bluuebunny/crossref_metadata_2025_split huggingface dataset:
WELLENS SYNDROME OR PNEUMONIA?
Authors: Massara M , Lanari A , Zappelli L , Pergolini M , Giovagnoli A , Refi G , Di Noto G 
Published: May 2024

Abstract

Background
Wellens syndrome, also known as "left anterior descending coronary syndrome," is characterized by the appearance of T–wave changes recorded on the ECG and it is an ECG manifestation of critical proximal left anterior descending artery stenosis.

Case Report
A 65–year–old man from Bangladesh with a history of chronic ischemic heart disease and trivessel coronary artery disease following surgical revascularization (CABG 2007). Recent admission for NSTEMI (June 2022) with unchanged coronary angiography compared to the previous one. Comorbidities include peripheral arterial disease, type II diabetes with organ damage, and COPD with recent exacerbations. Last myocardial scintigraphy (2021) was positive for inducible myocardial ischemia in the posterolateral region. Admission due to fever, productive cough, and severe chest pain. Initial instrumental assessments revealed ST–segment alterations in inferior leads and V1–V2 with negative/isodiphasic T–waves, not present in previous ECG tracings. A slight troponin elevation with ischemic curve (101 → 303 → 277 → 155 pg/dl, normal range &lt; 50 pg/dl) led to the diagnosis of NSTEMI. Echocardiogram showed concentric remodeling of the left ventricle with normal global systolic function and hypokinesia of the mid–basal inferior wall (noted). Additionally, chest CT revealed pulmonary consolidations in the right middle lobe and upper left lobe, prompting antibiotic therapy and bronchodilator inhalation. Arterial blood gas analysis: pH 7.45, pO2 83, Lactate 0.8, HCO3– 24, P/F 360. Coronary angiography showed an unchanged picture compared to the previous one (patent AMIS and AMID, good run–off in native branches, no distal stenosis at the anastomosis). Clinical symptoms, inflammatory indices, and myocardial damage markers clinically improved during hospitalization. Discharged after optimization of anti–ischemic therapy with DAPT and diagnosis of NSTEMI. However, ECG abnormalities persisted at discharge (negative T–waves in DI–aVL–V1–V2). Post–discharge cardiac MRI was requested.

Conclusions
Diagnostic hypotheses include, primarily, a possible type II myocardial infarction due to an ongoing pneumonia (although hypoxia/hypovolemia/hypotension sufficient to cause MI was never documented during hospitalization), MINOCA, or microcirculatory disease (functional tests such as iFR/FFR, ACh, IMR were not performed during coronary angiography), or a possible myocarditic outcome (pending MRI).
A NEGLECTED RARE DISORDER: IGG4 RELATED DISEASE
Authors: Prenna E , Maffè S , Paffoni P , Facchini E , Ariotti S , Bergamasco L , Franchetti Pardo N , Paino A , Ticozzi S , Dellavesa P 
Published: May 2024

