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Pubblicazioni recenti - cardiopulmonary
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ASK1 inhibition: a therapeutic strategy with multi-system benefits.
J Mol Med (Berl)2020 Feb;():. doi: 10.1007/s00109-020-01878-y.
Ogier Jacqueline M, Nayagam Bryony A, Lockhart Paul J,
Abstract
p38 mitogen-activated protein kinases (P38? and ?) and c-Jun N-terminal kinases (JNK1, 2, and 3) are key mediators of the cellular stress response. However, prolonged P38 and JNK signalling is associated with damaging inflammatory responses, reactive oxygen species-induced cell death, and fibrosis in multiple tissues, such as the kidney, liver, central nervous system, and cardiopulmonary systems. These responses are associated with many human diseases, including arthritis, dementia, and multiple organ dysfunctions. Attempts to prevent P38- and JNK-mediated disease using small molecule inhibitors of P38 or JNK have generally been unsuccessful. However, apoptosis signal-regulating kinase 1 (ASK1), an upstream regulator of P38 and JNK, has emerged as an alternative drug target for limiting P38- and JNK-mediated disease. Within this review, we compile the evidence that ASK1 mediates damaging cellular responses via prolonged P38 or JNK activation. We discuss the potential benefits of ASK1 inhibition as a therapeutic and summarise the studies that have tested the effects of ASK1 inhibition in cell and animal disease models, in addition to human clinical trials for a variety of disorders.
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Cardiorespiratory Fitness Is Associated With Better Cardiometabolic Health and Lower PTSD Severity in Post-9/11 Veterans.
Mil Med2020 Feb;():. doi: usaa005.
Whitworth James W, Hayes Scott M, Andrews Ryan J, Fonda Jennifer R, Beck Brigitta M, Hanlon Lilly B, Fortier Catherine B, Milberg William P, McGlinchey Regina E,
Abstract
INTRODUCTION:
Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD.
MATERIALS AND METHODS:
This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman's rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression.
RESULTS:
Peak oxygen uptake ($\dot{\mathrm{V}}$O2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = -0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = -0.61, P = 0.03 and diastolic blood pressure rho = -0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized ? = -0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) ? = -0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) ? = -0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status.
CONCLUSIONS:
These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.
Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US.
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Cardiopulmonary resuscitation and skill retention in emergency physicians.
Am J Emerg Med2020 Jan;():. doi: S0735-6757(20)30069-3.
Schmitz Gillian R, McNeilly Corey, Hoebee Shelby, Blutinger Erik, Fernandez Jessie, Kang Christopher, Schneider Sandra,
Abstract
STUDY OBJECTIVES:
The American Heart Association (AHA) recently established the Resuscitation Quality Improvement (RQI) program, which requires physicians to perform quarterly cardiopulmonary resuscitation (CPR) skill checks. The aim of this study was to determine if timing of last training impacted skill performance of emergency physicians.
METHODS:
A convenience sample of emergency medicine (EM) physicians was asked to complete a Basic Life Support (BLS) scenario on a manikin. Participants passed the scenario if they successfully performed high-quality CPR. Participants completed a survey to assess clinical experience and timing of prior BLS training. Outcomes were comparisons of skills check pass rates for physicians recently trained in BLS (?90 days) and those trained >90 days ago and those trained >2 years ago.
RESULTS:
A total of 113 individuals were included in the study: 87 attending physicians and 26 residents. Overall 92.9% correctly performed CPR with the proper assessment, compression rate, compression depth and rescue breaths. There was no difference between success rates in EM physicians who had BLS training within 90 days (91.7%) and physicians who had not had BLS within 90 days, (93.1%). (p = 1.00) There was no difference in the pass rate of those trained within 90 days (91.7%) to those trained >2 years ago (90.9%) (95CI 0.088, 0.096).
CONCLUSION:
There was no difference between delivery of high-quality CPR in EM physicians who had recent BLS training and those who did not.
Copyright © 2020 Elsevier Inc. All rights reserved.
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An impedance threshold device did not improve carotid blood flow in a porcine model of prolonged cardiac arrest.
J Transl Med2020 Feb;18(1):83. doi: 10.1186/s12967-020-02264-5.
