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Currently used methods of sedation for fiberoptic intubation such as benzodiazepines, propofol, or opioids have their limitations. Dexmedetomidine (DEX) is a selective α-2 adrenergic agonist that has been used clinically for its sympatholytic, analgesic, and sedative properties. We report on 4 patients with particularly difficult airways who underwent successful awake fiberoptic intubation with DEX. Dexmedetomidine was used to provide a moderate level of conscious sedation without causing respiratory distress or hemodynamic instability during fiberoptic intubation.

Brain tumors in children are a devastating disease in a high proportion of patients. Owing to inconsistent results in clinical trials in unstratified patients, the role of immunotherapy remains unclear. We performed an in-depth survey of the single-cell transcriptomes and clonal relationship of intra-tumoral T cells from children with brain tumors. Our results demonstrate that a large fraction of T cells in the tumor tissue are clonally expanded with the potential to recognize tumor antigens. Such clonally expanded T cells display enrichment of transcripts linked to effector function, tissue residency, immune checkpoints and signatures of neoantigen-specific T cells and immunotherapy response. We identify neoantigens in pediatric brain tumors and show that neoantigen-specific T cell gene signatures are linked to better survival outcomes. Notably, among the patients in our cohort, we observe substantial heterogeneity in the degree of clonal expansion and magnitude of T cell response. Our findings suggest that characterization of intra-tumoral T cell responses may enable selection of patients for immunotherapy, an approach that requires prospective validation in clinical trials.

Background Survival for patients with high‐risk neuroblastoma (HRNB) remains poor despite aggressive multimodal therapies. Aims To study the feasibility and safety of incorporating a genomic‐based targeted agent to induction therapy for HRNB as well as the feasibility and safety of adding difluoromethylornithine (DFMO) to anti‐GD2 immunotherapy. Methods Twenty newly diagnosed HRNB patients were treated on this multicenter pilot trial. Molecular tumor boards selected one of six targeted agents based on tumor‐normal whole exome sequencing and tumor RNA‐sequencing results. Treatment followed standard upfront HRNB chemotherapy with the addition of the selected targeted agent to cycles 3–6 of induction. Following consolidation, DFMO (750 mg/m2 twice daily) was added to maintenance with dinutuximab and isotretinoin, followed by continuation of DFMO alone for 2 years. DNA methylation analysis was performed retrospectively and compared to RNA expression. Results Of the 20 subjects enrolled, 19 started targeted therapy during cycle 3 and 1 started during cycle 5. Eighty‐five percent of subjects met feasibility criteria (receiving 75% of targeted agent doses). Addition of targeted agents did not result in toxicities requiring dose reduction of chemotherapy or permanent discontinuation of targeted agent. Following standard consolidation, 15 subjects continued onto immunotherapy with DFMO. This combination was well‐tolerated and resulted in no unexpected adverse events related to DFMO. Conclusion This study demonstrates the safety and feasibility of adding targeted agents to standard induction therapy and adding DFMO to immunotherapy for HRNB. This treatment regimen has been expanded to a Phase II trial to evaluate efficacy.

Cardiovascular magnetic resonance (CMR) with extensive late gadolinium enhancement (LGE) is a novel marker for increased risk for sudden death (SD) in patients with hypertrophic cardiomyopathy (HC). Small focal areas of LGE confined to the region of right ventricular (RV) insertion to ventricular septum (VS) have emerged as a frequent and highly visible CMR imaging pattern of uncertain significance. The aim of this study was to evaluate the prognostic significance of LGE confined to the RV insertion area in patients with HC. CMR was performed in 1,293 consecutive patients with HC from 7 HC centers, followed for 3.4 ± 1.7 years. Of 1,293 patients (47 ± 14 years), 134 (10%) had LGE present only in the anterior and/or inferior areas of the RV insertion to VS, occupying 3.7 ± 2.9% of left ventricular myocardium. Neither the presence nor extent of LGE in these isolated areas was a predictor of adverse HC-related risk, including SD (adjusted hazard ratio 0.82, 95% confidence interval 0.45 to 1.50, p = 0.53; adjusted hazard ratio 1.16/10% increase in LGE, 95% confidence interval 0.29 to 4.65, p = 0.83, respectively). Histopathology in 20 HC hearts show the insertion areas of RV attachment to be composed of a greatly expanded extracellular space characterized predominantly by interstitial-type fibrosis and interspersed disorganized myocyte patterns and architecture. In conclusion, LGE confined to the insertion areas of RV to VS was associated with low risk of adverse events (including SD). Gadolinium pooling in this region of the left ventricle does not reflect myocyte death and repair with replacement fibrosis or scarring.

At any rate, this piece describes some good books in cardiovascular disease received in 2016. Large Books Josephson ME. Josephson's Clinical Cardiac Electrophysiology: Techniques and Interpretations, 5th Edition. Dr. Frishman presently is the Barbara and William Rosenthal Professor of Medicine and Chairman of the Department of Medicine at the New York Medical College School of Medicine. Frishman describes the book as “a scientific memoir” and depicts the 40-year golden era of cardiovascular pharmacology of which he played a major role. The book is far more than a scientific memoir. Dr. Price, who appears to have heterozygous familial hypercholesterolemia, describes his experiences and consequences of coronary bypass surgery. Adrianna Huffington, the cofounder and until recently the president and editor in chief of the Huffington Post Media group, describes in this wonderful book the most important recent scientific discoveries on sleep and also many human stories and experiences.

