Reel syndrome, a diagnostic conundrum: a case report.

Background: Pacemaker lead dislodgement and failure, related to device manipulation, is a rare complication of permanent pacemaker (PPM) insertion. Reel's, Twiddler's, and Ratchet syndrome are rare causes of pacemaker failure with varying mechanisms, defined by their classical lead and generator findings on chest X-ray imaging. Misleading patient presentations may be attributed to lead stimulation of surrounding structures.

The Impact of Intraoperative Patient Blood Management on Quality Development in Cardiac Surgery.

Objectives: Patient blood management (PBM) is increasingly introduced into clinical practice. Minimizing effects on transfusion have been proven, but relevance for clinical outcome has been sparsely examined. In regard to this, the authors analyzed the impact of introducing intraoperative PBM to cardiac surgery.

Cornea donation in Germany: Obtaining consent.

Tissue donation is important to reverse cornea-related blindness. Unfortunately, the willingness to make a decision concerning organ and tissue donation while still alive remains low despite all efforts. By analyzing anonymized archived data from 25 654 next-of-kin interviews from our database over a period of 5 years (2013-2018), it was found that only 20.

Valve-Sparing Aortic Root Replacement as First-Choice Strategy in Acute Type a Aortic Dissection.

Although, in theory, valve-sparing aortic root replacement () is an ideal surgical option for acute aortic dissection type A (AADA) it is usually not regarded as the first-choice treatment due to the emergency setting and the relative complexity of the procedure. Here, we report the results of a consecutive, single-surgeon series of 45 AADA patients with the as first-choice treatment strategy. Between September 2009 and July 2013 a total of 49 patients with AADA were consecutively operated by the same surgeon at our institution.

Ionization injection of highly-charged copper ions for laser driven acceleration from ultra-thin foils.

Laser-driven ion acceleration is often analyzed assuming that ionization reaches a steady state early in the interaction of the laser pulse with the target. This assumption breaks down for materials of high atomic number for which the ionization occurs concurrently with the acceleration process. Using particle-in-cell simulations, we have examined acceleration and simultaneous field ionization of copper ions in ultra-thin targets (20-150 nm thick) irradiated by a laser pulse with intensity 1 × 10 W/cm.

Causes of plasma column contraction in surface-wave-driven discharges in argon at atmospheric pressure.

In this work we compute the main features of a surface-wave-driven plasma in argon at atmospheric pressure in view of a better understanding of the contraction phenomenon. We include the detailed chemical kinetics dynamics of Ar and solve the mass conservation equations of the relevant neutral excited and charged species. The gas temperature radial profile is calculated by means of the thermal diffusion equation.

Four-year experience of providing mobile extracorporeal life support to out-of-center patients within a suprainstitutional network-Outcome of 160 consecutively treated patients.

Aim: Mobile extracorporeal life support (ECLS) may soon be on the verge to become a fundamental part of emergency medicine. Here, we report on our four-year experience of providing advanced mechanical circulatory support for out-of-center patients within the Düsseldorf ECLS Network (DELSN).

Methods: This retrospective cohort study analyses the outcome of 160 patients with refractory circulatory failure consecutively treated with mobile veno-arterial extracorporeal membrane oxygenation (vaECMO) between July 2011 and October 2015 within the DELSN.

Moving evidence based guidelines for seizures into practice in the emergency department: What's stopping us?

Purpose: To identify barriers to implementation of an evidence based integrated care pathway (ICP) for seizure management in the Emergency Department (ED).

Methods: A site specific bespoke questionnaire was designed to solicit anonymous responses from all grades of ED medical and nursing staff to a series of questions regarding utility, feasibility, significance and implementation of a locally designed and championed ICP for seizure management and onward referral.

Results: While 95% of respondents agreed that the pathway ensured patients were treated according to best practice, a number of human factors were identified as barriers to use.

Reduction of apoptosis and preservation of mitochondrial integrity under ischemia/reperfusion injury is mediated by estrogen receptor β.

Background: Estrogen improves cardiac recovery after ischemia/reperfusion (I/R) by yet incompletely understood mechanisms. Mitochondria play a crucial role in I/R injury through cytochrome c-dependent apoptosis activation. We tested the hypothesis that 17β-estradiol (E2) as well as a specific ERβ agonist improve cardiac recovery through estrogen receptor (ER)β-mediated mechanisms by reducing mitochondria-induced apoptosis and preserving mitochondrial integrity.

Heart transplantation bridged by mechanical circulatory support in a HIV-positive patient.

We report on the unique clinical course of a 44-year-old male HIV-positive heart transplant recipient, who was bridged by mechanical circulatory support (MCS). The patient was admitted with acute ischemic heart failure due to severe myocardial infarction. After emergency coronary artery bypass grafting and nine days of extracorporeal life support, we implanted a left ventricular assist device.

A Suprainstitutional Network for Remote Extracorporeal Life Support: A Retrospective Cohort Study.