Abstract
IgG4–related disease (IgG4–RD) is an autoimmune disorder characterized by infiltration of plasma cells with IgG4. Almost any organ could be affected. Common presentations include lung manifestation, autoimmune pancreatitis, retroperitoneal fibrosis and tubulointerstitial nephritis. Cardiovascular involvement is less frequent. Corticosteroids are first line therapy, with or without anti–rheumatic drugs. Long–term prognosis of IgG4–RLD remains unknown. We present the case of a 65–years old woman, with a previuos diagnosis of IgG4–RD with mediastinal involvement. In the meantime she was recovered for pyelonephritis with high fever and positive blood coltures (S. hominis). We were called to perform a transthoracic echocardiogram to rule out infective endocarditis. The exam showed normal size of cardiac chambers, normal biventricular systolic function, absence of relevant valvular disease. In apical view we noticed a hyperechogenic ovalar imagine in the right atrium, not visible in all the projections. A first differential diagnosis included a mass with site of implantation at the top of the right atrium or something external but contiguous to heart structures. To clear this doubt the patient performed a thoracic CT with stunning results. The CT highlighted parietal encasement of chardiac structures and, particularly, of the superior vena cava at the confluence in right atrium, explaining the image we saw with transthoracic echo. The exam also showed encasement of ascending aorta, aortic arch and descending aorta with maximum thickness of 18 mm. CT also reported encasement of right pulmonary arthery. The CT highlighted a progression of the disease with indication to more aggressive therapy. In fact IgG4–RD of the cardiovascular system results in serious complications that need to be recognized and treated. Aortic involvement in IgG4–RD is extremely rare and tipically affects the infrarenal abdominal aorta. Cardiovascular IgG4–RD could also lead to aortitis, medium–vessel arteritis, pulmonary vascular disease, phlebitis, valvulopathy, pericarditis and myocardial disease. These forms of Igg4–RD are often underdiagnosed as clinical presentations is similar to cardiovascular disease due to more common aetiologies. Regarding our case the patient began methotrexate based on the results of the CT. This was a really interesting case for our working group to deepen this little–known disease. “The eyes see only what the mind is prepared to comprehend”.
THE APEX TALKS…CARDIAC METASTASIS MIMICKING ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Maurizi K , Lofiego C , Vagnarelli F , Capodaglio I , Patani F , Tofoni P , Brugiatelli L , Pietrucci F , Dottori M , Schicchi N , Fogante M , Esposto Pirani P , Dello Russo A , Perna G 
Published: May 2024

Abstract
A 78–year–old man with a recent diagnosis of lung squamous cell carcinoma was referred to our cardiology department for marked ECG abnormalities (ST segment elevation in V2–V4 and T waves inversion in the antero–lateral leads, Fig.1) in the absence of ischemic symptoms and for the detection of an intramyocardial mass at the apical segments on the CT scan. He had no significant previous cardiovascular history. A transthoracic echocardiogram (TTE) was performed and showed an isoechoic mass at the LV apical segments measuring 3 x 4 cm apparently incorporating the myocardial wall without a clear cleavage plane (Fig.2a). The EF was normal. No pericardial effusion present. The contrast echocardiography with Sonovue revealed a late uptake of the contrast (Fig.2b). Cardiac magnetic resonance (CMR) showed an ovular image in the para–apical area of 40 x 23 cm consistent with a secondary lesion (Fig.3). Unfortunately, the exam was interrupted early due to a patient’s claustrophobic crisis, without having acquired the post–contrast images. Due to infiltrative appearance of the mass and the oncology history, this formation was highly suspicious for metastasis. No complicated ventricular arrhythmias were detected on ECG monitoring. No symptoms of heart failure were reported. Due to the marked EKG repolarization abnormalities the patient underwent coronary angiography which excluded significant stenosis. FDG PET/CT showed areas of increased metabolism also at liver and adrenal left gland. Finally, the patient was transferred to the oncology department for specific management. Cardiac metastases are more common than primary cardiac malignancy and are more frequently related to primary lung cancer, followed by breast cancer and hematologic malignancies. Typical presentation includes arrhythmias or conduction disturbances. The imaging findings of cardiac metastases are non–specific but mostly infiltrative, heterogeneous, and multiple masses may be present. Echocardiography is the initial imaging test for the detection of cardiac metastasis, although CMR, CT and PET/CT may be helpful. Herein we described a case of cardiac metastasis with EKG mimicking acute coronary syndrome. This finding is not uncommon among these patients. EKG findings of myocardial ischemia or injury, particularly localized and prolonged ST elevation, in the absence of ischemic symptoms have been reported in previous studies as high specificity for cardiac metastasis in patients with malignancy.
ANOMALY OF ORIGIN AND COURSE OF THE CIRCUMFLEX ARTERY: AN ECHOCARDIOGRAPHIC DIAGNOSIS
Authors: Marino G , Di Fusco S , Cianfrocca C , Colivicchi F 
Published: May 2024

