Transplantation of donor lungs with pulmonary embolism – a retrospective study

Lung transplantation from donors with fulminant pulmonary arterial embolism as a cause of death remains controversial. An analysis was performed comparing preoperative characteristics and outcomes of 25 donors with a primary diagnosis of pulmonary arterial embolism to 1085 recipients of donor lungs without pulmonary arterial embolism. No early functional impairment of donor lungs with pulmonary embolism was detectable as depicted by the incidence of primary graft dysfunction immediately after surgery (P = 0.66), 24 (P = 0.79), 48 (P = 0.99) and 72 h (P = 0.99) after transplantation. Pulmonary function testing at 1 year (P = 0.003) and at last outpatient control (P < 0.05) showed superior results in the cohort receiving lungs from donors with pulmonary embolism. Incidence of chronic lung allograft dysfunction (CLAD) showed no difference within the first year after lung transplantation, however, 5 year‐CLAD free survival was superior in recipients (70.4% vs. 55.1%, P = 0.006) of donor lungs with pulmonary embolism. Overall survival was similar in both groups. Lungs from donors with fulminant pulmonary embolism prior to brain death can safely be used for lung transplantation without impairing postoperative outcomes. Lung function testing shows favorable midterm results in recipients of donor lungs with pulmonary embolism.     

Analgesie im Rettungsdienst: Vergleich zwischen Telenotarzt- und Callback-Verfahren hinsichtlich Anwendungssicherheit,Wirksamkeit und Verträglichkeit

Die Anaesthesiologie - Schmerzen gehören zu den häufigsten Einsatzanlässen im Rettungsdienst und erfordern abhängig von der Schmerzintensität eine medikamentöse...     

Verbal insight revisited: fMRI evidence for early processing in bilateral insulae for solutions with AHA! experience shortly after trial onset

In insight problem solving solutions with AHA! experience have been assumed to be the consequence of restructuring of a problem which usually takes place shortly before the solution. However, evidence from priming studies suggests that solutions with AHA! are not spontaneously generated during the solution process but already relate to prior subliminal processing. We test this hypothesis by conducting an fMRI study using a modified compound remote associates paradigm which incorporates semantic priming. We observe stronger brain activity in bilateral anterior insulae already shortly after trial onset in problems that were later solved with than without AHA!. This early activity was independent of semantic priming but may be related to other lexical properties of attended words helping to reduce the amount of solutions to look for. In contrast, there was more brain activity in bilateral anterior insulae during solutions that were solved without than with AHA!. This timing (after trial start/during solution) x solution experience (with/without AHA!) interaction was significant. The results suggest that (a) solutions accompanied with AHA! relate to early solution‐relevant processing and (b) both solution experiences differ in timing when solution‐relevant processing takes place. In this context, we discuss the potential role of the anterior insula as part of the salience network involved in problem solving by allocating attentional resources.     

Seeing Double: Annular Diaper Rash in Twins

We report a case of dichorionic, diamniotic twins who developed similar erythematous, annular, erosive plaques in the inguinal folds in the first few weeks of life that were refractory to topical antifungals and oral antibiotics. The twins were found to have high transaminase levels, antinuclear antibody positivity, and anti‐SSS/Ro) and anti‐SSB/La autoantibodies. The rash resolved without scarring by 7 months of age with the use of low‐potency topical corticosteroids. We suggest that physicians consider neonatal lupus erythematosus in neonates with atypical eruptions occurring in sun‐protected skin.     

Neuronal tuning: Selective targeting of neuronal populations via manipulation of pulse width and directionality

IntroductionMotor evoked potentials (MEP) in response to anteroposterior transcranial (AP) magnetic stimulation (TMS) are sensitive to the TMS pulse shape. We are now able to isolate distinct pulse properties, such as pulse width and directionality and evaluate them individually. Different pulse shapes induce different effects, likely by stimulating different populations of neurons. This implies that not all neurons respond in the same manner to stimulation, possibly, because individual segments of neurons differ in their membrane properties.ObjectivesTo investigate the effect of different pulse widths and directionalities of TMS on MEP latencies, motor thresholds and plastic aftereffects of rTMS.MethodsUsing a controllable pulse stimulator TMS (cTMS), we stimulated fifteen subjects with quasi-unidirectional TMS pulses of different pulse durations (40 μs, 80 μs and 120 μs) and determined thresholds and MEP AP latencies. We then compared the effects of 80 μs quasi-unidirectional pulses to those of 80 μs pulses with different pulse directionality characteristics (0.6 and 1.0 M ratios). We applied 900 pulses of the selected pulse shapes at 1 Hz.ResultsThe aftereffects of 1 Hz rTMS depended on pulse shape and duration. 40 and 80 μs wide unidirectional pulses induced inhibition, 120 μs wide pulses caused excitation. Bidirectional pulses induced inhibition during the stimulation but had facilitatory aftereffects. Narrower pulse shapes caused longer latencies and higher resting motor thresholds (RMT) as compared to wider pulse shapes.ConclusionsWe can tune the aftereffects of rTMS by manipulating pulse width and directionality; this may be due to the different membrane properties of the various neuronal segments such as dendrites.SignificanceTo date, rTMS frequency has been the main determinant of the plastic aftereffects. However, we showed that pulse width also plays a major role, probably by recruiting novel neuronal targets.     

Strategies to reduce stigma related to visible chronic skin diseases: a systematic review

Many patients with a visible chronic skin disease experience discrimination and stigmatization. This results in psychosocial impairments in addition to the burden of disease and emphasizes the urgency to implement effective stigma‐reduction strategies. To synthesize what is known globally about effective interventions to reduce stigma associated with visible chronic skin diseases, a systematic review was conducted. Four electronic databases were searched until May 2018. Studies evaluating interventions to reduce stigmatization in patients with visible chronic skin diseases and applying at least one stigma‐related outcome measure were included. Data were extracted on study design, country, study population, outcome measures and main findings. Results were subsequently synthesized in a narrative review. Critical Appraisal Skills Programme tools were used to assess study quality. Nineteen studies were included in the review. Study design was very heterogeneous and study quality rather poor. Thirteen studies addresses patients with leprosy in low‐ and middle‐income countries, and one study each targeted patients with onychomycosis, leg ulcer, facial disfigurement, atopic dermatitis, vitiligo and alopecia. Evaluated interventions were mainly multi‐faceted incorporating more than one type of intervention. While 10 studies focused on the reduction in self‐stigma and 4 on the reduction in public stigma, another 5 studies aimed at reducing both. The present review revealed a lack of high‐quality studies on effective approaches to reduce stigmatization of patients with visible chronic skin diseases. Development and evaluation of intervention formats to adequately address stigma is essential to promote patients’ health and well‐being.     

Genomic Dissection of Travel-Associated Extended-Spectrum-Beta-Lactamase-Producing Salmonella enterica Serovar Typhi Isolates Originating from the Philippines: a One-Off Occurrence or a Threat to Effective Treatment of Typhoid Fever?

One unreported case of extended-spectrum-beta-lactamase (ESBL)-producing Salmonella enterica serovar Typhi was identified, whole-genome sequence typed, among other analyses, and compared to other available genomes of S. Typhi. The reported strain was similar to a previously published strain harboring bla_SHV-12 from the Philippines and likely part of an undetected outbreak, the first of ESBL-producing S. Typhi.