bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster No. 080 Relationship between triglyceride glucose index, MACE and nephropathy in type 2 diabetes
Authors: Delia Mercea , Mihaela Mociran , Raluca Ianos , Adela Sitar-Taut , Sporis D , Ganea A , Lazar A , Malinescu V , Cozma A
Published: October 2022

Background

The triglyceride glucose (TyG) index, a simple surrogate estimate of insulin resistance, has been demonstrated to predict cardiovascular disease morbidity and mortality in the general population. To explore the relationship between TyG index, MACE (major adverse cardiovascular events) and diabetic nephropathy in type 2 diabetes, we evaluated TyG index for 3 consecutive years.

Material and methods

This was a cross-sectional observational study that examined 172 subjects with T2DM. The mean age of the study participants was 61.71 ± 13.16 years, and 90 were female. The primary outcomes included the occurrence of MACE, defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. Subjects underwent a detailed standard evaluation to detect diabetic nephropathy (defined as urinary albumin excretion ≥ 30 mg/24 h). The TyG index was calculated as ln (fasting triglycerides × fasting glucose/2) and stratified into 4 quartiles (TyG-Q). The baseline characteristics of the study population in the four TyG-Q (Q1 (≤ 8.95) n = 43, Q2 (> 8.95 to ≤ 9.27) n = 43, Q3 (> 9.27 to ≤ 9.7) n = 43, and Q4 (> 9.7) n = 43) were analysed.

Results and conclusions

Higher TyG-Q correlated with the presence of nephropathy (p = 0.028), age (p = 0.0172), HbA1c levels (p = 0.001) and the presence of arterial hypertension (p = 0.032). The optimal TyG index cut-off for predicting MACE was 9.271 (sensitivity 54.0%; specificity 54%; area under the curve 0.532).The TyG index was significantly associated with MACE, suggesting that the TyG index may be a valid marker for risk stratification and prognosis in patients with T2DM.
Retracted: Oral Presentation No. 089 Vascular access computed tomography angiography-derived iliofemoral calcium volume in the evaluation of vascular and bleeding complications after transfemoral TAVI
Authors: Silva Mariana Ribeiro , Oliveira Joana , Rodrigues Inês , Guerreiro Cláudio , Silva Gualter Santos , Brandão Mariana , Ferreira Wilson , Ferreira Nuno , Pires-Morais Gustavo , Melica Bruno , Santos Lino , Rodrigues Alberto , Braga Pedro , Sampaio Francisco , Fontes-Carvalho Ricardo
Published: October 2022

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Oral Presentation No. 096 Impact of Inflammatory and Hematological Factors to The Left Ventricule Function, Remodeling, and Clinical Outcomes after The First Myocardial Infarction
Authors: Korac Nina , Dekleva Milica
Published: October 2022

Background

It is known that hematological and inflammatory factors can affect the prognosis of patients with AMI, but the interpretations are different.

Material and methods

The study included 182 patients with their first AMI age < 70 years. Inflammatory (CRP, Sedimentation and Leukocytes), hematological factors (Platelets, Iron, Hct) and coronary status were obtained at admission. Doppler echocardiography was performed two days after admission and after 6 months.The degree of heart failure was assessed by clinical examination.

Results and conclusions

Remodeling of LV, measured by LV volume increase and Sphericity index was closely related to Sedimentation level (P = 0.013; P = 0.028). Sedimenation was related to systolic function measured by LVEF (P = 0.011) and with diastolic dysfunction measured by E/e ratio (P < 0.001). A significant impact of CRP on LVEF (P = 0.028) and degree of diastolic dysfunction (P = 0.024) was estimated. Iron level had an effect on LVEF (P = 0.017), while E/e was negatively correlated with Iron (P = 0.005). The degree of heart failure was positively correlated with the level of Iron and Sedimentation. Sedimentation level of 22.5 cut off had a sensitivity of 75%, a specificity of 52% in predicting NYHA III and IV. Iron level of 8.1 has a sensitivity of 72.4%, specificity of 57.9% in predicting NYHA III and IV. There were no significant correlations between coronary status and inflammation parameters .Inflammatory hematological status of patients is associated with changes in the morphology and function of the LV after the first MI. The sedimentation level and CRP contribute to a better risk stratification for the severity of heart failure.
Poster No. 098 SGLT2-inhibitors as add-on therapy in cardiac amyloidosis: our experience
Authors: Fazio Giovanni
Published: October 2022

Background

Cardiac amyloidosis (CA) is a severe and progressive infiltrative disease caused by physiological, inherited or acquired abnormalities, which lead to the accumulation of amyloid fibrils in the cardiac interstitium. Despite recent evidence support the use of SGLT2-inhibitors in heart failure, including HFpEF for empagliflozin and dapagliflozin, there are no studies on the use of these drugs for the treatment of CA.

