Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy--should surgical indications be revisited?

The treatment of massive pulmonary embolism (PE) is a matter of debate. We present our institutional experience of patients suffering from massive PE with the aim of comparing the early results, the outcome and quality of life (QoL) between patients primarily assigned to either pulmonary surgical embolectomy (SE) or thrombolytic therapy (TL). A subgroup of patients (TS) with failed responses to TL requiring SE was separately analysed.

The Catholic Doctrine of Transubstantiation: An Exposition and Defense

The purpose of this thesis is to offer both an exposition and defense for the Catholic Church's traditional understanding of eucharistic transubstantiation. I hope to show how a belief in such a doctrine is in no way irrational nor is it indefensible; butinstead, the doctrine of transubstantiation makes sense when it is viewed in light of what Catholic Christians believe about who the human being is, what the human desires, and the special way in which God personally works in human history. The method I am following investigates how the doctrine of transubstantiation coheres with and follows the other beliefs that Catholics hold; that is, beginning with certain presuppositions, there is a certain rational progression to the Catholic understanding of real presence.

Attempted suicide in shanghai districts: A pilot study

This is a pilot study whose objective was to collect data on attempted suicide in 5 districts of Shanghai and to test the feasibility of introducing an ongoing monitoring of attempted suicide. Data on a total of 363 cases were collected. The mean age of the patients was 33 years, 67% being female. Ingesting drugs or other chemical substances was the main method used for self-harm. Reasons for attempted suicide in these districts of Shanghai often appear to be related to family conflicts and unemployment. In spite of methodological limitations, the recorded data allow some preliminary conclusions regarding the characteristics of patients in districts of Shanghai admitted after a suicide attempt. Continuous monitoring of attempted suicide in this urban area of China should be established and data collection improved to raise awareness in health professionals and to develop preventive measures geared toward the needs of these patients.

Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series

Descending necrotizing mediastinitis (DNM) is a rare but rapidly progressing disease with a potentially fatal outcome, originating from odontogenical or cervical infections. The aim of this article was to give an up-to-date overview on this still underestimated disease, to draw the clinician's attention and particularly to highlight the need for rapid diagnosis and adequate surgical treatment.

High expression of octamer-binding transcription factor 4A, prominin-1 and aldehyde dehydrogenase strongly indicates involvement in the initiation of lung adenocarcinoma resulting in shorter disease-free intervals

The increasing relevance of the cancer stem cell (CSC) hypothesis and the impact of CSC-associated markers in the carcinogenesis of solid tumours may provide potential prognostic implications in lung cancer. We propose that a collective genetic analysis of established CSC-related markers will generate data to better define the role of putative CSCs in lung adenocarcinoma (LAC).

1,25-Dihydroxycholecalciferol with low-calcium diet reduces acute rejection in rat lung allotransplantation

The effect of 1,25-dihydroxycholecalciferol (calcitriol, vitamin D3) with a low-calcium diet on the acute lung allograft rejection in a rat unilateral left lung transplantation model was evaluated.

Seasonal variation and sources of low molecular weight organic acids in precipitation in the rural area of Anshun

Low mol. wt. (LMW) org. acids are important and ubiquitous chem. constituents in the atm. A comprehensive study of the chem. compn. of pptn. was carried out from June 2007 to June 2008 at a rural site in Anshun, in the west of Guizhou Province, China. During this period, 118 rainwater samples were collected and the main LMW carboxylic acids were detd. using ion chromatog. The av. pH of rainwater was 4.89 which is a typical acidic value. The most abundant carboxylic acids were formic acid (vol. wt. mean concn.: 8.77 μmol L-1) and acetic acid (6.90 μmol L-1), followed by oxalic acid (2.05 μmol L-1). The seasonal variation of concns. and wet deposition fluxes of org. acids indicated that direct vegetation emissions were the main sources of the org. acids. Highest concns. were obsd. in winter and were ascribed to the low winter rainfall and the contribution of other air pollution sources northeast of the study area. The ratio of formic and acetic acids in the pptn. ([F/A]T) was proposed as an indicator of pollution source. This suggested that the pollution resulted from direct emissions from natural or anthropogenic sources. Comparison with acid pptn. in other urban and rural areas in Guizhou showed that there was a decreasing contribution of LMW org. acids to free acidity and all anions in rainwater from urban to remote rural areas. Consequently, it is necessary to control emissions of org. acids to reduce the frequency of acid rain, esp. in rural and remote areas. [on SciFinder(R)]

The future of aortic surgery in Europe

At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS).

