bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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 &lt; 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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract

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

Abstract
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

Abstract
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

Abstract
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.
Progress in spatial resolution of structural analysis by cryo-EM
Authors: Fukuda Yoshiyuki , Stapleton Kevin , Kato Takayuki 
Published: October 2022

AbstractSince 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

Abstract
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

Abstract
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.