Noninfectious sternal wound inflammation after coronary artery bypass grafting in a patient with myelodysplastic syndrome: A no‐touch approach

Pyoderma gangrenosum (PG) is a rare, chronic inflammatory noninfectious dermatosis. It is associated with underlying systemic or hematological diseases such as myelodysplastic syndrome (MDS) and can be triggered after surgery. Recognition and diagnosis of PG can be difficult as it can mimic a wound infection. Misdiagnosis could lead to invasive procedures which worsen the disease and have possible disastrous aftermath. A 74‐year‐old male with a history of MDS presents with an atypical sternal wound inflammation. Diagnosis confirmed PG after skin biopsy. No surgical or invasive procedures were performed and the patient was treated on an outpatient basis with prednisolone, clobetasol cream, and cyclosporine. This case shows the importance of a rapid diagnosis of the disease. Awareness is required for the diagnosis of PG in a wound with pronounced livid borders, without improvement after antibiotic treatment or worsening after debridement. Rapid diagnosis and treatment reduce high healthcare costs, morbidity, and mortality

Clinical and electrophysiological predictors of device-detected new-onset atrial fibrillation during 3 years after cardiac surgery

Postoperative atrial fibrillation (POAF) after cardiac surgery is an independent predictor of stroke and mortality late after discharge. We aimed to determine the burden and predictors of early (up to 5th postoperative day) and late (after 5th postoperative day) new-onset atrial fibrillation (AF) using implantable loop recorders (ILRs) in patients undergoing open chest cardiac surgery Seventy-nine patients without a history of AF undergoing cardiac surgery underwent peri-operative high-resolution mapping of electrically induced AF and were followed 36 months after surgery using an ILR (Reveal XTTM). Clinical and electrophysiological predictors of late POAF were assessed. POAF occurred in 46 patients (58%), with early POAF detected in 27 (34%) and late POAF in 37 patients (47%). Late POAF episodes were short-lasting (mostly between 2 min and 6 h) and showed a circadian rhythm pattern with a peak of episode initiation during daytime. In POAF patients, electrically induced AF showed more complex propagation patterns than in patients without POAF. Early POAF, right atrial (RA) volume, prolonged PR time, and advanced age were independent predictors of late POAF

Infective endocarditis in the Netherlands:current epidemiological profile and mortality An analysis based on partial ESC EORP collected data

Introduction: Infective endocarditis (IE) is associated with a high in-hospital and long term mortality. Although progress has been made in diagnostic approach and management of IE, morbidity and mortality of IE remain high. In the latest European guidelines, the importance of the multi-modality imaging in diagnosis and follow up of IE is emphasized. Aim: The aim was to provide information regarding mortality and adverse events of IE, to determine IE characteristics and to assess current use of imaging in the diagnostic workup of IE. Methods: This is a prospective observational cohort study. We used data from the EURO-ENDO registry. Seven hospitals in the Netherlands have participated and included patients with IE between April 2016 and April 2018. Results: A total of 139 IE patients were included. Prosthetic valve endocarditis constituted 32.4% of the cases, cardiac device related IE 7.2% and aortic root prosthesis IE 3.6%. In-hospital mortality was 14.4% (20 patients) and one-year mortality was 21.6% (30 patients). The incidence of embolic events under treatment was 16.5%, while congestive heart failure or cardiogenic shock occurred in 15.1% of the patients. Transthoracic and transoesophageal echocardiography were performed most frequently (97.8%; 81.3%) and within 3 days after IE suspicion, followed by 18F‑fluorodeoxyglucose positron emission tomography/computed tomography (45.3%) within 6 days and multi-slice computed tomography (42.4%) within 7 days. Conclusion: We observed a high percentage of prosthetic valve endocarditis, rapid and extensive use of imaging and a relatively low in-hospital and one-year mortality of IE in the Netherlands. Limitations include possible selection bias

Normal-hearing listeners’ and cochlear-implant users’ perception of pitch cues in emotional speech

Contains fulltext : 166388.pdf (publisher's version ) (Open Access)20 p

Normal-hearing listeners' and cochlear implant users' perception of pitch cues in emotional speech

