS nucleoprotein complexes on the right replichore is a conserved feature in streptomycetes. Consequently, our studies reveal novel features of linear bacterial replicons that, through their manipulation, may lead to improvements in growth and productivity of this important industrial group of bacteria.

Pseudo-Wellens syndrome from sepsis-induced cardiomyopathy: a case report and review of the\xa0literature

BackgroundPseudo-Wellens syndrome is a rare entity characterized by the presence of electrocardiogram (ECG) changes of Wellens syndrome but without the stenosis of the left anterior descending (LAD) coronary artery. In previous reports, pseudo-Wellens syndrome most commonly resulted from recreational drug use or unidentified etiologies. We present a unique case of pseudo-Wellens syndrome due to sepsis-induced cardiomyopathy and a review of the literature.Case presentationA 62-year-old Caucasian woman was admitted for sepsis from left foot cellulitis. Laboratory data were notable for elevated lactate of 2.5 mmol/L and evidence of acute kidney injury. She developed chest pain on the third day of hospitalization. ECG showed symmetric T-wave inversion in leads V1–V4. Serial troponin I levels were within normal limits. Chest imaging showed no pulmonary embolism. Echocardiogram showed ejection fraction of 25%, left ventricular diastolic diameter of 4.6 cm, and multiple segmental wall motion abnormalities. Cardiac catheterization showed patent coronary arteries. The hospital course was complicated by transient sinus bradycardia and hypotension. She was hospitalized for a total of 17 days. ECG prior to discharge showed resolution of T-wave changes.ConclusionPseudo-Wellens syndrome may result from myocardial ischemia due to vasospasm or myocardial edema from external insults. In our case, we suspect sepsis-related cytokine production resulting in cardiomyopathy and pseudo-Wellens syndrome. The clinical manifestations were indistinguishable between Wellens and pseudo-Wellens syndrome. Physicians should include the diagnosis of pseudo-Wellens syndrome when considering the presence of LAD coronary artery occlusion given risk stratifications.

AN ACUTE MYOCARDIAL INFARCTION CAUSING A MOTOR VEHICLE ACCIDENT OR THE MOTOR VEHICLE ACCIDENT CAUSING AN ACUTE MYOCARDIAL INFARCTION: A CLINICAL DILEMMA

