SOSTIENICI
Pubblicazioni recenti - cardiopulmonary
-
Factors influencing prehospital physicians' decisions to initiate advanced resuscitation for asystolic out-of-hospital cardiac arrest patients.
Resuscitation2022 Jun;():. doi: S0300-9572(22)00580-9.
Gamberini Lorenzo, Alberto Mazzoli Carlo, Allegri Davide, Scquizzato Tommaso, Baroncini Simone, Guarnera Martina, Tartaglione Marco, Chiarini Valentina, Picoco Cosimo, Fiorenzo Semeraro Federico, Gordini Giovanni, Coniglio Carlo,
Abstract
BACKGROUND:
The decision to initiate or continue advanced life support (ALS) in out-of-hospital cardiac arrest (OHCA) could be difficult due to the lack of information and contextual elements, especially in non-shockable rhythms. This study aims to explore factors associated with clinicians' decision to initiate or continue ALS and the conditions associated with higher variability in asystolic patients.
METHODS:
This retrospective observational study enrolled 2653 asystolic patients on whom either ALS was attempted or not by the emergency medical services (EMS) physician. A multivariable logistic regression analysis was performed to find the factors associated with the decision to access ALS. A subgroup analysis was performed on patients with a predicted probability of ALS between 35% and 65%. The single physicians' behaviour was compared to that predicted by the model taking into account the entire agency.
RESULTS:
Age, location of event, bystander CPR and EMS-witnessed event were independent factors influencing physicians' choices about ALS. Non-medical OHCA, younger patients, less experienced physicians, presence of breath activity at the emergency call and a longer time for ALS arrival were more frequent among cases with an expected higher variability in behaviours with ALS. Significant variability was detected between physicians.
CONCLUSIONS:
Significant inter-physician variability in access to ALS could be present within the same EMS, especially among less experienced physicians, non-medical OHCA and in presence of signs of life during emergency call. This arbitrariness has been observed and should be properly addressed by EMS team members as it raises ethical issues regarding the disparity in treatment.
Copyright © 2022. Published by Elsevier B.V.
Guarda su PubMed
-
Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC Randomized Clinical Trial.
JAMA2022 Jun;():. doi: 10.1001/jama.2022.9376.
Schlapbach Luregn J, Gibbons Kristen S, Horton Stephen B, Johnson Kerry, Long Debbie A, Buckley David H F, Erickson Simon, Festa Marino, d'Udekem Yves, Alphonso Nelson, Winlaw David S, Delzoppo Carmel, van Loon Kim, Jones Mark, Young Paul J, Butt Warwick, Schibler Andreas, ,
Abstract
Importance:
In children undergoing heart surgery, nitric oxide administered into the gas flow of the cardiopulmonary bypass oxygenator may reduce postoperative low cardiac output syndrome, leading to improved recovery and shorter duration of respiratory support. It remains uncertain whether nitric oxide administered into the cardiopulmonary bypass oxygenator improves ventilator-free days (days alive and free from mechanical ventilation).
Objective:
To determine the effect of nitric oxide applied into the cardiopulmonary bypass oxygenator vs standard care on ventilator-free days in children undergoing surgery for congenital heart disease.
Design, Setting, and Participants:
Double-blind, multicenter, randomized clinical trial in 6 pediatric cardiac surgical centers in Australia, New Zealand, and the Netherlands. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized between July 2017 and April 2021, with 28-day follow-up of the last participant completed on May 24, 2021.
Interventions:
Patients were assigned to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator (n?=?679) or standard care cardiopulmonary bypass without nitric oxide (n?=?685).
Main Outcomes and Measures:
The primary end point was the number of ventilator-free days from commencement of bypass until day 28. There were 4 secondary end points including a composite of low cardiac output syndrome, extracorporeal life support, or death; length of stay in the intensive care unit; length of stay in the hospital; and postoperative troponin levels.
Results:
Among 1371 patients who were randomized (mean [SD] age, 21.2 [23.5] weeks; 587 girls [42.8%]), 1364 (99.5%) completed the trial. The number of ventilator-free days did not differ significantly between the nitric oxide and standard care groups, with a median of 26.6 days (IQR, 24.4 to 27.4) vs 26.4 days (IQR, 24.0 to 27.2), respectively, for an absolute difference of -0.01 days (95% CI, -0.25 to 0.22; P?=?.92). A total of 22.5% of the nitric oxide group and 20.9% of the standard care group developed low cardiac output syndrome within 48 hours, needed extracorporeal support within 48 hours, or died by day 28, for an adjusted odds ratio of 1.12 (95% CI, 0.85 to 1.47). Other secondary outcomes were not significantly different between the groups.
