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Objectives: To detect the virulence factors of yeasts which are proteinase and phospholipase which have important role in the pathogenesis of oral lesions. Patients and methods: This study included 120 children manifested with oral lesions admitted to the Consultating Clinic and Medical Wards of Ibn – Sina and Ibn Al – Ather Teaching Hospitals in addition to Neonatal Care Unit of Al – Battol Teaching Hospital. Samples collected during the period from December 2012 – May 2013. Control group was 60 apparently healthy children from whom oral swabs 'were obtained. Identification' of' the isolated yeasts were conceded by "direct examination, culture, biochemical tests and API – 20 C system, then detection of' protienase and phospholipase of yeasts isolated from oral lesions". Results: Candida albicans isolates have a high expression rate for the production of proteinase (95.3%) and phospholipase(97.1%) in comparison to the other candida and yeast species with a significant difference (p = 0.001). Conclusion: The isolates produce two important virulence factors namely proteinase and phospholipase significantly more in Candida albicans than other yeasts.

This article explores the portrayal of Mulan as a symbol of women's empowerment in Disney’s animated "Mulan" (1998) and live-action adaptation (2020). Drawing on Stuart Hall’s theory of reception study, the study examines how both films depict Mulan’s defiance of traditional gender roles and her journey towards empowerment. Through qualitative analysis of audience responses, it reveals that respondents from diverse backgrounds perceive Mulan as a bold, intelligent, and resourceful heroine who challenges societal expectations. In the 1998 animated film, Mulan's valor in replacing her father in battle resonates with themes of courage and sacrifice, while the 2020 live-action adaptation emphasizes her personal growth and mastery of chi, focusing less on romance and more on self-actualization. The findings underscore the films’ success in conveying messages of female empowerment across cultural and cinematic contexts, reflecting shifts in societal attitudes and interpretations of gender roles. Keywords : Mulan, Disney, Reception, Audience Meaning, Societal Expectations, Gender Roles

PT. XYZ is currently facing challenges in conducting their Good Corporate Governance (GCG) comprehension survey due to the manual distribution and collection of survey data using Google Drive and Microsoft Excel. To address this issue, the researcher proposes the development of a web-based E-Survey application to streamline the survey process. The development follows the waterfall model and utilizes the Laravel framework. To ensure its effectiveness, the application undergoes Load Testing to assess its performance with multiple users and User Acceptance Test (UAT) to evaluate its alignment with company requirements. The results indicate that the system operates optimally with up to 100 users and receives a favorable score on the System Usability Scale (SUS). This application provides a suitable solution for conducting comprehension surveys at PT. XYZ.

Fungsi pengawasan dalam manajemen pendidikan menjadi salah satu peran penting, guna mencapai tujuan pendidikan agar berjalan sesuai yang ditetapkan. Sayangnya, pelaksanaan pengawasan sekolah di Indonesia ternyata masih menemui hambatan dan kendala yang menyebabkan program tidak berjalan dengan efektif. Penelitian ini bertujuan untuk mencari tahu kinerja pengawas di jenjang sekolah yayasan menengah pertama ditinjau dari perspektif guru dan kepala sekolah. Penelitian dilakukan menggunakan metode deskriptif kuantitatif dengan melibatkan 54 orang diantaranya 51 guru, 2 kepala sekolah, 1 wakil kepala sekolah dari dua sekolah yang berbeda. Hasil penelitian menunjukkan bahwa secara umum, kinerja pengawas di jenjang sekolah menengah pertama mendapat respon yang positif dari guru dan kepala sekolah. Namun masih ada beberapa ruang lingkup tugas pengawas yang perlu perbaikan seperti pemantauan dalam elaborasi kemampuan peserta didik, pemantauan pengelolaan keuangan, dan pembimbingan dalam meningkatkan kompetensi pengelolaan kelas bagi guru.

The processing of fishery products in an effort to increase the economic sector is carried out by the Kelompok Usaha Bersama (Kube) Jaya Abadi and the Usaha Peningkatan Pendapatan Keluarga (UP2K) Sawo located in Pengudang Village, Teluk Sebong Sub-district, Bintan District. Through the Doktor Mengabdi program, the Doktor Mengabdi and Kuliah Kerja Nyata Tematik at Universitas Brawijaya offer packaging and label redesign to increase selling value to become a superior product that can penetrate a wider market. Activities carried out include from gathering information through interviews via telephone and text messages to providing training and counseling on packaging and product labels. The result of this activity is knowledge about increasing the selling value of products through packaging and labels, as well as assistance with various equipment along with printed packaging and labels.

The dysregulation of myeloid-derived cell metabolism can drive atherosclerosis. AMP-activated protein kinase (AMPK) controls various aspects of macrophage dynamics and lipid homeostasis, which are important during atherogenesis. Using LysM-Cre to drive the deletion of both the α1 and α2 catalytic subunits (MacKO), we aimed to clarify the role of myeloid-specific AMPK signaling in male and female mice made acutely atherosclerotic by injection of AAV vector encoding a gain-of-function mutant PCSK9 (PCSK9-AAV) and WD feeding. After 6 weeks of WD feeding, mice received a daily injection of either the AMPK activator A-769662 or a vehicle control for an additional 6 weeks. Following this (12 weeks total), we assessed myeloid cell populations and differences between genotype or sex were not observed. Similarly, aortic sinus plaque size, lipid staining, and necrotic area did not differ in male and female MacKO mice compared with their littermate floxed controls. Moreover, therapeutic intervention with A-769662 showed no treatment effect. There were also no observable differences in the amount of circulating total cholesterol or triglyceride, and only minor differences in the levels of inflammatory cytokines between groups. Finally, CD68+ area and markers of autophagy showed no effect of either lacking AMPK signaling or AMPK activation. Our data suggest that while defined roles for each catalytic AMPK subunit have been identified, complete deletion of myeloid AMPK signaling does not significantly impact atherosclerosis. Additionally, these findings suggest that intervention with the first-generation AMPK activator A-769662 is not able to stem the progression of atherosclerosis.

AbstrakUntuk mematuhi Peraturan Presiden No. 95 Tahun 2019 tentang Sistem Pemerintahan Berbasis Elektronik(SPBE), Pemerintah Kabupaten Bandung Barat harus mampu menyelaraskan layanan bisnis dengan teknologi informasi yang ada, khususnya pada fungsi promosi Dinas Pariwisata dan Kebudayaan. Enterprise Architecture merupakan salah satu metode yang dapat digunakan untuk menyelaraskan strategi bisnis dengan teknologi informasi dan mendukung program SPBE. Dalam melakukan perancangan EA dibutuhkan framework arsitektur untuk mengembangkan lingkup pembahasan secara luas dari sisi bisnis, aplikasi, data, dan teknologi. Framework yang digunakan pada perancangan ini adalah TOGAF ADM yang terdiri dari 9 fase. Pada penelitian ini, peneliti mengambil studi kasus pada Fungsi Promosi dengan menjadikan Government Service Bus (GSB) sebagai teknologi utama. Enterprise Architecture yang diharapkan dapat mempermudah pencapaian tujuan strategis, peningkatan proses bisnis, sistem informasi, dan teknologi informasi yang digunakan. Dari penelitian ini akan dihasilkan output berupa cetak biru dari rancangan enterprise architecture fase information system pada fungsi promosi Dinas Pariwisata dan Kebudayaan. Penilitian ini dapat menjadi referensi untuk pengembangan lebih lanjut hingga fase change management architecture.Kata kunci: SPBE, Enterprise Architecture, TOGAF ADM, GSB Abstract[Information System Architecture Analysis and Design Using TOGAF ADM in Promotion Function (Case Study: Department of Tourism and Culture in Bandung Barat Government)]. To approve Presidential Regulation No. 95 of 2019 concerning Electronic Based Government Systems (SPBE), the Government of West Bandung Regency must provide aligning business services with existing information technology, specifically in the promotion function of the Office of Tourism and Culture. Company architecture is one method that can be used to align business strategies with information technology and support the SPBE program. In designing an EA, an architectural framework is needed to develop broader, business, application, data and technology approvals. The framework used in this design is TOGAF ADM which consists of 9 phases. In this study, researchers took a case study on the Promotion Function by making the Government Service Bus (GSB) the main technology. The company architecture is expected to achieve strategic objectives, business process improvement, information systems, and information technology used. This research will produce output in the form of a blueprint of the architecture of the enterprise information system phase of the promotion of the Department of Tourism and Culture. This research can be a reference for further development until the phase of management architecture change TOGAF ADM.Keywords: SPBE, Enterprise Architecture, TOGAF ADM, GSB

The present study aims to reveal how to teach basic nanotechnology in daily life to students with deaf and hard of hearing (DHH). The study used a single-subject research approach in one special needs elementary school in Bandung (i.e., four students with DHH using pre- and post-test). The teaching was delivered using a bilingual method (i.e., sign and writing-and-speaking methods) completed with experimental demonstration. The results revealed that difficult subject (such as nanotechnology) could be taught to DHH students. However, the main key point is the way how to deliver the subject. The additional experimental demonstration is effective to boost the level of students’ understanding. In addition, the surrounding factors (i.e., light brightness) have a great impact for DHH students to understand what the teacher has articulated during the teaching and learning process as they relied on reading the lip movements of the teacher.

The authors present a historical analysis of the first neurosurgical service in Texas. Initially established as a subdivision within the Department of Surgery in the early 1900s, this service eventually evolved into the Department of Neurosurgery at the University of Texas Medical Branch (UTMB). The pivotal contributions of individual chiefs of neurosurgery throughout the years are highlighted, emphasizing their roles in shaping the growth of the neurosurgery division. The challenges faced by the neurosurgical division are documented, with particular attention given to the impact of hurricanes on Galveston Island, Texas, which significantly disrupted hospital operations. Additionally, a detailed account of recent clinical and research expansions is presented, along with the future directions envisioned for the Department of Neurosurgery. This work offers a comprehensive historical narrative of the neurosurgical service at UTMB, chronicling its journey of growth and innovation, and underscoring its profound contributions to Galveston's healthcare services, extending its impact beyond the local community.

Objective: We aimed to assess the incidence and risk factors for de novo epilepsy after arteriovenous malformation (AVM) resection and compare them with a nonresection cohort after propensity score matching, utilizing a national database., Methods: Utilizing the TriNetX Research Network, we queried cases from January 1, 2004 to March 1, 2022. We included patients of all ages who underwent supratentorial AVM resection, presenting without seizures on or before surgery and without being on antiseizure medications at least 1 day before surgery. The primary outcome was seizures manifesting at least 6 weeks after surgery. Patient characteristics and outcomes were compared between the cohorts with and without postoperative epilepsy. Further cohorts were created to compare cohorts with and without embolization or rupture. After propensity score matching, we compared an additional cohort of patients with an AVM diagnosis who did not undergo resection., Results: Of the 536 patients (mean age = 38.9 ± 19.6, 52% females) presenting without seizure who underwent AVM resection, 99 (18.5%) developed de novo epilepsy, with a 1-year cumulative incidence of 13.8%. Patients with epilepsy had higher rates of intracerebral hemorrhage, and intracerebral hemorrhage was less common in the embolization cohort. Patients in the ruptured cohort were older and more often males. After propensity score matching with 18 588 patients with AVM diagnosis but no resection, each group consisted of 529 patients, and de novo epilepsy at 1 year was significantly higher in the AVM resection cohort compared to the nonresection cohort (11.5% vs. 3.4%, p < .001)., Significance: This analysis of 536 patients provides evidence that de novo epilepsy after brain AVM resection occurs at a 1-year cumulative incidence of 13.8%, with a total of 19.4% developing de novo epilepsy. Intracerebral hemorrhage was inconsistently associated with postoperative de novo epilepsy. De novo epilepsy was significantly less frequent after AVM diagnosis without resection., (© 2023 International League Against Epilepsy.)

Objective: Middle meningeal artery embolization (MMAE) is an effective minimally invasive option for chronic subdural hematoma (cSDH). Dexamethasone and statins have been reported to improve the resolution of cSDH and reduce its recurrence. However, only 1 study has investigated the role of statins in patients treated with MMAE, and there is no such study on dexamethasone. Thus, we used the TriNetX research network to determine whether adding dexamethasone or statin along with primary MMAE is associated with a benefit in outcomes., Methods: We queried all primary MMAE cases for cSDH between January 1st, 2012, and July 1st, 2022, in the TriNetX research network. We included patients greater than or equal to 18 years old and separated them regarding statin and dexamethasone use around the time of MMAE. Outcomes were evaluated within 6 months and 3 years after MMAE, and analyses were performed before and after propensity score matching., Results: The study included 372 patients with chronic subdural hematoma who underwent MMAE and were on dexamethasone, 339 not on dexamethasone, 391 on statins, and 278 not on statins. After propensity score matching, the dexamethasone cohorts included 250 patients each and only headache remained more prevalent in the dexamethasone cohort at both 6 months (21.2% vs. 10.0%, P = 0.001) and 3 years (23.6% vs. 12.4%, P = 0.001). After propensity score matching, the statin cohorts included 150 patients each and no differences in outcomes were found at both 6 months and 3 months after MMAE., Conclusions: Patients treated with primary MMAE and were on dexamethasone or statins had no differences in mortality and functional/provider dependence compared to those who were not on dexamethasone or statins. Patients on dexamethasone had a higher prevalence of headaches., (Copyright © 2023. Published by Elsevier Inc.)

