Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series

OBJECTIVES Transcatheter aortic valve implantation (TAVI) is routinely performed via the transfemoral and the transapical route. Subclavian and direct aortic access are described alternatives for TAVI. Recently, the transcarotid approach has been shown to be feasible among patients with limited vascular access and severe native aortic valve stenosis. We aim to investigate the feasibility of transcatheter aortic valve-in-valve implantation via the transcarotid access in patients with severe aortic regurgitation due to degenerated stentless Shelhigh conduits using the 29 mm Medtronic CoreValve bioprosthesis. METHODS Three patients with complex vascular anatomy undergoing transcatheter valve-in-valve implantation via the transcarotid route were enrolled in the study. The procedure was performed under general anaesthesia using surgical cut-down to facilitate vascular access. Immediate procedural results as well as echocardiographic and clinical outcomes after 30 days and 6 months of the follow-up were recorded and analysed. RESULTS All three patients underwent unproblematic TAVI and experienced dramatic improvement of symptoms. Mean transvalvular gradient was 3, 6 and 11 mmHg, respectively. Effective orifice area ranged between 1.7 and 2.2 cm(2). Only mild paravalvular regurgitation was detected by echocardiography after 30 days of the follow-up. CONCLUSIONS The transcarotid approach can be safely performed for valve-in-valve procedures using the Medtronic CoreValve in patients with limited vascular access. It enables accurate positioning and implantation of the prosthesis.

In Vitro Activity of the Novel Antimicrobial Peptide Dendrimer G3KL against Multidrug-Resistant Acinetobacter baumannii and Pseudomonas aeruginosa.

The in vitro activity of the novel antimicrobial peptide dendrimer G3KL was evaluated against 32 Acinetobacter baumannii (including 10 OXA-23, 7 OXA-24, and 11 OXA-58 carbapenemase producers) and 35 Pseudomonas aeruginosa (including 18 VIM and 3 IMP carbapenemase producers) strains and compared to the activities of standard antibiotics. Overall, both species collections showed MIC50/90 values of 8/8 μg/ml and minimum bactericidal concentrations at which 50% or 90% of strains tested are killed (MBC50/90) of 8/8 μg/ml. G3KL is a promising molecule with antibacterial activity against multidrug-resistant and extensively drug-resistant A. baumannii and P. aeruginosa isolates.

Cooperative VET in Training Networks: Analysing the Free-Rider Problem in a Sociology-of-Conventions Perspective

In training networks, particularly small and medium-sized enterprises pool their resources to train apprentices within the framework of the dual VET system, while an intermediary organisation is tasked with managing operations. Over the course of their apprenticeship, the apprentices switch from one training company to another on a (half-) yearly basis. Drawing on a case study of four training networks in Switzerland and the theoretical framework of the sociology of conventions, this paper aims to understand the reasons for the slow dissemination and reluctant adoption of this promising form of organising VET in Switzerland. The results of the study show that the system of moving from one company to another creates a variety of free-rider constellations in the distribution of the collectively generated corporative benefits. This explains why companies are reluctant to participate in this model. For the network to be sustainable, the intermediary organisation has to address discontent arising from free-rider problems while taking into account that the solutions found are always tentative and will often result in new free-rider problems.

Die Organisation von Bildung. Soziologische Analysen zu Schule, Berufsbildung, Hochschule und Weiterbildung

Die Bedeutung von Bildung für Individuen und Gesellschaften ist enorm gestiegen. Dieser Band widmet sich der Organisation von Bildung in Schule, Berufsbildung und Hochschule. Die Beiträge befassen sich mit noch wenig untersuchten Phänomenen der Entstehung, dem Funktionieren und der Entwicklung von Bildungsorganisationen sowie deren Prozessen der Herstellung und (ungleichen) Verteilung von Bildung. Die Organisation von Bildung in Form von Schulen ist allgegenwärtig und gleichzeitig unhinterfragt. Dieser Band diskutiert vor dem Hintergrund der enorm gestiegenen Bedeutung von Bildung für Individuen und Gesellschaften, wie unterschiedliche Typen von Bildungsorganisationen im Bereich von Schule, Berufsbildung oder Hochschule entstehen, funktionieren und sich weiterentwickeln. Er fragt nach den Prozessen, durch die die Subjekte gebildet und Ungleichheiten reproduziert werden. Die theoretisch-konzeptionellen und empirischen Beiträge beleuchten vielfältige Perspektiven und führen bildungs- und organisationssoziologische Forschungsergebnisse innovativ zusammen.

Duale versus vollzeitschulische Berufsausbildung in der Schweiz. Zwei Institutionalisierungsmuster der beruflichen Bildung aus rechtfertigungstheoretischer und kantonal vergleichender Perspektive

Der historische und kantonsvergleichende Beitrag zur dualen versus vollzeitschulischen Berufsausbildung verbindet historische, berufsbildende und soziologische Perspektiven, um unterschiedlich verlaufende Institutionalisierungsprozesse nach Branche und Region bei der Entwicklung des Schweizer Berufsbildungssystems nachzuzeichnen. Im Zentrum steht die Frage, wie sich die zentralen, jedoch kontrastreichen, Organisationsmodelle der Berufsbildung – dual oder vollzeitschulisch – etablieren und kantonal durchsetzen konnten. Anhand von exemplarischen Fallstudien der Kantone Luzern und Genf werden rechtfertigungstheoretisch die zentralen Ordnungsprinzipien der Koordination und Legitimation sozialen Handelns, welches in Arbeits- und Bildungsorganisationen der Berufsbildung auf Dauer gestellt wird, verglichen. Gezeigt wird, dass die Organisation der Berufsbildung in den zwei Kantonen durch unterschiedliche Rechtfertigungsbezüge und Kompromisse befördert wurde. Mit dem dualen Berufsbildungsmodell zeichnete sich im historischen Rückblick dabei gleichzeitig eine auch überkantonal gangbare und durchsetzbare Kompromisslösung ab, um die unterschiedlichen bildungspolitischen Interessen und Bestrebungen der Kantone (Berufsbildung als Mittel der Integration und des sozialen Ausgleichs versus Berufsbildung als Mittel der Gewerbeförderung) in einem stark von Verbänden geprägten und gestalteten Modell der beruflichen Bildung zu integrieren und nachhaltig zu stabilisieren.

