Mcdowellmcfarland0332
This case underscores the use of modern interventional techniques and devices for addressing TR and improving QoL, whether as a stand-alone procedure or as part of complete interventional therapy of the atrioventricular valves.
Tricuspid regurgitation is an individual predictor of morbidity but frequently found in elderly patients who are deemed very high risk for surgical treatment. This case underscores the use of modern interventional techniques and devices for addressing TR and improving QoL, whether as a stand-alone procedure or as part of complete interventional therapy of the atrioventricular valves.
Solid-organ transplantation in patients with common variable immunodeficiency (CVID) is controversial due to the risk for severe and recurrent infections. Determining transplantation candidacy in CVID patients is further complicated by the presence of CVID-related non-infectious complications that can reduce overall survival and also recur in the transplanted organ. Data regarding solid organ transplantation in patients with CVID are limited, particularly in heart transplantation.
A 32-year-old female with CVID presented with new heart failure after 3 months of dyspnoea on exertion. Her echocardiogram showed severe global systolic dysfunction with an ejection fraction of approximately 10%, and her right heart catheterization revealed severe biventricular pressure overload and severely reduced cardiac output. Endomyocardial biopsy revealed giant cells and mononuclear infiltrate consistent with giant cell myocarditis (GCM). Despite medical management, she developed progressive cardiogenic shock and underwent uncomplicated orthotopic heart transplantation on hospital Day 38. After 2 years of follow-up, she has had no major infectious complications and continues to have normal graft function with no recurrence of GCM.
We report a case of successful heart transplantation for GCM in a patient with CVID, with no major infectious complications after 2 years of follow-up. CVID should not be considered an absolute contraindication for heart transplantation.
We report a case of successful heart transplantation for GCM in a patient with CVID, with no major infectious complications after 2 years of follow-up. CVID should not be considered an absolute contraindication for heart transplantation.
Transcatheter aortic valve implantation (TAVI) is usually planned using contrast-enhanced computed tomography (CT) to determine the suitability of cardiovascular anatomy. Computed tomography for TAVI planning requires the administration of intravenous contrast, which may not be desirable in patients with severely reduced renal function.
We present an unusual case of an 89-year-old patient with an urgent need for treatment of critical, symptomatic aortic stenosis who also had severe chronic kidney disease. We judged that this posed a relative contraindication to the use of intravenous contrast. We designed and implemented a novel, contrast-free cardiovascular magnetic resonance (CMR) protocol and used this to plan all aspects of the procedure. Transcatheter aortic valve implantation was conducted successfully with zero contrast medium administration leading to an excellent clinical result and recovery of renal function.
Contrast-free CMR appears to be a viable alternative to CT for planning structural aortic valve intervention in the rare cases where intravenous contrast is relatively contraindicated.
Contrast-free CMR appears to be a viable alternative to CT for planning structural aortic valve intervention in the rare cases where intravenous contrast is relatively contraindicated.
Patients with immune-mediated inflammatory disease (IMID) present an increased risk of infection. Here, we present the concept of a preventive consultation called ImmunoStart and the first results of its implementation in the care pathway of patients with IMID.
Relevant information about vaccination history, tuberculosis exposure and other infectious risks were collected through blood sampling, complete anamnesis, chest X-ray and Mantoux test. During the ImmunoStart consultation, vaccination schedules, specific treatments and risk considerations were discussed.
Between October 2016 and February 2020, 437 patients were seen at an ImmunoStart consultation, mainly referred by rheumatologists (56%), dermatologists (25%) and gastroenterologists (18%). A total of 421 (96%) patients needed at least one vaccine (a mean of 3.3 vaccines per patient). Live attenuated vaccine was indicated for 45 patients (10%), requiring them to reduce or interrupt their immunosuppressive drug(s). Ninety-two patients (21%) were treated for latent tuberculosis infection.
This preventive consultation provides a centralized and systematic setting for the direct management of patients with IMID in need of vaccination, treatment of latent disease and specific advice regarding their immunomodulating treatments.
This preventive consultation provides a centralized and systematic setting for the direct management of patients with IMID in need of vaccination, treatment of latent disease and specific advice regarding their immunomodulating treatments.
The aim was to study the clinical features of PMR/GCA and clinical predictors of treatment response during a 40-week follow-up period.
Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated with oral glucocorticoids were gathered at baseline and during a 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and
F-fluorodeoxyglucose (
F-FDG) PET/CT were undertaken at diagnosis. In total, each patient was seen on five occasions (i.e. baseline and weeks 4, 16, 28 and 40). Treatment response was assessed by considering clinical evaluations and results of inflammatory markers.
