OBJECTIVES
We previously reported a possible but unusual prosthetic-valve infective endocarditis (PV-IE) occurring on a Cryolife O'Brien Stentless Porcine Xenograft (CLOB) (anatomic damages ...suggestive of IE but negative inflammatory and microbiological markers). We reviewed all cases of aortic PV-IE admitted in our institution and compared the clinical presentation, bacteriological and echocardiographic features according to the type of prosthesis.
METHODS
Sixty consecutive cases with possible or definite aortic PV-IE (23 CLOB, 26 mechanical valve and 11 stented bioprosthesis) were admitted between 2002 and 2008.
RESULTS
Patients with CLOB had more prosthetic dehiscence (P = 0.006) and severe regurgitation (P = 0.01) than those with mechanical or stented prosthetic valves. In contrast, they had less fever (P = 0.003), lower C-reactive protein (CRP) levels (P = 0.02) and more frequently negative blood cultures (P = 0.08). Differences were due to seven patients who presented with no fever, low CRP, negative blood culture, negative valve culture and PCR when performed, despite echocardiographic features suggestive of IE (abscess or valve dehiscence). All were first operated on since 2004 when the manufacturing process changed and required a second surgery. The French Authority of Health was informed leading to the withdrawal of the CLOB from the market in 2010.
CONCLUSIONS
One-third of patients with CLOB admitted for possible or definite PV-IE presented with anatomic damages suggestive of IE but with negative inflammatory and microbiological markers. The exact aetiology remains unclear, but the present data have led to the worldwide withdrawal of prosthesis in 2010. A close follow-up of patients implanted with CLOB should be advised, especially if it has been manufactured since 2004.
Patients with acute myocardial infarction (AMI) represent a high-risk population in which screening for abdominal aortic aneurysm (AAA) is recommended but only occasionally performed. Transthoracic ...echocardiography (TTE) may offer the unique opportunity to evaluate the cardiac function and to screen for AAA during the same examination. We aimed to evaluate the feasibility of AAA screening at bedside using a portable cardiac ultrasound (US) echo machine and to determine the prevalence of AAA in population with AMI.
The AA diameter was measured at bedside at the end of a regular TTE performed in consecutive patients admitted for AMI in the coronary care unit using a portable echo machine (Vividi, General Electric). AAA was defined by a transverse diameter of ≥ 30 mm. We prospectively enrolled 193 patients (65 ± 11 years, 77% male). Measurement of the AA diameter was feasible in 93% and the duration was 3 ± 1 min. An AAA was observed in nine patients (4.7%) and the prevalence increased with age (7.7% after 60 years and 9.2% after 65 years). No AAA was observed in patients under 50 years old. Inter-observer variability between cardiologists using the portable US system was excellent (mean difference 1.8 ± 2.0 mm) as well as the accuracy compared with measurements performed by a radiologist using a dedicated vascular US system (mean difference 1.5 ± 1.3 mm).
Overall, the prevalence of AAA was 4.7%, increased with age, and seems higher than expected in the 'same-aged population'. In regard to the simplicity, accuracy, and feasibility, screening for AAA during TTE (one cardiovascular shot) may be of value after AMI especially in elderly patients.
BackgroundSevere aortic stenosis (AS) is one of the most common and most serious valve diseases. Without timely intervention with surgical aortic valve replacement or transcatheter aortic valve ...replacement, patients have an estimated survival of 2–3 years. Guidelines for the treatment of AS have been developed, but studies suggest that as many as 42% of patients with AS are not treated according to these recommendations.The aims of this registry are to delineate the caseload of patients with AS, outline the management of these patients and determine appropriateness of treatments in participating centres with and without onsite access to surgery and percutaneous treatments.Methods/designThe IMPULSE enhanced registry is an international, multicentre, prospective, observational cohort registry conducted at four central full access centres (tertiary care hospitals) and at least two satellite centres per hub (primary/secondary care hospitals). An estimated 800 patients will be enrolled in the registry and patient follow-up will last for 12 months.DiscussionIn addition to the primary aims determining the caseload management and outcome of patients with AS in primary, secondary and tertiary care settings, the registry will also determine a time course for the transition from asymptomatic to symptomatic status and the diagnostic steps, treatment decisions and the identification of decision-makers in tertiary versus primary/secondary care hospitals. The last patient will be enrolled in the registry in 2018 and results of the registry are anticipated in 2019.Registration numberNCT03112629.
In patients with mitral stenosis (MS), previous studies have shown discordant results with regards to improvements in right ventricular (RV) function immediately after percutaneous mitral ...commissurotomy (PMC). Hence, the study aim was to evaluate the impact of PMC on RV function, by using Doppler-echocardiography.
A total of 41 patients with severe symptomatic MS, in sinus rhythm, who had been referred to the authors' institution for PMC, was prospectively enrolled. A group of 25 healthy age- and gender-matched subjects served as controls. Transthoracic echocardiography (TTE) was performed on the day before and at 24/48 h after PMC. The RV function was evaluated using the Tricuspid Annular Plane Excursion (TAPSE), the RV Tei index, and systolic myocardial velocities by Doppler tissue imaging peak isovolumic contraction (DTI(IVC)) and peak systolic (DTI(S)) at the lateral tricuspid annulus).
