Graphical visualization of the pattern of muscular weakness in neuromuscular diseases.

A graphical method for the description of the spatial extension and temporal development of muscular weakness in neurological disorders implemented on a personal computer is described. Different degrees of paresis of individual muscle groups are represented by distinct grey tone values or colors in a semi-anatomic scheme. This representation provides a rapid recognition of essential features of the clinical syndrome, such as the pattern of muscular weakness and its temporal development. In parallel to the results of force testing, the results of other investigations in the same muscle groups can also be presented by the graphical method.A graphical method for the description of the spatial extension and temporal development of muscular weakness in neurological disorders implemented on a personal computer is described. Different degrees of paresis of individual muscle groups are represented by distinct grey tone values or colors in a semi-anatomic scheme. This representation provides a rapid recognition of essential features of the clinical syndrome, such as the pattern of muscular weakness and its temporal development. In parallel to the results of force testing, the results of other investigations in the same muscle groups can also be presented by the graphical method

Structure-Based Design of a Potent and Selective Small Peptide Inhibitor of Mycobacterium tuberculosis 6-Hydroxymethyl-7, 8-Dihydropteroate Synthase: A Computer Modelling Approach

In an attempt to design novel anti-TB drugs, the target chosen is the enzyme 6-hydroxymethyl-7,8-dihydropteroate synthase (DHPS), which is an attractive target since it is present in microorganisms but not in humans. The existing drugs for this target are the sulfa drugs, which have been used for about seven decades. However, single mutations in the DHPS gene can cause resistance to sulfa drugs. Therefore, there is a need for the design of novel drugs. Based on the recently determined crystal structure of Mycobacterium tuberculosis (M.tb) DHPS complexed with a known substrate analogue, and on the crystal structures of E. coli DHPS and Staphylococcus aureus DHPS, we have identified a dipeptide inhibitor with the sequence WK. Docking calculations indicate that this peptide has a significantly higher potency than the sulfa drugs. In addition, the potency is 70-90 times higher for M.tb DHPS as compared to that for the pterin and folate-binding sites of key human proteins. Thus, the designed inhibitor is a promising lead compound for the development of novel antimycobcaterial agents

Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

International audienceBackground: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. Methods: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score–matched cohort. Results: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63–0.98]; P =0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site–related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). Conclusions: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial