Primary percutaneous coronary intervention for unprotected left main disease in patients with acute ST-segment elevation myocardial infarction the AMIS (Acute Myocardial Infarction in Switzerland) plus registry experience.

OBJECTIVES: This study sought to assess outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) for unprotected left main (LM) disease. BACKGROUND: Limited data are available on outcomes in patients with ST-segment elevation myocardial infarction undergoing LM PCI. METHODS: Of 9,075 patients with ST-segment elevation myocardial infarction enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus registry between 2005 and June 30, 2010, 6,666 underwent primary PCI. Of them, 348 (5.2%; mean age: 63.5 ± 12.6 years) underwent LM PCI, either isolated (n = 208) or concomitant to PCI for other vessel segments (n = 140). They were compared with 6,318 patients (94.8%; mean age: 61.9 ± 12.5 years) undergoing PCI of non-LM vessel segments only. RESULTS: The LM patients had higher rates of cardiogenic shock (12.2% vs. 3.5%; p < 0.001), cardiac arrest (10.6% vs. 6.3%; p < 0.01), in-hospital mortality (10.9% vs. 3.8%; p < 0.001), and major adverse cardiac and cerebrovascular events (12.4% vs. 5.0%; p < 0.001) than non-LM PCI. Rates of mortality and major adverse cardiac and cerebrovascular events were highest for concurrent LM and non-LM PCI (17.9% and 18.6%, respectively), intermediate for isolated LM PCI (6.3% and 8.3%, respectively), and lowest for non-LM PCI (3.8% and 5.0%, respectively). Rates of mortality and major adverse cardiac and cerebrovascular events for LM PCI were higher than for non-LM multivessel PCI (10.9% vs. 4.9%, p < 0.001, and 12.4% vs. 6.4%, p < 0.001, respectively). LM disease independently predicted in-hospital death (odds ratio: 2.36; 95% confidence interval: 1.34 to 4.17; p = 0.003). CONCLUSIONS: Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI.

Group A rotavirus genotypes and the ongoing Brazilian experience: a review

Brazil was the first Latin American country to introduce universal group A rotavirus (RV-A) vaccination in March 2006, resulting in a unique epidemiological scenario. Since RV-A first identification in Brazil, 2,691 RV-A-positive stool samples, collected between 1982- 2007, were typed by independent research groups throughout the country. In the pre-vaccination era, 2,492 RV-A-positive samples collected from 1982-2005 were successfully typed, while 199 samples were analyzed from 2006-2007. According to the reviewed studies, there were two important times in the pre-vaccination era: (i) the period from 1982-1995, during which the detection of G5P[8] RV-A, in addition to the classical genotypes G1-4, challenged vaccine development programs; and (ii) the period from 1996-2005, during which genotype G9P[8] emerged, following a global trend. The rate of G2P[4] RV-A detection decreased from 26% (173/653) during 1982-1995 to 2% (43/1,839) during 1996-2005. The overall detection rate of RV-A genotypes from 1982-2005 was as follows: 43% (n = 1,079) G1P[8]/G1P[not typed (NT)]; 20% (n = 488) G9P[8]/G9P[NT]; 9% (n = 216) G2P[4]/G2P[NT]; 6% (n = 151) G3P[8]/G3P[NT]; 4% (n = 103) G4P[8]/G4P[NT]; and 4% (n = 94) G5P[8]/G5P[NT]. Mixed infections accounted for 189 (7%) of the positive samples, while atypical G/P combinations or other genotypes, including G6, G8, G10 and G12, were identified in 172 (7%) samples. The initial surveillance studies carried out in several Brazilian states with RV-A-positive samples collected in 2006 and 2007 show a predominance of G2P[4] strains (148/199 or 74%). Herein, we review RV-A typing studies carried out since the 1980s in Brazil, highlighting the dynamics of RV-A strain circulation profiles before and early after universal use of RV-A vaccine in Brazil.

