Follow-up after biventricular repair of the hypoplastic left heart complex.

OBJECTIVES: In hypoplastic left heart complex patients, biventricular repair is preferred over staged-single ventricle palliation; however, there are too few studies to support either strategy. Therefore, we retrospectively characterized our patient cohort with hypoplastic left heart complex after biventricular repair to measure left-sided heart structures and assess our treatment strategy. METHODS: Patients with hypoplastic left heart complex who had biventricular repair between 2004 and 2018 were retrospectively reviewed. Operative results were evaluated and echocardiographic mitral valve (MV) and aortic valve (AoV) dimensions, left ventricular length and left ventricular internal diastolic diameter (LVIDd) were measured preoperatively and during follow-up after 0.5, 1, 3, 5 and 10 years. RESULTS: In 32 patients, the median age at surgery was 10 (interquartile range 5.0) days. The median follow-up was 6.19 (interquartile range 6.04) years. During the 10-year follow-up, the mean Z-scores increased from -2.82 to -1.49 and from -2.29 to 0.62 for MV and AoV, respectively. Analysis of variance results with post hoc paired t-tests showed that growth of left-sided heart structures was accelerated in the first year after repair, but was not equal, with the MV lagging behind the AoV (P = 0.033), resulting in significantly smaller MV Z-scores compared with AoV Z-scores at 10-year follow-up (P < 0.001). There were 2 (6%) early deaths. The major adverse events occurred in 4 (13%) patients. The surgical or catheter-based reintervention was required in 14 (44%) patients. CONCLUSIONS: The growth rate of heart structures was most prominent during the first year after biventricular repair with lower growth rate of the MV compared with the AoV.

Pre- to post-inpatient treatment of subjective sleep quality in 5,481 patients with mental disorders: A longitudinal analysis.

There is only limited evidence of the course of sleep quality and sleep disturbances during acute inpatient treatment and the prediction of/association with treatment outcome in mental disorders. Within this naturalistic study, 5,481 consecutively admitted inpatients completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI-II) at admission and at discharge. Treatment included both individual and group psychotherapy (but no specific interventions for sleep disturbances) and pharmacotherapy based on current national treatment guidelines. Correlation analyses, analyses of variance and linear models were calculated to analyse the datasets. The PSQI improved significantly (p < 0.001) from admission (mean score 9.51 [±4.11]) to discharge (mean score 8.08 [±4.20]) in all diagnostic subgroups. Despite this improvement, 47% of the patients still showed elevated PSQI scores (>5) at discharge. Patients with post-traumatic stress disorder showed the largest sleep disturbances at both time-points; patients with obsessive-compulsive disorder were the least impaired. An improvement of the PSQI was found to be significantly correlated (p < 0.001) to the change of BDI-II values (without the sleep item) during treatment. The likelihood of achieving remission of depressive symptoms (BDI-II total score <14) was significantly associated with less sleep disturbances at admission. The results suggest that almost half of inpatients with mental disorders treated successfully with state-of-the art specific psychotherapy and pharmacotherapy do not have remission of their sleep problems. Therefore, specific treatment programmes for insomnia should be evaluated and implemented in daily clinical routines.

Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: analysis of routine data.

BACKGROUND: A substantial rate of patients with bulimia nervosa (BN) also suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Aims of the study were to examine (1) specific characteristics of patients with BN + BPD at admission, discharge, and during treatment, and (2) differential effects of inpatient treatment for BN vs. BN + BPD. METHOD: We analyzed routine data of inpatients admitted for the treatment of BN between 2013 and 2017 in a specialized hospital for eating disorders. (1) Cross-sectional differences were examined with independent t-tests and χ2-tests; and (2) treatment effects pertaining to eating disorders symptoms, depression, psychosocial functioning and general psychopathology with repeated measures analysis of variance. RESULTS: Of 1298 inpatients (96% female), 13.2% also had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments (p = 0.001), had a longer length of stay (p = 0.003), gained more weight during treatment (p = 0.006), and were more often irregularly discharged (p = 0.018) as well as rated as unfit to work at discharge (p = 0.003). (2) Both groups improved in all examined variables (all main effects treatment p <  0.001). Patients with BN + BPD showed worse symptoms aggregated across admission and discharge (all main effects diagnosis p <  0.05). Patients with BN + BPD showed smaller improvements (interaction treatment×discharge) in depressive symptoms (p = 0.018), perfectionism (p = 0.009), and asceticism (p = 0.035) and discharge scores mostly lay in the range of the admission scores of the BN-only group. CONCLUSION: Patients with BN + BPD improve during intense and specialized inpatient treatment, yet, retain pronounced impairment at discharge despite longer treatment. Treatment needs to be improved and should focus on transdiagnostic symptoms of BN and BPD.

