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Thrombus entrapment with left atrial appendage closure to facilitate early cardioversion in tachycardiomyopathy: a case report.
Get PDFBACKGROUND
The aetiological spectrum of heart failure with reduced ejection fraction is various. Tachycardiomyopathy is recognized as one of the cause, usually made retrospectively. In this clinical context, rhythm control with restoration of sinus rhythm is considered crucial to minimize ventricular function damage and allow contractility recovery. However, the presence of a thrombus in the left atrial appendage is a limiting factor, typically requiring anticoagulation until the thrombus resolves, at least 3 weeks, thus delaying the therapy.
CASE SUMMARY
We present a case of 65-year-old man with diagnosis of new-onset acute symptomatic heart failure with severe reduced ejection fraction (left ventricular ejection fraction 15%), in the context of a typical tachycardic atrial flutter and concomitant thrombus in the left atrial appendage confirmed by transoesophageal echocardiography. We successfully performed a thrombus entrapment procedure by means of percutaneous left atrial appendage closure, which allowed immediate restoration of sinus rhythm through cavotricuspid isthmus ablation. After the institution of the heart failure therapy, titrated up to the maximum tolerated dose, we observed a complete restoration of left ventricular function after 6 months.
DISCUSSION
Thrombus entrapment by means of left atrial appendage closure is a valid strategy that enables early cardioversion with arrhythmia ablation and rapid restoration of normal cardiac rhythm in severe heart failure with reduced ejection fraction, even in acute situations and typical atrial flutter
Benign Metastasizing Leiomyoma: New insights into a rare disease with an obscure etiopathogenesis.
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Benign metastasizing leiomyoma (BML) is a rare disease with an unknown etiopathogenesis that mostly affects middle-aged women with uterine leiomyoma. Many metastatic nodules outside the uterus characterize the condition. The metastases are smooth muscle lesions without malignancy. Morphologically and immunohistochemically, they resemble uterine leiomyomas, indicating a shared clonal origin. The lungs are the most prevalent site for incidental metastasis detection. BML has a relatively slow progression and good prognosis, and historically, there has been a lack of established guidelines for its treatment.
CASE PRESENTATION
Herein, we report a case of BML in a patient with multiple metastases. Through extensive histological and immunohistochemical analyses, this complex case enabled not only the definitive diagnosis of BML, but also shed light on its complex etiopathogenesis.
CONCLUSION
This study presents novel histology evidence suggesting a potential causal relationship between metaplasia and the development of BML
Refining the Concept of Microscopic Colitis: HLA Signatures Discriminating Collagenous and Lymphocytic Colitis.
No full textDoes Improved Upward Social Mobility Foster Frustration and Conflict? A Large-Scale Online Experiment Testing Boudon’s Model
Get PDFThe rise of populism has reignited scholarly interest in the paradox of societal advancement leading to frustration and social tension. Globalization and digitalization have increased social opportunities for parts of the population, but a substantial portion of society feels disadvantaged, resulting in discontent. This study, rooted in Boudon’s model of relative deprivation, examines the mechanisms that fuel this frustration. We conducted an online experiment involving 2,114 US-based MTurk participants, in which we manipulated the availability of status positions to create varying degrees of upward social mobility. We also varied group sizes to ensure robustness. We assessed relative deprivation with structural, subjective, and behavioral measures. For example, frustration was measured using the “joy-of-destruction game,” in which subjects had to make the costly decision to destroy part of another player’s winnings. Contrary to the model’s prediction, we found that the proportion of individuals who were worse off, the losers, decreased consistently as mobility increased. This outcome can be attributed to overentry in conditions of low mobility and underentry in conditions of intermediate or high mobility. The losers displayed increased frustration and hostility towards noncompetitors and winners. Intriguingly, winners also exhibited heightened hostility. However, at the aggregate level, hostile behavior did not surge as conditions improved. In our exploratory analyses at the individual level, we identified several distinct patterns. Risk-tolerant individuals and women were more likely to enter competition. Conversely, those with advanced education levels showed a decreased inclination to competitiveness. Risk-tolerant individuals reported greater feelings of frustration and displayed increased hostility. This effect was also observed particularly among politically right-leaning individuals
ModE-RA: a global monthly paleo-reanalysis of the modern era 1421 to 2008.
