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Pubblicazioni recenti - cardiac arrest
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Delays in recognition of the need for Telephone-assisted CPR due to caller descriptions of chief complaint.
Resuscitation2020 Feb;():. doi: S0300-9572(20)30078-2.
Stangenes Scott R, Painter Ian S, Rea Tom, Meischke Hendrika,
Abstract
BACKGROUND:
The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR).
METHODS:
We conducted an analysis of N?=?433 cardiac arrest calls from six large call centers in the United States. Calls were abstracted for initial chief complaint description: caller reports (1) correct medical condition (CMC); (2) incorrect medical condition (IMC), or (3) signs/symptoms only (SS), as well the time interval between call pickup and recognition of the need for T-CPR. In addition, we abstracted if EMDs asked questions related to the caller's chief complaint (rather than, or before), asking about patients' consciousness and breathing status.
RESULTS:
The majority of cardiac arrest calls (60%) were reported as SS. Median time to recognition of the need for T-CPR was 64 seconds for SS chief complaints, 47 seconds for CMC chief complaints, and 100 seconds for IMC chief complaints. EMDs pursued chief complaint descriptions for 9% of the calls with SS chief complaints, 41% of the calls with IMC chief complaints, and 19% of the calls with CMC chief complaints. Median time to recognition of the need for CPR for calls in which the chief complaint description was pursued was 166 seconds compared to 62 seconds for calls in which the chief complaint description was not pursued.
CONCLUSION:
Caller chief complaint description affects the time to recognition of the need for T-CPR.
CLINICAL TRIAL REGISTRATION:
http://www.clinicaltrials.gov Trial # NCT01972087.
Copyright © 2020. Published by Elsevier B.V.
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Variability in chest compression rate calculations during pediatric cardiopulmonary resuscitation.
Resuscitation2020 Feb;():. doi: S0300-9572(20)30079-4.
Landis William P, Morgan Ryan W, Reeder Ron W, Graham Kathryn, Siems Ashley, Diddle J Wesley, Pollack Murray M, Maa Tensing, Fernandez Richard P, Yates Andrew R, Tilford Bradley, Ahmed Tageldin, Meert Kathleen L, Schneiter Carleen, Bishop Robert, Mourani Peter M, Naim Maryam Y, Friess Stuart, Burns Candice, Manga Arushi, Franzon Deborah, Tabbutt Sarah, McQuillen Patrick S, Horvat Christopher, Bochkoris Matthew, Carcillo Joseph A, Huard Leanna, Federman Myke, Sapru Anil, Viteri Shirley, Hehir David A, Notterman Daniel A, Holubkov Richard, Dean J Michael, Nadkarni Vinay M, Berg Robert A, Wolfe Heather A, Sutton Robert M, ,
Abstract
AIM:
The mathematical method used to calculate chest compression (CC) rate during cardiopulmonary resuscitation varies in the literature and across device manufacturers. The objective of this study was to determine the variability in calculated CC rates by applying four published methods to the same dataset.
METHODS:
This study was a secondary investigation of the first 200 pediatric cardiac arrest events with invasive arterial line waveform data in the ICU-RESUScitation Project (NCT02837497). Instantaneous CC rates were calculated during periods of uninterrupted CCs. The defined minimum interruption length affects rate calculation (e.g., if an interruption is defined as a break in CCs ? 2?s, the lowest possible calculated rate is 30?CCs/min). Average rates were calculated by four methods: 1) rate with an interruption defined as ? 1?s; 2) interruption ? 2?s; 3) interruption ? 3?s; 4) method #3 excluding top and bottom quartiles of calculated rates. American Heart Association Guideline-compliant rate was defined as 100-120?CCs/min. A clinically important change was defined as ±5?CCs/min. The percentage of events and epochs (30?s periods) that changed Guideline-compliant status was calculated.
RESULTS:
Across calculation methods, mean CC rates (118.7-119.5/min) were similar. Comparing all methods, 14 events (7%) and 114 epochs (6%) changed Guideline-compliant status.
CONCLUSION:
Using four published methods for calculating CC rate, average rates were similar, but 7% of events changed Guideline-compliant status. These data suggest that a uniform calculation method (interruption ? 1?s) should be adopted to decrease variability in resuscitation science.