Conclusions and Relevance:
In children younger than 2 years undergoing cardiopulmonary bypass surgery for congenital heart disease, the use of nitric oxide via cardiopulmonary bypass did not significantly affect the number of ventilator-free days. These findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery.
Trial Registration:
anzctr.org.au Identifier: ACTRN12617000821392.
Guarda su PubMed
-
Towards Exercise Radiomics: Deep Neural Network-Based Automatic Analysis of Thermal Images Captured During Exercise.
IEEE J Biomed Health Inform2022 Jun;PP():. doi: 10.1109/JBHI.2022.3186530.
Hillen Barlo, Lopez Daniel Andres, Schomer Elmar, Nagele Markus, Simon Perikles,
Abstract
Infrared thermography is increasingly applied in sports science due to promising observations regarding changes in skin's surface radiation temperature ( T) before, during, and after exercise. The common manual thermogram analysis limits an objective and reproducible measurement of T. Previous analysis approaches depend highly on expert knowledge and have not been applied during movement. We aimed to develop a deep neural network (DNN) capable of automatically and objectively segmenting body parts, recognizing blood vessel-associated T distributions, and continuously measuring T during exercise. We conducted 38 cardiopulmonary exercise tests on a treadmill. We developed two DNNs: body part network and vessel network, to perform semantic segmentation of 1 107 855 captured thermal images. Both DNNs were trained with 263 training and 75 validation images. Additionally, we compare the results of a common manual thermogram analysis with these of the DNNs. Performance analysis identified a mean IoU of 0.8 for body part network and 0.6 for vessel network. There is a high agreement between manual and automatic analysis (r = 0.999; p 0.001; T-test: p = 0.116), with a mean difference of 0.01 (0.08). Non-parametric Bland Altman's analysis showed that the 95% agreement ranges between -0.086 and 0.228 . The developed DNNs enable automatic, objective, and continuous measurement of T and recognition of blood vessel-associated T distributions in resting and moving legs. Hence, the DNNs surpass previous algorithms by eliminating manual region of interest selection and form the currently needed foundation to extensively investigate T distributions related to non-invasive diagnostics of (patho-)physiological traits in means of exercise radiomics.
Guarda su PubMed
-
Effect of wearing N95 mask on the quality of chest compressions in prehospital emergency personnel: a cross-over study.
Prehosp Emerg Care2022 Jun;():1-10. doi: 10.1080/10903127.2022.2095066.
Chen Liang, Shen Yang, Liu Shuangmei, Cao Yanyan, Zhu Zhe,
Abstract
OBJECTIVE:
To evaluate the effect of wearing an N95 mask on the quality of chest compression and fatigue of prehospital emergency personnel during cardiopulmonary resuscitation (CPR).
METHODS:
Twenty-four eligible participants were recruited. Participants' age, sex, height, and weight were recorded. After completing the CPR training and examination, participants were tested twice, wearing surgical mask or an N95 mask, while performing chest compressions for 2?minutes. The quality of chest compression (including compression frequency, depth, rebound, and position) was recorded by the simulator. Borg fatigue scores and physiological parameters (including heart rate, mean arterial pressure, pulse oxygen saturation, and respiratory rate) were recorded before and after chest compressions.
RESULTS:
Compared to wearing surgical masks, participants wearing N95 masks had significantly lower quality of chest compression, including compression frequency (98.3?±?4.9 bpm vs 104.0?±?6.0 bpm, P?0.001), depth (47.1?±?4.5?mm vs 50.5?±?5.4?mm, P?0.001), and rebound (90.2?±?2.7% vs 94.3?±?2.1%, P?0.001). The compression position was not affected. The period data showed that the difference in compression quality started after 1?minute of compressions. Participants wearing N95 masks had higher Borg fatigue scores [6.1(2) vs 5.1(2), P?0.001], heart rates (121.2?±?5.7 bpm vs 109.9?±?6.0 bpm, P?0.001), mean arterial pressures (106.3?±?8.0?mmHg vs 99.0?±?8.5?mmHg, P?=?0.012), and respiratory rates (29.5?±?2.7 bpm vs 24.7?±?2.5 bpm, P?0.001).
