Transient repolarization alterations dominate the initial phase of an acute anterior infarction — a vectorcardiography study

Objective

To study effects of ischemia-reperfusion on ventricular electrophysiology in humans by three-dimensional electrocardiography.

Methods

Fifty-seven patients with first-time acute anterior ST elevation myocardial infarction were monitored from admission and > 24 h after symptom onset with continuous vectorcardiography (VCG; modified Frank orthogonal leads). Global ventricular depolarization and repolarization (VR) measures were compared at maximum vs. minimum ST vector magnitude (STVM) (median 208; 111–303 vs. 362; 165–1359 min after symptom onset).

Results

At maximum vs. minimum STVM the Tarea (overall VR dispersion) almost tripled (118 vs. 41 μVs; p < 0.0001), the T-loop bulginess was 90% greater (Tavplan 0.91 vs 0.48 μV; p < 0.0001), and Tpeak-end/QT was 39% larger (0.32 vs 0.23; p < 0.0001). QRSarea (overall dispersion of depolarization) was 12% larger at maximum STVM, while QRS duration was 10% longer at minimum STVM.

Conclusions

Ischemia-reperfusion was accompanied by profound and transient alterations of VR dispersion, while changes in depolarization were modest and delayed.     

Squamous Cell Carcinoma of the Larynx Arising in Multifocal Pharyngolaryngeal Oncocytic Papillary Cystadenoma: A Case Report and Review of the Literature

We report on a rare case of a laryngeal carcinoma arising in a multifocal pharyngolaryngeal oncocytic papillary cystadenoma (OPC). The disease of a 63-year-old man is well documented by computed and positron emission tomography, histology, and electron microscopy. We could show that an OPC can even develop in the pharynx. The coexistence of both tumors makes this a challenging diagnosis for pathologists. Treated by surgery and radiotherapy, both lesions dissolved. Based on the literature available, we discuss the theory that the laryngeal carcinoma might be the result of a true metaplasia facilitated by chronic irritation and recommend a regular follow-up for OPC too. As in benign oncocytic lesions, we could show that the detection of numerous mitochondria is a diagnostic indicator for malignant variants as well.     