Methods

We enrolled 5 consecutive patients with symptomatic CA (II or II NYHA). The diagnosis of was based on non-invasive criteria: echocardiographic criteria + grade 2 or 3 cardiac uptake at diphosponate scintigraphy + negative serum light chains and negative serum and urine immunofixation. Mean age was 66,52 years, all male. Despite optimal therapy, they had symptoms of pulmonary and peripheral congestion. We added 10 mg of dapagliflozin daily to therapy and reassessed patients after 7 days.

Results

Dapagliflozin was effective as add-on therapy in CA. All treated patients reported an improvement in symptoms and signs. After7 days, dyspnea improved, exercise tolerance evaluated in six minutes walking test increased (from a mean of 123 meters to a mean of212 meters), and oedema decreased. Therapy was well tolerated, and no side effects were reported.

Conclusions

Our initial experience with dapagliflozin suggests that SGLT2-inhibitors may play a role in the treatment of cardiac amyloidosis. In our opinion, the growing evidence of this class of drugs in heart failure therapy justifies clinical trials on amyloidosis.
Poster No. 104 Impact of pre-treatment with a P2Y12 receptor inhibitor on delay to CABG surgery in a real-world population with non-ST segment elevation acute coronary syndrome
Authors: Gomes Daniel , Rocha Bruno M L , Ferreira Jorge , Paiva Mariana Sousa , Santos Rita Reis , Santos Marina Raquel , Cunha Gonçalo , de Araújo Gonçalves Pedro , Fevereiro Susana , Trabulo Marisa , Aguiar Carlos , Sousa-Uva Miguel , Neves José , Mendes Miguel
Published: October 2022

Background

ESC guidelines for non-ST elevation acute coronary syndromes (NSTE-ACS) recommend against P2Y12 pre-treatment receptor inhibitors (P2Y12i) in patients undergoing early invasive management (< 24 h). The rationale is, in part, to prevent bleeding complications and the delay of coronary artery bypass graft surgery (CABG) in patients with suitable anatomy. This study aims to analyze the impact of P2Y12i pre-treatment on delay to CABG surgery in a real-world population with NSTE-ACS.

Methods

Single-centre retrospective cohort of consecutive patients with NSTE-ACS undergoing invasive evaluation in 2019. Those with previous CABG (n = 31) or non-obstructive coronary disease (n = 57) were excluded.

Results

Total cohort included 262 patients (mean age 68 ± 12 years, 69% male, 15% with unstable angina and mean GRACE score 134 ± 35). Median time from first medical contact to angiography was 2 (1–4) days. Overall, 168 (64%) patients underwent percutaneous coronary intervention, 47 (18%) were proposed for CABG and the remainder received conservative management. All patients considered for CABG received pre-treatment with P2Y12i, either clopidogrel or ticagrelor. Median time from angiography to CABG was 12 (7–15) days. Six patients experienced recurrent angina (13%) and 2 (4%) died before surgery due to refractory ventricular fibrillation. Those who underwent CABG under P2Y12i effect were more likely to receive blood and platelets transfusions (64.7% vs. 28.6%, P = 0.017 and 82.4% vs. 21.4%, P < 0.001, respectively), although there were no differences regarding major bleeding.

Conclusion

Pre-treatment with P2Y12i was a potential driver of CABG delay in our cohort. In the real-world, adopting the new recommendations of withholding pre-treatment might decrease this delay.
Poster No. 122 Predicting the rate of progressive dilation by wall shear stress in bicuspidaortic valve patients
Authors: Rodriguez-Palomares Jose , Dux-Santoy Lydia , Teixidó-Turà Gisela , Ruiz-Muñoz Aroa , Garrido-Oliver Juan , Johnson Kevin , Wieven Oliver , Galian Laura , Valente Filipa , Gutierrez Laura , Gonzalez-Alujas Teresa , Sao-Aviles Augusto , Evangelista Arturo , Ferreira-Gonzalez Ignacio , Guala Andrea
Published: October 2022

Background

Despite the high prevalence of ascending aorta (AAo) dilation in bicuspid aortic valve (BAV) patients there is limited evidence of dilation aetiology. Several cross-sectional studies pointed to a role for wall shear stress (WSS), but this hypothesis has not been tested. Recently, a technique for 3D-maps of aortic growth from two contrast-enhanced computed tomography angiograms (CTA) was presented and validated. We aim to test if local WSS predicts local dilation rates in BAV patients.

Materials and methods

Forty BAV patients free from aortic valve disease and previous relevant interventions underwent a baseline 4D flow CMR followed by two CTA. WSS, and its axial and circumferential components, and growth rate (GR) were computed at 64 standardized regions in the ascending aortic (AAo). A two-tailed p-value < 0.05 was considered statistically significant.

Results and conclusions

Patients were relatively young (51 ± 13 yeas) and follow-up duration was 44.8 ± 2.6 months. Growth rate was heterogeneous in the AAo, with fastest progression located in the outer mid AAo region and in the inner region of the proximal-mid AAo. WSS magnitude and WSS axial component were maximum in the right region of the mid AAo while circumferential WSS was highest in the outer region of the mid AAo, the region experiencing fastest growth. Significant associations between GR and circumferential WSS were located in the regions with fastest progressive dilation, while WSS magnitude and its axial component resulted in limited predictive capacity. In conclusion, circumferential WSS is related to fast progressive dilation in BAV patients.