Of 77 patients [49 (63.6%) female; mean age 71.8 (8.0) years], 64 (83.1%) patients had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. The patients reported that clinical symptoms, apart from scalp pain and duration of morning stiffness, improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. A complete response was seen in 68.7, 62.9, 44.1 and 33.3% of patients at weeks 4, 16, 28 and 40, respectively. Several clinical features, including female biological sex, younger age, fewer relapses and a lower level of baseline ESR, were significantly associated with a better treatment response. Ripasudil in vivo Treatment response during the follow-up period was independent of TAB results and fluorodeoxyglucose uptakes on
F-FDG PET/CT at diagnosis.
Obtaining valid disease-specific outcome measures for evaluating treatment efficacy in PMR and GCA that can be applied universally is clearly an unmet clinical need.
ClinicalTrials.gov, https//clinicaltrials.gov, NCT02985424.
ClinicalTrials.gov, https//clinicaltrials.gov, NCT02985424.By some accounts, as many as 93% of individuals diagnosed with antisocial personality disorder (ASPD) or psychopathy also meet criteria for some form of substance use disorder (SUD). This high level of comorbidity, combined with an overlapping biopsychosocial profile, and potentially interacting features, has made it difficult to delineate the shared/unique characteristics of each disorder. Moreover, while rarely acknowledged, both SUD and antisociality exist as highly heterogeneous disorders in need of more targeted parcellation. While emerging data-driven nosology for psychiatric disorders (e.g., Research Domain Criteria (RDoC), Hierarchical Taxonomy of Psychopathology (HiTOP)) offers the opportunity for a more systematic delineation of the externalizing spectrum, the interrogation of large, complex neuroimaging-based datasets may require data-driven approaches that are not yet widely employed in psychiatric neuroscience. With this in mind, the proposed article sets out to provide an introduction into machine learning methods for neuroimaging that can help parse comorbid, heterogeneous externalizing samples. The modest machine learning work conducted to date within the externalizing domain demonstrates the potential utility of the approach but remains highly nascent. Within the paper, we make suggestions for how future work can make use of machine learning methods, in combination with emerging psychiatric nosology systems, to further diagnostic and etiological understandings of the externalizing spectrum. Finally, we briefly consider some challenges that will need to be overcome to encourage further progress in the field.Like socio-economic status and cognitive abilities, personality traits predict important life outcomes. Traits that reflect unusually low or high approach motivations, such as low extraversion and high disinhibition, are linked to various forms of mental disorder. Similarly, the dopamine system is theoretically linked to approach motivation traits and to various forms of mental disorder. Identifying neural contributions to extremes of such traits should map to neural sources of psychopathology, with dopamine a prime candidate. Notably, dopamine cells fire in response to unexpected reward, which suggests that the size of non-invasive, scalp-recorded potentials evoked by unexpected reward could reflect sensitivity in approach motivation traits. Here, we evaluated the validity of evoked electroencephalography (EEG) responses to unexpected reward in a monetary gain/loss task to assess approach motivation traits in 137 participants, oversampled for externalizing psychopathology symptoms. We demonstrated that over the 0-400 ms period in which feedback on the outcome was presented, responses evoked by unexpected reward contributed to all theoretically relevant approach motivation trait domains (disinhibition, extraversion and the behavioural activation system); and did so only at times when dopamine responses normally peak and reportedly code salience (70-100 ms) and valuation (200-300 ms). In particular, we linked "dopaminergic" salience and valuation to the psychopathology-related constructs of low extraversion (social anxiety) and high disinhibition (impulsivity) respectively, making the evoked potential components biomarker candidates for indexing aberrant processing of unexpected reward.Traditionally, personality has been conceptualized in terms of dimensions of human experience - habitual ways of thinking, feeling, and behaving. By contrast, psychopathology has traditionally been conceptualized in terms of categories of disorder - disordered thinking, feeling, and behaving. The empirical literature, however, routinely shows that psychopathology does not coalesce into readily distinguishable categories. Indeed, psychopathology tends to delineate dimensions that are relatively similar to dimensions of personality. In this special issue of Personality Neuroscience, authors took up the challenge of reconceptualizing personality and psychopathology in terms of connected and interrelated dimensions, and they considered the utility of pursuing neuroscientific inquiry from this more integrative perspective. In this editorial article, we provide the relevant background to the interface between personality, psychopathology, and neuroscience; summarize contributions to the special issue; and point toward directions for continued research and refinement.
