Mechanical circulatory support (MCS) is often required to stabilize patients with acute fulminant myocarditis with cardiogenic shock. This review gives an overview of the successful use of left-sided Impella in the setting of fulminant myocarditis and cardiogenic shock as the sole means of MCS as well as in combination with right ventricular (RV) support devices including extracorporeal life support (ECLS) (ECMELLA) or an Impella RP (BI-PELLA). It further provides evidence from endomyocardial biopsies that in addition to giving adequate support, LV unloading by Impella exhibits disease-modifying effects important for myocardial recovery (i.e., bridge-to-recovery) achieved by this newly termed "prolonged Impella" (PROPELLA) concept in which LV-IMPELLA 5.0, implanted via an axillary approach, provides support in awake, mobilized patients for several weeks. Finally, this review addresses the question of how to define the appropriate time point for weaning strategies and for changing or discontinuing unloading in fulminant myocarditis.

Aims Haemodynamic load induces cardiac remodelling via mechano-transduction pathways, which can further trigger inflammatory responses. We hypothesized that particularly in an inflammatory disorder such as myocarditis, a therapeutic strategy is required which, in addition to providing adequate circulatory support, unloads the left ventricle, decreases cardiac wall stress, and mitigates inflammatory responses. Methods and results Axial flow pumps such as the Impella systems comply with these requirements. Here, we report a potential mode-of-action of prolonged Impella support (PROPELLA concept) in fulminant myocarditis, including a decrease in cardiac immune cell presence, and integrin α1, α5, α6, α10 and β6 expression during unloading. Conclusion PROPELLA may provide benefits beyond its primary function of mechanical circulatory support in the form of additional disease-altering effects, which may contribute to enhanced myocardial recovery/remission in patients with chronic fulminant myocarditis.

BACKGROUND. The aim of this study was to investigate the possibility of identifying prostatic adenocarcinoma by nuclear chromatin texture feature analysis of adjacent histologically benign-looking tissue. METHODS. Two hundred and forty prostatectomy specimens were selected from the archives of the Department of Pathology, University of Innsbruck. These consisted of 67 cases of benign prostatic hyperplasia (BPH) and 173 cases of prostatic adenocarcinoma (PAC). The specimen collection was divided randomly into a training set and test set. Cytospin preparations of disaggregated cells prepared from paraffin-embedded material were stained specifically for DNA by the Feulgen method. For the cancer cases, only tissue that histologically appeared nonmalignant, from the vicinity of the lesion, was used in the sample preparation. Only normal-appearing diploid cell nuclei were analyzed from both the BPH and PAC groups. A discriminator comprised of three nuclear texture features to separate BPH from PAC cases was derived from the training set of cases, and then applied to the independent test set cases. RESULTS. PAC cases were separated from BPH cases with a sensitivity of 90% and a specificity of 97% on the independent test set of cases. CONCLUSIONS. This retrospective investigation demonstrates that by high-resolution image cytometry it is possible to detect the presence of prostatic adenocarcinoma with very high reliability when examining prostate samples that only contain histologically normal-looking cells. This method could become clinically relevant in identification of cancers missed by histologically negative core needle biopsies.

The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons.In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin.Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n51, small cell lung cancer n51, bacterial pneumonia n52), and the surgical strategy had to be modified to bilobectomy in one patient.Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular preoperative work-up of patients with SPN.KEYWORDS: Flexible bronchoscopy, lung cancer, pre-operative evaluation, solitary pulmonary nodule T he diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. There are significant differences in the management of SPN; whereas radiologists tend to recommend short-term follow-up or needle aspiration under computed tomography (CT) guidance, pneumologists and thoracic surgeons prefer a more aggressive approach, especially in patients with a higher likelihood of malignancy [1].New pulmonary nodules have a high probability of malignancy. In the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines, studies are cited in which SPN, detected either by screening or incidentally, were malignant in 33-60% with a diameter measuring 11-20 mm and in 64-82% with a diameter measuring .20 mm [2]. Smaller pulmonary nodules less often have a malignant aetiology.The second edition of the ACCP evidence-based clinical practice guidelines recommends a very limited use of bronchoscopy (or transthoracic needle biopsy) in the management of patients who have an indeterminate SPN that measures at least 8-10 mm in diameter and are candidates for curative (surgical) treatment [3]. The reasoning against routine pre-operative bronchoscopy is that it has been shown to rarely change tumour stage and/or to contraindicate surgery [4,5].In most German specialised chest hospitals/departments, the endobronchial status is routinely evaluated pre-operatively via flexible bronchoscopy under local anaesthesia in order to: exclude additional endobronchial tumour manifestations; examine vocal cord function; find anatom...

We conclude that perivascular application of CNP inhibits neointimal hyperplasia of vein grafts in a mouse model. These results suggest that CNP may have a therapeutic potential for the prevention of vein graft disease.