Funding

PI17/00381,SEC/FEC-INV-CLI20/015,LCF/BQ/PR22/11920008,RTC2019-007280-1.
Poster No. 138 Thromboembolic and bleeding risks due to perioperative stop of antithrombotic treatment in non-cardiac surgery - a single center experience
Authors: Carvalho Mariana Ferreira , Gonçalves Carolina , Cabral Margarida , Fernandes Sara Lopes , Carvalho Rita Ribeiro , Guardado Jorge , Antunes Alexandre , Morais João
Published: October 2022

Introduction

Discontinuation of antiplatelet therapy is essential for patients in the perioperative period submitted to high bleeding risk non-cardiac surgery (NCS). Similarly, oral anticoagulants should be interrupted before high risk surgical procedures, excluding patients with mechanical heart valves together with any thromboembolic risk factors. Interruption of this medication may increase thromboembolic events, however, their frequency still remains unclear.

Purpose

We aim to evaluate the thromboembolic and bleeding events due to perioperative cessation of antithrombotic treatment in non-cardiac surgery approach in the population in our center.

Methods

A single-center retrospective observational analysis between January 2015 and August 2022 evaluated 356 patients. Eligibility criteria included: interruption of antithrombotic or anticoagulant therapy, high cardiovascular risk with previous cardiovascular disease diagnosis, planned major non-cardiac surgery, and perioperative follow-up at our center.

Results

A total 356 patients undergoing NCS were eligible in the cohort: 91.2% of patients with high bleeding risk surgery and 94.5% with mild-moderate thrombotic risk.

All cause death occurred in 4 patients (1.1%), thrombotic events in 4 patients (1.1%) and major bleeding events in 11 patients (3.1%). Hemoglobin level (P = 0.004), duration of surgery (P < 0.001) and age (P = 0.004) were significantly related to the risk of bleeding events. Mean duration of interruption of antithrombotic therapy was of 8 ± 2 days.

Conclusions

Although cessation of antithrombotic therapy, hemorrhagic events are more associated than thrombotic ones in patients with previous cardiac disease that underwent elective NCS. The factors with significant association with bleeding complications after NCS were age, hemoglobin level, and duration of surgery.
Poster No. 142 An unusal heart-kidney connection: from diagnosis to staging of renal cell carcinoma
Authors: Quintal Jéni , Lopes Paula , Póvoa Joana , Cassama Aissato , Diogo Ana Cristina , Pereira Vanessa
Published: October 2022

A 58-years-old man is admited in emergency department with complaints of 2-days le flank pain and hematuria. When questioned, he mentions 6-months bilateral low back pain. His medical history was relevant for tobacco consumption (80 pack-year) and acute myocardial infarction in 2011. During abdominal examination, a painless 7 cm mass is detected in the left abdominal flank. Blood tests were remarkable for macrocytic anemia, increased D-dimers and serum calcium levels and leukocytosis. A thoracoabdominal-pelvic CT was performed to exclude advanced neoplasia. A 15×13 cm heterogeneous renal lesion involving the lower half of the left kidney was shown. This lesion extended through the renal vein and suprarenal inferior vena cava (IVC) to the right atrium. Bilateral pulmonary thromboembolism and metastatic lesions in the liver, left adrenal gland, latero-aortic ganglia and lung parenchyma were also detected. A thrombus was confirmed in the IVC with extension to the Eustachian valve by echocardiography. Metastatic renal carcinoma was assumed and enoxaparin was started. A renal biopsy identified clear cell renal carcinoma (CCRC). Embolization of the left renal artery was performed and Palliative Care follow-up was started after multidisciplinary team discussion. Renal cell carcinoma accounts for 2% of all tumors in adulthood with its classic symptomatic triad (flank pain, hematuria, and palpable abdominal mass) occuring only 9% of cases, as does endovascular dissemination from the renal vein and IVC. It is associated with a median survival of 5 months. We emphasize the importance of complete clinical examination and the recognition of poor prognosis predictors of CRCL.
Clinical Case 04—Percutaneous patent foramen ovale closure after a thrombotic storm: a case report
Authors: Alexandre André , Couto David Sá , Luz André , Marinho António , Oliveira Filomena , Silveira João , Torres Severo
Published: October 2022

