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First report from the european registry for anomalous aortic origin of coronary artery (EURO-AAOCA).
Get PDFOBJECTIVES
Anomalous aortic origin of a coronary artery (AAOCA) is a group of rare congenital heart defects with various clinical presentations. The lifetime-risk of an individual living with AAOCA is unknown, and data from multicentre registries are urgently needed to adapt current recommendations and guide optimal patient management. The European AAOCA Registry (EURO-AAOCA) aims to assess differences with regard to AAOCA management between centers.
METHODS
EURO-AAOCA is a prospective, multicentre registry including 13 european centers. Herein, we evaluated differences in clinical presentations and management, treatment decisions and surgical outcomes across centers from 01/2019 to 06/2023.
RESULTS
262 AAOCA patients were included, with a median age of 33 years (12-53) with a bimodal distribution. 139 (53.1%) were symptomatic, whereas chest pain (n = 74, 53.2%) was the most common complaint, followed by syncope (n = 21, 15.1%). Seven (5%) patients presented with a myocardial infarction, two (1.4%) with aborted sudden cardiac death. Right-AAOCA (R-AAOCA) was most frequent (150, 57.5%), followed by left-AAOCA (L-AAOCA) in 51 (19.5%), and circumflex-AAOCA (Cx-AAOCA) in 20 (7.7%). There were significant differences regarding diagnostics between age groups and across centers. 74 (28.2%) patients underwent surgery with no operative deaths; minor post-operative complications occurred in 10 (3.8%) cases.
CONCLUSIONS
Currently no uniform agreement exists among european centers with regard to diagnostic protocols and clinical management for AAOCA variants. Although surgery is a safe procedure in AAOCA, future longitudinal outcome data will hopefully shed light on how to best decide towards optimal selection of patients undergoing revascularization versus conservative treatment
National Consensus on Contraindications for Corneal Donation for Transplantation in Switzerland.
No full textPURPOSE
To establish a national consensus on contraindications for corneal donation for transplantation in Switzerland.
METHODS
Swisstransplant (SWT), the Swiss national foundation coordinating tissue and organ donations, convened a working group consisting of six national corneal surgeons and eye bankers and donation experts to create a contraindication list for corneal donation. The group reviewed available national and international guidelines and recommendations, while adhering to Swiss law and transplant regulations. In cases of opposing opinions, the group held follow-up meetings until a consensus was reached. A consensus was defined as agreement among all parties present.
RESULTS
From March 2021 to November 2021, the study group held six meetings and created a standardized minimal contraindication list for corneal donation in Switzerland. Thanks to this list, SWT has created a mandatory working and documentation file for donor coordinators to use when evaluating multiorgan donors for corneal harvesting. The authors agreed that while the national consensus list provides standardized minimal contraindication criteria, local eye banks may choose to introduce additional, more rigorous criteria.
CONCLUSION
Given that corneal transplantation is the most commonly performed transplantation, establishing a consensus on contraindications is crucial for recipient safety. The creation of a consensus on contraindications for corneal donation in Switzerland is an essential contribution to fulfil the legal requirements concerning quality assurance and provides sufficient high-quality donor tissue within the country. Therefore, periodic review and revision of the consensus is considered critical
Experts' view on the role of oestrogens in combined oral contraceptives: emphasis on oestetrol (E4).
Get PDFINTRODUCTION
The evolution of contraception has been crucial for public health and reproductive well-being. Over the past 60 years, combined oral contraceptives (COCs) have remained an important part of the contraceptive landscape worldwide; continued development has worked toward maintaining efficacy and improving safety.
METHODS
Seven global experts convened to discuss the clinical relevance of the oestrogen in COCs, focusing on the impact of the new oestrogen, oestetrol (E4). Participants then commented through an online forum on the summary content and other participants' feedback. We prepared this report to describe the experts' views, their follow-up from the open forum and the evidence supporting their views.
RESULTS
Ethinylestradiol (EE) and oestradiol (E2) affect receptors similarly whereas E4 has differential effects, especially in the liver and breast. Adequate oestrogen doses in COCs ensure regular bleeding and user acceptability. EE and E4 have longer half-lives than E2; accordingly, COCs with EE and E4 offer more predictable bleeding than those with E2. Oestrogen type and progestin influence VTE risk; E2 poses a lower risk than EE; although promising, E4/DRSP VTE risk is lacking population-based data. COCs alleviate menstrual symptoms, impact mental health, cognition, libido, skin, and bone health.