The deployment of an e-book consultation and loan service : the experience of the Open University of Catalonia Library

La Biblioteca de la UOC (UOC Library) ha ofert durant tres mesos (octubre-desembre 09), en fase de prova pilot, un servei de consulta i préstec de lectors de llibres electrònics (e-readers). Aquest nou desplegament s'ha desenvolupat en consonància amb l'aposta general de la Universitat en innovació en tecnologies aplicades a l'educació, i la voluntat de potenciar les col·leccions de llibres electrònics i l'ús dels dispositius de lectura de llibres electrònics com una extensió més de la tecnologia del Campus 5.0, en el suport a l'aprenentatge dels seus estudiants durant la seva formació a la Universitat. Aquest treball presenta en detall les especificacions de la prova pilot, a més de contenir una anàlisi i avaluació dels resultats obtinguts: punts forts i punts febles, relació dels aspectes a millorar i modificar, de cara a la consolidació final del servei.

Hepatic Manifestations of Wilson Disease - CHUV Experience 2005-2010

Background and aim: Wilson disease (WD) is an inherited disorder ofhepatic copper excretion leading to toxic accumulation of copper in theliver as well as the brain, cornea, and other organs. The defect is due tomutations of the copper-transporting ATPase ATP7B. Here, we describethe adult cases of hepatic WD diagnosed at the CHUV between 2005and 2010.Methods: Clinical manifestions, results of diagnostic tests, and follow-upof adult patients with hepatic WD were recorded systematically.Results: Seven new adult cases of hepatic WD were diagnosed in ourcenter between 2005 and 2010. Three were women and 4 men, with amedian a ge at d iagnosis o f 24 (range, 1 8-56) years. Three patientspresented with acute liver failure (ALF), three with persistently elevatedliver function tests, and one with a dvanced cirrhosis. None hadneurological manifestations. Only one patient, presenting with ALF, had aKayser-Fleischer corneal ring. Median ceruloplasmin levels at diagnosiswere 0.13 (range, <0.03-0.30) g/l, median 24 h urinary copper excretion6.3 (range, 0.4-62.0) μmol/24 h, and median hepatic copperconcentration 591 (range, 284-1049) μg/g. At least one mutation in theATP7B g ene was i dentified in a ll patients. Allelic frequency of t hecommon H1069Q mutation was 14%. Two patients presenting with ALFand the one with advanced cirrhosis underwent successful l ivertransplantation. One patient with ALF recovered under chelator therapy.D-penicillamine was used as first-line chelator treatment, with a switch totrientine due to adverse effects in 2 out of 4 patients u nder l ong-termtreatment.Conclusions: The clinical presentation of WD and the performance ofdiagnostic tests are variable. A high index of suspicion i n clinicallycompatible situations i s key, with a combination of tests allowing thediagnosis of WD.

Clinical role of trastuzumab in metastatic breast cancer: experience of a center

Objective: To study the efficacy of different regimens of treatment based on trastuzumab in patients with Her2+ metastatic breast cancer (MBC).

Effect of investigator experience in CT colonography.

The aim of this study was to determine the impact of the learning curve on the diagnostic performances of CT colonography. Two blinded teams, each having a radiologist and gastroenterologist, prospectively examined 50 patients using helical CT scan followed by colonoscopy. Intermediate data evaluation was performed after 24 data sets (group 1) and compared with data from 26 subsequent patients (group 2). Parameters evaluated included sensitivity, specificity, false-positive and false-negative findings, time of data acquisition and interpretation. Using colonoscopy as the gold standard, sensitivity for CT colonography was for lesions >5 mm 63% for both teams for group 1 patients; for group 2 patients sensitivity was 45% for team 1 and 64% for team 2. Specificity per patients was for patient group 1 42% for team 1 and 58% for team 2; for patient group 2 it was 79% for both teams ( p=0.04 for team 1; p=0.2 for team 2). Comparing group 1 with group 2, the number of false-positive findings decreased significantly ( p=0.02). Furthermore, the mean time of data evaluation decreased from 45 to 17 min ( p=0.002) and the mean time of data acquisition from 19 to 17 min. With increasing experience, specificity and the time required for data interpretation improved and false positives decreased. There was no significant change of sensitivity, false-negative findings and time of data acquisition. A minimum experience of the readers is required for data interpretation of CT colonography.