Background: Dural venous sinus stenting (VSS) is an effective intervention for patients with idiopathic intracranial hypertension (IIH) refractory to medical treatment. Our goal was to evaluate the efficacy by utilizing a large multi-institutional sample., Methods: Five hundred forty-one patients >18 years old who underwent VSS within 3 years of IIH diagnosis were queried using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes from the TriNetX Analytics Network. Patient demographics, baseline symptoms, procedures, and clinical outcomes were evaluated within 1 year postoperatively. Outcomes examined were headache, tinnitus, blindness/low vision, optic nerve sheath fenestration (ONSF), cerebrospinal fluid (CSF) shunt, and use of medications (acetazolamide, methazolamide, furosemide, topiramate, tricyclic antidepressants, and valproate) for IIH. Prestent and poststent data were compared using Fisher exact test, and the odds ratios were computed using the Baptista-Pike method., Results: The mean age at VSS was 36.7 ± 10.6; 92% were female, 65% of patients were Caucasian, 25% were Black/African American, 1% were Asian, and 9% were of other/unknown race. Within the 1-year follow-up, acetazolamide and topiramate use were significantly reduced post-VSS (P < 0.0001∗; odds ratio, 0.45; confidence interval, 0.35-0.57 and P = 0.03∗; odds ratio, 0.71; confidence interval, 0.52-0.95, respectively). Also, headaches, visual disturbance, dizziness/giddiness, and tinnitus significantly improved post-VSS (P < 0.005∗). Finally, the number of CSF shunt procedures and ONSF procedures demonstrated no significant change post-VSS (P > 0.05)., Conclusions: VSS is an effective and safe procedure resulting in significant improvement of headaches, visual impairment, dizziness, and tinnitus, acetazolamide and topiramate usage were lower after VSS in patients with IIH. The paucity of pre-VSS and post-VSS CSF shunt and ONSF procedure data does not provide enough evidence to establish significance., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Middle meningeal artery embolization (MMAE) is an effective minimally invasive treatment for chronic subdural hematomas (cSDHs). The authors investigated outcomes of primary, adjunct, and rescue MMAE and primary surgery for the treatment of cSDH using a large-scale national database., Methods: A retrospective study of all patients who underwent MMAE and/or surgery to treat cSDH was performed using the TriNetX Analytics Network. Primary MMAE was compared with adjunct and rescue MMAE and primary surgery. Primary outcomes included headache, facial weakness, mortality, and treatment failure, within 6 months., Results: A total of 4274 patients with cSDH met the inclusion criteria. Of these, 209 (4.9%) were treated with primary MMAE, 4050 (94.8%) were treated with primary surgery, 15 (0.35%) were treated using MMAE as an adjunct therapy, and 18 (0.42%) were treated using MMAE as a rescue following a failed surgical intervention. There were no significant differences in headache, facial weakness, and mortality between the groups. Patients who underwent primary MMAE had a significantly higher Charlson comorbidity index (P < 0.0001) than those who underwent primary surgery. The need for surgical rescue was not significantly different between primary MMAE, adjunct MMAE, and rescue MMAE (P > 0.05). Additionally, patients with primary surgery had significantly higher treatment failure than those with primary MMAE (odds ratio = 2.11, 95% confidence interval = 1.11-4.01, P = 0.020)., Conclusions: This analysis suggests no significant difference in the need for surgical rescue, complication, or mortality between primary MMAE, adjunct MMAE, and rescue MMAE. Additionally, primary MMAE is associated with a significantly lower need for surgical rescue than primary surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Cerebrovascular diseases (CVDs), including varying strokes, can recur in patients upon coronavirus disease 2019 (COVID-19) diagnosis, but risk factor stratification based on stroke subtypes and outcomes is not well studied in large studies using propensity-score matching. We identified risk factors and stroke recurrence based on varying subtypes in patients with a prior CVD and COVID-19., Methods: We analyzed data from 45 health care organizations and created cohorts based on ICDs for varying stroke subtypes utilizing the TriNetX Analytics Network. We measured the odds ratios and risk differences of hospitalization, ICU/critical care services, intubation, mortality, and stroke recurrence in patients with COVID-19 compared to propensity-score matched cohorts without COVID-19 within 90-days., Results: 22,497 patients with a prior history of CVD within 10 years and COVID-19 diagnosis were identified. All cohorts with a previous CVD diagnosis had an increased risk of hospitalization, ICU, and mortality. Additionally, the data demonstrated that a history of ischemic stroke increased the risk for hemorrhagic stroke and transient ischemic attack (TIA) (OR:1.59, 1.75, p-value: 0.044*, 0.043*), but a history of hemorrhagic stroke was associated with a higher risk for hemorrhagic strokes only (ORs 3.2, 1.7, 1.7 and p-value: 0.001*, 0.028*, 0.001*). History of TIA was not associated with increased risk for subsequent strokes upon COVID-19 infection (all p-values: ≥ 0.05)., Conclusions: COVID-19 was associated with an increased risk for hemorrhagic strokes and TIA among all ischemic stroke patients, an increased risk for hemorrhagic stroke in hemorrhagic stroke patients, and no associated increased risk for any subsequent strokes in TIA patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Tirofiban is a glycoproteine (GP) IIb/IIIa receptor antagonist, which inhibits platelet-platelet aggregation and is a potential adjunctive antithrombotic treatment in patients with acute coronary syndromes (ACS) or high-risk percutaneous coronary interventions (PCI). It is administered intravenously as a bolus followed by continuous infusion. However, the dosage recommendations in the United States (US) and European Union (EU) differ considerably. Furthermore, in routine clinical practice, deviations from the recommendations may occur. The objective of the present study was to investigate the impact of different alterations on tirofiban plasma concentrations in US and EU administration regimens and to give suggestions for delay management in clinical practice. We therefore mathematically simulated the effects of different bolus-infusion delays and infusion interruptions in different scenarios according to the renal function. Here, we provide a systematic assessment of concentration patterns of tirofiban in the US versus EU dosage regimens. We show that differences between the two regimens have important effects on plasma drug levels. Furthermore, we demonstrate that deviations from the proper administration mode affect the concentration of tirofiban. Additionally, we calculated the optimal dosage of a second bolus to rapidly restore the initial concentration without causing overdosage. In conclusion, differences in tirofiban dosing regimens between the U.S and EU and potential infusion interruptions have important effects on drug levels that may impact on degrees of platelet inhibition and thus antithrombotic effects. Thus, the findings of our modelling studies may help to explain differences in clinical outcomes observed in previous clinical trials on tirofiban., (© 2022. The Author(s).)

