Usefulness of electrocardiographic parameters for risk prediction in arrhythmogenic right ventricular dysplasia

The value of electrocardiographic findings predicting adverse outcome in patients with arrhythmogenic right ventricular dysplasia (ARVD) is not well known. We hypothesized that ventricular depolarization and repolarization abnormalities on the 12-lead surface electrocardiogram (ECG) predict adverse outcome in patients with ARVD. ECGs of 111 patients screened for the 2010 ARVD Task Force Criteria from 3 Swiss tertiary care centers were digitized and analyzed with a digital caliper by 2 independent observers blinded to the outcome. ECGs were compared in 2 patient groups: (1) patients with major adverse cardiovascular events (MACE: a composite of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or arrhythmic syncope) and (2) all remaining patients. A total of 51 patients (46%) experienced MACE during a follow-up period with median of 4.6 years (interquartile range 1.8 to 10.0). Kaplan-Meier analysis revealed reduced times to MACE for patients with repolarization abnormalities according to Task Force Criteria (p = 0.009), a precordial QRS amplitude ratio (∑QRS mV V1 to V3/∑QRS mV V1 to V6) of ≤ 0.48 (p = 0.019), and QRS fragmentation (p = 0.045). In multivariable Cox regression, a precordial QRS amplitude ratio of ≤ 0.48 (hazard ratio [HR] 2.92, 95% confidence interval [CI] 1.39 to 6.15, p = 0.005), inferior leads T-wave inversions (HR 2.44, 95% CI 1.15 to 5.18, p = 0.020), and QRS fragmentation (HR 2.65, 95% CI 1.1 to 6.34, p = 0.029) remained as independent predictors of MACE. In conclusion, in this multicenter, observational, long-term study, electrocardiographic findings were useful for risk stratification in patients with ARVD, with repolarization criteria, inferior leads TWI, a precordial QRS amplitude ratio of ≤ 0.48, and QRS fragmentation constituting valuable variables to predict adverse outcome.

Weiji: Globale Dimensionen des Ersten Weltkrieges

Es gehört heute schon fast zum guten Ton, sich in Publikationen zur Geschichte des Ersten Weltkrieges nicht mehr nur auf Europa zu beschränken, sondern auch andere Teile der Welt in den Blick zu nehmen. Das zeigen jüngst Publikationen von Oliver Janz oder Jörn Leonhard. In diesem Vortrag sollen die nicht europäischen Teile der Welt nun aber die europäischen nicht einfach ergänzen, sie sollen vielmehr im Zentrum stehen. Ausgehend vom chinesischen Wort weiji, welches aus den beiden Schriftzeichen wei für Gefahr oder Risiko und ji für Chance oder Gelegenheit besteht, soll in diesem Vortrag mit Blick auf globalgeschichtliche Überlegungen danach gefragt werden, was den Ersten Weltkrieg wirklich zum ersten Weltkrieg macht. In einem weiteren Teilen werden dann aussereuropäische Kriegsschauplätze in Togo, Samoa, Neuguinea und dem Pazifik, in China, Deutsch Südwestafrika und Kamerun, im Osmanischen Reich sowie in Ostafrika kurz vorgestellt, um zu zeigen, dass auch mit Blick auf die Kampfhandlungen nicht nur Europa Schauplatz war und dass der Krieg dort sogar länger dauerte als in Europa selbst. Unter dem Titel Yigong Daibing – Arbeiter statt Soldaten widmet sich der dritte Teil des Vortrages der Mobilisierung aussereuropäischer Arbeiter aus drei Ländern, nämlich Australien, China und Südafrika. In allen Fällen ging es sicherlich darum, damit dem Arbeitskräftemangel auf Seiten der Ententemächte zu begegnen, zumindest langfristig bedeutsamer waren aber das Wissen und die Fertigkeiten, welche die Arbeiter am Ende des Krieges in ihre Länder zurückbrachten. Ebenso wichtig war auch die Tatsache, dass die Behörden der betreffenden Länder mit der Entsendung der Arbeiter auch eigene Absichten verfolgten, so im Fall Australiens mit Blick auf den Aufbau einer eigenen Rüstungsindustrie, im Fall Chinas mit Blick auf die Aufwertung des Status des eigenen Landes auf der internationalen Bühne und im Fall Südafrikas um die Aufstellung bewaffneter schwarzer Einheiten im Land im Zeichen der Rassentrennung zu verhindern. Die Hoffnungen der einzelnen Arbeiter erfüllten sich nur selten und vor allem nicht in dem von ihnen gewünschten Tempo, die durch sie bewirkten politischen, wirtschaftlichen und/oder sozialen Veränderungen waren aber durchaus nachhaltig. Der letzte Aspekt, der im Vortrag angesprochen wird, ist die globale Ernährungskrise der Jahre 1916/17, die in der Forschung lange Zeit zu wenig beachtet wurde, dies zumindest mit Blick auf ihre globale Dimension. Dies ist eigentlich erstaunlich, denn die Lebensmittelversorgung war vor 1914 durch einen sich verstärkenden transnationalen, wenn nicht globalen Austausch geprägt. Trotzdem hatte sich auf die daraus resultierenden Folgen kaum eine kriegführende Macht ausreichend vorbereitet. Im Krieg musste daher häufig improvisiert werden, was der Entente insgesamt wesentlich besser gelang als den Mittelmächten, auch weil sie in diesem Bereich wesentlich mehr zu investieren bereit war.

