Clinical Profiles and Outcomes of Prosthesis-Specific Infective Endocarditis Subsequent to Transcatheter Versus Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Prosthetic valve endocarditis (PVE) is a rare but serious complication following aortic valve replacement using either a transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). This study aims to review the profiles and outcomes of PVE after surgical versus transcatheter aortic valve replacement. Electronic searches were performed on Scopus, EMBASE, and PubMed to retrieve related articles. To be included, study designs had to be randomized controlled trials (RCT) or observational cohort studies (in English) with PVE patients that compared differences based on TAVI or SAVR. This review included data for 13,221 patients with PVE diagnoses. Of those, 2,109 patients had an initial SAVR, and 11,112 patients had an initial TAVI. There was no difference in the incidence of PVE in patients who had initial TAVI versus SAVR (1.05% versus 1.01% per person-year, p=0.98). However, the onset of early PVE was more frequently observed in the TAVI group (risk ratio (RR): 1.54, 95% confidence interval (CI) [1.14, 2.08], p=0.005). Patients in the TAVI group had a lower indication for surgery to treat PVE when compared to SAVR (RR: 0.55, 95%CI [0.44, 0.69], p<0.001). Staphylococcus aureus was more likely to be the source of PVE in patients who had previous TAVI (RR: 1.34, 95%CI [1.17, 1.54], p<0.001). Also, Enterococcus faecalis was more frequently observed as a cause of PVE in the TAVI group (RR: 1.49, 95%CI [1.21, 1.82], p<0.001). Patients who underwent SAVR and TAVI had similar incidences of PVE. However, patients who underwent SAVR had a greater indication for surgery to treat PVE, while those who underwent TAVI had higher comorbidities, a higher likelihood of early PVE, and a trend towards higher one-year mortality.

Resolving Cross-modal Semantic Interference among Object Concepts Requires Medial Temporal Lobe Cortex.

The ability to flexibly categorize object concepts is essential to semantic cognition because the features that make two objects similar in one context may be irrelevant and even constitute interference in another. Thus, adaptive behavior in complex and dynamic environments requires the resolution of feature-based interference. In the current case study, we placed visual and functional semantic features in opposition across object concepts in two categorization tasks. Successful performance required the resolution of functional interference in a visual categorization task and the resolution of visual interference in a functional categorization task. In Experiment 1, we found that patient D. A., an individual with bilateral temporal lobe lesions, was unable to categorize object concepts in a context-dependent manner. His impairment was characterized by an increased tendency to incorrectly group objects that were similar on the task-irrelevant dimension, revealing an inability to resolve cross-modal semantic interference. In Experiment 2, D. A.'s categorization accuracy was comparable to controls when lures were removed, indicating that his impairment is unique to contexts that involve cross-modal interference. In Experiment 3, he again performed as well as controls when categorizing simple concepts, suggesting that his impairment is specific to categorization of complex object concepts. These results advance our understanding of the anterior temporal lobe as a system that represents object concepts in a manner that enables flexible semantic cognition. Specifically, they reveal a dissociation between semantic representations that contribute to the resolution of cross-modal interference and those that contribute to the resolution of interference within a given modality.

Juvenile systemic lupus erythematosus in the Sultanate of Oman: clinical and immunological comparison between familial and non-familial cases.

Consanguineous marriage is quite prevalent in the Sultanate of Oman, with up to 45% of marriages being consanguineous. The aim of this study was to determine demographic, clinical and serological characteristics between familial and non-familial cases of juvenile systemic lupus erythematosus (SLE) in a highly consanguineous region such as Oman. Hospital medical records were retrospectively reviewed for 44 consecutive children with juvenile SLE seen at Sultan Qaboos University Hospital, 16 with familial SLE and 28 with non-familial SLE. All the children included in the study were Omani, diagnosed before 13 years of age, and fulfilled the 1982 revised ACR criteria. Analyses were performed using descriptive statistics. There were largely no significant differences in the clinical and serological manifestations between the two cohorts. However, the familial SLE group was associated with worse SLEDAI score at onset of diagnosis compared with the non-familial cohort (12 vs. 17; p = 0.003) suggesting a greater severity of disease in the familial group. Even though the rate of familial SLE is higher in Oman (36%) compared with the Western world (10-12%), it appears that familial and non-familial SLE cases are in fact similar disease entities in both the West and the Middle Eastern countries.

