Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

A high-fidelity,virtual-reality,transurethral resection of bladder tumor simulator: Validation as a tool for training

IntroductionSimulation-based training is used to help trainees learn surgical procedures in a safe environment. The objective of our study was to test the face, content, and construct validity of the transurethral resection of bladder tumor (TURBT) module built on the Simbionix TURP Mentor simulator.MethodsParticipants performed five standardized cases on the simulator. Domains of the simulator were evaluated on a five-point Likert scale to establish face and content validity. Construct validity was assessed through the simulator’s built-in scoring metrics, as well as video recordings of the simulator screen and an anonymized view of participants’ hands and feet, which were evaluated using an objective structured assessment of technical skills (OSATS) tool.ResultsTen experienced operators and 15 novices participated. Face validity was somewhat acceptable (mean realism 3.8/5±1.03 standard deviation [SD]; mean appearance 4.1/5±0.57), as was content validity, represented by simulation of key steps (mean 3.9±0.57). The simulator failed to achieve construct validity. There was no difference in mean simulator scores or OSATS scoring between experienced operators and novices. Novices significantly improved their mean simulator scores (305.9 vs. 332.4, p=0.006) and OSATS scoring (15.8 vs. 18.1, p=0.001), while 87% felt their confidence to perform TURBT improved. Overall, 92% of participants agreed that the simulator should be incorporated into residency training.ConclusionsOur study suggests a role for the TURBT module of the Simbionix TURP Mentor simulator as an introduction to TURBT for urology trainees. Strong support was found from both experienced operators and novices for its formal inclusion in resident education.     

Microsatellite markers for the freshwater shrimp Paratya australiensis (Atyidae)

Paratya australiensis is a common freshwater shrimp found in most catchments in south-eastern Australia. Microsatellite loci were isolated from a partial genomic library created using 454 sequencing. Of the 25 tested, 13 were found to be polymorphic, however, for pooling purposes only 12 were used for genotyping. The number of alleles per locus varied from 2 to 14 in a population from Wakefield River, South Australia, and the mean (range) observed and expected heterozygosity were 0.512 (0.136–0.909) and 0.590 (0.165–0.788), respectively across all alleles. These microsatellites will be used to study the genetic structure of populations in two catchments in South Australia.     

State of the art and recommendationsKangaroo mother care: application in a high‐tech environment

Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent–infant skin‐to‐skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow‐up. In affluent settings, intermittent KMC with sessions of one or a few hours skin‐to‐skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high‐tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high‐tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents’ role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. Conclusion: Implementation of the original KMC method, with continuous skin‐to‐skin contact whenever possible, is recommended for application in high‐tech environments, although scientific evaluation should continue.     

Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients

BACKGROUND: Colonization and infection with vancomycin-resistant enterococci have been associated with exposure to antibiotics that are active against anaerobes. In mice that have intestinal colonization with vancomycin-resistant enterococci, these agents promote high-density colonization, whereas antibiotics with minimal antianaerobic activity do not. METHODS: We conducted a seven-month prospective study of 51 patients who were colonized with vancomycin-resistant enterococci, as evidenced by the presence of the bacteria in stool. We examined the density of vancomycin-resistant enterococci in stool during and after therapy with antibiotic regimens and compared the effect on this density of antianaerobic agents and agents with minimal antianaerobic activity. In a subgroup of 10 patients, cultures of environmental specimens (e.g., from bedding and clothing) were obtained. RESULTS: During treatment with 40 of 42 antianaerobic-antibiotic regimens (95 percent), high-density colonization with vancomycin-resistant enterococci was maintained (mean [+/-SD] number of organisms, 7.8+/-1.5 log per gram of stool). The density of colonization decreased after these regimens were discontinued. Among patients who had not received antianaerobic antibiotics for at least one week, 10 of 13 patients who began such regimens had an increase in the number of organisms of more than 1.0 log per gram (mean increase, 2.2 log per gram), whereas among 10 patients who began regimens of antibiotics with minimal antianaerobic activity, there was a mean decrease in the number of enterococci of 0.6 log per gram (P=0.006 for the difference between groups). When the density of vancomycin-resistant enterococci in stool was at least 4 log per gram, 10 of 12 sets of cultures of environmental specimens had at least one positive sample, as compared with 1 of 9 sets from patients with a mean number of organisms in stool of less than 4 log per gram (P=0.002). CONCLUSIONS: For patients with vancomycin-resistant enterococci in stool, treatment with antianaerobic antibiotics promotes high-density colonization. Limiting the use of such agents in these patients may help decrease the spread of vancomycin-resistant enterococci.     