Objective: To describe recent trends in treatment and outcomes of endovascular coil embolization and microsurgical clipping treatment strategies for ruptured intracranial aneurysms., Methods: Using International Classification of Diseases, Tenth Revision, codes, 1332 propensity-matched patients >18 years old who underwent coiling or clipping were identified. Patient demographics, baseline characteristics, comorbidities, and clinical outcomes were evaluated within 1 year postoperatively. Pooled and individual studies of the International Classification of Diseases codes investigated differences in clinical outcomes owing to aneurysm location. Outcomes were mortality, intensive care, surgical complications, hydrocephalus, and vasospasm., Results: After propensity matching for baseline characteristics and comorbidities, 666 patients were included in the coiling and clipping cohorts. There was no significant difference in 1-year mortality between cohorts. However, incidence of intensive care, surgical/medical complications, and vasospasm was significantly lower in the pooled coiling cohort (P = 0.02, P = 0.03, and P = 0.014) compared with the clipping cohort within 1 year postoperatively. Additionally, individual International Classification of Diseases code analysis revealed that coiling of anterior communicating artery aneurysms was associated with significantly fewer surgical/medical complications and hydrocephalus (P = 0.0008 and P = 0.015) and coiling of posterior communicating artery aneurysms was associated with substantially less vasospasm treatment (P = 0.034) compared with the respective clipping cohorts., Conclusions: Analysis revealed no difference in 1-year mortality between coiling and clipping. Clinical outcomes, including intensive care, surgical complications, and vasospasm, favored coiling regardless of aneurysm location. Patients with coiling of anterior communicating artery aneurysms had significantly less hydrocephalus and patients with coiling of posterior communicating artery aneurysms had substantially less vasospasm treatment within 1 year compared with the clipping cohort., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: We set out to evaluate the risk for severe coronavirus disease 2019 (COVID-19) infection and subsequent cerebrovascular disease (CVD) in the population with a prior diagnosis of CVD within the past 10 years., Methods: We utilized the TriNetX Analytics Network to query 369,563 CO-VID-19 cases up to December 30, 2020. We created 8 cohorts of patients with COVID-19 diagnosis based on a previous diagnosis of CVD. We measured the odds ratios, relative risks, risk differences for hospitalizations, ICU/critical care services, intubation, mortality, and CVD recurrence within 90 days of COVID-19 diagnosis, compared to a propensity-matched cohort with no prior history of CVD within 90 days of COVID-19 diagnosis., Results: 369,563 patients had a confirmed diagnosis of COVID-19 with a subset of 22,497 (6.09%) patients with a prior diagnosis of CVD within 10 years. All cohorts with a CVD diagnosis had an increased risk of hospitalization, critical care services, and mortality within 90 days of COVID-19 diagnosis. Additionally, the data demonstrate that any history of CVD is associated with significantly increased odds of subsequent CVD post-COVID-19 compared to a matched control., Conclusions: CVD, a known complication of CO-VID-19, is more frequent in patients with a prior history of CVD. Patients with any previous diagnosis of CVD are at higher risks of morbidity and mortality from COVID-19 infection. In patients admitted to the ED due to COVID-19 symptoms, these risk factors should be promptly identified as delayed or missed risk stratification and could lead to an ineffective and untimely diagnosis of subsequent CVD, which would lead to protracted hospitalization and poor prognosis., (© 2021 S. Karger AG, Basel.)

Background: Middle meningeal artery embolization (MMAE) has been used as an effective minimally invasive treatment for chronic subdural hematoma (cSDH). The demographics and clinical outcomes after MMAE treatment for cSDH have not yet been studied using a national database., Methods: We queried all MMAE cases up to October 7, 2020, from the TriNetX Analytics Network. We identified patients >18 years old who underwent MMAE for treatment of cSDH. Patient demographics, baseline characteristics, comorbidities, and clinical outcomes were evaluated within 180 days after MMAE. Analyses of 180-day mortality and recurrence were performed after propensity score matching to control for baseline characteristics and comorbidities., Results: The study included 191 patients (mean age 71.2 ± 13.5 years, 73.3% male, 69.6% White, 13.6% Black/African American, and 16.8% other race). Essential hypertension (71.3%), heart disease (62.8%), type 2 diabetes mellitus (27.2%), nicotine dependence (23.6%), chronic kidney disease (19.4%), and overweight/obesity (19.4%) were among the most prevalent comorbidities. At presentation, 20.4% and 40.3% of patients were on antiplatelet and anticoagulation therapy, respectively. Outcomes within 180-day follow-up were 6.3% (1.0%-5.8% when propensity matched) for mortality (12 patients), 7.3% for craniotomy/craniectomy after MMAE (14 patients), 0.52%-5.2% for burr hole procedures (1-10 patients), and no patients with low vision/blindness., Conclusions: MMAE is a safe and effective minimally invasive procedure for treatment of cSDH. This is the first analysis of patients undergoing MMAE for cSDH using a national database., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Yolk sac tumor (YST) is the most common prepubertal testicular tumor. It is considered a subtype of non-seminoma germ cell tumor (NSGCT) that is presumed to have an aggressive behavior with high malignant potential, thus requiring multimodality treatment with resection and chemotherapy. Treatment is curative for the majority of patients, even the ones with relapse after a few years. Here, we describe for the first time an atypical case of YST recurrence 17 years after primary treatment of YST. This is a case of YST in a 32-year-old man who presented with a large cerebellar mass consistent with YST recurrence after being in remission for 17 years. He underwent suboccipital craniotomy and complete excision of the tumor, as evident on postoperative MRI with a plan for stereotactic radiosurgery with dose and fractionation determined by MRI at four weeks postoperatively. However, the four-week MRI postoperatively revealed a large mass that was engulfing the prior resection cavity, indicative of unusual rapid tumor recurrence despite evidence of complete resection. The highly aggressive nature of this tumor should prompt clinicians to consider chemotherapy and radiation earlier than four weeks postoperatively., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Nia et al.)

