Atrial and ventricular septal defects can safely be closed by percutaneous intervention

Various transcatheter devices and methods to close congenital heart defects are currently available. Devices have been designed specifically for atrial septal defect (ASD), patent foramen ovale (PFO), and ventricular septal defect (VSD) closure. The trend in interventional treatment of intracardiac shunts shows toward defect-specific systems. The PFO is a tunnel defect requiring occluders that adapt to its length while common ASD strongly vary in their diameter, making a large scale of device sizes indispensable. VSDs are predominantly sealed by coils or tissue-adapted devices like muscular or perimembranous occluders. Since VSDs may occur with an aneurysm (VSA), a multi-perforated septum, an instable myocardial situation (postinfarction) or a high interventricular pressure gradient, closure of these defects is regarded sometimes as complicated. But during the last 30 years (since King and Mills implanted the first double-umbrella occluding system) several studies have proven procedure efficacy and safety of both ASD and VSD closure. This article reviews a large scale of studies and includes our single center data on 1,609 PFO, ASD, and VSD patients.     

Antibacterial Effect of Endodontic Disinfections on Enterococcus Faecalis in Dental Root Canals—An In-Vitro Model Study

Enterococcus faecalis (E. faecalis) is rather unsusceptible to many root canal disinfections which often cause a therapeutic problem. Therefore, the present in vitro study observed the efficiency of different endodontic antiseptics in their capability to suppress E. faecalis, especially inside dentinal tubules. Prior to any testing, root canals of extracted third human molars were inoculated with E. faecalis for 48 h. Antiseptic dressings with chloramine-T or calcium hydroxide (CaOH) for 24 h or irrigations with 1.3% sodium hypochlorite (NaOCl) were applied with n = 10 in each group. As control irrigation with normal saline was used. All treated canals were manually enlarged from size ISO 50 to 110 and the ablated dentin debris was subjected to microbial culture analysis. Bacterial colonization of the dentinal tubules up to 300 µm was verified by scanning electron microscopy and histological sample preparation. Application of crystalline chloramine-T caused total bacterial suppression inside the dentinal tubules. Dressings with CaOH showed only minor effects. Irrigation with NaOCl caused total eradication of bacteria adhering to the root canal walls, but also failed to completely suppress E. faecalis inside the dentinal tubules. The study showed that chloramine-T is of strong antiseptic activity and also efficient in suppressing E. faecalis inside dentinal tubules.     

A Method for the Evaluation of Early Osseointegration of Implant Materials Ex Vivo: Human Bone Organ Model

In the present work, an ex vivo organ model using human bone (explant) was developed for the evaluation of the initial osseointegration behavior of implant materials. The model was tested with additive manufactured Ti6Al4V test substrates with different 3D geometries. Explants were obtained from patients who underwent total knee replacement surgery. The tibial plateaus were used within 24 h after surgery to harvest bone cylinders (BC) from the anterior side using hollow burrs. The BCs were brought into contact with the test substrate and inserted into an agarose mold, then covered with cell culture media and subjected to the external load of 500 g. Incubation was performed for 28 days. After 28d the test substrate was removed for further analysis. Cells grown out BC onto substrate were immunostained with DAPI and with an antibody against Collagen-I and alkaline phosphatase (ALP) for visualization and cell counting. We show that cells stayed alive for up to 28d in our organ model. The geometry of test substrates influences the number of cells grown onto substrate from BCs. The model presented here can be used for testing implant materials as an alternative for in vitro tests and animal models.     

Adaptation and validation of the German Patient Activation Measure for adolescents with chronic conditions in transitional care: PAM® 13 for Adolescents

Measuring adolescent patients’ engagement in their health care is especially important in preparing for chronically ill adolescents’ transition into adult care. In this study, we aimed to create an adolescent version of the German language Patient Activation Measure (PAM‐13‐D) originally tested in in adults and psychometrically test the adapted measure (PAM^® 13 for Adolescents). After linguistic and content‐related adaptations, the PAM^® 13 for Adolescents was tested in a large sample of adolescents with different chronic conditions (N = 586, mean age 17.5 years, SD = 1.4) in 40 health centers. Internal consistency was assessed with Cronbach's alpha and test–retest reliability with Pearson correlation. Convergent and divergent validity were calculated with Pearson correlations between the two IE‐4 scales (internal and external Locus of Control) and the PAM^® 13 for Adolescents. Known‐group validity (type 1 diabetes vs. IBD, higher vs. lower education level) was checked by Mann–Whitney‐U‐tests. The PAM^® 13 for Adolescents showed good test–retest reliability (rtt = .68), internal consistency (α = .79) and demonstrated good validity. The original structure of the PAM 13‐D was replicated. Rasch analysis using the partial credit model was used to investigate the operating characteristics of the items. Rasch analysis indicated a sufficient fit of 12 of the 13 items. PAM^® 13 for Adolescents is the first instrument measuring patient activation of adolescents with chronic conditions in a broad age range. Patient activation level can be used by clinicians to better plan and structure transition processes.     

