Local laboratory-run donor-derived cell-free DNA assay for rejection surveillance in heart transplantation-first six months of clinical experience.

INTRODUCTION: Donor-derived cell-free DNA (dd-cfDNA) is a blood biomarker detecting graft injury with high negative predictive value. While non-invasive strategies for heart transplant (HTx) rejection surveillance are widely adopted in the United States with centralized testing, data on the feasibility of dd-cfDNA assay at the local level are lacking. Here, we report the first 6 months of experience with a local laboratory-run dd-cfDNA assay in the routine clinical surveillance setting. METHODS: Twenty-six HTx patients with stable graft function were transitioned from endomyocardial biopsy-based (EMB) to dd-cfDNA-led rejection surveillance using a commercially available next-generation sequencing-based assay. RESULTS: In the 90 samples analyzed, dd-cfDNA fraction remained continuously low in most patients, thus 88% of surveillance EMBs could be safely avoided. In the case of ≥.25% dd-cfDNA, EMB was performed. There was no missed rejection. CONCLUSION: Our data show the feasibility to analyze dd-cfDNA at the local level and successful implementation of this non-invasive surveillance method into clinical practice, thus considerably reducing the frequency of invasive surveillance EMBs.

Cardiac sarcoidosis completely mimicking biventricular arrhythmogenic cardiomyopathy.

Cardiac sarcoidosis (CS) is a chameleon of cardiology, and it can mimic different cardiac diseases; among them is arrhythmogenic cardiomyopathy (ACM). We admitted a 70-year-old female patient with heart failure symptoms in 2015, who fulfilled all major ECG and non-invasive imaging criteria of biventricular ACM. She was well with the recommended medications for 3 years, showing only isolated cardiac involvement, but in 2018, cervical and mediastinal lymphadenopathy appeared and cervical lymph node core biopsy histology, bronchoalveolar lavage flow cytometry strongly suggested extracardiac sarcoidosis. Therefore, our suspicion was that sarcoidosis is responsible for the cardiac involvement, which was not confirmed by PET-CT and gallium scintigraphy examinations. At the end of 2018, she died in septicaemia with multiorgan failure, and only autopsy verified her CS. A new ECG algorithm published in 2021 for the differential diagnosis of CS and biventricular ACM, when applied on her ECGs recorded in 2015, suggested the diagnosis of CS.

Perinatal, neonatal, developmental and demographic predictors of intelligence at 4 years of age among low birth weight children: a panel study with a 2-year follow-up.

INTODUCTION: Childhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities. OBJECTIVES: The purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children. METHODS: We designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated. RESULTS: Stepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4. CONCLUSION: Sociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored.

Blood-filled cyst of the tricuspid valve: Multiple cardiac disorders, one surgical case.

BACKGROUND: Intracardiac blood cysts are an exceedingly rare occurrence in adulthood. Detailed imaging modalities aid in the diagnosis of such incidental lesions and procedure planning. METHODS: We report the case of a 51-year-old male accusing dyspnea on exertion as a sole symptom which led to the discovery of multiple cardiac anomalies, namely, severe aortic valve insufficiency on a bicuspid aortic valve, ascending aortic aneurysm, a cystic mass on the tricuspid valve, patent foramen ovale, and an occluded right coronary artery. RESULTS: The disorders were managed in a single surgical intervention, the resected mass being confirmed as a blood cyst. CONCLUSIONS: Our case presents a unique association of cardiac disorders, including a highly uncommon intracardiac blood-filled cyst, and underlines the importance of multimodality imaging and interdisciplinary approach in the successful management of such complex cases.

Behçet's disease: successful aortic root reconstruction in severely dilated aortoventricular junction after aortic valve replacement with novel surgical method - case report.

BACKGROUND: Behçet's disease is an auto-inflammatory disorder categorized as a primer systemic vasculitis of unknown aetiology. Genetic factors, infectious agents and the irregularity of T-cell homeostasis are presumed to be responsible for the emergence of Behçet's disease. Characteristic symptoms are multisystemic. Although cardiovascular involvement is rare, it should be noted due to the difficulty of surgical treatment options. CASE PRESENTATION: Our 44-year-old male patient underwent aortic valve replacement due to aortic regurgitation. At the 15-month follow-up, echocardiography showed detachment of the prosthetic valve and in the aortic root, multiple pseudo-aneurysms were identified. We performed an aortic root reconstruction with a Bentall procedure using a special "skirted" conduit to reduce strain in the suture line between the conduit and the extremely dilated left ventricular outflow tract. CONCLUSIONS: The surgical treatment of cardiovascular manifestations of Behçet's disease remains challenging. This new technique may be beneficial in well-selected cases where the annulus of the aorta is extremely dilated or annular tissue disorder is present.

Adaptive Behavioral, Social-Emotional, and Neurodevelopmental Outcomes at 2 Years of Age in Hungarian Preterm Infants Based on Bayley III.