Oro- and nasopharyngeal swab specimens by quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 is currently the main diagnostic tool during the ongoing COVID-19 pandemia. Accurate performance of the procedure to avoid false negative results, adequate personal protective equipment and material sparing algorithms are mandatory while obtaining swab specimens. In the current stey-by-step review a feasible approach will be presented., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Pathogenic Rickettsia species belonging to the spotted fever group are arthropod-borne, obligate intracellular bacteria which exhibit preferential tropism for host microvascular endothelium in the mammalian hosts, resulting in disease manifestations attributed primarily to endothelial damage or dysfunction. Although rickettsiae are known to undergo evolution through genomic reduction, the mechanisms by which these pathogens regulate their transcriptome to ensure survival in tick vectors and maintenance by transovarial/transstadial transmission, in contrast to their ability to cause debilitating infections in human hosts remain unknown. In this study, we compare the expression profiles of rickettsial sRNAome/transcriptome and determine the transcriptional start sites (TSSs) of R. conorii transcripts during in vitro infection of human and tick host cells., Results: We performed deep sequencing on total RNA from Amblyomma americanum AAE2 cells and human microvascular endothelial cells (HMECs) infected with R. conorii. Strand-specific RNA sequencing of R. conorii transcripts revealed the expression 32 small RNAs (Rc&#95;sR's), which were preferentially expressed above the limit of detection during tick cell infection, and confirmed the expression of Rc&#95;sR61, sR71, and sR74 by quantitative RT-PCR. Intriguingly, a total of 305 and 132 R. conorii coding genes were differentially upregulated (> 2-fold) in AAE2 cells and HMECs, respectively. Further, enrichment for primary transcripts by treatment with Terminator 5'-Phosphate-dependent Exonuclease resulted in the identification of 3903 and 2555 transcription start sites (TSSs), including 214 and 181 primary TSSs in R. conorii during the infection to tick and human host cells, respectively. Seventy-five coding genes exhibited different TSSs depending on the host environment. Finally, we also observed differential expression of 6S RNA during host-pathogen and vector-pathogen interactions in vitro, implicating an important role for this noncoding RNA in the regulation of rickettsial transcriptome depending on the supportive host niche., Conclusions: In sum, the findings of this study authenticate the presence of novel Rc&#95;sR's in R. conorii, reveal the first evidence for differential expression of coding transcripts and utilization of alternate transcriptional start sites depending on the host niche, and implicate a role for 6S RNA in the regulation of coding transcriptome during tripartite host-pathogen-vector interactions.

Characterization of lipids by matrix-assisted laser desorption ionization mass spectrometry imaging (MALDI-MSI) is of great interest because not only are lipids important structural molecules in both the cell and internal organelle membranes, but they are also important signaling molecules. MALDI-MSI combined with spatial image segmentation has been previously used to identify tumor heterogeneities within tissues with distinct anatomical regions such as the brain. However, there has been no systematic study utilizing MALDI-MSI combined with spatial image segmentation to assess the tumor microenvironment in the liver. Here, we present that image segmentation can be used to evaluate the tumor microenvironment in the liver. In particular, to better understand the molecular mechanisms of irradiation-induced hepatic carcinogenesis, we used MALDI-MSI in the negative ion mode to identify lipid changes 12 months post exposure to low dose 28 Si and 137 Cs γ ray irradiation. We report here the changes in the lipid profiles of male C3H/HeNCrl mice liver tissues after exposure to irradiation and analyzed using the spatial shrunken centroid clustering algorithm. These findings provide valuable information as astronauts will be exposed to high-charge high-energy (HZE) particles and low-energy γ-ray irradiation during deep space travel. Even at low doses, exposure to these irradiations can lead to cancer. Previous studies infer that irradiation of mice with low-dose HZE particles induces oxidative damage and microenvironmental changes that are thought to play roles in the pathophysiology of hepatocellular carcinoma., Competing Interests: The authors declare no competing financial interest.

Background: Identification of complex multidimensional interaction patterns within microbial communities is the key to understand, modulate, and design beneficial microbiomes. Every community has members that fulfill an essential function affecting multiple other community members through secondary metabolism. Since microbial community members are often simultaneously involved in multiple relations, not all interaction patterns for such microorganisms are expected to exhibit a visually uninterrupted pattern. As a result, such relations cannot be detected using traditional correlation, mutual information, principal coordinate analysis, or covariation-based network inference approaches., Results: We present a novel pattern-specific method to quantify the strength and estimate the statistical significance of two-dimensional co-presence, co-exclusion, and one-way relation patterns between abundance profiles of two organisms as well as extend this approach to allow search and visualize three-, four-, and higher dimensional patterns. The proposed approach has been tested using 2380 microbiome samples from the Human Microbiome Project resulting in body site-specific networks of statistically significant 2D patterns as well as revealed the presence of 3D patterns in the Human Microbiome Project data., Conclusions: The presented study suggested that search for Boolean patterns in the microbial abundance data needs to be pattern specific. The reported presence of multidimensional patterns (which cannot be reduced to a combination of two-dimensional patterns) suggests that multidimensional (multi-organism) relations may play important roles in the organization of microbial communities, and their detection (and appropriate visualization) may lead to a deeper understanding of the organization and dynamics of microbial communities. Video Abstract.

Lipid-lowering therapy is one major cornerstone of medical treatment of cardiovascular disease in order to modulate atherosclerosis. Statins, ezetimibe and novel PCSK9-inhibitors are already recommended in current guidelines and were shown to improve lipid profiles and have positive effects on the rate of ischemic events and cardiovascular mortality. Recent studies suggest that the concept of "The lower the better" might be valid at least regarding low density lipoproteins. In addition, lowering lipoprotein (a) still displays a major challenge in lipid therapy. Furthermore, also lowering triglycerides seems to improve cardiovascular outcome. Regarding triglycerides, icosapent ethyl, a polyunsaturated fatty acid recently attracted attention showing cardiovascular risk reduction due to triglyceride lowering. Therefore, new therapeutic strategies and drug classes are eagerly awaited. Targeting LDL, bempedoic acid and the siRNA inclisiran provide promising results. Moreover, regarding TG a monoclonal antibody called evinacumab and an antisense-oligonucleotide against ANGPTL3 showed effective TG-lowering. At least, using antisense-oligonucleotides against ApoC-III and Lp(a) resulted in promising outcomes. In this review, current and future options for lipid management are presented depending on different drug classes., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2020. Published by Elsevier Inc.)

Background: Profound knowledge about cardiovascular physiology in the setting of microgravity can help in the course of preparations for human space missions. So far, influences of microgravity on the cardiovascular system have been demonstrated, particularly pertaining to venous fluid shifts. Yet, little is known about the mechanisms of these adaptations on continuous macrocirculatory level and regarding the microcirculation., Methods: Twelve healthy volunteers were subjected to alternating microgravity and hypergravity in the course of parabolic flight maneuvers. Under these conditions, as well as in normal gravity, the sublingual microcirculation was assessed by intravital sidestream dark field microscopy. Furthermore, hemodynamic parameters such as heart rate, blood pressure, and cardiac output were recorded by beat-to-beat analysis. In these settings, data acquisition was performed in seated and in supine postures., Results: Systolic [median 116 mmHg (102; 129) interquartile range (IQR) vs. 125 mmHg (109; 136) IQR, p = 0.01] as well as diastolic [median 72 mmHg (61; 79) IQR vs. 80 mmHg (69; 89) IQR, p = 0.003] blood pressure was reduced, and cardiac output [median 6.9 l/min (6.5; 8.8) IQR vs. 6.8 l/min (6.2; 8.5) IQR, p = 0.0002] increased in weightlessness compared to normal gravitation phases in the seated but not in the supine posture. However, microcirculation represented by perfused proportion of vessels and by total vessel density was unaffected in acute weightlessness., Conclusion: Profound changes of the macrocirculation were found in seated postures, but not in supine postures. However, microcirculation remained stable in all postures., (Copyright © 2020 Bimpong-Buta, Muessig, Knost, Masyuk, Binneboessel, Nia, Kelm and Jung.)

