Cardiac surgery in Germany during 2013: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery.

On the basis of a voluntary registry of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), data of all cardiac surgical procedures performed in 79 German cardiac surgical units during the year 2013 are presented. In 2013, a total of 99,128 cardiac surgical procedures (implantable cardioverter defibrillator [ICD] and pacemaker procedures excluded) were submitted to the registry. More than 13.8% of the patients were older than 80 years, which remains equal in comparison to the previous year. In-hospital mortality in 40,410 isolated coronary artery bypass grafting procedures (84.5% on-pump and 15.5% off-pump) was 2.9%. In 29,672 isolated valve procedures (including 7,722 catheter-based procedures), an in-hospital mortality of 4.7% was observed. This long-lasting registry of the GSTCVS will continue to be an important tool for quality control and voluntary public reporting by illustrating current facts and developments of cardiac surgery in Germany.

Nasal septum morphology in human fetuses in computed tomography images.

OBJECTIVES: Nasal septum deformation (NSD) may cause breathing dysfunction. The reason for a septal deviation is the developmental anomaly in growth of the elastic septum or its skeleton. Such a type of deviation is called physiological. Some deviations can result from the prenatal trauma. The aim of the work was the analysis of the anatomy of the nasal cavity with a special interest focused on the nasal septum and its deviation. MATERIAL AND METHODS: The nasal cavity with its bones and septum was analyzed in CT images of 105 spontaneously aborted fetuses (57 males and 48 females) aged 12 and 40 weeks of gestation. We attempted to assess the morphometric development of the nasal cavity with tomographic scanning methods and to detect anatomical variations. RESULTS: In 15 (14.3%) fetuses, NSD were detected on radiological sections. The angle between the virtual line from the sphenoid sinus ostium through limen nasi and the horizontal plane was 33.6 ±2.3°, on average. CONCLUSIONS: NSD may already be found in fetuses. The observation of the nasal cavity development enables to evaluate the growth and symmetry of the nasal septum and to foretell predispositions for dysfunction in the upper respiratory tract.

A suite of solid-state NMR experiments to utilize orphaned magnetization for assignment of proteins using parallel high and low gamma detection.

We present a suite of two-receiver solid-state NMR experiments for backbone and side chain resonance assignment. The experiments rely on either dipolar coupling or scalar coupling for polarization transfer and are devised to acquire a 1H-detected 3D experiment AND a nested 13C-detected 2D from a shared excitation pulse. In order to compensate for the lower sensitivity of detection on 13C nucleus, 2D rows are signal averaged during 3D planes. The 3D dual receiver experiments do not suffer from any appreciable signal loss compared to their single receiver versions and require no extra optimization. The resulting data is higher in information content with no additional experiment time. The approach is expected to become widespread as multiple receivers become standard for new NMR spectrometers.

Does field hockey increase morphofunctional asymmetry? A pilot study.

Common practice in field hockey requires athletes to adopt a semi-crouched posture, so players have a greater risk of musculoskeletal disorders than non-athletes. The aim of the present study was to assess how field hockey determines asymmetry in morphological and functional characteristics of the body by comparing athletes to control participants. The sample consisted of 15 male field hockey players from the Polish Youth National Team and 14 male university students. Antimeric differences in the chosen variables between body sub-regions were assessed. All morphological characteristics (bone mineral density, fat mass, and lean mass) were estimated using a dual energy X-ray absorptiometry. Additionally, the range of motion in transverse and frontal planes of the cervical, thoracic and lumbar spine was measured by using an electrogoniometric system. The results showed that the values of all morphological characteristics were higher in the left body segments, both in athletes and controls. However, the differences between sides were much more pronounced in the field hockey players. With regard to functional traits, higher values were obtained for the right body side in athletes but for the left side of the body among the controls. The difference between right and left side bending increased from the cervical spine (2.7%) through thoracic spine (7.8%) to lumbar spine (16.5%) in athletes. Rotational asymmetry in the thoracic spine was the largest in both groups. These findings indicate that it is important to monitor all athletes to prevent injury and health problems connected with strong morphological asymmetry.