CONCLUSION
Oestrogens play an important role in the contraceptive efficacy, bleeding patterns, and overall tolerability/safety of COCs. Recent studies exploring E4 combined with DRSP show promising results compared to traditional formulations, but more definitive conclusions await further research
Rare case of a chronic rhinocerebral mucormycosis.
Get PDFWe describe a case of rhino-orbital-cerebral mucormycosis (ROCM) in a diabetic patient. She presented with cavernous sinus syndrome and ischemia of the optic nerve. Initially unremarkable findings in the nasal cavity and paranasal sinus delayed early diagnosis. Within two weeks, a follow-up MRI showing progressive orbital inflammation, thrombosis of the cavernous sinus and erosive destruction of the left middle nasal concha together with necrotic black tissue in the left nasal cavity and destruction of the maxillary sinus demonstrated in a consecutively performed ethmoidectomy, finally gave way to diagnosis. Definite diagnosis was established by histopathology and culture. Treatment consisted of a combination of liposomal Amphotericin B, partial surgical resection and improved diabetes control. Despite insufficient surgical treatment, the progression of the disease was remarkably slow - a typical hallmark of chronic ROCM. With this case report we aim to underline the difficulties in establishing a prompt diagnosis of ROCM and to remind readers of its chronic form. 2012 Elsevier Ltd. All rights reserved
Treatment methods for cervical intraepithelial neoplasia in England: A cost-effectiveness analysis.
Get PDFOBJECTIVE
To compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN).
DESIGN
A cost-effectiveness analysis based on data available in the literature and expert opinion.
SETTING
England.
POPULATION
Women treated for CIN.
METHODS
We developed a decision-analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10-year period. The costs calculated were those incurred by the National Health Service (NHS) of England.
MAIN OUTCOME MEASURES
Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted.
RESULTS
For young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost-effective treatment overall at all willingness-to-pay thresholds. For postmenopausal women, LLETZ remained the most cost-effective treatment up to a threshold of £31,500, but laser conisation became the most cost-effective treatment above that threshold.
CONCLUSIONS
LLETZ is the most cost-effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence
Les Salons en vers: de petits poèmes sur du grand art
Get PDFLa poésie sur les arts visuels au XVIIIe siècle est un type spécifique d’écrit sur l’art qui connaît une phase d’intense publication en France au milieu du siècle avec les poèmes didactico-descriptifs de Marsy, Baillet de Saint-Julien, Watelet et de Lemierre pour citer les plus connus. Stimulée par la réouverture des expositions au Salon carré du Louvre en 1737, cette poésie répond au goût du public pour la peinture française contemporaine. Le contexte historique de la réouverture des expositions bisannuelles favorise l’essor de nouvelles formes d’écriture en particulier sur la peinture, à l’image de ce que nous appelons aujourd’hui la critique d’art. L’émergence de celle-ci coïncide aussi avec une abondante production poétique inspirée par les expositions de peinture contemporaine. La Collection Deloynes et le Portefeuille de poésies fugitives constitué par Nicole Masson sont de précieuses sources pour la constitution de ce corpus de poésie de circonstance sur les Salons. Ces ouvrages contiennent des vers qui invitent à une promenade poétique parmi les tableaux exposés. La poésie articule ainsi une forme de critique d’art versifiée qui méandre entre l’expression d’un avis et d’une émotion. Le propos de ma présentation s’attelle à étudier le fonctionnement de ce type de poésie au XVIIIe siècle. Le caractère hétérogène de ce corpus du point de vue des tonalités littéraires employées (élégiaque, critique, didactique, descriptive, satirique) est complétée par la volonté d’illustrer, voire d’intensifier l’expérience esthétique par la voix poétique lors d’une exposition d’œuvres d’art. La lecture des poèmes fait donc office d’une forme de réalité augmentée et complémentaire à la contemplation des œuvres d’art exposées. La mise en vers assure une transmission des connaissances sur le savoir-faire pictural, une forme de publicité pour les artistes ainsi que l’expression de la beauté des œuvres d’art dévoilées. Ce sont autant de fonctions qu’a la poésie des Lumières et qui se réunissent au sein de ce corpus de poèmes de circonstance. Celui-ci comporte également des innovations poétiques en termes de stratégies d’appropriation et d’intégration d’un vocabulaire issu de la pratique picturale. Dépassant la transposition classique des règles de la rhétorique d’un art à l’autre, les poèmes sont ainsi susceptibles d’aboutir à une nouvelle forme d’ut pictura poesis. La poésie sur les Salons honore cet adage horacien par l’expression d’une relation de solidarité et de complémentarité
Detection of SARS-CoV-2 RNA in a Zoo-Kept Red Fox (Vulpes vulpes).