Generic versus non-generic formulation of extended-release clarithromycin in patients with community-acquired respiratory tract infections: a prospective, randomized, comparative, investigator-blind, multicentre study.

BACKGROUND AND OBJECTIVE: There is a general concern about the use of multisource (generic) antibacterials in the clinical setting with registration based solely on bioequivalence data. In order to address this concern, two modified-release formulations of clarithromycin (i.e. the originator Klacid XL and the generic Klarithran MR) were compared in patients with acute community-acquired respiratory tract infections. METHODS: Patients presenting with tonsillopharyngitis, sinusitis or pneumonia were randomized to receive either of the test drugs provided they clinically qualified for empirical clarithromycin treatment. The study endpoints were clinical and bacteriological cure rates, tolerability and safety. The study was designed to test for non-inferiority with regard to cure rates. RESULTS: The main outcome of this study was that both agents had similar clinical (non-inferior) and bacteriological cure rates and demonstrated no difference in tolerability in patients. The study also demonstrated the clinical efficacy of clarithromycin when used as empirical treatment in patients with respiratory tract infections in community practice (i.e. 95% clinical cure rate). CONCLUSION: The clarithromycin extended-release multisource product (Klarithran MR) does not differ significantly from the originator (Klacid XL) and the clinical cure rate of the generic formulation is non-inferior to that of the originator. The two formulations are tolerated similarly.

Disseminated lipogranulomatosis.

Farber disease or disseminated lipogranulomatosis is a rare inherited disorder of lipid metabolism resulting from a defect in ceramide degradation. Because of the feature of nodular swellings around various joints, this may sometimes be confused with juvenile idiopathic arthritis. We report a 4-year-old boy with Farber disease who presented with nodular swellings around the joint, angle of the mouth and conjunctiva, and was subsequently diagnosed to be a case of Farber Disease.

Prevalence of anti HCV, HBsAg and HIV antibodies in high risk recipients of blood and blood products.

Along with hepatitis B virus (HBV) and human immunodeficiency virus (HIV), Hepatitis C virus (HCV) is emerging as a major transfusion hazard. 22 cases of haemophilia (A 19, B 3) and 20 cases of thalassaemia (2 16, E(2) 4) constituted the study group. Patients tested for anti HCV (using third generation ELISA), HBsAg and antibodies to HIV I and II. Prevalence of anti HCV was 54.5% in haemophilics and 5% in thalassaemics. HBsAg was detected in 9.09% haemophilics and 5% thalassaemics. No anti HIV was detected in this cohort. Anti HCV seropositivity in haemophilics has increased compare to previous studies.

[A case of atypical cryptogenic organising pneumonitis during pregnancy]. / Un cas atypique de pneumopathie organisée cryptogénique au cours d'une grossesse.

Cryptogenic organising pneumonitis (COP) is now a well defined clinico-pathological entity. It may be idiopathic or secondary to infection, a drug reaction or a connective tissue disorder. Corticosteroid treatment is remarkably effective. We describe a case of COP occurring during the course of an acute respiratory distress syndrome in a pregnant woman. The unusual association of blood and pulmonary eosinophilia leads us to envisage a borderline form of COP and eosinophilic pneumonitis. Other unusual features were the poor response to steroids and the rapid improvement following death of the foetus.

[Simultaneous occlusion of the abdominal aorta and both internal carotid arteries as the presenting symptoms of left atrial myxoma]. / Occlusions simultanées de l'aorte abdominale et des deux artères carotides internes révélant un myxome de l'oreillette gauche.