Glycocalyx-mimetic dextran-modified poly(vinyl amine) surfactant coating reduces platelet adhesion on medical-grade polycarbonate surface.

A dextran-modified poly(vinyl amine) comb-like surfactant polymer, poly(N-vinyl dextran aldonamide-co-N-vinyl hexanamide), that can surface-adsorb on hydrophobic polymeric substrates, was designed to improve the interfacial blood-compatibility of polymeric biomaterials. Medical-grade polycarbonate was selected as a model substrate because of its extensive use in blood-contacting biomedical devices like hemodialyzers, blood pumps and oxygenators. The surfactant polymer was physisorbed from aqueous solution onto the polycarbonate substrate. The surfactant coating was stable under dynamic shear conditions in whole blood, as confirmed by fluorescence microscopy and total internal reflection fluorescence (TIRF) experiments with fluorescein-labeled surfactant polymer. The coated disks and uncoated control disks were exposed to platelet-rich plasma (PRP) and whole human blood in a rotating disk system (RDS) to study platelet-adhesion under dynamic shear stress environments. Adhered platelets were stained with fluorescein isothiocyante (FITC)-tagged anti-CD41a monoclonal antibody and imaged by epifluorescence microscopy. Complimentary images were obtained by phase-contrast microscopy. Platelet adhesion on the surfactant-coated disks was reduced by approximately 90%, compared with uncoated disks. The images also showed a concomitant reduction in platelet-derived microparticles on surfactant-coated disks, compared with uncoated disks. The results suggest potential application of carbohydrate-modified surfactant polymers as a glycocalyx-mimetic non-thrombogenic interfacial coating for blood-contacting biomaterials.

Amperometric glucose sensor: short-term, in vivo test.

The influence of selected physiologic coreactants on current-voltage scans of a (Pt-pvc) Pt electrode (the working electrode of the amperometric glucose sensor) was tested. It was shown that the electrode is sufficiently sensitive to glucose even in a case when a strong interference of tested substances was observed. On the basis of the preliminary in vivo measurements it was concluded that after the proper pretreatment, the amperometric glucose sensor can be used for short-term blood glucose monitoring.

Mega-electron-volt ultrafast electron diffraction at SLAC National Accelerator Laboratory.

Ultrafast electron probes are powerful tools, complementary to x-ray free-electron lasers, used to study structural dynamics in material, chemical, and biological sciences. High brightness, relativistic electron beams with femtosecond pulse duration can resolve details of the dynamic processes on atomic time and length scales. SLAC National Accelerator Laboratory recently launched the Ultrafast Electron Diffraction (UED) and microscopy Initiative aiming at developing the next generation ultrafast electron scattering instruments. As the first stage of the Initiative, a mega-electron-volt (MeV) UED system has been constructed and commissioned to serve ultrafast science experiments and instrumentation development. The system operates at 120-Hz repetition rate with outstanding performance. In this paper, we report on the SLAC MeV UED system and its performance, including the reciprocal space resolution, temporal resolution, and machine stability.

Generic isolated horizons and their applications

The notion of isolated horizons is extended to allow for distortion and rotation. Space-times containing a black hole, itself in equilibrium but possibly surrounded by radiation, satisfy these conditions. The framework has three types of applications: (i) it provides new tools to extract physics from strong field geometry; (ii) it leads to a generalization of the zeroth and first laws of black hole mechanics and sheds new light on the "origin" of the first law; and (iii) it serves as a point of departure for black hole entropy calculations in nonperturbative quantum gravity.

Use of the leukocyte esterase and nitrite tests to determine the need for culturing urine specimens from a pediatric and adolescent population.

Using a commercially available dip stick 601 urine specimens were screened for leukocytes and bacteria by testing for the presence of leukocyte esterase and nitrite. The screening method was found to have a sensitivity of 88.7% and a predictive value of negative results of 98.5%.

Blood pressure, plasma NPY and catecholamines during physical exercise in relation to menstrual cycle, ovariectomy, and estrogen replacement.