Copyright © 2020. Published by Elsevier B.V.
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Do peak times exist for sudden cardiac arrest?
Trends Cardiovasc Med2020 Feb;():. doi: S1050-1738(20)30018-9.
Ramireddy Archana, Chugh Sumeet S,
Abstract
Sudden cardiac arrest remains an unexpected and dynamic cardiovascular disease process that continues to present challenges for accurate risk prediction and prevention. The notion of a circadian pattern in the occurrence of sudden cardiac arrest had long been supported by the presence of an early morning peak; however, more recent studies are calling this observation into question. This likely paradigm shift in the presentation and mechanisms of sudden cardiac arrest has major implications and needs to be carefully considered. In this review, we present the current state of the science of circadian and septadian trends in sudden cardiac arrest through an in-depth analysis of the published literature.
Copyright © 2020. Published by Elsevier Inc.
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Survival, neurological and safety outcomes after out of hospital cardiac arrests treated by using prehospital therapeutic hypothermia: A systematic review and meta-analysis.
Am J Emerg Med2020 Feb;():. doi: S0735-6757(20)30092-9.
Szarpak Lukasz, Filipiak Krzysztof J, Mosteller Lauretta, Jaguszewski Milosz, Smereka Jacek, Ruetzler Kurt, Ahuja Sanchit, Ladny Jerzy R,
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National prevalence, trends and outcomes of takotsubo syndrome in hospitalizations with prior history of mediastinal/intrathoracic cancer and radiation therapy.
Int J Cardiol2020 Feb;():. doi: S0167-5273(20)30251-5.
Desai Rupak, Desai Aakash, Abbas Shabber A, Patel Upenkumar, Bansod Snehal, Damarlapally Nanush, Doshi Rajkumar, Savani Sejal, Gangani Kishorbhai, Sachdeva Rajesh, Kumar Gautam,
Abstract
BACKGROUND:
Radiation therapy (RT) for cancers in thoracic/mediastinal region has been linked with heart damage following years of radiation exposure. However, prevalence of takotsubo syndrome (TTS) in patients with prior intrathoracic/mediastinal malignancies treated with RT has never been analyzed on a large scale.
METHODS:
We identified adult hospitalizations with prior mediastinal/intrathoracic cancer and RT and TTS using ICD-9 CM codes and the National Inpatient Sample (2007-2014) after excluding current admissions for chemotherapy. We then assessed the prevalence, odds, trends and in-hospital outcomes of TTS-related admissions in patients with vs. without prior intrathoracic cancer and RT.
RESULTS:
We identified a total of 5,991,314 hospitalizations with prior intrathoracic/mediastinal malignancies and RT (~73 yrs., 85.2% female), of which 7663 (0.13%, 128 per 100,000) were diagnosed with TTS (~74 yrs., 95.8% females, 88.1% white). Higher odds and rising trends in TTS per 100,000 hospitalizations (from 31 to 241) were seen among patients with prior intrathoracic malignancies and RT as compared to those without (from 19 to 104) (p < 0.001). All-cause in-hospital mortality (4.6% vs 2.8%; OR 1.45; 95%CI 1.29-1.63, p < 0.001), cardiogenic shock (4.3% vs 0.2%), cardiac arrest (3.1% vs 0.9%), arrhythmia (34.3% vs 24.6%), stroke (3.6% vs 2.8%), respiratory failure (14.5% vs 4.6%), and median length of stay and hospital charges were significantly higher in the TTS cohort.
CONCLUSIONS:
This study showed higher odds and increasing trends in TTS-related admissions with worse in-hospital outcomes among patients with prior intrathoracic/mediastinal cancer and RT, irrespective of the time interval from cancer diagnosis or RT to TTS occurrence.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome.
Crit Care2020 Feb;24(1):60. doi: 10.1186/s13054-020-2762-5.
Corral Torres Ervigio, Hernández-Tejedor Alberto, Suárez Bustamante Rosa, de Elías Hernández Ramón, Casado Flórez Isabel, San Juan Linares Antonio,
Abstract
BACKGROUND:
The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome).