Huge aneurysm of the ascending aorta in a patient with adult-type Pompe's disease: histological findings mimicking fibrillinopathy

Adult-type Pompe's disease (glycogen storage disease type II) has rarely been shown to present with dilatative arteriopathy, suggesting potential smooth muscle involvement in addition to lysosomal glycogen deposits usually restricted to skeletal muscle tissue. We report the case of a middle-aged man under enzyme replacement therapy presenting with an exceedingly large thoracic aortic aneurysm. Surprisingly, the histological work-up of resected aortic tissue revealed changes mimicking those observed in patients with classic connective tissue diseases. Enzyme replacement therapy, in addition to musculoskeletal and pulmonary treatment for patients with Pompe's disease, may prolong survival and lead to patients presenting with vascular alterations that may pose surgical and potential diagnostic challenges in the future.

Asymmetric speed modulation of a rotary blood pump affects ventricular unloading

Rotary blood pumps (RBPs) running at a constant speed are routinely used for the mechanical support of the heart in various clinical applications, from short-term use in heart-lung machines to long-term support of a failing heart. Their operating range is delineated by suction and regurgitation events, leaving limited control on the cardiac workload. This study investigates whether different ratios of systolic/diastolic support are advantageous over a constant-speed operation.

Quality of life in high-risk patients: comparison of transcatheter aortic valve implantation with surgical aortic valve replacement

OBJECTIVES To compare health-related quality of life (QoL) in patients undergoing transcatheter aortic valve implantation via transapical access (TA TAVI) with patients undergoing surgical aortic valve replacement (SAVR). METHODS One hundred and forty-four high-risk patients referred for aortic valve replacement underwent TAVI screening and were assigned to either TA TAVI (n = 51, age 79.7 ± 9.2 years, logistic EuroSCORE 26.5 ± 16.1%, 51% males) or SAVR (n = 93, age 81.1 ± 5.3 years, logistic EuroSCORE 12.1 ± 9.3%, 42% males) by the interdisciplinary heart team. QoL was assessed using the Short Form 36 (SF-36) Health Survey Questionnaire and the Hospital Anxiety and Depression Scale. Furthermore, current living conditions and the degree of independence at home were evaluated. RESULTS Patients undergoing TA TAVI were at higher risk as assessed by EuroSCORE (26.5 ± 16 vs. 12.1 ± 9, P < 0.001) and STS score (6.7 ± 4 vs. 4.4 ± 3, P < 0.001) compared with SAVR patients. At the 30-day follow-up, the rate of mortality was similar and amounted to 7.8% for TA TAVI and 7.5% for SAVR patients and raised to 25.5% in TA TAVI and 18.3% in SAVR patients after a follow-up period of 15 ± 10 months. Assessment of QoL revealed no differences in terms of anxiety and depression between TA TAVI and SAVR patients. The SF-36 mental health metascore was similar in both groups (65.6 ± 19 vs. 68.8 ± 22, P = 0.29), while a significant difference was observed in the physical health metascore (49.7 ± 21 vs. 62.0 ± 21, P = 0.015). After adjustment for baseline characteristics, this difference disappeared. However, every added point in the preoperative risk assessment with the STS score decreased the SF-36 physical health dimension by two raw points at the follow-up assessment. CONCLUSIONS Selected high-risk patients undergoing TAVI by using a transapical access achieve similar clinical outcomes and QoL compared with patients undergoing SAVR. Increased STS scores predict worse QoL outcomes.