CONCLUSION:
This study showed that the use of an N95 mask by prehospital emergency personnel during the performance of chest compressions resulted in a reduction of compression quality and increased clinician fatigue. There is a need for CPR training for medical personnel wearing personal protective equipment.
Guarda su PubMed
-
Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children.
Interact Cardiovasc Thorac Surg2022 Jun;():. doi: ivac186.
Kulyabin Yuriy Y, Voitov Alexey V, Nichay Nataliya R, Soynov Ilya A, Zubritskiy Alexey V, Bogachev-Prokophiev Alexander V,
Abstract
OBJECTIVES:
The appropriate approach for surgical repair of coarctation of the aorta with ventricular septal defect remains controversial. This study evaluated the outcomes of primary repair of ventricular septal defects with perventricular device closure without cardiopulmonary bypass through left thoracotomy in patients without arch hypoplasia.
METHODS:
We selected 21 patients aged
RESULTS:
The median occluder size was 6 (range, 5-8) mm. The median mechanical ventilation time was 14 (range, 2-68) h, and the median duration of hospital stay was 11 (range, 7-16) days. No reoperations were required to correct ventricular septal defect shunting, and the median residual shunt size was 1 (range, 1-2) mm. The median follow-up period was 13 (range, 4-31) months. No late mortality was reported, and no haemodynamically significant pressure gradient at the anastomotic site was observed. The median distal aortic arch z-score was 0.39 (range, -0.1 to 0.9). Only one patient underwent permanent pacemaker implantation towards the end of the follow-up.
CONCLUSIONS:
PVDC can be used safely for closure of VSD in children with CoAo without a hypoplastic aortic arch even in neonates to reduce the risk of prolonged CPB. This hybrid approach can be performed with low incidence of rhythm disturbances and residual shunting. However, a meticulous assessment of the VSD anatomy is essential to avoid any unfavorable events.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
Guarda su PubMed
-
Evaluation of severe adverse events during rehabilitation for acute-phase patients: A retrospective cohort study.
Medicine (Baltimore)2022 Jun;101(25):e29516. doi: 10.1097/MD.0000000000029516.
Kinoshita Tokio, Kamijo Yoshi-Ichiro, Kouda Ken, Yasuoka Yoshinori, Nishimura Yukihide, Umemoto Yasunori, Ogawa Takahiro, Mikami Yukio, Kawanishi Makoto, Tajima Fumihiro,
Abstract
ABSTRACT:
Early mobilization decreases the likelihood of negative outcomes for acute-phase inpatients. Adverse events occurring during intensive care unit rehabilitation have previously been reported; however, no study has reported the incidence rates for adverse events during the acute rehabilitation phase. This study aimed to investigate the incidence of severe adverse events during acute-phase rehabilitation and evaluate them in detail.Reports of adverse events occurring during acute-phase rehabilitation in a university hospital from April 1, 2011 to March 31, 2018 were retrospectively assessed.Nine severe adverse events occurred during this period (incidence rate, 0.032%), comprising 2 cardiopulmonary arrests, 2 pulseless electrical activity events, 2 deterioration in consciousness events, 1 deterioration in consciousness event due to cerebral infarction, 1 fracture due to a fall, and 1 event involving removal of a ventricular drain. Pulmonary thromboembolism was implicated in 1 adverse event involving pulseless electrical activity and 1 deterioration in consciousness event. The causes for the 6 other adverse events could not be identified. The mean days from admission and the onset of rehabilitation to adverse event occurrence were 22.0?±?18.2 and 17.9?±?13.5?days (mean ± standard deviation), respectively. Four of 9 patients died, and 5 patients were discharged home or transferred to other stepdown facilities. When assessed retrospectively, there were no conflicts between patient conditions and the cancellation criteria of rehabilitation by the Japanese Association of Rehabilitation Medicine.The occurrences of severe adverse event may not be related to early mobilization (or onset time of rehabilitation) and compliance status of cancellation criteria.
