A placental model of SARS-CoV-2 infection reveals ACE2-dependent susceptibility and differentiation impairment in syncytiotrophoblasts

SARS-CoV-2 infection causes COVID-19. Several clinical reports have linked COVID-19 during pregnancy to negative birth outcomes and placentitis. However, the pathophysiological mechanisms underpinning SARS-CoV-2 infection during placentation and early pregnancy are not clear. Here, to shed light on this, we used induced trophoblast stem cells to generate an in vitro early placenta infection model. We identified that syncytiotrophoblasts could be infected through angiotensin-converting enzyme 2 (ACE2). Using a co-culture model of vertical transmission, we confirmed the ability of the virus to infect syncytiotrophoblasts through a previous endometrial cell infection. We further demonstrated transcriptional changes in infected syncytiotrophoblasts that led to impairment of cellular processes, reduced secretion of HCG hormone and morphological changes vital for syncytiotrophoblast function. Furthermore, different antibody strategies and antiviral drugs restore these impairments. In summary, we have established a scalable and tractable platform to study early placental cell types and highlighted its use in studying strategies to protect the placenta.

Grandparents of children with cancer: a controlled comparison of perceived family functioning

PURPOSE

Grandparents can be profoundly emotionally affected when a grandchild is diagnosed with cancer. They also often provide invaluable support for the family (e.g., caring for the sick child and/or siblings). Multigenerational family functioning may therefore change. Limited research has assessed grandparents' perspectives after their grandchild is diagnosed with cancer. In this study, we aimed to (1) assess differences in perceived family functioning among grandparents of a child with cancer and grandparents of healthy children and (2) assess the cancer-specific and demographic factors related to perceived family functioning in grandparents of a grandchild with cancer.

PROCEDURE

Grandparents of a child with cancer (n = 89) and grandparents of healthy children (n = 133) completed the general functioning, communication, and problem-solving scales of the Family Assessment Device. We used multilevel models with a random intercept to detect (1) between-group differences and (2) identify factors related to perceived family functioning among grandparents with a grandchild with cancer.

RESULTS

Grandparents with a grandchild with cancer reported poorer family functioning than grandparents with healthy grandchildren. Among the grandparents with a grandchild with cancer, impairments in family functioning were correlated with fewer years since diagnosis, providing care to their sick grandchild and/or siblings and living far away from the sick grandchild.

CONCLUSIONS

The detrimental impact of childhood cancer likely extends beyond the immediate family members. Including grandparents in interventions-beginning at diagnosis-to reduce distress and increase cohesion for families of a child with cancer is warranted, particularly for grandparents who provide care to their sick grandchild or siblings.

Apathy in rapid eye movement sleep behaviour disorder is common and under-recognized

BACKGROUND AND PURPOSE

Apathy is an important neuropsychiatric feature of Parkinson's disease (PD), which often emerges before the onset of motor symptoms. Patients with rapid eye movement sleep behaviour disorder (RBD) have a high probability of developing PD in future. Neuropsychiatric problems are common in RBD, but apathy has not previously been detailed in this key prodromal population.

METHODS

Eighty-eight patients with polysomnographically proven RBD, 65 patients with PD and 33 controls were assessed for apathy using the Lille Apathy Rating Scale. Cognition and depression were also quantified. The sensitivity of the Unified Parkinson's Disease Rating Scale screening questions for apathy and depression was calculated.

RESULTS

A total of 46% of patients with RBD were apathetic, compared with 31% of patients with PD in our sample. Most patients with RBD with depression were apathetic but more than half of apathetic patients were not depressed. The sensitivity of the single Unified Parkinson's Disease Rating Scale screening question was only 33% for mild apathy and 50% for severe apathy.

CONCLUSIONS

Apathy is common in RBD and is underestimated by a single self-report question. Recognition of apathy as a distinct neuropsychiatric feature in RBD could aid targeted treatment interventions and might contribute to the understanding of prodromal PD.

Grandparents of children with cancer: Quality of life, medication and hospitalizations

BACKGROUND

Grandparents can play a crucial role of providing emotional and practical support for families facing childhood cancer. Yet, many have their own healthcare needs. This controlled study systematically assesses the impact of childhood cancer on grandparents' quality of life (QOL). Our objective was to compare QOL in grandparents of children with and without cancer and to identify factors associated with grandparents' QOL.