A class of exact Navier-Stokes solutions for homogeneous flat-plate boundary layers and their linear stability

We introduce a new boundary layer formalism on the basis of which a class of exact solutions to the Navier–Stokes equations is derived. These solutions describe laminar boundary layer flows past a flat plate under the assumption of one homogeneous direction, such as the classical swept Hiemenz boundary layer (SHBL), the asymptotic suction boundary layer (ASBL) and the oblique impingement boundary layer. The linear stability of these new solutions is investigated, uncovering new results for the SHBL and the ASBL. Previously, each of these flows had been described with its own formalism and coordinate system, such that the solutions could not be transformed into each other. Using a new compound formalism, we are able to show that the ASBL is the physical limit of the SHBL with wall suction when the chordwise velocity component vanishes while the homogeneous sweep velocity is maintained. A corresponding non-dimensionalization is proposed, which allows conversion of the new Reynolds number definition to the classical ones. Linear stability analysis for the new class of solutions reveals a compound neutral surface which contains the classical neutral curves of the SHBL and the ASBL. It is shown that the linearly most unstable Görtler–Hämmerlin modes of the SHBL smoothly transform into Tollmien–Schlichting modes as the chordwise velocity vanishes. These results are useful for transition prediction of the attachment-line instability, especially concerning the use of suction to stabilize boundary layers of swept-wing aircraft.

Stabilization of subcritical bypass transition in the leading-edge boundary layer by suction

This work investigates the subcritical spatial transition in the swept Hiemenz boundary layer by means of direct numerical simulations (DNS). A pair of steady co-rotating vortices located at the attachment line is enforced as a primary disturbance leading to streaks which are stable. A small secondary, time-dependent disturbance interacts with these streaks such that instability and breakdown to turbulence may occur. The instability only occurs for a certain band of secondary disturbance frequencies. Positive secondary instability growth rates could be observed for Reynolds numbers as low as , whereas the linear critical Reynolds number is. Uniform wall suction is shown to stabilise this transition mechanism, analogously to results from linear stability theory. The effects of suction on the formation of primary streaks and on the secondary growth rate are decoupled. For streaks of different suction whose amplitude is held constant by adjusting the Reynolds number, the suction is shown to increase the growth rate of the secondary instability. The stabilising influence of wall suction consists in decreasing the streak amplitude only. Depending on the Reynolds number and the suction strength, breakdown may either occur locally and may be convected along the far-field streamlines, or occur globally and cover broad regions in the downstream direction.