METHODS:
Prospective observational study of all non-traumatic OHCA in patients older than 17?years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO, HCO, base excess (BE), Na, K, Ca and lactate. ROSC upon arrival at the hospital and neurological status 30?days later (Cerebral Performance Categories (CPC) scale) were recorded.
RESULTS:
We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30?days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p?=?0.020), high pCO levels (adjusted OR 1.03 [1.01-1.05], p?=?0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p?=?0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p?
CONCLUSION:
There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.
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The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis.
Crit Care2020 Feb;24(1):61. doi: 10.1186/s13054-020-2773-2.
Yan Shijiao, Gan Yong, Jiang Nan, Wang Rixing, Chen Yunqiang, Luo Zhiqian, Zong Qiao, Chen Song, Lv Chuanzhu,
Abstract
BACKGROUND:
To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR).
METHODS:
We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis.
RESULTS:
A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6-31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7-23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2-9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1-13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8-9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2-11.7%), who received bystander CPR (11.3%, 95% CI 9.3-13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5-13.0%; North America: 7.7%; 95% CI 6.9-8.6%). The survival to discharge (8.6% in 1976-1999 vs. 9.9% in 2010-2019), 1-month survival (8.0% in 2000-2009 vs. 13.3% in 2010-2019), and 1-year survival (8.0% in 2000-2009 vs. 13.3% in 2010-2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger's test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR.
CONCLUSIONS:
The global survival rate of OHCA patients who received CPR has increased in the past 40?years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries.
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The application of the single branch-first combined with the mid-arch clamping technique and the embedded anastomosis technique for DeBakey type II aortic dissection.
J Cardiothorac Surg2020 Feb;15(1):38. doi: 10.1186/s13019-020-1082-9.
Li Quan, Qu Hong, Liu Tianqi, Li Min, Chen Shanliang, Li Peijie, Xu Li, Wang Hengbao,
Abstract
BACKGROUND:
Patients with DeBakey type II aortic dissection or ascending aortic aneurysms involving the right innominate artery require hemiarch replacement and placement of a right innominate artery graft. Traditional aortic hemiarch replacement surgery must be performed under right axillary artery cannulation perfusion and moderate or deep hypothermia circulatory arrest. However, the axillary artery perfusion is always associated with left subclavian artery "steal blood", and it cannot guarantee blood supply to the left cerebral hemisphere in patients with an incomplete circle of Willis, and hypothermia and hypoperfusion cause damage to the brain and spinal cord; therefore, postoperative complications of the nervous system are common. Herein, we present a hemiarch replacement procedure with the use of the single branch-first combined with the mid-arch clamping technique. This procedure can not only reduce the axillary artery incision but also eliminate the need for mid-deep hypothermia and circulatory arrest.
CASE PRESENTATION:
A 41-year-old male patient underwent surgery with this technique. Computed tomography angiography performed upon admission showed calcified plaques scattered throughout the aorta and showed DeBakey type II aortic dissection involving the right innominate artery, accompanied by cardiac tamponade. The patient underwent aortic root repair, ascending aorta replacement, and hemiarch replacement as well as the placement of a right innominate artery graft. Aortic root anastomosis was performed with the embedded anastomosis technique. There were no postoperative complications. The patient was discharged 11?days after the operation. During more than 3?months of follow-up, there were no cases of aortic valve regurgitation or anastomotic fistula.
CONCLUSIONS:
The single branch-first combined with the mid-arch clamping technique for the right innominate artery can reduce the axillary artery incision and avoid damage to the body under mid-deep hypothermia and circulatory arrest. The embedded anastomosis technique is easy to perform, results in a limited amount of bleeding and requires almost no extra needling. We believe that these techniques can serve as good alternative strategies for patients with DeBakey type II aortic dissection or ascending aortic aneurysms involving the right innominate artery.
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Nitrite elicits divergent NO-dependent signaling that associates with outcome in out of hospital cardiac arrest.
Redox Biol2020 Feb;32():101463. doi: S2213-2317(19)31504-6.
