Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter

OBJECTIVES: This study was designed to assess the feasibility, efficacy and safety of mechanical fragmentation of pulmonary emboli using a new rotational pigtail catheter system. BACKGROUND: Acute massive pulmonary embolism associated with right ventricular dysfunction is frequently lethal, despite high-dose thrombolytic therapy. Adjunctive catheter fragmentation may prevent a fatal outcome. METHODS: In 20 patients (age 58.9+/-10.5 years) with severe hemodynamic impairment, massive pulmonary emboli were fragmented by mechanical action of the rotating pigtail. Fifteen patients received thrombolysis after embolus fragmentation or no thrombolysis at all (noninterference group). RESULTS: Prefragmentation pulmonary arterial occlusion was 68.6 +/- 11.3% for both lungs. Pulmonary placement and navigation of the fragmentation catheter was easy and rapid. Fragmentation time was 17+/-8 min. The noninterference group showed a decrease pre- to postfragmentation of shock index from 1.28+/-0.53 to 0.95+/-0.38 (p = 0.011), mean pulmonary artery pressure from 31+/-5.7 to 28+/-7.5 mm Hg (p = 0.02) and a recanalization by fragmentation of 32.9+/-11.8% (mean angiographic score per treated lung from 7.4 to 5.0). Overall mortality was 20%. CONCLUSIONS: Fragmentation by pigtail rotation catheter provided for a rapid and safe improvement of the hemodynamic situation and an average recanalization of about one-third of the pulmonary embolic occlusion. The method appears useful especially in high-risk patients threatened by right ventricular failure, to accelerate thrombolysis, and as a minimal-invasive alternative to surgical embolectomy.     

Assessment of Viral Targeted Sequence Capture Using Nanopore Sequencing Directly from Clinical Samples

Shotgun metagenomic sequencing (SMg) enables the simultaneous detection and characterization of viruses in human, animal and environmental samples. However, lack of sensitivity still poses a challenge and may lead to poor detection and data acquisition for detailed analysis. To improve sensitivity, we assessed a broad scope targeted sequence capture (TSC) panel (ViroCap) in both human and animal samples. Moreover, we adjusted TSC for the Oxford Nanopore MinION and compared the performance to an SMg approach. TSC on the Illumina NextSeq served as the gold standard. Overall, TSC increased the viral read count significantly in challenging human samples, with the highest genome coverage achieved using the TSC on the MinION. TSC also improved the genome coverage and sequencing depth in clinically relevant viruses in the animal samples, such as influenza A virus. However, SMg was shown to be adequate for characterizing a highly diverse animal virome. TSC on the MinION was comparable to the NextSeq and can provide a valuable alternative, offering longer reads, portability and lower initial cost. Developing new viral enrichment approaches to detect and characterize significant human and animal viruses is essential for the One Health Initiative.     

Pr?vention der Kontrastmittelnephropathie

In America and Europe contrast medium nephropathy, also called contrast-induced nephropathy (CIN) is responsible for 10% of all cases of renal failure acquired in hospital. The incidence of this disease is dependent on the fundamental definition of acute kidney injury, on the type and dose of the contrast medium, the type of procedure carried out and patient-specific risk factors. In up to 30% of cases CIN leads to permanent renal damage and is accompanied by increased morbidity and a higher incidence of long-lasting severe events. Even for patients with no previous renal problems it is associated with an increased mortality within the following 12 months. The exact definition of CIN is still problematic. In one study increases in creatinine could be found even without administration of contrast medium in hospital. For this reason it is necessary to include a control group in future studies to exclude this??background noise??. A large multicenter study on the administration of acetylcysteine must also be promoted. If possible renal function should be determined using, for example measurement of cystatin C and not with serum creatinine. At present there are no evidence-based guidelines for prevention of CIN. This article presents the various currently available procedures. An interesting approach recommended by some physicians especially for patients with hyperhydration and those in intensive care, is the administration of theophylline. However, there are limitations due to the side-effects and large randomized studies are also lacking.     

Effects of beta-blockade on urinary albumin excretion in normal subjects.

Urinary albumin excretion is a marker of renal damage in diabetic or hypertensive patients and a reduction of albuminuria during beta-blockade has been demonstrated in several studies. In the present study the effects of beta-blockade with drugs known for differences in their impact on renal function (propranolol, atenolol, bopindolol) on albumin excretion in normotensive and normoalbuminuric subjects were investigated. No effect of beta-blockade on albumin excretion was found, despite decreased plasma renin activity, blood pressure and heart rate. It was concluded that studies in healthy controls are not useful to predict the outcome of treatment in microalbuminuric patients. Cross-over studies using different beta-blockers have yet to be done in micro- or macroalbuminuric patients to evaluate the potential for benefit.     

Kriterien der Deutschen Gesellschaft für Kardiologie, Deutschen Hochdruckliga e.V. DHL®/Deutschen Gesellschaft für Hypertonie und Prävention und der Deutschen Gesellschaft für Nephrologie zur Zertifizierung von „Renale-Denervations-Zentren (RDZ)“

This position paper from the Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V., the Deutsche Gesellschaft für Nephrologie e.V. and the Deutsche Hochdruckliga summarizes the criteria for certification of renal denervation centers. In addition to personnel and facility requirements, proper patient selection as well as pre- and post-procedural follow-up examinations are discussed. The certification of renal denervation centers ought to help physicians, patients, and health care providers/insurance companies to identify appropriate sites for the implementation of catheter-based renal denervation.