No abstract

Echinococcosis is an endemic disease, most common in sheep-raising communities, usually caused by the larval or cyst stage of the tapeworm Echinococcus granulosus. Isolated cardiac hydatid cyst is uncommon at any age, occurs through the coronary circulation, and accounts for less than 3% of all hydatid disease. We describe a case of an 18-year-old female, who died suddenly. The post-mortem examination revealed an isolated cyst in the left ventricle of the heart with intact wall. The cytologic examination of the cyst fluid demonstrated the presence of the characteristic scolices and hooklets and es-tablished the diagnosis of cardiac hydatid cyst. The present case is of special interest because of the rare primary localization and the onset of sudden death in a young person as the initial manifestation of the disease.

Pacemaker dependency is observed in an appreciable number of chronically paced patients. Although there is no standard definition, pacemaker dependency has a significant impact on the management of patients in several clinical settings. In this review, we provide a comprehensive overview of the available data regarding definition, testing, clinical significance, epidemiology, and mechanisms of pacemaker dependency. Several issues regarding the underlying pathophysiology remain obscure and the potential value of interventions that may alter its incidence, clinical course, and consequences remains to be elucidated.

Through mechanical forces, biological cells remodel the surrounding collagen network, generating striking deformation patterns. Tethers—tracts of high densification and fibre alignment—form between cells, thinner bands emanate from cell clusters. While tethers facilitate cell migration and communication, how they form is unclear. Combining modelling, simulation and experiment, we show that tether formation is a densification phase transition of the extracellular matrix, caused by buckling instability of network fibres under cell-induced compression, featuring unexpected similarities with martensitic microstructures. Multiscale averaging yields a two-phase, bistable continuum energy landscape for fibrous collagen, with a densified/aligned second phase. Simulations predict strain discontinuities between the undensified and densified phase, which localizes within tethers as experimentally observed. In our experiments, active particles induce similar localized patterns as cells. This shows how cells exploit an instability to mechanically remodel the extracellular matrix simply by contracting, thereby facilitating mechanosensing, invasion and metastasis.

The platelet response to the aggregatory effect of platelet-activating factor (PAF) in relation to blood PAF levels, serum PAF-acetylhydrolase (PAF-AH) activity and to their lipidaemic profile, was studied in 44 patients with coronary artery disease undergoing exercise tests. The PAF EC50 values in 21 patients with positive exercise test results were found to be significantly decreased at rest compared with 21 normal subjects (12.6 +/- 3.9 nM and 24.9 +/- 11.7 nM respectively) (P<0.0001). Moreover, the maximal percentage of aggregation to 50 nM PAF was found to be significantly increased (20.0 +/- 4.3% vs 13.5 +/- 3.6%, respectively) (P<0.0001). By contrast, the PAF EC50 values and the maximal percentage of aggregation in 23 patients with negative exercise test results were not statistically significantly different from the control group (25.2 +/- 11.4 nM and 14.1 +/- 4.7%, respectively). At the end of exercise, the PAF EC50 values and the maximal percentage of aggregation did not change in any group, and there were no significant differences in the whole-blood PAF levels either at rest or at the end of exercise. In patients with positive exercise test results, the PAF-AH activity at rest was significantly higher compared with the control group (37.2 +/- 8.0 nmol.ml(-1).min(-1) vs 32.4 nmol.ml(-1).min(-1), (P<0.03), whereas the enzyme activity did not differ in patients with negative exercise test results compared to controls (33.6 +/- 6.1 nmol.ml(-1).min(-1)). There was no change in PAF-AH activity during exercise in any group. The enzyme activity was positively correlated to the serum total and low density lipoprotein (LDL) cholesterol levels in the control group and in patients with negative exercise test results, whereas no correlation was found between PAF-AH activity and total or LDL cholesterol levels in patients with positive exercise test results.