Vitturi Dario A, Maynard Charles, Olsufka Michele, Straub Adam C, Krehel Nick, Kudenchuk Peter J, Nichol Graham, Sayre Michael, Kim Francis, Dezfulian Cameron,
Abstract
Brain and heart injury cause most out-of-hospital cardiac arrest deaths but limited pharmacotherapy exists to protect these tissues. Nitrite is a nitric oxide precursor that is protective in pre-clinical models of ischemic injury and safe in Phase I testing. Protection may occur by cGMP generation via the sGC pathway or through S-nitrosothiol and nitrated conjugated linoleic acid (NO-CLA) formation. We hypothesized that nitrite provided during CPR signals through multiple pathways and that activation of signals is associated with OHCA outcome. To this end, we performed a secondary analysis of a phase 1 study of intravenous nitrite administration during resuscitation in adult out-of-hospital cardiac arrest. Associations between whole blood nitrite and derived plasma signals (cGMP and NO-CLA) with patient characteristics and outcomes were defined using Chi-square or t-tests and multiple logistic regression. Whole blood nitrite levels correlated inversely with plasma NO-CLA (p = 0.039) but not with cGMP. Patients with shockable rhythms had higher cGMP (p = 0.027), NO-CLA (p < 0.0001) and trended towards lower nitrite (p = 0.077). Importantly, plasma cGMP and NO-CLA levels were higher in survivors (p = 0.033 and 0.019) and in those with good neurological outcome (p = 0.046 and 0.021). Nitrite was lower in patients with good neurologic outcome (p = 0.029). cGMP (OR 4.02; 95% CI 1.04-15.54; p = 0.044) and NO-CLA (OR 3.74; 95% CI 1.11-12.65; p = 0.034) were associated with survival. Nitrite (OR 0.20; 95% CI 0.05-0.08; p = 0.026) and NO-CLA (OR 3.96; 95% CI 1.01-15.60; p = 0.049) were associated with favorable neurologic outcome. In summary, nitrite administration was associated with increased plasma cGMP and NO-CLA formation in selected OHCA patients. Furthermore, patients with the highest levels of cGMP and NO-CLA were more likely to survive and experience better neurological outcomes.
Copyright © 2020. Published by Elsevier B.V.
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Sudden cardiac arrest survival in HEARTSafe communities: A response.
Resuscitation -
The influence of prolonged temperature management on acute kidney injury after out-of-hospital cardiac arrest: A post-hoc analysis of the TTH48 trial.
Resuscitation2020 Feb;():. doi: S0300-9572(20)30076-9.
Strand Kristian, Søreide Eldar, Kirkegaard Hans, Taccone Fabio Silvio, Grejs Anders Morten, Duez Christophe Henri Valdemar, Jeppesen Anni Nørgaard, Storm Christian, Rasmussen Bodil Steen, Laitio Timo, Hassager Christian, Toome Valdo, Hästbacka Johanna, Skrifvars Markus B,
Abstract
BACKGROUND:
Acute kidney injury (AKI) is common after cardiac arrest and targeted temperature management (TTM). The impact of different lengths of cooling on the development of AKI has not been well studied. In this study of patients included in a randomised controlled trial of TTM at 33°C for 24 versus 48hours after cardiac arrest (TTH48 trial), we examined the influence of prolonged TTM on AKI and the incidence and factors associated with the development of AKI. We also examined the impact of AKI on survival.
METHODS:
This study was a sub-study of the TTH48 trial, which included patients cooled to 33±1?C after out-of-hospital cardiac arrest for 24 versus 48hours. AKI was classified according to the KDIGO AKI criteria based on serum creatinine and urine output collected until ICU discharge for a maximum of seven days. Survival was followed for up to six months. The association of admission factors on AKI was analysed with multivariate analysis and the association of AKI on mortality was analysed with Cox regression using the time to AKI as a time-dependent covariate.
RESULTS:
Of the 349 patients included in the study, 159 (45.5%) developed AKI. There was no significant difference in the incidence, severity or time to AKI between the 24- and 48-hour groups. Serum creatinine values had significantly different trajectories for the two groups with a sharp rise occurring during rewarming. Age, time to return of spontaneous circulation, serum creatinine at admission and body mass index were independent predictors of AKI. Patients with AKI had a higher mortality than patients without AKI (hospital mortality 36.5% vs 12.5%, p<0.001), but only AKI stages 2 and 3 were independently associated with mortality.
