Chorea minor mit subklinischer Herzbeteiligung Welche Wertigkeit hat die Farbdopplerechokardiographie bei der Diagnose der rheumatischen Valvulitis?

Zusammenfassung Für die Diagnose einer rheumatischen Valvulitis wird nach den revidierten Jones-Kriterien von 1992 ein pathologischer Auskultationsbefund gefordert, der echokardiographische Befund einer Mitralklappeninsuffizienz wird nicht akzeptiert. Wir stellen eine Patientin mit akutem rheumatischem Fieber vor, bei der sich neben einer Chorea minor keine weiteren Major- oder Minorsymptome fanden. Allerdings konnte echokardiographisch neben einem Perikardergu? eine Mitralklappeninsuffizienz nachgewiesen werden. Diskussion: Bei Patienten mit akutem rheumatischem Fieber wird eine Mitralklappeninsuffizienz ohne auskultatorisches Korrelat weitaus h?ufiger als bei gesunden Kindern nachgewiesen und ist unter Anwendung strenger echokardiographischer Kriterien von physiologischen Mitralklappenregurgitationen abgrenzbar. Da sich auch bei Patienten ohne klinische Zeichen einer Valvulitis nach langer Latenz ein rheumatischer Herzfehler manifestieren kann, sollte – unter Anwendung strenger echokardiographischer Kriterien – der Nachweis einer pathologischen Mitralklappeninsuffizienz in den Jones-Kriterien berücksichtigt werden.      

Expression, localization, and function of the carnitine transporter octn2 (slc22a5) in human placenta.

L-carnitine is assumed to play an important role in fetal development, and there is evidence that carnitine is transported across the placenta. The protein involved in this transfer, however, has not been identified on a molecular level. We therefore characterized localization and function of the carnitine transporter OCTN2 in human placenta. Significant expression of OCTN2 mRNA was detected in human placenta applying real-time polymerase chain reaction technology. Confocal immunofluorescence microscopy using an antibody directed against the carboxy terminus of OCTN2 protein revealed that it is predominantly expressed in the apical membrane of syncytiotrophoblasts. This was confirmed by the costaining of organic anion-transporting polypeptide B and MRP2, which are known to be expressed mainly in the basal and apical syncytiotrophoblasts membrane, respectively. To further support this finding, we performed transport studies using basal and apical placenta membrane vesicles. We could demonstrate that the carnitine uptake into the apical vesicles was about eight times higher compared with the basal ones. Moreover, this uptake was sodium- and pH-dependent with an apparent K(m) value of 21 muM and inhibited by verapamil, which is in line with published data for recombinant OCTN2. Finally, experiments using trophoblasts in cell culture revealed that expression of OCTN2 paralleled human choriogonadotropin production and thus is modulated by cellular differentiation. In summary, we show expression and function of OCTN2 in human placenta. Moreover, several lines of evidence indicate that OCTN2 is localized in the apical membrane of syncytiotrophoblasts, thereby suggesting a major role in the uptake of carnitine during fetal development.     

Malignancy Rate and Malignancy Risk Assessment in Different Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions): An Analysis of 192 Cases from a Single Institution

BackgroundThe question of how to deal with B3 lesions is of emerging interest.MethodsIn the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding.ResultsThe distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3%; flat epithelial atypia (FEA), 7.8%; lobular neoplasia (LN), 7.8%; papilloma (Pa), 49.5%; phylloidal tumour (PT), 8.9%; radial sclerosing scar (RS), 3.1%; mixed findings, 10.4%; and other B3 lesions, 5.2%. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). The most important risk factor was increasing age. Postmenopausal status was considered an increased risk for an upgrade (p = 0.015). A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade (p = 0.003).ConclusionIncreasing knowledge about B3 lesions allows us to develop a “lesion-specific” therapy approach in the heterogeneous group of B3 lesions, with follow-up imaging for some lesions with less malignant potential and concordance with imaging or further surgical resection in cases of disconcordance with imaging or higher malignant potential.     

Opposition to voluntary and mandated COVID-19 vaccination as a dynamic process: Evidence and policy implications of changing beliefs

COVID-19 vaccination rates slowed in many countries during the second half of 2021, along with the emergence of vocal opposition, particularly to mandated vaccinations. Who are those resisting vaccination? Under what conditions do they change their minds? Our three-wave representative panel survey from Germany allows us to estimate the dynamics of vaccine opposition, providing the following answers. Without mandates, it may be difficult to reach and to sustain the near-universal level of repeated vaccinations apparently required to contain the Delta, Omicron, and likely subsequent variants. But mandates substantially increase opposition to vaccination. We find that few were opposed to voluntary vaccination in all three waves of the survey. They are just 3.3% of our panel, a number that we demonstrate is unlikely to be the result of response error. In contrast, the fraction consistently opposed to enforced vaccinations is 16.5%. Under both policies, those consistently opposed and those switching from opposition to supporting vaccination are sociodemographically virtually indistinguishable from other Germans. Thus, the mechanisms accounting for the dynamics of vaccine attitudes may apply generally across societal groups. What differentiates them from others are their beliefs about vaccination effectiveness, their trust in public institutions, and whether they perceive enforced vaccination as a restriction on their freedom. We find that changing these beliefs is both possible and necessary to increase vaccine willingness, even in the case of mandates. An inference is that well-designed policies of persuasion and enforcement will be complementary, not alternatives.

The challenge of the first half-year of most COVID-19 vaccination campaigns was the supply of vaccines, not demand for them. It then appeared that, once vaccines were widely available, vaccination rates would approach the two-thirds level initially thought to be sufficient to control the pandemic. But the Delta and then Omicron variants along with substantial and persistent reported opposition to vaccination have raised doubts about whether vaccine willingness will be sufficient. In response, by the end of 2021, vaccination mandates were being widely adopted by governments, businesses, and educational institutions, and universal mandates were being considered and implemented (1–8).The appropriate strategies for raising vaccination rates depend on the target rate, on how many are unlikely to be vaccinated willingly in a sufficiently timely manner, on the conditions under which opponents change their minds, and on the effect of the policies themselves on vaccination preferences. Our study sheds light on the behavioral side of this evaluation.     

Clinical Aspects of Feline Retroviruses: A Review

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma), bone marrow suppression syndromes (mainly anemia), and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests) also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats.     

Hemispheric asymmetry for auditory processing in the human auditory brain stem, thalamus, and cortex

We report evidence for a context- and not stimulus-dependent functional asymmetry in the left and right human auditory midbrain, thalamus, and cortex in response to monaural sounds. Neural activity elicited by left- and right-ear stimulation was measured simultaneously in the cochlear nuclei, inferior colliculi (ICs), medial geniculate bodies (MGBs), and auditory cortices (ACs) in 2 functional magnetic resonance imaging experiments. In experiment 1, pulsed noise was presented monaurally to either ear, or binaurally, simulating a moving sound source. In experiment 2, only monaural sounds were presented. The results show a modulation of the neural responses to monaural sounds by the presence of binaural sounds at a time scale of tens of seconds: In the absence of binaural stimulation, the left and right ICs, MGBs, and ACs responded stronger to stimulation of the contralateral ear. When blocks of binaural stimuli were interspersed in the sound sequence, the contralateral preference vanished in those structures in the right hemisphere. The resulting hemispheric asymmetry was similar to the asymmetry demonstrated for spatial sound processing. Taken together, the data demonstrate that functional asymmetries in auditory processing are modulated by context. The observed long time constant suggests that this effect results from a "top-down" mechanism.