Respiratory self-navigated postcontrast whole-heart coronary MR angiography: initial experience in patients.

PURPOSE: To assess the diagnostic performance of respiratory self-navigation for whole-heart coronary magnetic resonance (MR) angiography in a patient cohort referred for diagnostic cardiac MR imaging. MATERIALS AND METHODS: Written informed consent was obtained from all participants for this institutional review board-approved study. Self-navigated coronary MR angiography was performed after administration of a contrast agent in 78 patients (mean age, 48.5 years ± 20.7 [standard deviation]; 53 male patients) referred for cardiac MR imaging because of coronary artery disease (n = 40), cardiomyopathy (n = 14), congenital anomaly (n = 17), or "other" (n = 7). Examination duration was recorded, and the image quality for each coronary segment was assessed with consensus reading. Vessel sharpness, length, and diameter were measured. Quantitative values in proximal, middle, and distal segments were compared by using analysis of variance and t tests. A double-blinded comparison with the results of x-ray angiography was performed when such results were available. RESULTS: When patients with different indications for cardiac MR imaging were examined with self-navigated postcontrast coronary MR angiography, whole-heart data sets with 1.15-mm isotropic spatial resolution were acquired in an average of 7.38 minutes ± 1.85. The main and proximal coronary segments could be visualized in 92.3% of cases, while the middle and distal segments could be visualized in 84.0% and 55.8% of cases, respectively. Subjective scores and vessel sharpness were significantly higher in the proximal segments than in the middle and distal segments (P < .05). Anomalies of the coronary arteries could be confirmed or excluded in all cases. Per-vessel sensitivity and specificity for stenosis detection were 64.7% and 85.0%, respectively, in the 31 patients for whom reference standard x-ray coronary angiography results were available. CONCLUSION: The self-navigated coronary MR angiography sequence shows promise for coronary imaging. However, technical improvements are needed to improve image quality, especially in the more distal coronary segments.

Femur fracture in preschool children : experience with flexible intramedullary nailing in 72 children

RESUME Fractures du fémur chez les enfants d'âge préscolaire. Expérience avec l'enclouage centromédullaire élastique stable chez 72 enfants Introduction L'immobilisation plâtrée est le traitement le plus fréquemment utilisé pour traiter les fractures du fémur chez les enfants d'âge préscolaire de moins de 6 ans. L'enclouage centromédullaire élastique stable (ECMES), qui a remplacé les immobilisations plâtrées chez les enfants d'âge scolaire, est une alternative qui n'a jamais été étudiée spécifiquement dans la tranche d'âge préscolaire. Matériel et Méthode Nous avons réalisé une étude rétrospective de tous les cas de fractures du fémur chez l'enfant de moins de 6 ans traitées par ECMES dans le service de chirurgie pédiatrique du Centre Hospitalier Universitaire Vaudois et de l'Hôpital de l'Enfance de Lausanne sur une période de 15 ans. Résultats Parmi les 210 fractures du fémur traitées par ECMES entre le 1.1.1988 et le 31.12.2003, 74 fractures du fémur ont été identifiées chez 73 enfants âgés de 1.5 à 5.9 ans. Ces fractures étaient sous-trochantériennes (n=5), diaphysaires (n=64, dont 5 ouvertes), ou métaphysaires discales (n=4). Le type de fracture était transverse (n=35, dont 2 ouvertes), oblique (n=28, dont 3 ouvertes) au spiroïde (n=11). Quatre fractures étaient comminutives. Le temps opératoire moyen était de 56,9 minutes (limites entre 20 et 155 min.) pour les enfants ne présentant pas d'autre pathologie chirurgicale. Le séjour hospitalier moyen était de 9.1 jours (limites entre 1 et 46 jours) pour tous les enfants n'ayant pas de pathologie associée. Chez les enfants sans lésion ou pathologie associée, la première mise en charge s'est effectuée en moyenne au 14,1 ème jour post-opératoire (limites entre 1 et 42ème jour) alors que la première mobilisation a eu lieu en moyenne dès le 2,7ème jour post-opératoire (limites entre le 1 et le 14ème jour). 64 enfants ont été suivis à long terme avec un recul moyen de. 36,8 mois (limites entre 4 et 124 mois). Nous avons relevés 6 enfants avec une inégalité de longueur de plus d'un centimètre, alors que nous n'avons jamais constaté de défaut de rotation. Durant le 11 premières années de l'étude, 9 enfants ont dû être réopérés pour raccourcissement secondaire de broches extériorisées ou douloureuses sous la peau. Aucun problème de broche n'a été observé après introduction d'une nouvelle pince à couper. 2 réductions de fracture se sont faites à foyer ouvert. Une infection localisée transitoire du point de ponction d'une broche a été notée, sans ostéite associée. Discussion L' ECMES chez le petit enfant est techniquement réalisable sans véritable limite inférieure d'âge. Il favorise la mobilisation et la charge précoces. Les complications sont avant tout en rapport avec la technique et peuvent être évitées. Les résultats sont au moins aussi bons et meilleurs sur certains points que ceux publiés en utilisant les immobilisations. En outre ce traitement évite une longue hospitalisation. Conclusions L'ECMES peut être appliqué aux enfants de moins de 6 ans avec les mêmes bénéfices que ceux observés pour les plus grands, sans en augmenter la morbidité. La limite inférieure d'âge reste à déterminer. Un suivi à long terme s'impose pour vérifier l'absence d'inégalité de longueur des membres inférieurs.