Cognitive improvement in patients with carotid stenosis is independent of treatment type

Treatment of carotid artery stenosis decreases the long-term risk of stroke and may enhance cerebral blood flow. It is therefore expected to have the potential to prevent cognitive decline or even improve cognition over the long-term. However, intervention itself can cause peri-interventional cerebral infarcts, possibly resulting in a decline of cognitive performance, at least for a short time. We investigated the long-term effects of three treatment methods on cognition and the emotional state one year after intervention. In this prospective observational cohort study, 58 patients with extracranial carotid artery stenosis (≥70%) underwent magnetic resonance imaging and assessment of cognition, mood and motor speed before carotid endarterectomy (n = 20), carotid stenting (n = 10) or best medical treatment (n = 28) (i.e., time-point 1 [TP1]), and at one-year follow-up (TP2). Gain scores, reflecting cognitive change after treatment, were built according to performance as (TP2 -TP1)/TP1. Independent of the treatment type, significant improvement in frontal lobe functions, visual memory and motor speed was found. Performance level, motor speed and mood at TP1 were negatively correlated with gain scores, with greater improvement in patients with low performance before treatment. Active therapy, whether conservative or interventional, produces significant improvement of frontal lobe functions and memory in patients with carotid artery disease, independent of treatment type. This effect was particularly pronounced in patients with low cognitive performance prior to treatment.

Completeness of Follow-Up Determines Validity of Study Findings: Results of a Prospective Repeated Measures Cohort Study.

BACKGROUND Current reporting guidelines do not call for standardised declaration of follow-up completeness, although study validity depends on the representativeness of measured outcomes. The Follow-Up Index (FUI) describes follow-up completeness at a given study end date as ratio between the investigated and the potential follow-up period. The association between FUI and the accuracy of survival-estimates was investigated. METHODS FUI and Kaplan-Meier estimates were calculated twice for 1207 consecutive patients undergoing aortic repair during an 11-year period: in a scenario A the population's clinical routine follow-up data (available from a prospective registry) was analysed conventionally. For the control scenario B, an independent survey was completed at the predefined study end. To determine the relation between FUI and the accuracy of study findings, discrepancies between scenarios regarding FUI, follow-up duration and cumulative survival-estimates were evaluated using multivariate analyses. RESULTS Scenario A noted 89 deaths (7.4%) during a mean considered follow-up of 30±28months. Scenario B, although analysing the same study period, detected 304 deaths (25.2%, P<0.001) as it scrutinized the complete follow-up period (49±32months). FUI (0.57±0.35 versus 1.00±0, P<0.001) and cumulative survival estimates (78.7% versus 50.7%, P<0.001) differed significantly between scenarios, suggesting that incomplete follow-up information led to underestimation of mortality. Degree of follow-up completeness (i.e. FUI-quartiles and FUI-intervals) correlated directly with accuracy of study findings: underestimation of long-term mortality increased almost linearly by 30% with every 0.1 drop in FUI (adjusted HR 1.30; 95%-CI 1.24;1.36, P<0.001). CONCLUSION Follow-up completeness is a pre-requisite for reliable outcome assessment and should be declared systematically. FUI represents a simple measure suited as reporting standard. Evidence lacking such information must be challenged as potentially flawed by selection bias.

Proliferative kidney disease in brown trout – infection level, pathology and mortality under field conditions

Proliferative kidney disease (PKD) is an emerging disease threatening wild salmonid populations. In temperature-controlled aquaria, PKD can cause mortality rates of up to 85% in rainbow trout. So far, no data about PKD-related mortality in wild brown trout Salmo trutta fario are available. The aim of this study was to investigate mortality rates and pathology in brown trout kept in a cage within a natural river habitat known to harbor Tetracapsuloides bryosalmonae. Young-of-the-year (YOY) brown trout, free of T. bryosalmonae, were exposed in the River Wutach, in the northeast of Switzerland, during 3 summer months. Samples of wild brown trout caught by electrofishing near the cage location were examined in parallel. The incidence of PKD in cage-exposed animals (69%) was not significantly different to the disease prevalence of wild fish (82 and 80% in the upstream and downstream locations, respectively). The mortality in cageexposed animals, however, was as low as 15%. At the termination of the exposure experiment, surviving fish showed histological lesions typical for PKD regression, suggesting that many YOY brown trout survive the initial infection. Our results at the River Wutach suggest that PKD in brown trout does not always result in high mortality under natural conditions.

"ein anmuot und liebe zuo allerlei herrlichen khünsten". Abt Christoph Silberysen und seine Werke

Der Artikel verortet Entstehung und Gebrauch des reich illustrierten Vogeljagdbuchs im Kontext standesgemässer Repräsentationspolitik des Wettinger Abts Christoph Silberysen.