Kjaergaard Benedict, Holdgaard Hans O, Magnusdottir Sigridur O, Lundbye-Christensen Søren, Christensen Erika F,
Abstract
BACKGROUND:
An impedance threshold device (ITD) was developed to increase venous return to the heart and therefore increase cardiac output and organ blood flow during cardiopulmonary rescue (CPR). Basic CPR aims to maintain coronary and cerebral blood flow at the minimum level necessary for survival. The present study compared the effects of an ITD on cerebral blood flow assessed as blood flow in both carotid arteries to the blood flow of a control group during prolonged CPR.
METHODS:
Fourteen anaesthetized pigs were monitored during 60 min of CPR after induced ventricular fibrillation. The primary outcome was blood flow in both carotid arteries, and the secondary outcomes were blood pressure, acid-base parameters, plasma potassium, and plasma lactate. The pigs were randomized to mechanical compressions and ventilation with an ITD added to the ventilation or to a control group treated only with mechanical compressions and ventilation. The time course for the parameters was tested using analysis of variance.
RESULTS:
The cumulative carotid blood flow in the ITD group decreased from 64 to 42 ml/min, and it decreased from 69 to 51 ml/min in the control group during 60 min of CPR. The difference was not significant. The secondary outcome measures were also not significantly different.
CONCLUSIONS:
This study did not show any beneficial effect of an ITD on carotid blood flow.
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The Effect of Transition Period on Performance Parameters in Elite Female Soccer Players.
Int J Sports Med2020 Feb;():. doi: 10.1055/a-1103-2038.
Parpa Koulla Parpa, Michaelides Marcos A,
Abstract
The purpose of this study was to examine the effect of a 4-week off-season period (transition period) on the anthropometric and performance parameters in elite female soccer players who participated in the UEFA women's Champions league. Eighteen female players (age 23.6±4.3 years) underwent testing at the end of the competitive period and right after the transition period. An incremental cardiopulmonary testing, body composition assessment and isokinetic testing at 60 °/sec were performed on both occasions. The cardiopulmonary exercise testing revealed that VO (p=0.001) and time on the treadmill (p=0.000) were significantly reduced after the transition period that included a 2 times/week exercise regimen. Furthermore, the quadriceps torque production at 60 °/s was significantly reduced for both the right (p=0.013) and left quadriceps (p=0.004) following the transition period. Finally, body weight (p=0.001) and body fat (p=0.000) significantly increased after 4 weeks of significantly reduced training volume. It is concluded that the transition period negatively affected the anthropometric and performance parameters of the female players. These data maybe informative for coaches and trainers as they demonstrate that despite the efforts to keep the players physically active the performance parameters decreased significantly.
© Georg Thieme Verlag KG Stuttgart · New York.
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Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock.
Crit Care Med2020 Mar;48(3):319-328. doi: 10.1097/CCM.0000000000004122.
Zimmerman Jerry J, Banks Russell, Berg Robert A, Zuppa Athena, Newth Christopher J, Wessel David, Pollack Murray M, Meert Kathleen L, Hall Mark W, Quasney Michael, Sapru Anil, Carcillo Joseph A, McQuillen Patrick S, Mourani Peter M, Wong Hector, Chima Ranjit S, Holubkov Richard, Coleman Whitney, Sorenson Samuel, Varni James W, McGalliard Julie, Haaland Wren, Whitlock Kathryn, Dean J Michael, Reeder Ron W, ,
Abstract
OBJECTIVES:
A companion article reports the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock. In this article, the investigators examine critical illness factors associated with these adverse outcomes.
DESIGN:
Prospective, cohort-outcome study, conducted 2013-2017.
SETTING:
Twelve United States academic PICUs.
PATIENTS:
Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.
INTERVENTIONS:
Illness severity, organ dysfunction, and resource utilization data were collected during PICU admission. Change from baseline health-related quality of life at the month 3 follow-up was assessed by parent proxy-report employing the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale.