Laminar and turbulent nozzle-jet flows and their acoustic near-field

We investigate numerically the effects of nozzle-exit flow conditions on the jet-flow development and the near-field sound at a diameter-based Reynolds number of Re D = 18 100 and Mach number Ma = 0.9. Our computational setup features the inclusion of a cylindrical nozzle which allows to establish a physical nozzle-exit flow and therefore well-defined initial jet-flow conditions. Within the nozzle, the flow is modeled by a potential flow core and a laminar, transitional, or developing turbulent boundary layer. The goal is to document and to compare the effects of the different jet inflows on the jet flow development and the sound radiation. For laminar and transitional boundary layers, transition to turbulence in the jet shear layer is governed by the development of Kelvin-Helmholtz instabilities. With the turbulent nozzle boundary layer, the jet flow development is characterized by a rapid changeover to a turbulent free shear layer within about one nozzle diameter. Sound pressure levels are strongly enhanced for laminar and transitional exit conditions compared to the turbulent case. However, a frequency and frequency-wavenumber analysis of the near-field pressure indicates that the dominant sound radiation characteristics remain largely unaffected. By applying a recently developed scaling procedure, we obtain a close match of the scaled near-field sound spectra for all nozzle-exit turbulence levels and also a reasonable agreement with experimental far-field data.

Fluid-structure interaction of an elastic pipe immersed inside a coaxial rigid pipe: a model for the Tullio phenomenon

An axisymmetric, elastic pipe is filled with an incompressible fluid and is immersed in a second, coaxial rigid pipe which contains the same fluid. A pressure pulse in the outer fluid annulus deforms the elastic pipe which invokes a fluid motion in the fluid core. It is the aim of this study to investigate streaming phenomena in the core which may originate from such a fluid-structure interaction. This work presents a numerical solver for such a configuration. It was developed in the OpenFOAM software environment and is based on the Arbitrary Lagrangian Eulerian (ALE) approach for moving meshes. The solver features a monolithic integration of the one-dimensional, coupled system between the elastic structure and the outer fluid annulus into a dynamic boundary condition for the moving surface of the fluid core. Results indicate that our configuration may serve as a mechanical model of the Tullio Phenomenon (sound-induced vertigo).

Immunohistochemical panel for the diagnosis of Hirschsprung's disease using antibodies to MAP2, calretinin, GLUT1 and S100.

AIMS The diagnosis of Hirschsprung's disease is currently based on the identification of aganglionosis and the presence of an increase in acetylcholinesterase-positive hypertrophic nerve fibres in the large bowel submucosa. However, acetylcholinesterase staining is laborious and requires a skilled technician. The aim of this study was to identify a method for diagnosing Hirschsprung's disease reliably using an immunohistochemical panel of recently proposed markers. METHODS AND RESULTS Sixty-nine specimens from 37 patients were evaluated. MAP2 and calretinin antibodies were shown to stain ganglia reliably in the submucosal and myenteric plexuses of normal tissue. By contrast, reduced staining of ganglia was observed in patients with Hirschsprung's disease. Staining for GLUT1 and S100 was used to evaluate the number and thickness of nerve fibres. Gain of GLUT1 and S100 expression was in contrast to the loss of calretinin and MAP2. Hypertrophic submucosal nerve fibres in Hirschsprung's disease develop a perineurium with a ring-like GLUT1 staining pattern similar in size and intensity to that observed in deeper subserosal tissue. CONCLUSIONS The diagnosis of Hirschsprung's disease using immunohistochemical panels could be as accurate as with conventional frozen section techniques. In particular, the use of a combination of markers for ganglia and hypertrophic nerve fibres highlighting a prominent perineurium in Hirschsprung's disease could be an alternative method.

Assessing efficacy of different nucleos(t)ide backbones in NNRTI-containing regimens in the Swiss HIV Cohort Study.

