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Pancreatic cystic lesions are a frequent incidental finding in abdominal imaging. Despite its usually benign background, a small fraction exhibiting features suspicious for cancerous development demands continuous follow-up or surgical removal. Current guidelines advocate magnetic resonance imaging and endoscopic ultrasound to evaluate the risk of malignancy, whereas transabdominal ultrasound is perceived as subordinate imaging. The objective of this study was to analyze cyst detection rates of latest-generation ultrasound machines compared to magnetic resonance imaging, computed tomography, and endosonographic ultrasound and to determine inter-rater reliability. The results showed that large cysts facilitate their visualization by transabdominal ultrasound while detection rates are independent of the anatomical part of the pancreas in which they were sited. Changes in the pancreatic duct width, a connection to the pancreatic duct system, and the architectural characteristics of cysts are poorly recognized by transabdominal ultrasound compared to magnetic resonance imaging and endoscopic ultrasound. Computed tomography imaging is preferred over transabdominal ultrasound to detect calcifications and regional lymphadenopathy. Even if conducted by experienced investigators, transabdominal ultrasound examinations fail to agree with magnetic resonance imaging scans regarding cyst detection rates (κ = 0.093).

Zusammenfassung SARS-CoV-2 ist eine neuartige humanpathogene Coronavirus-Variante, deren Prädilektion für den Atemwegstrakt zu einer raschen pandemischen Verbreitung durch viruspartikelhaltige Aerosole geführt hat. Die individuelle Organsuszeptibilität wird maßgeblich durch die Besatzdichte mit dem membranständigen Rezeptormolekül ACE2 bestimmt, das als zentraler Interaktionspartner für das virale Spike-Protein den Adhäsions- und Fusionsprozess vermittelt und somit die Grundvoraussetzung zur Aufnahme des Virusgenoms in die Wirtszelle schafft. Ausgehend von einem umfangreichen Datensatz klinischer Studien und Fallberichte, gilt es mittlerweile als gesichert, dass auch bestimmte Zellpopulationen des Verdauungstrakts sowie des funktionell angegliederten olfaktorisch-gustatorischen Systems über die erforderliche Rezeptorenausstattung verfügen und somit durch SARS-CoV-2 „angreifbar“ sind. Zahlreiche Berichte über gastrointestinale Beschwerden und Laborabnormalitäten sind als Indizien für relevante Organdysfunktionen zu werten und untermauern die klinische Bedeutsamkeit einer Mitbeteiligung des Verdauungstrakts im Rahmen einer SARS-CoV-2-Infektion. Organoide sind dreidimensional wachsende In-vitro-Replikate von Organgeweben und nehmen insbesondere dank der organtypisch komplexen zellulären Zusammensetzung und Imitation der physiologischen Funktionsweise von Primärzellen einen hohen Stellenwert für die infektiologische Grundlagenforschung ein. Diese Übersichtsarbeit befasst sich thematisch mit den pathophysiologischen Aspekten der Infektion verdauungsrelevanter Organe mit SARS-CoV-2 unter besonderer Würdigung existierender organoid- oder primärzellkulturbasierter Infektionsmodelle und der daraus hervorgegangenen Erkenntnisse.

All-time preservation of an intact mucosal barrier is crucial to ensuring intestinal homeostasis and, hence, the organism’s overall health maintenance. This complex process relies on an equilibrated signaling system between the intestinal epithelium and numerous cell populations inhabiting the gut mucosa. Any perturbations of this delicate cross talk, particularly regarding the immune cell compartment and microbiota, may sustainably debilitate the intestinal barrier function. As a final joint event, a critical rise in epithelial permeability facilitates the exposure of submucosal immunity to microbial antigens, resulting in uncontrolled inflammation, collateral tissue destruction, and dysbiosis. Organoid-derived intestinal coculture models have established themselves as convenient tools to reenact such pathophysiological events, explore interactions between selected cell populations, and assess their roles with a central focus on intestinal barrier recovery and stabilization.