MEASUREMENTS AND MAIN RESULTS:
In univariable modeling, critical illness variables associated with death and/or persistent, serious health-related quality of life deterioration were candidates for multivariable modeling using Bayesian information criterion. The most clinically relevant multivariable models were selected among models with near-optimal statistical fit. Three months following septic shock, 346 of 389 subjects (88.9%) were alive and 43 of 389 had died (11.1%); 203 of 389 (52.2%) had completed paired health-related quality of life surveys. Pediatric Risk of Mortality, cumulative Pediatric Logistic Organ Dysfunction scores, PICU and hospital durations of stay, maximum and cumulative vasoactive-inotropic scores, duration of mechanical ventilation, need for renal replacement therapy, extracorporeal life support or cardiopulmonary resuscitation, and appearance of pathologic neurologic signs were associated with adverse outcomes in univariable models. In multivariable regression analysis (odds ratio [95% CI]), summation of daily Pediatric Logistic Organ Dysfunction scores, 1.01/per point (1.01-1.02), p < 0.001; highest vasoactive-inotropic score, 1.02/per point (1.00-1.04), p = 0.003; and any acute pathologic neurologic sign/event, 5.04 (2.15-12.01), p < 0.001 were independently associated with death or persistent, serious deterioration of health-related quality of life at month 3.
CONCLUSIONS AND RELEVANCE:
Biologically plausible factors related to sepsis-associated critical illness organ dysfunction and its treatment were associated with poor outcomes at month 3 follow-up among children encountering septic shock.
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Frequency of Thrombocytopenia and Heparin-Induced Thrombocytopenia in Patients Receiving Extracorporeal Membrane Oxygenation Compared With Cardiopulmonary Bypass and the Limited Sensitivity of Pretest Probability Score.
Crit Care Med2020 Feb;():. doi: 10.1097/CCM.0000000000004261.
Arachchillage Deepa R J, Laffan Mike, Khanna Sanjay, Vandenbriele Christophe, Kamani Farah, Passariello Maurizio, Rosenberg Alex, Aw T C, Banya Winston, Ledot Stephane, Patel Brijesh V,
Abstract
OBJECTIVES:
To ascertain: 1) the frequency of thrombocytopenia and heparin-induced thrombocytopenia; 2) positive predictive value of the Pretest Probability Score in identifying heparin-induced thrombocytopenia; and 3) clinical outcome of heparin-induced thrombocytopenia in adult patients receiving venovenous- or venoarterial-extracorporeal membrane oxygenation, compared with cardiopulmonary bypass.
DESIGN:
A single-center, retrospective, observational cohort study from January 2016 to April 2018.
SETTING:
Tertiary referral center for cardiac and respiratory failure.
PATIENTS:
Patients who received extracorporeal membrane oxygenation for more than 48 hours or had cardiopulmonary bypass during specified period.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Clinical and laboratory data were collected retrospectively. Pretest Probability Score and heparin-induced thrombocytopenia testing results were collected prospectively. Mean age (± SD) of the extracorporeal membrane oxygenation and cardiopulmonary bypass cohorts was 45.4 (± 15.6) and 64.9 (± 13), respectively (p < 0.00001). Median duration of cardiopulmonary bypass was 4.6 hours (2-16.5 hr) compared with 170.4 hours (70-1,008 hr) on extracorporeal membrane oxygenation. Moderate and severe thrombocytopenia were more common in extracorporeal membrane oxygenation compared with cardiopulmonary bypass throughout (p < 0.0001). Thrombocytopenia increased in cardiopulmonary bypass patients on day 2 but was normal in 83% compared with 42.3% of extracorporeal membrane oxygenation patients at day 10. Patients on extracorporeal membrane oxygenation also followed a similar pattern of platelet recovery following cessation of extracorporeal membrane oxygenation. The frequency of heparin-induced thrombocytopenia in extracorporeal membrane oxygenation and cardiopulmonary bypass were 6.4% (19/298) and 0.6% (18/2,998), respectively (p < 0.0001). There was no difference in prevalence of heparin-induced thrombocytopenia in patients on venovenous-extracorporeal membrane oxygenation (8/156, 5.1%) versus venoarterial-extracorporeal membrane oxygenation (11/142, 7.7%) (p = 0.47). The positive predictive value of the Pretest Probability Score in identifying heparin-induced thrombocytopenia in patients post cardiopulmonary bypass and on extracorporeal membrane oxygenation was 56.25% (18/32) and 25% (15/60), respectively. Mortality was not different with (6/19, 31.6%) or without (89/279, 32.2%) heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation (p = 0.79).
