Subclinical epileptiform activity in the Alzheimer continuum: association with disease, cognition and detection method.

Background: Epileptic seizures are an established comorbidity of Alzheimer's disease (AD). Subclinical epileptiform activity (SEA) as detected by 24-h electroencephalography (EEG) or magneto-encephalography (MEG) has been reported in temporal regions of clinically diagnosed AD patients. Although epileptic activity in AD probably arises in the mesial temporal lobe, electrical activity within this region might not propagate to EEG scalp electrodes and could remain undetected by standard EEG.

Normalization of FFR after surgical unroofing of a myocardial bridge: a case report.

Background: Cardiac computed tomography angiography derived fractional flow reserve (FFR) is a diastolic measurement and has emerged as a valuable non-invasive alternative to FFR in patients with stable coronary artery disease. It has, unlike FFR during coronary angiography, not been validated for the physiological evaluation of an isolated myocardial bridge (MB) so far.

Case Summary: Our patient, previously known with a long myocardial bridge of the mid-segment of the left anterior descending artery, presented with a non-ST-segment elevation myocardial infarction that was treated by surgical unroofing of the MB.

Clinical and prognostic incremental value of FFRCT in screening of patients with obstructive coronary artery disease.

Background: Coronary computed tomography angiography (CCTA) -derived fractional flow reserve (FFR) is recommended to evaluate the functional consequences of obstructive coronary artery disease (OCAD). Real-world incremental impacts of FFR use still remains under debate.

Methods: 1601 patients with suspected OCAD on CCTA (>50 ​% stenosis), including 808 (50.

Depression and Malnutrition for Prediction of Mortality after Transcatheter Aortic Valve Replacement: A Registry Study of a Tertiary Referral Hospital.

Moderate to severe frailty is a predictor of a poor outcome after transcatheter aortic valve replacement (TAVR), but little is known about the prognostic importance of different geriatric frailty markers in an overall fit or pre-frail geriatric population undergoing TAVR. This retrospective study aimed to examine the incremental value of adding patient frailty markers to conventional surgical risk score to predict all-cause mortality in relatively fit elderly patients undergoing TAVR. Overall patient frailty was assessed using the comprehensive geriatric assessment frailty index (CGA-FI).

Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease.

Background: In significant obstructive coronary artery disease (SOCAD), a mismatch in assessment of severity of coronary artery stenosis may occur between invasive coronary angiography (ICA) and computed tomography (CT) derived fractional flow reserve (FFR). The present study aimed to identify the factors giving an FFR > 0.80 and leading to an underestimation of coronary artery severity in SOCAD vessels.

Long term effects of surgical and transcatheter aortic valve replacement on FFR in patients with severe aortic valve stenosis.

The long-term variations of fractional flow reserve derived from coronary computed tomography (FFR) after surgical (SAVR) or transcatheter (TAVR) aortic valve replacement in patients with severe aortic valve stenosis (AS) have not been investigated. A total of 25 patients with isolated, severe AS underwent coronary computed tomography with 3-vessel FFR analysis (Heartflow Inc.-Redwood City, California, USA) and measurement of total coronary volume (V), left ventricular mass (M) and their ratio (V/M) before and 6 months after SAVR or TAVR.

Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease.

Background: Computed-tomography (CT) derived fractional-flow-reserve (FFR) gradually may decrease from proximal to distal vessels even without apparent coronary artery disease (CAD). It may be unclear whether the decrease in FFR at the distal coronal artery is physiological or due to stenosis. We decided to study predictive factors of an FFR decline below the pathological value of 0.

Streptococcal pharyngitis associated myocarditis (SPAM): the perfect ST-segment elevation myocardial infarction (STEMI) mimic in young individuals. A case series.

Background: The mean prevalence of ST-segment elevation myocardial infarction (STEMI) in the absence of obstructive coronary artery disease is 5-6%, while one third of these cases is attributed to myocarditis. Streptococcal pharyngitis associated myocarditis (SPAM) is a rare form of myocarditis which appears shortly after a streptococcal pharyngitis and presents as a STEMI on the surface electrocardiogram.