SARS-CoV-2 is a novel human pathogenic coronavirus whose predilection for the respiratory tract has given rise to a rapid pandemic spread via airborne particles. Organ-specific susceptibility is substantially determined by the density of cell surface expression of ACE2, which is exploited by viral spike protein as a receptor molecule to mediate adhesion and, thus, to permit internalization of the viral genome into the host cell. Based on an ample data set derived from clinical studies and case reports, evidence suggests that distinct cell populations of the digestive and olfactory-gustatory system are equally equipped with membrane-bound ACE2, rendering them "vulnerable" to SARS-CoV-2. Numerous reports on concomitant gastrointestinal complaints and laboratory abnormalities are thought to reflect a relevant degree of organ dysfunction and underscore the tropism of SARS-CoV-2 for the digestive tract. Organoids are three-dimensionalSARS-CoV-2 ist eine neuartige humanpathogene Coronavirus-Variante, deren Prädilektion für den Atemwegstrakt zu einer raschen pandemischen Verbreitung durch viruspartikelhaltige Aerosole geführt hat. Die individuelle Organsuszeptibilität wird maßgeblich durch die Besatzdichte mit dem membranständigen Rezeptormolekül ACE2 bestimmt, das als zentraler Interaktionspartner für das virale Spike-Protein den Adhäsions- und Fusionsprozess vermittelt und somit die Grundvoraussetzung zur Aufnahme des Virusgenoms in die Wirtszelle schafft. Ausgehend von einem umfangreichen Datensatz klinischer Studien und Fallberichte, gilt es mittlerweile als gesichert, dass auch bestimmte Zellpopulationen des Verdauungstrakts sowie des funktionell angegliederten olfaktorisch-gustatorischen Systems über die erforderliche Rezeptorenausstattung verfügen und somit durch SARS-CoV-2 „angreifbar“ sind. Zahlreiche Berichte über gastrointestinale Beschwerden und Laborabnormalitäten sind als Indizien für relevante Organdysfunktionen zu werten und untermauern die klinische Bedeutsamkeit einer Mitbeteiligung des Verdauungstrakts im Rahmen einer SARS-CoV-2-Infektion. Organoide sind dreidimensional wachsende

Enteric infections represent a major health care challenge which is particularly prevalent in countries with restricted access to clean water and sanitation and lacking personal hygiene precautions, altogether facilitating fecal-oral transmission of a heterogeneous spectrum of enteropathogenic microorganisms. Among these, bacterial species are responsible for a considerable proportion of illnesses, hospitalizations, and fatal cases, all of which have been continuously contributing to ignite researchers’ interest in further exploring their individual pathogenicity. Beyond the universally accepted animal models, intestinal organoids are increasingly valued for their ability to mimic key architectural and physiologic features of the native intestinal mucosa. As a consequence, they are regarded as the most versatile and naturalistic in vitro model of the gut, allowing monitoring of adherence, invasion, intracellular trafficking, and propagation as well as repurposing components of the host cell equipment. At the same time, infected intestinal organoids allow close characterization of the host epithelium’s immune response to enteropathogens. In this review, (i) we provide a profound update on intestinal organoid-based tissue engineering, (ii) we report the latest pathophysiological findings defining the infected intestinal organoids, and (iii) we discuss the advantages and limitations of this in vitro model.

Objective: Myomectomy is the cornerstone of therapy for hypertrophic obstructive cardiomyopathy (HOCM) in the presence of a high gradient. The importance of mechanical gradient across the left ventricle outflow track (LVOT) vs left ventricular diastolic dysfunction (LVDD) is debatable. Methods: We retrospectively analyzed data on 14 patients with HOCM who underwent myomectomy from 2007 to 2011 at our institution. All patients in this study were symptomatic. The purpose of this study was to assess the significance of immediate reduction of the gradient across the LVOT as well as improved LVDD and its correlation with hemodynamics. Results: A total of 14 patients with a mean age of 52.5 ± 19.0 years (male-female ratio of 5/8) were evaluated. The preoperative LVOT peak gradient was 76.9 ± 63.4 mmHg, the left atrial (LA) diameter was 41.9 ± 6.1 mm, and the septal thickness was 15.4 ± 3.2 mm. The relevant preoperative risk factors included DM (23.0%; n = 3), angina pectoris (15.4%; n = 2), cerebrovascular disease (CVD) (30.8%; n = 4), stroke (15.4%; n = 2), arrhythmias (30.8%; n = 4), and COPD (15.4%; n = 2). The concurrent procedures included mitral valve repair/ replacement (MVR) (30.8%; n = 4), aortic valve replacement (AVR) (23.0%; n = 3), coronary artery bypass grafting (CABG) (15.4%; n = 2), and modified MAZE procedure/ablation (15.4%; n = 2). The perioperative mortality was 7.7% (n = 1), and the long-term survival was 85.6% at a median follow up of 30 months. The postoperative LVOT gradient improved to 32.3 ± 24.4 mmHg and the septal thickness to 12.5 ± 3.8 mm. These differences were not statistically significant, likely due to small sample size. The postoperative complications included iatrogenic small VSD in one patient (who had myomectomy for a third time), atrial fibrillation (n = 4), cardiac arrest (7.7%; n = 1), neurologic adverse event (7.7%; n = 1), and new onset renal failure (7.7%; n = 1). We did not observe any new onset AV block. The length of stay (LOS) in the surgical critical care unit was 95.5 ± 112.7 hours. The overall hospital LOS was 15 ± 11.5 days. Conclusion: The septal myomectomy results showed an immediate reduction of the LVOT gradient, which translates into clinical and echocardiographic improvement.