CONCLUSIONS:
Thrombocytopenia is already common at extracorporeal membrane oxygenation initiation. Heparin-induced thrombocytopenia is more frequent in both venovenous- and venoarterial-extracorporeal membrane oxygenation compared with cardiopulmonary bypass. Positive predictive value of Pretest Probability Score in identifying heparin-induced thrombocytopenia was lower in extracorporeal membrane oxygenation patients. Heparin-induced thrombocytopenia had no effect on mortality.
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Deviations from AHA Guidelines During Pediatric Cardiopulmonary Resuscitation are Associated with Decreased Event Survival.
Resuscitation2020 Feb;():. doi: S0300-9572(20)30061-7.
Wolfe Heather A, Morgan Ryan W, Zhang Bingqing, Topjian Alexis A, Fink Ericka L, Berg Robert A, Nadkarni Vinay M, Nishisaki Akira, Mensinger Janell, Sutton Robert M, ,
Abstract
BACKGROUND:
Deviations (DEVs) from resuscitation guidelines are associated with worse outcomes after adult in-hospital cardiac arrest (IHCA), but impact during pediatric IHCA is unknown.
METHODS:
Retrospective cohort study of prospectively collected data from the American Heart Association's Get With The Guidelines-Resuscitation registry. Children who had an index IHCA of ?1?minute from 2000-2014 were included. DEVs are defined by the registry by category (airway, medications, etc.) A composite measure termed circulation DEV(C-DEV), defined as at least one process deviation in the following categories: medications, defibrillation, vascular access, or chest compressions, was the primary exposure variable. Primary outcome was survival to hospital discharge. Mixed-effect models with random intercept for each hospital assessed the relationship of DEVs with survival to hospital discharge. Robustness of findings was assessed via planned secondary analysis using propensity score matching.
RESULTS:
Among 7078 eligible index IHCA events, 1200 (17.0%) had DEVs reported. Airway DEVs (466; 38.8%) and medication DEVs (321; 26.8%) were most common. C-DEVs were present in 629 (52.4%). Before matching, C-DEVs were associated with decreased rate of ROSC (aOR?=?0.53, CI95: 0.43-0.64, p?
CONCLUSIONS:
DEVs were common in this cohort of pediatric IHCA. In a propensity matched cohort, while survival to hospital discharge was similar between groups, events with C-DEVs were less likely to achieve ROSC.
Copyright © 2020. Published by Elsevier B.V.
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The impact of flipped classroom andragogy on student assessment performance and perception of learning experience in two advanced physiology subjects.
Adv Physiol Educ2020 Mar;44(1):80-92. doi: 10.1152/advan.00125.2019.
Rathner Joseph A, Schier Mark A,
Abstract
Flipped classroom teaching has been used by many educators to promote active learning in higher education. This andragogy is thought to increase student engagement by making them more accountable for their learning and increase time on task in the classroom. While there are several systematic reviews that point to improved student results, it remains unclear if flipped classrooms have positive learning effects in physiology education. Flipped classroom teaching was introduced in two advanced physiology subjects (advanced neuroscience, , and cardiorespiratory and renal physiology, ). Changing the mode of content delivery reduced the time students needed to spend listening to lectures by one-third, without sacrificing either learning content or academic standards. Higher pass rates were observed with larger number of students earning distinction and high-distinction grades. Statistically significant improvements in final grades were observed from both subjects (: 2017, 49.28?±?20.16; 2018, 53.29?±?19.77, ?=?2.058, = 0.0405; : 2017, 58.87?±?21.19; 2018, 67.91?±?20.40, ?=?2.306, = 0.023). Finally, students' perception of their learning experience remained at or above the university benchmarks (median score of >80% for all iterations of the subjects). While the most frequent and persistent area that students suggested could be improved was reduction of content, equal numbers of students commented that no improvement in the subjects was required. Despite the generally positive attitude to recorded didactic teaching content, classroom attendance remained very low, and students did not engage with the active learning content. This suggest that more emphasis needs to be placed on promoting class attendance by developing better active learning content.
