다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

[신간의 별자리x] 우리/미술, 그리고 ‘슬픔의 박물관’

EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

During the past decade, catheter ablation of atrial fibrillation (AF) has evolved rapidly from an investigational procedure to its current status as a commonly performed ablation procedure in many major hospitals throughout the world. Surgical ablation of AF, using either standard or minimally invasive techniques, is also performed in many major hospitals throughout the world.

In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society.1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons and the American College of Cardiology. Since the publication of the 2007 document, there has been much learned about AF ablation, and the indications for these procedures have changed. Therefore the purpose of this 2012 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a Task Force, convened by the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society and charged with defining the indications, techniques, and outcomes of this procedure. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation, including definitions relevant to this topic.

This statement summarizes the opinion of the Task Force members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF. This statement is not intended to recommend or promote catheter ablation of AF. Rather the ultimate judgment regarding care of a particular patient …

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

Many studies on severe infections use in-hospital mortality, 14-day mortality, or 30-day mortality, as classic endpoints. However, in the era of high-performance intensive care, these endpoints no longer seem appropriate. Modern intensive-care medicine has massively reduced early mortality in patients with sepsis.1 Although this reduction is gratifying, it should not obscure the fact that these patients are still far from being healed. 

In-hospital mortality of patients with severe bloodstream infection: only the tip of the iceberg.

Hypoglycemia is a clinical hallmark of severe malaria, the often-lethal presentation of Plasmodium falciparum infection of humans. Here we report that mice reduce blood glucose levels in response to Plasmodium infection via a coordinated response whereby labile heme, an alarmin produced via hemolysis, induces anorexia and represses hepatic glucose production (HGP). While protective against unfettered immune-mediated inflammation, organ damage and anemia, when sustained over time heme-driven repression of HGP can progress towards hypoglycemia, compromising host energy expenditure and thermoregulation. This hypometabolic state arrests the development of asexual stages of Plasmodium spp., which undergo pyknosis and develop mitochondrial dysfunction. In response, Plasmodium activates a transcriptional program reducing its virulence and inducing sexual differentiation towards the production of transmissible gametocytes. We infer that malaria-associated hypoglycemia represents a trade-off of an evolutionarily conserved defense strategy restricting Plasmodium spp. from accessing host-derived glucose and balancing parasite virulence and transmission.

/pdf/a-hypometabolic-defense-strategy-against-plasmodium-2rm3e4g8g3.pdf

A hypometabolic defense strategy against plasmodium infection

Minimally-invasive mitrofanoff procedure in children: An analysis of learning curve over a 18-years period

Robot-assisted continent urinary diversion in children according to the Mitrofanoff principle: It is safe and feasible even in low-volume centers – a bi-institutional study

Die Blutstrominfektion mit Staphylococcus aureus (SAB) stellt eine eigene klinische Entität dar. Aufgrund ihrer Häufigkeit und der hohen assoziierten Morbidität und Mortalität gelten besondere Anforderungen an das klinische Management. So ist im Gegensatz zu koagulasenegativen Staphylokokken, schon der einmalige Nachweis von Staphylococcus (S.) aureus in der Blutkultur als behandlungsbedürftige Infektion anzusehen. Es erfolgt die Einteilung in komplizierte vs. unkomplizierte Blutstrominfektion mit Auswirkung auf die empfohlene Therapiedauer (2 vs. 4 bis 6 Wochen). Die Durchführung einer transösophagealen Echokardiographie zum Ausschluss einer Endokarditis ist in den allermeisten Fällen indiziert. Aufgrund häufig klinisch stummer septischer Metastasen kann eine Positronenemissionstomographie mit Computertomographie (PET-CT) zur Fokussuche erwogen werden. Bei Methicillin-sensiblem S. aureus (MSSA) werden Flucloxacillin und Cefazolin als Basistherapie eingesetzt, bei Methicillin-resistentem S. aureus (MRSA) je nach Fokus und Komorbidität Vancomycin oder Daptomycin. Bei einliegendem Fremdmaterial sollte eine Kombination der Basistherapie mit Rifampicin oder Fosfomycin erwogen werden. Eine Fokussanierung durch Abszessdrainage oder Entfernung von infizierten intravaskulären Kathetern, intrakardialen Devices oder ggf. künstlichen Gelenken ist wichtig. Infektiologische Konsile verbessern die Behandlungsqualität und Mortalität bei SAB. Aktuelle offene Fragen behandeln die Identifikation der Subpopulation, die von einer Kombinationstherapie profitiert, die Effektivität und den Zeitpunkt einer Oralisierung der antibiotischen Therapie im Verlauf sowie eine mögliche Verkürzung der Gesamttherapiedauer. In diesem Übersichtsbeitrag fassen wir die aktuellen Standards zur Diagnostik und Therapie von Patienten mit SAB zusammen und stellen aktuelle relevante Studien zu diesem Krankheitsbild vor. 

Sebastian Weis

Papers

In-hospital mortality of patients with severe bloodstream infection: only the tip of the iceberg.

A hypometabolic defense strategy against plasmodium infection

Minimally-invasive mitrofanoff procedure in children: An analysis of learning curve over a 18-years period

Robot-assisted continent urinary diversion in children according to the Mitrofanoff principle: It is safe and feasible even in low-volume centers – a bi-institutional study

Behandlung von Staphylococcus-aureus-Blutstrominfektionen