The growing elderly population in Western societies has led to an increasing number of primary brain tumors occurring in patients beyond the age of 65. The purpose of this study was to assess and compare the safety, efficacy, and outcomes of oncological craniotomy procedures between patients above and below 65 years. We performed a retrospective analysis of the ACS-NSQIP database to identify patients undergoing supratentorial and infratentorial tumor excisions by neurosurgeons between 2008 and 2016. We stratified them based on a cutoff age of 65 years and analyzed for minor and major complications, reoperation, the total length of hospital stay, and mortality within a standardized 30-day follow-up. Among the 30,183 analyzed patients, 9,652 (32%) were elderly (age ≥ 65). The bivariate analysis demonstrated significantly increased risk of complications, including major and minor complications and mortality in patients with metabolic syndrome, preoperative steroid use, and ASA classification ≥3. (p-value ≤ 0.001***). After controlling for confounding variables in our logistic regression models, older age, metabolic syndrome, extended operative time beyond 5 h, dependent functional health status, ASA class ≥3, steroid use pre-operatively, and black/African American race were found to be significant predictors of major and minor complication. Our study provides a comprehensive analysis of perioperative risk factors and predictors of adverse outcomes following craniotomy for supratentorial and infratentorial tumors in elderly patients. We identified increased age as an independent risk factor for minor and major adverse events as well as extended hospitalization., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: One of the health risks posed to astronauts during deep space flights is exposure to high charge, high-energy (HZE) ions (Z > 13), which can lead to the induction of hepatocellular carcinoma (HCC). However, little is known on the molecular mechanisms of HZE irradiation-induced HCC., Results: We performed comparative RNA-Seq transcriptomic analyses to assess the carcinogenic effects of 600 MeV/n 56 Fe (0.2 Gy), 1 GeV/n 16 O (0.2 Gy), and 350 MeV/n 28 Si (0.2 Gy) ions in a mouse model for irradiation-induced HCC. C3H/HeNCrl mice were subjected to total body irradiation to simulate space environment HZE-irradiation, and liver tissues were extracted at five different time points post-irradiation to investigate the time-dependent carcinogenic response at the transcriptomic level. Our data demonstrated a clear difference in the biological effects of these HZE ions, particularly immunological, such as Acute Phase Response Signaling, B Cell Receptor Signaling, IL-8 Signaling, and ROS Production in Macrophages. Also seen in this study were novel unannotated transcripts that were significantly affected by HZE. To investigate the biological functions of these novel transcripts, we used a machine learning technique known as self-organizing maps (SOMs) to characterize the transcriptome expression profiles of 60 samples (45 HZE-irradiated, 15 non-irradiated control) from liver tissues. A handful of localized modules in the maps emerged as groups of co-regulated and co-expressed transcripts. The functional context of these modules was discovered using overrepresentation analysis. We found that these spots typically contained enriched populations of transcripts related to specific immunological molecular processes (e.g., Acute Phase Response Signaling, B Cell Receptor Signaling, IL-3 Signaling), and RNA Transcription/Expression., Conclusions: A large number of transcripts were found differentially expressed post-HZE irradiation. These results provide valuable information for uncovering the differences in molecular mechanisms underlying HZE specific induced HCC carcinogenesis. Additionally, a handful of novel differentially expressed unannotated transcripts were discovered for each HZE ion. Taken together, these findings may provide a better understanding of biological mechanisms underlying risks for HCC after HZE irradiation and may also have important implications for the discovery of potential countermeasures against and identification of biomarkers for HZE-induced HCC.

Background: mRNA interaction with other mRNAs and other signaling molecules determine different biological pathways and functions. Gene co-expression network analysis methods have been widely used to identify correlation patterns between genes in various biological contexts (e.g., cancer, mouse genetics, yeast genetics). A challenge remains to identify an optimal partition of the networks where the individual modules (clusters) are neither too small to make any general inferences, nor too large to be biologically interpretable. Clustering thresholds for identification of modules are not systematically determined and depend on user-settable parameters requiring optimization. The absence of systematic threshold determination may result in suboptimal module identification and a large number of unassigned features., Results: In this study, we propose a new pipeline to perform gene co-expression network analysis. The proposed pipeline employs WGCNA, a software widely used to perform different aspects of gene co-expression network analysis, and Modularity Maximization algorithm, to analyze novel RNA-Seq data to understand the effects of low-dose 56 Fe ion irradiation on the formation of hepatocellular carcinoma in mice. The network results, along with experimental validation, show that using WGCNA combined with Modularity Maximization, provides a more biologically interpretable network in our dataset, than that obtainable using WGCNA alone. The proposed pipeline showed better performance than the existing clustering algorithm in WGCNA, and identified a module that was biologically validated by a mitochondrial complex I assay., Conclusions: We present a pipeline that can reduce the problem of parameter selection that occurs with the existing algorithm in WGCNA, for applicable RNA-Seq datasets. This may assist in the future discovery of novel mRNA interactions, and elucidation of their potential downstream molecular effects.

Background: When diagnosed simultaneously, obesity, diabetes, and hypertension form a medical constellation called metabolic syndrome (MetS). The prevalence of MetS in Western cultures has been on a steady increase and MetS has been associated with increased postoperative complications in multiple surgical settings., Objective: In this study, we evaluate the relationship between MetS and the outcomes of craniotomy for supratentorial brain tumor., Methods: Cases of craniotomy for supratentorial brain tumors were extracted from the American College of Surgeons National Surgical Quality Improvement Program for 2012-2016. The 15,136 patients identified were divided into 2 cohorts based on the presence (4.1%) or absence (95.9%) of MetS. We compared the 2 cohorts for preoperative comorbidities, intraoperative details, and postoperative morbidity and mortality., Results: Patients in the MetS+ cohort were significantly older (63.4 vs. 56.1 years) and were more likely to show comorbidities of various organ systems (all P ≤ 0.05). However, operative times were similar (P = 0.573). The number of medical complications was almost double in patients with MetS (15.8% vs. 8.5%; P ≤ 0.001). Unplanned readmissions (14.6% vs. 10.4%; P = 0.004), reoperations (6.9% vs. 4.6%; P = 0.007), and mortality (5.6% vs. 2.9%; P ≤ 0.001) were also more frequent in our MetS+ group. Nevertheless, surgical complications localized to the operative site were not statistically increased (7.4% vs. 5.8%; P = 0.098)., Conclusions: A diagnosis of MetS does not seem to be associated with increased rates of surgical site events. However, neurosurgeons should be aware that these patients have a significantly higher likelihood of general medical complications, readmissions, reoperations, and death., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Competing Interests: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. CJ reports to have received speaking fee by Osprey Medical. All other authors report no conflicts of interest regarding the content herein. This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-Universität Düsseldorf (No. 2018-32 to Georg Wolff, No. 2018-50 to Ralf Erkens)) for a Clinician Scientist Track. The open-access publication fee for this journal will be covered by the manufacturer of the device Osprey Medical.