AIM:  This study aimed to assess cognitive, language, and motor development as well as social-emotional and adaptive behavior skills of low birthweight (LBW) children. METHODS: Our cohort contained 305 two-year-old LBW children. Developmental functioning was assessed by the Bayley Scales of Infant and Toddler Development, 3rd Edition. RESULTS: Performance in language, particularly in expressive communication was the poorest. Extremely low birthweight (ELBW) children were found to be at increased risk of developmental delay: 12.73 times in motor (95%CI = 2.8-57.5), 9.81 times in cognitive (95%CI = 3.2-29.6) and 3.91 times in language (95%CI = 1.6-9.4), and social-emotional skills (95%CI = 1.6-9.5). Parents of children with lower birthweight reported poorer social and practical adaptive skills. Self-care domain seemed to be the least developed. CONCLUSION: Additionally, the screening for developmental delays, monitoring the adaptive behavior skills may also be useful - especially among ELBW children - in order to identify the specific areas, situations, and functions that are most in need of interventions. ABBREVIATIONS: AB: Adaptive Behavior; ABAS-II: Adaptive Behavior Assessment System-II; BPD: Bronchopulmonary Dysplasia; BSID-III: Bayley Scales of Infant Development 3rd Edition; BW: Birthweight; CI: Confidence Interval; CS: Composite Score; ELBW: Extremely Low Birthweight; GA: Gestational Age; IVF: In Vitro Fertilization; IVH: Intraventricular Hemorrhage; LBW: Low Birthweight; NEC: Necrotizing Enterocolitis; OR: Odds Ratio; ROP: Retinopathy of Prematurity; SE: Social-Emotional Development; VLBW: Very Low Birthweight.

Evaluation of the performance of a human D-dimer test in dogs with neoplasia.

The goal of this study was to evaluate the suitability of a commercially available D-dimer assay as a diagnostic tool for testing dogs. This assay is an immunoturbidimetric diagnostic test, capable of determining the D-dimer levels in human plasma by using 2B9 monoclonal antibody. Plasma samples of clinically healthy (n = 20) and tumour-bearing (n = 50) dogs were measured. The tumours were grouped on the basis of histological type and aggressiveness, and then the measured D-dimer concentrations of these groups were compared to those of the control group. The differences were analysed statistically. For benign tumours, we did not find alterations in the D-dimer levels. However, in the case of malignant tumours (lymphoma, sarcoma, and carcinoma) and in the presence of metastases, significantly elevated D-dimer levels were measured. The assay proved to be suitable for measuring the D-dimer levels in plasma samples of dogs. The calculated reference range for dogs was confirmed to be between 0.06 and 0.69 µg/mL fibrinogen equivalent unit.

[Psychomotor state of development of preterm children concerning chronic neonatal morbidities at the age of 2 years]. / Koraszülöttek kétéves kori pszichomotoros fejlettsége a leggyakoribb krónikus utóbetegségek tekintetében.

Introduction: Over the last few years, in the development of neonatology, the limits to which it is possible to sustain the lives of premature babies have been extended, and thus the proportion of survivors with chronic morbidities has increased. Retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD), all of which deeply influence the quality of life, life expectancy and social integration, are the most significant morbidities among premature newborns. Aim: Description of psychomotor development of low birth weight (<2500 g) premature infants at the age of 2 years, in relation to the most common chronic morbidities. Method: Psychomotor development (Brunet-Lézine scale, 1980) of low-birth-weight preterm infants at the age of 2 years (n = 200) was measured and the neonatal final reports were analysed retrospectively. Results: After age correction, birth weight positively correlated with the developmental quotient (DQ), while the length of stay in hospital correlated negatively. Grades I/II of neonatal IVH were not significant predictors of lower DQ, while the opposite was true for grades III/IV. We identified a similar relationship with the stages of ROP. According to the result of the homogeneity test, we can consider the independent effects of significant diseases. We also observed that the more diagnoses the premature baby received, the more they are at risk of later developmental delay at the age of 2 years. Conclusions: We recommend the early childhood interventions of the most vulnerable children of ≤1500 g birth weight with severe ROP and IVH - to reduce deficiencies in capabilities and prevent future mental and motor difficulties. Orv Hetil. 2020; 161(5): 183-192.

[Specific quality of life factors in patients with inflammatory bowel disease]. / Specifikus életminoség-jellemzok egészségpszichológiai szempontú vizsgálata gyulladásos bélbetegségben szenvedo betegek körében.

INTRODUCTION: Inflammatory bowel disease is a chronic disease with a fluctuating course and unknown origin. Its two major forms are Crohn's disease and ulcerative colitis. OBJECTIVE: The authors attempted to analyse the quality of life of patients with inflammatory bowel disease as compared to healthy persons and patients with asthma in order to identify specific factors which most significantly affect the quality of life of these patients. METHOD: 269 subjects participated in the study (control group, 115 subjects; Crohn's disease, 67 patients; ulcerative colitis, 25 patients; asthma, 62 patients). The following methods were used: WHO-5, IIRS, SIBDQ and AQLQ(S) questionnaires and content analysis. RESULTS: Patients with inflammatory bowel disease had the worst quality of life with respect to both subjective well-being and burden of disease. The results obtained from questionnaires developed for the analysis of quality of life indicated that extraintestinal symptoms and emotional problems are the major factors which interfere with the quality of life of patients with inflammatory bowel disease. These findings were confirmed by content analysis of interviews with patients. CONCLUSIONS: The authors recommend that more attention should be paid to improving the quality of life of patients with inflammatory bowel disease and helping them to live with the illness, especially at the level of interpersonal relations.