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Background: Primary thyroid leiomyosarcoma (LMS) is a very rare tumour with less than 40 published cases yet. Direct metastatic extension into the great cervical veins and caval veins is extremely uncommon. Extension to the right heart has not yet been reported. Case summary: A 62-year-old man was admitted for sudden onset of left neck pain and dyspnoea. Computed tomography and ultrasonography found an extensive mass of the left great cervical veins, superior vena cava, and a nodule in the left thyroid lobe. Transesophageal echocardiography visualized large protrusion of this mass into the right atrium. Cytology of a thyroid nodule diagnosed a benign hyperplastic nodule. The mass was considered to be likely an extensive thrombus. The patient was started on anticoagulant therapy. The next course was complicated by pulmonary embolism and later by enterorrhagia. Despite clinical stabilization, the patient died suddenly. Autopsy finding differed from the clinical conclusion. Microscopic investigation revealed that the mass seen in the cervical veins down to the right atrium was a spindle cell tumour with a primary site in the left thyroid lobe. Immunohistochemistry was consistent with the final diagnosis of primary thyroid LMS. Discussion: Differential diagnosis of the masses of great cervical veins and right atrium can be challenging. Pure venous thrombus and tumour thrombus must be distinguished. Thyroid LMS should also be considered in patients with masses in the right atrium and thyroid nodules.
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The majority of naturally occurring proteins have evolved to function under mild conditions inside the living organisms. One of the critical obstacles for the use of proteins in biotechnological applications is their insufficient stability at elevated temperatures or in the presence of salts. Since experimental screening for stabilizing mutations is typically laborious and expensive, in silico predictors are often used for narrowing down the mutational landscape. The recent advances in machine learning and artificial intelligence further facilitate the development of such computational tools. However, the accuracy of these predictors strongly depends on the quality and amount of data used for training and testing, which have often been reported as the current bottleneck of the approach. To address this problem, we present a novel database of experimental thermostability data for single-point mutants FireProtDB. The database combines the published datasets, data extracted manually from the recent literature, and the data collected in our laboratory. Its user interface is designed to facilitate both types of the expected use: (i) the interactive explorations of individual entries on the level of a protein or mutation and (ii) the construction of highly customized and machine learning-friendly datasets using advanced searching and filtering. The database is freely available at https://loschmidt.chemi.muni.cz/fireprotdb.
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Biología Computacional/métodos , Bases de Datos de Proteínas , Aprendizaje Automático/estadística & datos numéricos , Mutación Puntual , Proteínas/química , Conjuntos de Datos como Asunto , Internet , Modelos Moleculares , Anotación de Secuencia Molecular , Estabilidad Proteica , Proteínas/genética , Programas InformáticosRESUMEN
BACKGROUND: The data on heart rate in chronic heart failure in the real-world practice in Slovakia are not sufficiently known. The objective of the "3P (Patient-Pulse-Prognosis) in heart failure" survey was to collect epidemiological data with particular emphasis on heart rate control in sinus rhythm. METHODS: The survey was performed by 162 cardiologists and internists. Outpatients or clinically stable hospitalized patients diagnosed with chronic heart failure were included in the survey. No exclusion criteria for patients enrollment were used. A total of 4738 patients were prospectively included. RESULTS: 93.6% of patients with heart failure were taking beta-blockers. At least 50% of the target dose according to ESC had 48.1% of patients receiving beta-blockers. Heart rate ≥ 70 bpm was present in 55.3% of all patients and in 48.1% of patients with sinus rhythm. Out of the total unselected study population we identified 28.0% of patients with symptomatic heart failure (NYHA class II-IV), sinus rhythm, and suboptimal heart rate ≥ 70 bpm. The prevalence of heart rate ≥ 70 bpm was significantly higher in patients with beta-blocker dose < 50% of the target dose according to ESC compared with patients receiving ≥ 50% of the target dose (58.0% vs 52.4%, p < 0.001). Heart rate ≥ 70 bpm was significantly more common in patients with history of hospitalization for heart failure compared with patients who have not been hospitalized (56.8% vs 53.7%, p < 0.05). The physicians planned up-titration of the dose only in 20.2% of patients treated with beta-blockers. CONCLUSIONS: Despite extensive beta-blockers therapy we found suboptimal heart rate control in chronic heart failure. Patients on lower doses of beta-blockers (< 50 % of the target dose according to ESC) and patients with history of hospitalization for heart failure were noted to be in significantly higher risk of unsatisfactory heart rate. The proportion of patients with intended up-titration of the beta-blocker dose was low. Therefore it is necessary to reduce heart rate by alternative or complementary pharmacotherapy.
