Two Patients with Therapy-Resistant Pemphigus Vulgaris and Severe Underlying Disease Showing Good Response to a New IVIg Preparation.

Pemphigus vulgaris is a severe and often therapy-resistant bullous autoimmune disease. Standard therapy with steroids often administered together with another immunosuppressant does not respond in all patients or may not be a good therapeutic option in patients with severe underlying diseases. Intravenous immunoglobulins (IVIgs) represent a treatment alternative, often showing a rapid response which allows one to reduce concomitant immunosuppression.

Dual Chamber Pacemaker Implant in Coronary Sinus Leading to Several Complications.

Permanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4-8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications.

Morphology-dependent Li ion dynamics in X-ray amorphous and crystalline LiPS prepared by solvent-assisted synthesis.

Solid-state electrolytes with high ionic conductivity will be crucial for future energy storage systems. Among many possible materials, thiophosphates offer both favourable mechanical properties and fast ionic transport. β-LiPS, as a member of the thiophosphate family, has gained recent attention, due to its remarkable increase in Li ionic conductivity when prepared solvent-assisted synthesis.

Arrhythmia and Death Following Percutaneous Revascularization in Ischemic Left Ventricular Dysfunction: Prespecified Analyses From the REVIVED-BCIS2 Trial.

Background: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date.

Methods: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone.

Ionic Conductivity of Nanocrystalline and Amorphous LiGePS: The Detrimental Impact of Local Disorder on Ion Transport.

Solids with extraordinarily high Li dynamics are key for high performance all-solid-state batteries. The thiophosphate LiGePS (LGPS) belongs to the best Li-ion conductors with an ionic conductivity exceeding 10 mS cm at ambient temperature. Recent molecular dynamics simulations performed by Dawson and Islam predict that the ionic conductivity of LGPS can be further enhanced by a factor of 3 if local disorder is introduced.

Opening Diffusion Pathways through Site Disorder: The Interplay of Local Structure and Ion Dynamics in the Solid Electrolyte LiPGeSI as Probed by Neutron Diffraction and NMR.

Solid electrolytes are at the heart of future energy storage systems. Li-bearing argyrodites are frontrunners in terms of Li ion conductivity. Although many studies have investigated the effect of elemental substitution on ionic conductivity, we still do not fully understand the various origins leading to improved ion dynamics.

With a Little Help from P NMR: The Complete Picture on Localized and Long-Range Li Diffusion in LiPSI.

LiPSI acts as a perfect model substance to study length scale-dependent diffusion parameters in an ordered matrix. It provides Li-rich cages which offer rapid but localized Li translational jump processes. As jumps between these cages are assumed to be much less frequent, long-range ion transport is sluggish, resulting in ionic conductivities in the order of 10 S cm at room temperature.

Prognostic value of changes in high-sensitivity cardiac troponin T beyond biological variation in stable outpatients with cardiovascular disease: a validation study.

Objective: To evaluate the prognostic implications of longitudinal long-term changes beyond the biological variation of high-sensitivity cardiac troponin T (hs-cTnT) in outpatients with stable or asymptomatic cardiovascular disease (CV) and to assess possible differences in the prognostic value while using reference change value (RCV) and minimal important differences (MID) as metric for biological variation.

Methods: Hs-cTnT was measured at index visit and after 12 months in outpatients presenting for routine follow-up. The prognostic relevance of a concentration change of hs-cTnT values exceeding the biological variation defined by RCV and MID of a healthy population within the next 12 months following the stable initial period was determined regarding three endpoints: all-cause mortality (EP1), a composite of all-cause mortality, non-fatal myocardial infarction and stroke (EP2), and a composite of all-cause mortality, non-fatal myocardial infarction, stroke, hospitalization for acute coronary syndrome (ACS) or decompensated heart failure, and planned and unplanned percutaneous coronary interventions (PCI, EP3).

Isolable Geminal Bisgermenolates: A New Synthon in Organometallic Chemistry.

We have synthesized the first isolable geminal bisenolates LKGe[(CO)R] (=2,4,6-trimethylphenyl (,), L=THF for () or [18]-crown-6 for ()), a new synthon for the synthesis of organometallic reagents. The formation of these derivatives was confirmed by NMR spectroscopy and X-ray crystallographic analysis. The UV/Vis spectra of these anions show three distinct bands, which were assigned by DFT calculations.

Fuzzy logic: about the origins of fast ion dynamics in crystalline solids.

Nuclear magnetic resonance offers a wide range of tools to analyse ionic jump processes in crystalline and amorphous solids. Both high-resolution and time-domain [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] NMR helps throw light on the origins of rapid self-diffusion in materials being relevant for energy storage. It is well accepted that [Formula: see text] ions are subjected to extremely slow exchange processes in compounds with strong site preferences.

Isolable Geminal Bisgermenolates: A New Synthon in Organometallic Chemistry.