Abstract
Coronary artery anomalies are often incidental findings. Most anomalies are benign, but some can cause sudden death. It is important to identify them especially before invasive procedures and cardiac surgery. The echocardiogram, as in this case report, provides a high diagnostic accuracy. We describe three typical echocardiographic signs that we find when the circumflex artery originates from the right coronary cusp and has a retroaortic course. A 42–year–old man presented to the emergency department with oppressive chest pain at rest lasting 1 h. In his medical history, the patient reported the following cardiovascular risk factors: smoking, family history of coronary heart disease, hypertension, type 2 diabetes mellitus for 10 years and hypercholesterolemia. Electrocardiogram showed sinus rhythm at 70 bpm without signs of myocardial ischemia. Troponin, D–dimer, C–reactive protein were normal in consecutive blood samples. The echocardiogram documented a left ventricle with normal size and wall thickness, preserved systolic function and absence of significant valvular disease and pericardial effusion. Apical 4–chamber view showed a tubular structure on the atrial side of the mitral valve (Figure 1A, RAC sign). The same structure was identified in parasternal short–axis view just below the noncoronary aortic cusp (Figure 1B, crossed aorta). The tubular shape suggested a vascular structure in an anomalous position. In the parasternal long–axis view, a transverse section of this vessel was visible near aortic valve (Figure 1C, bleb sign). Patient underwent coronary angiography due to persistence of symptoms. Angiography did not reveal significant coronary stenoses, but documented anomalies in the origin and course of the coronary arteries. The circumflex artery shared its origin from the right coronary cusp with the right coronary artery and had a retroaortic course while the only anterior descending artery originated from the left coronary cusp. Anomalies of origin and/or course of the coronary arteries can be detected in 1.3% of the population undergoing coronary angiography. On echocardiogram “RAC sign”, “crossed aorta” and “bleb sign” are often misdiagnosed as artefacts, calcifications or catheter. In case of suspected coronary anomalies, CT is the reference diagnostic test. The abnormal origin and course found in our patient are considered benign and not associated with an increased risk of sudden death and myocardial ischemia.
ACUTE CORONARY SYNDROME IN A PATIENT WITH LEFT SUBCLAVIAN OCCLUSION AND ANTEROLATERAL CORONARY STEAL
Authors: Biancofiore A , Filippi F , Pieraccini M , De Angelis F , Belcastro M , Landini R , Picchi A , Limbruno U 
Published: May 2024

Abstract
This is a 57–year–old male patient suffering from multiple cardiovascular risk factors: obesity, arterial hypertension, dyslipidemia, type 2 diabetes mellitus, active smoker. Chronic obstructive pulmonary disease. Stage 2 chronic kidney disease. Peripheral vascular disease with previous bilateral thromboendarterectomy and percutaneous revascularization of the lower limbs. Stable angina for which three years ago he underwent Coronary Artery Bypass Graft: left internal mammary artery (LIMA) to left anterior descending artery combined with saphenous vein grafts to the main obtuse marginal branch. The patient presented with Acute Coronary Syndrome non ST–segment elevation myocardial infarction (N–STEMI), intermittent episodes of chest pain due to mild exertion in the previous days. Antero–lateral ST depression and inverted T waves, associated with a mild reduction in left ventricular systolic function due to hypokinesia of the antero–lateral walls and increased troponin values were present. Coronary angiography documented patency of the LIMA graft without evidence of any culprit lesions on the coronary branches. However, selective angiography documented a sub–occlusion of the proximal left subclavian artery (Figure 1). A computed tomography scan confirmed a hyperdense calcified plaque occluding 95% of the origin of the left subclavian artery. The patient then underwent angioplasty with stenting of the left subclavian artery (Figure 2). Subclavian coronary steal syndrome usually presents with exertional angina, but rarely can cause Acute Coronary Syndrome. During coronary angiography performed for Acute Coronary Syndrome and in the absence of detection of clear coronary culprit lesions, selective angiography of the subclavian artery may confirm the suspicion of coronary steal syndrome.
AN UNCOMMON CASE OF MINOCA
Authors: Scordato F , Giunta N , Smecca I , Longo R , Cirrincione G , Vicari C 
Published: May 2024