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Antagonistas Adrenérgicos beta/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Frecuencia Cardíaca/fisiología , Hospitalización/estadística & datos numéricos , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Relación Dosis-Respuesta a Droga , Femenino , Adhesión a Directriz , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Guías de Práctica Clínica como Asunto , Pronóstico , Eslovaquia , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The prognostic impact of right ventricular systolic dysfunction (RVSD) in heart failure (HF) with preserved ejection fraction (HFPEF) is not sufficiently understood. This pilot study evaluates the prevalence and prognostic impact of RVSD in HFPEF. METHODS: Ninety-five consecutive patients, admitted due to HF within one year were included and followed up for 12 months. Patients were classified based on left ventricular ejection fraction (LVEF) into two groups: HFPEF (LVEF >40%; n = 54), and heart failure with reduced ejection fraction (HFREF) (LVEF < or = 40%; n = 41). RVSD was defined as peak systolic tricuspid annular velocity (S') <10.8 cm/s. RESULTS: The prevalence of RVSD was 22% vs 59%, in HFPEF vs HFREF, respectively (P < 0.001). Patients with HFPEF and RVSD had significantly higher one-year all-cause mortality compared to HFPEF with normal RV function (41.7% vs. 4.8%, P = 0.004). The same trend was found in HFREF (33.3% vs. 5.9%, P = 0.057). A similar outcome was obser ved in cardiovascular mortality (H FPEF 33.3% vs. 0%, P = 0.002 and HFREF 20.8% vs. 0%, P= 0.06). RVSD was the only independent predictor of all-cause one-year mortality in patients with HFPEF (HR 11.5, 95% Cl 2.2 to 59.5, p = 0.004). CONCLUSION: RVSD is an independent predictor of all-cause mortality in HFPEF. Patients with HFPEF and RVSD had significantly higher one-year all-cause and cardiovascular mortality than those with normal RV function.
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Insuficiencia Cardíaca , Función Ventricular Izquierda , Función Ventricular Derecha , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Eslovaquia/epidemiología , Volumen Sistólico , Análisis de Supervivencia , Válvula Tricúspide/fisiopatologíaRESUMEN
The long-term prognosis of patients after haematopoietic stem cell transplantation (HSCT) has greatly improved. Cardiac complications represent unresolved and potentially life-threatening conditions in these patients. We prospectively examined 37 consecutive patients with a median age of 28 years who underwent allogeneic HSCT. Biomarkers of cardiac injury were measured serially before the conditioning regimen, the first day after HSCT and then 14, 30, 90 and 180 days after HSCT. Echocardiography was performed before and 1 month after HSCT. Eleven patients (30%) had persistently increased NT-proBNP values, 14 patients (38%) had only transient elevations and 12 (32%) had no changes in NT-proBNP concentrations for a period exceeding 14 days after HSCT. Elevated NT-proBNP values at day 14 after HSCT remained an independent predictor of cardiotoxicity during the first 6 months after HSCT (P < 0.01). Patients with persistent elevations in NT-proBNP also had significant elevations in hs-cTnT concentrations (P < 0.01). Only patients with persistently increased NT-proBNP had a significant worsening in systolic and some diastolic echocardiographic parameters, and we observed in this group the highest values of both cardiomarkers during the 6-month period. Forty-five percent of these patients developed clinical manifestation of cardiotoxicity. Elevations in NT-proBNP concentrations at day 14 after HSCT can predict patients at risk of developing cardiac events during the first 6 months after HSCT. Simultaneous elevations of both cardiomarkers (NT-proBNP and hs-cTnT) persisting 14 days after HSCT had a sensitivity of 83% and a specificity of 80.69%.