Extraction of open-state mitral valve geometry from CT volumes

Purpose

The importance of mitral valve therapies is rising due to an aging population. Visualization and quantification of the valve anatomy from image acquisitions is an essential component of surgical and interventional planning. The segmentation of the mitral valve from computed tomography (CT) acquisitions is challenging due to high variation in appearance and visibility across subjects. We present a novel semi-automatic approach to segment the open-state valve in 3D CT volumes that combines user-defined landmarks to an initial valve model which is automatically adapted to the image information, even if the image data provide only partial visibility of the valve.

Methods

Context information and automatic view initialization are derived from segmentation of the left heart lumina, which incorporates topological, shape and regional information. The valve model is initialized with user-defined landmarks in views generated from the context segmentation and then adapted to the image data in an active surface approach guided by landmarks derived from sheetness analysis. The resulting model is refined by user landmarks.

Results

For evaluation, three clinicians segmented the open valve in 10 CT volumes of patients with mitral valve insufficiency. Despite notable differences in landmark definition, the resulting valve meshes were overall similar in appearance, with a mean surface distance of \(1.62 \pm 2.10\) mm. Each volume could be segmented in 5–22 min.

Conclusions

Our approach enables an expert user to easily segment the open mitral valve in CT data, even when image noise or low contrast limits the visibility of the valve.

     

Cancer therapy modulates VEGF signaling and viability in adult rat cardiac microvascular endothelial cells and cardiomyocytes

This work was motivated by the incomplete characterization of the role of vascular endothelial growth factor-A (VEGF-A) in the stressed heart in consideration of upcoming cancer treatment options challenging the natural VEGF balance in the myocardium. We tested, if the cytotoxic cancer therapy doxorubicin (Doxo) or the anti-angiogenic therapy sunitinib alters viability and VEGF signaling in primary cardiac microvascular endothelial cells (CMEC) and adult rat ventricular myocytes (ARVM). ARVM were isolated and cultured in serum-free medium. CMEC were isolated from the left ventricle and used in the second passage. Viability was measured by LDH-release and by MTT-assay, cellular respiration by high-resolution oxymetry. VEGF-A release was measured using a rat specific VEGF-A ELISA-kit. CMEC were characterized by marker proteins including CD31, von Willebrand factor, smooth muscle actin and desmin. Both Doxo and sunitinib led to a dose-dependent reduction of cell viability. Sunitinib treatment caused a significant reduction of complex I and II-dependent respiration in cardiomyocytes and the loss of mitochondrial membrane potential in CMEC. Endothelial cells up-regulated VEGF-A release after peroxide or Doxo treatment. Doxo induced HIF-1α stabilization and upregulation at clinically relevant concentrations of the cancer therapy. VEGF-A release was abrogated by the inhibition of the Erk1/2 or the MAPKp38 pathway. ARVM did not answer to Doxo-induced stress conditions by the release of VEGF-A as observed in CMEC. VEGF receptor 2 amounts were reduced by Doxo and by sunitinib in a dose-dependent manner in both CMEC and ARVM. In conclusion, these data suggest that cancer therapy with anthracyclines modulates VEGF-A release and its cellular receptors in CMEC and ARVM, and therefore alters paracrine signaling in the myocardium.     

A 1‐Year Controlled Clinical Trial of Immediate Implants Placed in Fresh Extraction Sockets: Stability Measurements and Crestal Bone Level Changes

Purpose: The aim of this study was to measure stability and crestal bone level changes of implants placed in fresh extraction sockets in elderly patients. Methods: Thirty‐five patients who were in need of tooth extractions were recruited for this study. They received a total of 65 implants in both jaws to support fixed or removable prostheses. The teeth were carefully extracted, the implants set directly in the root socket, and resonance frequency analysis (RFA) measurements were simultaneously performed (Time 1 = T1). After a healing time of 6 to 10 weeks the measurements were repeated (Time 2 = T2). Orthograd periapical radiographs were taken when the new prostheses were fabricated and after 1 year of loaded period. The distance between the first visible bone implant contact (BIC) and the implant‐shoulder was measured and crestal bone loss was calculated (ΔBIC). Mean RFA and BIC were compared for various subgroups (p < .05). By means of a fixed effects model, the impact of the parameters gender, jaw, and prosthetic indication on RFA measurements was analyzed (p < .016). Results: The mean implant stability quotient (ISQ) values were 64.4 ± 6.7 at T1 and 64.0 ± at 8.6 T2, with a trend to higher values for male patients. The mixed model showed that only the jaw had a statistically significant impact on ISQ values, with higher values for the mandible. Mean crestal bone loss was small with 0.49 ± 0.81 mm, ranging form 0.1 to 2.4 mm. Twenty percent of the implant sites lost more than 1‐mm crestal bone. No differences were found in subgroups. Conclusions: Good primary and secondary stability of the implants was reached in both jaws. Crestal bone loss was small but may not be fully predictable for a single site. This treatment modality can be applied successfully in elderly patients and can be suggested for various prosthetic indications in both jaws.