A 38-year-old woman with a 32-week gestation was admitted in the emergency department complaining of acute lower limb pain. She had history of smoking, 1 voluntary interruption of pregnancy, 1 miscarriage at age 34, and family history of antiphospholipid syndrome (APS). At admission, bilateral acute limb ischemia and foetal death were diagnosed. CT angiography revealed acute bilateral thrombotic occlusion of the iliac arteries, left renal artery thrombosis with extension to the distal abdominal aorta, deep vein thrombosis (DVT) of the left iliac vein and distal inferior vena cava, and bilateral pulmonary embolism. The patient started on anticoagulation and underwent caesarean section and axillobifemoral bypass. Plasmapheresis and rituximab were attempted due to high clinical suspicion of catastrophic APS. Immunological and neoplastic study were repeatedly negative. The patient was ultimately discharged on vitamin K antagonist (VKA). Further investigation revealed a patent foramen ovale (PFO) with spontaneous right-to-left shunt. Given the risk of paradoxical embolism in this thrombophilic setting of unclear cause, she was referred for percutaneous PFO closure using a GORE® CARDIOFORM 25 mm device. Post-procedure maintenance of antithrombotic therapy with VKA was decided by a multidisciplinary team. Since the event, she had no recurrence of thromboembolic events and continues under investigation in autoimmune disease outpatient clinic. Although simultaneous arterial and venous thrombosis cannot be ruled out, we suspect of left paradoxical embolism following DVT. PFO closure in this setting might be useful for reduction of paradoxical arterial embolism risk on top of systemic anticoagulation. Figure 1Panels A and B show the presence of patent foramen ovale (PFO). Panels C and D show the final result after percutaneous PFO closure using a GORE® CARDIOFORM 25 mm device.
Clinical Case 17—A catastrophic case of ischemic stroke and acute myocarditis in a young patient following mRNA COVID-19 vaccination: coincidence or consequence?
Authors: Quintal Jéni José Sá , Graça Carina , Passos Dúlio , Camacho Tiago , Silva Gonçalo Faro , Chaves Susana , Fernandes Nicodemos , Catanho Tiago , Sousa João Adriano , Rijo Diogo , Caires Joana , Nóbrega José Júlio
Published: October 2022

A healthy 32-years-old man was admitted in emergency department after cardiac arrest at home. He had complaints of fatigue and general malaise after Pfizer-BioNTech Coronavirus disease-2019 (COVID-19) first dose vaccine 48 hours earlier. Upon hospital admission, patient scored 3 points in Glasgow Coma Scale. Electrocardiogram showed atrial fibrillation with rapid ventricular response and a point-of-care ultrasound demonstrated severe left ventricular dysfunction with global hypokinesia. Blood tests were remarkable for elevation of high-sensitivity cardiac troponin-T and inflammatory parameters, normal platelet and fibrinogen levels and slightly increased D-dimer. A computed tomography (CT) with angiography of the cerebral arteries revealed acute ischemic posterior circulation stroke with total occlusion of the basilar artery and partial occlusion of the left vertebral artery. Life-saving systemic thrombolysis was performed but there was no clinical benefit. Pulmonary embolism was excluded. Transesophageal echocardiography showed severe left ventricular dysfunction (LVEF 30%), global hypokinesia and an apical thrombus with no other significant abnormalities. De novo multiple ischemic injuries were shown in 24h control brain CT. Once autoimmunity, thrombophilia study, PCR and serologic tests for viral infections including SARS-CoV-2 were negative, cardioembolic stroke following post-vaccinal myocarditis was suspected. Brain stem death was verified 72h later and a post-mortem endomyocardial biopsy was performed, although no signal of myocarditis was found. COVID-19 mRNA vaccination is associated with increased risk of myocarditis. We report the first known case of cardioembolic stroke and probable myocarditis after BNT162b2 first dose. This highlights that, although rare and with a predominantly favorable course, vaccine-related myocarditis can have life-threatening complications. Figure 1Apical left ventricle thrombus on transesophageal echocardiography.
Clinical Case 31—Active gastrointestinal bleeding during STEMI: a management dilemma
Authors: Lopes Vanessa Filipa de Sousa , Moreira Nádia , Gonçalves Francisco , Gonçalves Lino
Published: October 2022

A man in his 40s presented to the emergency department with chest pain for 8 hours. ECG showed an anterior wall ST-segment elevation myocardial infarction (MI). He received a loading dose of both aspirin and ticagrelor. Coronary angiography demonstrated occlusion of the proximal left anterior descending artery, and primary percutaneous coronary intervention (PCI) with one drug-eluting stent was performed.

The patient also presented melena for 5 days. At admission, his hemoglobin was 6.3 g/dL and he was stable. He received a blood transfusion and was started on IV pantoprazole. Endoscopic study was postponed due to concerns related to performing such exam in the setting of a recent MI.

The day after PCI, the patient presented major bleeding and hypotension, leading to interruption of the P2Y12 inhibitor. On day 3 of hospitalization, while on single antiplatelet therapy with aspirin, the patient presented new onset of chest pain. He was diagnosed with subacute stent thrombosis (type 4b MI), and thrombus aspiration and balloon angioplasty were performed (Figure 1A, and B). Dual antiplatelet therapy was immediately restarted. Echocardiography revealed worsened left ventricular disfunction (LVEF of 20%). Endoscopy showed tears in the esophagogastric junction (Mallory-Weiss syndrome).

This case challenged clinical decision-making, especially the antithrombotic strategy after primary PCI in a patient with major bleeding.

Learning points Management of a bleeding patient with acute MI should be individualized. The decision to withhold antithrombotic treatment should weigh the risks related to ongoing bleeding and stent thrombosis. Early endoscopy for acute gastrointestinal bleed in recent MI appears to be a safe procedure for hemorrhage control, although evidence is lacking.