We have synthesized the first isolable geminal bisenolates L K Ge[(CO)R] (R=2,4,6-trimethylphenyl (2 a,b), L=THF for (2 a) or [18]-crown-6 for (2 b)), a new synthon for the synthesis of organometallic reagents. The formation of these derivatives was confirmed by NMR spectroscopy and X-ray crystallographic analysis. The UV/Vis spectra of these anions show three distinct bands, which were assigned by DFT calculations.

Conductor-Insulator Interfaces in Solid Electrolytes: A Design Strategy to Enhance Li-Ion Dynamics in Nanoconfined LiBH/AlO.

Synthesizing Li-ion-conducting solid electrolytes with application-relevant properties for new energy storage devices is a challenging task that relies on a few design principles to tune ionic conductivity. When starting with originally poor ionic compounds, in many cases, a combination of several strategies, such as doping or substitution, is needed to achieve sufficiently high ionic conductivities. For nanostructured materials, the introduction of conductor-insulator interfacial regions represents another important design strategy.

Nonverbal Semantics Test (NVST)-A Novel Diagnostic Tool to Assess Semantic Processing Deficits: Application to Persons with Aphasia after Cerebrovascular Accident.

Assessment of semantic processing capacities often relies on verbal tasks which are, however, sensitive to impairments at several language processing levels. Especially for persons with aphasia there is a strong need for a tool that measures semantic processing skills independent of verbal abilities. Furthermore, in order to assess a patient's potential for using alternative means of communication in cases of severe aphasia, semantic processing should be assessed in different nonverbal conditions.

Tracking Ions the Direct Way: Long-Range Li Dynamics in the Thio-LISICON Family LiMCh (M = Sn, Ge; Ch = S, Se) as Probed by Li NMR Relaxometry and Li Spin-Alignment Echo NMR.

Solid electrolytes are key elements for next-generation energy storage systems. To design powerful electrolytes with high ionic conductivity, we need to improve our understanding of the mechanisms that are at the heart of the rapid ion exchange processes in solids. Such an understanding also requires evaluation and testing of methods not routinely used to characterize ion conductors.

Short-term adverse remodeling progression in asymptomatic aortic stenosis.

Objectives: Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS.

Methods: Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI.

Structural Disorder in LiPSI Speeds Li Nuclear Spin Recovery and Slows Down P Relaxation-Implications for Translational and Rotational Jumps as Seen by Nuclear Magnetic Resonance.

Lithium-thiophosphates have attracted great attention as they offer a rich playground to develop tailor-made solid electrolytes for clean energy storage systems. Here, we used poorly conducting LiPSI, which can be converted into a fast ion conductor by high-energy ball-milling to understand the fundamental guidelines that enable the Li ions to quickly diffuse through a polarizable but distorted matrix. In stark contrast to well-crystalline LiPSI (10 S cm), the ionic conductivity of its defect-rich nanostructured analog touches almost the mS cm regime.

Pacemaker Lead Perforation Mimicking Symptoms of Acute Pulmonary Embolism.

Myocardial perforation is a rare yet serious complication following cardiac pacemaker or defibrillator device procedures. In this article, the authors describe a case of right ventricular pacemaker lead perforation presenting to our hospital's medical assessment unit with a clinical presentation suggestive of an acute pulmonary embolism. Treatment dose low molecular weight heparin (LMWH) was commenced while awaiting CT scan.

Evaluating Models of Gesture and Speech Production for People With Aphasia.

People with aphasia use gestures not only to communicate relevant content but also to compensate for their verbal limitations. The Sketch Model (De Ruiter, 2000) assumes a flexible relationship between gesture and speech with the possibility of a compensatory use of the two modalities. In the successor of the Sketch Model, the AR-Sketch Model (De Ruiter, 2017), the relationship between iconic gestures and speech is no longer assumed to be flexible and compensatory, but instead iconic gestures are assumed to express information that is redundant to speech.

Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation.

Background: Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses.

Objectives: To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions.

Methods: An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses.

The Production of Gesture and Speech by People With Aphasia: Influence of Communicative Constraints.

Purpose People with aphasia (PWA) use different kinds of gesture spontaneously when they communicate. Although there is evidence that the nature of the communicative task influences the linguistic performance of PWA, so far little is known about the influence of the communicative task on the production of gestures by PWA. We aimed to investigate the influence of varying communicative constraints on the production of gesture and spoken expression by PWA in comparison to persons without language impairment.

'Hearing hooves, finding zebras': the differential diagnosis of cardiac arrest precipitated by chest pain in the postpartum woman.

We describe the case of a 3-week postpartum 27-year-old woman who presented with chest pain to the emergency department shortly before developing cardiac arrest with refractory ventricular fibrillation. She was initially misdiagnosed and treated for presumed pulmonary embolism (PE) with thrombolysis. A total of 14 direct current cardioversion shocks were given and return of spontaneous circulation (ROSC) was achieved post thrombolysis.

Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves.

Objectives: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).

Methods: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.