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BackgroundPrevious literature has demonstrated equivalent or improved survival post mitral valve (MV) surgery amongst patients with obesity when compared to their normal-weight counterparts. This relationship is poorly understood and the impact of body mass index (BMI) on cardiac remodeling has not been established.MethodsIn this retrospective, single-center study, we sought to identify the impact that BMI may have on long-term outcomes and cardiac remodeling post-MV repair. Outcomes were compared between patients of varying BMI undergoing MV repair between 2004 and 2018. The primary outcome was mortality and secondary outcomes included stroke, myocardial infarction, reoperation of the MV, rehospitalization, and cardiac remodeling.ResultsA total of 32 underweight, 249 normal weight, 249 overweight, 121 obese, and 50 morbidly obese patients were included in this study. Underweight patients had increased mortality at longest follow-up. Patients with morbid obesity were found to have higher rates of readmission for heart failure. Only underweight patients did not demonstrate a significant reduction in LVEF. Patients with normal weight and overweight had a significant reduction in left atrial size, and patients with obesity had a significant reduction in MV area.ConclusionsAn obesity paradox has been identified in cardiac surgery. While patients with obesity have higher rates of comorbidities preoperatively, their rates of mortality are equivalent or even superior to those with lower BMI. The results of our study confirm this finding with patients of high BMI undergoing MV repair demonstrating equivalent rates of morbidity to their normal BMI counterparts. While the obesity paradox has been relatively consistent in the literature, the understanding of its cause and long-term impacts are not well understood. Further focused investigation is necessary to elucidate the cause of this relationship.

ObjectivesChronic kidney disease (CKD) is increasingly prevalent in patients undergoing mitral valve replacement (MVR). While CKD is known to result in suboptimal outcomes for patients with mitral valve disease, there is limited literature evaluating the long-term outcomes and cardiac remodeling of patients with CKD undergoing MVR. We present the first analysis coupling long-term outcomes of combined morbidity, mortality, and cardiac remodeling post-MVR in patients with CKD.MethodsPatients with varying degrees of CKD undergoing MVR from 2004 to 2018 were compared. Patients were grouped by estimated glomerular filtration rate (eGFR) > 90 mL/min/1.73m2 (n = 109), 60–89 mL/min/1.73m2 (450), 30–59 mL/min/1.73m2 (449), < 30 mL/min/1.73m2 (60). The primary outcome was mortality. Secondary outcomes included measures of postoperative morbidity and cardiac remodeling.ResultsOne-year mortality was significantly increased in patients with eGFR < 30 (p = 0.023). Mortality at 7 years was significantly increased in patients with eGFR < 30 mL/min/1.73m2 (p < 0.001). Multivariable regression analysis of 7-year all-cause mortality indicated an eGFR of 15 mL/min/1.73m2 (HR 4.03, 95% CI 2.54–6.40) and 30 mL/min/1.73m2 (HR 2.17 95% CI 1.55–3.05) were predictive of increased mortality. Reduced eGFR predicted the development of postoperative sepsis (p = 0.002), but not other morbidities. Positive cardiac remodeling of the left ventricle, left atrium, and valve gradients were identified postoperatively for patients with eGFR > 30 mL/min/1.73m2 while patients with eGFR < 30 mL/min/1.73m2 did not experience the same changes.ConclusionsCKD is predictive of inferior clinical and echocardiographic outcomes in patients undergoing MVR and consequently requires careful preoperative consideration and planning. Further investigation into optimizing the postoperative outcomes of this patient population is necessary.

Few data exist regarding outcomes after resection versus embolic treatment of symptomatic metastatic carcinoid and neuroendocrine tumors. The purpose of this study was to determine whether cytoreduction provides any benefit over embolic management of diffuse neuroendocrine tumors. A prospective database of 734 patients treated at our institution was retrospectively queried for symptomatic metastatic tumors treated with embolization or cytoreduction. Patients were compared with regard to pretreatment performance status, relief of symptoms, and survival. A total of 120 patients were identified: 59 undergoing embolization and 61 undergoing cytoreduction. Twenty-three patients had palliative cytoreduction (gross residual disease). Pretreatment performance status (Eastern Cooperative Oncology Group) was similar for both groups: .7+/-.70 (embolization) versus .8+/-.72 (cytoreduction; P=.27). Complete symptomatic relief was observed in 59% and partial relief in 32% of patients who underwent embolization, with a mean symptom-free interval of 22+/-13.6 months. A total of 69% of patients who underwent cytoreduction had complete symptomatic relief, and 23% had partial relief (P=.08 vs. embolization). The mean duration of relief was 35+/-22.0 months (P<.001 vs. embolization). The mean survival for the patients who underwent embolization was 24+/-15.8 months versus 43+/-26.1 months for those who underwent cytoreduction (P<.001). Survival in patients who underwent palliative cytoreduction was 32+/-18.9 months (P<.001 vs. embolization), whereas it was 50+/-27.6 months in patients who underwent curative resection (P<.001 vs. embolization; P<.001 vs. palliative). Cytoreduction for metastatic neuroendocrine tumors resulted in improved symptomatic relief and survival when compared with embolic therapy in this nonrandomized study. Cytoreduction should be pursued whenever possible even if complete resection may not be achievable.