In cochlear implants (CIs), acoustic speech cues, especially for pitch, are delivered in a degraded form. This study's aim is to assess whether due to degraded pitch cues, normal-hearing listeners and CI users employ different perceptual strategies to recognize vocal emotions, and, if so, how these differ. Voice actors were recorded pronouncing a nonce word in four different emotions: anger, sadness, joy, and relief. These recordings' pitch cues were phonetically analyzed. The recordings were used to test 20 normal-hearing listeners' and 20 CI users' emotion recognition. In congruence with previous studies, high-arousal emotions had a higher mean pitch, wider pitch range, and more dominant pitches than low-arousal emotions. Regarding pitch, speakers did not differentiate emotions based on valence but on arousal. Normal-hearing listeners outperformed CI users in emotion recognition, even when presented with CI simulated stimuli. However, only normal-hearing listeners recognized one particular actor's emotions worse than the other actors'. The groups behaved differently when presented with similar input, showing that they had to employ differing strategies. Considering the respective speaker's deviating pronunciation, it appears that for normal-hearing listeners, mean pitch is a more salient cue than pitch range, whereas CI users are biased toward pitch range cue

Reappraisal of Atrial fibrillation:interaction between hyperCoagulability, Electrical remodelling and Vascular destabilisation in the progression of AF (RACE V) Tissue Bank Project: study design

Background The development of atrial fibrillation (AF) is a complex multifactorial process. Over the past few decades, much has been learned about the pathophysiological processes that can lead to AF from a variety of specific disease models in animals. However, our ability to recognise these disease processes in AF patients is still limited, which has contributed to the limited progress in improving rhythm control in AF. Aims/objectives We believe that a better understanding and detection of the individual pathophysiological mechanisms underlying AF is a prerequisite for developing patient-tailored therapies. The RACE V Tissue Bank Project will contribute to the unravelling of the main molecular mechanisms of AF by studying histology and genome-wide RNA expression profiles and combining this information with detailed phenotyping of patients undergoing cardiac surgery. Methods As more and more evidence suggests that AF may occur not only during the first days but also during the months and years after surgery, we will systematically study the incidence of AF during the first years after cardiac surgery in patients with or without a history of AF. Both the overall AF burden as well as the pattern of AF episodes will be studied. Lastly, we will study the association between the major molecular mechanisms and the clinical presentation of the patients, including the incidence and pattern of AF during the follow-up period. Conclusion The RACE V Tissue Bank Project combines deep phenotyping of patients undergoing cardiac surgery, including rhythm follow-up, analysis of molecular mechanisms, histological analysis and genome-wide RNA sequencing. This approach will provide detailed insights into the main pathological alterations associated with AF in atrial tissue and thereby contribute to the development of individualised, mechanistically informed patient-tailored treatment for AF

Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock

Extracorporeal membrane oxygenation (ECMO) in the veno-arterial (VA) configuration is an established method for the treatment of refractory cardiogenic shock. Such a condition characterizes the postoperative course of approximatively 1% of cardiac surgery patients. Although some studies have reported ECMOrelated short-term results, little is known about the long-term outcomes of VA-ECMO therapy in the postcardiotomy setting. Therefore, an extensive literature search was conducted regarding articles published after 1990 reporting postoperative ECMO use. PubMed, EMBASE and Web of Science were searched for sources. In-hospital mortality was high in post-cardiotomy VA-ECMO patients, ranging from 24.8% to 52%. Long-term results were poorly reported. However, based on the limited information available, hospital survivors showed a favorable outcome, with improvement in overall clinical condition, quality of life and limited hospital readmission for cardiac-related events. To conclude, in-hospital outcome in post-cardiotomy ECMO is often unfavorable, post-discharge results show satisfactory condition, with stable improvement of overall patient clinical status and low rate of hospital readmission and cardiac-related adverse events. Data reporting is, however, scarce and hence new and detailed studies are still warranted to investigate such aspects

Ultimate attainment in late second language acquisition: Phonetic and grammatical challenges in advanced Dutch–English bilingualism

The present article provides an exploration of ultimate attainment in second language (L2) and its limitations. It is argued that the question of maturational constraints can best be investigated when the reference population is bilingual and exposed on a regular basis to varieties of their first language (L1) that show cross-linguistic influence. To this end, 20 advanced Dutch–English bilinguals are compared to 9 English native speakers immersed in a Dutch environment. All participants are teachers or students of English at a Dutch institution of higher education. The populations are shown to be at similar global proficiency levels. Two phonetic variables (voice onset time or VOT and vowel discrimination) and one grammatical variable (verb phrase ellipsis), which are assumed to present particular challenges to Dutch learners of English, are explored, and speakers are furthermore rated for their global nativeness. The findings show no differences between populations on VOT but some variance on the production of a vowel that has no correlate in Dutch (the English trap vowel). However, all but one of the L2ers are rated outside the range of the natives on perceived foreign accent. There are also differences between groups where acceptance of different sentence types with verb phrase ellipsis are concerned. We interpret these findings to indicate that there are areas of L2 knowledge and production that are persistently difficult to acquire even under circumstances that are highly favourable for L2 acquisition. </jats:p