Figure 1 Coronary angiography. A—Total occlusion with in-stent thrombus in the proximal left anterior descending artery. B—After thrombus aspiration and angioplasty with paclitaxel-coated balloon of stent thrombosis in the proximal left anterior descending artery, remaining a residual lesion of 50–70%, and distal flow TIMI grade 3.
Clinical Case 09—Acute pulmonary embolism complicated by acute limb ischemia: a case report on the role of patent foramen ovale closure in thrombophilia
Authors: Couto David Sá , Alexandre André , Marinho António , Oliveira Filomena , Luz André , Torres Severo
Published: October 2022

Case report

A 40-year-old obese man with hypertension and history of femoro-popliteal deep vein thrombosis (DVT), presented to the emergency department with right lower limb (RLL) ischemia associated with exertional dyspnoea for the past three weeks. Physical examination revealed a cold RLL without peripheral pulses and mild respiratory failure. Angio-CT revealed bilateral acute pulmonary embolism (APE), thrombosis of the right common iliac artery and left renal infarct (Figure 1A). Transthoracic echocardiogram revealed signs of pulmonary hypertension (PH), dilated right ventricle and a suspected patent foramen ovale (PFO) with spontaneous high volume right-to-left shunt. A diagnosis of intermediate-low risk APE with concomitant RLL acute ischemia was made. The patient underwent iliac thrombectomy, local fibrinolysis and started anticoagulation. Immunological study was positive for antiphospholipid syndrome. He recovered well and was discharged on Vitamin-K antagonists. Six months later, transoesophageal echocardiogram confirmed the PFO with persistence of right-to-left shunt with a bubble test, and recovery of the right ventricle function without signs of PH (Figure 1B). Due to the suspected paradoxical embolic event, resolution of the PH and shunt persistence, the patient underwent percutaneous PFO closure with Amplatzer PFO Occluder (25mm) [Abbott®] (Figure 1C). He has had no recurrence of thrombotic events ever since.

Conclusion

Concomitant arterial and venous thrombosis should prompt screening for an intracardiac shunt. Despite unclear evidence, PFO closure might reduce the risk for paradoxical embolism recurrence in a thrombophilic setting on top of oral anticoagulation.
Clinical Case 16—Intracoronary thrombus- a fatality to unmask
Authors: da Cruz Isabel Martins , Oliveira Inês , Bragança Bruno , Lopes Rafaela , Campos Inês , Santos Rui , Andrade Aurora
Published: October 2022

26-years-old man, occasional cannabis smoker, attended the emergency department due to chest pain and epigastralgia for the past 24h, after cannabis consumption. Electrocardiogram revealed ST-segment elevation with Q-waves in V3-V5 and inferior leads. Transthoracic echocardiogram presented: (1) cardiac chamber dilation; (2) severely reduced biventricular systolic function; (3) hypokinesia of left ventricle basal segments of the anterior, lateral and septal walls; (4) scar appearance of the posterior wall and ventricular apex; (5) apical thrombus. Emergent cardiac catheterization showed thrombus located at the medial and distal segments of the left anterior descending artery (LAD), occlusion of the first obtuse marginal (OM) artery and thrombus at the medial and distal segments of the right coronary artery. Angioplasty of the OM was unsuccessful and hypocoagulation was initiated. The patient started veno-arterial ECMO. Immunological study was normal. His clinical condition deteriorated with multiple organ dysfunction, and he died after 20 days. The autopsy revealed coronary atherosclerosis with fibrous plaques causing 80% stenosis of the LAD with two sub-occlusive thrombus, occlusion of the circumflex artery, 70% stenosis of the posterior descending artery, two areas of myocardial infarction and several intracardiac thrombus.

We aim to discuss the possible aetiologies for the thrombus formation. The association between cannabis and acute coronary syndromes has been reported and in cases of young adults with chest pain this diagnosis should be considered. Alternatively, our patient presented dilated cardiac chambers with scar walls and presence of intracardiac thrombus that could be the cause of systemic embolization in an undiagnosed dilated cardiomyopathy.
Clinical Case 24—Multisite thrombosis in a patient with acute coronary syndrome: when the unlikely becomes reality
Authors: Marcu Marius Traian Dragoș , Adam Cristina Andreea , Andy Sascău Radu , Stătescu Cristian
Published: October 2022

We present the case of a 78-year-old patient, admitted for chest pain for 1 week prior to presentation. In the view of the electrocardiographic changes, myocardial cytolysis and severely decreased left ventricular ejection fraction, an acute coronary syndrome was highly likely. Coronary angiography identified a 99% stenosis in the anterior descending artery for which an angioplasty was performed.

Afterwards, the patient becomes dyspneic, hemodynamically unstable, suggesting a pulmonary embolism. The pulmonary CT angiography confirmed the presence of a thrombus in the right pulmonary artery. During thrombolysis, the patient was hemodynamically stable, without complications, achieving improvement of symptoms.

