First report of a prosthetic joint infection with Fannyhessea (Atopobium) vaginae

European Journal of Clinical Microbiology & Infectious Diseases - This case describes a 77-year-old woman with dysregulated type II diabetes, presenting with a prosthetic joint infection and...     

Can noncontact mapping distinguish between endo- and epicardial foci?

Objectives  Noncontact mapping has been demonstrated to facilitate RF ablation of ventricular arrhythmias, but the reproducibility in the localization of endocardial exit sites during focal ventricular tachycardia (“VT”) originating from defined myocardial layers has not been systematically studied. Furthermore, it remains unclear whether noncontact mapping can distinguish between endo- and epicardial foci. Methods  In six dogs, constant pacing was applied through octopolar needle electrodes in the left ventricle to mimic VT of subendocardial, midmyocardial (mid1; mid2) or subepicardial origin. Using noncontact mapping, the site of origin was determined for each of 50 consecutive beats of all “VTs” and the variation between respective exit sites was measured. Exit sites were reconstructed for 50 consecutive beats of each “VT” and the time span between site of origin and exit site was measured as a parameter of intramural conduction. Results  While subendocardial and midmyocardial (mid1, mid2) foci were pinpointed with a variation of ≤2 mm, a variation of 4 mm was encountered for subepicardial foci. A gradual increase in intramural conduction was evident from endocardial towards epicardial foci, with significant differences between subendocardial (4.8 ± 0.9 ms), midmyocardial (mid1 = 11.1 ± 4.6 ms; mid2 = 11.8 ± 3.5 ms) and subepicardial (16.8 ± 3.6 ms) foci (P < 0.005). Systematic differences in the morphology of virtual waveforms depending on the site of origin could not be detected. Conclusions  Except for subepicardial foci, noncontact mapping localized focal activity in the LV with high reproducibility. In contrast to morphological parameters, the determination of intramural conduction provides a fair estimate of the depth of foci and is proposed as a novel parameter to identify a subepicardial origin. Dr. Frederik Voss and Dr. Alexander Bauer contributed equally to this work.     

Low‐density lipoprotein receptor‐related protein 1 is a novel modulator of radial glia stem cell proliferation,survival, and differentiation

The LDL family of receptors and its member low‐density lipoprotein receptor‐related protein 1 (LRP1) have classically been associated with a modulation of lipoprotein metabolism. Current studies, however, indicate diverse functions for this receptor in various aspects of cellular activities, including cell proliferation, migration, differentiation, and survival. LRP1 is essential for normal neuronal function in the adult CNS, whereas the role of LRP1 in development remained unclear. Previously, we have observed an upregulation of LewisX (LeX) glycosylated LRP1 in the stem cells of the developing cortex and demonstrated its importance for oligodendrocyte differentiation. In the current study, we show that LeX‐glycosylated LRP1 is also expressed in the stem cell compartment of the developing spinal cord and has broader functions in the developing CNS. We have investigated the basic properties of LRP1 conditional knockout on the neural stem/progenitor cells (NSPCs) from the cortex and the spinal cord, created by means of Cre‐loxp‐mediated recombination in vitro. The functional status of LRP1‐deficient cells has been studied using proliferation, differentiation, and apoptosis assays. LRP1 deficient NSPCs from both CNS regions demonstrated altered differentiation profiles. Their differentiation capacity toward oligodendrocyte progenitor cells (OPCs), mature oligodendrocytes and neurons was reduced. In contrast, astrocyte differentiation was promoted. Moreover, LRP1 deletion had a negative effect on NSPCs proliferation and survival. Our observations suggest that LRP1 facilitates NSPCs differentiation via interaction with apolipoprotein E (ApoE). Upon ApoE4 stimulation wild type NSPCs generated more oligodendrocytes, but LRP1 knockout cells showed no response. The effect of ApoE seems to be independent of cholesterol uptake, but is rather mediated by downstream MAPK and Akt activation. GLIA 2016 GLIA 2016;64:1363–1380     

Identification of risk factors for 30-day postoperative complications in patients undergoing primary ventral hernia repair: a prospective cohort study of 2,374 patients

Background

Primary ventral hernia is a common condition. Surgical repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society classification offers a structured framework to describe hernias and to analyze postoperative complications. Given this structured nature, the European Hernia Society classification might prove useful for preoperative patient or treatment classification. The objective of this study was to investigate the European Hernia Society classification as a predictor for complications within 30 days after primary ventral hernia surgery.

