Antiplatelet or anticoagulant therapy after coronary artery bypass surgery. A meta-analysis of clinical trials

PURPOSE: To determine the efficacy of antiplatelet or anti-coagulant therapy in preventing graft occlusions after coronary artery bypass surgery. DATA IDENTIFICATION: Studies published from 1966 to 1988 were identified through a computerized search using MEDLINE, by searching the bibliographies of all identified articles, and by consulting with the cardiologists and cardiothoracic surgeons in the Veterans Administration Cooperative Study Group on Antiplatelet Therapy After Coronary Artery Bypass Surgery. STUDY SELECTION: All studies selected were randomized, controlled clinical trials comparing at least one active drug with a placebo or nonplacebo control group. DATA EXTRACTION: Key data were extracted from each article, including the percentage of patients in each treatment group with one or more grafts occluded, the percentage of patients with completed postoperative catheterizations, timing of postoperative catheterization, and timing of start of treatment. These data were easily obtained from each article and did not require multiple observers. RESULTS OF DATA ANALYSIS: All studies had positive treatment-effect sizes in favor of active treatment, although some studies did not achieve statistical significance. A meta-analysis combining all treatment effects clearly shows that active treatment is beneficial (overall effect size = 0.30; CI, 0.21 to 0.38). Efficacy improves with early initiation of treatment. CONCLUSIONS: Early initiation of antiplatelet or anticoagulant drugs reduces the incidence of graft occlusions after coronary artery bypass surgery.     

Mid-term follow up of mitral valve reconstruction due to active infective endocarditis

BACKGROUND AND AIM OF THE STUDY: Mitral valve reconstruction in patients with acute endocarditis (AE) is a challenging operation which prompts the surgeon into immediate action. This report summarizes the mid-term results of 22 patients who required mitral valve reconstruction due to AE. METHODS: Mean patient age was 46 years (range: 20-79 years); mean follow up was 46 months (range: 1-90 months). Preoperatively, >70% of patients had severe mitral regurgitation and were in NYHA functional class III. Surgical techniques used were annuloplasty (n = 16; 10 with Carpentier ring, five Wooler-Kay and one Frater); suture closure of the perforation (n = 1), patch closure of the perforation (n = 5), leaflet resection with primary closure (n = 2), leaflet resection with patch closure (n = 8), and chordal transfer (n = 3). Additional surgery included CABG (n = 3) and De Vega plasty (n = 4). Aortic valve replacement or reconstruction (n = 9) included one mechanical valve, one bioprosthesis, one reconstruction and six homografts. Patients were followed up annually in our outpatient department and/or by questionnaires. RESULTS: Two patients died perioperatively due to either low output syndrome or uncontrolled sepsis. There were three reoperations; two of these were successful, and one patient subsequently died. In addition, one patient died six years after operation due to prostatic cancer, and one seven years later due to progressive heart failure. At the last follow up, 15 patients were in NYHA class I (68%) and five in class II (23%); no or only mild mitral insufficiency was seen on transthoracic echocardiography (91%). The estimated survival rate at 60 months was 87 +/- 12.7%, and 12 patients were followed up for >60 months. No incidence of recurrent valve infection occurred. CONCLUSION: Mitral valve reconstruction in patients with AE shows a low incidence of valve-related complications with promising postoperative functional results and mid-term survival. On this basis, mitral valve reconstruction for mitral insufficiency secondary to AE may be recommended as a valve salvage treatment, when it is technically possible.     

Spatio-temporal Regularization in Linear Distributed Source Reconstruction from EEG/MEG: A Critical Evaluation

The high temporal resolution of EEG/MEG data offers a way to improve source reconstruction estimates which provide insight into the spatio-temporal involvement of neuronal sources in the human brain. In this work, we investigated the performance of spatio-temporal regularization (STR) in a current density approach using a systematic comparison to simple ad hoc or post hoc filtering of the data or of the reconstructed current density, respectively. For the used STR approach we implemented a frequency-specific constraint to penalize solutions outside a narrow frequency band of interest. The widely used sLORETA algorithm was adapted for STR and generally used for source reconstruction. STR and filtering approaches were evaluated with respect to spatial localization error and spatial dispersion, as well as to correlation of original and reconstructed source time courses in single source and two source scenarios with fixed source locations and oscillating source waveforms. We used extensive computer simulations and tested all algorithms with different parameter settings (noise levels and regularization parameters) for EEG data. To verify our results, we also used data from MEG phantom measurements. For the investigated scenarios, we did not find any evidence that STR-based methods outperform purely spatial algorithms applied to temporally filtered data. Furthermore, the results show very clearly that the performance of STR depends very much on the choice of regularization parameters.     

Step Away from Depression—Study protocol for a multicenter randomized clinical trial for a pedometer intervention during and after in‐patient treatment of depression

ObjectivesIncreasing the number of daily steps by using a pedometer and a diary leads to an activity increase and improved health outcomes in a variety of somatic disorders. Hence, for the inpatient treatment of depression, supervised exercise interventions are more widespread. We aim to examine if a self‐managed pedometer intervention (PI) with the option of being proceeded after discharge leads to reduction of depression and to a physical activity (PA) increase.MethodsThe Step Away from Depression (SAD) study is a multicenter randomized controlled trial targeting 400 patients with major depressive disorder. Treatment as usual (TAU) is compared to TAU plus PI after 4 weeks, at discharge, and 6 months after hospital admission. Primary outcomes are clinically rated depression severity and accelerometer‐measured step counts. Secondary outcomes include self‐reported depression symptoms and PA level, psychiatric symptoms, health‐related quality of life, self‐efficacy, and components of the Motivation Volition Process Model.ResultsWe report the design of the SAD study considering several methodological aspects for exercise studies, in general.ConclusionsResults of our study will provide information about efficacy of PI for inpatient treatment and about interrelating processes of change concerning depression, PA, and aspects of motivation and volition.     

In vivo optical molecular imaging of inflammation and immunity

Journal of Molecular Medicine - Inflammation is the phenotypic form of various diseases. Recent development in molecular imaging provides new insights into the diagnostic and therapeutic evaluation...     

SARS-CoV-2-reactive T-cell receptors isolated from convalescent COVID-19 patients confer potent T-cell effector function

Both B cells and T cells are involved in an effective immune response to SARS-CoV-2, the disease-causing virus of COVID-19. While B cells—with the indispensable help of CD4⁺ T cells—are essential to generate neutralizing antibodies, T cells on their own have been recognized as another major player in effective anti-SARS-CoV-2 immunity. In this report, we provide insights into the characteristics of individual HLA-A*02:01- and HLA-A*24:02-restricted SARS-CoV-2-reactive TCRs, isolated from convalescent COVID-19 patients. We observed that SARS-CoV-2-reactive T-cell populations were clearly detectable in convalescent samples and that TCRs isolated from these T cell clones were highly functional upon ectopic re-expression. The SARS-CoV-2-reactive TCRs described in this report mediated potent TCR signaling in reporter assays with low nanomolar EC50 values. We further demonstrate that these SARS-CoV-2-reactive TCRs conferred powerful T-cell effector function to primary CD8⁺ T cells as evident by a robust anti-SARS-CoV-2 IFN-γ response and in vitro cytotoxicity. We also provide an example of a long-lasting anti-SARS-CoV-2 memory response by reisolation of one of the retrieved TCRs 5 months after initial sampling. Taken together, these findings contribute to a better understanding of anti-SARS-CoV-2 T-cell immunity and may contribute to paving the way toward immunotherapeutics approaches targeting SARS-CoV-2.     

Effect of interdental brush design on plaque during nonsurgical periodontal therapy

Clinical Oral Investigations - The aim of this randomized controlled trial was to evaluate the interproximal cleaning efficacy of waist-shaped compared with straight soft interdental brushes in...     

Retention forces between primary and secondary CAD/CAM manufactured telescopic crowns: an in vitro comparison of common material combinations

Clinical Oral Investigations - To analyze the retention forces between primary and secondary telescopic crowns milled from various materials and to compare them with the retention forces between...     

Metacognitive beliefs in obsessive-compulsive patients: A comparison with healthy and schizophrenia participants

Introduction. Distorted metacognitive beliefs are increasingly considered in theoretical models of obsessive-compulsive disorder (OCD). However, so far no consensus has emerged regarding the specific metacognitive profile of OCD.

Methods. Participants with OCD (n=55), schizophrenia (n=39), and nonclinical controls (n=49) were assessed with the Metacognitions Questionnaire (MCQ-30).

Results. Except for positive beliefs about worry, both patient samples exceeded nonclinical controls on all MCQ subscales. The MCQ “need to control thoughts” and “negative beliefs about uncontrollability and danger” subscales showed strong correlations with obsessions, and scores in the former scale were elevated in hallucinators. In contrast to several prior studies, “cognitive confidence” was related neither to core OCD nor to schizophrenia symptomatology.

Conclusions. Notwithstanding large pathogenetic differences between OCD and schizophrenia, findings suggest that obsessions and hallucinations may share a common metacognitive pathway. Need to control thoughts and dysfunctional beliefs about the malleability of worries may represent critical prerequisites for the two phenomena to emerge.