Abstract
We report the case of a 51 year old male, smoker of about 20 cigarettes/day and with history of uninvestigated headache. In March 2023 he arrived in the Emergency Department for oppressive retrosternal chest pain radiating to the left arm; the electrocardiogram (ECG) showed sinus rhythm, no acute ST segment changes; HS troponin T was elevated. Transthoracic echocardiogram showed 55% EF, no kinesis defects, no major valvulopathy, neither pericardial effusion. The patient was admitted to the ICU with a diagnosis of NSTE myocardial infarction. Despite on admission HS troponin T HS was further increased and ECG evolved with inferior and lateral subepicardial ischemia, coronary angiogram showed normal coronary arteries, with an area of haziness in the right coronary artery. To investigate the etiology of myocardial damage the patient underwent cardiac MRI, that showed a left ventricle with normal size and mildly reduced systolic function; inferior apical and septal segment were akinetic; right ventricle was normal with preserved systolic function; edema and fibrosis with ischemic pattern was seen in the inferior apical and septal segment. Then we looked for embolic sources: continuous ECG monitoring excluded supraventricular arrhythmias. We performed echocardiogram that raised suspicion of a patent foramen ovale (PFO) confirmed on transesophageal contrast echocardiogram. Brain MRI showed no obvious changes compatible with recent ischemic lesions; few millimeters focal hyperintense areas in T2 and FLAIR, of gliotic nonspecific significance were reported in the frontal subcortical white matter bilaterally, left parietal and in the right corona radiata. We concluded for diagnosis of paradoxical coronary embolism and the patient was treated with percutaneous closure of PFO: by right femoral vein route and under intracardiac ultrasound guidance, closure of PFO was performed with Amplatzer No. 25 with excellent fluoroscopic and final ultrasound result. The broad spectrum of the possible cause of myocardial injury in MINOCA makes defining the extact underlying etiology challenging, but correctly knowing the culprit mechanism improves therapies and outcome; paradoxical coronary embolism due to a patent foramen ovale is rarely diagnosed; in our clinical case integrated multimodality imaging diagnostic work up, proved highly effective in identifying the cause of the myocardial damage and allowed the appropriate treatment.
STENT FRAME DECOUPLING FOLLOWING SELF–EXPANDABLE TAVR
Authors: Lentini E , Moscarelli M , Sollami G , Fattouch K 
Published: May 2024

Abstract

Introduction
Transcatheter heart valve (THV) deformation may affect leaflet kinematics and coaptation, with potential formation of hypoattenuated leaflet thickening (HALT). The flexible nitinol frame of the self–expandable THV, conforms to the native annulus shape while maintaining the prosthesis in a higher position. This arrangement is called stent–frame ‘decoupling’ and should minimize the impact of ellipticity at the valve level post–deployment.

Methods
We analysed multi detector computer tomography scan and 2D transthoracic echocardiography from 50 patients. Prosthesis eccentricity was computed at 6 levels: i) frame inflow; ii) native annulus; iii) leaflets inflow; iv) prosthesis waist; v) leaflets outflow; vi) frame outflow). Implantation depth and canting, leaflets expansion and alignment and residual anatomic sinus area ratio were also calculated. Frame inflow and native annulus eccentricity were compared to the valvular eccentricity to assess ‘decoupling’.

Results
Highest eccentricity was observed at the native annulus (0.540.12) and progressively decreases toward the outflow level (0.230.11). Subvalvular eccentricity was significantly higher as compared with valvular components (0.500.13 vs. 0.370.09, p&lt;0.001). Similar results were observed in the subgroup analysis of 23, 26, 29 and 34 size. At 12 months follow–up, HALT with mild to severe restricted movement was detected in 8 individuals (16%). There was no correlation between implantation depth and prothesis eccentricity (r= –0.08, p=0.128).

Conclusions
Stent frame decoupling can be frequently detected after (THV) replacement with Evolut R. The effect on valve performance and clinical implications remains uncertain.
Activity-based protein profiling of serine hydrolases and penicillin-binding proteins in Enterococcus faecium
Authors: Grunnvåg Jeanette S , Hegstad Kristin , Lentz Christian S 
Published: May 2024