Global water resources affected by human interventions and climate change

Humans directly change the dynamics of the water cycle through dams constructed for water storage, and through water withdrawals for industrial, agricultural, or domestic purposes. Climate change is expected to additionally affect water supply and demand. Here, analyses of climate change and direct human impacts on the terrestrial water cycle are presented and compared using a multimodel approach. Seven global hydrological models have been forced with multiple climate projections, and with and without taking into account impacts of human interventions such as dams and water withdrawals on the hydrological cycle. Model results are analyzed for different levels of global warming, allowing for analyses in line with temperature targets for climate change mitigation. The results indicate that direct human impacts on the water cycle in some regions, e.g., parts of Asia and in the western United States, are of the same order of magnitude, or even exceed impacts to be expected for moderate levels of global warming (+2 K). Despite some spread in model projections, irrigation water consumption is generally projected to increase with higher global mean temperatures. Irrigation water scarcity is particularly large in parts of southern and eastern Asia, and is expected to become even larger in the future.Terrestrial water fluxes are affected by both climate and direct human interventions, e.g., dam operations and water withdrawals. Climate change is expected to alter the water cycle and will subsequently impact water availability and demand. Several hydrologic modeling studies have focused on climate change impacts on discharge in large river basins or global terrestrial areas under naturalized conditions using a single hydrologic model forced with multiple climate projections (1, 2). Recently, hydrological projections from eight global hydrological models (GHMs) were compared (3). In many areas, there was a large spread in projected runoff changes within the climate–hydrology modeling chain. However, at high latitudes there was a clear increase in runoff, whereas some midlatitude regions showed a robust signal of reduced runoff. The study also concluded that the choice of GHM adds to the uncertainty for hydrological change caused by the choice of atmosphere–ocean general circulation models (hereafter called GCMs) (3). Expected runoff increases in the north and decreases in parts of the middle latitudes have been found also when analyzing runoff from 23 GCMs (4).These studies focused on the naturalized hydrological cycle, i.e., the effects of direct human interventions were not taken into account. However, in many river basins humans substantially alter the hydrological cycle by constructing dams and through water withdrawals. Reservoir operations alter the timing of discharge, although mean annual discharge does not necessarily change much. A study with the water balance model (WBM) showed that the impact of human disturbances, i.e., dams and water consumption, in some river basins is equal to or greater than the impact of expected climate changes on annual runoff over the next 40 y (5). Also, rising water demands are found to outweigh global warming in defining the state of global water systems in the near future (6). Water for irrigation is the largest water use sector, currently accounting for about 70% of global water withdrawals and nearly 90% of consumptive water use (7). A recent synthesis of simulations from seven GHMs found that irrigation water consumption currently amounts to 1,250 km³⋅y⁻¹ (±25%) and that considerable differences among models appear in the spatiotemporal patterns of water consumption (8).Direct comparisons of the climate impact and human intervention modeling studies can be difficult given that the setups are not identical, i.e., the input forcing data and climate models vary. Also, because of the uncertainty of model-specific results, a multimodel approach is preferable in impact modeling studies (3, 9). This approach is similar to assessments performed within the climate community. Here, multimodel results on current and future water availability and consumption at the global scale from the Water Model Intercomparison Project (WaterMIP) within the European Union Water and Global Change (EU WATCH) project (9, 10), and Inter-Sectoral Impact Model Intercomparison Project (ISI-MIP) (11) are presented. (Information on how to get access to WaterMIP and ISI-MIP simulation results can be found at www.eu-watch.org and www.isi-mip.org, respectively.) Results from these two projects are synthesized to obtain a large ensemble of impact model results. The integration of results from the different projects is achieved by extracting impacts for time periods of global mean temperature (GMT) increases of 2 and 3 K from the simulations, largely following the method of Tang and Lettenmaier (4). The advantage of this approach is that it allows presenting results in a way that is in line with temperature targets used in climate mitigation discussions.Other studies have focused on future water scarcity using results from WaterMIP and ISI-MIP, but have analyzed changes of naturalized runoff only (3, 12). We here aim to fill this knowledge gap by comparing the different impacts from climate change and direct human impacts and analyzing their interplay. The models included take into account water withdrawals and consumption in different sectors; for more information, see Models and Data and Supporting Information, SI Models and Data. The objectives of this study are to (i) assess the relative contribution of anthropogenic impacts and climate change to river basin scale water fluxes, and (ii) identify areas where climate change can be expected to cause substantial changes in water consumption and water scarcity, focusing on water for irrigation. The effects of future changes in irrigated areas or irrigation practices are not taken into account, and only dams that currently exist are included in the analyses. In this paper, simulations considering man-made reservoirs, water withdrawals, and water consumption are referred to as human impact simulations, whereas the simulations without these disturbances are referred to as naturalized simulations. The results are mainly presented in a way intended to give an overview of impacts at larger spatial scales (river basin and country levels). However, some finer-scale results are included to reveal effects that can be concealed at coarse spatial scales.     

“Quid autem vides festucam in oculo fratris tui et trabem in oculo tuo non vide” on the hyperthyroidism-induced mortality and antithyroid drug-induced side effects in the era of radioiodine fake news

European Journal of Nuclear Medicine and Molecular Imaging -     

Bilateraler Pneumothorax als Komplikation bei der Implantation einer Schultertotalendoprothese

This case report presents a case of subcutaneous emphysema, bilateral pneumothorax and pneumomediastinum during the implantation of a total shoulder prosthesis. Near the end of the operation after shoulder arthroplasty the oxygen saturation of the patient decreased, a subcutaneous emphysema occurred and initially a unilateral and then bilateral pneumothorax was detected via x-ray and treated with bilateral thorax drainage. Anesthesiological or pulmonary causes for the bilateral pneumothorax could not be found. The most likely reason for this complication was the application of air and water using a high pressure pulsatile lavage (jet lavage) to prepare the glenoid and to extract a free joint body from under the coracoid.     