CONCLUSIONS:
We did not find any association between prolonged TTM at 33°C and the risk of AKI during the first seven days in the ICU. AKI is prevalent after cardiac arrest and TTM and occurs in almost half of all ICU admitted patients and more commonly in the elderly, with an increasing BMI and longer arrest duration. AKI after cardiac arrest is an independent predictor of time to death.
Copyright © 2020. Published by Elsevier B.V.
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Intraosseous adrenaline for adult out-of-hospital cardiac arrest: Faster access with worse outcomes.
Resuscitation -
Timing is everything: combining EEG and MRI to predict neurological recovery after cardiac arrest.
Resuscitation -
DOuble Sequential External Defibrillation for Refractory Ventricular Fibrillation: The DOSE VF Pilot Randomized Controlled Trial.
Resuscitation2020 Feb;():. doi: S0300-9572(20)30074-5.
Cheskes Sheldon, Dorian Paul, Feldman Michael, McLeod Shelley, Scales Damon C, Pinto Ruxandra, Turner Linda, Morrison Laurie J, Drennan Ian R, Verbeek P Richard,
Abstract
OBJECTIVES:
The primary objective was to determine the feasibility and safety of a cluster randomized controlled trial (RCT) with crossover comparing vector change defibrillation (VC) or double sequential external defibrillation (DSED) to standard defibrillation for patients experiencing refractory ventricular fibrillation (VF). Secondary objectives were to assess the rates of VF termination (VFT) and return of spontaneous circulation (ROSC).
METHODS:
We conducted a pilot cluster RCT with crossover in four Canadian paramedic services including all treated adult OHCA patients who presented in VF and received a minimum of three successive defibrillation attempts. Each EMS service was randomly assigned to provide standard defibrillation, VC or DSED. Agencies crossed over to an alternate defibrillation strategy after six months.
RESULTS:
152 patients were enrolled. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no safety concerns reported. In the standard group, 66.6% of cases resulted in VFT, compared to 82.0% in VC and 76.3% in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively.
CONCLUSIONS:
Our findings suggest the DOSE-VF protocol is feasible and safe. Rates of VFT and ROSC were higher in the VC and DSED than standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact clinical outcomes.
Copyright © 2020. Published by Elsevier B.V.
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Control of Shivering During Targeted Temperature Management.
Crit Care Nurs Q;43(2):251-266. doi: 10.1097/CNQ.0000000000000305.
Armahizer Michael J, Strein Micheal, Pajoumand Mehrnaz,
Abstract
Targeted temperature management (TTM) is used frequently in patients with a variety of diseases, especially those who have experienced brain injury and/or cardiac arrest. Shivering is one of the main adverse effects of TTM that can often limit its implementation and efficacy. Shivering is the body's natural response to hypothermia and its deleterious effects can negate the benefits of TTM. The purpose of this article is to provide an overview of TTM strategies and shivering management.
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Impact of Wearable Cardioverter-Defibrillator Compliance on Outcomes in the VEST Trial: As-Treated and Per-Protocol Analyses.
J Cardiovasc Electrophysiol2020 Feb;():. doi: 10.1111/jce.14404.
Olgin Jeffrey E, Lee Byron K, Vittinghoff Eric, Morin Daniel P, Zweibel Steven, Rashba Eric, Chung Eugene H, Borggrefe Martin, Hulley Stephen, Lin Feng, Hue Trisha F, Pletcher Mark J,
Abstract
BACKGROUND:
VEST did not demonstrate a significant reduction in arrhythmic death with the wearable cardioverter-defibrillator (WCD), but compliance with the device may have substantially affected the results. The influence of WCD compliance on outcomes has not yet been fully evaluated.
METHODS:
Using linear and pooled logistic models, we performed as-treated analyses omitting person-time in the hospital and adjusted for correlates of WCD compliance. To assess the impact of early stopping of WCD, we performed a per-protocol Kaplan-Meier analysis, censoring after the last day the WCD was worn. Interactions of potential effect modifiers with treatment assignment and WCD compliance on outcomes were investigated. Lastly, we used linear models to identify predictors of WCD compliance.