Get PDFThe Modern Era Reanalysis (ModE-RA) is a global monthly paleo-reanalysis covering the period between 1421 and 2008. To reconstruct past climate fields an offline data assimilation approach is used, blending together information from an ensemble of transient atmospheric model simulations and observations. In the early period, ModE-RA utilizes natural proxies and documentary data, while from the 17th century onward instrumental measurements are also assimilated. The impact of each observation on the reconstruction is stored in the observation feedback archive, which provides additional information on the input data such as preprocessing steps and the regression-based forward models. The monthly resolved reconstructions include estimates of the most important climate fields. Furthermore, we provide a reconstruction, ModE-RAclim, which together with ModE-RA and the model simulations allows to disentangle the role of observations and model forcings. ModE-RA is best suited to study intra-annual to multi-decadal climate variability and to analyze the causes and mechanisms of past extreme climate events
Vagus nerve stimulation for the treatment of narcolepsy.
Get PDFBACKGROUND AND OBJECTIVE
No study on neurostimulation in narcolepsy is available until now. Arousal- and wake-promoting effects of vagus nerve stimulation (VNS) have been demonstrated in animal experiments and are well-known as side effects of VNS therapy in epilepsy and depression. The objective was to evaluate the therapeutic effect of VNS on daily sleepiness and cataplexies in narcolepsy.
METHODS
In our open-label prospective comparative study, we included narcolepsy patients who were treated with VNS because of depression or epilepsy and compared them to controls without narcolepsy treated with VNS for depression or epilepsy (18 patients in each group, aged 31.5 ± 8.2 years). We evaluated daily sleepiness (Epworth Sleepiness Scale, ESS) and the number of cataplexies per week before the implantation of VNS and at three and six month follow-ups.
RESULTS
Compared to baseline (ESS: 15.9 ± 2.5) patients with narcolepsy showed a significant improvement on ESS after three months (11.2 ± 3.3, p < 0.05) and six months (9.6 ± 2.8, p < 0.001) and a trend to reduction of cataplexies. No significant ESS-improvement was observed in patients without narcolepsy (14.9 ± 3.9, 13.6 ± 3.7, 13.2 ± 3.5, p = 0.2 at baseline, three and six months, correspondingly). Side effects did not differ between the study groups.
CONCLUSION
In this first evaluation of VNS in narcolepsy, we found a significant improvement of daily sleepiness due to this type of neurostimulation. VNS could be a promising non-medical treatment in narcolepsy
One- Versus Three-Month DAPT in Older Patients at High Bleeding Risk Undergoing PCI: Insights From the XIENCE Short DAPT Global Program.
