Identificaçao da Via Lenta na Reentrada Nodal Atrioventricular Usando o Intervalo Atrioventricular Mais Curto

Em 10 pacientes consecutivos, realizou-se o mapeamento da parede septal do átrio direito durante taquicardia supraventricular por reentrada nodal AV, para comprovar a hipótese de que o intervalo AV mais curto identificava a área de conduçao da via lenta. O septo atrial foi dividido em quatro zonas distintas. Em sete dos pacientes o intervalo AV anterógrado mais curto foi encontrado na zona 3; em dois, na zona 4; no último, na zona 2. A modificaçao por radiofreqüência da via lenta foi obtida com sucesso, em todos os pacientes, na área de conduçao AV mais curta. O intervalo AV durante ritmo sinusal permaneceu inalterado antes e após a ablaçao. Após um seguimento de 21 ±4 meses, nenhum deles teve recorrência dos sintomas

Identificaçao da Via Lenta na Reentrada Nodal Atrioventricular Usando o Intervalo Atrioventricular Mais Curto

Em 10 pacientes consecutivos, realizou-se o mapeamento da parede septal do átrio direito durante taquicardia supraventricular por reentrada nodal AV, para comprovar a hipótese de que o intervalo AV mais curto identificava a área de conduçao da via lenta. O septo atrial foi dividido em quatro zonas distintas. Em sete dos pacientes o intervalo AV anterógrado mais curto foi encontrado na zona 3; em dois, na zona 4; no último, na zona 2. A modificaçao por radiofreqüência da via lenta foi obtida com sucesso, em todos os pacientes, na área de conduçao AV mais curta. O intervalo AV durante ritmo sinusal permaneceu inalterado antes e após a ablaçao. Após um seguimento de 21 ±4 meses, nenhum deles teve recorrência dos sintomas

Do Neutrophils Play a Role in Establishing Liver Abscesses and Distant Metastases Caused by Klebsiella pneumoniae?

Serotype K1 Klebsiella pneumoniae is a major cause of liver abscesses and endophthalmitis. This study was designed to identify the role of neutrophils in the development of distant metastatic complications that were caused by serotype K1 K. pneumoniae. An in vitro cellular model was used to assess serum resistance and neutrophil-mediated killing. BALB/c mice were injected with neutrophils containing phagocytosed K. pneumoniae. Serotype K1 K. pneumoniae was significantly more resistant to serum killing, neutrophil-mediated phagocytosis and intra-cellular killing than non-K1 isolates (p<0.01). Electron microscopic examination had similar findings as in the bioassay findings. Intraperitoneal injection of neutrophils containing phagocytosed serotype K1 K. pneumoniae led to abscess formation in multiple sites including the subcutaneous tissue, lung, and liver, whereas no abscess formation was observed in mice injected with non-K1 isolates. The resistance of serotype K1 K. pneumoniae to complement- and neutrophil-mediated intracellular killing results in the dissemination of K. pneumoniae via the bloodstream. Escape from neutrophil intracellular killing may contribute to the dissemination and establishment of distant metastases. Thus, neutrophils play a role as a vehicle for helping K. pneumoniae and contributing to the establishment of liver abscess and distant metastatic complications

ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial

Background Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CH) and profoundly impacts on residents’ dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in care homes is not known. The ELECTRIC Trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in care home residents and investigate the associated costs and consequences. Methods This is a pragmatic, multicentre, placebo controlled randomised parallel group trial comparing effectiveness of TPTNS (target n=250) with sham stimulation (target n=250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff- reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-hour pad weight tests (PWT), post void residual urine (bladder scans), Patient Perception of Bladder Condition (PPBC), Minnesota Toileting Skills Questionnaire (MTSQ) and Dementia Quality of Life (DEMQOL). Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. Discussion TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC Trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. Trial registration Clinical Trials.gov. NCT03248362. Registered on 14/08/2017. https://clinicaltrials.gov/ ISRCTN, ISRCTN 98415244. Registered on 25/04/2018. https://www.isrctn.com