Potential impact of cell-free DNA blood testing in the diagnosis of sepsis.

BACKGROUND: Classical blood culture testing is still the gold standard in correct and timely diagnosis of the responsible microorganisms in sepsis. CASE SUMMARY: In this case (a patient with a colon perforation and severe peritonitis with septic shock), an alternative approach (cell-free DNA next-generation sequencing from full blood samples, NGS) showed the responsible microorganisms, whereas the classical blood culture testing remainedstayed sterile. Interestingly, samples from the abdominal fluid showed the same bacteria as NGS. CONCLUSION: These findings may be interpreted as that the threshold for positive testing is lower through the molecular approach than through culture techniques; however, more studies are necessary to prove this theory.

Percutaneous Mechanical Thromboembolectomy in Acute Lower Limb Ischemia.

PURPOSE: To analyze the immediate outcome of percutaneous mechanical thromboembolectomy in acute infrainguinal leg ischemia in a consecutive cohort of patients with acute lower limb ischemia. MATERIAL AND METHOD: We retrospectively analyzed the data of 156 acute infrainguinal ischemic events in 148 patients. Patients presented with acute limb ischemia Rutherford category I in 68 cases (44%), Rutherford category II A in 64 instances (41%) and Rutherford II B in 24 instances (15%). In 62 cases (39.7%), the occlusion site started below the knee joint level, in 94 (60.3%) cases above. As a basic technique, an intervention was started by manual aspiration but if aspiration failed, an additional device was added. Most frequently, a rotational thrombectomy device (Rotarex, Straub Medical, Wangs, Switzerland) was used. An antegrade access to the femoral artery was the preferred access to the limb (154/156). RESULTS: In 145 of 156 incidents, a technical success was achieved (93%). Aspiration was used in 153 cases (98%). Rotational thrombectomy by use of the Rotarex catheter was added in 60 cases (38%). Directional atherectomy was applied in a total of five patients. As main technical complications, a downward embolization occurred (n = 11). There were four surgical groin revisions. Five patients died during the early follow-up with four not related to the intervention. Clinically, 135 patients (86.5%) showed an improvement in their clinical situation. CONCLUSION: Acute lower limb ischemia can be successfully treated by mechanical thromboembolectomy only by combining aspiration embolectomy with rotational thrombectomy in most cases but manual aspiration alone will frequently fail especially above the knee joint level.

Parameters influencing hand grip strength measured with the manugraphy system.

BACKGROUND: This study aimed to determine whether sex, hand length and the individual training status affect hand strength and whether these measurements differ if they are recorded using the Jamar dynamometer or a new cylindrical measuring system. METHODS: For this purpose, 152 healthy adults were examined using a new manugraphy measuring system (novel, Munich, Germany) comprising two measuring cylinders of different sizes and a Jamar electronic dynamometer with two grip positions corresponding approximately to the sizes of the cylinders. A descriptive analysis was performed as well as a correlation analysis using the Pearson correlation coefficient. To prepare predictive models, multiple linear regression analyses were carried out to determine factors that influence the force and p ≤ 0.05 was considered statistically significant. RESULTS: A significant difference in the maximum and mean strength was observed that is dependent on sex, with men stronger than women, in line with expectations, and hand length, with small hands able to exert less force than large hands. No consistent increase in strength could be attributed to repetitive manual loads applied either at work or in leisure activities. CONCLUSIONS: Both measurement techniques yielded similar results, suggesting that manugraphy is well suited for clinical research purposes because it not only takes measurements that are just as reproducible and valid as the conventional measurement technique but in doing so measures not just the total strength of a hand but also enables more precise comparisons of isolated hand regions applying dynamic measurements.

Load distribution of the hand during cylinder grip analyzed by Manugraphy.