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute myocardial infarction is seen in very few patients (0.5%) who are admitted post-motor vehicle accidents (MVAs) (1). It is, however, one of the common natural causes of incapacitation leading to MVA (2). We present a case of a male, who suffered a V-fib cardiac arrest post-MVA and was subsequently diagnosed with a 99 percent occlusion of the proximal left main coronary artery. CASE PRESENTATION: A 68-year old male known to have hypertension was brought to the ED after a head-on motor vehicle collision. EMS reported that the patient self-extricated from the vehicle, walked on the sidewalk, and fell unconscious afterward with V-fib arrest. The patient achieved ROSC after one round of CPR with cardioversion, and 1mg epinephrine. Due to low GCS, he was intubated and transferred to ICU. His labs were significant for elevated white blood cells and troponin of 0.14 (normal<0.03). EKG showed sinus rhythm with non-specific ST-T wave changes in Leads I, aVL, V5, and V6. CT chest showed non-displaced multiple ribs and sternal fractures with small retrosternal hematoma. TTE demonstrated a 25-30% ejection fraction and multiple wall motion abnormalities with apical ballooning. The patient was extubated after his respiratory status showed signs of improvement. Meanwhile, since the troponin levels continued to rise (0.14 < 1.93 < 3.62 < 6.89 < 7.02), heparin drip was started. Although the patient was finally alert and oriented, he had amnesia of the event. However, he denied having any chest pain, or anginal symptoms before the accident. Our differential diagnoses were cardiac injury from either accident or CPR, Takostubo cardiomyopathy, or myocardial infarction. His repeat EKG was different from the one on arrival and showed biphasic T-wave in V2 -V3 and symmetric T-wave inversion in V4-V6. On the second day of his hospital stay, cardiac catheterization was performed that showed 99% proximal LAD stenosis, leading to percutaneous coronary intervention. His status slowly improved and was discharged on a life vest with a follow up with a cardiologist. DISCUSSION: While myocardial injury post blunt trauma, associated with MVAs, are common, thrombotic occlusions are rare. Unlike our case, in a few of the reported cases of thrombotic occlusion, (3) (4) the patients were fairly young. The presentations of the case poised a clinical dilemma because we could not establish if MI caused the MVA or vice-versa. Also, coronary thrombosis was not the top differential diagnosis in this case given the trauma, CPR, rib fractures, and TTE findings. Regardless, a timely cardiac catheterization with revascularization was performed, and the patient recovered. CONCLUSIONS: Acute myocardial infarction should always be one of the differential diagnoses after cardiac injury associated with trauma as timely cardiac catheterization and revascularization can be life-saving. Reference #1: 1.Alkhouli M, Alqahtani F. Incidence and outcomes of acute myocardial infarction during motor vehicle accident related hospitalizations. The American journal of cardiology. 2019 Mar 1;123(5):725-8. Reference #2: 2. Antecol DH, Roberts WC. Sudden death behind the wheel from natural disease in drivers of four-wheeled motorized vehicles. The American journal of cardiology. 1990 Dec 1;66(19):1329-35. Reference #3: 3.Watt AH, Stephens MR. Myocardial infarction after blunt chest trauma incurred during rugby football that later required cardiac transplantation. Heart. 1986 Apr 1;55(4):408-10. 4.Calvo Orbe L, Garcia Gallego F, Sobrino N, Sotillo J, Lopez-Sendon JL, Oliver J, Coma I, Frutos A, Sobrino JA, Navarro JM. Acute myocardial infarction after blunt chest trauma in young people: need for prompt intervention. Catheterization and cardiovascular diagnosis. 1991 Nov;24(3):182-5. DISCLOSURES: No relevant relationships by Abhishek Kalidas Kulkarni, source=Web Response No relevant relationships by Odalys Lara-Garcia, source=Web Response No relevant relationships by Ruby Maini, source=Web Response No relevant relationships by Priyanka Parajuli, source=Web Response No relevant relationships by Manjari Regmi, source=Web Response No relevant relationships by Mohsin Salih, source=Web Response No relevant relationships by Nitin Tandan, source=Web Response

Abstract P232: Dilated Cardiomyopathy With Electrocardiographic Changes And Coronary-Pulmonary Fistula: An Uncommon Presentation Of Primary Aldosteronism In The Covid-19 Era

Primary aldosteronism is the most frequent forms of curable hypertension and elevated aldosterone levels have been associated with endothelial proliferation and pathological remodeling of the heart and arteries; however, coronary arterial abnormalities have never been reported in patients with primary aldosteronism. We report the case of a 53-year-old Caucasian obese man (BMI 37 Kg/m 2 ) with recent history of hypertension, fatigue and subjective dyspnea who was admitted to our hospital after performing an outpatient echocardiography that showed hypertensive and ischemic heart disease in dilated phase (LVEDVI 95 mL/m 2 ; LVEF 43%). His laboratory results showed hypokalemia (3 mmol/L) and an elevated aldosterone-renin ratio [(294 ng/L)/(1μU/mL)]. After case confirmation with saline infusion test, the abdominal CT scan showed a subcentimeter adenoma in the right adrenal gland. Surprisingly we noticed that, after oral potassium correction, the electrocardiogram revealed a symmetrical T-wave inversion and subsequently a coronary angiography detected a coronary artery fistula between the left anterior descending artery and the pulmonary artery in the absence of significant stenosis. In the Italy's CoViD-19 pandemic full spread, we preferred to postpone the diagnosis of the lateralization of aldosterone hypersecretion by adrenal vein sampling and we started a mineralocorticoid receptor antagonist with a clinical follow-up of cardiovascular symptoms for the optimal treatment of coronary artery fistula. After about two months of follow-up, the patient remains asymptomatic with good blood pressure control, normal potassium levels and significant echocardiographic improvement (LVEDVI 67 mL/m 2 ; LVEF 51%). Our case highlights a possible association between hypertensive patients with coronary artery fistulas and primary aldosteronism. We recommend cardiologists and clinicians to maintain a high level of suspicion of primary aldosteronism in these patients.