Restoration of humeral head geometry in posttraumatic fracture sequelae with stemless or resurfacing arthroplasty: a matched-paired analysis

Background

The objective of this study was to analyze proximal humeral geometry in two groups of patients with posttraumatic fracture sequelae who were treated with either resurfacing (R) or stemless (S) arthroplasty. The hypothesis was that there is no difference in the radiographic restoration of postoperative proximal humeral geometry after resurfacing or stemless arthroplasties.

Material and methods

A match-paired analysis of 48 cases was completed (R?=?24, S?=?24). Proximal geometry was assessed reviewing true anterior–posterior x-rays, measuring the inclination angle of osteotomy (IAO), distance above tuberosity (DAT), superior humeral translation (SHT) according to Torchia, medial offset (MO), and lateral offset (LO).

Results

The average follow-up was 32.4?±?9.2 months for group R and 37.9?±?22.9 months for group S (p?=?0.317). Except for MO and SHT, no significant differences were found. Restoration of the anatomical MO was more accurate for group S. SHT of the humerus was detected more frequently for group R.

Conclusions

In this match-paired analysis, stemless arthroplasty reconstructed an anatomic MO more consistently than resurfacing arthroplasty as evaluated on x-rays; we did not document differences in the remaining evaluated parameters. However, no significant differences were found between both groups regarding clinical outcomes.     

The activation pattern of macrophages in giant cell (temporal) arteritis and primary angiitis of the central nervous system

To determine if the pattern of macrophage activation reflects differences in the pathogenesis and clinical presentation of giant cell arteritis and primary angiitis of the central nervous system, specimens of 10 patients with giant cell arteritis and five with primary angiitis of the central nervous system were immunohistochemically studied and the expression of the macrophage activation markers 27E10, MRP14, MRP8 and 25F9 was determined in the vasculitic infiltrates. Thus, a partly different expression pattern of macrophage activation markers in giant cell arteritis and primary angiitis of the central nervous system was observed. The group comparison revealed that giant cell arteritis cases had significantly higher numbers of acute activated MRP14‐positive macrophages, whereas primary angiitis of the central nervous system is characterized by a tendency toward more MRP8‐positive intermediate/late activated macrophages. Furthermore, in giant cell arteritis comparably fewer CD8‐positive lymphocytes were observed. These observations suggest, that despite their histopathological similarities, giant cell arteritis and primary angiitis of the central nervous system appear to represent either distinct entities within the spectrum of granulomatous vasculitides or different stages of similar disease processes. Their discrete clinical presentation is reflected by different activation patterns of macrophages, which may characterize giant cell arteritis as a more acute process and primary angiitis of the central nervous system as a more advanced inflammatory process.     

Control over a stressor involves the posterior dorsal striatum and the act/outcome circuit

Controllable/escapable tailshocks (ESs) do not produce the behavioral and neurochemical outcomes produced by equal yoked uncontrollable/inescapable tailshocks (ISs). The prelimbic cortex is known to play a key role in mediating the protective effects of control. The concepts of act/outcome learning and control seem similar, and act/outcome learning is mediated by a circuit involving the prelimbic cortex and posterior dorsomedial striatum (DMS). Thus, we tested the involvement of the DMS in the protective effect of ES, in rats. First, we examined Fos immunoreactivity in both the DMS and dorsolateral striatum (DLS) after ES and yoked IS. We then investigated the effect of blocking DMS or DLS N‐methyl‐d ‐aspartate receptors with the specific antagonist D‐(‐)‐2‐amino‐5‐phosphopentanoic acid (D‐AP5) on the release of dorsal raphe nucleus serotonin (5‐HT) during ES, as well as on the level of anxiety produced by the ES experience 24 h later. ES, but not yoked IS, produced a large increase of Fos activity in the DMS. Consistent with the Fos data, D‐AP5 in the DMS, but not in the DLS, prevented the inhibition of dorsal raphe nucleus 5‐HT release normally produced by ES. Furthermore, D‐AP5 administered into the DMS before ES, but not into the DLS, increased anxiety 24 h later, leading to levels similar to those produced by IS. These results suggest that, as with appetitive act/outcome contingency learning, the protective effects of behavioral control over a stressor require the DMS.