No full textThis analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from three prospective, single-arm studies (XIENCE Short DAPT Program), including high bleeding risk (HBR) patients successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and <75 years). The primary endpoint was all-cause death or myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2-5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. Out of 3,364 patients, 2,241 (66.6%) were ≥75 years old. The risk of death or MI was similar with 1- vs 3-month DAPT in patients ≥75 (8.5% vs 8.0%, adjusted HR 0.95, 95% CI 0.69-1.30) and <75 years old (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60-1.57; interaction p-value 0.478). BARC type 2-5 bleeding was consistently lower with 1- than with 3-month DAPT in patients ≥75 years old (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48-0.91) and <75 years old (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57-1.29; interaction p-value 0.737). In conclusion, among HBR patients undergoing PCI, patients older and younger than 75 years of age derived a consistent benefit from 1- as compared with 3-month DAPT in terms of bleeding reduction with no increase in all-cause death or MI at 1 year
The phenomenology of pareidolia in healthy subjects and patients with left- or right-hemispheric stroke
Get PDFPareidolia are perceptions of recognizable images or meaningful patterns where none exist. In recent years, this phenomenon has been increasingly studied in healthy subjects and patients with neurological or psychiatric diseases. The current study examined pareidolia production in a group of 53 stroke patients and 82 neurologically healthy controls who performed a natural images task. We found a significant reduction of absolute pareidolia production in left- and right-hemispheric stroke patients, with right-hemispheric patients producing overall fewest pareidolic output. Responses were categorized into 28 distinct categories, with ‘Animal’, ‘Human’, ‘Face’, and ‘Body parts' being the most common, accounting for 72% of all pareidolia. Regarding the percentages of the different categories of pareidolia, we found a significant reduction for the percentage of “Body parts” pareidolia in the left-hemispheric patient group as compared to the control group, while the percentage of this pareidolia type was not significantly reduced in right-hemispheric patients compared to healthy controls. These results support the hypothesis that pareidolia production may be influenced by local-global visual processing with the left hemisphere being involved in local and detailed analytical visual processing to a greater extent. As such, a lesion to the right hemisphere, that is believed to be critical for global visual processing, might explain the overall fewest pareidolic output produced by the right-hemispheric patients
Klauengesundheitsprojekt in der Schweiz – Ein Update
Get PDFDas Schweizer Klauengesundheitsprojekt (SKGP) wurde am 01.01.2019 gestartet und dauert insgesamt 6 Jahre. Die Hauptziele des SKGP sind (a) die digitale Erhebung von Klauengesundheitsdaten beim Rindvieh in der Schweiz im Rahmen der Klauenpflege durch 100 gewerbsmäßig arbeitende Klauenpfleger; (b) die Erarbeitung von Klauengesundheitsprogrammen durch das wissenschaftliche Begleitteam; (c) die Erarbeitung von Zuchtwerten für Klauengesundheit durch die Arbeitsgemeinschaft Schweizer Rinderzüchter ASR; (d) die Verbesserung der Klauengesundheit beim Rindvieh in der Schweiz und (e) die Reduktion des Einsatzes von Antibiotika und Schwermetall-haltigen Klauenbadlösungen zur Bekämpfung von Klauengesundheitsproblemen. Im ersten Jahr wurde ein Weiterbildungskonzept für Klauenpfleger entwickelt. Dabei wurden nur Daten in die statistische Auswertung aufgenommen, die von Klauenpflegern stammen, welche die Weiterbildung erfolgreich abgeschlossen haben. Bis dato (September 2023) haben 60 Klauenpfleger das Weiterbildungsprogramm vollständig abgeschlossen. 1043 Betriebsleitende sind dem Projekt beigetreten. Insgesamt sind die Klauengesundheitsdaten von 134.739 Klauenpflegen an jeweils 4 Füßen pro Tier in der zentralen Datenbank gespeichert, und es wurden 169 Besuche und Analysen von Betrieben mit Klauengesundheitsproblemen durchgeführt. Im Rahmen einer aktuellen Doktorarbeit wurden die Biosicherheitsmaßnahmen anlässlich der Klauenpflege analysiert und eine Broschüre mit Biosicherheitsempfehlungen für Klauenpfleger erarbeitet. In einer weiteren wissenschaftlichen Untersuchung wurden Risikofaktoren für das Vorkommen von Dermatitis digitalis (DD) in Milchviehbetrieben in der Schweiz untersucht. In Bearbeitung begriffen sind folgende drei Projekte: (i) Beschreibung der Prävalenz von Klauenveränderungen und Risikofaktoren von Alarmerkrankungen in der Schweiz; (ii) Einflussfaktoren für die Entwicklung der Betriebswerte der Klauengesundheit in Schweizer Milchviehbetrieben und (iii) Erarbeitung von betriebsspezifischen Konzepten zur Bekämpfung von DD in Schweizer Milchviehbetrieben
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