[Electroconvulsive therapy in patients with metallic skull implants]. / Elektroconvulsietherapie bij patiënten met metallische schedelimplantaten.

BACKGROUND: Electroconvulsive therapy is an effective treatment for mood disorders. There is, however, no consensus about the safety of use in patients with metallic skull implants even though these patients are at higher risk of developing mood disorders. AIM: To bundle the existing literature concerning the use of electroconvulsive therapy in patients with metallic skull implants and to examine the evidence concerning safety and efficacy in this group. METHODS: Relevant case reports and literature reviews published since 1950 were located using PubMed. RESULTS: We selected and reviewed 37 case reports. There were no complications related to the interaction between electroconvulsive therapy and the metallic objects. Psychiatric outcomes were positive in 95% of cases. CONCLUSION: There is no evidence that electroconvulsive therapy is unsafe in patients metallic skull implants. With appropriate caution, its use can be considered on a case-by-case basis by psychiatrists.

Desmoplakin cardiomyopathy-an inherited cardiomyopathy presenting with recurrent episodes of acute myocardial injury.

We present two female patients with recurrent episodes of myocardial injury, consisting of acute chest pain and elevated cardiac markers without coronary artery disease. Cardiovascular magnetic resonance imaging identified extensive late gadolinium enhancement suggestive of an inherited cardiomyopathy. Genetic testing showed heterozygous pathogenic variants in the desmoplakin (DSP) gene, the gene coding for the desmoplakin protein, a structural protein found in the cardiac desmosome. Pathogenic variants in the DSP gene are associated with dilated and arrhythmogenic cardiomyopathy. DSP cardiomyopathies may cause recurring myocardial injury mimicking an acute coronary syndrome or myocarditis. Cardiac magnetic resonance imaging is key in its diagnosis due to its specifying imaging features. Genetic testing is essential for the evaluation and confirmation of the diagnosis.

Shear stress is associated with markers of plaque vulnerability and MMP-9 activity.

BACKGROUND: Vulnerable plaque has been associated with local macrophage accumulation and local high matrix metalloproteinase-2 (MMP-2) and MMP-9 activity. Since shear stress is a known local modulator of plaque location, we have determined whether local shear stress was associated with local plaque composition and with local MMP activity. METHODS AND RESULTS: In 17 NZW rabbits plaque was generated by denudation of the infrarenal aorta over a region of 5 cm and feeding them a high cholesterol diet for 2 months. After 2 months, a motorised IVUS pullback of the infrarenal aorta was performed with a 40 MHz IVUS catheter (CVIS, Boston Scientific, USA). IVUS derived vessel wall-lumen contours were reconstructed in 3D with in-house developed software. These reconstructions served as an input for a computational fluid dynamics technique, from which the 3-D shear stress field was calculated. Plaque regions were divided in 5 regions (n=8) to identify the location of highest macrophage accumulation or selected on basis of shear stress to identify whether high shear stress selects macrophage accumulation (n=8). In a second series, shear stress values were used to select regions -containing both latent and active MMP-2 and MMP-9. Segments were sectioned with a microtome and stained for smooth muscle cells (SMC), macrophages (MPhi) and collagen (COL). MPhi, displayed the highest density upstream of the plaque (6.9+/-2.4%, p<0.05), while SMC accumulated downstream (74.8+/-1.9%) of the plaque. High shear stress was associated with MPhi accumulation and MMP-9 activity (p<0.05). CONCLUSION: Upstream location of macrophages in plaques is associated with high shear stress and MMP-9 accumulation. These findings are discussed in relation to rheological theories reported previously in atherosclerosis.

Miniaturized EI/Q/oa TOF mass spectrometer.

A miniaturized orthogonal time-of-flight mass spectrometer with an electron impact ionization ion source and a rf quadrupole ion guide has been developed. A mass resolving power of m/deltam = 5500 has been obtained in a 0.4 m instrument. The addition of helium at pressures of about 4.0 mtorr into the ion source showed collisional focusing taking place in the rf quadrupole. An automated gas chromatograph designed for air monitoring applications has been coupled to the time-of-flight mass analyzer and tested for the detection of simulants of chemical-warfare agents.

Towards a meta-syntax for medical edi.

Assessment of the current medical edi (electronic data interchange) environment shows that 'old' syntaxes are used to specify interchange formats of messages containing highly complex information of a quickly evolving nature. After translation of message requirements towards message interchange format specifications in accordance with underlying syntax rules, system developers use modern technologies to implement the sending and receiving of edi message instances towards the distorted view imposed by these message interchange formats. The coexistence of several syntaxes and the urgent need for more standardised message types, require a new type of techniques and tools. The new mechanism should support a non-distorted message type development and provide the framework for data-driven conversion of message instances, from one interchange format to another.

Investigation of syntaxes for existing interchange formats to be used in healthcare.

This paper gives a summary of the work done by CEN TC 251 PT 004. The project team objective has been to investigate syntaxes of existing interchange formats (IFs) to be used in healthcare. A set of evaluation criteria have been developed based on functional requirements from two healthcare domains. 5 IFs; ASN.1, ASTM E1238, EDIFACT, Euclides and ODA have been evaluated. ASN.1 scores highest in the evaluation. However mapping from General Message Models (GMDs) to IF dependent message models (IFMDs) shows that all the IFs can be used. The project team recommends a strategy for development of GMDs, IFs and IFMDs.

Medical EDI message specification and interchange formats.

Assessment of the current medical edi environment learns that "old" interchange formats are being used to represent information of highly complex and quickly evolving nature. Whenever the domain requirements are translated into acceptable messages according to these interchange format specifications, system developers use the latest technologies to implement the messages towards the distorted view imposed by the interchange format constraints. This situation, combined with the fact of coexistence of several interchange formats and the urgent need for more standardised message types, led to the specification of a new meta-syntax, supporting easy message definition and allowing the data-driven conversion between multiple interchange formats. As such, and supported by the development of interchange format independent message descriptions, it may become a tool to support the medical edi needs of the future.