To evaluate short-term procedural outcomes and safety for infants < 2.5 kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5 kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0 kg (range 0.7–2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems ( p  = 0.017) and cases with multiple devices attempted ( p  = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.

Fungi are pivotal in transitioning to a bio-based, circular economy due to their ability to transform organic material into valuable products such as organic acids, enzymes, and drugs. Mucor circinelloides is a model organism for studying lipogenesis and is particularly promising for its metabolic capabilities in producing oils like TAGs and carotenoids, influenced by environmental factors such as nutrient availability. Notably, strains VI04473 and FRR5020 have been identified for their potential in producing single-cell oils and carotenoids, respectively. Calcium starvation has previously been shown to have strain-specific effects, with VI04473 accumulating more lipids and FRR5020 producing more carotenoids. Here, we used genome sequencing, comparative genomics, transcriptomics, and metabolite phenotyping to explore the genetic basis of lipid and carotenoid production under calcium starvation in these strains. We found extensive genomic rearrangements between these strains, as well as low conservation of gene regulatory responses to calcium depletion. This lack of conservation also applies to genes involved in lipid and carotenoid production, ie the lipidome. Crucially, we identified several metabolic pathways with distinct transcriptional responses to calcium depletion, suggesting the existence of a previously unrecognized, strain-dependent mechanism by which calcium signaling modulates metabolite production. This points to a potentially novel regulatory pathway linking calcium homeostasis to secondary metabolism in fungi, which may be linked to the complex gene family evolution of several lipidome-genes. Our study sheds light on the complexity of the evolution of metabolic networks in M. circinelloides. Understanding these genetic underpinnings can optimize the industrial use of M. circinelloides, enhancing lipid productivity and stress tolerance, and tailoring metabolic profiles for specific applications.

Improvements in technology offer the ability to refine operations without compromising safety. In this study, we determine whether a modified method of laparoscopic cholecystectomy using three ports and an aggregate incision length of 20 mm offers any advantage or poses increased risk. Using a 5-mm, 30° laparoscope, clip applier, and dissector, the gall bladder is removed through an extended umbilical incision. Standard safety principles were followed: achieving the “critical view,” lateral retraction of the fundus, double ligation of the proximal structures, and maintaining sterility for specimen removal. Forty-one consecutive standard laparoscopic cholecystectomies were used as a control group to compare complications, length of stay and surgery, pain scores, and return to work. Sixty patients have undergone the modified technique. There were no differences between the modified and standard technique with regard to cost or complications. Length of surgery was significantly shorter, as was length of stay, narcotics use, and return to work for the modified group versus the control. A modified technique for laparoscopic cholecystectomy poses no increased risk to patients but offers potential for shorter surgery and hospital stays, less need for narcotic analgesia, and faster recovery.

Mortality after complex surgical procedures has been shown to be inversely related to hospital volume. The purpose of this study was to determine whether these findings are applicable to radiologic and surgical procedures for complicated portal hypertension. The Agency for Healthcare Administration for the State of Florida database was queried to determine outcomes after transjugular intrahepatic stent shunts (TIPS) or surgical shunts from 2000 to 2003. A total of 1486 patients underwent either TIPS (1321) or surgical shunts (165). Natural breakpoints occurred at two and six procedures per year were correlated with survival for surgical shunts but not TIPS. Overall mortality was not different between TIPS and surgical shunts (11.0 vs. 12.7%, P = 0.51); however, the cost of TIPS was significantly lower (62,000 ± 58.5 vs. 107,000 ± 97.8, P < 0.001) as well as the length of hospitalization (9 ± 9.0 days vs. 15 days ± 12.6 days, P < 0.001). Surgical procedures for complicated portal hypertension are rapidly being replaced by TIPS. Like with other complex procedures, outcomes are related to hospital volume.