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Anesthetic Management for Squamous Cell Carcinoma of the Esophagus.
Methods Mol Biol2020 ;2129():359-383. doi: 10.1007/978-1-0716-0377-2_26.
Chan Eva Y F, Ip Danny K Y, Irwin Michael G,
Abstract
While surgery plays a major role in the treatment and potential cure of esophageal cancers, esophagectomy remains a high-risk operation with significant perioperative morbidity and mortality compared to other oncosurgical procedures. Perioperative management for esophagectomy is complex, and close attention to detail in various areas of anesthetic and perioperative management is crucial to improve postoperative outcomes. Patients undergoing esophagectomy should be offered an evidence-based risk assessment for their postoperative outcomes to allow active participation and informed, shared-decision making. Novel perioperative risk scores have been developed to predict both short-term and long-term outcomes in patients with esophageal cancer, although independent validation of such scoring systems is still required. Apart from accurate preoperative risk assessment, further efforts to improve morbidity and mortality from esophagectomy is achieved through comprehensive Enhanced Recovery after Surgery (ERAS) protocols, which comprise an individualized bundle of care throughout the perioperative journey for each patient and should be implemented as a standard practice. Furthermore, anesthetic practice and perioperative anesthetic drug usage can potentially affect cancer progression and recurrence. This chapter reviews current evidence for various factors that contribute to the improvement of perioperative outcomes, including prehabilitation, preoperative optimization of anemia, thoracic epidural analgesia, intraoperative protective ventilatory strategies, goal-directed fluid therapy, as well as special attention to other perioperative issues that potentially reduce anastomotic and cardiopulmonary complications. In summary, it is difficult to show a measurable benefit from any one single intervention, and a multidisciplinary approach that encompasses multiple aspects of perioperative care is necessary to improve outcomes after esophagectomy.
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[Effect of different training methods on the use of the i-gel laryngeal mask by lay persons on a manikin].
Med Klin Intensivmed Notfmed2020 Feb;():. doi: 10.1007/s00063-020-00665-4.
Jänig C, Poplawski A, Sammito S, Liebler S, Schmidbauer W, Piepho T,
Abstract
BACKGROUND:
Several studies have described the successful application of extraglottic airways by lay people to a phantom.
OBJECTIVES:
This study examined the influence of the training method on the success of the application.
METHODS:
A total of 150 visitors of a shopping mall were asked to place an i?gel laryngeal mask (Intersurgical GmbH, Sankt Augustin, Germany) on a manikin. The short instruction was randomized and performed either as a practical demonstration or through the self-study of an illustrated manual.
RESULTS:
Application success in the first attempt was 95.8?% for the practical demonstration group and 78.5?% for the written instruction group (p?=?0.001). Placement times were also significantly different (median 11.5?s vs. 22.5?s, p?
CONCLUSIONS:
Learning success can be achieved with both training methods. Initially, a hands-on training should be carried out with a practical demonstration.
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Advance care planning in patients referred to hospital for acute medical care: Results of a national day of care survey.
EClinicalMedicine2020 Feb;19():100235. doi: 10.1016/j.eclinm.2019.12.005.
Knight Thomas, Malyon Alexandra, Fritz Zoe, Subbe Chris, Cooksley Tim, Holland Mark, Lasserson Daniel,
Abstract
Background:
Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care provider. ACP is a key focus of national policy as a means to improve patient centered care at the end-of-life. Despite a wide held belief that ACP is beneficial, uptake is sporadic with considerable variation depending on age, ethnicity, location and disease group.
Methods:
This study looked to establish the prevalence of ACP on initial presentation to hospital with a medical emergency within The Society for Acute Medicine Benchmarking Audit (SAMBA18). 123 acute hospitals from across the UK collected data during a day of care survey. The presence of ACP and the presence of 'Do Not Attempt Cardiopulmonary Resuscitation' orders were recorded separately.
