Resynchronization or dyssynchronization--successful treatment with biventricular stimulation of a child with obstructive hypertrophic cardiomyopathy without dyssynchrony

CRT in a Child with Hypertrophic Cardiomyopathy. We present a case of a 10-year-old boy with hypertrophic cardiomyopathy, intraventricular pressure gradient of 104 mmHg, and indications for prophylactic ICD implantation. Based on intraoperative pressure measurements, the child was implanted with biventricular ICD. During 2.5 months of observation, the patient's functional status improved significantly, as shown by subjective and objective parameters and, moreover, the pressure gradient fell to 12 mmHg. Significant electrical and mechanical cardiac dyssynchrony appeared parallel to clinical improvement.     

Incidence and outcome of TCF3-PBX1-positive acute lymphoblastic leukemia in Austrian children

Lessons from the analysis of children with TCF3-PBX1 ALL could help to identify treatment components essential for this leukemia subtype. Of 859 children with ALL who were treated in ALL-BFM trials in Austria, 31 (3.6%) had a TCF3-PBX1 ALL. The 5-year event-free survival rate for these 31 patients was 90%+/-5%. Patients with TCF3-PBX1 ALL treated on the ALL-BFM 86 trial had a poorer outcome than patients with TCF3-PBX1 ALL treated on later trials. These data document that contemporary ALL-BFM treatment is highly effective in children with TCF3-PBX1 ALL. Implementation of early dose-intensified remission induction may be an essential treatment component.     

Cerebrospinal fluid biomarkers predict decline in subjective cognitive function over 3 years in healthy elderly

OBJECTIVE: To investigate whether cerebrospinal fluid (CSF) biomarkers can predict cognitive decline in healthy, elderly individuals as they have been shown to do in cognitively impaired patient samples. METHODS: In this study, 57 controls were tested for CSF biomarkers at baseline and then cognitively followed over 3 years. RESULTS: Low levels of baseline beta-amyloid 1-42 (Abeta42) were associated with development of subjective memory impairment affecting quality of life (memQoL), with a worse Mini Mental Status Examination score and with inability to live in regular housing at follow-up (p < 0.05). The combination of baseline Abeta42 and phosphorylated tau (P-tau) was found to predict development of pathological memQoL with a sensitivity of 71.4% and a specificity of 75.7 (<0.01). CONCLUSION: Low Abeta42 and combined Abeta42 and P-tau predicted subjective cognitive decline in healthy individuals. In summary, this study shows that already in the clinically normal population Alzheimer-disease-related biological signs might be detectable.     

Elevated plasma levels of soluble CD40 in incipient Alzheimer's disease

CD40 is a member of the tumor necrosis factor receptor super-family and has been suggested to play a role in the metabolism of beta-amyloid (Abeta) in Alzheimer's disease (AD). However, the role of CD40-signalling in incipient AD has not yet been studied. We investigated the plasma levels of soluble CD40 (sCD40) and the soluble CD40 ligand (sCD40L) at baseline in 136 subjects with mild cognitive impairment (MCI) and 30 age-matched controls. Sixty of the 136 MCI cases converted to AD (MCI-AD) during a clinical follow-up period of 4-7 years. The baseline levels of sCD40, but not sCD40L, were elevated in MCI-AD cases when compared to age-matched controls (Mann-Whitney U-test, p=0.02). However, MCI patients who were cognitively stable or developed vascular dementia during follow-up did not have significantly increased levels of sCD40 or sCD40L when compared to controls. The levels of sCD40 correlated to decreased baseline performance on mini-mental state examination (MMSE) in both controls (r(s)=-0.37, p<0.05) and MCI-AD cases (r(s)=-0.29, p<0.05). Finally, the plasma levels of sCD40 correlated with the levels of soluble amyloid precursor protein-alpha (sAPP-alpha) (r(s)=0.28, p<0.01) and sAPP-beta (r(s)=0.23, p<0.05) in cerebrospinal fluid. In conclusion, CD40-signalling might play a role in the pathogenesis of early AD.     

Hospital antibiotic management in Austria – results of the ABS maturity survey of the ABS International group

BACKGROUND: The ABS International group conducted a survey to estimate the prevalence and characteristics of country-specific hospital antibiotic management programs. This paper summarizes the results for Austria. METHODS: The survey was conducted in April and May 2007. A questionnaire with various items related to hospital antibiotic management was sent to 160 Austrian hospitals. MAIN FINDINGS: Of 160 questionnaires sent, 80 were returned and evaluable. The mean total score for all items and all hospitals was 3.29 (median: 3.42; range 1.35-4.74). The larger the hospital the higher were the reported scores concerning diagnostics, antibiotic-related organization and antibiotic-consumption control, but the lower the scores for antibiotic-related personnel development and antibiotic-related relationships to relevant environments. The maturity figure for large hospitals (>500 beds) was 3.57, for medium hospitals 3.34, and for small hospitals (<200 beds) 3.01. CONCLUSIONS: The self-reported results of our questionnaire-based survey clearly show that there is still need for improvement. In all five categories surveyed, Austrian hospitals scored their antibiotic maturity lower than the international averages. The establishment of an antibiotic officer enables the development of antibiotic stewardship tools such as antibiotic lists. Such tools can be seen as quality indicators.