Are there differences between men and women in outcome of intensive inpatient treatment for anorexia nervosa? An analysis of routine data.

OBJECTIVE: Anorexia nervosa (AN) in men is rare and understudied. We compared admission characteristics and response to specialized inpatient treatment between men and women with AN. METHOD: One hundred sixteen consecutive male patients with AN were matched to 116 female patients. Patients completed the self-rating Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S) at admission and discharge. Differences at admission and in treatment response were examined with independent samples t-tests and ANOVA for repeated measures, respectively. RESULTS: Men had lower body mass index (BMI)-percentiles (Cohen's d = -0.55), higher levels of weight suppression (d = 0.65), and higher scores in the SIAB-S general psychopathology and social integration scale (d = 0.47) at admission. There were no differences in response to treatment except for changes in BMI-percentile (F = 4.49, p = 0.035). CONCLUSIONS: There were more similarities than differences between genders in AN. Because this similarity might be confounded with traditionally "feminine" conceptualizations of AN, further studies of male AN are needed.

Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation.

BACKGROUND: Surgical treatment of critical aortic coarctation (CoA) is difficult in very low birth weight (VLBW) infants ≤1500 g and preferably postponed until 3 kg with prostaglandins (PGE). OBJECTIVES: To investigate the procedure and outcome of primary coronary stent implantation as bridging therapy to surgery in VLBW infants with CoA. METHODS: Retrospective evaluation of primary CoA stenting in VLBW infants from 2010 to 2015. RESULTS: Five VLBW infants with a median gestational age of 29 weeks (27-32) underwent primary CoA stenting. Indication was cardiac failure in 4 and severe hypertension in 1 patient. Age and weight at intervention were 14 days (range 12-16) and 1200 g (680-1380), respectively. Stent diameter ranged 3-5 mm. The femoral artery used for intervention was occluded in all infants without clinical compromise. Severe restenosis and aneurysm occurred in 1 VLBW infant and was successfully treated with covered coronary stents. Median age at surgical correction was 200 days (111-804) and weight 5500 g (4500-11,400). No reinterventions were required during a median postoperative follow-up of 2.8 years (0.1-5.0). Neurodevelopmental outcomes were normal and comparable between patients and siblings (4/5 gemelli). CONCLUSIONS: Primary coronary stent implantation in VLBW infants with critical CoA is a feasible bridging therapy to surgery.

Isolation and antimicrobial susceptibility of Brachy -spira species from feces of layer chickens in Germany.

OBJECTIVE: Anaerobic spirochetes of the genus Brachyspira are important pathogens causing swine dysentery (Brachyspira [B.] hyodysenteriae) and porcine intestinal spirochetosis (B. pilosicoli, PIS). In addition, avian intestinal spirochetosis (AIS) is caused by B. pilosicoli, B. intermedia and B. alvinipulli. Despite the economic impact of AIS, the disease has not received appropriate attention in Germany. This study was aimed at identifying Brachyspira spp. in Germany and determining their antimicrobial susceptibility. MATERIAL AND METHODS: From 2009 to 2013, a total of 71 fecal swabs were obtained from clinically healthy layer hens from eight different commercial flocks. Brachyspira spp. culture was performed in trypticase soybean agar added with 5% sheep blood. Species determination was conducted by PCRs targeting the NADH-gen and the 16S rDNA or by nox-gene sequencing. Antimicrobial susceptibility to macrolides, lincosamides and pleuromutilins was tested by a microdilution assay. RESULTS: Brachyspira spp. were isolated from 40 (56.3%) swabs distributed over all eight flocks. In 26 cases, the following species were determined by PCR: B. pilosicoli (n = 16), B. intermedia (2), B. innocens (3), B. murdochii (1), mixtures of B. pilosicoli/B. intermedia (2), B. innocens/B. intermedia (1), B. innocens/B. murdochii (1). Remaining isolates were characterized by noxgene sequencing as B. "pulli" (n = 9), B. alvinipulli (3), B. intermedia (1) and as not identifiable (1). Antimicrobial susceptibility testing of 37 isolates revealed minimal inhibitory concentrations 90 (MIC90) of > 128 mg/l (tylosin), 64 mg/l (lincomycin), 8 mg/l (tiamulin) and 4 mg/l (valnemulin), respectively. Comparing to breakpoints applied to pigs, these values lie within the range of resistance. CONCLUSION: The demonstration of different Brachyspira spp., particularly B. pilosicoli, intermedia and alvinipulli in commercial layers, indicates the need of further research to assess their potential role in causing AIS in German poultry flocks. The increased antimicrobial resistance of Brachyspira spp. isolates to tylosin and pleuromutilins is likely associated with extensive use of these drugs in poultry medicine.

