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Abstract: To describe the use of levosimendan in a quaternary referral center with a dedicated heart failure service and compare its efficacy and safety to continuous outpatient support with inotropes (COSI) among patients with advanced heart failure (AHF) who require bridge-to-decision (BTD) or bridge-to-transplant (BTT) therapy. This study was a retrospective, single-center, descriptive study of patients with AHF who received either a single levosimendan infusion or COSI between 2018 and 2021. A total of 23 patients received a levosimendan infusion, and 14 were started on COSI. Three indications for levosimendan were identified: (1) to facilitate weaning of continuous inotropes, (2) to augment diuresis in cardiorenal syndrome, and (3) as first-line therapy for cardiogenic shock in selected patients. Eighty-three percent (19 of 23) of patients who received levosimendan survived to discharge, and there were few clinically significant adverse events. Overall survival at 12 months among patients who received levosimendan was 74%. No statistically significant difference in survival was observed at 12 months (P = 0.68) or beyond (P = 0.63) between patients who received levosimendan and were discharged with a plan for BTD or BTT and those who received COSI. Levosimendan is a safe and effective short-term therapy in AHF and offers comparable long-term survival to COSI in patients who require BTD or BTT therapy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

We report a case of a 74-year-old man who developed myocarditis complicated by atrioventricular (AV) block following two doses of nivolumab for the treatment of non-small cell lung cancer. A diagnosis of drug-induced acute myocarditis with complete AV block was considered on the basis of elevated troponin, new onset left ventricular (LV) systolic dysfunction, absence of acute myocardial infarction and some findings suggestive of myocarditis on cardiac magnetic resonance. The patient was commenced on glucocorticoids, perindopril and carvedilol. AV block and LV dysfunction persisted despite 2 weeks of treatment. He ultimately became hypotensive which prompted an implantation of a cardiac resynchronisation therapy pacemaker. Follow-up echocardiogram at 6 weeks showed resolution of LV systolic dysfunction. However, he continued to have AV block., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of this study was to investigate and compare total mercury (Hg), selenium (Se), and Se:Hg molar ratios in fish muscles (phytophages n=3; benthophages n=32; predators n=5) and semiaquatic carnivores, including piscivores (the European otter n=8, the feral American mink n=7) and the omnivorous raccoon (n=37) from a riverine European ecosystem in a Se-deficient area. The Hg concentration in fish reached 0.337μg/g dry weight, dw (0.084μg/g wet weight, ww). We found significant differences among Hg levels in tested vertebrate groups (predators vs benthophages: 0.893 vs 0.281μg/g; piscivores vs omnivores: 6.085 vs 0.566μg/g dw). Fish groups did not differ in Se concentrations, with a mean value of 0.653μg/g dw. Significant differences were revealed between Se levels in piscivorous and omnivorous carnivores (0.360 vs 0.786μg/g dw, respectively). Fish Se:Hg molar ratio values were >2.2. Benthophages had higher the ratio than predators but similar to phytophages. Among carnivores, piscivores had much lower the ratio than raccoon (0.14 vs 3.75) but raccoon and fish medians did not significantly differ. We found almost two times higher Se levels in fish and raccoons compared to piscivores, possibly resulting from lower fish Se digestibility by piscivores in contrast to higher absorption of plant Se by many fish and omnivorous raccoons. Considering that a tissue Se:Hg molar ratio <1 may be connected with a Hg toxicity potential increase, we assume that piscivores in Se-deficient area are in worse situation and more exposed to Hg than fish and omnivores., (Copyright © 2016 Elsevier Inc. All rights reserved.)

A dedicated ultrasonic scanner for acquiring RF echoes backscattered from the trabecular bone was developed. The design of device is based on the goal of minimizing of custom electronics and computations executed solely on the main computer processor and the graphics card. The electronic encoder-digitizer module executing all of the transmission and reception functions is based on a single low-cost field programmable gate array (FPGA). The scanner is equipped with a mechanical sector-scan probe with a concave transducer with 50 mm focal length, center frequency of 1.5 MHz and 60% bandwidth at -6 dB. The example of femoral neck bone examination shows that the scanner can provide ultrasonic data from deeply located bones with the ultrasound penetrating the trabecular bone up to a depth of 20 mm. It is also shown that the RF echo data acquired with the scanner allow for the estimation of attenuation coefficient and frequency dependence of backscattering coefficient of trabecular bone. The values of the calculated parameters are in the range of corresponding in vitro data from the literature but their variation is relatively high.