Objective: There have been numerous advances to accelerate and improve quality and dexterous proficiency of surgical training to meet the growing US demand of graduating surgeons. The authors aimed to investigate the learning effects of such limited visual input on the surgical proficiency in untrained novice surgeons., Design: A prospective randomized-controlled study was created with 11 participants in the study and 11 in the control group., Setting: An inanimate surgical simulation lab of a tertiary academic institution (Houston Methodist Hospital, Houston, Texas)., Participants: Adult medical students in the experimental group were wearing stroboscopic eyewear while performing the same tasks as students in the control group with normal vision. For 5 weeks, the subjects were scored during 3 standardized surgical tasks from the American College of Surgeons and the Association of Program Directors in Surgery Resident Skills Curriculum: knot tying, simple interrupted sutures, and a running stitch. Pretrial, we employed the State-Trait Anxiety Inventory and post-trial, the NASA Task Load Index., Results: The demographic characteristics of our study participants were uniformly distributed between the 2 cohorts: each group had 7 males and 4 females. Average ages were 23.6 and 24.2 years (p = 0.471). The anxiety was low during all 5 sessions and indifferent between both groups. At the end of the study, no changes were observed in the stroboscopic group for the knot-tying task (p = 0.619). However, for the simple interrupted and the running stitch, the students with stroboscopic glasses performed significantly better (p = 0.001 and p = 0.024, respectively). The stroboscopic students also had significantly lower NASA workload scores (p = 0.001)., Conclusions: Regular training with stroboscopic glasses that limit visual input has a significant positive effect on the technical skills of novice surgical trainees with regards to more complex tasks such as multiple simple interrupted suturing or running suture. Intermittently impaired vision is beneficial in the early education of students and surgical residents., (Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Previous reports individually identified different factors that predict death after burns. The authors employed the multi-center American Burn Association's (ABA) National Burn Repository (NBR) to elucidate which parameters have the highest negative impact on burn mortality., Methods: We audited data from the NBR v8.0 for the years 2002-2011 and included 137,061 patients in our study. The cases were stratified into two cohorts based on the primary outcome of death/survival and then evaluated for demographic data, intraoperative details, and their morbidity after admission. A multivariable regression analysis aimed to identify independent risk factors associated with mortality., Results: A total of 3.3% of patients in this analysis did not survive their burn injuries. Of those, 52.0% expired within 7 days after admission. Patients in the mortality cohort were of older age ( p  < 0.001), more frequently female ( p  < 0.001), and had more pre-existing comorbidities ( p  < 0.001). Total body surface area (TBSA), inhalation injury, hospitalization time, and occurrence of complications were higher compared to survivors ( p  < 0.001). Lack of insurance (odds ratio (OR) = 1.84, confidence interval (CI) 1.38-2.46), diabetes (OR = 1.24, CI 1.01-1.53), any complication (OR = 4.09, CI 3.27-5.12), inhalation injury (OR = 3.84, CI 3.38-4.36), and the need for operative procedures (OR = 2.60, CI 2.20-3.08) were the strongest independent contributors to mortality after burns ( p  < 0.001). Age (OR = 1.07, CI 1.06-1.07) and TBSA (OR = 1.09, CI 1.09-1.09) were significant on a continuous scale ( p  < 0.001) while overall comorbidities were not a statistical risk factor., Conclusion: Uninsured status, inhalation injury, in-hospital complications, and operative procedures were the strongest mortality predictors after burns. Since most fatal outcomes (52.0%) occur within 7 days after injury, physicians and medical staff need to be aware of these risk factors upon patient admission to a burn center., Competing Interests: No informed consent or institutional review board approval was obtained as the patient data from the National Burn Repository are only available in a de-identified format. No studies on animals were performed. The authors adhered to the Declaration of Helsinki at all times.Not applicable.None of the authors, nor their close family members, has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Furthermore, the authors declare that no commercial associations or financial disclosures exist that might pose or create a conflict of interest with information presented in this manuscript.

Background: In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs., Methods: This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality., Results: Patients had a median age of 84 [IQR 82-87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival., Conclusions: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany., Trial Registration: The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807 ) on May 1, 2017.

Background: Cangrelor is an intravenous adenosine diphosphate (ADP) P2Y12 receptor antagonist, which has to be administered as a bolus followed by immediate infusion. Nevertheless, in clinical routine deviations from the correct practice, such as delayed infusion onset or interruptions during infusion, may occur., Objective: The objective of the present study was to investigate the impact of administration delays on cangrelor concentration in a pharmacological simulation setting and to give possible solutions for the clinical practice., Methods: We simulated the effects of different delays in administration of cangrelor in a model based on known pharmacokinetic parameters. Additionally, we calculated the optimal dosage of a second bolus., Results: We demonstrate that already a short delay between the bolus and begin of infusion as well as short infusion interruptions considerably affect the serum concentration of cangrelor. Additionally, we estimate the dosage of a possible second bolus which highly depends on the duration of the delay., Conclusions: Our results emphasize that continuous administration of cangrelor is crucial to avoid the critical time frame of increased thrombosis risk. We suggest a strategy for dealing with interruptions by demonstrating that a second bolus allows to reach rapidly an effective but not excessive cangrelor serum concentration.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The aging population increases the demand of intensive care unit (ICU) treatments. However, the availability of ICU beds is limited. Thus, ICU admission of octogenarians is considered controversial. The population above 80 years is a very heterogeneous group though, and age alone might not be the best predictor. Aim of this study was to analyze resource consumption and outcome of octogenarians admitted to a medical ICU to identify reliable survival predictors in a senescent society.This retrospective observational study analyzes 930 octogenarians and 5732 younger patients admitted to a medical ICU. Admission diagnosis, APACHE II and SAPS II scores, use of ICU resources, and mortality were recorded. Long-term mortality was analyzed using Kaplan-Meier survival curves and multivariate cox regression analysis.Patients ≥80 years old had higher SAPS II (43 vs 38, P < .001) and APACHE II (23 vs 21, P = .001) scores. Consumption of ICU resources by octogenarians was lower in terms of length of stay, mechanical ventilation, and renal replacement therapy. Among octogenarians, ICU survivors got less mechanical ventilation or renal replacement therapy than nonsurvivors. Intra-ICU mortality in the very old was higher (19% vs 12%, P < .001) and long-term survival was lower (HR 1.76, P < .001). Multivariate cox regression analysis of octogenarians revealed that admission diagnosis of myocardial infarction (HR 1.713, P = .023), age (1.08, P = .002), and SAPS II score (HR 1.02, 95%, P = .01) were independent risk factors, whereas admission diagnoses monitoring post coronary intervention (HR .253, P = .002) and cardiac arrhythmia (HR .534, P = .032) had a substantially reduced mortality risk.Octogenarians show a higher intra-ICU and long-term mortality than younger patients. Still, they show a considerable life expectancy after ICU admission even though they get less invasive care than younger patients. Furthermore, some admission diagnoses like myocardial infarction, cardiac arrhythmia and monitoring post cardiac intervention are much stronger predictors for long-term survival than age or SAPS II score in the very old.