Prenatal diagnosis of aneurysms of the vein of Galen (vena magna cerebri) with conventional sonography, three-dimensional sonography, and magnetic resonance imaging: report of 2 cases.

OBJECTIVE: To describe the cases of 2 fetuses with aneurysms of the vein of Galen diagnosed prenatally. METHODS: The techniques used were conventional sonography, three-dimensional sonography, and ultrafast magnetic resonance imaging. On the basis of these imaging modalities, prognostic factors, such as drainage and secondary damage, were assessed. RESULTS: The first fetus had good prognostic indices, and embolization after birth was successful. According to the prognostic factors, a poor neonatal outcome was predicted for the second fetus. The neonate died soon after birth. CONCLUSIONS: Conventional sonography, color Doppler imaging, and magnetic resonance imaging appeared to be useful diagnostic tools. The prognostic factors can be useful in counseling patients and providing the best possible care after birth.     

Price effects of a hospital merger: Heterogeneity across health insurers,hospital products,and hospital locations

In most studies on hospital merger effects, the unit of observation is the merged hospital, whereas the observed price is the weighted average across hospital products and across payers. However, little is known about whether price effects vary between hospital locations, products, and payers. We expand existing bargaining models to allow for heterogeneous price effects and use a difference‐in‐differences model in which price changes at the merging hospitals are compared with price changes at comparison hospitals. We find evidence of heterogeneous price effects across health insurers, hospital products and hospital locations. These findings have implications for ex ante merger scrutiny.     

Indications for predismissal testing with arrhythmia-induction in patients receiving an implantable cardioverter defibrillator

Arrhythmia induction during implantation of cardioverter defibrillators (ICD) is a standard procedure. However, controversy exists regarding the need for routine arrhythmia induction before discharge from hospital (pre-hospital discharge (PHD) test). In order to reduce the number of tests we identified risk factors that predict relevant ICD malfunction. METHODS AND RESULTS: 965 patients receiving a first device implantation (n=724) or device/system replacement (n=241) between 1998 and 2004 were analysed. During implantation 176 (18%) complications (intraoperative undersensing of induced arrhythmias, unsuccessful arrhythmia-therapy or low DFT safety margin) occurred. Frequent (>4 times) intraoperative lead repositioning due to low sensing values was present in 44 patients (5%). 9% of the patients with first ICD implantation, 21% with device replacement and 27% with system replacement developed complications during PHD testing with arrhythmia induction. Intraoperative complications, although corrected during implantation, were independent risk factors for malfunction during PHD testing (p<0.05). Additional predictors for malfunction were intraoperative lead repositioning (>4 times) and a history of both VF and VT (p<0.05). Patients without intraoperative complications rarely developed malfunction during PHD testing (3.7% first device, 6.25% system replacement). Only in patients undergoing device replacement was a higher risk for failure (13%) evident. No risk factors could be identified for these subgroups. CONCLUSION: Routine arrhythmia induction during PHD is recommended in ICD patients with intraoperative complications, although corrected during implantation, as well as frequent intraoperatives lead repositioning. Patients undergoing device/system replacement uncomplicated implantation are not generally at low risk for device failure.     

The Effect of Ergotamine on Prostaglandin Formation in Guinea Pig''s Ear Slices

SYNOPSIS
We have studied the effect of ergotamine tartrate (10⁻⁷ and 10⁻⁵ M) on prostaglandin (PG) formation in guinea pig's ear slices because of the suggested role of PGs in the pathophysiology of the migraine attack. The ear slices were incubated with arachidonic acid (AA) and the amount of different PGs (6-keto-F_1a, F_2a, E₂, D₂ and A₂) in the incubation medium was determined. The results indicate that ergotamine is an inhibitor of PG synthesis and that it probably affects either the phospholipase A₂ or the cyclo-oxygenase activity.