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
Guarda su PubMed
-
Mesenchymal Stem Cell-derived Extracellular Vesicles Prevent Experimental Bronchopulmonary Dysplasia Complicated By Pulmonary Hypertension.
Stem Cells Transl Med2022 Jun;():. doi: szac041.
Sharma Mayank, Bellio Michael A, Benny Merline, Kulandavelu Shathiyah, Chen Pingping, Janjindamai Chawisa, Han Chenxu, Chang Liming, Sterling Shanique, Williams Kevin, Damianos Andreas, Batlahally Sunil, Kelly Kaitlyn, Aguilar-Caballero Daniela, Zambrano Ronald, Chen Shaoyi, Huang Jian, Wu Shu, Hare Joshua M, Schmidt Augusto, Khan Aisha, Young Karen,
Abstract
Mesenchymal stem cell (MSC) extracellular vesicles (EVs) have beneficial effects in preclinical bronchopulmonary dysplasia and pulmonary hypertension (BPD-PH) models. The optimal source, dosing, route, and duration of effects are however unknown. The objectives of this study were to (a) compare the efficacy of GMP-grade EVs obtained from Wharton's Jelly MSCs (WJ-MSCs) and bone marrow (BM-MSCs), (b) determine the optimal dosing and route of administration, (c) evaluate its long-term effects, and (d) determine how MSC EVs alter the lung transcriptome. Newborn rats exposed to normoxia or hyperoxia (85% O2) from postnatal day (P)1-P14 were given (a) intra-tracheal (IT) BM or WJ-MSC EVs or placebo, (b) varying doses of IT WJ-MSC EVs, or (c) IT or intravenous (IV) WJ-MSC EVs on P3. Rats were evaluated at P14 or 3 months. Early administration of IT BM-MSC or WJ-MSC EVs had similar beneficial effects on lung structure and PH in hyperoxia-exposed rats. WJ-MSC EVs however had superior effects on cardiac remodeling. Low, medium, and high dose WJ-MSC EVs had similar cardiopulmonary regenerative effects. IT and IV WJ-MSC EVs similarly improved vascular density and reduced PH in hyperoxic rats. Gene-set enrichment analysis of transcripts differentially expressed in WJ-MSC EV-treated rats showed that induced transcripts were associated with angiogenesis. Long-term studies demonstrated that a single early MSC EV dose has pulmonary vascular protective effects 3 months after administration. Together, our findings have significant translational implications as it provides critical insight into the optimal source, dosing, route, mechanisms of action, and duration of effects of MSC-EVs for BPD-PH.
© The Author(s) 2022. Published by Oxford University Press.
Guarda su PubMed
-
Ten Years of Data Verification: The European Congenital Heart Surgeons Association Congenital Database Audits.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):466-474. doi: 10.1177/21501351221103794.
Herbst Claudia, Tobota Zdzislaw, Urganci Erhan, Sarris George, Jacobs Jeffrey P, Kansy Andrzej, Maruszewski Bohdan,
Abstract
BACKGROUND:
Congenital heart surgery databases are tools for internal programmatic evaluation, benchmarking institutional results to multi-institutional aggregate data, and research. Therefore, it is essential to ensure the completeness and accuracy of data. This study analyzes the results of ten years of on-site source data verification of the European Congenital Heart Surgeons Association Congenital Heart Surgery Database (ECHSA CHSD).
METHODS:
All data forms verified between 2009 and 2018 were analyzed. The data form consists of 12 data elements: dates of birth, admission, surgery, discharge, and death; weight; case category; cardiopulmonary bypass time; aortic cross-clamp time; validation rules; diagnoses; and procedures. Descriptive data calculation and rates of completeness and accuracy were determined. The trend of error rate of seven centers with ?5 visits was analyzed.
RESULTS:
Sixty-nine on-site verification visits took place at 17 centers. A total of 26,245 cases were verified; 2,841 of these 26,245 cases (10.8%) showed an error. The total mean error rate of centers for all years was 12.3?±?2.1%. Rates of completeness and accuracy were 99% and 89.2%, respectively. Coded diagnoses and procedure analysis revealed that 716 (2.7%) and 456 (1.7%) datasets were incorrect, respectively. Rates of completeness and accuracy of dates were 100%, and 97.1%, respectively. Validation fields showed no errors.