The next day, the patient had pain at the inguinal level and a significant decrease in hemoglobin. A soft tissue ultrasound was performed, showing a partially thrombosed femoral pseudoaneurysm. Vascular Doppler ultrasound revealed multiple occlusive thrombi in the femoral, popliteal and posterior tibial veins. Echocardiography confirms the presence of floating thrombi in the right ventricle.

After a first dose of Apixaban the patient develops erythema. Allergology tests showed intolerance to Apixaban. Considering the associated pro-coagulant status, we performed a series of biological and imaging explorations that showed the presence of a malignant brain neoplasm that induced the complications mentioned above. Unfortunately, the patient died one month after discharge.

The occurrence of pulmonary embolism secondary to revascularized acute myocardial infarction, apparently without risk factors, requires identification of underlying pathologies associated with a pro-coagulant status. Unfortunately, often, behind such events, we discuss about an oncological pathology. Figure 13D reconstruction of right pulmonary artery thrombosis.
Architectural groups of a subtelomeric gene family evolve along distinct paths in Candida albicans
Authors: Dunn Matthew J , Shazib Shahed U A , Simonton Emily , Slot Jason C , Anderson Matthew Z
Published: October 2022

Subtelomeres are dynamic genomic regions shaped by elevated rates of recombination, mutation, and gene birth/death. These processes contribute to formation of lineage-specific gene family expansions that commonly occupy subtelomeres across eukaryotes. Investigating the evolution of subtelomeric gene families is complicated by the presence of repetitive DNA and high sequence similarity among gene family members that prevents accurate assembly from whole genome sequences. Here, we investigated the evolution of the telomere-associated (TLO) gene family in Candida albicans using 189 complete coding sequences retrieved from 23 genetically diverse strains across the species. Tlo genes conformed to the 3 major architectural groups (α/β/γ) previously defined in the genome reference strain but significantly differed in the degree of within-group diversity. One group, Tloβ, was always found at the same chromosome arm with strong sequence similarity among all strains. In contrast, diverse Tloα sequences have proliferated among chromosome arms. Tloγ genes formed 7 primary clades that included each of the previously identified Tloγ genes from the genome reference strain with 3 Tloγ genes always found on the same chromosome arm among strains. Architectural groups displayed regions of high conservation that resolved newly identified functional motifs, providing insight into potential regulatory mechanisms that distinguish groups. Thus, by resolving intraspecies subtelomeric gene variation, it is possible to identify previously unknown gene family complexity that may underpin adaptive functional variation.
1. Introduction
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This introduction provides an overview of topics covered in this book which relate to all areas of intellectual property law, including the justifications that have been put forward for granting intellectual property rights. It also considers the key international and regional developments that have influenced intellectual property law in the UK, such as the creation of the World Intellectual Property Organisation (WIPO), the Trade-Related Aspects of Intellectual Property Rights (TRIPS) negotiations, and European Union law. The chapter also discusses the extent to which retained European Union law continues to be significant in relation to intellectual property law, including the UK-EU Trade and Cooperation Agreement and other Free Trade Agreements.
3. Subject Matter
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter is concerned with the subject matter, or types of creation, protected by copyright law as stipulated by the Copyright, Designs and Patents Act 1988. Eight categories of work are examined: literary works, dramatic works, musical works, artistic works, films, sound recordings, broadcasts, and published editions (or typographical works). The chapter considers the definitions of these categories of work in the case law and through the jurisprudence of the European Court of Justice. It discusses whether the list of works must be treated as an exhaustive list.
5. Authorship and First Ownership
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter examines the concept of authorship, as it is understood in copyright law, as well as the first ownership of copyright and the various exceptions to this rule. It begins by discussing the author of a work as defined in the Copyright, Designs and Patents Act 1988 before elaborating on the task of determining who the author of a work is, including difficulties raised by joint authorship. The chapter also looks at exceptions to first ownership, including works created by employees, those governed by Crown copyright or made under the direction or control of Parliament, and commissioned works.
6. Nature of the Rights
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter is about the rights conferred by the law on copyright owners and the types of activity that amount to copyright infringement. It begins by considering the right to copy the work, in particular its distinct definition for different categories and types of work. It then looks at other rights granted to copyright owners, including distribution right (and the concept of its ‘exhaustion’); the right to rent and lend copies of the work, including the distinctive treatment of digital copies; the right to perform the work in public and UK law’s concept of ‘the public’; the right to communicate the work to the public, including the CJEU’s extensive case-law on the concept of ‘a new public’ and its treatment of hyperlinking, file-sharing, and content-sharing platforms; and the right to make an adaptation of the work. The chapter concludes by considering the copyright owner’s right to ‘authorize’ the carrying out of any of the exclusive rights as a mechanism to extend the field of responsibility.
15. Nature of a Patent
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter provides an overview of the nature of the patent, with emphasis on the variety of ways in which patents are described, how they are drafted, and what they contain. It begins by looking at the types of patent in the UK and the two authorities that grant patents in the country: the UK Intellectual Property Office and the European Patent Office. It then considers the complex and difficult process of drafting a patent before discussing the four key parts of a patent, namely, an abstract, a description of the invention, one or more claims, and any drawings referred to in the description or claims. It also looks at some of the more common types of claims.
17. Patentable Subject Matter
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter deals with patentable subject matter and the ways in which it is regulated under the Patents Act 1977 and the 2000 European Patents Convention (EPC). More specifically, it discusses five criteria that an invention must satisfy to be patentable, including the requirement that it must be capable of ‘industrial application’, and that patents are not granted for immoral inventions. The chapter also considers two different approaches that are used when deciding whether an invention falls within the scope of section 1(2)/Article 52(2): the ‘technical contribution’ approach in the UK and the ‘any hardware’ approach applied by the European Patent Office. The chapter also examines in detail the exclusions from protection of methods of treatment, of certain biological subject matter (including plant and animal varieties), and of inventions which are immoral or against public policy. Finally, it examines how the law deals with a number of specific types of invention and looks at possible reforms, particularly in relation to computer programs and computer-related inventions.
22. Infringement
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter deals with patent infringement and the scope of protection that the law provides to patent owners. It discusses three criteria that are used to determine whether a patent has been infringed: the types of activity that constitute an infringement; whether the activity in question falls within the scope of the patent monopoly; and whether the defendant is able to invoke any of the defences that are available to them. The chapter discusses in detail the right to make a product (and the relationship with repair), the concept of a ‘direct’ product from a patented process, and infringement of new medical use patents, as well as ‘indirect’ infringement by supplying means to put an invention into effect. It then considers the scope of protection, closely examining the evolution in the United Kingdom of the interpretation of claims and the recognition of a doctrine of equivalents extending the scope of protection beyond the terms of the claims. The chapter also examines the defences of private and non-commercial use, experimental use, and ‘farmers’ privileges’.
25. How Design Protection Arises in the United Kingdom
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter considers the way in which design right comes into being, whether by registration in the case of registered designs in the United Kingdom or automatically in the case of unregistered designs. It also discusses the conditions that must be satisfied for an unregistered design right to arise, as well as the procedures for applying for national registered design protection in the UK. The chapter also explains the ramifications of Brexit for design protection in the UK.
27. Grounds for Invalidity: Novelty, Individual Character, and Relative Grounds
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter explores the criteria that are applied to determine the validity of a design, whether a registered design in the UK or an unregistered design: the design must be ‘new’; the design must have ‘individual character’; the applicant or the right holder must be entitled to the protected design; and the design must not conflict with earlier relevant rights (including earlier design applications, copyright, trade mark rights, and rights relating to certain types of emblem). The factors to take into account to determine the novelty of a design, such as prior art, are also considered. The chapter concludes by looking at relative grounds for design invalidity.
37. Absolute Grounds for Refusal
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter examines the ‘absolute’ grounds for refusing to register a trade mark as set out in section 3 of the Trade Marks Act 1994. It first looks at the reasons for denying an application for trade mark registration before analysing the absolute grounds for refusal, which can be grouped into three general categories: whether the sign falls within the statutory definition of a trade mark found in sections 1(1) and 3(1)(a) and (2) of the Trade Marks Act 1994; whether trade marks are non-distinctive, descriptive, and generic; and whether trade marks are contrary to public policy or morality, likely to deceive the public, or prohibited by law, or if the application was made in bad faith. Provisions for specially protected emblems are also considered.
45. Obligation of Confidence
Authors: Bently L. , Sherman B. , Gangjee D. , Johnson P.
Published: October 2022