Get PDFMany different animal species are susceptible to SARS-CoV-2, including a few Canidae (domestic dog and raccoon dog). So far, only experimental evidence is available concerning SARS-CoV-2 infections in red foxes (Vulpes vulpes). This is the first report of SARS-CoV-2 RNA detection in a sample from a red fox. The RT-qPCR-positive fox was zoo-kept together with another fox and two bears in the Swiss Canton of Zurich. Combined material from a conjunctival and nasal swab collected for canine distemper virus diagnostics tested positive for SARS-CoV-2 RNA with Ct values of 36.9 (E gene assay) and 35.7 (RdRp gene assay). The sample was analysed for SARS-CoV-2 within a research project testing residual routine diagnostic samples from different animal species submitted between spring 2020 and December 2022 to improve knowledge on SARS-CoV-2 infections within different animal species and investigate their potential role in a One Health context. Within this project, 246 samples from 153 different animals from Swiss zoos and other wild animal species all tested SARS-CoV-2 RT-qPCR and/or serologically negative so far, except for the reported fox. The source of SARS-CoV-2 in the fox is unknown. The fox disappeared within the naturally structured enclosure, and the cadaver was not found. No further control measures were undertaken
Molecular Mechanisms Responsible for the Therapeutic Potential of Mesenchymal Stem Cell-Derived Exosomes in the Treatment of Lung Fibrosis.
Get PDFMesenchymal stem cell-derived exosomes (MSC-Exos) are nano-sized extracellular vesicles which contain various MSC-sourced anti-fibrotic, immunoregulatory and angio-modulatory proteins (growth factors, immunoregulatory cytokines, chemokines), lipids, and nucleic acids (messenger RNA and microRNAs). Due to their lipid envelope, MSC-Exos easily by-pass all barriers in the body and deliver their cargo directly in target cells, modulating their viability, proliferation, phenotype and function. The results obtained in recently published experimental studies demonstrated beneficial effects of MSC-Exos in the treatment of lung fibrosis. MSC-Exos reduced activation of fibroblasts and prevented their differentiation in myofibroblasts. By delivering MSC-sourced immunoregulatory factors in lung-infiltrated monocytes and T cells, MSC-Exos modulate their function, alleviating on-going inflammation and fibrosis. MSC-Exos may also serve as vehicles for the target delivery of anti-fibrotic and immunomodulatory agents, enabling enhanced attenuation of lung fibrosis. Although numerous pre-clinical studies have demonstrated the therapeutic potential of MSC-Exos in the treatment of pulmonary fibrosis, there are several challenges that currently hinder their clinical implementation. Therefore, in this review article, we summarized current knowledge and we discussed future perspectives regarding molecular and cellular mechanisms which were responsible for the anti-fibrotic, anti-inflammatory and immunoregulatory properties of MSC-Exos, paving the way for their clinical use in the treatment of lung fibrosis
Time-resolved Spectroelectrochemical Investigation of Organic Mixed Conductors.
Get PDFOrganic mixed ionic and electronic conductors (OMIECs) are an emerging class of materials that have been applied for a wide range of electrochemical applications. Due to the complexity inherent to the ionic-electroniccoupling, understanding the underlying mechanisms involved in the OMIEC operation is an exciting and very lively research field. In this work, we highlight the use of time-resolved Vis-NIR spectroelectrochemistry tocharacterize these materials. We discuss an example, where we show that by combining this tool with spectraldecomposition, we are able to understand fundamental aspects of the doping in an OMIEC film. The methodswe present here can be generalized and used to characterize any electrochromic material
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