Effect of experimentally induced trichinellosis on the infection with Erysipelothrix rhusiopathiae in rats

Summary Infection with Erysipelothrix rhusiopathiae in rats infested 20 days earlier with Trichinella spiralis developed more slowly, the clinical and pathoanatomic changes in the joints were expressed to a less extent, and the mortality rate was lower. The erythrocyte sedimentation rate, the precipitin formation and the phagocytic activity of the macrophages did not considerably change.Experiments carried out to elucidate this fact did not reveal any antigenic or antagonistic relationships between parasite and bacterium nor any protective effect of the host's serum.The inhibitory influence of corticosteroids on the defence forces was not completely manifested in the rats infested. This fact might be explained by interrelations depending both on the cycle of helminth development and on the non-specific immunological reactivity of the organism, the latter being stimulated by the helminth invasion.     

An Unreported Congenital Anomaly: Aneurysm of the Lateral Half of the Mitral Valve

This case draws our attention to a new type of mitral valve anomaly, which seems to be congenital. A 42‐year‐old man with symptomatic primary severe mitral regurgitation was admitted to our hospital. Echocardiography revealed an aneurysm of the half of the valve, on the anterolateral commissure side, with significant excess tissue. The other half of the valve was normal. The two parts seemed to be separated by a continuous fibrous raphe. The anterolateral papillary muscle was hyperplasic and gave the main part of chordae tendinae.     

Successful weaning and explantation of the Heartmate II left ventricular assist device

Background

Ventricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre.

Methods

Patients who had a VAD explanted were identified in the mechanical support institutional database and their outcomes were analyzed. Clinical examinations, biochemical markers, and serial echocardiograms were used to demonstrate myocardial recovery.

Results

Seventeen patients had a Heartmate II VAD inserted between 2008 and 2010. Four patients underwent successful weaning and subsequent VAD explantation. Etiology of decompensated heart failure was idiopathic dilated cardiomyopathy (n = 1), ischemic (n = 1), or myocarditis (n = 2). Mean age was 35.3 years. Patients were supported for 213 days (range 70-293 days) and were in New York Heart Association class I in the community before explantation. The devices were explanted via a minimally invasive approach, without cardiopulmonary bypass. All patients survived explantation and were discharged alive from hospital after an average of 5.7 ± 1.5 days post pump explantation. No adverse events were reported after explantation. Only one patient required allogenic blood transfusion after the procedure.

Conclusions

Patients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.     

创伤后应激障碍患者杏仁核为主的边缘系统静息态脑功能磁共振研究

目的 观察静息状态下创伤后应激障碍(posttraumatic stress disorder,PTSD)患者以杏仁核为主的脑区的脑功能改变.方法 采用基于低频振幅(amplitude of low frequency fluctuation,ALFF)算法的静息功能磁共振成像技术(fMRI)对10例临床确诊的PISD患者和10例性别、年龄及受教育年限匹配的正常对照进行静息fMRI检查,采用t检验比较两组的杏仁核等脑区基于血氧水平依赖活动的差异.结果 与正常对照组相比,PTSD患者组右侧杏仁核ALFF活性明显增加(P<0.01),海马旁回、钩回等边缘系统其他脑区亦见ALFF活性增加(P<0.01),而前额叶、岛叶及楔前叶ALFF活性减低(P<0.01).结论 PTSD患者静息态下包括杏仁核在内的边缘系统多个脑区活动增强,前额叶、岛叶、楔前叶等脑区功能抑制.     

A negative emotional and economic judgment bias in major depression

Although major depression is projected to be among the top three causes of disability-adjusted life years lost in 2030, relatively little is known concerning the extent to which depressed mood states can bias social–economic decision making away from optimal outcomes. One experimental framework to study the interaction between negative emotion and social–economic decisions is the ultimatum game (UG), where the fair, cooperative player altruistically punishes the unfair, non-cooperative player. To assess a potential susceptibility of altruistic punishment to depressed mood, we repeatedly administered the UG task to a cohort of 20 currently depressed patients with a diagnosis of recurrent major depressive disorder and 20 healthy controls. Furthermore, valence and arousal ratings of emotionally laden pictures were obtained from all participants in order to assess a depressed mood-related distortion of emotion judgments. Compared to healthy controls, depressed patients over-sanctioned unfair proposals in the UG and judged emotional stimuli too negatively. Thus, major depression is associated with a negative emotional bias that hampers social–economic decision making and produces large personal costs.     

The natural history of HCV-related cirrhosis and its temporal progression across the different clinical stages

Purpose

The clinical course of hepatitis C virus-related cirrhosis and its temporal progression across the different clinical stages has not been completely investigated. Our study evaluated the cumulative incidences (CIs) of clinical outcomes marking disease progression across the different clinical stages.

Methods

At baseline, 660 patients were classified as compensated [absence (294), or presence (108) of gastroesophageal varices] or decompensated [ascites (144), variceal bleeding alone (45) or in combination with ascites (17) and encephalopathy alone or together with bleeding and/or ascites (52)]. Subjects were followed for 312 weeks to identify time to a first event marking disease progression.

Results

Among compensated patients without varices, the 312-week CIs for developing varices, ascites, and encephalopathy were 37.4, 13.6 and 3.5 %, respectively. The 312-week CIs of development of ascites, bleeding and encephalopathy were 24, 12.5 and 9.9 % for compensated subjects with varices, respectively. Among patients with ascites, the 312-week CIs of bleeding, liver-related deaths/transplant and encephalopathy were 23.5, 27.8, and 47.3 %, respectively. The 312-week CIs of ascites, liver-related deaths/transplant and encephalopathy were 22.5, 14.7 and 5.7 % among patients with bleeding; however, CIs of liver-related deaths were significantly higher in those with ascites plus bleeding (77.6 %). Patients with encephalopathy alone or in combination with ascites and/or bleeding displayed the highest rates of deaths (312 weeks, 90 %).

Conclusions

Among compensated patients, the presence of varices suggests a more accelerated course of the disease. Decompensated patients show the most severe clinical course, particularly in those with a combination of two or more clinical events.