Background: Phospholemman regulates the plasmalemmal sodium pump in excitable tissues such as the heart. Results: Phospholemman is palmitoylated at two intracellular cysteines, and this reduces ion transport by the sodium pump. Conclusion: Phospholemman must be palmitoylated to inhibit the sodium pump. Significance: This is a potentially new way to regulate the sodium pump, an enzyme expressed in most eukaryotic cells.

A two-year-old Border Collie presented with a three-month history of regurgitation. Investigation with plain radiography, digital fluoroscopy, endoscopy and CT angiography (CTA) confirmed the presence of an aberrant right subclavian artery causing dorsal oesophageal compression. In this report, CTA was used to depict the anatomy of an aberrant right subclavian vessel and to highlight the importance of this imaging modality to identify the structures involved in a vascular ring. This report also identifies a patient with a congenital vascular ring anomaly presenting with adult-onset regurgitation, which has been successfully managed with medical treatment.

Purpose of ReviewThe purpose of this review is to discuss the risk of bacterial cross-infection for bronchiectasis patients in the outpatient setting. Cross-infection has primarily been a matter of concern in cystic fibrosis (CF). There is considerable evidence of transmission of pathogens between CF patients, and this has led to guideline recommendations advocating strict segregation policies. Guidelines in bronchiectasis do not specifically address the issue of cross-infection. If cross-infection is prevalent, it may have significant implications for patients and the practical running of specialist care.Recent FindingsMultiple UK-based studies have now published evidence of cross-infection with Pseudomonas aeruginosa within cohorts of bronchiectasis patients; however, the risk does not appear to be high. There is also evidence suggesting cross-infection from CF patients to bronchiectasis patients.SummaryThe current evidence for cross-infection in bronchiectasis is limited, but suggests a small risk with Pseudomonas aeruginosa. Longitudinal studies looking at Pseudomonas aeruginosa and other pathogens are now required.

AbstractObjectivesHigh-sensitivity (hs) cardiac troponin (cTn) assays can quantitate small fluctuations in cTn concentration. Determining biological variation allows calculation of reference change values (RCV), to define significant changes. We assessed the short- and long-term biological variation of cardiac troponin I (cTnI) in healthy individuals and patients with renal failure requiring haemodialysis or cardiomyopathy.MethodsPlasma samples were collected hourly for 4 h and weekly for seven further weeks from 20 healthy individuals, 9 renal failure patients and 20 cardiomyopathy patients. Pre- and post-haemodialysis samples were collected weekly for 7 weeks. Samples were analysed using a hs-cTnI assay (Abbott Alinity ci-series). Within-subject biological variation (CVI), analytical variation (CVA) and between-subject biological variation (CVG) was used to calculate RCVs and index of individuality (II).ResultsFor healthy individuals, CVI, CVA, CVG, RCV and II values were 8.8, 14.0, 43.1, 45.8% and 0.38 respectively for short-term, and 41.4, 14.0, 25.8, 121.0% and 1.69 for long-term. For renal failure patients, these were 2.6, 5.8, 50.5, 17.6% and 0.30 respectively for short-term, and 19.1, 5.8, 11.2, 55.2% and 1.78 for long-term. For cardiomyopathy patients, these were 4.2, 10.0, 65.9, 30.0% and 0.16 respectively for short-term, and 17.5, 10.0, 63.1, 55.8% and 0.32 for long-term. Mean cTnI concentration was lower post-haemodialysis (15.2 vs. 17.8 ng/L, p < 0.0001), with a 16.9% mean relative change.ConclusionsThe biological variation of cTnI is similar between end-stage renal failure and cardiomyopathy patients, but proportionately greater in well-selected healthy individuals with very low baseline cTnI concentrations.

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This is the case of a 25-year-old primigravida with gradual onset abdominal pain and vomiting, 1 day postvaginal delivery. After three hospital admissions over the following 3 weeks, a diagnosis of small bowel obstruction secondary to adhesions was made; the patient had undergone a previous appendicectomy. The patient was taken to theatre for laparotomy and adhesiolysis, where the bowel was found to be viable but with two small serosal tears. Postoperative recovery was uncomplicated. This case highlights the importance of assessing abdominal pain in the puerperium in a similar manner to that done in a non-pregnant state, to avoid delay in diagnosis.

