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Peripartum cardiomyopathy shares clinical features with idiopathic dilated cardiomyopathy, a disorder associated with mutations in more than 40 genes. This study shows that mutations in some of these genes, notably TTN, also have a strong association with this condition. Peripartum cardiomyopathy is marked by the development of maternal systolic heart failure late in pregnancy or early in the postpartum period. 1 , 2 The incidence varies from 1 in 100 to 1 in 300 in geographic hot spots, including Nigeria and Haiti, to 1 in 1000 to 1 in 4000 in Europe and the United States. The strongest known risk factors are the presence of preeclampsia, twin gestation, and advanced maternal age. Among patients with peripartum cardiomyopathy, heart failure can resolve but often does not: rates of death of 5 to 10% are common, and 4% of cardiac transplantations in the . . .

We recently isolated and discovered new Bradyrhizobiaceae microbes from the cryopreserved culture broth of blood samples from 3 patients with poorly defined illnesses using modified SP4 media and culture conditions coupled with genomic sequencing. Using a similar protocol, we studied a previously cryopreserved culture broth of blood sample from a patient who had succumbed to an acute onset of fulminant pulmonary illness. We report that two phases of microbial growth were observed in the re-initiated culture. Biochemical and genomic characterization revealed microbes isolated from the first phase of growth were new Afipia species of Bradyrhizobiaceae, tentatively named A. cberi with a ~ 5 MB chromosome that was different from those of all previously known Afipia microbes including the newly discovered A. septicemium. The microbes isolated from the second phase of growth were prominent sugar assimilators, novel Phyllobacteriaceae, phylogenetically most closely related to Mesorhizobium and tentatively named M. hominis with a ~ 5.5 MB chromosome. All A. cberi isolates carry a circular ~ 140 KB plasmid. Some M. hominis isolates possess a circular ~ 412 KB plasmid that can be lost in prolonged culture or passage. No antibiotics resistant genes could be identified in both of the A. cberi and M. hominis plasmids. Antibiotic susceptibility studies using broth culture systems revealed isolates of A. cberi could be sensitive to some antibiotics, but all isolates of M. hominis were resistant to essentially all tested antibiotics. However, the cell-free antibiotics susceptibility test results may not be applicable to clinical treatment against the microbes that are known to be capable of intracellular growth. It remains to be determined if the 2 previously unknown Rhizobiales were indeed pathogenic and played a role in the pulmonary disease process in this patient. Specific probes and methods will be developed to re-examine the diseased lungs from patient's autopsy.

Objectives There are four immunoglobulin (IgG) subtypes that have varying complement‐activating ability: strong (IgG3 and IgG1) and weak (IgG2 and IgG4). The standard flow cytometric crossmatch (FCM) assay does not distinguish between the various subtypes of the IgG molecule. This study outlines the development and use of a novel cell‐based IgG subtype‐specific FCM assay that is able to detect the presence of and quantitate the IgG subtypes bound to donor cells. Methods A six‐colour lyophilised reagent was designed that specifically detects the four IgG subtypes, as well as distinguishes between T cells and B cells in the lymphocyte population. To test the efficacy of this reagent, a retrospective evaluation of a group of highly sensitised patients awaiting heart and kidney transplant was carried out, who, because of positive standard FCM results, had been deemed incompatible with numerous prior potential donors. Results Observations in this study demonstrate that the positive standard FCM results were mainly because of the presence of noncomplement‐activating IgG2 or IgG4 antibodies. The results were supported by the absence of C3d‐binding donor‐specific antibodies (DSA) and a negative complement‐dependent cytotoxicity crossmatch (CDC). Conclusion Preliminary data presented in this study demonstrate the reliability of the novel IgG subtype assay to detect the presence of pretransplant, complement‐activating antibodies bound to donor cells. The knowledge gained from the IgG subtype assay and the C3d‐binding specificities of DSAs provides improved identification of donor suitability in pretransplant patients, potentially increasing the number of transplants. In this study, we demonstrate that our novel IgG subtype‐specific FCM assay is able to distinguish between complement‐activating and noncomplement‐activating antibodies bound to donor cells. We observed that in highly sensitised heart and kidney transplant patients, the positive standard FCM results were mainly because of the presence of noncomplement‐binding IgG2 and/or IgG4 antibodies, which was supported by negative CDC assay results and the absence of C3d binding DSAs. Thus, incorporating the IgG subtype assay in the transplant testing regimen for patients awaiting solid organ transplant may aid in increasing donor availability for highly sensitised pretransplant patients.