Background. Benefits of ministernotomy have been reported but not yet fully established in the current literature. Ministernotomy may be associated with less bleeding, less need for transfusion, and reduced hospital length of stay. Methods. We retrospectively evaluated 347 patients who underwent aortic valve replacement between 2007 and 2011 at our institution. Results. Standard sternotomy was performed in 303 patients (154 males, 50.8% and 149 females, 49.2%) and ministernotomy in 44 patients (13 males, 30% and 30 females, 70%); most of the patients in ministernotomy group were female (75%) (P=.0095). The mean age for ministernotomy patients was 71.8±12.6 years and for sternotomy patients 67.4±13.8 years (P=.045). Significant preoperative morbidities (for ministernotomy and sternotomy, resp.) included stroke (11%, n=5 versus 18%, n=55; P=.39), PVD (23%, n=10 versus 16%, n=49; P=.29), COPD (25%, n=11 versus 17%, n=52; P=.21), renal failure (0.0%, n=0 versus 8.8%, n=26; P=.06), and previous heart surgery (9%, n=4 versus 9.5%, n=29; P=1.0). Intraoperative blood transfusion was required in 23% of ministernotomy patients (n=9) and 30% of sternotomy patients (n=91), P=.16. Major postoperative complications (for ministernotomy and sternotomy, resp.) included exploration for bleeding (4.5%, n=2 versus 6%, n=18; P=1) and adverse neurologic events (4.5%, n=2 versus 1.6%, n=5; P=.05). The length of stay (LOS) in the CCU was 75.4±57.1 hours for the ministernotomy group and 125.4±160.3 hours for the sternotomy group (P=.12). The LOS was slightly shorter following ministernotomy (9.00±7.78 days) compared to sternotomy (10.0±9.46 days) (P=.31). Perioperative mortality was 2.3% (n=1) for ministernotomy and 3.3% (n=10) for sternotomy (P=1.0). The 1-, 3-, and 7-year survival following ministernotomy was 93.8%, 93.8%, and 88.3%, respectively; following sternotomy, these rates were 87.7%, 83.7%, and 82.6%, respectively (95% CI 0.273 to 1.325, P=.20). Conclusion. Ministernotomy is less invasive and is associated with less perioperative and postoperative bleeding and reduced LOS in CCU and in hospital.

The inflammatory response to pathogen-associated molecular patterns such as lipopolysaccharide (LPS) in sepsis is mediated via Toll-like receptors (TLRs). Since TLRs also trigger various immune functions, including phagocytosis, their modulation is a promising strategy in the treatment of sepsis. As antibiotics have immunomodulatory properties, this study examined the effect of commonly used classes of antibiotics on i) the expression of TLRs and cytokines and ii) the phagocytic activity under sepsis-like conditions in vitro. This was achieved by incubating THP-1 monocytes and peripheral blood mononuclear cells (PBMCs) obtained from patients after open-heart surgery with the addition of LPS and six key antibiotics (piperacillin, doxycycline, erythromycin, moxifloxacin or gentamicin). After 24h, mRNA levels of both cytokines (IL-1β, IL-6) and TLRs (1, 2, 4, and 6) were monitored and phagocytosis was determined following coincubation with Escherichia coli. Each antibiotic differentially regulated the gene expression of the investigated TLRs and cytokines in monocytes. Erythromycin, moxifloxacin and doxycyclin displayed the strongest effects and changed mRNA-levels of the investigated genes up to 5.6-fold. Consistent with this, antibiotics and, in particular, moxifloxacin, regulated the TLR-and cytokine expression in activated PBMCs obtained from patients after open-heart surgery. Furthermore, piperacillin, doxycyclin and moxifloxacin inhibited the phagocytic activity of monocytes. Our results suggest that antibiotics regulate the immune response by modulating TLR- and cytokine expression as well as phagocytosis under septic conditions. Moxifloxacin, doxycycline and erythromycin were shown to possess the strongest immunomodulatory effects and these antibiotic classes should be considered for future immunomodulatory studies in sepsis.