Methods: We present the clinical course and outcome of two young and previously healthy individuals, diagnosed with SPAM.

An irregular, extremely broad QRS complex rhythm.

We report a case of a 74-year-old lady admitted to the emergency department with a very broad QRS complex caused by flecainide intoxication due to acute renal failure. Appropriate recognition of the ECG changes and symptoms provoked by flecainide intoxication permitted quick directed treatment with intravenous administration of high dose sodium bicarbonate, which resolved the QRS elongation.

Role of cerebral hypoperfusion in multiple sclerosis (ROCHIMS): study protocol for a proof-of-concept randomized controlled trial with bosentan.

Background: Axonal degeneration is related to long-term disability in patients with multiple sclerosis (MS). The underlying mechanism remains ill understood but appears to involve axonal energetic dysfunction. A globally impaired cerebral blood flow (CBF) has been observed in the normal-appearing white matter (NAWM) of patients with MS, which is probably related to astrocytic overexpression of endothelin-1 (ET-1).

A shocking bike accident.

CLINICAL INTRODUCTION: A man in his late 40s presented with severe chest pain and progressive dyspnoea after hitting a tree at high speed during a bike ride in the woods. On admission, the patient appeared agitated, pale and sweaty. Core temperature was 35.

Bilateral low frequency rTMS of the primary motor cortex may not be a suitable treatment for levodopa-induced dyskinesias in late stage Parkinson's disease.

Background: In late stage Parkinson patients there is an unmet need for new treatments to adequately control motor complications, especially dyskinesias. In several preliminary studies, it has been suggested that applying unilateral low-frequency repetitive transcranial magnetic stimulation (LF rTMS), delivered at the primary motor cortex (MC) or the supplementary motor area (SMA), may reduce levodopa-induced dyskinesias (LID), either in a single or a multiple session stimulation protocol. In our current clinical research, we examined whether single or multiple (accelerated) sham-controlled bilateral LF rTMS session(s) applied to the primary motor cortices are able to reduce levodopa-induced dyskinesias in patients with advanced Parkinson's disease.

"First experience with JenaValve™: a single-centre cohort".

Aims: Since the introduction of transcatheter aortic valve implantation (TAVI), newer generation and novel devices such as the retrievable JenaValve™ have been developed. We evaluated the procedural and 6-month results of our first experience with implantation of the JenaValve™.

Methods And Results: From June 2012 to December 2013, 24 consecutive patients (mean age 80 ± 7 years, 42 % male) underwent an elective transapical TAVI with the JenaValve™.

Transcatheter mitral paravalvular leakage closure: A beautiful last resort.

We describe a case of a 54-year-old patient with rheumatic heart valve disease who was treated with double valve replacement (both aortic and mitral) twice. Two months after the second operation she developed a severe mitral paravalvular leakage (PVL) leading to cardiogenic shock for which she was hospitalized in the intensive care unit. Multiple weaning efforts proved to be unsuccessful because of persistent hemodynamic instability caused by the severe PVL.

Fluoxetine in progressive multiple sclerosis (FLUOX-PMS): study protocol for a randomized controlled trial.

Background: Currently available disease-modifying treatments acting by modifying the immune response are ineffective in progressive multiple sclerosis (MS), which is caused by a widespread axonal degeneration. Mechanisms suspected to be involved in this widespread axonal degeneration are reduced axonal energy metabolism, axonal glutamate toxicity, and reduced cerebral blood flow. Fluoxetine might theoretically reduce axonal degeneration in MS because it stimulates energy metabolism through enhancing glycogenolysis, stimulates the production of brain-derived neurotrophic factor, and dilates cerebral arterioles.

Relationship between time of day and periprocedural myocardial infarction after elective angioplasty.

Objectives: To test if the time of day significantly influences the occurrence of type 4A myocardial infarction in elective patients undergoing percutaneous coronary intervention (PCI).

Background: Recent studies have suggested an influence of circadian rhythms on myocardial infarction size and mortality among patients with ST-elevation myocardial infarction. The aim of the study is to investigate whether periprocedural myocardial infarction (PMI) is influenced by the time of day in elective patients undergoing PCI.