Endovascular management of pseudoaneurysms of the splenic artery: experience with six patients

The purpose of this paper was to describe our experience with the endovascular management of splenic artery pseudoaneurysms (SAPA). Seven patients with documented SAPA on CT and/or angiography were considered for endovascular treatment. The pseudoaneurysms were located in the main splenic artery (n = 4) or its branches (n = 3). In one patient in whom the pseudoaneurysm was located in a hilar branch, selective catheterization of splenic artery failed. Metallic coils (n = 1), gelfoam and hydrogel particles (n = 1), metallic coils and gelfoam (n = 2), metallic coil, gelfoam and acrylic glue (n = 2) were used as embolization material in the remaining six patients. These patients were followed for a mean period of 11.3 months. Transcatheter embolization was successful in five patients with no procedure‐related complications. In one patient, embolization was incomplete and the patient underwent surgery, but died on the 10th postoperative day because of irreversible shock. Another patient, after successful embolization, underwent surgery for management of an associated pseudocyst. Endovascular treatment is a safe and effective method of management of SAPA.     

Quantification of urinary TIMP-2 and IGFBP-7: an adequate diagnostic test to predict acute kidney injury after cardiac surgery?

IntroductionPostoperative acute kidney injury (AKI) is a frequently observed complication after on-pump cardiac surgery (CS) and is associated with adverse patient outcomes. Early identification of patients at risk is essential for the prevention of AKI after CS. In this study, we analysed whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urine insulin-like growth factor binding protein 7 (IGFBP-7) ([TIMP-2] × [IGFBP-7]) is an adequate diagnostic test to identify early AKI after on-pump CS.MethodsIn 42 patients undergoing coronary artery bypass graft surgery, we surveyed individual risk factors for AKI and defined AKI by applying the Kidney Disease: Improving Global Outcomes (KDIGO) classification during the day of surgery and the following 2 days after surgery. Concentrations of urinary TIMP-2 multiplied by IGFBP-7 were recorded at four time points: at baseline pre-surgery, at the end of surgery, 4 hours after cardiopulmonary bypass (CPB) and at 8:00 am on the first postoperative day.ResultsIn total, 38% of the patients experienced AKI. The results showed a median baseline [TIMP-2] × [IGFBP-7] concentration of 0.3 (ng/ml)²/1,000, decreasing at the end of surgery and then increasing at the next measurement point 4 hours after CPB and further on the first postoperative day. On the first postoperative day, patients with AKI had significantly higher concentrations of [TIMP-2] × [IGFBP-7]. On the day of surgery, the concentration did not significantly differ between patients classified as KDIGO 0 or KDIGO 1 or 2. Previously published cutoff points of 0.3 and 2 were not confirmed in our study cohort.Conclusion[TIMP-2] × [IGFBP-7] concentration can be used as a diagnostic test to identify patients at increased risk of AKI after CS on the first postoperative day. At earlier time points, no significant difference in [TIMP-2] × [IGFBP-7] concentration was found between patients classified as KDIGO 0 or KDIGO 1 or 2.

Trial registration

German Clinical Trials Register (DRKS) DRKS00005457. Registered 26 November 2013.     

Neutralization of poliovirus by polyclonal antibodies requires binding of a single IgG molecule per virion

Summary Neutralization of poliovirus type 1 was studied using radioactively labelled polyclonal IgG. With nonsaturating antibody concentrations various virus-antibody complexes were produced which were isolated by sucrose gradient centrifugation and identified by electron microscopy as virus monomers, dimers, trimers, tetramers and pentamers. The neutralization rate (n. r.) of each of the virus-antibody complexes relative to non-neutralized virus and the stoichiometry have been estimated. The monomer fraction showed that about every fifth virion was associated with one IgG molecule and neutralized. The antibody was bivalently attached. The majority of virus particles formed aggregates of different sizes, which were cross-linked by antibodies. The following neutralization rates and ratios of IgG to virus (IgG/V) were determined for the oligomers: dimers, 59.2 per cent n. r. and 0.55 IgG/V; trimers, 67.3 per cent n. r. and 0.66 IgG/V; tetramers, 79.0 per cent n. r. and 0.75 IgG/V; pentamers, 86.3 per cent n. r. and 0.98 IgG/V.Two different mechanisms of neutralization are proposed: i) an antibody-mediated mechanism specifically inhibits infectivity of the monomer virus-antibody complexes and ii) reduction of infectivity of oligomer virus-antibody complexes is caused simply by reduction of the actual number of infectious units.Immunoprecipitation of the denatured capsid proteins showed that only VP1 was recognized by the polyclonal IgGs.With 5 Figures     

Einfluss des C-Leg-Kniegelenk-Passteiles der Fa. Otto Bock auf die Versorgungsqualität Oberschenkelamputierter

