Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis intermediate and late follow-up.

Objectives: the aim of this study was to evaluate the long-term results of transcatheter balloon aortic valvuloplasty, the preferred treatment for congenital aortic stenosis (AS).

Background: aortic valve function and reintervention late after this procedure are not well characterized.

Methods: from 1985 to 2008, 563 patients underwent balloon dilation for congenital AS.

An update on retinal laser therapy.

Since its discovery in the 1940s, retinal photocoagulation has evolved immensely. Although the first photocoagulators used incandescent light, it was the invention of the laser that instigated the widespread use of photocoagulation for treatment of retinal diseases. Laser permits selection of electromagnetic wavelength, energy levels, spot size and pulse duration.

PtdIns(3,4,5)P₃ is a regulator of myosin-X localization and filopodia formation.

Phosphatidylinositol (3,4,5)-trisphosphate [PtdIns(3,4,5)P₃] is a key regulator of cell signaling that acts by recruiting proteins to the cell membrane, such as at the leading edge during cell migration. Here, we show that PtdIns (3,4,5)P₃ plays a central role in filopodia formation via the binding of myosin-X (Myo10), a potent promoter of filopodia. We found that the second pleckstrin homology domain (Myo10-PH2) of Myo10 specifically binds to PtdIns(3,4,5)P₃, and that disruption of this binding led to impairment of filopodia and partial re-localization of Myo10 to microtubule-associated Rab7-positive endosomal vesicles.

Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.

Context: Evidence-based treatment trials for adolescents with anorexia nervosa are few.

Objective: To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission.

Design: Randomized controlled trial.

Effect of tacrolimus dosing on glucose metabolism in an experimental rat model.

Background: Post-transplant diabetes mellitus (PTDM) is a serious complication after transplantation. The complex clinical situation makes it difficult to distinct influence of the single factors. To define impact of calcineurin inhibitor therapy on the PTDM after transplantation an experimental study analyzing the impact of different tacrolimus - dosages on the pancreatic beta-cell function was designed.

The cost of graft failure and other severe complications after liver transplantation - experience from a German Transplant Center.

Background: Orthotopic liver transplantation (OLT) is a cost consuming therapy for only a relatively small number of patients. The aim of the present study was to explore specific cost drivers in a German transplant centre.

Material/methods: The analysis was done by combination of two separate databases with prospective clinical and case-related cost data.

Integrin-mediated cell attachment induces a PAK4-dependent feedback loop regulating cell adhesion through modified integrin alpha v beta 5 clustering and turnover.

Cell-to-extracellular matrix adhesion is regulated by a multitude of pathways initiated distally to the core cell-matrix adhesion machinery, such as via growth factor signaling. In contrast to these extrinsically sourced pathways, we now identify a regulatory pathway that is intrinsic to the core adhesion machinery, providing an internal regulatory feedback loop to fine tune adhesion levels. This autoinhibitory negative feedback loop is initiated by cell adhesion to vitronectin, leading to PAK4 activation, which in turn limits total cell-vitronectin adhesion strength.

Resource utilization after introduction of a standardized clinical assessment and management plan.

Introduction: A Standardized Clinical Assessment and Management Plan (SCAMP) is a novel quality improvement initiative that standardizes the assessment and management of all patients who carry a predefined diagnosis. Based on periodic review of systemically collected data the SCAMP is designed to be modified to improve its own algorithm. One of the objectives of a SCAMP is to identify and reduce resource utilization and patient care costs.

Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology.

Introduction: Chest pain in children is common, but rarely heralds serious underlying cardiac pathology. Despite this, the anxiety of missing a potentially life threatening condition creates a large burden of referrals and diagnostic testing. We evaluated patients diagnosed with 1 of 9 serious cardiac diseases and detailed the clinical signs and symptoms of the patients presenting with chest pain.

To close or not to close: the very small patent ductus arteriosus.

Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2-4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear.

A novel approach to gathering and acting on relevant clinical information: SCAMPs.

The current tools to adequately inform the process of improving health-care delivery consist primarily of retrospective studies, prospective trials, and clinical practice guidelines. We propose a novel and systematic approach that bridges the gap of our current tools to affect change, provides an infrastructure to improve health-care delivery, and identifies unnecessary resource utilization. The objective of this special article is to introduce the rationale and methods for this endeavor entitled "Standardized Clinical Assessment and Management Plans" (SCAMPs).

