Alternative presentation of Tako-Tsubo syndrome with spontaneous echo-contrast and “onion” shaped apical ballooning

We report the case of a 79-year-old woman with transient left ventricular systolic dysfunction with apical ballooning (tako-tsubo like syndrome, TTS) showing an alternative newly reported “onion” shape. The patient was also characterized by atrial fibrillation and marked spontaneous echo-contrast: possible precipitating role for these conditions in TTS are discussed.     

Functional disability after instrumented stabilization in lumbar degenerative spondylolisthesis: a follow-up study

Low back pain (LBP) is a widespread health problem and a major contributor to increasing health costs and lost work days. Different pathologies cause LBP and one of these is lumbar degenerative spondylolisthesis (SPL). There are no generally accepted and standardized methods for assessing the outcome of patients treated for degenerative lumbar SPL. This study aims to assess quality of life after surgery for lumbar degenerative SPL through the adoption of outcome measures. We studied 76 patients treated, for degenerative lumbar SPL, with spinal stabilization, decompression and bilateral dorsolateral fusion, followed up for at least two years. We used the Roland-Morris (RM) scale and the Oswestry Disability Index (ODI) to assess the quality of life of the patients before surgery and at follow up. Each patient was pre-operatively studied through standard and dynamic x-rays, CT scan and MRI of lumbar column. Relationships between clinical, radiological and disability scores, grouped by categories, were tested. The sample comprised 25 males and 51 females. Mean age was 59.6 years (SD 12.2). The mean duration of symptoms (from clinical onset to surgery) was 23.42 months (median 13, range 4-100 months). In about half of the cases, duration of symptoms before surgery was >12 months. At follow up, the fusion rate was 85.5%, and the ODI score was significantly reduced: an improvement of <20 points in 35.7% of patients, and of >20 points in 55.7%. On the RM scale, 59.4% of patients had a reduction >5 points, 13.1% a reduction of 2-4 points, and 27.5% an unchanged or worse score. There was no significant reduction in RM scale and ODI scores in patients with fusion versus pseudoarthrosis. Instrumental pedicle screw fixation and arthorodesis seem to be very effective in improving quality of life, as shown by the reduced disability scores at follow up.     

Direct oral anticoagulants more effective than low-molecular-weight heparin for venous thrombo-embolism in cancer: an updated meta-analysis of randomized trials

Journal of Thrombosis and Thrombolysis - In the recent past, low-molecular-weight heparin (LMWH) was the first choice in the treatment of cancer related venous thrombo-embolism (VTE). Evidence...     

Association of reduced glyoxalase 1 activity and painful peripheral diabetic neuropathy in type 1 and 2 diabetes mellitus patients

AimsThe present study was undertaken to investigate the relationship between glyoxalase 1 (Glo1) enzyme activity and painful diabetic neuropathy (DN) in patients with diabetes mellitus.MethodsGlo1 activity and biochemical markers were determined in blood samples from 108 patients with type 1 diabetes, 109 patients with type 2 diabetes, and 132 individuals without diabetes as a control. Painful and painless peripheral DN was assessed and multivariate regression analysis was used to determine independent association of Glo1 activity with occurrence of painful DN.ResultsIn patients with type 1 and type 2 diabetes mellitus and painful DN compared to patients with painless DN, Glo1 activity was significantly reduced by 12 and 14%, respectively. The increase in Glo1 activity was significantly associated with reduced occurrence of painful DN after adjusting for confounders by multivariate analysis.ConclusionsOur results demonstrate for the first time that Glo1 activity is lower in patients with both types of diabetes mellitus who were diagnosed with painful DN. These data support the hypothesis that Glo1 activity modulates the phenotype of DN and warrant further investigation into the role of Glo1 in DN.     

Die τ-Fraktion im Liquor cerebrospinalis

Ohne Zusammenfassung     

Dielectric Properties of Hybrid Polyethylene Composites Containing Cobalt Nanoparticles and Carbon Nanotubes

Polymer composites with electrically conductive inclusions are intensively developed for microwave shielding applications, where lightweight and elastic coatings are necessary. In this paper, dielectric properties of hybrid polyethylene composites containing cobalt nanoparticles and multi-wall carbon nanotubes (MWCNT) were investigated in the wide frequency range of 20–40 GHz for electromagnetic shielding applications. The percolation threshold in the hybrid system is close to 6.95 wt% MWCNT and 0.56 Co wt%. Cobalt nanoparticles (up to highest investigated concentration 4.8 wt%) had no impact on the percolation threshold, and for the fixed total concentration of fillers, the complex dielectric permittivity is higher for composites with bigger MWCNT concentrations. Moreover, the microwave complex dielectric permittivity of composites with high concentration of fillers is quite high (for composites with 13.4 wt% MWCNT and 1.1 wt% Co ε′ ≈ ε″ ≈ 20 at 30 GHz, it corresponds to microwave absorption 50% of 1 mm thickness plate); therefore, these composites are suitable for electromagnetic shielding applications.     

Gastrectomy impact on the gut microbiome in patients with gastric cancer: A comprehensive review

Gastric cancer is one of the most common malignancies worldwide and gastrectomy remains the only potentially curative treatment option for this disease. However, the surgery leads to significant physiological and anatomical changes in the gastrointestinal (GI) tract including loss of the gastric barrier, an increase in oxygenation levels in the distal gut, and biliary diversion after gastrectomy. These changes in the GI tract influence the composition of the gut microbiome and thus, host health. Gastrectomy-induced dysbiosis is characterized by increased abundance of typical oral cavity bacteria, an increase in aero-tolerant bacteria (aerobes/facultative anaerobes), and increased abundance of bile acid-transforming bacteria. Furthermore, this dysbiosis is linked to intestinal inflammation, small intestinal bacterial overgrowth, various GI symptoms, and an increased risk of colorectal cancer.     

Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies

Stereotactic biopsies represent a routine neurosurgical procedure for the diagnosis of intracranial lymphomas and selected diffusely infiltrating gliomas. Acquisition of tissue samples that do not allow correct tumor typing and grading is, however, not uncommon. Five-aminolevulinic acid (5-ALA) has been shown to accumulate in malignant tumor tissue. The aim of this study was to prospectively investigate the clinical usability of 5-ALA for intraoperative detection of representative tissue in stereotactic tumor biopsies. Fifty consecutive patients underwent frameless stereotactic biopsy for a suspected brain tumor. 5-ALA was administered 4 h before anesthesia. Serial biopsy samples were obtained and intraoperatively checked for 5-ALA fluorescence (strong, vague, or none) using a modified neurosurgical microscope. All samples were examined for the presence of representative tumor tissue according to neuroimaging (MRI, positron emission tomography, and/or chemical shift imaging) and histopathological parameters. Visible 5-ALA fluorescence was observed in 43/50 patients (strong in 39 and vague fluorescence in four cases). At biopsy target, 52/53 samples of glioblastomas, 9/10 samples of gliomas grade III, and 14/16 samples of lymphomas revealed strong 5-ALA fluorescence. Samples with strong 5-ALA fluorescence were only observed at, but not outside the biopsy target. All tissue samples with strong 5-ALA fluorescence were representative according to our neuroimaging and histopathological criteria (positive predictive value of 100%). Our data indicate that strong 5-ALA fluorescence is a reliable and immediately available intraoperative marker of representative tumor tissue of malignant gliomas and intracranial lymphomas in stereotactic biopsies. Thereby, the application of 5-ALA in stereotactic brain tumor biopsies may in future reduce costs for operating room and neuropathology and may decrease procedure-related morbidity.