Some evidences indicate that the female sex hormones protect against the development of cardiovascular diseases. Modulation of sympathetic activity may be one of the possibilities. We investigated the influence of treadmill stress on blood pressure (BP) and plasma neuropeptide Y (NPY), norepinephrine (NE) and epinephrine (E) concentrations in 11 normotensive, menstruating women in the follicular (HWf) and luteal (HWl) phases and in eight ovariectomized women, before (OVX) and after estrogen supplementation (OVXe). Both at rest and during exercise there were no differences in BP between HWf and HWl and between OVX and OVXe. During stress BP was significantly lower in HWf and HWl than in OVX but not in OVXe. NPY did not differ significantly between the groups of women either at rest or during activity. We did not observe differences in resting and stimulated NE and E between HWf and HWl and between OVX and OVXe. Neither resting nor activated NE and E differed between the groups, except higher stimulated NE in OVX than in HWf. These results suggest that the female sex hormones may modulate the BP response to dynamic exercise. Our data support evidence that this influence may be exerted by circulating catecholamines and not by NPY.

Detection of hepatotoxicity associated with methotrexate therapy for psoriasis.

To determine whether liver function tests and clinical and demographic information would predict methotrexate-associated hepatotoxicity, we identified 78 patients who had undergone 147 liver biopsies associated with methotrexate therapy for psoriasis. The joint sensitivity of aspartate aminotransferase, alkaline phosphatase, and total bilirubin values in detecting abnormal results from a biopsy specimen obtained after treatment was .86; the predictive value of negative test results was .93. A logistic regression model significantly predicted the presence of abnormal (grade III or higher) liver biopsy specimen results. The concordance index was .92 (perfect, 1.0). Regression coefficients may be used along with information from a specific patient to calculate the predicted probability of an abnormal result from a liver biopsy specimen after treatment. We conclude that this multivariate risk estimation model significantly predicts the likelihood of positive findings from liver biopsy specimens in this patient population. The clinical use of this model awaits further validation.

Evaluation of plasma aldosterone to plasma renin activity ratio in patients with primary aldosteronism.

The plasma aldosterone to renin activity ratio (A/PRA) was assessed retrospectively in 103 patients with primary aldosteronism including 74 patients with surgically proven adrenal cortical adenoma (APA) and 29 patients with idiopathic adrenal cortical hyperplasia (IHA). The results were compared with those obtained in 31 patients with essential hypertension (EH) and 45 healthy normotensive controls. The upper limit of normal A/PRA ratio, as obtained in the controls was 17.8. This value was exceeded in 89% of patients with APA; postoperatively it decreased in 97% of the APA group, and returned to normal in 81%. In the IHA group the A/PRA was elevated in 70% of patients. The normal ratios in patients with primary aldosteronism were associated with unsuppressed plasma renin activity (PRA). Although the mean values of the A/PRA ratio differed significantly between the groups, complete separation was not obtained. The serum potassium level at time of testing did not influence the diagnostic value of the A/PRA ratio, although an inverse correlation between serum potassium and the A/PRA ratio was found in the patients with APA. This study supports the high sensitivity of the A/PRA ratio in diagnosis of primary aldosteronism, however, a single determination with a normal result may not be sufficient for exclusion of the disease.

Endothelin-1 and neuropeptide Y plasma concentrations in renal venous blood of hypertensive patients with unilateral renal artery stenosis.

The aim of the study was to investigate endothelin-1 (ET-1) and neuropeptide Y (NPY) plasma concentrations in renal venous blood of hypertensive patients with unilateral renal artery stenosis (URAS). The study was performed in 22 patients with URAS and 18 patients diagnosed as essentially hypertensive. In each subject renal arteriography and renal vein catheterisation was performed. Blood samples for ET-1, NPY and plasma renin activity (PRA) were withdrawn from renal veins and vena cava inferior, and for ET-1 and NPY from the aorta. Patients with URAS were divided in two subgroups according to the renal vein renin ratio. Both in nine patients with URAS and ratio > 1.5 and in 13 patients with URAS and ratio < 1.5, ET-1 and NPY plasma concentrations evaluated in renal venous blood of the ischaemic kidney were not different from those assessed in the contralateral side, in vena cava inferior and in the aorta. In essential hypertension, the mean ET-1 and NPY plasma concentrations of both renal veins were not different from the ET-1 and NPY plasma values assessed in renal vein of stenosed and contralateral side, vena cava and aorta of patients with URAS with and without activation of the renin system. Our study indicates that chronic ischaemia does not affect ET-1 and NPY plasma concentrations in renal venous blood of hypertensive URAS patients both with and without activation of the renin system.

