Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms:results from a multicentre long-term registry

AIMS : To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs). METHODS AND RESULTS: Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38 years; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63 months (interquartile range: 25-110 months), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, P = 0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age ≤16 years at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; P = 0.03]. CONCLUSION : Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences

Infections due to Pseudallescheria/Scedosporium species in patients with advanced HIV disease — a diagnostic and therapeutic challenge

Objectives: The aim of this study is to highlight the importance of infections caused by members of the genera Pseudallescheria/Scedosporium in HIV-positive patients. Methods: We describe a case of a fatal scedosporiosis in a treatment-naïve HIV patient and review all previously reported cases of pseudallescheriosis/scedosporiosis from a search of the PubMed and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) databases, applying the terms ‘Pseudallescheria’, ‘Scedosporium’, ‘Allescheria’, ‘Monosporium’, ‘Petriellidium’, ‘boydii’, ‘prolificans’, ‘inflatum’, cross-referenced with ‘HIV’ and ‘AIDS’. Results: Detection of Scedosporium and Pseudallescheria species has been reported in 22 HIV-positive patients. Fourteen isolates belonged to the Pseudallescheria boydii complex and eight to Scedosporium prolificans. Invasive scedosporiosis (IS) was proven in 54.5% of the patients. Among them dissemination was observed in 66.7%. Pseudallescheria/Scedosporium species were mainly isolated from male individuals. Patients with proven IS showed CD4+ cell count

Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre

Abstract Background To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours. Methods We retrospectively analysed patients’ chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015–2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have “immediate consequence”, inquiry was eligible for “processing next working day” or whether there was “no need for further action”. Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients’ acute hospitalization or need for nurses’ home visits were evaluated and quantified. Results In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00–9:00; median, 25-75th CI) and 6:30 p.m. (5:00–8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an “immediate consequence”. Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients’ home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively). Conclusion The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD

A novel calibration phantom for combining echocardiography with electromagnetic tracking

Ultrasound compounding techniques offer the possibility to enlarge the otherwise limited field of view of ultrasound. However, existing works mainly rely on larger ultrasound sensors. In this work, we attach electromagnetic (EM) tracking sensors to small tubular echo probes, namely an intracardiac echocardiographic (ICE) probe and a transesophageal echocardiographic (TEE) transducer. The EM tracking allows, when synchronized to the ultrasound, localization of the probes in either 5 DOF (Degrees of Freedom) or 6 DOF without line-of-sight requirement. For computation of the references between the two systems, we developed a novel customized 3D-printable phantom, which is especially convenient for tubular probes that acquire images laterally. Calibration with the phantom and 3D volume reconstruction was conducted in the Plus Toolkit. The volume reconstructor uses the captured position and orientation information to fuse 2D ultrasound slices into a compounded volume. Mean calibration error is below 2.5 mm for ICE and TEE. An accuracy evaluation of the 3D reconstruction using an object of known geometry revealed that tracking with 5 DOF provides unsatisfactory results, while the combination of 6 DOF and TEE achieved a mean absolute difference of 3.08 mm. Our calibration phantom fCal-Echo1.0 is openly available at http://perk-software.cs.queensu.ca/plus/doc/nightly/modelcatalog/

Additional file 1 of Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre

Supplementary Material 1. Figures S1-S3, Tables S1-S5

Role of the Phosphatase PTEN in Early Vascular Remodeling

<div><p>Background</p><p>The phosphatase PTEN represents an important physiological inhibitor of phosphatidylinositol-3 kinase (PI3-K)/protein kinase B (Akt) signalling, however, the functional role of PTEN in the initial phase of angioplasty-induced vascular injury remains elusive. In the present study we sought to determine PTEN's effect on vascular smooth muscle cell (VSMC) apoptosis following acute injury <i>in vivo</i> and <i>in vitro</i>.</p> <p>Methods and Results</p><p>Immunohistochemistry indicated a faint basal expression and equal distribution of PTEN in uninjured rat carotid arteries. 12 h following balloon-injury, PTEN expression was strongly increased in apoptotic (TUNEL+) VSMC. In vitro, stimulation with serum or different growth factors or subjecting VSMC to cyclic stretch had no effect on PTEN expression, whereas stimulation with H₂O₂ robustly increased PTEN expression in a time- and dose-dependent manner. To evaluate the functional role of PTEN expression, human VSMC were transduced with WT-PTEN. Overexpression of PTEN increased the number of apoptotic VSMC (19.8%±4.4 vs. 5.6%±2.3; <i>P</i><0.001) as determined by TUNEL assay. In contrast, siRNA-mediated knock-down of PTEN attenuated the basal as well as H₂O₂-induced apoptosis of VSMC. Mechanistically, overexpression of PTEN prevented serum-induced Akt-phosphorylation, whereas siRNA-mediated knock down of PTEN augmented Akt-activation. Moreover, co-transfection of PTEN and a constitutive active Akt mutant prevented PTEN-dependent augmentation of VSMC apoptosis, indicating, that PTEN regulates VSMC apoptosis by inhibition of Akt phosphorylation/activation.</p> <p>Conclusion</p><p>By interfering with the PI3-K/Akt-dependent survival signalling, the oxidative stress-induced up regulation of PTEN in VSMC of injured arteries augments the sensitivity of VSMC to apoptotic stimuli in the early phase following vascular injury, augmenting the initial injury and cell loss of the injured vessel wall. Thus, these data add to our understanding of PTEN's role during vascular remodelling.</p> </div

PTEN expression in human coronary VSMC <i>in vitro</i>.

<p><b>A</b>, PTEN-expression is not upregulated by mechanical stress in VSMC. Lysates of cells exposed to mechanical forces using a stretching device were analyzed by western blotting using specific antibodies. <b>B</b>, Lysates of SMC exposed to growth medium (FCS). PTEN expression was not upregulated after 24 h. Protein expression was determined using specific antibodies. Detection of Cdk4 served as loading control. <b>C</b>, Lysates of SMC exposed to oxidative stress using 500 µM H₂O₂. PTEN upregulation was triggered by oxidative stress within 24 h. Detection of p53 and Cdk4 served as apoptotic marker and loading control, respectively. <b>D</b>, The upregulation of PTEN protein levels was quantified by densitometric analysis of immunoblots (n = 3; *<i>P</i><0.05). <b>E</b>, The upregulation of PTEN activity is mediated by H₂O₂-induction. Shown is a phosphatase activity assay of immunoprecipitated protein from lysates of HcASMC with and without 24 h H₂O₂–treatment. Immunoprecipitations from lysates employing an IgG iso-antibody without H₂O₂-treatment with and without bpV supplementation, an anti-PTEN-antibody without H₂O₂ and bpV treatment and an anti-PTEN-antibody with H₂O₂– and bpV-treatment served as controls. Results are expressed as mean OD650 ± SD using an ELISA plate reader (^#<i>P</i><0.001, *<i>P</i><0.001; n = 4).</p

PTEN overexpression augments SMC apoptosis under basal conditions as well as following exposure to oxidative stress.

<p>HcASMC transfected with a plasmid carrying WT-PTEN or a control (empty) vector and PTEN protein-expression levels were determined by immunoblotting (<b>A</b>). SMC were incubated in basal medium (<b>B</b>) and in basal medium supplemented with H₂O₂ (<b>C</b>) and the relative number of apoptotic cells was evaluated following TUNEL-staining (expressed as % of total cells; *<i>P</i><0.001; n = 6). HcASMC were transfected as follows: non transfected (NT); transfected with an empty plasmid without PTEN-cDNA (pControl); transfected with a plasmid coding for PTEN (pPTEN).</p