Objectives: This study sought to evaluate patient outcome within the Düsseldorf Extracorporeal Life Support (ECLS) Network, a suprainstitutional network for rapid-response remote ECLS and to define survival-based predictors.

Background: Mobile venoarterial extracorporeal membrane oxygenation (vaECMO) used for ECLS has become a treatment option for a patient population with an otherwise fatal prognosis. However, outcome data remain scarce and institutional standards required to manage these patients are still poorly defined.

Incremental cost-effectiveness of dobutamine stress cardiac magnetic resonance imaging in patients at intermediate risk for coronary artery disease.

Aims: The effectiveness of stress cardiac magnetic resonance (CMR) as a gatekeeper for coronary angiography (CA) has been established. Level five HTA studies according to the hierarchical model of diagnostic test evaluation are not available.

Methods: This cohort study included 1,158 consecutive patients (mean age 63 ± 11 years, 42 % women) presenting at our institution between January 1, 2003 and December 31, 2004 with suspected coronary artery disease (CAD) for an elective CA.

Maladaptive remodeling is associated with impaired survival in women but not in men after aortic valve replacement.

Objectives: The purpose of this study was to test whether adaptive or maladaptive remodeling is associated with survival in women and men after aortic valve replacement (AVR).

Background: Women with isolated aortic valve stenosis (AS) develop more concentric left ventricular hypertrophy (LVH) than men in similar disease states. We recently reported less up-regulation of profibrotic genes at AVR and faster LVH regression post-operatively in women than in men, suggesting that there are sex differences in the adaptation to pressure overload and its regression.

Sex-dependent regulation of fibrosis and inflammation in human left ventricular remodelling under pressure overload.

Aims: Women with aortic stenosis develop a more concentric form of LV hypertrophy than men. However, the molecular factors underlying sex differences in LV remodelling are incompletely understood. We took an unbiased approach to identify sex-specific patterns in gene expression and pathway regulation, and confirmed the most prominent findings in human hearts.

Mapping nanoscale absorption of femtosecond laser pulses using plasma explosion imaging.

We make direct observations of localized light absorption in a single nanostructure irradiated by a strong femtosecond laser field, by developing and applying a technique that we refer to as plasma explosion imaging. By imaging the photoion momentum distribution resulting from plasma formation in a laser-irradiated nanostructure, we map the spatial location of the highly localized plasma and thereby image the nanoscale light absorption. Our method probes individual, isolated nanoparticles in vacuum, which allows us to observe how small variations in the composition, shape, and orientation of the nanostructures lead to vastly different light absorption.

Observation and control of shock waves in individual nanoplasmas.

Using an apparatus that images the momentum distribution of individual, isolated 100-nm-scale plasmas, we make the first experimental observation of shock waves in nanoplasmas. We demonstrate that the introduction of a heating pulse prior to the main laser pulse increases the intensity of the shock wave, producing a strong burst of quasimonoenergetic ions with an energy spread of less than 15%. Numerical hydrodynamic calculations confirm the appearance of accelerating shock waves and provide a mechanism for the generation and control of these shock waves.

Effects of estrogen, an ERα agonist and raloxifene on pressure overload induced cardiac hypertrophy.

The aim of this study was to investigate the effects of 17β-estradiol (E2), the selective ERα agonist 16α-LE2, and the selective estrogen receptor modulator (SERM) raloxifene on remodeling processes during the development of myocardial hypertrophy (MH) in a mouse model of pressure overload. Myocardial hypertrophy in ovariectomized female C57Bl/6J mice was induced by transverse aortic constriction (TAC). Two weeks after TAC, placebo treated mice developed left ventricular hypertrophy and mild systolic dysfunction.

17β-Estradiol-induced interaction of ERα with NPPA regulates gene expression in cardiomyocytes.

Aims: 17β-Oestradiol (E2) and its receptors (ERα and ERβ) are important regulators of physiological and pathological processes in the cardiovascular system. ER act in concert with other regulatory factors mediating oestrogenic effects. However, the underlying mechanisms modulating ER transcriptional activity are not fully elucidated.

Genetic association study identifies HSPB7 as a risk gene for idiopathic dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) is a structural heart disease with strong genetic background. Monogenic forms of DCM are observed in families with mutations located mostly in genes encoding structural and sarcomeric proteins. However, strong evidence suggests that genetic factors also affect the susceptibility to idiopathic DCM.

Regression of myocardial hypertrophy after aortic valve replacement: faster in women?

Background: In patients with aortic stenosis, pressure overload induces cardiac hypertrophy and fibrosis. Female sex and estrogens influence cardiac remodeling and fibrosis in animal models and in men. Sex differences and their molecular mechanisms in hypertrophy regression after aortic valve replacement have not yet been studied.

Heart transplantation in women with dilated cardiomyopathy.

Background: Dilated cardiomyopathy (DCM) is responsible for over half of all heart transplants. Fewer women with DCM undergo heart transplants than men with DCM; the reasons for this state of affairs are unclear.

Methods And Results: We analyzed prospectively a cohort of 698 DCM patients who were referred to our heart transplant center.