STUDY DESIGN: Clinical measurement and basic research. INTRODUCTION: Manugraphy allows assessing dynamically all forces applied perpendicular to a cylinder surface by the whole contact area of the hand with a high spatial resolution. PURPOSE OF THE STUDY: To identify the physiological load distribution of the whole contact area of the hand during cylinder grip. METHODS: A sample of 152 healthy volunteers performed grip force tests with 3 cylinder sizes of the Manugraphy system (novel, Munich, Germany) on 3 different days. The whole contact area of the hand was sectioned into 7 anatomic areas, and the percent contribution of each area in relation to the total load applied was calculated. The load distribution of the dominant and nondominant hands and with different cylinder sizes was compared. Furthermore, the load distribution between the finger phalanges of each finger was analyzed. RESULTS: The results for the dominant and nondominant hands were in all 7 areas of the hand similar with the percent contribution differing within a range of 1%-4% (P > .138). Load distribution changed significantly with different cylinder sizes: all 7 areas differed between 1% and 7% with P < .001, most pronounced for the thumb. The load distribution of the phalanges showed that the contribution of the distal phalanges increased with ascending cylinder size, whereas the contribution of the proximal phalanges decreased. The interindividual variability of the load distribution pattern was noticeable. DISCUSSION: For the clinical practice, Manugraphy might be a useful supplement to traditional grip force measurement for identifying the individual characteristics of a patient's dysfunction and monitoring the progress of hand rehabilitation. CONCLUSIONS: There is no universal or typical load distribution pattern of the hand but only an individual pattern. To evaluate a compromised hand, it is permissible to compare it with the healthy opposite hand as a reference. Several cylinder sizes should be used for load distribution testing. Using smaller handles in the daily life can help to compensate impairment of the thumb and fingertips. LEVEL OF EVIDENCE: 2.

Grip force monitoring on the hand: Manugraphy system versus Jamar dynamometer.

INTRODUCTION: For clinical grip force assessment, the Jamar dynamometer is a wide accepted tool. Users have to be aware that this method does not represent all grip efforts applied. The Manugraphy system is a tool that measure total grip force as well as identify load distribution patterns of the hand while gripping cylinders wrapped with calibrated capacitive matrix sensor mats. The aim of this study was to validate an assessment setting of the Manugraphy system for clinical use. Further, the relationship and difference between the Manugraphy system and the Jamar dynamometer were investigated. MATERIALS AND METHODS: At two study centers, 152 healthy volunteers performed grip force tests with a digital Jamar dynamometer using handle positions 3 and 4 and the novel(®) Manugraphy system using two cylinders with circumferences of 150 and 200 mm. The subjects performed grip force testing with both devices on three different days. The intra- and inter-day variability for both methods was evaluated. To compare the values of both systems, the Spearman correlation coefficient was calculated. RESULTS: The force values, as measured by the sensor matrix, were higher than those of the Jamar dynamometer. Analyses showed significant positive correlations between values obtained by the two measurement methods (p < 0.001). There was no significant inter-day variation for the 200-mm cylinder of the Manugraphy system. For the 150-mm cylinder, a significant variation was observed at center B, but not at A. Nevertheless, the fluctuation of the grip force values obtained with the Manugraphy system was equal or better than those obtained with the Jamar dynamometer. CONCLUSIONS: The force values, obtained using the two systems, have a high correlation but are not directly comparable. Both systems allow valid and constant grip force measurement. As the sensor mat detects all forces applied perpendicularly to the cylinder surface, it characterizes grip force better than the Jamar dynamometer. In addition, information about load distribution of the hand is gained.

Diagnostic value of routine clinical parameters in acute myocardial infarction: a comparison to delayed contrast enhanced magnetic resonance imaging. Delayed enhancement and routine clinical parameters after myocardial infarction.

AIMS: Contrast enhanced magnetic resonance imaging (ceMRI) has been shown to reliably identify irreversible myocardial injury. The aim of this study was to compare the findings on ceMRI with routine clinical markers of myocardial injury in patients with acute myocardial infarction (MI). METHODS AND RESULTS: Twenty-four patients with acute MI were investigated at 1.5 T. The global myocardial function was analysed with a standard cine MR protocol and a stack of short axis slices encompassing the entire left ventricle. Corresponding short axis slices were acquired for delayed ceMRI 15-20 min after the administration of 0.2 mmol gadolinium-DTPA/kg body weight. Mass of hyperenhancement and peak creatine kinase release (peak CK) was determined for each patient. The presenting 12-lead ECG was analysed for ST-elevation on admission and later development of Q-waves. Mass of hyperenhancement correlated moderately well to peak CK (r = 0.65, p < 0.01) and endsystolic volume index (r = 0.55, p < 0.01). Mass of hyperenhancement was inversely correlated to ejection fraction (r = -0.50, p = 0.02). Neither the presence of ST elevation on the admission ECG nor the later development of Q-waves did relate to the transmural extent of hyperenhancement and to the mass of hyperenhancement. CONCLUSION: Mass of hyperenhancement significantly correlates to global myocardial function and to peak CK. However, there is no relationship between the findings in ceMRI and 12-lead ECG abnormalities on admission suggesting an advantage of ceMRI in defining transmural extent and depicting small areas of necrosis.