Findings:
Among 6072 patients presenting with an acute medical emergency, 290 patients (4.8%) had an ACP that was available for the admitting medical team. The prevalence of ACP increased incrementally with age, in patients less than 80 years old the prevalence was 2·9% (95% CI 2·7-3·1) compared with 9·5% (95% CI 9·1-10·0%) in patients aged over 80. In the patients aged over 90 the prevalence of ACP was 12·6% (95% CI 9·8-16·0). ACP was present in 23·3% (95% CI 21.8-24.8%) of patients admitted from institutional care compared with 3·5% (95% CI 3·3-3·7) of patients admitted from home. The prevalence of ACP was 7.1% (95% CI 6·6-7·6) amongst patients re-admitted to the hospital within the previous 30 days.
Interpretation:
Very few patients have an ACP that is available to admitting medical teams during an unscheduled hospital admission. Even among patients with advanced age, and who have recently been in hospital, the prevalence of available ACP remains low, in spite of national guidance. Further interventions are needed to ensure that patients' wishes for care are known by providers of acute medical care.
© 2019 Published by Elsevier Ltd.
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Advances in Preclinical Research Models of Radiation-Induced Cardiac Toxicity.
Cancers (Basel)2020 Feb;12(2):. doi: E415.
Schlaak Rachel A, SenthilKumar Gopika, Boerma Marjan, Bergom Carmen,
Abstract
Radiation therapy (RT) is an important component of cancer therapy, with >50% of cancer patients receiving RT. As the number of cancer survivors increases, the short- and long-term side effects of cancer therapy are of growing concern. Side effects of RT for thoracic tumors, notably cardiac and pulmonary toxicities, can cause morbidity and mortality in long-term cancer survivors. An understanding of the biological pathways and mechanisms involved in normal tissue toxicity from RT will improve future cancer treatments by reducing the risk of long-term side effects. Many of these mechanistic studies are performed in animal models of radiation exposure. In this area of research, the use of small animal image-guided RT with treatment planning systems that allow more accurate dose determination has the potential to revolutionize knowledge of clinically relevant tumor and normal tissue radiobiology. However, there are still a number of challenges to overcome to optimize such radiation delivery, including dose verification and calibration, determination of doses received by adjacent normal tissues that can affect outcomes, and motion management and identifying variation in doses due to animal heterogeneity. In addition, recent studies have begun to determine how animal strain and sex affect normal tissue radiation injuries. This review article discusses the known and potential benefits and caveats of newer technologies and methods used for small animal radiation delivery, as well as how the choice of animal models, including variables such as species, strain, and age, can alter the severity of cardiac radiation toxicities and impact their clinical relevance.
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Single-Stage Hybrid Arch Repair for Patients with Shaggy Aorta.
Aorta (Stamford)2020 Feb;():. doi: 10.1055/s-0039-3401996.
Oishi Yasuhisa, Kimura Satoshi, Sonoda Hiromichi, Shiose Akira,
Abstract
Operating on extended arch aneurysms that contain severe atherosclerotic plaques is difficult. In such cases, the incidence of intraoperative multiple embolization is very high. We applied single-stage hybrid arch repair, which involved ascending aorta replacement and debranching of arch vessels, consecutively with endovascular repair for two patients. This technique was developed to prevent embolization of atherosclerotic plaques during cardiopulmonary bypass, and abrasion of the plaques during thoracic endovascular repair. Both patients recovered without embolic complications.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study.
Intensive Care Med2020 Feb;():. doi: 10.1007/s00134-020-05926-6.
Lunz Dirk, Calabrò Lorenzo, Belliato Mirko, Contri Enrico, Broman Lars Mikael, Scandroglio Anna Maria, Patricio Daniel, Malfertheiner Maximilian, Creteur Jacques, Philipp Alois, Taccone Fabio Silvio, Pappalardo Federico,
Abstract
PURPOSE:
The aim of this study was to assess the neurologic outcome following extracorporeal cardiopulmonary resuscitation (ECPR) in five European centers.
METHODS:
Retrospective database analysis of prospective observational cohorts of patients undergoing ECPR (January 2012-December 2016) was performed. The primary outcome was 3-month favorable neurologic outcome (FO), defined as the cerebral performance categories of 1-2. Survival to ICU discharge and the number of patients undergoing organ donation were secondary outcomes. A subgroup of patients with stringent selection criteria (i.e., age???65 years, witnessed bystander CPR, no major co-morbidity and ECMO implemented within 1 h from arrest) was also analyzed.