RESULTS:
A per-protocol analysis demonstrated a significant reduction in total (p<0.001) and arrhythmic (p=0.001) mortality. Better WCD compliance was independently predicted by cardiac arrest during index MI, higher maximum Cr, diabetes, prior heart failure, EF?25%, Polish enrolling center and number of WCD alarms, while worse compliance was predicted by being divorced, Asian race, higher BMI, prior PCI, or any WCD shock. Neither excluding time in hospital from the as-treated analysis nor adjustment for factors affecting WCD compliance materially changed the results. No variable demonstrated a significant interaction in either the intention-to-treat or as-treated analysis.
CONCLUSION:
Robust sensitivity analyses of as-treated and per-protocol analyses suggest that the WCD is protective in compliant patients with EF?35% during the first 3 months post-MI. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Lineage reprogramming of fibroblasts into induced cardiac progenitor cells by CRISPR/Cas9-based transcriptional activators.
Acta Pharm Sin B2020 Feb;10(2):313-326. doi: 10.1016/j.apsb.2019.09.003.
Wang Jianglin, Jiang Xueyan, Zhao Lixin, Zuo Shengjia, Chen Xiantong, Zhang Lingmin, Lin Zhongxiao, Zhao Xiaoya, Qin Yuyan, Zhou Xinke, Yu Xi-Yong,
Abstract
Overexpression of exogenous lineage-determining factors succeeds in directly reprogramming fibroblasts to various cell types. Several studies have reported reprogramming of fibroblasts into induced cardiac progenitor cells (iCPCs). CRISPR/Cas9-mediated gene activation is a potential approach for cellular reprogramming due to its high precision and multiplexing capacity. Here we show lineage reprogramming to iCPCs through a dead Cas9 (dCas9)-based transcription activation system. Targeted and robust activation of endogenous cardiac factors, including GATA4, HAND2, MEF2C and TBX5 (G, H, M and T; GHMT), can reprogram human fibroblasts toward iCPCs. The iCPCs show potentials to differentiate into cardiomyocytes, smooth muscle cells and endothelial cells . Addition of MEIS1 to GHMT induces cell cycle arrest in G2/M and facilitates cardiac reprogramming. Lineage reprogramming of human fibroblasts into iCPCs provides a promising cellular resource for disease modeling, drug discovery and individualized cardiac cell therapy.
© 2020 Chinese Pharmaceutical Association and Institute of Materia Medica, Chinese Academy of Medical Sciences. Production and hosting by Elsevier B.V.
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Acute ST-Segment Elevation: Don't Rush me to the Catheter Laboratory- Please Wait.
Heart Views;21(1):37-39. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_87_19.
Albizreh Bassim, Alibrahim Mohammad, Hamid Tahir,
Abstract
We report a case of a young woman with no cardiac history who presented with out-of-hospital cardiac arrest and ST-segment elevation on the electrocardiogram. The cardiac arrest initially was suspected to be secondary to coronary artery disease. Further history was taken from a relative who said that the patient had a severe headache before the cardiac arrest. It was subsequenly found on computed tomography of the head that the patient had infratentorial subarachnoid hemorrhage and diffurse brain edema. The management of course was totally different from what was contemplated initially. This case illustrates that ST-segment elevation can be caused by other conditions besides on occlusive thrombus in the coronary arteries.
Copyright: © 2020 Heart Views.
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Transthoracic echocardiography is a noninvasive alternative to TEE.
Am J Emerg Med -
Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea.
J Korean Med Sci2020 Feb;35(7):e54. doi: 10.3346/jkms.2020.35.e54.
Choi Wook Jin, Ha Young Rock, Oh Je Hyeok, Cho Young Soon, Lee Won Woong, Sohn You Dong, Cho Gyu Chong, Koh Chan Young, Do Han Ho, Jeong Won Joon, Ryoo Seung Mok, Kwon Jae Hyun, Kim Hyung Min, Kim Su Jin, Park Chan Yong, Lee Jin Hee, Lee Jae Hoon, Lee Dong Hyun, Park Sin Youl, Kang Bo Seung,
Abstract
Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
© 2020 The Korean Academy of Medical Sciences.
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