Introduction: The elder abuse and neglect burden in Milwaukee County, Wisconsin, is substantial, with 3384 reports made from 2006 to 2009. Current prevalence estimates are determined from reported cases only and are likely underestimated. Provider awareness of victim and perpetrator characteristics is necessary to increase recognition and response., Methods: A cross-sectional analysis of elder abuse and neglect cases reported to the Milwaukee County Department on Aging (MCDA) from 2006 to 2009 was performed to provide a profile of the county's elder abuse burden by victim, perpetrator, and reporter characteristics. Annual reporting trends were identified using Poisson regression analysis., Results: Fifty-eight percent of MCDA reports of abuse were substantiated after investigation. Victims in Milwaukee County tended to be older than 75 (64%), female (64%), and white (62%). Reporting rates to the MCDA were significantly lower in 2009 than 2006. Perpetrators were often adult children (48%) or a spouse (14%). Forty percent of life-threatening cases of self-neglect were due to unfulfilled medical needs. Most reports were made by medical professionals (23%), relatives of the victim (21%), and community agencies (18%). Only 13% of elder abuse victims were placed in nursing homes and assisted living centers; many received services to assist independent living., Discussion: Although this study is limited to reported cases only, it provides a valuable profile of pertinent elder abuse characteristics in Milwaukee County., Conclusion: Characteristics of vulnerable elders, potential abusers, and investigation outcomes are described to inform clinical practice about this important social issue.

The paper describes the investigations intended to compare the results of experimental measurements of backscattering properties of the trabecular bone with the results of computer simulations. Ultrasonic RF echoes were collected using two bone scanners operating at 0.58 and 1.3 MHz. The simulations of the backscattered RF echoes were performed using the scattering model of the trabecular bone that consisted of cylindrical and spherical elements uniformly distributed in water-like medium. For each measured or simulated RF backscatter the statistical properties of the signal envelope were determined. Experimental results suggest deviations of the backscattering properties from the Rayleigh distribution. The results of simulation suggest that deviation from Rayleigh distribution depends on the variation of trabeculae diameters and the number of thin trabeculae. Experimentally determined deviations corresponded well to the deviations calculated from simulated echoes assuming trabeculae thickness variation equaled to the earlier published histomorphometric study results., (© 2011 Acoustical Society of America)

Background: Little data exists describing the impact that walking has on metabolic syndrome (MetS) in a multicultural sample of older adults., Methods: Walking was measured via pedometer in 150 older adults from 4 different ethnic categories. Steps per day were classified as low (< 3100 steps/d) or high (> or = 3100 steps/d) for statistical analyses., Results: Occurrence of MetS was lower in the white (33%) versus non-white population (50%). Low steps/d were related to an increase in MetS for both white (OR = 96.8, 95% CI 12.3-764.6) and non-white individuals (OR = 4.5, 95% CI 1.8-11.3). Low steps/d also increased the odds for selected components of MetS in both the white and non-white groups., Conclusion: Low levels of walking increase the likelihood of having MetS in both white and nonwhite older adults. Efforts to increase walking in older adults may decrease the likelihood of developing this clustering of disease risk factors.

Background: The purpose of this study was to examine the extent to which physical activity (PA) is related to obesity in older adults when accounting for race/ethnicity., Methods: Cross-sectional data were collected on 214 older adults (72.3 +/- 8.9 y; body mass index [BMI] 28.9 +/- 6.0; 151 females; 96 non-White). Measures of body height and mass were collected; BMI was calculated. PA was assessed via an electronic pedometer worn for seven consecutive days., Results: "White" subjects accumulated 5036 +/- 286 steps/d. "Non-White" subjects accumulated significantly fewer steps/d (3671 +/- 253 steps/d; z = -3.45, P = 0.001). Race/ethnicity, income, age, gender, and steps/d accounted for 27.4% (P < 0.001) of the variance in BMI, with steps/d accounting for 21.2% (P < 0.001). The most influential factor in this model was PA level (beta = -0.510), followed by age (beta = -0.220), and finally gender being the least influential, but still a significant factor (beta = 0.168)., Conclusion: Although race/ethnicity and income have been associated with obesity levels, this study shows that older adults who accumulate more ambulatory activity tend to have healthier levels of BMI irrespective of race/ethnicity or income.