RESULTS:
A total of 423 patients treated with ECPR were included (median age 57 [48-65] years; male gender 78%); ECPR was initiated for OHCA in 258 (61%) patients. Time from arrest to ECMO implementation was 65 [48-84] min. Eighty patients (19%) had favorable neurological outcome. ICU survival was 24% (n?=?102); 23 (5%) non-survivors underwent organ donation procedures. Favorable neurological outcome rate was lower (9% vs. 34%, p?
CONCLUSIONS:
ECPR was associated with intact neurological recovery in 19% of unselected cardiac arrest victims, with 38% favorable outcome if stringent selection criteria would have been applied.
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Epidemiological Features and Clinical Presentations of Acute Coronary Syndrome in Young Patients.
Intern Med2020 Feb;():. doi: 10.2169/internalmedicine.4138-19.
Sawada Hiroaki, Ando Hirohiko, Takashima Hiroaki, Waseda Katsuhisa, Shimoda Masahiro, Ohashi Hirofumi, Suzuki Akihiro, Sakurai Shinichiro, Nakano Yusuke, Amano Tetsuya,
Abstract
Objective Although acute coronary syndrome (ACS) is an uncommon entity in young patients, it constitutes an important problem due to the devastating effects of the disease on the more active lifestyle of young patients. At present, there are no guidelines regarding the prevention of ACS in young patients. Methods We performed a retrospective study of ACS patients between 2014 and 2017. Epidemiological data, clinical findings, and short-term outcomes were evaluated between young ACS patients (?50 years old) and elderly ACS patients (>50 years old). Results Of a total of 361 consecutive ACS patients, 37 were young ACS patients (10.2%). Compared with elderly ACS patients, young ACS patients showed a higher prevalence of males (94.6% vs. 73.8%, p<0.001), current smoking (70.3% vs. 29.9%; p<0.001), and overweight persons (67.6% vs. 27.8%, p<0.001). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio was significantly lower in young ACS patients than in elderly ACS patients (0.17 [0.12-0.25] vs. 0.25 [0.18-0.37], p=0.002). The prevalence of cardio-pulmonary arrest and percutaneous cardiopulmonary support use was higher in young ACS patients than in elderly ACS patients (24.3% vs. 8.6%, p=0.003, 16.2% vs. 3.1%, p<0.001). Conclusion The features were markedly different between young ACS patients and elderly ACS patients. In young ACS patients, smoking, being overweight, and a low EPA/AA ratio were distinctive risk factors, and more serious clinical presentations were observed at the onset of ACS than in older patients.
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Transbronchial lung cryobiopsy in the diagnosis of interstitial lung disease.
Tuberk Toraks2019 Dec;67(4):300-306. doi: 10.5578/tt.69078.
Keenan Joseph, Backer Elliot, Gibson Heidi, Cho Roy, Dinçer H Erhan,
Abstract
Transbronchial cryoprobe lung biopsy (TBCLB) have recently been introduced as a safe diagnostic tool in the diagnosis of interstitial lung diseases. While we do not enough evidence its role and place as a diagnostic procedure, the technique has been adopted by many centers. In spite of expanding body of literature, there are variations in patient selection and procedural aspect of the procedure. It has been established as a safe procedure if safety measures are practiced. Diagnosis of interstitial lung diseases continuous to be challenging. Surgical lung biopsy considered as gold standard but its morbidity and mortality limit its utilization in every case. Multidisciplinary medical decision is a validated team work effort when approaching patients with interstitial lung disease.
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[Guidance to the Interpretation of Cardiopulmonary Exercise Testing].
Pneumologie2020 Feb;74(2):88-102. doi: 10.1055/a-1069-0611.
Glaab T, Schmidt O, Fritsch J,
Abstract
Cardiorespiratory fitness has been established as an independent overall predictor of morbidity and mortality. However, patients' symptoms or stated levels of exercise intolerance correlate only poorly with resting functional and imaging tests. Cardiopulmonary exercise testing (CPET) is the gold standard for the integrative assessment of the cardiocirculatory, pulmonary and metabolic response to exercise and can help identify the source of exercise limitation, monitor disease progression, evaluate treatment responsiveness and inform about prognosis. Though CPET offers more valuable and pertinent information with slightly more expenditure of time compared to other methods even at submaximal exercise levels, it remains underutilized for various reasons such as costs, reimbursement and expertise. CPET can be seen as a complex, but not necessarily difficult tool. The objective of this review was to provide a description of the underlying principles of physiology, and an easy-to-follow guidance to indications, methodology, and interpretative strategies of CPET.