ZusammenfassungHintergrund: Das mikroprozessorgesteuerte C-Leg Kniegelenksystem stellt eine große Verbesserung in der Versorgung Oberschenkelamputierter dar. Dies liegt besonders an der Kombination Mikroprozessor + Hydraulik, die eine elektronische Schwung- und Standphasensteuerung erlaubt. Es wird erwartet, dass der Patient sicherer und leistungsfähiger wird und eine Annäherung an das natürliche Gangbild erreicht. Die Klinische Prüfstelle hat 7 Kriterien dieses funktionellen Zugewinns definiert, den die Patienten bei Nutzung des C-Leg erreichen können. Nach Empfehlung des Herstellers sind die Indikationen für dieses Kniegelenksystem: einseitig Oberschenkelamputierte mit Mobilitätsgrad uneingeschränkter Außenbereichsgeher (AK 3) oder uneingeschränkter Außenbereichsgeher mit besonders hohen Ansprüchen (AK 4), wenn gleichzeitig eine zusätzliche Behinderung oder ein weiterer Befund wie Berufstätigkeit o.ä. vorliegt. Ziel der Studie: Die Indikationsstellung des Herstellers soll kritisch überprüft werden. Darüber hinaus wird die Frage gestellt, ob die Indikationsstellung über die Mobilitätsgrade hinaus verfeinert werden muss, z. B. im Sinne einer Binnendifferenzierung. Aus diesem Grund konzentriert sich die Studie nicht auf das Passteil, sondern auf das System Patient + C-Leg. Somit wird das C-Leg gegen die bisher getragene Versorgung des Patienten getestet. Dabei wird angenommen, dass dies eine akzeptable Versorgung darstellt.Patienten/Ergebnisse: Bislang nahmen 25 Patienten der AK 2 (5), AK 3 (13), und AK 4 (7) an der Studie teil. 23 dieser Patienten — mit Ausnahme jeweils eines Patientes der AK 2 und AK 3 — wiesen eine Funktionsverbesserung bei mindestens einem Kriterium auf. Aber nur 3 Patienten erfüllten 6 bzw. 7 der Kriterien der Funktionsverbesserung.Fazit: In allen Aktivitätsklassen haben mehrfachbehinderte Patienten einen funktionellen Zugewinn durch das C-Leg in Bezug auf mindestens ein Kriterium. Auch Patienten der AK 2 können einen erheblichen funktionalen Zugewinn mit dem C-Leg Kniegelenksystem erzielen. Voraussetzung dafür ist, dass keine wesentliche Einschränkung der Stumpfbeweglichkeit, des Muskelstatus oder der kognitiven Fähigkeit vorliegt. Aktive Patienten (AK 3, AK 4) profitieren in den meisten der vorliegenden Fälle. Einige hochaktive Patienten der AK 4 beklagen jedoch, dass sie sich durch das elektronische Kniepassteil fremdbestimmt fühlen.Unter Mitarbeit von: S. Bieringer; D. Gisbertz; M. Gurk; T. Kretschmer; L. Linkemeyer; C. Müller-Gliemann; R. Schmidt; D. Schulze Frenking; J. Wühr     

The Possible Importance of Glutamine Supplementation to Mood and Cognition in Hypoxia from High Altitude

Hypoxia induced by low O₂ pressure is responsible for several physiological and behavioral alterations. Changes in physiological systems are frequent, including inflammation and psychobiological declines such as mood and cognition worsening, resulting in increased reaction time, difficulty solving problems, reduced memory and concentration. The paper discusses the possible relationship between glutamine supplementation and worsening cognition mediated by inflammation induced by high altitude hypoxia. The paper is a narrative literature review conducted to verify the effects of glutamine supplementation on psychobiological aspects. We searched MEDLINE/PubMed and Web of Science databases and gray literature by Google Scholar for English articles. Mechanistic pathways mediated by glutamine suggest potential positive effects of its supplementation on mood and cognition, mainly its potential effect on inflammation. However, clinical studies are scarce, making any conclusions impossible. Although glutamine plays an important role and seems to mitigate inflammation, clinical studies should test this hypothesis, which will contribute to a better mood and cognition state for several people who suffer from problems mediated by hypoxia.     

Current concepts in triglyceride metabolism, pathophysiology, and treatment

It is becoming more evident that age, gender, and race play a significant role in the metabolic profiles that are seen among individuals in a clinical setting. It is important to understand these variances in metabolic profiles; and with these variances in mind it is now possible to understand why a single diet might not decrease cardiovascular disease risk profiles uniformly for everyone. Much is now understood about triglyceride metabolism and its contribution to energy storage. In this review we will focus on triglycerides; their production, metabolism and influence on daily life, as well as the various methods for the treatment of hypertryglyceridemia and prevention of its sequelae.     

Rett syndrome from quintuple and triple deletions within the MECP2 deletion hotspot region

Rett syndrome results from mutations in the X-linked methyl-CpG-binding protein 2 (MECP2) gene, which are nearly always lethal in males and lead to regression and reduced life expectancy in females. Herein we report one propositus with five tandem deletions and a second propositus with three tandem deletions within MECP2 exon 4 that encode truncated protein products resulting in classic Rett syndrome. These deletion breakpoints and single deletions in 3 other patients were all found within a 185-bp region along with 64 of 69 other reported deletion breakpoints in the MECP2 gene. Illegitimate recombination resulting in deletion at a substantial proportion of the shared MECP2 sites is enhanced by repeated guanosine (G) DNA sequences in the antisense direction, consistent with reports at other gene loci that polypurine (multiple guanosine or adenosine (A)) basepairs enhance sequence deletion. Multiple deletions at the same poly G recombination sites confirm the existence of deletion hotspots in this gene region with numerous repeated antisense sites that are enriched 26- to 161-fold. Deletion by illegitimate recombination within a single allele can occur during mitotic or meiotic cell cycles. Although prone to disease-causing deletion, this region is unique in humans and highly conserved among mammals for the last 75 000 000 years to maintain the MECP2 gene's critical function.