Background Myocardial extracellular volume (ECV) can be estimated by cardiac magnetic resonance imaging (CMR) using preand post-contrast T1 MOLLI maps. The age and sex associations with myocardial ECV in healthy mid-life adults are uncertain. Methods Healthy adults without any history of cardiovascular disease or treatment underwent contrast-enhanced CMR at 1.5 Tesla (Siemens MAGNETOM Avanto). T1 mapping with MOLLI was performed before and 15 min after contrast (0.15 mmol/kg gadoterate meglumine). ECV was estimated in regions (AHA 16-segment LV model) and for the whole left ventricular (LV) myocardium (all regions). ECV was calculated as the difference in relaxation rate (R1=1/T1) for myocardium and LV blood pool before vs. after gadolinium contrast administration, corrected for haematocrit (HCT). LV segments which were not evaluable due to artefact were excluded from analysis. Results 114 segments were assessed from 19 subjects (mean age 61 ± 12 years; 10 (53%) male). 21 (18%) segments were excluded due to blood pool artefact or signal drop-out in the pre-contrast T1 MOLLI scan. All segments were evaluable in the post-contrast T1 MOLLI scans. The remaining segments for each subject were averaged to give an overall ECV (global LV). The mean ECV for all subjects was 25.6 ± 2.9%. There was no overall segmental variation in ECV. ECV in females was higher than in males (27.6 ± 3.1% vs. 23.9 ± 1.3%; P = 0.003) The percentage difference was 14.5%. ECV was higher in septal segments in females (anteroseptal: 28.0 ± 3.3% vs. 24.2 ± 1.5%; P = 0.004; inferoseptal: 27.3 ± 3.8% vs. 23.5 ± 1.6%; P = 0.011), whereas no differences were observed for other segments (Table 1). Conclusion In this preliminary analysis, myocardial ECV was higher in women than in men, which was attributable to higher ECV in the septum in females. This sex difference merits further study. If these results are confirmed by other studies, then sex-specific reference ranges for ECV would seem appropriate. Background Traditionally, the presence of Q-waves on 12 lead ECG is considered a marker of a large and/or transmural myocardial infarction (MI). Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) accurately identifies the presence and extent of myocardial infarction and has become the gold standard for the assessment of myocardial viability. Aim To determine the diagnostic accuracy of Q-waves on 12 lead ECG to identify myocardial scarring as compared with CMR. Methods Data was collected on 631 consecutive patients referred for a stress CMR with suspected ischaemic heart disease (April 2013 to Mar 2014). A 12-lead ECG was recorded. Pathological Q-waves -deflection amplitude of >25% of the subsequent R wave, or being >0.04 s (40 ms) in width and >2 mm in amplitude in >1 corresponding lead. A comprehensive CMR protocol was used. Transmural infarction was defined as >50% LGE. DIAGNOSTIC ACCURACY OF 12 LEAD ECG Q-WAVES AS A MARKER OF MYOCARDIAL SCAR: VALIDATION WITH CMRResults 498 patients were included (mean age of 64 ± 12 years, 71% ...

Background There is some evidence of Pseudomonas aeruginos across-infection between patients with non-cystic fibrosis bronchiectasis (NCFB), and clear evidence in Cystic Fibrosis. Haemophilus influenzae (H. influenzae) is the more common pathogen in NFCB patients, yet cross-infectionremains unexplored. We present the novel application of culture-independent Multilocus Sequence Typing (MLST) to screen for cross-infection of H. influenzae in NCFB in both culture-positive and -negative samples. Methods We interrogated DNA from 32 sputum samples (26 patients) in our NCFB biorepository, who were known to have H.influenzae in their sputum by preceding 16S rRNA sequencing. Fragments of 7 H. influenzae housekeeping genes were amplified and sequenced. Sequence types were allocated via the MLST scheme. For 5 patients, multiple sputum samples taken at least 4 months apart were assessed longitudinally. Results Culture-independent MLST identified 31 of 32 sputum samples as harboring H. influenzae. Of these, 26 were positive for H. influenzae using culture methods. 25 of the 26 culture-positive samples were MLST positive. All 6 culture-negative samples were MLST positive. A MLST sequence type (ST) was allocated to 27 of 32 sputum samples. Five patients had multiple sputum samples with matching STs, indicating strain stability and the consistency of MLST. Two patients who were known household contacts had matching STs and possibly transmitted H.influenzae in their household. The remaining 15 STs were unique, suggesting no evidence of cross-infection. Conclusion Culture-independent MLST identifies H. influenzae in culture-negative patients with NCFB and is a potential screening tool for cross-infection. This study did not reveal potential cross-infection events in this cohort.