Myxoma is a benign tumour but which has redoubtable embolic complications. When situated in the left atrium, the emboli obstruct, in the majority of cases, the cerebral arteries, occasionally the visceral or coronary arteries, and, very rarely, the aorta. In this case, the authors report an atypical presentation with ischaemia of the lower half of the body, associated with pulmonary oedema and deep coma. The left atrial myxoma was responsible for complete and simultaneous obstruction of the internal carotid arteries and the infra-renal abdominal aorta. This report illustrates the fact that myxoma can be responsible for massive, life-threatening, embolisation.

Rapid diagnosis of alcoholic ketoacidosis by proton NMR.

In alcoholic patients, metabolic acidosis can be related to lactate acidosis associated with sepsis or thiamine deficiency, ketoacidosis, methanol or ethylene glycol poisoning. High resolution proton nuclear magnetic resonance (NMR) can be used to detect abnormal organic acid metabolites in urine or serum from patients with various metabolic disorders. In the present case, a 26-year-old patient was admitted for a coma associated with severe metabolic acidosis. Alcoholic ketoacidosis (AKA) was identified by urine proton NMR. Her metabolic disorders rapidly improved. Persisting associated neurological alteration was related to extrapontine myelinolysis as shown by imaging cerebral NMR.

Adenovirus-mediated transfer of the atrial natriuretic peptide gene in rat pulmonary vascular smooth muscle cells leads to apoptosis.

Atrial natriuretic peptide (ANP) exhibits relaxant and growth-inhibiting effects on vascular smooth muscle cells (VSMCs). To obtain ANP gene expression in VSMCs, we built a recombinant adenovirus containing the ANP cDNA controlled by the adenovirus major late promotor (AdMLP-ANP). After pulmonary VSMC treatment with AdMLP-ANP at a multiplicity of infection ranging from 5 to 100 TCID(50)/cell, immunoreactive ANP was detectable in the cell culture medium at a level that reached 101 +/- 27 pmol/well after 2 days. The newly expressed ANP was biologically active, as evidenced by its ability to induce cyclic guanosine monophosphate accumulation in target cells and to mimic the effect of exogenous ANP (10(-8) to 10(-7) mol/L). Cell growth and survival of AdMLP-ANP-infected cells were decreased and were associated with the promotion of VSMC apoptosis. These effects, which occurred at a multiplicity of infection of 10 to 100 TCID(50)/cell, were observed neither in cells infected with the control adenoviral constructs (AdMLP-betaGAL and AdMLP-gD) nor in cells treated with exogenous ANP (10(-7) to 10(-6) mol/L). These results showing VSMC apoptosis in response to ANP gene expression may have important implications for the prevention of vascular remodeling by gene therapy.

[Outcome of patients with systemic rheumatic diseases admitted to intensive care units: a retrospective study of 39 cases]. / Pronostic des maladies systémiques admises en réanimation: étude rétrospective de 39 séjours.

PURPOSE: Patients with systemic rheumatic diseases are rarely admitted in intensive care units and very few studies focusing on the prognosis of those patients have been published. METHODS: Retrospective study over seven years in two intensive care units. RESULTS: Among 33 patients with systemic disease diagnosed 90 +/- 133 months before admission in the intensive care unit, who were aged 50 +/- 21 years and represented a total of 39 stays in the intensive care unit, the main cause of admission was acute respiratory failure (33%). Mean simplified acute physiology score (SAPS II) was 47 +/- 22. Two-thirds of the patients were under mechanical ventilation. Infection was diagnosed in 33% of the cases and exacerbation of the systemic rheumatic disease in 26%. Nosocomial infection was found in 19 patients (49%). Ten patients died during their stay in the intensive care unit, six from infection, three from an exacerbation of the systemic rheumatic disease, one from an unidentified cause. CONCLUSION: Even if severity scores of patients suffering from systemic diseases are higher at admission in intensive care units than those of other patients, there is no relevant reason to refuse critical care to these patients.

Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients: therapeutic considerations and outcome.

PURPOSE: Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia. MATERIALS AND METHODS: The population study included 53 intensive care unit patients with nosocomial pneumonia in whom, using a protected specimen brush, anaerobic bacteria were isolated, which were associated or not with aerobes. Current and empirical antibiotherapies were retrospectively analyzed, regarding their efficacy against anaerobic bacteria. Since it was debated, sensitivity to cefotaxime, ceftazidime, and ciprofloxacin was determined in 38 strains of Prevotella species. Outcome was evaluated 10 days after the day of protected specimen brushes. Improvement was defined as a decrease of Murray score or ventilator weaning. RESULTS: The most frequently isolated bacteria were Prevotella species, which were more frequently resistant to cefotaxime (37%), ceftazidime (50%), and ciprofloxacine (32%) than usually reported in the literature. Sixty-six percent of these strains produced beta-lactamase. The effect of empirical anti-anaerobic antibiotherapy on the outcome at day 10 was evaluable in 39 patients. Twenty-nine patients were improved and 10 patients worsened. Interestingly, patients who had received well-adapted antibiotics against anaerobes had a better outcome after 10 days (P < .02). CONCLUSIONS: This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with nosocomial pneumonia.

[Thyroid manifestations of sarcoidosis: a case report]. / Manifestations thyroïdiennes de la sarcoïdose: à propos d'un cas.

Sarcoidosis is a systemic disease with many localizations. Thyroid involvement has been often described but rarely confirmed histologically. A common immune mechanism appears to be the cause. Thyroid sarcoidosis should be envisaged in patients with a thyroid nodule and mediastino-pulmonary involvement. We report the case of a 63-year-old woman with no past history who was hospitalized for dyspnea. Explorations evidenced a cold thyroid nodule associated with diffuse interstitial lung disease and mediastinal node enlargement. Pathology examination disclosed the sarcoid nature of the thyroid nodule and the lung lesions.

[Vitelline tumor: a rare tumor of the mediastinum]. / La tumeur vitelline: une tumeur rare du médiastin.

A young patient presented with a rare tumour of the mediastinum. The first sign was liquid effusion in the right hemithorax. A major rise in alpha-foeto-protein level to 34,000 ng/ml rapidly led to diagnosis. Histological confirmation was obtained on a surgical biopsy specimen of the lung. Management included primary polychemotherapy followed by complete surgical exeresis. A second post-operative cycle of chemotherapy was given but only led to temporary normalization of alpha-foeto-protein levels and intensive chemotherapy followed by autograft to peripheral stem cells was performed. The vitellin tumour is a primary germ cell tumour usually observed in young men. It originates in extraembryonary primary mesenchymal tissue. Like other germ cell tumours, the diagnosis should be entertained for all tumours of the anterior mediastinum. Tumour markers useful for diagnosis and prognosis are beta-HCG, AFP and CEA. Levels above 500 ng/ml confirm vitellin tumour. Chemotherapy should be instituted rapidly using a BEP protocol (bleomycine, etoposide, cisplatinium) or a PVB protocol (cisplatinium, vinblastin, bleomycine). Using these new drugs and current therapeutic protocols, the rate of complete remission has risen from 13% to 40%.

Isolation and characterization of a novel mutant mouse cell line resistant to Newcastle disease virus: constitutive interferon production and enhanced interferon sensitivity.