Abstract Background  Acute severe mitral regurgitation (MR) associated with cardiogenic shock is a life-threatening emergency. Traditional teaching has focused on the need for emergent coronary angiography and/or intra-aortic balloon counterpulsation in preparation for emergent open-heart surgery for repair/replacement. Unfortunately, emergent open-heart surgery in patients with acute MR complicated by cardiogenic shock is associated with 25–46% perioperative mortality. New devices have provided additional options for stabilization prior to emergent surgery which facilitate improved outcomes. Case summary  We present two cases of acute severe MR resulting in cardiogenic shock and profound hypoxaemia. TandemHeart® mechanical circulatory support with an oxygenator spliced into the circuit, akin to veno-arterial extracorporeal membrane oxygenation (ECMO), facilitated haemodynamic stabilization and decongestion of the lungs facilitating successful bridge to mitral valve surgery. Successful discharge to home was achieved in both patients with good neurological outcomes and sustained long-term functional recovery at 18 and 14 months, respectively. Discussion Selective use of the TandemHeart®, with or without ECMO, facilitates management of the critically ill cardiogenic shock patient with acute severe MR.

This article calls attention to an assortment of lesser-known artistic allusions in Renaissance literature, focusing on the work of Pietro Aretino and other writers of fiction. The examples cited are either pornographic, erotic, lewd or obscene, bawdy or ribald, or some combination thereof. (Quotes from original text)

The article examines an important series of seventy-eight Italian engravings, known as the \"Sola-Busca Tarocchi,\" and attributes them decisively to the late quattrocento Ferrarese school. The Master of the \"Sola-Busca Tarocchi\" remains anonymous, but a number of other prints can be assigned to his hand, most notably a group that had been published in1949 but then dropped out of sight. These and several other works, distinctive in both style and iconography, are herein ascribed to the Master, who emerges as a major figure in the field of early Italian engraving. Lists of prints attributed to or associated with the Master of the \"Sola-Busca Tarocchi\" are included in appendices.

Dominican saints appear in countless Italian pictures of the fifteenth and sixteenth centuries, with St. Vincent Ferrer occupying fourth place in their normal order of importance. His comparative obscurity in modern times, however, has resulted in his frequent misidentification as St. Dominic and sometimes as St. Antoninus of Florence; occasionally, he is simply called \"a Dominican saint.\" Yet his life (1350-1419) and legend are well known, and such erroneous identifications can be avoided once several conventional aspects of Vincent's iconography are recalled. The article also discusses hitherto unnoticed features of the cult of St. Vincent, above all his association in various works with St. Peter Martyr. Like St. Roch and St. Sebastian, with whom they also appear, these two might have been seen as guarding against the plague. St. Vincent may even have served as a sort of all-purpose helper, healer, savior, protector, and miracle-worker. /// Les saints Dominicains se retrouvent dans de nombreux tableaux du quinzième et seizième siècle, saint Vincent Ferrier occupant la quatrième place dans l'ordre d'importance. Mais il retomba pratiquement dans l'oubli par la suite et c'est ainsi qu'il fut souvent faussement identifié comme saint Dominique, parfois aussi comme saint Antoine de Florence; occasionnellement, on l'a aussi tout simplement dénommé \"un saint Dominicain\". Pourtant la vie (1350-1419) et la légende du saint sont bien documentées et de telles confusions pourraient être évitées si l'on se rappelait certains aspects caractéristiques de l'iconographie de saint Vincent. Cet article traite également de certaines traits du culte de saint Vincent auxquels jusqu'à présent on n'a pas accordé d'importance, notamment sa représentation conjointe avec saint Pierre Martyr dans beaucoup d'oeuvres. De même que saint Roch ou saint Sébastien, en compagnie desquels on les trouve également représentés, il est probable qu'on ait considéré ces deux saints comme préservateurs de la peste. Saint Vincent pourrait avoir été vénéré comme une sorte de saint universel, en même temps guérisseur, sauveur, protecteur et thaumaturge. /// Dominikanerheilige finden sich auf zahlreichen italienischen Gemälden des 15. und 16. Jahrhunderts, wobei der hl. Vincent Ferrer in der Bedeutungshierarchie die vierte Stelle einnimmt. Seine relative Unbekanntheit in späteren Jahrhunderten hat jedoch dazu geführt, daß er oft fälschlich als hl. Dominikus, manchmal auch als hl. Antoninus von Florenz identifiziert wird; gelegentlich wird er auch nur \"ein Dominikanerheiliger\" genannt. Doch Leben (1350-1419) und Legende des Heiligen sind gut dokumentiert, und Verwechslungen könnten vermieden werden, wenn man sich einige traditionelle Abbildungsmerkmale in Erinnerung ruft. Der Artikel erörtert auch bisher nicht beachtete Züge des Vincent-Kultes, insbesondere die gemeinsame Darstellung auf vielen Werken mit dem hl. Petrus Martyr. Wie den hl. Rochus und den hl. Sebastian, in deren Gesellschaft sie auch abgebildet werden, könnte man die beiden als Beschützer vor der Pest gesehen haben. Möglicherweise wurde der hl. Vincent sogar als Universalheiliger, als Heiler, Retter, Beschützer und Wundertäter verehrt.