A preliminary morphometric magnetic resonance imaging study of regional brain volumes in body dysmorphic disorder

Morphometric magnetic resonance imaging (MRI) was used to compare regional brain volumes in eight women with body dysmorphic disorder (BDD) and eight healthy comparison subjects. The BDD group exhibited a relative leftward shift in caudate asymmetry and greater total white matter vs. the comparison group. Findings with respect to the caudate nucleus are consistent with both the conceptualization of BDD as an obsessive-compulsive spectrum disorder, and the 'striatal topography model' of obsessive-compulsive disorders.     

The role of protective antireflux procedures in neurologically impaired children: a decision analysis

Background/Purpose: Despite normal clinical history and preoperative radiologic and pH studies, gastroesophageal reflux (GER) can become apparent in neurologically impaired (NI) children after gastrostomy tube placement. An antireflux procedure performed at the time of gastrostomy tube placement may prevent postoperative GER and help avoid the need for a subsequent surgical procedure but is associated with a high morbidity and mortality rate in NI children. The purpose of this study was to determine the role of protective antireflux procedures in NI children undergoing gastrostomy tube placement. Methods: Decision analysis was used to evaluate the effect of a protective antireflux procedure on morbidity and mortality in NI children. The rate of postoperative GER, need for secondary antireflux procedures, and morbidity and mortality rates after gastrostomy tube placement with or without an antireflux procedure in NI children were estimated from the literature and expert opinion and used to construct decision trees. Results: At baseline values, gastrostomy tube placement resulted in a lower morbidity (11% v 13%) than gastrostomy tube placement with a protective antireflux procedure. One-way sensitivity analysis showed that gastrostomy tube placement was the favored approach when the morbidity of gastrostomy tube placement was less than 11% or the morbidity of antireflux surgery was greater than 10%. At baseline values, gastrostomy tube placement resulted in a lower mortality rate (0.3% v 0.8%) than gastrostomy tube placement with a protective antireflux procedure. Using 1-way sensitivity analysis, no threshold value of any variable was found that favored the use of a protective antireflux procedure with respect to mortality. Conclusions: Although a protective antireflux procedure may reduce the need for additional surgery, inclusion of this procedure is associated with a higher morbidity and mortality rate. Initial placement of a gastrostomy tube without a protective antireflux procedure is the favored approach for NI children without preoperative evidence of GER.     

Brief butyltin exposure induces irreversible inhibition of the cytotoxic function on human natural killer cells, in vitro

Despite mounting evidence on butyltin (BT) contamination and related immunotoxic effects on wildlife, very little is known about BT-associated immunotoxic effects on humans, particularly the effects on human natural killer (NK) lymphocyte function. Our earlier studies demonstrated that in vitro exposure to environmentally relevant concentrations of BTs negatively affect human NK cells and that there are measurable levels of BTs in human blood. In this study we examined whether the inhibition of NK cell cytotoxic function induced by a brief exposure (1 h) to BTs is reversible when the cells are allowed to recover in BT-free media for up to 6 days. Standard methods were used in chemical preparation, blood sampling, NK cell isolation, and 51-Chromium release assay. The results revealed that exposure to 300 nM TBT for 1 h caused an approximately 65- decrease in NK cytotoxic function, whether the lymphocytes were given as long as a 6-day recovery period or no recovery period. There was no recovery (nor any further loss) of NK cytotoxic function following removal of the compound. Exposure to 5 microM DBT for 1 h showed a 41% decrease in cytotoxic function with 0-h recovery and an 83% decrease after a 24-h recovery period. Thus, not only is there no significant recovery of NK cytotoxic function when the lymphocytes are allowed to incubate in BT-free medium for up to 6 days but there is additional loss of cytotoxic function. The results indicated that short-term exposure to BTs causes persistent negative effects on NK cell ability to kill cancer cells.     