Detection of suspected placental invasion by MRI: Do the results depend on observer' experience?

PURPOSE: To evaluate the diagnostic value of previously described MR features used for detecting suspected placental invasion according to observers' experience. MATERIALS AND METHODS: Our population included 25 pregnant women (mean age 35.16) investigated by prenatal MRI (1.5T, T1- and T2-weighted MR-sequences without i.v. contrast), among them 12 with histopathologically proven placental invasion and 13 women (52%) without placental invasion used as control group. Two senior and two junior radiologists blindly and independently reviewed MR-examinations in view of 6 previously defined MR-features indicating presence and degree of placental invasion (placenta increta, accreta or percreta). For each reader the sensibility, specificity, and receiver operating curve (ROC) were calculated. Interobserver agreements between senior and junior readers were determined. Stepwise logistic regression was performed including the 6 MR-features predictive of placental invasion. RESULTS: Demographics between both groups were statistically equivalent. Overall sensitivity and specificity for placental invasion was 90.9% and 75.0% for seniors and 81.8% and 61.8% for juniors, respectively. The best single MR-feature indicating placental invasion was T2-hypointense placental bands (r(2)=0.28), followed by focally interrupted myometrial border, infiltration of pelvic organs and tenting of the bladder (r(2)=0.36). Interobserver agreement for detecting placental invasion was 0.64 for seniors and 0.41 for juniors, thus substantial and moderate, respectively. Seniors detected placental invasion and depth of infiltration with significantly higher diagnostic certitude than juniors (p=0.0002 and p=0.0282, respectively). CONCLUSION: MRI can be a reliable and reproducible tool for the detection of suspected placental invasion, but the diagnostic value significantly depends on observers' experience.

Effects of Interviewer Experience on Components of Nonresponse in the European Social Survey

We analyze interviewer related nonresponse differences in face-to-face surveys distinguishing three types of interviewers: those who have previous experience with the same high standard cross-sectional survey ("experienced"), those who were chosen by the survey agency to complete refusal conversions ("seniors"), and usual interviewers. The nonresponse components are obtaining household contact, target person contact, and target person cooperation. In addition we examine if interviewer homogeneity with respect to these components is different across the three interviewer groups. Data come from the European Social Survey (ESS) contact forms from four countries which participated during the three rounds 2002/04/06 and used the same survey agency that in turn used to some extent the same interviewers. To analyze interviewer effects, we use discrete two-level models. We find some evidence of better performance by both senior and experienced interviewers and indications of greater homogeneity for nonresponse components, especially for those that contain room for improvement. Surprisingly, the senior interviewers do not outperform those experienced. We conclude that survey agencies should make more efforts to decrease the comparatively high interviewer turnover.