Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode.

The prognostic role of decongestion-related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients. This prospective observational single-centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly-reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion-related change of cardiac function and morphology. The combined endpoint of 1 year all-cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion-related change. The 176 study participants were 83 years old [74-87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups (P < 0.004 for all). Decongestion-related increase in TAPSE independent of the LVEF was associated with improvement of right-ventricular-pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33-0.78, P = 0.002; adjusted HR 0.46 95% CI: 0.33-0.78, P = 0.001). Decongestion-related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode

Summation of visual attributes in auditory‐visual crossmodal

Crossmodal correspondences are a feature of human perception in which two or more sensory dimensions are linked together; for example, high‐pitched noises may be more readily linked with small objects than large objects. However, no study yet has systematically examined the interaction between different visual‐auditory crossmodal correspondences. We investigated how the visual dimensions of luminance, saturation, size and vertical position can influence decisions when matching particular visual stimuli with high‐pitched or low‐pitched auditory stimuli. For multi‐dimensional stimuli, we found a general pattern of summation of individual crossmodal correspondences, with some exceptions that may be explained by Garner interference. These findings have applications for the design of sensory substitution systems, which convert information from one sensory modality to another

Wine and music (III): so what if music influences the taste of the wine?

A growing body of evidence, both anecdotal and scientifically rigorous, now points to the fact that what people taste when evaluating a wine, not to mention how much they enjoy the experience, can be influenced by the specifics of any music that happens to be playing at the same time. The question that we wish to address here is ‘So what?’ Why should anyone care that music (or, for that matter, specially composed soundscapes) exert(s) a crossmodal influence over the wine-tasting experience? ‘Why not just drink great wine and forget about the music?’ a sceptic might ask. Here, we outline a number of the uses that such research findings have been put to in the marketplace, in experiential events, in artistic performances, and in terms of furthering our theoretical understanding of those factors that influence the tasting experience. We also highlight how the latest in technology (think sensory apps and hyperdirectional loudspeakers, not to mention digitally augmented glassware) augurs well for those wanting to deliver the most stimulating, the most memorable, and certainly the most multisensory of tasting experiences in the years to come. Demonstrations of sound’s influence on wine perception will most likely be applicable to a variety of other drinks and foods too. Ultimately, the argument is forwarded that there are many reasons, both theoretical and applied, as to why we should all care about the fact that what we listen to can change the sensory-discriminative, the descriptive, and the hedonic attributes of what we taste

Evidence-based optimisation of empirical antibiotic regimens in paediatric complicated appendicitis: a retrospective study of 94 patients.

Acute appendicitis is the most frequent surgical emergency in the paediatric population. Complicated appendicitis accounts for 30% of cases and is inextricably linked to postoperative infectious complications. A study at our institution showed that amoxicillin-clavulanate resistant Escherichia coli in complicated appendicitis was significantly linked to postoperative infectious complications. These findings led to a change in the empirical antibiotic protocol (amoxicillin-clavulanate changed to ceftriaxone + metronidazole as of 2017), intending to reduce postoperative infectious complications in complicated appendicitis in our institution. This study aimed to analyse the microbiology and resistance profiles of pathogens of complicated appendicitis at our institution since implementing the new antibiotic protocol and the postoperative infectious complications rate. We designed a retrospective comparative cohort study. During the defined study period (01 January 2017 to 31 July 2020), medical records were analysed for cases of acute appendicitis, complicated appendicitis and postoperative infectious complications, retaining only those who fulfilled inclusion criteria. Postoperative outcomes, microbiology and antibiotic resistance of peritoneal swabs were analysed. During the study period, 95 patients presented with a complicated appendicitis, and 11 (12%) developed postoperative infectious complications. The most frequent pathogens found in complicated appendicitis were E. coli (66%), Streptococcus anginosus (45%), and Bacteroides fragilis (22%). Pseudomonas aeruginosa was present in 17% of complicated appendicitis. Pathogens involved in postoperative infectious complications mirrored the distribution found in complicated appendicitis without postoperative infectious complications. Antibiotic susceptibility analysis showed that 10 (15%) of E. coli strains were resistant to amoxicillin-clavulanate but sensitive to ceftriaxone + metronidazole, with only one strain responsible for causing a postoperative infectious complication. Six additional strains of E. coli (9%) were resistant to amoxicillin-clavulanate and our empirical antibiotic regimen but were not associated with an increase in postoperative infectious complications. Compared with our previous study, there was a decrease in postoperative infectious complications from 16% to 12%. Postoperative infectious complications caused by amoxicillin-clavulanate-resistant E. coli decreased from 28% to 9%. This retrospective study demonstrated a decrease in the rate of postoperative infectious complications due to amoxicillin-clavulanate-resistant E. coli in complicated appendicitis. These findings accentuate the need to implement evidence-based treatment protocols based on local microbiology profiles and resistance rates to optimise post-operative antibiotics in complicated appendicitis

Acute abdominal emergency due to infectious enteritis: an observational study comparing Campylobacter spp. to other enteric pathogens in children.

Campylobacter spp. are a frequent cause of gastroenteritis, presenting in some patients as an acute abdominal emergency. Here we describe the distinctive clinical characteristics of these patients. We designed a retrospective, single-centre, observational study. Children and adolescents under 18 years of age who had positive stool cultures for Campylobacter spp. during the period between June 1, 2008 and May 31, 2016 were identified from our database. Hospitalised patients with Campylobacter spp. were then matched for age and gender with patients hospitalised for gastroenteritis of other or unknown aetiology. Patients who had undergone abdominal radiographic investigation or had received a surgery consultation were included as "acute abdomen" (AA) cases. Demographics, clinical characteristics and management were compared between AA and non-AA cases. One hundred and forty-one patients with cultures positive for Campylobacter spp. were included in the analysis. Nineteen patients were identified as AA cases. Fewer of these had diarrhoea (14/19, 74% vs 117/121, 97%; p = 0.02) and more reported a lower sense of general wellbeing (8/18, 44% vs 8/108, 7%; p <0.001). Localised pain (9/18, 50% vs 20/115, 17%; p = 0.002) and abdominal tenderness (2/18, 11% vs 0/111; p = 0.02) were also more common among AA cases. Forty-four patients with Campylobacter spp. infections were hospitalised and matched with 44 patients with gastroenteritis of other or unknown aetiology. Campylobacter spp. infection (risk ratio 3.6, 95% CI 1.3-9.7; p = 0.01) was positively correlated with being seen by a surgeon and/or a prescription for radiological examination. We identified a subset of patients with Campylobacter spp. gastroenteritis who present as an acute abdominal emergency. The presentation of these patients was characterised mainly by the nature of the associated abdominal pain