[Clinical Considerations in the Surgical Management of Active Infective Endocarditis of the Mitral Valve].

In the surgical management of infective endocarditis (IE), the presence of circulatory failure from valve destruction and vegetation embolization are important factors in determining the timing of surgery. Emergency surgery carries certain risks, such as infection control problems due to the unknown portal of entry of bacteria and infection, and the possibility of worsening cerebral hemorrhage in patients with hemorrhagic cerebrovascular disease. In recent years, there has been a trend toward more aggressive attempts at mitral valve repair for mitral IE, with improved success rates and rates of recurrent mitral regurgitation, and some reports suggesting that valve repair for active IE has better longterm survival rates than valve replacement. One possible factor is that early surgical intervention to resect the lesion may have a significant impact on the cure rate by preventing progression of valve destruction and controlling infection. Based on our clinical experience, we discuss the optimal timing of surgical intervention for mitral valve IE and present the postoperative remote survival rate, avoidance rate of reinfection, and avoidance rate of reoperation.

Single patch technique for aortic annulus reconstruction in prosthetic valve endocarditis.

Aortic root reconstruction during aortic root replacement for a patient with prosthetic valve endocarditis and aortic root abscess can be a difficult procedure with many possible complications. In this video case report, we describe our novel technique using a single bovine pericardial patch that avoids deep stitches or external sutures to support the friable annulus. Compared with more standard methods, this approach has shorter cross-clamp and cardiopulmonary bypass times and is less demanding technically.

Accurate kidney surface reconstruction from 3D ultrasonography for volume assessment: First clinical evaluation.

An accurate, repeatable and noninvasive measurement of kidney volume is an important but difficult task for nephrologists. This paper proposes a new kidney volumetry method by reconstructing the kidney surface from three-dimensional ultrasonography (3DUS) using statistical shape model (SSM). The measurement starts with picking sparse points on the kidney contour from 3DUS images. Then an accurate 3D kidney surface mesh can be reconstructed from the input points using the SSM in a fine-tune way. The kidney volume is finally calculated from the surface using divergence theorem of Gauss. The accuracy and repeatability of the proposed method have been validated on 36 patients. The results demonstrate that the proposed method is a promising solution for clinical evaluation of the kidney volume.

Intrahippocampal administration of A beta(1-40) impairs spatial learning and memory in hyperglycemic mice.

Age-related neurodegenerative dementia, particularly Alzheimer's disease (AD), may be exacerbated by several interacting risk factors including genetic predisposition, beta amyloid (A beta) protein accumulation, environmental toxins, head trauma, and abnormal glycolytic metabolism. We examined the spatial learning and memory effects of A beta(1-40) administration on hyperglycemic mice by their performance in the Morris water maze. Chronic hyperglycemia was induced in male C57BL/6J mice to mimic diabetes mellitus by intraperitoneal injection of streptozotocin (STZ), which specifically destroys pancreatic beta-islet cells. Ten days after STZ treatment, intrahippocampal infusion of vehicle, monomer, or oligomer A beta(1-40) was given to these hyperglycemic mice. Our results demonstrate that in comparison with vehicle or monomer A beta(1-40), oligomer A beta(1-40) induced significant deficits of spatial learning and memory in hyperglycemic mice. Apoptotic signals were identified in the CA1 and dentate gyrus of hippocampus in hyperglycemic mice. A beta accumulation, oxidative stress, and apoptosis in the CA1 region were more intensive in hyperglycemic mice than that in normoglycemic mice after acute treatment with oligomer A beta(1-40) peptide treatment. These results indicate that CA1 apoptosis was enhanced by oxidative stress resulting from accumulation of A beta. Considered together, these findings suggest that hyperglycemic mice are more vulnerable to the A beta-induced-oxidative stress than normal subjects. We therefore propose that A beta accumulation would be enhanced by hyperglycemia, and the oxidative stress caused by A beta accumulation would in turn enhance the AD symptoms.

Implementing the new International Health Regulations in the Pacific--challenges and opportunities.

The newly revised International Health Regulations, i.e. IHR (2005), adopted by the World Health Assembly in May 2005, are the legally binding international instruments for preventing and controlling international spread of disease while avoiding unnecessary interference with international traffic and trade. IHR (2005), which will enter into force in June 2007, set out new obligations for detection, assessment and notification of and response to public health events of international concern. In particular, under the IHR (2005), each Member State is required to notify WHO directly of any event that may consititue a public health emergency of international concern. Although the implementation of the new IHR to contribute to regional and global health security will be very challenging in the Pacific, they provide new opportunities for the Pacific Island Countries and areas (PICs) to build, strengthen and maintain their core capacities for surveillance and response. This article describes the major changes in the new Regulations and discusses the opportunity of using existing mechanisms for the implementation of IHR (2005). In the PICs, while strengthening the capacity of national public health surveillance and response systems is essential and the key to the effective implementation of the new Regulations, the Pacific Public Health Surveillance Network (PPHSN) can also be utilized to facilitate the IHR implementation, including disseminating updated information related to IHR such as WHO guidelines and capacity building, whenever possible.