In our attempt to isolate mutant cell lines resistant to Newcastle disease virus (NDV) we developed an improved procedure for enrichment of NDV-resistant cells from mouse FM3A cells and isolated a novel NDV-resistant mutant cell line, Had-2, with characteristics different from Had-1, a previously reported NDV-receptor-deficient mutant strain. Had-2 cells adsorbed NDV normally but the accumulation of viral mRNAs and proteins was inhibited. Had-2 cells had to be grown at higher cell densities in order to be NDV-resistant, and it was revealed that they did not exhibit NDV-resistance when grown at lower cell densities. A conditioned medium prepared from a culture of Had-2 cells grown at high cell density was able to make a low-density culture NDV-resistant. The activity of the conditioned medium to induce NDV-resistance was completely neutralized by addition of both anti interferon (IFN)-alpha and anti IFN-beta antibodies, indicating that Had-2 cells were constitutively releasing IFNs, though their levels were rather low. Had-2 cells were also characterized by an increased sensitivity to IFNs as compared with the parental FM3A cells, since the conditioned medium containing IFNs did not render FM3A cells resistant to NDV.

Biochemical study on the process of skin graft take.

Investigations on the process of skin graft take have been performed by many investigators and it has been shown that skin grafts become viable after revascularization from the graft bed after passing through a certain period of circulatory interruption. However, there are some disagreements between researchers regarding the role played by serum and the onset time of revascularization. We have investigated the changes in adenosine 5'-triphosphate (ATP) and glucose levels of skin grafts in rats to understand the biochemical process of skin graft take. A total of 250 male Wistar rats were used, and 450-microns split-thickness skin grafts were cut from their backs using a dermatome. In Group 1, the skin graft was grafted onto the dorsal fascia of the same rat. In Group 2, a 191-microns-thick Millipore filter with 1.5-microns pores was interposed between the graft and the dorsal fascia to inhibit revascularization. In Group 3, the skin graft was enveloped in a piece of gauze containing physiological saline solution and incubated at 37 degrees C. Skin grafts were removed at 6, 12, and 24 hours as well as on days 2, 3, 4, 5, 6, and 7 after grafting. The ATP and glucose levels were extracted from the grafts and quantitated using high-performance liquid chromatography. In Group 1, the ATP and glucose levels in the graft decreased rapidly after grafting; the ATP level fell to approximately 30% of that before grafting and glucose to about 20%, on days 2 and 3, respectively. Thereafter, these levels increased gradually.(ABSTRACT TRUNCATED AT 250 WORDS)

The metabolism of skin grafts stored with excess carbon dioxide.

In Japan, the long-term storage of cereals and foods in the presence of excess carbon dioxide is already a practical reality. The present study was conducted to assess the metabolic changes in skin grafts during storage in the presence and absence of excess carbon dioxide, with the aim of seeking a simple and effective method to prolong skin-graft viability during storage. In experiment 1, 120 male Wistar rats weighing 250 to 300 gm were used. A split-thickness skin graft 450 microns in thickness was harvested from the back of each rat with a dermatome and was divided into two pieces for separate storage. One piece was stored in normal air at 4 degrees C (control grafts), and the other was stored in a gas mixture composed of 20% O2, 20% CO2, and 60% N2 at 4 degrees C (CO2 grafts). Metabolic changes in the skin grafts during storage were investigated by ATP and glucose assays. In experiment 2, 60 male Wistar rats were used. Collection and storage of the split-thickness skin grafts were performed as in experiment 1. In both groups, skin grafts were stored for 1, 2, or 3 weeks, and the oxygen consumption rate of each graft was determined. Experiment 3 used 80 male Wistar rats and the same procedure as in experiment 1; split-thickness skin grafts were harvested, divided into two pieces, and stored for 1, 2, or 3 weeks. In both groups, the stored skin grafts were regrafted onto the backs of the same donor rats.(ABSTRACT TRUNCATED AT 250 WORDS)

A new method for correction of Stahl's ear.

Stahl's ear is characterized by a third crus, a flat helix, hypoplasia or total absence of the superior crus, and deformity of the scaphoid fossa. There are various methods for the correction of Stahl's ear, but the surgical correction of this deformity is more difficult than it appears. We recently devised a new surgical method of our own. During the past 4 years, we treated 5 patients with Stahl's ear with this procedure. Our procedure can be used in every kind of deformity of Stahl's ear and can get satisfactory results.