This chapter considers one requirement in a breach of confidence action: that the defendant was under a legal (as opposed merely to a moral) obligation of confidentiality. It first looks at the basic test for a confidence arising that is ‘knowledge’ or ‘notice’. More specifically, the chapter examines the duties that arise in different situations, such as where the parties are in a direct relationship, where there is an indirect relationship, and where no relationship exists.
Progress in spatial resolution of structural analysis by cryo-EM
Authors: Fukuda Yoshiyuki , Stapleton Kevin , Kato Takayuki
Published: October 2022

Since the Human Genome Project, drug discovery via structure-based drug design and development has significantly accelerated. Therefore, generating high-resolution structural information from biological macromolecules and macromolecular complexes, such as proteins and nucleic acids, is paramount in structural biology, medicine and the pharmaceutical industry. Recently, electron cryomicroscopy (cryo-EM) has undergone a technological revolution and attracted much attention in the structure-based drug discovery pipeline. This recognition is primarily due to its ability to analyze and reconstruct high-resolution structures of previously unattainable large target macromolecular complexes captured in various functional and dynamic states. Previously, cryo-EM was a niche method in the structure determination field, and research was limited to a small number of laboratories and produced low-resolution structures incomplete for detailed and unambiguous structural interpretation. However, with the development of new camera technology, software and computational algorithms that now seamlessly integrate these new developments, the achievable resolutions produced from cryo-EM–determined structures have dramatically improved. This has solidified cryo-EM as one of the main structural determination methods widely used in the field. In this review, we introduce the evolution of two essential techniques incorporated into the cryo-EM workflow—single particle analysis and tomography—focusing on achievable resolution and the technological innovations that have become indispensable tools for high-resolution reconstruction and structural analysis of biological macromolecules. Here, we also describe challenges and discuss future prospects that have fixed cryo-EM as a dominant feature in the landscape of high-resolution structure determination methods and the structure-based drug discovery pipeline.
Low-energy scanning transmission electron microscopy applied to ice-embedded biological macromolecules
Authors: Adaniya Hidehito , Cheung Martin , Yamashita Masao , Taba Seita , Cassidy Cathal , Shintake Tsumoru
Published: October 2022