Abstract
Enterococcus faecium is a gut commensal bacterium which is gaining increasing relevance as an opportunistic, nosocomial pathogen. Its high level of intrinsic and acquired antimicrobial resistance is causing a lack of treatment options, particularly for infections with vancomycin-resistant strains, and prioritizes the identification and functional validation of novel druggable targets. Here, we use activity-based protein profiling (ABPP), a chemoproteomics approach using functionalized covalent inhibitors, to detect active serine hydrolases across 11 E. faecium and Enterococcus lactis strains. Serine hydrolases are a big and diverse enzyme family, that includes known drug targets such as penicillin-binding proteins (PBPs), whereas other subfamilies are underexplored. Comparative gel-based ABPP using Bocillin-FL revealed strain- and growth condition-dependent variations in PBP activities. Profiling with the broadly serine hydrolase-reactive fluorescent probe fluorophosphonate-TMR showed a high similarity across E. faecium clade A1 strains, but higher variation across A2 and E. lactis strains. To identify these serine hydrolases, we used a biotinylated probe analog allowing for enrichment and identification via liquid chromatography–mass spectrometry. We identified 11 largely uncharacterized targets (α,β-hydrolases, SGNH-hydrolases, phospholipases, and amidases, peptidases) that are druggable and accessible in live vancomycin-resistant E. faecium E745 and may possess vital functions that are to be characterized in future studies.
The Rapid Evolution of De Novo Proteins in Structure and Complex
Authors: Chen Jianhai , Li Qingrong , Xia Shengqian , Arsala Deanna , Sosa Dylan , Wang Dong , Long Manyuan 
Published: May 2024

AbstractRecent studies in the rice genome-wide have established that de novo genes, evolving from noncoding sequences, enhance protein diversity through a stepwise process. However, the pattern and rate of their evolution in protein structure over time remain unclear. Here, we addressed these issues within a surprisingly short evolutionary timescale (&lt;1 million years for 97% of Oryza de novo genes) with comparative approaches to gene duplicates. We found that de novo genes evolve faster than gene duplicates in the intrinsically disordered regions (such as random coils), secondary structure elements (such as α helix and β strand), hydrophobicity, and molecular recognition features. In de novo proteins, specifically, we observed an 8% to 14% decay in random coils and intrinsically disordered region lengths and a 2.3% to 6.5% increase in structured elements, hydrophobicity, and molecular recognition features, per million years on average. These patterns of structural evolution align with changes in amino acid composition over time as well. We also revealed higher positive charges but smaller molecular weights for de novo proteins than duplicates. Tertiary structure predictions showed that most de novo proteins, though not typically well folded on their own, readily form low-energy and compact complexes with other proteins facilitated by extensive residue contacts and conformational flexibility, suggesting a faster-binding scenario in de novo proteins to promote interaction. These analyses illuminate a rapid evolution of protein structure in de novo genes in rice genomes, originating from noncoding sequences, highlighting their quick transformation into active, protein complex-forming components within a remarkably short evolutionary timeframe.
Experimental investigation of using the evaporative air cooling technique to enhance the performance of the photovoltaic module
Authors: Jaffar Malik F , Mohammad Abdulrahman Th , Ahmed Ahmed Qasim , Al-Shohani Wisam A M 
Published: May 2024

Abstract
In this experimental study, two techniques of photovoltaic thermal (PVT) collector with active cooling were used to enhance the performance of the photovoltaic (PV) module. The first technique was prepared by integrating the PV module with a forced air duct (PVTFC). At the same time, the second technique was the PV module integrated with a forced air duct including a direct evaporative cooling unit (PVTDEC). In these two techniques, the air was forced by an electrical centrifugal fan with variable speeds (1.5, 2.5 and 3.5 m/s) placed at the end of the duct. The output electrical characteristics of the PVTFC and PVTDEC modules were compared with the reference PV module. The obtained results showed a significant decrease in the temperature of the PV module, where the reduction in the temperature of the PV module was achieved between 5°C and 16°C and 21°C and 25°C in PVTFC and PVTDEC techniques, respectively. Accordingly, the voltage was dropped to 15.1 and 15.8 V in PVTFC and PVTDEC, respectively, as compared with the sharp decline of voltage for the reference PV module, which recorded 14.2 V at a maximum PV module temperature of 69°C. In addition, the maximum enhancement percentage of PV efficiency was achieved at a maximum airflow rate of 0.22 kg/s, where it was recorded between 3.5% and 6.2% in the case of PVTFC and 7% and 9.3% in the case of PVTDEC.