The use of an integrated clinical laboratory and pharmacy diabetes database to provide physician performance feedback in an IPA-model HMO.

The ability to link pharmacy claims and clinical laboratory result databases in a managed care setting holds great promise as an outcomes management tool. The authors have created a powerful disease management capability that generates dynamic, disease-specific reports containing actionable, provider-patient-level laboratory and pharmacy information. This system is used to send reports to primary care physicians in an independent practice association (IPA)-model managed care setting to improve the care of patients with diabetes mellitus. This systematic feedback methodology can augment physician decision-making behavior, promote compliance with national guidelines, and measure improvement in plan-level, population-based outcomes over time.

Variations in quadriceps femoris muscle in human fetuses.

In 138 human fetuses (70 males and 68 females) aging 9 to 36 weeks variations were recorded in the shape of individual heads of quadriceps femoris muscle. The typical traits of morphology of the vastus lateralis and the vastus medialis included additional fleshy lamellae and associations with the neighbouring muscles.

Morphology of splenii muscles in human fetuses.

Splenii muscles were studied in 60 human fetuses (27 males and 33 females) aged 14 to 25 weeks. The intersplenial triangle was present in all fetuses. The origins were displaced cranially and insertions were limited to smaller area than in adults. Numerous connections with adjacent muscles and more oblique course of muscular fibres were also observed.

[Activation of hemostasis in patients with chronic cholecystitis]. / Aktywacja hemostazy u chorych na przewlekle kamicze zapalenie pecherzyka zólciowego.

The aim of the study was to evaluate the influence of chronic cholecystitis on haemostasis. The study was conducted on 48 patients suffering from chronic cholecystolithiasis admitted for cholecystectomy to the Department of Surgery Regional Hospital in Bialystok. The control group consisted of 25 healthy subjects in this same age range. As a result of the study we found out that patients with chronic cholecystitis had hypercoagulability characterised by increase plasma concentrations of the sensitive markers of haemostasis: prothrombin fragments (F1 + 2), thrombin/antithrombin complex (TAT) and D-dimer.

[A case of thrombosis of the portal vein treated conservatively]. / Przypadek zakrzepicy zyly wrotnej leczonej zachowawczo.

Portal vein thrombosis is a difficult diagnostic and therapeutic problem. The predominating clinical sign of isolated portal vein thrombosis is usually a haemorrhage from oesophageal varices. A case is presented of portal vein thrombosis without the above mentioned sign, treated conservatively with good effect. The importance is worth stressing of abdominal USG examination in early diagnosis of the described disease.

[Neonatal blood aldosterone]. / Aldosteronemia noworodka.

Postnatal aldosterone levels have been studied in 13 newborns from birth to the end of the 3rd day of life. The examinations were performed in children in whom blood samples were collected frequently for the clinical reasons (mostly because of suspected serologic incompatibility). Aldosterone level was measured by radioimmunoassay in the mixed cord blood and then at 2, 6, 12, 48, 72 hours after birth. Aldosterone concentration in the cord blood was 0.35 ng/dl and rapidly increased to 0.79 ng/dl during the first two hours after birth. The same value was obtained at the 6th hour of life. The mean aldosterone concentrations were 0.85 ng/dl at the 12th hour, 0.89 ng/dl at the 24th and 48th and 0.85 at the 72nd hour of life. Postnatal variation of aldosterone levels differs from previously investigated variations of glucocorticoids levels.