PROCEDURE

Grandparents (N = 222) completed two patient-reported outcome (PRO) measures assessing QOL: EQ-5D-5L and WHOQOL-BREF. Secondary endpoints included sleep, medications and hospitalizations. We used independent samples t-tests and multivariate linear regression to assess between-group differences and identify predictors.

RESULTS

Grandparents of children with cancer (n = 89) reported significantly worse QOL than controls (n = 133) [mean WHOQOL-BREF score: 75.6 (SD = 17.6) vs. 81.5 (15.6), P = 0.007; mean EQ-5D-5L index value: 0.777 (0.20) vs. 0.874 (0.14), P < 0.001)]. They also reported more problems with anxiety and depression (47.2 vs. 21.8%, P < 0.001) and pain (64.8 vs. 49.6%, P = 0.031). Grandparents of children with cancer reported taking longer to fall asleep [mean: 30.4 min (55.6) vs. 18.2 (20.2), P = 0.011] and taking more medications in the last 4 weeks [mean: 2.9 (SD = 3.8) vs. 1.8 (SD = 2.3), P = 0.012]. Hospitalizations were comparable across groups. Grandmothers, those living in urban locations, and retired/unemployed grandparents experienced reduced QOL.

CONCLUSIONS

Grandparents are significantly affected by childhood cancer. The impact appears across many domains of life and results in meaningful QOL differences. Given that four or more individuals may be affected per child, and that grandparent well-being can influence the whole family, interventions targeting at-risk grandparents are needed.

An in-vacuo optical levitation trap for high-intensity laser interaction experiments with isolated microtargets

We report on the design, construction, and characterisation of a new class of in-vacuo optical levitation trap optimised for use in high-intensity, high-energy laser interaction experiments. The system uses a focused, vertically propagating continuous wave laser beam to capture and manipulate micro-targets by photon momentum transfer at much longer working distances than commonly used by optical tweezer systems. A high speed (10 kHz) optical imaging and signal acquisition system was implemented for tracking the levitated droplets position and dynamic behaviour under atmospheric and vacuum conditions, with ±5 μm spatial resolution. Optical trapping of 10 ± 4 μm oil droplets in vacuum was demonstrated, over timescales of >1 h at extended distances of ∼40 mm from the final focusing optic. The stability of the levitated droplet was such that it would stay in alignment with a ∼7 μm irradiating beam focal spot for up to 5 min without the need for re-adjustment. The performance of the trap was assessed in a series of high-intensity (10(17) W cm(-2)) laser experiments that measured the X-ray source size and inferred free-electron temperature of a single isolated droplet target, along with a measurement of the emitted radio-frequency pulse. These initial tests demonstrated the use of optically levitated microdroplets as a robust target platform for further high-intensity laser interaction and point source studies.

Brain haemosiderin in older people: pathological evidence for an ischaemic origin of magnetic resonance imaging (MRI) microbleeds

Introduction

Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. Light microscopy of ageing brain frequently reveals foci of haemosiderin from single crystalloids to larger, predominantly perivascular, aggregates. The pathological and radiological relationship between these findings is not resolved.

Methods

Haemosiderin deposition and vascular pathology in the putamen were quantified in 200 brains donated to the population-representative Medical Research Council Cognitive Function and Ageing Study. Molecular markers of gliosis and tissue integrity were assessed by immunohistochemistry in brains with highest (n = 20) and lowest (n = 20) levels of putamen haemosiderin. The association between haemosiderin counts and degenerative and vascular brain pathology, clinical data, and the haemochromatosis (HFE) gene H63D genotype were analysed. The frequency of MRI CMB in 10 cases with highest and lowest burden of putamen haemosiderin, was compared using post mortem 3T MRI.

Results

Greater putamen haemosiderin was significantly associated with putaminal indices of small vessel ischaemia (microinfarcts, P < 0.05; arteriolosclerosis, P < 0.05; perivascular attenuation, P < 0.001) and with lacunes in any brain region (P < 0.023) but not large vessel disease, or whole brain measures of neurodegenerative pathology. Higher levels of putamen haemosiderin correlated with more CMB (P < 0.003).

