Type 2 diabetes mellitus is a complex metabolic disease, and cardiovascular disease is a leading complication of diabetes. Epicardial adipose tissue surrounding the heart displays biochemical, thermogenic, and cardioprotective properties. However, the metabolic cross-talk between epicardial fat and the myocardium is largely unknown. This study sought to understand epicardial adipose tissue metabolism from heart failure patients with or without diabetes. We aimed to unravel possible differences in glucose and lipid metabolism between human epicardial and subcutaneous adipocytes and elucidate the potential underlying mechanisms involved in heart failure. Insulin-stimulated [(14)C]glucose uptake and isoproterenol-stimulated lipolysis were measured in isolated epicardial and subcutaneous adipocytes. The expression of genes involved in glucose and lipid metabolism was analyzed by reverse transcription-polymerase chain reaction in adipocytes. In addition, epicardial and subcutaneous fatty acid composition was analyzed by high-resolution proton nuclear magnetic resonance spectroscopy. The difference between basal and insulin conditions in glucose uptake was significantly decreased (P= 0.006) in epicardial compared with subcutaneous adipocytes. Moreover, a significant (P< 0.001) decrease in the isoproterenol-stimulated lipolysis was also observed when the two fat depots were compared, and it was strongly correlated with lipolysis, lipid storage, and inflammation-related gene expression. Moreover, the fatty acid composition of these tissues was significantly altered by diabetes. These results emphasize potential metabolic differences between both fat depots in the presence of heart failure and highlight epicardial fat as a possible therapeutic target in situ in the cardiac microenvironment.
We report a case of two babies with absence of pericardium and patent ductus arteriosus (PDA). The absence of pericardium was found coincidentally during PDA ligation. The PDA was successfully ligated but the pericardium was not reconstructed. Postoperatively, the agenesis of the pericardium did not interfere with cardiac function.
Bovine pericardium has widely been used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report our experience of using locally processed bovine pericardium for dural grafts in 22 patients undergoing cranial operations.
Flying feather is a traditional street weapon, which is believed to be originated from Philippine. It is a famous weapon in Tawau, Sabah, shot within short distance and being used with the aim to debilitate the victims. Some may even apply poison at the tip of the weapon. We report two cases of severe chest injuries in resulting from flying feathers. Case 1, a 25-year old man sustained left sided hemothorax with anterior right ventricle injury. He underwent thoracotomy and was discharged well. Case 2, a 40-year old man, presented to emergency department with no signs of life, sustained penetrating injury to the left second intercostal muscle, the pericardium and the anterior wall of the right ventricle adjacent to the interventricular septum. These cases highlight the severity spectrum of cardiac injury resulting from flying feathers.