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Paget-Schroetter syndrome is a form of primary venous thoracic outlet syndrome whereby thrombosis of the subclavian vein is instigated by repeated and vigorous overhead activity of the arm. We describe a 35-year-old pregnant white woman at 8 weeks' gestation, a competitive swimmer by profession, who was diagnosed with a left upper extremity thrombus. First rib resection through an infraclavicular approach was performed 1 week after percutaneous pharmacomechanical thrombectomy. Repeated venography demonstrated residual thrombus requiring percutaneous pharmacomechanical thrombectomy with balloon venoplasty. We present a challenging case with focus on the unique diagnostic evaluation and management of pregnant patients with this condition. © 2019 The Authors.Inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation has been described as a technique to prevent potentially lethal pulmonary embolism in this critically ill population. With long-standing extracorporeal membranous oxygenation cannulae, venous fibrin sheaths may develop, which may predispose to filter maldeployment or inadequate embolus filtration. This report describes the use of a balloon catheter to disrupt a fibrin sheath at patient bedside using intravascular ultrasound guidance to facilitate inferior vena cava filter placement. © 2019 The Author(s).An arteriovenous malformation is a rare vascular anomaly composed of a complex network of interconnected arteries and veins of the scalp. SHP099 It is usually congenital, but infrequently occurs after trauma. Over the years, several terms have been used to describe these lesions, such as cirsoid/rasemose/arteriovenous aneurysm, plexiform angioma and aneurysma serpentinum, or arteriovenous fistula when a single connection exists. Head and neck malformations occur in 0.1% of the population. Involvement of the superficial temporal artery is rare, occurring in about 0.5% to 2.0% of cases. They are diagnosed by angiography and can be managed by endovascular or open resection. The case of a 23-year-old man who presented with a pulsatile head mass after blunt trauma 5 years prior is presented. This entity was diagnosed as an arteriovenous malformation supplied by the superficial temporal arteries. He subsequently underwent successful open exploration and resection. The information is presented with the patient's consent. © 2019 The Authors.A 50-year-old woman was referred to the noninvasive vascular laboratory for carotid artery evaluation because of a bruit in the neck. Color Doppler ultrasound examination demonstrated absence of the right common carotid artery and parallel internal and external carotid arteries originating at the brachiocephalic trunk. Computed tomography angiography further described anomalous anatomy, demonstrating a common origin of the innominate artery and left common carotid artery. Knowledge of such unusual anatomy may become valuable in future evaluation or treatment of this patient. © 2019 The Author(s).A pancreaticoduodenal artery arcade aneurysm (PDAA) is rare and often associated with celiac axis stenosis by the median arcuate ligament. Although rupture risk of the PDAA is not related to its size, treatment guidelines are absent. Here we describe a 59-year-old woman with multiple ruptured PDAAs associated with celiac axis stenosis who was successfully treated with coil embolization. As follow-up computed tomography revealed rapid expansion of residual PDAAs and new gastric artery dissection, median arcuate ligament resection was followed by aorta-common hepatic artery bypass, which resulted in aneurysmal regression. Blood flow modification might prevent secondary rupture of PDAA associated with celiac axis stenosis. © 2019 The Authors.Middle aortic syndrome (MAS), a coarctation of the lower thoracic and/or abdominal aorta, is typically diagnosed and treated in the pediatric population. We present a 48-year-old patient with a long-standing history of hypertension who was lost to follow-up owing to a lack of insurance coverage. After two myocardial infarcts owing to severe hypertension, a vascular workup including a computed tomography angiogram revealed a diagnosis of MAS. He underwent open vascular reconstruction with a thoracoabdominal Dacron bypass graft. He was discharged within 1 week with no hypertension or claudication. Adult patients diagnosed with MAS should undergo open or endovascular surgical repair with close follow-up. © 2019 The Author(s).The human gene MUTYH codes for a DNA glycosylase involved in the repair of oxidative DNA damage. Faulty MUTYH protein activity causes the accumulation of G→T transversions due to unrepaired 8-oxoGA mismatches. MUTYH germ-line mutations in humans are linked with a recessive form of Familial Adenomatous Polyposis (FAP) and colorectal cancer predisposition. We studied the repair capacity of variants identified in MUTYH-associated polyposis (MAP) patients. MAP is inherited in an autosomal recessive type due to mutations in MUTYH (Y165C, G382D, P54S, A22V, Q63R, G45D, S136P and N43S), indicating that both copies of the gene become inactivated. However, the parents of an individual with an autosomal recessive condition may serve as carriers, each harboring one copy of the mutated gene without showing signs or symptoms of MAP. Six protein partners have been associated with MUTYH, four via direct physical interactions, namely, hMSH6, hPCNA, hRPA1, and hAPEX1. We examined, for the first time, specific interactions of these protein partners with MAP-associated MUTYH mutants using molecular dynamics simulations. The approach provided tools for exploration of the conformational energy landscape accessible to protein partners. The investigation also determined the impact before and after energy minimization of protein-protein interactions and binding affinities of MUTYH wild type and mutant forms, as well as the interactions with other proteins. Taken together, this study provided new insights into the role of MUTYH and its interacting proteins in MAP. © 2020 Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
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