Conclusions

The MRI-CMB concept should take account of brain iron homeostasis, and small vessel ischaemic change in later life, rather than only as a marker for minor episodes of cerebrovascular extravasation. These data are of clinical relevance, suggesting that basal ganglia MRI microbleeds may be a surrogate for ischaemic small vessel disease rather than exclusively a haemorrhagic diathesis.

Gestational trophoblastic disease in the Asian population of Northern England and North Wales

OBJECTIVE

To determine the incidence and trends of gestational trophoblastic disease in the Asian population of Northern England and North Wales.A prospective observational study.

SETTING

Trophoblastic Screening and Treatment Centre, Weston Park Hospital.

POPULATION

A total of 3660 women registered with gestational trophoblastic disease between 1991 and 1999.

MAIN OUTCOME MEASURES

1. The incidence of gestational trophoblastic disease in Asian and non-Asian population. 2. Trend in incidence over study period.

RESULTS

Three hundred and twenty-two Asian patients were registered. The incidence of gestational trophoblastic disease in the northern part of England and Wales averaged 1 per 714 live births. The incidence of gestational trophoblastic disease in the Asian population was 1.95 times higher than in the non-Asian population (1 per 387 live births vs 1 per 752 live births). There was an excess of molar pregnancies in the extreme maternal age groups; the incidence in these women was twice as high as in the whole reproductive cohort. The ratio of partial to complete hydatidiform mole increased from 0.9 in the lower age to 2.6 in the older age group. There appeared to be a slowly rising trend in the incidence of gestational trophoblastic disease; the increase was higher in the Asian than in the non-Asian population. The ratio of partial to complete moles increased with age in both populations.

CONCLUSION

Asian women are at increased risk of having molar pregnancies. Molar pregnancies are more common at the extremes of reproductive age. The setting up of regional or national registration centres has helped to provide more accurate estimates of the true incidence of the disease.

Effects of disability compensation on participation in and outcomes of vocational rehabilitation

OBJECTIVE

The authors sought to determine the relationship between receipt of disability compensation and participants' success in a vocational rehabilitation program.

METHODS

Administrative data for 22,515 individuals who participated in the Veterans Health Administration compensated work therapy program between 1993 and 1998 were analyzed. Six dependent variables were compared between participants who were receiving disability compensation and those who were not: duration of participation in compensated work therapy, number of hours worked per week, mean hourly earnings, total income from compensated work therapy, dropout rate, and competitive employment status at discharge. Regression equations were determined for each dependent variable to assess associations with the degree of disability, the amount of disability compensation, and the type of compensation program.

RESULTS

Participants who were receiving disability benefits worked fewer hours in compensated work therapy each week, earned less income, had a higher dropout rate, and were less likely to be competitively employed at discharge. The amount of compensation and the type of program were modestly but significantly associated with participation in compensated work therapy and with outcome.

CONCLUSIONS

Unintended effects of disability compensation programs discourage full participation in vocational rehabilitation and result in poorer rehabilitation outcomes.

Muscle learning therapy--efficacy of a biofeedback based protocol in treating work-related upper extremity disorders

Work-related upper extremity disorders (WRUEDs) continue to present significant treatment and financial challenges to providers, employers, and insurers. This retrospective study reviews outcomes for 309 subjects who, between 1995 and 1999, were referred through the workers' compensation system for treatment of computer keyboard- and mouse-related WRUED injuries. The mean length of time from the recorded date of injury to the date of intake was 12.9 months. Subjects were offered a 12-visit course in muscle learning therapy (MLT). MLT is an operant conditioning program which uses surface electromyography (sEMG) to train injured workers to control their muscles during work activities. Patient response to therapy was obtained by a therapist-administered questionnaire during Visit 8 of 12. A group of 309 subjects, who had failed to respond to a previous course of therapy (typically physical therapy), reported significant improvements of pain in the neck, thorax, and upper extremities. Ninety six percent reported that they felt "more in control," 86% reported feeling "better overall," and 81% reported either "working the same and feeling better" or "working and accomplishing more." This study provides preliminary support for this approach and provides justification for controlled clinical trials in the future.

An international feasibility study of parental decision making in pediatric oncology

PURPOSE/OBJECTIVES

To describe parental decision making about treatment options for children with cancer and determine the feasibility of a similar but larger international study.

DESIGN

Exploratory.

SETTINGS

A pediatric catastrophic illness research hospital in the United States and children's hospitals in Australia and Hong Kong.

