Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis

BACKGROUND: The diagnosis of myocarditis is challenging due to its varying clinical presentation. Since myocarditis can be associated with significant 5-year mortality, and postmortem data show myocarditis in almost 10% of all adults suffering sudden cardiac death, individual risk stratification for patients with suspected myocarditis is of great clinical interest. We sought to demonstrate that patients with clinically suspected myocarditis and a normal cardiovascular magnetic resonance (CMR) according to our definition have a good prognosis, independent of their clinical symptoms and other findings. METHODS: Prospective clinical long-term follow-up of consecutive patients undergoing CMR for work-up of clinically suspected myocarditis at our institution in 2007-2008. RESULTS: Follow-up was available for n = 405 patients (all-comers, 54.8% inpatients, 38% outpatient referrals from cardiologists). Median follow-up time was 1591 days. CMR diagnosis was “myocarditis” in 28.8%, “normal” in 55.6% and “other pathology” in 15.6%. Normal CMR was defined as normal left ventricular (LV) volumes and normal left ventricular ejection fraction (LV-EF) in the absence of late Gadolinium Enhancement (LGE). The overall mortality was 3.2%. There were seven cardiac deaths during follow-up, in addition one aborted SCD and two patients had appropriate internal cardioverter defibrillator (ICD) shocks – all of these occurred in patients with abnormal CMR. Kaplan-Meier analysis with log-rank test showed significant difference for major adverse cardiac events (cardiac death, sudden cardiac death (SCD), ICD discharge, aborted SCD) between patients with normal and abnormal CMR (p = 0.0003). CONCLUSION: In our unselected population of consecutive patients referred for CMR work-up of clinically suspected myocarditis, patients with normal CMR have a good prognosis independent of their clinical symptoms and other findings

Auf Augenhöhe: Wissenstransfer zwischen Forschung und Praxis der ökologischen und nachhaltigen Land- und Lebensmittelwirtschaft (Teilprojekt des FiBL Deutschland e.V.)

Im vom FiBL bearbeiteten Teil des Projektes wurde ein sehr breiter Ansatz gewählt: Unterschiedlichste Akteure der ökologischen Landwirtschaft und Lebensmittelwirtschaft, die sich mit dem Thema Wissenstransfer beschäftigen, wurden angesprochen mit dem Ziel, sie zur Kooperation zu gewinnen und gemeinsam aktuelle Fragestellungen aus dem Bereich Wissenskommunikation zu bearbeiten. Eine Vernetzung mit Kolleg/innen in anderen Organisationen sollte aufgebaut werden, die die Projektlaufzeit überdauert und die Nachhaltigkeit sichert. Als Ergebnisse des Projekts entstanden Leitfäden/Praxishandreichungen zur Konzeption und Organisation von Veranstaltungen und von Videoaufnahmen. Weitere Praxishandreichungen stellen grundlegende Voraussetzungen zur Wissenskommunikation sowie aktuelle Werkzeuge für typische Netzwerkarbeiten im Steckbriefformat vor. Eine Tagung zur Wissenskommunikation wurde durchgeführt und dokumentiert. Die Tagungsdokumentation umfasst neben Videos, Fotos, Graphic Records auch die Präsentationen der Vorträge. Sie bietet einen fundierten Einblick in aktuelle Themen und Methoden der Wissenskommunikation. Zwei Vorhaben zur Praxisforschung wurden umgesetzt. Zum einen wurde der Aufbau des Verbunds zur ökologischen Praxisforschung V.Ö.P durch das Projekt begleitet. Der durch Bioland, Demeter und Naturland getragene Verbund bleibt auch nach Ende der Projektlaufzeit aktiv. Zum anderen wurden in einer Studie die Voraussetzungen für gelingende Praxisforschung in der Landwirtschaft analysiert. Mitarbeitende aus Organisationen der ökologischen Lebensmittelwirtschaft wurden im Rahmen einer Ausbildung im Bereich des Wissensmanagements qualifiziert. Die Teilnehmenden wurden dabei begleitet, Projekte des Wissensmanagements in ihren Organisationen durchzuführen und zu optimieren. Die DLG-Feldtage 2016 und die Öko-Feldtage 2017 dienten wiederum als Plattform für vielfältige Wissenstransfer-Veranstaltungen (Infostand, Vorträge, Diskussionen etc.) für die landwirtschaftliche Praxis