Background: Nepeta dschuparensis Bornm (NP) is used as a medicinal herb in Iran. In traditional medicine, this herb is extensively employed for curing ailments such as cardiovascular diseases. NP has antioxidant and anti-inflammatory properties. This project examined the effects of the NP extract on cyclooxygenase-2 (COX-2) and interleukin-1β (IL-1β) protein levels and its efficacy in neuroprotection in a cerebral ischemia-reperfusion model., Methods: Twenty-six male rats were randomly divided into 3 groups: 1) sham (n=6): no middle cerebral artery occlusion (MCAO) procedure, 2) control (n=10): MCAO procedure and treatment with normal saline, and 3) NP extract (n=10): MCAO procedure and treatment with the NP extract (20 mg/kg, i.p.) at the beginning of reperfusion. To examine the injury caused by cerebral ischemia, we measured motor coordination and the infarct area using the rotarod test and triphenyl tetrazolium chloride staining, respectively. IL-1β and COX-2 protein levels, as inflammatory markers, were measured by immunoblotting assay. The statistical analyses were performed using SPSS, version 16, and the data are expressed as means±SEMs. Statistical difference was evaluated using the one-way ANOVA, followed by the post hoc LSD test (P<0.01)., Results: Treatment with the NP extract significantly diminished the infarct volume and alleviated the motor coordination disorder induced by cerebral ischemia. The NP extract administration significantly attenuated the increase in IL-1β and COX-2 protein levels too (P<0.01)., Conclusion: The beneficial effects of the NP extract are related to its ability to decrease the levels of IL-1β and COX-2.

Sinus of Valsalva (SoV) aneurysm is a rare cardiac disease which can be congenital or acquired. A ruptured SoV aneurysm presents a clinical emergency and can lead to progressively deteriorating heart failure. Therefore, appropriate treatment requires prompt and accurate diagnosis. Most ruptured or nonruptured SoV aneurysms are diagnosed by the means of echocardiography. However, cardiovascular magnetic resonance (CMR) can provide information on precise anatomy and mechanisms due to its excellent soft tissue contrast and high resolution, and thereby allows for optimized preoperative planning of the repair strategy. In the present case, we demonstrate the benefit of CMR in emergency settings., Competing Interests: The authors have no conflicts of interest to declare.

Objectives: This study sought to evaluate the role of esmolol-induced tight sympathetic control in patients with ST-segment elevation myocardial infarction (STEMI)., Background: Elevated sympathetic drive has a detrimental effect on patients with acute STEMI. The effect of beta-blocker-induced heart rate mediated sympathetic control on myocardial damage is unknown., Methods: The authors conducted a prospective, randomized, single-blind trial involving patients with STEMI and successful percutaneous intervention (Killip class I and II). Patients were randomly allocated to heart rate control with intravenous esmolol for 24 h or placebo. The primary outcome was the maximum change in troponin T release as a prognostic surrogate marker for myocardial damage. A total of 101 patients were enrolled in the study., Results: There was a significant difference between patients allocated to placebo and those who received sympathetic control with esmolol in terms of maximum change in troponin T release: the median serum troponin T concentration increased from 0.2 ng/ml (interquartile range [IQR] 0.1 to 0.7 ng/ml) to 1.3 ng/ml (IQR: 0.6 to 4.7 ng/ml) in the esmolol group and from 0.3 ng/ml (IQR: 0.1 to 1.2 ng/ml) to 3.2 ng/ml (IQR: 1.5 to 5.3 ng/ml) in the placebo group (p = 0.010). The levels of peak creatine kinase (CK), CK subunit MB (CK-MB), and n-terminal brain natriuretic peptide (NT-proBNP) were lower in the esmolol group compared with placebo (CK 619 U/l [IQR: 250-1,701 U/l] vs. 1,308 U/l [IQR: 610 to 2,324 U/l]; p = 0.013; CKMB: 73.5 U/l [IQR: 30 to 192 U/l] vs. 158.5 U/l [IQR: 74 to 281 U/l]; p = 0.005; NT-proBNP: 1,048 pg/ml (IQR: 623 to 2,062 pg/ml] vs. 1,497 pg/ml [IQR: 739 to 3,318 pg/ml]; p = 0.059). Cardiogenic shock occurred in three patients in the placebo group and in none in the esmolol group., Conclusions: Esmolol treatment statistically significantly decreased troponin T, CK, CK-MB and NT-proBNP release as surrogate markers for myocardial injury in patients with STEMI. (Heart Rate Control After Acute Myocardial Infarction; DRKS00000766)., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

There is currently no effective prophylactic regimen available to prevent contrast-induced AKI (CI-AKI), a frequent and life-threatening complication after cardiac catheterization. Therefore, novel treatment strategies are required to decrease CI-AKI incidence and to improve clinical outcomes in these patients. Remote ischemic preconditioning (rIPC), defined as transient brief episodes of ischemia at a remote site before a subsequent prolonged ischemia/reperfusion injury of the target organ, is an adaptational response that protects against ischemic and reperfusion insult. Indeed, several studies demonstrated the tissue-protective effects of rIPC in various target organs, including the kidneys. In this regard, rIPC may offer a novel noninvasive and virtually cost-free treatment strategy for decreasing CI-AKI incidence. This review evaluates the current experimental and clinical evidence for rIPC as a potential renoprotective strategy, and discusses the underlying mechanisms and key areas for future research.