Meningitis por Enterococcus faecium secundaria a anestesia epidural. A propósito de un caso y revisión de la literatura

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode.We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.     

Clinical Perspectives and Pearls from the 2015 ESC NSTE-ACS Guidelines

Four years after the latest edition, the 2015 non-ST-segment elevation acute coronary syndromes guidelines of the European Society of Cardiology have been published. Novel aspects include a new diagnostic algorithm for non-ST-segment elevation myocardial infarction using high-sensitivity cardiac troponins as well as guidance on cardiac rhythm monitoring duration. A large section is dedicated to antiplatelet therapy including initiation and duration of dual-antiplatelet therapy as well as the management of patients requiring, at the same time, long-term oral anticoagulation. New sections include the management of antiplatelet agent in patients requiring coronary artery bypass surgery and of acute bleeding events related to antiplatelet agents, vitamin K antagonist (VKA), and non-VKA oral anticoagulant drugs. Current evidence supports the radial access over the femoral one for coronary angiography and percutaneous revascularization.     

Who Benefits from Oncoplastic Surgical Techniques?

Breast-conserving therapy, which includes wide local excision of the tumor followed by irradiation, has become a standard treatment option for women with early-stage invasive breast cancer. The potential advantages of conservative breast surgery include the minor outpatient nature of the procedures, lower incidence of post-operative pain and complications, preservation of the breast and nipple areolar complex, and shorter delay to adjuvant therapy. However, not all patients are optimal candidates for breast-conserving procedures. Oncoplastic techniques combine the removal of breast cancer tumors in combination with either local volume replacement techniques to correct small defects, or by immediate reconstruction of larger defects using techniques of plastic surgery with or without contralateral breast procedures for symmetry. Therefore, oncoplastic techniques offer the potential to perform a wider excision of the tumor with an improved cosmetic result, thus potentially increasing the eligible pool for breast conservation.     

Left ventricular cardiac hemangioma in a patient with chronic heart failure

Cardiac hemangiomas are rare benign tumors. Here, we report the case of a man in his 30s who had a cardiac hemangioma with no symptoms. He was being treated with β-blockers for chronic heart failure with hypertensive heart disease at Osaka Minato Central Hospital. Routine echocardiography revealed a mobile spherical mass in the left ventricle that had not been detected on echocardiography performed 4 months previously. Subsequently, the tumor was excised to prevent potential embolic events and was pathologically diagnosed as a cardiac hemangioma. This case demonstrates the relatively rapid progress of a cardiac hemangioma regardless of β-blocker administration, which is occasionally used for the treatment of hemangiomas. The efficacy of β-blockers in treating cardiac hemangiomas may vary according to the type of β-blocker. Echocardiography is useful in screening and follow-up of cardiac hemangiomas; however, additional imaging modalities are needed for differential diagnosis.     

Synthesis of a New Nitrate-Fertilizer Form with a Controlled Release Behavior via an Incorporation Technique into a Clay Material

The current study shows an advanced synesthetic technique of a nitrate-fertilizer with a controlled release behavior into different soils (normal and acidic agriculture soils solutions) at different climate temperatures. The environmentally friendly and the biocompatible layered double hydroxide (LDH) clay material was used as a host to accommodate the nitrate anion into its interlayer gallery by applying a reconstruction-incorporation technique (the memory effect property of LDH that allows calcined LDH to memorize its original structure). The prepared materials were characterized by different spectroscopic techniques including; X-ray powder spectroscopy, IR, SEM, TEM, and TGA analyses. A remarkable loading ratio of the nitrate anion fertilizer was recorded into the LDH structure. Around 90 wt% of the intercalated nitrate anion was released in a sustained controlled behavior over around 24 days, while the same amount of nitrate was released over 10 days in the acidic soil. Accordingly, the present study offers a new passway for the formulation of controlled release fertilizers by using the hosting anionic clay LDH materials.     

Ellipsoid bounding region-based ChainMail algorithm for soft tissue deformation in surgical simulation

Real-time modelling of force interaction with soft tissues is of great importance for interactive surgical simulation. This paper presents a new ChainMail algorithm for real-time modelling of soft tissue deformation under force interaction. Unlike traditional ChainMails using a box-shaped bounding region, the proposed method defines an ellipsoid-shaped bounding region according to the concept of principal strains in continuum mechanics to control the movement of chain elements. Based on this ellipsoid-shaped bounding region, new position adjustment rules are developed and further integrated with temporal-domain model dynamics for dynamic simulation of soft tissue deformation. Haptic interaction with soft tissues is achieved via force input, soft tissue deformation, and force feedback. Experimental results demonstrate that the proposed ChainMail can simulate soft tissue mechanical behaviours, accommodate isotropic and homogeneous, anisotropic and heterogeneous materials, and handle large deformation. The proposed ChainMail also requires only small computational time, capable of achieving real-time computational performance.     

A System for the Measurement of the Subjective Visual Vertical using a Virtual Reality Device

The Subjective Visual Vertical (SVV) is a common test for evaluating the perception of verticality. Altered verticality has been connected with disorders in the otolithic, visual or proprioceptive systems, caused by stroke, Parkinson’s disease or multiple sclerosis, among others. Currently, this test is carried out using a variety of specific, mostly homemade apparatuses that include moving planes, buckets, hemispheric domes or a line projected in a screen. Our aim is to develop a flexible, inexpensive, user-friendly and easily extensible system based on virtual reality for the measurement of the SVV and several related visual diagnostic tests, and validate it through an experimental evaluation. Two different hardware configurations were tested with 50 healthy volunteers in a controlled environment; 28 of them were males and 22 females, with ages ranging from 18 to 49 years, being 23 the average age. The Intraclass Correlation Coefficient (ICC) was computed in each device. In addition, a usability survey was conducted. ICC?=?0.85 in the first configuration (CI?=?0.75–0.92), ICC?=?0.76 in the second configuration (CI?=?0.61–0.87), both with 95% of confidence, which means a substantial reliability. Moreover, 92.2% of subjects rated the usability of the system as “very good”. Our evaluation showed that the proposed system is suitable for the measurement of SVV in healthy subjects. The next step is to perform a more elaborated experimentation on patients and compare the results with the measurements obtained from traditional methods.