Deciding without data.

Introduction: Physician decisions drive most of the increases in health care expenditures, yet virtually no published literature has sought to understand the types of evidence used by physicians as they make decisions in real time.

Methods: Ten pediatric cardiologists recorded every clinically significant decision made during procedures, test interpretation, or delivery of inpatient and outpatient care during 5 full days and 5 half days of care delivery. The basis for each decision was assigned to one of 10 predetermined categories, ranging from arbitrary and anecdotal, to various qualities of published studies, to parental preference and avoiding a lawsuit.

Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US melody valve trial.

Background: Transcatheter pulmonary valve placement is an emerging therapy for pulmonary regurgitation and right ventricular outflow tract obstruction in selected patients. The Melody valve was recently approved in the United States for placement in dysfunctional right ventricular outflow tract conduits.

Methods And Results: From January 2007 to August 2009, 136 patients (median age, 19 years) underwent catheterization for intended Melody valve implantation at 5 centers.

Left ventricular diastolic heart failure in teenagers who underwent balloon aortic valvuloplasty in early infancy.

We report 4 teenage patients who, after successful palliation of severe aortic valve stenosis by balloon aortic valvuloplasty in early infancy, presented within the previous 3 years with significant left ventricular (LV) diastolic heart failure. All patients had remained asymptomatic until their teenage years and had normal or hyperdynamic LV systolic function on presentation, with limited residual aortic valve stenosis and regurgitation. All underwent echocardiography, cardiac catheterization, and cardiac magnetic resonance evaluation.

All better? How former anorexia nervosa patients define recovery and engaged in treatment.

The purpose of this study was to explore how individuals with anorexia nervosa (AN) engage in treatment and define recovery. A mixed methods design was used to triangulate the experience of 20 women with a history of AN. Interview data were analysed thematically to explore frequency of emergent themes and current eating disorder psychopathology was assessed using standardized self-report measures.

The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery.

Background: Liver failure has remained a major cause of mortality after hepatectomy, but it is difficult to predict preoperatively. This study describes the introduction into clinical practice of the new LiMAx test and provides an algorithm for its use in the clinical management of hepatic tumours.

Methods: Patients with hepatic tumours and indications for hepatectomy were investigated perioperatively with the LiMAx test.

Initial liver graft function is a reliable predictor of tacrolimus trough levels during the first post-transplant week.

The narrow therapeutic range of tacrolimus requires careful management after liver transplantation (LT). The aim of this study was to investigate the influence of graft function on tacrolimus trough levels during the first post-transplant week. Ninety-three patients receiving deceased-donor LT were observed in a prospective observational study.

How to define initial poor graft function after liver transplantation? - a new functional definition by the LiMAx test.

Initial poor function (IPF) is a frequent complication after liver transplantation, but there is no consensus on its definition. Ninety-nine patients undergoing primary deceased-donor liver transplantation were examined in a prospective clinical trial. A new functional classification for initial graft function was developed based on two LiMAx readouts during 24 h after transplantation with a cutoff LiMAx of 60 and 120 μg/kg/h using a simple algorithm.

Real-time Position Control of Concentric Tube Robots.

A novel approach to constructing robots is based on concentrically combining pre-curved elastic tubes. By rotating and extending the tubes with respect to each other, their curvatures interact elastically to position and orient the robot's tip, as well as to control the robot's shape along its length. Since these robots form slender curves, they are well suited for minimally invasive medical procedures.

Family-based treatment for adolescents with anorexia nervosa: a dissemination study.

This open trial of Family-Based Treatment for Anorexia Nervosa was completed in order to assess the dissemination of this treatment, including effectiveness, fidelity, and acceptability. Fourteen adolescents with Anorexia Nervosa were recruited with mean age 14.0+1.

Feasibility, acceptability, and effectiveness of family-based treatment for adolescent anorexia nervosa: an observational study conducted in Brazil.

Objective: There is strong evidence that family-based treatment is effective in cases of adolescent anorexia nervosa. Although family-based treatment has been studied in English-speaking countries, there is a need to examine the generalizability of this approach to non-English speaking cultures. This pilot-study aimed to examine the feasibility, acceptability, and effectiveness of family-based treatment in Brazil.