In this report, we applied annular bright-field and annular dark-field low-energy (30 keV) scanning transmission electron microscopy imaging to a vitreous ice-embedded biological macromolecule, T4 phage, to investigate the applicability of these methods for morphological investigation and sample screening. Multiple camera lengths were examined to find the optimal acceptance angle for both modes. Image clarity differed substantially between the modes, with the presence of ice also strongly influencing the quality of acquired micrographs. In annular dark-field mode, the proper discrimination of electrons scattered by the specimen from those scattered by the background ice was found to be difficult due to the severe overlap of the scattered electrons. The resulting micrographs lacked clarity, and the ice-embedded phage particles could only be discerned after post-processing image adjustment. However, in annular bright-field mode, despite similar overlapping of the scattered electrons, it was possible to assess the morphology and intactness of the specimen in the embedding ice, suggesting that this mode may find utility in low-energy cryo-scanning transmission electron microscopy imaging methods.
Thermodynamic and structural characterization of an EBV infected B-cell lymphoma transcriptome
Authors: O’Leary Collin A , Tompkins Van S , Rouse Warren B , Nam Gijong , Moss Walter N
Published: October 2022

Epstein–Barr virus (EBV) is a widely prevalent human herpes virus infecting over 95% of all adults and is associated with a variety of B-cell cancers and induction of multiple sclerosis. EBV accomplishes this in part by expression of coding and noncoding RNAs and alteration of the host cell transcriptome. To better understand the structures which are forming in the viral and host transcriptomes of infected cells, the RNA structure probing technique Structure-seq2 was applied to the BJAB-B1 cell line (an EBV infected B-cell lymphoma). This resulted in reactivity profiles and secondary structural analyses for over 10000 human mRNAs and lncRNAs, along with 19 lytic and latent EBV transcripts. We report in-depth structural analyses for the human MYC mRNA and the human lncRNA CYTOR. Additionally, we provide a new model for the EBV noncoding RNA EBER2 and provide the first reported model for the EBV tandem terminal repeat RNA. In-depth thermodynamic and structural analyses were carried out with the motif discovery tool ScanFold and RNAfold prediction tool; subsequent covariation analyses were performed on resulting models finding various levels of support. ScanFold results for all analyzed transcripts are made available for viewing and download on the user-friendly RNAStructuromeDB.
8 The Effect of Decreased Physical Activity on Physical and Mental Health of School-Aged Children During the COVID-19 Pandemic
Authors: McCann Maggie , Kumar Kriti , Lepore Natasha , Metivier Emma , Lahey Kelcie , Barootes Hailey , Holyer Karissa , Miller Michael , Lim Rod
Published: October 2022

Background

School-aged children are recommended to complete at least one hour of moderate to vigorous intensity physical activity per day. North American data has shown that due to COVID-19 restrictions placed on in person schooling and extracurricular activities, children were not meeting recommended levels of physical activity. Additional barriers to activity during the first wave of the COVID-19 pandemic included lack of access to public facilities including community centers, parks, and outdoor recreation. Decreased physical activity in children has been shown to have a negative impact on both physical and mental health, and childhood development. However, there is a paucity of literature on parents’ perceptions of the association between physical activity and physical and mental health.

Objectives

The objective of this study was to gain a better understanding of the implications of the COVID-19 pandemic on levels of physical activity and parents’ perceptions surrounding physical activity and physical and mental health.

Design/Methods

An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children’s physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic’s impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media.

Results

Of 361 participants, 90.4% strongly agreed that physical activity was important for mental health, and 92.2% strongly agreed that physical activity was important for physical health. There was a statistically significant decrease in the overall mean number of hours of physical activity per week between pre-COVID and the first wave of COVID (mean difference = 9.34 hours, SD = 10.06, p<0.001). Additionally, parents of children with decreased physical activity reported a statistically significant negative impact on physical and mental health as compared to parents whose children had no change in amount of physical activity. Decreased energy, poor sleep, increased anxiety, mood disturbances, and disruptive behaviour were noted by over 50% of respondents.

Conclusion

This survey highlights that parents themselves perceived a significant negative impact on children’s mental and physical well-being with decreased physical activity during the COVID-19 pandemic. This emphasizes the importance of retaining access to recreational facilities and extracurricular activities. Future research includes identifying ways to re-engage parents and children with physical activity during times of decreased access.