WELLEN’S SYNDROME IS NOT ALWAYS CORONARY ARTERY DISEASE: A RARE FINDING IN PULMONARY EMBOLISM

The characteristics features of Wellen's syndrome, seen in right precordial leads, are biphasic T-waves or symmetrical T-wave inversion with normal R-wave progression and the absence of Q waves. It is associated with critical stenosis of proximal left anterior descending (LAD) artery. Similar ECG

Accelerated Multifidelity Emulator Modeling for Probabilistic Rotor Response Study

Abstract This paper presents an efficient methodology to build a modal solution emulator for the probabilistic study of geometrically mistuned bladed rotors by using the newly developed localized-Galerkin multifidelity (LGMF) modeling and eigensolution reanalysis (ER) with the symmetric successive matrix inversion (SSMI) methods. The key idea of the mistuned blade emulator is to establish a reduced functional relationship between the stochastic geometric variations and the disturbed modal responses. The prediction accuracy of an emulator generally depends on how many training samples of modal solutions are available and how well the potential modal switching due to stochastic mistuning is captured. To reduce the computational costs of generating training samples without sacrificing accuracy, this paper introduces the collaborative framework of the new approaches of multifidelity (MF) modeling and ER. The proposed framework is demonstrated for its computational benefits with several numerical examples including the point-cloud scanned mistuned blade problem.

Conserved Patterns of Symmetric Inversion in the Genome Evolution of Bordetella Respiratory Pathogens.

Whooping cough (pertussis), primarily caused by Bordetella pertussis, has resurged in the United States, and circulating strains exhibit considerable chromosome structural fluidity in the form of rearrangement and deletion. The genus Bordetella includes additional pathogenic species infecting various animals, some even causing pertussis-like respiratory disease in humans; however, investigation of their genome evolution has been limited. We studied chromosome structure in complete genome sequences from 167 Bordetella species isolates, as well as 469 B. pertussis isolates, to gain a generalized understanding of rearrangement patterns among these related pathogens. Observed changes in gene order primarily resulted from large inversions and were only detected in species with genomes harboring multicopy insertion sequence (IS) elements, most notably B. holmesii and B. parapertussis While genomes of B. pertussis contain >240 copies of IS481, IS elements appear less numerous in other species and yield less chromosome structural diversity through rearrangement. These data were further used to predict all possible rearrangements between IS element copies present in Bordetella genomes, revealing that only a subset is observed among circulating strains. Therefore, while it appears that rearrangement occurs less frequently in other species than in B. pertussis, these clinically relevant respiratory pathogens likely experience similar mutation of gene order. The resulting chromosome structural fluidity presents both challenges and opportunity for the study of Bordetella respiratory pathogens.IMPORTANCE Bordetella pertussis is the primary agent of whooping cough (pertussis). The Bordetella genus includes additional pathogens of animals and humans, including some that cause pertussis-like respiratory illness. The chromosome of B. pertussis has previously been shown to exhibit considerable structural rearrangement, but insufficient data have prevented comparable investigation in related species. In this study, we analyze chromosome structure variation in several Bordetella species to gain a generalized understanding of rearrangement patterns in this genus. Just as in B. pertussis, we observed inversions in other species that likely result from common mutational processes. We used these data to further predict additional, unobserved inversions, suggesting that specific genome structures may be preferred in each species.