Life expectancies in Portugal (81.3 years for females and 74.9 for males) and Spain (83.5 years for females and 76.9 for males) in 2005 rank among the lowest in Western Europe (Portuguese males) and the highest (Spanish females), respectively. This article studies the converging trends in mortality for these two countries of the Iberian Peninsula during the second half of the twentieth century. Portuguese life expectancy appears to follow the same trajectory as that of Spain, but lagged by several years (10 years for females, 15 years for males). Major improvements have occurred at all ages, however, helping to narrow the mortality gap between the two countries. Age- and cause-specific decomposition analyses reveal that ages 20-79 for men and ages 60 and above for women account for the largest share of the remaining inter-country gap in life expectancy. The causes of death that are the major contributors to this gap include diseases of the circulatory system and, for males, external causes. /// Aujourd'hui, les espérances de vie au Portugal (81,3 ans pour les femmes et 74,9 ans pour les hommes en 2005) et en Espagne (respectivement 83,5 ans et 76,9 ans) présentent la particularité de figurer pour les hommes portugais parmi les plus basses d'Europe occidentale et pour les femmes espagnoles parmi les plus élevées. Cet article décrit les tendances convergentes de la mortalité dans la péninsule Ibérique au cours de la seconde moitié du XXe siécle. L'espérance de vie au Portugal semble suivre la même trajectoire que celle de l'Espagne avec plusieurs années de retard (dix ans pour les femmes, quinze ans pour les hommes) grâce aux progrès enregistrés à tous les âges. Les analyses de la mortalité par âge et par cause montrent que c'est la mortalité entre 20 et 79 ans chez les hommes et au-dessus de 60 ans chez les femmes qui est responsable de la majeure partie de l'écart d'espérance de vie subsistant entre les deux pays. Les causes de décès qui contribuent le plus à ces différences sont les maladies de l'appareil circulatoire et, pour les hommes, les traumatismes et morts violentes. /// Hoy en día, la esperanza de vida en Portugal (81,3 años para las mujeres y 74,9 años para los hombres en 2005) y en España (respectivamente 83,5 años y 76,9 años) presentan la particularidad de figurar, en lo que se refiere a los hombres portugueses, entre las más bajas de Europa occidental y, en lo que se refiere a las mujeres españolas, entre las más elevadas. Este artículo describe las tendencias convergentes de la mortalidad en la península Ibérica durante la segunda mitad del siglo XX. La esperanza de vida en Portugal parece seguir la misma trayectoria que la de España con varios años de retraso (diez años para las mujeres, quince años para los hombres) gracias a los progresos registrados en todas las edades. Los análisis de la mortalidad por edad y por causa muestran que es la mortalidad entre 20 y 79 años en los hombres y por encima de 60 años en las mujeres la causante de la mayor parte de la diferencia de esperanza de vida que subsiste entre ambos países. Las causas de muerte que contribuyen más a esas diferencias son las enfermedades del aparato circulatorio y para los hombres, los traumatismos.

Hepatic artery infusional (HAI) chemotherapy has been shown to favorably impact outcome in patients with metastatic colorectal cancer, but complications often preclude complete treatment. The purpose of this study was to determine whether HAI complications impact survival in these patients. Patients undergoing HAI pump placement at our institution from September 2001 to July 2004 were separated into terciles based on the number of treatments completed: ≤1 (none), 2 to 4 (partial), and ≥5 (complete). Complications relating to pump placement or treatment were recorded for each and their impact on survival was determined. Kaplan-Meier survival in 15 patients receiving no treatment was significantly shorter than 7 patients completing therapy (P = 0.02). Thirty-three per cent of patients receiving no therapy were alive at 26 months, whereas 63 per cent of partially and 86 per cent of completely treated patients were alive at 32 and 30 months, respectively. Patients receiving no treatment had more overall complications (80%) and significantly (P < 0.05) more pump-related complications (60%) than those completing therapy (43% and 0%, respectively). Cox regression revealed a significant correlation to gender (hazard ratio, 3.9), tumor size (hazard ratio, 1.17), and carcinoembryonic antigen level (hazard ratio, 1.02) to survival. Patients receiving complete HAI treatment survive longer than those receiving no treatment. Potentially preventable pump-related complications not only impacted the patients’ ability to continue therapy, but survival times as well.