SAMPLE

A convenience sample of 43 parents (5 fathers and 38 mothers ages 23-59 years).

METHODS

Six open-ended interview questions posed to parents during private individual interviews. Content analysis techniques were used.

MAIN RESEARCH VARIABLES

Parental perceptions of (a) factors considered in the decision-making process, (b) behaviors of healthcare professionals that affected the process, and (c) satisfaction with the process. Feasibility of a larger study was estimated by considering ease of access to parents, number of refusals to participate, understanding of the interview questions, and level of interest at each setting.

FINDINGS

Access to parents was possible at all sites. Refusal to participate was reported only at the U.S. site. Certain factors (e.g., getting information from the healthcare team, trusting staff) were important to all parents considering end-of-life decisions. Site-specific factors included considering alternative therapies (at the Australian site) and strengthening faith (at the U.S. site).

CONCLUSIONS

A larger international study of parental decision making is feasible. Sufficient similarities in parental decision making exist across these sites to justify future efforts to identify universal decision-making factors that, in conjunction with site-specific differences, could be helpful in developing guidelines for healthcare professionals who assist parents in making treatment-related decisions for a sick child.

Cisplatin ototoxicity, increased DPOAE amplitudes, and magnesium deficiency. Distortion product otoacoustic emissions

Outer hair cell (OHC) metabolism is blocked by cisplatin. Concurrent changes in the renal handling of magnesium occur because of the damage cisplatin causes to the renal proximal tubule cells within the thick ascending loop of Henle. Although there is no evidence of cisplatin within the OHCs, there are significant levels of intracellular calcium, the antagonist to magnesium at the cell membrane. The OHC motile response is dependent on intracellular calcium. When the calcium current is suppressed by an antagonist, the extracellular OHC microphonic potential decreases. Magnesium deficiency is known to produce hyperexcitability within the central nervous system, including fatal audiogenic seizures. In addition, increases in the amplitude of the auditory brainstem response wave V occur with aminoglycoside therapy and magnesium deficiency. This paper illustrates the amplitude growth of distortion product otoacoustic emissions in two patients treated with cisplatin and explores the possible underlying reasons why this may be related to magnesium metabolism.

How healthcare professionals contribute to hope in patients with cancer

PURPOSE/OBJECTIVES

To explore whether healthcare professionals influence the level of hope in patients with cancer and, if so, how they influence their hope.

DESIGN

Descriptive, qualitative design.

SETTING

An adult hematology/oncology unit in the upper midwestern United States.

SAMPLE

Thirty-two men and women receiving active or supportive treatment or palliative care for cancer.

METHODS

Semistructured interviews conducted in the participants' hospital rooms. Ten investigators and two consultants transcribed and analyzed the interview data using content analysis. They identified themes and subthemes that described healthcare professionals' roles.

MAIN RESEARCH VARIABLES

Healthcare professionals' contributions to hope as described by patients with cancer.

FINDINGS

Healthcare professionals positively and negatively influenced hope in this sample. Hope was facilitated by being present, giving information, and demonstrating caring behaviors. Negative influences on hope primarily concerned the way in which healthcare professionals gave information.

CONCLUSION

Healthcare professionals do influence patients' perceptions of their hope. Although most nursing actions are hope enhancing, nurses can reduce a patient's sense of hope if information provided or attitude toward the patient is insensitive or disrespectful.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can increase patients' hope by being present, taking time to talk, and being helpful. They must provide information and answer questions in a compassionate, positive, honest, and respectful manner. Caring behaviors such as thoughtful gestures, showing warmth and genuineness, and being friendly and polite also increase patients' hope.

Australian midwives: leaders in lactation consultancy

Midwives all over Australia are furthering their breastfeeding knowledge and skills, to lead the world in lactation support. The certification exam conducted by the International Board of Lactation Consultant Examiners has played a central role in this extraordinary revolution by setting competency standards, motivating the acquisition of specialist skills, and opening up career opportunities. However, it is the consumers, the mothers and babies, who are the principal beneficiaries.