The Munich eating and feeding disorder questionnaire (Munich ED-Quest) DSM-5/ICD-10: validity, reliability, sensitivity to change and norms.

OBJECTIVE: The aim of the article is to report on the psychometric properties of a newly developed self-rating scale (Munich Eating and Feeding Disorder Questionnaire) for the detailed assessment of eating and feeding disorders on the basis of the DSM-5 criteria. The questionnaire aims at developing a comprehensive assessment of eating disorder symptoms suitable for severity ratings with regard to total scale and subscales, for deriving eating disorder diagnoses according to DSM-5 and ICD-10 and for measuring (intervention induced) changes over time. METHODS: Items were formulated by clinical experts and entered into factor analysis in two separate samples of eating-disordered inpatients. Additionally, 47 clinical and 547 community control participants were assessed. Internal consistency and sensitivity to change over time are also reported. RESULTS: Three subscales were identified covering 'preoccupation with figure and weight', 'bingeing and vomiting' and 'inappropriate compensatory behaviour' for current and past state. Test-retest reliability for the three subscales ranged between .95 and .98 (current status). A high sensitivity to change during inpatient treatment from admission to discharge was expressed in high effect sizes; for the total score (current status) for all eating disorders, the effect size was 1.70. Effect sizes for anorexia nervosa were mostly lower than those for bulimia nervosa. Clinical and community controls obtained significantly lower scores compared with eating-disordered patients. CONCLUSION: This new DSM-5 questionnaire shows satisfying psychometric properties and is well suited for the rating of eating disorder severity in clinical practice and research.

Tenacity of mammalian viruses in the gut of leeches fed with porcine blood.

Leech therapy is currently considered to be of high therapeutic value in medicine. However, feeding leeches with fresh animal blood during the maintenance and reproduction phase bears the risk of transmission of zoonotic viruses to the patient. We hypothesize that this would be abolished by subjecting leeches to quarantine measures prior to use. The required duration of quarantine would depend on the maximum survival time of pathogens in contaminated leeches. In order to be able to estimate this survival time reliably, experiments were conducted with enveloped and non-enveloped mammalian viruses possessing either RNA or DNA. Leeches were fed porcine blood contaminated with bovine parvovirus (BPV), feline calicivirus (FCV), equine arteritis virus (EAV) and equine herpesvirus type 1 (EHV-1) and kept in aquaria at 10 °C. From week 6 after feeding onwards, some leeches were held at 30 °C. Before feeding and at different time points thereafter, blood samples were taken from the leeches to determine residual virus infectivity. Prototype mammalian viruses were able to survive in inoculated leeches for considerable periods of time. When leeches were kept at 10 °C throughout, reisolation of infectious virus from the leeches' abdominal cavity blood was no longer possible at 23 (FCV), 23 (EAV), 27 (EHV-1) and 29 (BPV) weeks after inoculation. Shifting the temperature to 30 °C in week 6 slightly reduced the duration of detection of infectious viruses to 15 (EAV and EHV-1), 21 (FCV) and 27 (BPV) weeks. These data indicate that the ability of mammalian viruses to survive in leeches theoretically poses a possible risk for patients unless adequate precautionary measures are adopted. Application of a quarantine period, e.g. 31 weeks (i.e. including an additional safety period) at 10 °C, may be a suitable measure to significantly decrease this risk.