CONCLUSION:
Source data verification is an appropriate tool to determine completeness and accuracy of data. The ECHSA CHSD verification analysis of a ten-year period showed a high level of completeness and accuracy. The verified data of the ECHSA CHSD are well-suited for benchmarking and research.
Guarda su PubMed
-
Surgical Treatment Following Stent Angioplasty for High-Risk Neonates With Critical Coarctation of the Aorta.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):426-435. doi: 10.1177/21501351221099933.
Grieshaber Philippe, Merbecks Moritz, Jaschinski Christoph, Fonseca Elizabeth, Arnold Raoul, Karck Matthias, Gorenflo Matthias, Loukanov Tsvetomir,
Abstract
BACKGROUND:
Neonatal coarctation of the aorta (CoA) is primarily treated by surgical repair. However, under certain high-risk constellations, initial stent angioplasty may be considered followed by surgical repair. We report our experience with this staged approach. All patients undergoing surgical CoA repair following prior stenting at our institution between January 2011 and December 2019 were included in this retrospective analysis. The patients were classified to be at high risk because of cardiogenic shock, associated complex cardiac malformations, neonatal infection, necrotizing enterocolitis, and extracardiac conditions, respectively. Outcomes were analyzed and compared with neonates who underwent surgical CoA repair without prior stenting in the same observation period.
RESULTS:
Twenty-six neonates received stent implantation at a median age of 20 days (IQR 9-33 days). Subsequent surgical repair was conducted at an age of 4.2 months (IQR 3.2-6.1 months) with a median body weight of 5.6?kg (IQR 4.5-6.5?kg). Cardiopulmonary bypass was applied in 96% of cases. Extended end-to-end anastomosis was possible in 11 patients. Extended reconstruction with patch material was necessary in the remaining patients. One fatality (3.8%) occurred 33 days postoperatively. At a median follow-up of 5.2 years after initial stenting, all remaining patients were alive; 15/25 patients (60%) were free from re-intervention. Of note, re-intervention rates were comparable in neonates (n?=?76) who were operated on with native CoA (28/74 patients; 38%; ?=?.67).
CONCLUSIONS:
Neonatal stent angioplasty for CoA results in increased complexity of the subsequent surgical repair. Nevertheless, this staged approach allows to bridge high-risk neonates to later surgical repair with reduced perioperative risk and acceptable midterm outcomes.
Guarda su PubMed
-
Prognostic implication of noninvasive right ventricle-to-pulmonary artery coupling in chronic thromboembolic pulmonary hypertension.
Ther Adv Chronic Dis2022 ;13():20406223221102803. doi: 10.1177/20406223221102803.
Duan Anqi, Li Xin, Jin Qi, Zhang Yi, Zhao Zhihui, Zhao Qing, Yan Lu, Huang Zhihua, Hu Meixi, Liu Jiaran, An Chenhong, Ma Xiuping, Xiong Changming, Luo Qin, Liu Zhihong,
Abstract
Aims:
Impairment of right ventricle-to-pulmonary artery coupling (RV-PA coupling) is a major determinant of poor prognosis in patients with pulmonary hypertension. This study sought to evaluate the ability of an echo-derived metric of RV-PA coupling, the ratio between tricuspid annular plane systolic excursion (TAPSE), and pulmonary artery systolic pressure (PASP) and to predict adverse clinical outcomes in chronic thromboembolic pulmonary hypertension (CTEPH).
Methods and results:
A total of 205 consecutive patients with confirmed CTEPH were retrospectively recruited from Fuwai Hospital between February 2016 and November 2020. Baseline echocardiography, right heart catheterization, and cardiopulmonary exercise testing were analyzed. Patients with lower TAPSE/PASP had a significantly compromised echocardiographic and hemodynamic status and exercise capacity at baseline. The TAPSE/PASP ratio correlated significantly with hemodynamic parameters, including pulmonary vascular resistance (?=?-0.48, ?0.001) and pulmonary arterial compliance (?=?0.45, ?0.001). During a median period of 1-year follow-up, 63 (30.7%) patients experienced clinical worsening. The relationship between TAPSE/PASP and clinical worsening was assessed using different multivariate Cox regression models. After adjustment for a series of previously screened independent predictors, TAPSE/PASP remained significantly associated with outcomes, and the hazard ratio (per standard deviation increase) of the final model was 0.402.