DNA vaccines for bacterial infections

DNA vaccines are an exciting development in vaccine technology which may have a special role in preventing viral infections and as 'theracines' for cancer. Their use in preventing bacterial infections has, by comparison, been less well documented. While it is unlikely that traditional, highly successful and cheap vaccines for diseases such as diphtheria will be replaced by DNA vaccines, naked DNA may be particularly appropriate for preventing bacterial infections where cytotoxic T cells confer protection, or where a Th1 type T cell response mediates resistance. For example, DNA vaccines containing different mycobacterial antigens have been shown to inhibit overt infections by Mycobacterium tuberculosis in rodent models. The use of DNA vaccines in bacterial infections may be complicated by fundamental differences between prokaryotic and eukaryotic genes and gene products, including mRNA stability, codon bias, secondary structures surrounding native start sequences and glycosylation. These problems can be solved by re-synthesis of bacterial genes to produce 'new' sequences which are more highly expressed by eukaryotic cells.

Nutrition and cancer: educating the public through a health fair

Minnesota has a high incidence of dietary-associated cancer, including colorectal, breast, and prostate. To increase public awareness of cancer risks and health benefits of dietary behaviors, the Metro Minnesota Chapter of the Oncology Nursing Society (ONS) participated in a public education health fair. Supported by a Special Project Funding Grant from the ONS, 42 chapter members assisted more than 700 Metro area residents at seven locations to assess and improve their diet according to the American Cancer Society (ACS) guidelines. To evaluate the effectiveness of the project, a postcard survey was sent to 200 (29%) names randomly drawn from raffle entries. Seventy-five surveys were returned (38%). Ninety-five percent found the assessment helpful in evaluating their diet, and 80% made dietary changes in the two weeks following the health fair. Results indicate that nurses should continue to educate the public about the relationship between diet and cancer. Recommendations for further consideration include assessment of long-term effects of the health fair education format and provision of a brochure about ONS. Benefits included community education and ONS member participation in a chapter activity.

Determination of thiocyanate in plasma and saliva without deproteinisation and its validation as a smoking parameter

A simple photometric procedure was developed for the determination of thiocyanate (SCN-) in plasma and saliva without deproteinisation or dialysis. Fe(III) ions form a red coloured complex with SCN- with a maximum absorbance at 460 nm. Mercury(II) nitrate is used to run a sample blank. A manual and an automated version (COBAS BIO) of the method is described. The method is linear up to 5000 mumol/l SCN-. The CV of the between-run precision is 2.8-8% for the manual and 2.6-6.6% for the automated method. The SCN- plasma concentration was 21-134 mumol/l in nonsmokers and 44-260 mumol/l in smokers. In mixed saliva, the concentration is much higher than in plasma: 1.57-5.5 mumol/l in smokers and 0.79-3.9 mumol/l in nonsmokers. Plasma, but not oral fluid SCN-, is a valuable parameter for studying smoking habits in population surveys. However, its use is limited. In our experience only heavy smokers can be distinguished from nonsmokers.

Homogeneity of potassium chloride in small volume intravenous containers

The purpose of this investigation was to determine whether potassium chloride as an additive is distributed homogeneously throughout small volume parenteral solutions and whether the pattern of electrolyte distribution is identical for two types of delivery systems. The effect of purposeful mixing after addition of potassium chloride was also studied. Thirty-one registered nurses prepared two supplementary intravenous solutions consisting of 10mEq potassium chloride in 50ml of 5% dextrose solution. One solution was prepared in a soft polyvinyl chloride minibag (Viaflex, Baxter-Travenol), the other in a semirigid plastic burette (Buretrol, Baxter-Travenol). The solutions were discharged through a volumetric pump (IMED) and four aliquots were taken at regular intervals. Samples were chemically analyzed by flame photometry to determine the potassium concentration in each solution layer of the container. For each container type, there were significant differences in the potassium concentrations among the layers of solution. The pattern of distribution also differed significantly between the two containers. The strata in the minibag showed smaller variations in potassium concentration than did corresponding layers in the burette. Some single sample concentrations from burettes exceeded the expected concentration of 200mEq/L by 105mEq. Nurses manipulated the two types of containers differently. Thirty of 31 minibags were mechanically mixed, but only 11 of 31 burettes were treated in this way. When the effect of mixing was considered, solutions in mixed containers were essentially no different from those not agitated after addition of the electrolyte.

Intravenous leiomyomatosis with cardiac extension

A woman with intravenous leiomyomatosis experienced syncope 7 years after a total abdominal hysterectomy and oophorectomy for a uterine fibroid. The workup revealed a tumor that extended from the iliac veins to the right ventricle. It was totally removed under cardiopulmonary bypass. One year later, the patient was found to be asymptomatic and without evidence of tumor recurrence.