In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm.

EDITORIAL PAGES 3872 Articles 3688 (95%) Staff and Editorial Board 48 (1%) Table of Content 71 (2%) Reader's Comments (total) [replies] 65(67)[16] (2%) TYPES OF ARTICLES - TOTAL 615 Multi- Patient Studies 537 (87%) Case Reports 11 (1%) Electrocardiographic Reports 15 (2%) Reviews 31 (5%) Editorials 11 (2%) Non-Patient Reports 8 (1%) From-the-Editor Columns 2 (< 1%) TOPICS OF ARTICLES - TOTAL 615 Coronary Artery Disease 206 (33%) Valvular Heart Disease 80 (13%) Miscellaneous 75 (12%) Arrhythmias & Conduction Disturbances 72 (12%) Heart Failure 50 (8%) Cardiomyopathy 43 (7%) Preventative Cardiology 42 (7%) Congenital Heart Disease 29 (5%) Methods 9 (1%) Systemic Hypertension 7 (1%) Historical Studies 2 (<1%) Table 6 Total number of pages, types and topics of articles published in the AJC 2015 (Volumes 115 & 116, January-December)

AIMS Medical Science (Cardiology Section) Annals of Clinical and Experimental Hypertension Archives of Clinical Hypertension (India) BioMed Research International (Cardiology) Cardiology and Angiology: An International Journal Cardiovascular System Eurointervention Heart and Vessels International Journal of Cardiovascular Research Invasive Cardiology: Future Medicine Journal of Cardiac Anesthesia Journal of Cardiac Circulation Journal of Cardiology and Clinical Research Journal of Cardiovascular Disorders Journal of Cardiovascular Medicine and Cardiology Journal of Cardiovascular Research Journal of Clinical Trials in Cardiology Journal of Heart & Cardiology Journal of Heart Health Journal of Interpretive Cardiology HSOA Journal of Cardiology & Neurocardiovascular Diseases Open Journal of Thoracic Surgery Research in Cardiovascular Medicine Research Reports in Clinical Cardiology Scientific Journal of Cardiac Circulation The Anatolian Journal of Cardiology Table 1 Heart-related journals American International Journal of Scientific Research Anatomy & Physiology: Current Research Anesthesia: Essays and Researches Annals of Otolaryngology and Rhinology Archives of Clinical and Experimental Surgery Archives of Clinical Nephrology Austin Journal of Anatomy BioMed Research International Biomedicine Hub Case Reports in Clinical Pathology Case Reports in Internal Medicine Case Studies in Surgery Chinese Medicine Journal Clinical Epidemiology Clinical Medical Image Library Clinical Research: Open Access Cuencua ETV Journal European Journal of Forensic Sciences Fibromyalgia Global Journal of Medical and Clinical Case Reports Global Journal of Obesity, Diabetes and Metabolic Syndrome Global Journal of Stem Cell Biology and Transplantation Hereditary Genetics: Current Research Integrative Cancer Science and Therapeutics International Archives of Endocrinology Clinical Research International Journal of Advances in Case Reports International Journal of Biological Instrumentation International Journal of Biotechnology and Biomaterial Science International Journal of Clinical Medicine International Journal of Clinical Therapeutics and Diagnosis International Journal of Critical Care and Emergency Medicine International Journal of Critical Illness and Injury Science International Journal of Dentistry and Oral Health International journal of Dermatology and Clinical Research International Journal of Diabetes and Clinical Research International Journal of Diagnostic Imaging International Journal of Medical and Pharmaceutical Case Reports International Journal of Surgery Research & Practice International Journal of Transplantation Research and Medicine Jacobs Journal of Community Medicine Jacobs Journal of Epidemiology and Preventive Medicine Jacobs Journal of Internal Medicine Jokull Journal Journal of Advances in Physics Journal of Aging and Gerontology Journal of Anesthesia & Surgery Journal of Applied Hematology Journal of Biomedical Graphics and ComputingJournal of Cancer Research and Therapeutics Journal of Cardiovertebral Junction and Spine Journal of Clinical Case Reports Journal of Gastrointestinal Disorder & Liver Function Journal of Nursing Education and Practice Journal of Obesity and Bariatrics Journal of Obstetrics and Gynaecology Journal of Pharma Biology Journal of Respiratory Research Journal of Science Journal of Solid Tumors Journal of Surgery: Open Access Journal of Surgery and Surgical Research Madridge Journal of Diabetes Medicine Microbiology Discovery Middle East African Journal of Ophthalmology Neural Regeneration Research Open Journal of Preventive Medicine OMICS Journal of Radiology Optometry: Open Access Pharmacognosy Magazine Physiology Journal Shiraz E-Medical Journal Surgery and Transplantation Transplant Reports: Open Access Transplantation Research Journal Urology Annals Table 2 Non-heart related journals