BACKGROUND The most recommended NRTI combinations as first-line antiretroviral treatment for HIV-1 infection in resource-rich settings are tenofovir/emtricitabine, abacavir/lamivudine, tenofovir/lamivudine and zidovudine/lamivudine. Efficacy studies of these combinations also considering pill numbers, dosing frequencies and ethnicities are rare. METHODS We included patients starting first-line combination ART (cART) with or switching from first-line cART without treatment failure to tenofovir/emtricitabine, abacavir/lamivudine, tenofovir/lamivudine and zidovudine/lamivudine plus efavirenz or nevirapine. Cox proportional hazards regression was used to investigate the effect of the different NRTI combinations on two primary outcomes: virological failure (VF) and emergence of NRTI resistance. Additionally, we performed a pill burden analysis and adjusted the model for pill number and dosing frequency. RESULTS Failure events per treated patient for the four NRTI combinations were as follows: 19/1858 (tenofovir/emtricitabine), 9/387 (abacavir/lamivudine), 11/344 (tenofovir/lamivudine) and 45/1244 (zidovudine/lamivudine). Compared with tenofovir/emtricitabine, abacavir/lamivudine had an adjusted HR for having VF of 2.01 (95% CI 0.86-4.55), tenofovir/lamivudine 2.89 (1.22-6.88) and zidovudine/lamivudine 2.28 (1.01-5.14), whereas for the emergence of NRTI resistance abacavir/lamivudine had an HR of 1.17 (0.11-12.2), tenofovir/lamivudine 11.3 (2.34-55.3) and zidovudine/lamivudine 4.02 (0.78-20.7). Differences among regimens disappeared when models were additionally adjusted for pill burden. However, non-white patients compared with white patients and higher pill number per day were associated with increased risks of VF and emergence of NRTI resistance: HR of non-white ethnicity for VF was 2.85 (1.64-4.96) and for NRTI resistance 3.54 (1.20-10.4); HR of pill burden for VF was 1.41 (1.01-1.96) and for NRTI resistance 1.72 (0.97-3.02). CONCLUSIONS Although VF and emergence of resistance was very low in the population studied, tenofovir/emtricitabine appears to be superior to abacavir/lamivudine, tenofovir/lamivudine and zidovudine/lamivudine. However, it is unclear whether these differences are due to the substances as such or to an association of tenofovir/emtricitabine regimens with lower pill burden.

[An Uncommon Diagnosis].

We report on a 61-year-old patient who suffered from severe protein-energy malnutrition due to an inadequately treated exocrine pancreatic insufficiency. In this context, a thiamine deficiency was not recognized and there were clinical manifestations of beriberi disease with decompensated biventricular heart failure. In the course of time, a manifest niacin deficiency (pellagra) with dermatitis, diarrhea and persistent delirium occurred, which was recognized and could be treated. We highlight differential diagnostic considerations about the consequences and the treatment of malnutrition, with special focus on the classical deficiency diseases beriberi and pellagra.

[The overheated lunch].

We report about three patients consulting a general practitioner with acute onset of allergy-like clinical signs after having consumed tuna fish salad in the same restaurant. The treatment with antihistamines and steroids was effective and induced a quick regression of the symptoms. We look at considerations regarding the differential diagnosis and explain the pathophysiologic and the biochemical mechanisms of scombrotoxicosis.

Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair).

BACKGROUND Preterm infants suffering from intraventricular hemorrhage (IVH) are at increased risk for neurodevelopmental impairment. Observational data suggest that recombinant human erythropoietin (rEPO) improves long-term cognitive outcome in infants with IVH. Recent studies revealed a beneficial effect of early high-dose rEPO on white matter development in preterm infants determined by magnetic resonance imaging (MRI). OBJECTIVES To summarize the current evidence and to delineate the study protocol of the EpoRepair trial (Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants). METHODS The study involves a review of the literature and the design of a double-blind, placebo-controlled, multicenter trial of repetitive high-dose rEPO administration, enrolling 120 very preterm infants with moderate-to-severe IVH diagnosed by cranial ultrasound in the first days of life, qualitative and quantitative MRI at term-equivalent age and long-term neurodevelopmental follow-up until 5 years of age. RESULTS AND CONCLUSIONS The hypothesis generated by observational data that rEPO may improve long-term cognitive outcomes of preterm infants suffering from IVH are to be confirmed or refuted by the randomized controlled trial, EpoRepair.

Optimized CUDA-Based PDE Solver for Reaction Diffusion Systems on Arbitrary Surfaces

Partial differential equation (PDE) solvers are commonly employed to study and characterize the parameter space for reaction-diffusion (RD) systems while investigating biological pattern formation. Increasingly, biologists wish to perform such studies with arbitrary surfaces representing ‘real’ 3D geometries for better insights. In this paper, we present a highly optimized CUDA-based solver for RD equations on triangulated meshes in 3D. We demonstrate our solver using a chemotactic model that can be used to study snakeskin pigmentation, for example. We employ a finite element based approach to perform explicit Euler time integrations. We compare our approach to a naive GPU implementation and provide an in-depth performance analysis, demonstrating the significant speedup afforded by our optimizations. The optimization strategies that we exploit could be generalized to other mesh based processing applications with PDE simulations.