© Georg Thieme Verlag KG Stuttgart · New York.
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Pulmonary hypertension in children with Down syndrome.
Pediatr Pulmonol2020 Feb;():. doi: 10.1002/ppul.24687.
Bush Douglas, Galambos Csaba, Dunbar Ivy David,
Abstract
Individuals with Down syndrome (DS) have an increased risk of developing pulmonary hypertension (PH). In this review, we explore the epidemiology and clinical characteristics of PH in the population with DS and examine genetic, molecular and clinical contributions to the condition. The presence of an additional copy of chromosome 21 (trisomy 21) increases the risk of developing PH in children with DS through many mechanisms, including increased hemodynamic stress in those with congenital heart disease, hypoxemia through impaired ventilation to perfusion matching secondary to developmental lung abnormalities, pulmonary hypoplasia from pulmonary vascular endothelial dysfunction, and an increase in pulmonary vascular resistance often related to pulmonary comorbidities. We review recent studies looking at novel biomarkers that may help diagnose, predict or monitor PH in the population with DS and examine current cardiopulmonary guidelines for monitoring children with DS. Finally, we review therapeutic interventions specific to PH in individuals with DS. Contemporary work has identified exciting mechanistic pathways including the upregulation of antiangiogenic factors and interferon activity, which may lead to additional biomarkers or therapeutic opportunities. Throughout the manuscript, we identify gaps in our knowledge of the condition as it relates to the population with DS and offer suggestions for future clinical, translational, and basic science research.
© 2020 Wiley Periodicals, Inc.
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Deficiency of Interleukin-36 Receptor Protected Cardiomyocytes from Ischemia-Reperfusion Injury in Cardiopulmonary Bypass.
Med Sci Monit2020 Feb;26():e918933. doi: 10.12659/MSM.918933.
Luo Cheng, Xie Xiaoyong, Feng Xu, Lei Binfeng, Fang Chen, Li Yugui, Cai Xiongwei, Ling Guoxing, Zheng Baoshi,
Abstract
BACKGROUND Interleukin-36 has been demonstrated to be involved in inflammatory responses. Inflammatory responses due to ischemia-reperfusion injury following cardiopulmonary bypass (CPB) can cause heart dysfunction or damage. MATERIAL AND METHODS The CPB models were constructed in IL-36R-/-, IL-36RN-/-, and wild-type SD rats. Ultrasonic cardiography and ELISA were used to evaluate the cardiac function and measuring myocardial biomarker levels in different groups. TUNEL assay was used to evaluate apoptosis. Western blot assays and RT-PCR were performed to measure the expression of chemokines and secondary inflammatory cytokines in the heart. Oxidative stress in tissue and cultured cells was assessed using a DCFH-DA fluorescence probe and quantification of superoxide dismutase activity. RESULTS Improved systolic function and decreased serum levels of myocardial damage biomarkers were found in IL-36R-/- rats compared to WT rats, while worse cardiac function and cardiomyocyte IR injury were observed in IL-36RN-/- rats compared to WT rats. TUNEL staining and Western blot analyses found that cardiomyocyte apoptosis and inflammation were significantly lower in the hearts of IL-36R-/- rats compared with that of WT rats. Oxidative stress was significantly lower in IL-36R-/- rats compared to WT rats. iNOS expression was significantly reduced, while eNOS expression was increased in the hearts of IL-36R-/- rats. Silencing of IL-36R expression in vitro activated SIRT1/FOXO1/p53 signaling in cardiomyocytes. CONCLUSIONS IL-36R deficiency in cardiomyocytes repressed infiltration of bone marrow-derived inflammatory cells and oxidative stress dependent on SIRT1-FOXO1 signaling, thus protecting cardiomyocytes and improving cardiac function in CPB model rats.
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