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Cardiotoxicidad/sangre , Cardiotoxicidad/diagnóstico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Troponina T/sangre , Adulto , Biomarcadores/sangre , Cardiotoxicidad/etiología , Femenino , Estudios de Seguimiento , Trasplante de Células Madre Hematopoyéticas/tendencias , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Adulto JovenAsunto(s)
Fístula Arteriovenosa , Embolización Terapéutica/métodos , Embolia Intracraneal , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Accidente Cerebrovascular , Adulto , Angiografía/métodos , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/fisiopatología , Fístula Arteriovenosa/terapia , Ecocardiografía Transesofágica , Femenino , Pruebas Hematológicas , Humanos , Embolia Intracraneal/diagnóstico , Embolia Intracraneal/etiología , Embolia Intracraneal/fisiopatología , Embolia Intracraneal/terapia , Arteria Cerebral Media/patología , Arteria Pulmonar/fisiopatología , Venas Pulmonares/fisiopatología , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Previous therapy with anthracyclines (ANT) and conditioning regimen followed by hematopoietic stem cell transplantation (HSCT) represents a high risk for development of cardiotoxicity. The aim of this study was to assess subclinical myocardial damage after HSCT using echocardiography and cardiac biomarkers--high sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and to identify patients at risk of developing clinical cardiotoxicity. PATIENTS AND METHODS: Thirty-seven patients who were treated with allogeneic HSCT for hematologic diseases at median age of 28 years at time of HSCT were studied. Conditioning regimen included either chemotherapy without total body irradiation (TBI) or combination of chemotherapy with TBI. Twenty-nine (78.3%) patients were pretreated with ANT therapy. Cardiac biomarkers were serially measured before conditioning regimen and at days 1, 14 and 30 after HSCT. Cardiac systolic and diastolic functions were assessed before conditioning regimen and 1 month after HSCT by echocardiography. RESULTS: The changes in plasma NT-proBNP and hs-cTnT levels during the 30 days following the HSCT were statistically significant (P < 0.01 v.s. P < 0.01). Persistent elevations of NT-proBNP and hs-cTnT simultaneously for a period exceeding 14 days after HSCT were found in 29.7% patients. Serum concentrations of cardiomarkers were significantly elevated in ANT group compared to non-ANT group. These observations were underscored by the echocardiographic studies which did reveal significant changes in systolic and diastolic parameters. Five of 37 (13.5%) patients developed clinical manifestation of cardiotoxicity. CONCLUSIONS: Elevations in both cardiac biomarkers were found before clinical signs of cardiotoxicity developed. Persistent elevations in NT-pro-BNP and hs-cTnT concentrations simultaneously for a period exceeding 14 days might be used for identification of patients at risk of developing cardiotoxicity and requiring further cardiological follow up.
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Antraciclinas/efectos adversos , Biomarcadores/sangre , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Troponina T/sangre , Adulto , Antraciclinas/uso terapéutico , Terapia Conductista/métodos , Femenino , Estudios de Seguimiento , Enfermedades Hematológicas/terapia , Humanos , Masculino , Miocardio/metabolismo , Miocardio/patología , Trasplante HomólogoAsunto(s)
Divertículo/etiología , Cardiopatías/etiología , Anciano , Divertículo/diagnóstico por imagen , Femenino , Cardiopatías/diagnóstico por imagen , Defectos del Tabique Interventricular/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Non-Hodgkin's lymphoma (NHL) rarely presents initially with cardiac symptoms. In this case, its first symptom was a recurrent syncope. The diagnosis of mediastinal tumor was made with transesophageal echocardiography. Considerable compression of the left atrium and superior vena cava without intracardiac growth was a cause of the syncope. Tumor biopsy revealed a diffuse, high-grade, large B-cell NHL. The patient died after four cycles of chemotherapy. To our knowledge, no previous report has demonstrated a syncope as an initial presentation of mediastinal lymphoma not invading the heart.