Conclusion:
In patients with CTEPH, baseline RV-PA coupling measured as the TAPSE/PASP ratio is associated with disease severity and adverse outcomes. A low TAPSE/PASP identifies patients with a high risk of clinical deterioration, and this novel metric could be applicable for risk stratification in CTEPH.
© The Author(s), 2022.
Guarda su PubMed
-
Comparison of Post-operative Outcomes Between Direct Axillary Artery Cannulation and Side-Graft Axillary Artery Cannulation in Cardiac Surgery: A Systematic Review and Meta-Analysis.
Front Cardiovasc Med2022 ;9():925709. doi: 10.3389/fcvm.2022.925709.
Xie Yi, Liu Yu, Yang Peng, Lu Chen, Hu Jia,
Abstract
Background:
There is a growing perception of using axillary artery cannulation to improve operative outcomes in cardiopulmonary bypass surgery. Two techniques, direct cannulation or side-graft cannulation, can be used for axillary artery cannulation, but which technique is better is controversial.
Methods:
A meta-analysis of comparative studies reporting operative outcomes using direct cannulation vs. side-graft cannulation was performed. We searched the PubMed, EMbase, Web of Science, and Cochrane Library. Outcomes of interest were neurological dysfunction, cannulation-related complications and early mortality. The fixed effects model was used.
Results:
A total of 1,543 patients were included in the final analysis. Direct cannulation was used in 846 patients, and side-graft cannulation was used in 697 patients. Meta-analysis showed a higher occurrence of neurological Complication in direct cannulation group [odds ratio, 1.45, 95% CI (1.00, 2.10), ? = 4.40, = 0.05] and a significantly higher incidence of cannulation-related complications in the direct cannulation group [odds ratio, 3.12, 95% CI (1.87, 5.18), ? = 2.54,
Conclusions:
This study suggests that side-graft axillary artery cannulation is a better strategy as it reduces the incidence of neurological dysfunction and cannulation-related complications.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022325456.
Copyright © 2022 Xie, Liu, Yang, Lu and Hu.
Guarda su PubMed
-
Prediction Nomogram for Postoperative 30-Day Mortality in Acute Type A Aortic Dissection Patients Receiving Total Aortic Arch Replacement With Frozen Elephant Trunk Technique.
Front Cardiovasc Med2022 ;9():905908. doi: 10.3389/fcvm.2022.905908.
Lin Hongyuan, Chang Yi, Guo Hongwei, Qian Xiangyang, Sun Xiaogang, Yu Cuntao,
Abstract
Objective:
To develop and validate a nomogram model to predict postoperative 30-day mortality in acute type A aortic dissection patients receiving total aortic arch replacement with frozen elephant trunk technique.
Method:
Clinical data on 1,156 consecutive acute type A aortic dissection patients who got total aortic arch replacement using the frozen elephant trunk technique was collected from January 2010 to December 2020. These patients were divided into training and testing cohorts at random with a ratio of 7:3. To predict postoperative 30-day mortality, a nomogram was established in the training set using the logistic regression model. The novel nomogram was then validated in the testing set. The nomogram's calibration and discrimination were evaluated. In addition, we created four machine learning prediction models in the training set. In terms of calibration and discrimination, the nomogram was compared to these machine learning models in testing set.
Results:
Left ventricular end-diastolic diameter 4 h were independent predictors of the 30-day mortality. The nomogram based on these 6 predictors manifested satisfying calibration and discrimination. In testing set, the nomogram outperformed the other 4 machine learning models.
Conclusion:
The novel nomogram is a simple and effective tool to predict 30-day mortality rate for acute type A aortic dissection patients undergoing total aortic arch replacement with frozen elephant trunk technique.
Copyright © 2022 Lin, Chang, Guo, Qian, Sun and Yu.
Guarda su PubMed
-
The kidney in hantavirus infection-epidemiology, virology, pathophysiology, clinical presentation, diagnosis and management.
Clin Kidney J2022 Jul;15(7):1231-1252. doi: 10.1093/ckj/sfac008.