Topographic distribution pattern of morphologically different G cells in the murine antral mucosa

Gastrin-secreting enteroendocrine cells (G cells) in the antrum play an important role in the regulation of gastric secretion, gastric motility and mucosal cell proliferation. Recently we have uncovered the existence of two subpopulations of G cells with pivotally different morphology and a distinct localization in the antral invaginations; the functional implications of the different G cell types are still elusive. In this study a transgenic mouse line in which EGFP is expressed under the control of a gastrin promoter was used to elucidate the distribution pattern of the two G cell types throughout the different regions of the antrum. The results of immunohistochemical analyses revealed that G cells were not equally distributed along the anterior/posterior axis of the antrum. The “typical” pyramidal- or roundish-shaped G cells, which are located in the basal region of the antral invaginations, were more abundant in the proximal antrum bordering the corpus region but less frequent in the distal antrum bordering the pylorus. In contrast, the “atypical” G cells, which are located in the upper part of the antral invaginations and have a spindle-like contour with long processes, were evenly distributed along the anterior/posterior axis. This characteristic topographic segregation supports the notion that the two G cell types may serve different functions. A comparison of the antrum specific G cells with the two pan-gastrointestinal enteroendocrine cell types, somatostatin-secreting D cells and serotonin-secreting enterochromaffin (EC) cells, revealed a rather similar distribution pattern of G and D cells, but a fundamentally different distribution of EC cells. These observations suggest that distinct mechanisms govern the spatial segregation of enteroendocrine cells in the antrum mucosa.</p

Retraction: Bruder, L. et al. Transcatheter Decellularized Tissue-Engineered Heart Valve (dTEHV) Grown on Polyglycolic Acid (PGA) Scaffold Coated with P4HB Shows Improved Functionality over 52 Weeks due to Polyether-Ether-Ketone (PEEK) Insert. <i>J. Funct. Biomater</i>. 2018, <i>9</i>(4), 64

Due to human error, the authors included some of the experimental data in this article [...

Transcatheter Decellularized Tissue-Engineered Heart Valve (dTEHV) Grown on Polyglycolic Acid (PGA) Scaffold Coated with P4HB Shows Improved Functionality over 52 Weeks due to Polyether-Ether-Ketone (PEEK) Insert

Many congenital heart defects and degenerative valve diseases require replacement of heart valves in children and young adults. Transcatheter xenografts degenerate over time. Tissue engineering might help to overcome this limitation by providing valves with ability for self-repair. A transcatheter decellularized tissue-engineered heart valve (dTEHV) was developed using a polyglycolic acid (PGA) scaffold. A first prototype showed progressive regurgitation after 6 months in-vivo due to a suboptimal design and misguided remodeling process. A new geometry was developed accordingly with computational fluid dynamics (CFD) simulations and implemented by adding a polyether-ether-ketone (PEEK) insert to the bioreactor during cultivation. This lead to more belly-shaped leaflets with higher coaptation areas for this second generation dTEHV. Valve functionality assessed via angiography, intracardiac echocardiography, and MRI proved to be much better when compared the first generation dTEHV, with preserved functionality up to 52 weeks after implantation. Macroscopic findings showed no thrombi or signs of acute inflammation. For the second generation dTEHV, belly-shaped leaflets with soft and agile tissue-formation were seen after explantation. No excessive leaflet shortening occurred in the second generation dTEHV. Histological analysis showed complete engraftment of the dTEHV, with endothelialization of the leaflets and the graft wall. Leaflets consisted of collagenous tissue and some elastic fibers. Adaptive leaflet remodeling was visible in all implanted second generation dTEHV, and most importantly no fusion between leaflet and wall was found. Very few remnants of the PGA scaffold were detected even 52 weeks after implantation, with no influence on functionality. By adding a polyether-ether-ketone (PEEK) insert to the bioreactor construct, a new geometry of PGA-scaffold based dTEHV could be implemented. This resulted in very good valve function of the implanted dTEHV over a period of 52 weeks