Interleukins 2 and 12 produce recovery of cytotoxic function in tributyltin-exposed human natural killer cells

Cytotoxic function of human natural killer (NK) cells is modulated by a variety of cytokines. Interleukins (IL) 2 and 12 are both potent stimulators of NK cell cytotoxic function. Tributyltin (TBT) is used in a variety of consumer products and industrial applications. TBT is found in dairy products, meat, and fish. We and others have shown that there are measurable levels of TBT in human blood. Butyltins appear to increase the risk of cancer and viral infections in exposed individuals. We have demonstrated that the ability of NK cells to kill tumor cells is greatly diminished after a l-h exposure to TBT and that this inhibition persists even after removal of the compound. In the current study we examine the effects of the NK-stimulatory ILs, IL2 and IL12, on the ability of NK cells to recover from the persistent inhibitory effects of a 1-h TBT treatment. Highly purified NK cells (> 95% CD16(+)) or a lymphocyte preparation containing both T lymphocytes and NK cells were treated with 300 nM TBT and then allowed to recover for 24 h, 48 h, 4 days, and 6 days in TBT-free media containing no interleukin, 1000 U/mL IL2, 20 ng/mL IL l2, or a combination of IL2 plus IL12. Tumor killing function was then tested using a radioactive chromium release assay. As seen in our previous studies there is no recovery of NK cell cytotoxic function even after a 6-day recovery period when no interleukin is present in the medium. However, there is significant recovery of NK cytotoxic function when IL2, IL12, or the combination of IL2 plus IL12 is present in the medium during the recovery period.     

Interleukins 2 and 12 produce significant recovery of cytotoxic function in dibutyltin-exposed human natural killer cells

Cytotoxic function of human natural killer (NK) cells is modulated by a variety of cytokines. Interleukins (IL) 2, 12, 15, and 18 and Interferon gamma (IFNgamma) are potent stimulators of NK cell cytotoxicity. Butyltins (BTs) are used in a variety of consumer products and industrial applications. Dibutyltin (DBT) is found in plastic products, beverages stored in PVC pipes during manufacturing, and poultry products. BTs appear to increase the risk of cancer and viral infections in exposed individuals. Recently, we have demonstrated that the ability of NK cells to kill tumor cells is greatly diminished after a 1-h exposure to dibutyltin. This inhibition of tumor killing function continues even after removal of the compound. There is no significant recovery of NK cytotoxic function even when the cells are allowed to recover for 6 days. In the current study we examine the effects of NK-stimulatory cytokines on the ability of NK cells to recover from the inhibitory effects of a 1-h DBT treatment. Highly purified NK cells (>95% CD16(+)) or a lymphocyte preparation containing both T lymphocytes and NK cells were treated with 5 microM DBT and then allowed to recover for 24 h, 48 h, 4 days, and 6 days in DBT-free medium containing either no cytokine or a maximally stimulatory dose of several NK-stimulatory cytokines. Tumor killing function was tested using a radioactive chromium release assay. As seen in our previous studies there is no recovery of NK cell cytotoxic function even after a 6-day recovery period when no cytokine is present in the medium. However, there is significant recovery of NK cytotoxic function when IL2, IL12, or the combination of IL2 plus IL12 is present in the medium during the recovery period. The other cytokines tested (IL15, IL18, and IFNgamma) were unable to increase the cytotoxicity of DBT-exposed NK cells.