Evaluation of left ventricular performance by gated radionuclide angiography

Gated radionuclide angiography (RVG) in orthogonal projections was used to evaluate left ventricular volume, ejection fraction, and segmental wall motion. Images of the left ventricle at end-diastole and end-systole were outlined in two projections using a simple manual method. The perimeter drawings were digitized on a desktop computer, interfaced to an XY recorder and left ventricular volumes and ejection fraction calculated. The results were compared to contrast left ventriculography (CVG) in the same projections. RVG and CVG gave similar results for end-diastolic volume (r = .87, P less than 0.001), end-systolic volume (r = .95, P less than 0.001), and ejection fraction (r = .89, P less than 0.001) over a wide range of values. In 92% of all left ventricular segments analyzed, RVG and CVG showed only minor differences in the analysis of wall motion. Reproducibility of the method by a trained observer was excellent. Interobserver trials demonstrated that less well-trained observers consistently over- or underestimated volumes, emphasizing the need for prior experience in RVG analysis. Use of this manual method for analysis of gated equilibrium RVG in orthogonal projections appears to be a reasonably accurate, reproducible method for evaluating left ventricular function.

Left ventricular volume from paired biplane two-dimensional echocardiography

To evaluate the applicability of two-dimensional echocardiography to left ventricular volume determination, 30 consecutive patients undergoing biplane left ventricular cineangiography were studied with a wide-angle (84 degrees), phased-array, two-dimensional echocardiographic system. Two echographic projections were used to obtain paired, biplane, tomographic images of the left ventricle. We used the short-axis view (from the precordial window) as an anolog of the left anterior oblique angiogram, and the long-axis, two-chamber view (from the apex impulse window) as a right anterior oblique angiographic equivalent. A modified Simpson's rule formula was used to calculate systolic and diastolic left ventricular volumes from the biplane echogram and the biplane angiogram. These methods correlated well for ejection fraction (r = 0.87) and systolic volume (r = 0.90), but only modestly for diastolic volume (r = 0.80). These correlations are noteworthy because 65% of the patients had significant segmental wall motion abnormalities. The volumes determined from the minor-axis dimensions of M-mode echograms in 23 of the same patients correlated poorly with angiography.

Combination vasodilator therapy for severe chronic congestive heart failure

A patient with severe, chronic congestive heart failure was unresponsive not only to conventional therapy, but also to nonparenteral nitroglycerin and isosorbide dinitrate; he became nitroprusside dependent. Oral minoxidil therapy produced a significant decrease in systemic vascular resistance and an increase in cardiac output, with no tachycardia, hypotension, or decrease in systemic and pulmonary venous pressures. The addition of sublingual isosorbide dinitrate decreased venous pressures and produced a further increase in cardiac output. The combination of oral minoxidil and sublingual isosorbide dinitrate maintained clinical and hemodynamic improvements, and the patient could be weaned off nitroprusside. Deterioration in hemodynamics occurred with the withdrawal of minoxidil. Therapy with oral hydralazine produced hemodynamic effects comparable to those of oral minoxidil. These observations suggest that chronic reduction of impedance to left ventricular ejection with minoxidil or hydralazine is possible in patients with severe intractable heart failure and deserves further clinical trial.

Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse

From 1969 to 1974, 19 cases of Serratia marcescens endocarditis were observed in the San Francisco Bay Area. Seventeen patients were intravenous drug users, and Serratia caused 14% of all addict-associated endocarditis in San Francisco. Serratia strains were nonpigmented and had typical antibiotic sensitivities, except that 9 of the isolates exhibited colonial variation, with each variant having different antibiotic sensitivities. Aortic or mitral valves were involved in 13 patients, and heart failure developed in 9 of these. Twelve patients had embolic episodes to brain, iliofemoral arteries, or lung. Five of 6 patients with tricuspid valvulitis were cured by antibiotics either with (1) or without excision of the valve. All 12 patients with aortic or mitral valvulitis treated medically died; 11 had unremitting sepsis. Aortic valve replacement and antibiotics were effective in 1. Gentamicin combined with either carbenicillin or chloramphenicol was the most effective treatment regimen.