All patients but three underwent a successful PMC. The mitral valve area (MVA) was significantly increased (1.8 +/- 0.3 versus 1.1 +/- 0.2 cm2, p <0.0001), while the mean gradient (5 +/- 2 versus 10 +/- 7 mmHg, p <0.0001) and systolic pulmonary artery pressure (40 +/- 10 versus 54 +/- 21 mmHg, p = 0.0002) were decreased. Compared to healthy controls, the RV dysfunction in MS patients was authenticated by the DTI(IVC) and the Tei index (8.4 +/- 3.0 versus 11.1 +/- 2.1 cm/s, p = 0.0002 and 0.33 +/- 0.10 versus 0.18 +/- 0.10 respectively, p <0.0001), but not by DTI(S) (12.9 +/- 3 versus 12.3 +/- 1.5 cm/s, p = 0.35) or TAPSE (24 +/- 5 versus 23 +/- 3 mm, p = 0.50). After PMC, no significant change regarding RV function was observed (TAPSE: 24 +/- 5 versus 24 +/- 5 mm, p = 0.54; Tei Index: 0.33 +/- 0.10 versus 0.36 +/- 0.12, p = 0.20; DTI(IVC): 8.4 +/- 3.0 versus 9.2 +/- 3.4 cm/s, p = 0.08 and DTI(S): 12.9 +/- 3.0 versus 13.0 +/- 3.4 cm/s, p = 0.54).
The DTI(IVC) and Tei index appear to serve as the more sensitive indices of RV dysfunction in patients with MS. Immediately after a successful PMC, no significant change in Doppler echocardiographic parameters of RV function was observed. Whether late improvement in RV function can be observed, and the prognostic value of these parameters realized, deserve further investigation.
O objetivo do estudo foi avaliar o conhecimento acerca da importância do controle do biofilme dentário dos pacientes da clínica de Odontologia do Centro Universitário da Serra Gaúcha – FSG. A coleta ...dos dados foi realizada em 60 pacientes, por meio de um questionário contendo perguntas objetivas a fim de avaliar o conhecimento dos pacientes no que diz respeito a importância do controle do biofilme dentário. Observou-se que 78,3% dos indivíduos eram do sexo feminino, com idade média de 49,7 anos, a maioria dos pacientes possuía ensino fundamental completo (26,7%) e ensino médio completo (26,7%). Grande parte dos entrevistados procurou a instituição para manutenção de rotina (63,3%). Além disso, constatou-se que os pacientes possuíam um bom nível de conhecimento acerca do biofilme dentário e de patologias causadas por ele. Entretanto, mostraram conhecimento sobre higiene bucal insatisfatório. De acordo com os resultados obtidos na pesquisa, constatou-se que a maioria dos entrevistados possui um bom nível de conhecimento acerca da importância do controle do biofilme.
Stochastic motion on the surface of living cells is critical to promote molecular encounters that are necessary for multiple cellular processes. Often the complexity of the cell membranes leads to ...anomalous diffusion, which under certain conditions it is accompanied by non-ergodic dynamics. Here, we unravel two manifestations of ergodicity breaking in the dynamics of membrane proteins in the somatic surface of hippocampal neurons. Three different tagged molecules are studied on the surface of the soma: the voltage-gated potassium and sodium channels Kv1.4 and Nav1.6 and the glycoprotein CD4. In these three molecules ergodicity breaking is unveiled by the confidence interval of the mean square displacement and by the dynamical functional estimator. Ergodicity breaking is found to take place due to transient confinement effects since the molecules alternate between free diffusion and confined motion.
Voltage-gated sodium (Nav) channels are responsible for the depolarizing phase of the action potential in most nerve cells, and Nav channel localization to the axon initial segment is vital to action ...potential initiation. Nav channels in the soma play a role in the transfer of axonal output information to the rest of the neuron and in synaptic plasticity, although little is known about Nav channel localization and dynamics within this neuronal compartment. This study uses single-particle tracking and photoactivation localization microscopy to analyze cell-surface Nav1.6 within the soma of cultured hippocampal neurons. Mean-square displacement analysis of individual trajectories indicated that half of the somatic Nav1.6 channels localized to stable nanoclusters ∼230 nm in diameter. Strikingly, these domains were stabilized at specific sites on the cell membrane for >30 min, notably via an ankyrin-independent mechanism, indicating that the means by which Nav1.6 nanoclusters are maintained in the soma is biologically different from axonal localization. Nonclustered Nav1.6 channels showed anomalous diffusion, as determined by mean-square-displacement analysis. High-density single-particle tracking of Nav channels labeled with photoactivatable fluorophores in combination with Bayesian inference analysis was employed to characterize the surface nanoclusters. A subpopulation of mobile Nav1.6 was observed to be transiently trapped in the nanoclusters. Somatic Nav1.6 nanoclusters represent a new, to our knowledge, type of Nav channel localization, and are hypothesized to be sites of localized channel regulation.
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