Koehler Felix C, Di Cristanziano Veronica, Späth Martin R, Hoyer-Allo K Johanna R, Wanken Manuel, Müller Roman-Ulrich, Burst Volker,
Abstract
Hantavirus-induced diseases are emerging zoonoses with endemic appearances and frequent outbreaks in different parts of the world. In humans, hantaviral pathology is characterized by the disruption of the endothelial cell barrier followed by increased capillary permeability, thrombocytopenia due to platelet activation/depletion and an overactive immune response. Genetic vulnerability due to certain human leukocyte antigen haplotypes is associated with disease severity. Typically, two different hantavirus-caused clinical syndromes have been reported: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). The primarily affected vascular beds differ in these two entities: renal medullary capillaries in HFRS caused by Old World hantaviruses and pulmonary capillaries in HCPS caused by New World hantaviruses. Disease severity in HFRS ranges from mild, e.g. Puumala virus-associated nephropathia epidemica, to moderate, e.g. Hantaan or Dobrava virus infections. HCPS leads to a severe acute respiratory distress syndrome with high mortality rates. Due to novel insights into organ tropism, hantavirus-associated pathophysiology and overlapping clinical features, HFRS and HCPS are believed to be interconnected syndromes frequently involving the kidneys. As there are no specific antiviral treatments or vaccines approved in Europe or the USA, only preventive measures and public awareness may minimize the risk of hantavirus infection. Treatment remains primarily supportive and, depending on disease severity, more invasive measures (e.g., renal replacement therapy, mechanical ventilation and extracorporeal membrane oxygenation) are needed.
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.
Guarda su PubMed
-
Value of carbon-ion radiotherapy for early stage non-small cell lung cancer.
Clin Transl Radiat Oncol2022 Sep;36():16-23. doi: 10.1016/j.ctro.2022.06.005.
Ruan Hanguang, Xiong Juan,
Abstract
Carbon-ion radiotherapy (CIRT) is an important part of modern radiotherapy. Compared to conventional photon radiotherapy modalities, CIRT brings two major types of advantages to physical and biological aspects respectively. The physical advantages include a substantial dose delivery to the tumoral area and a minimization of dose damage to the surrounding tissue. The biological advantages include an increase in double-strand breaks (DSBs) in DNA structures, an upturn in oxygen enhancement ratio and an improvement of radiosensitivity compared with X-ray radiotherapy. The two advantages of CIRT are that the therapy not only inflicts major cytotoxic lesions on tumor cells, but it also protects the surrounding tissue. According to annual diagnoses, lung cancer is the second most common cancer worldwide, followed by breast cancer. However, lung cancer is the leading cause of cancer death. Patients with stage I non-small cell lung cancer (NSCLC) who are optimally received the treatment of lobectomy. Some patients with comorbidities or combined cardiopulmonary insufficiency have been shown to be unable to tolerate the treatment when combined with surgery. Consequentially, radiotherapy may be the best treatment option for this patient category. Multiple radiotherapy options are available for these cases, such as stereotactic body radiotherapy (SBRT), volumetric modulated arc therapy (VMAT), and intensity-modulated radiotherapy (IMRT). Although these treatments have brought some clinical benefits to some patients, the resulting adverse events (AEs), which include cardiotoxicity and radiation pneumonia, cannot be ignored. The damage and toxicity to normal tissue also limit the increase of tumor dose. Due to the significant physical and biological advantages brought by CIRT, some toxicity induced by radiotherapy may be avoided with CIRT Bragg Peak. CIRT brought clinical benefits to lung cancer patients, especially geriatric patients. This review introduced the clinical efficacy and research results for non-small cell lung cancer (NSCLC) with CIRT.
© 2022 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.
Guarda su PubMed
-
Functional Status, Mood State, and Physical Activity Among Women With Post-Acute COVID-19 Syndrome.
Int J Public Health2022 ;67():1604589. doi: 10.3389/ijph.2022.1604589.
Carter Stephen J, Baranauskas Marissa N, Raglin John S, Pescosolido Bernice A, Perry Brea L,
Abstract
While organ-specific pathophysiology has been well-described in SARS-CoV-2 infection, less is known about the attendant effects on functional status, mood state and leisure-time physical activity (PA) in post-acute COVID-19 syndrome (PASC). A case-control design was employed to recruit 32 women ( = 17 SARS-CoV-2; = 15 controls) matched on age (54 ± 12 years) and body mass index (27 ± 6 kg/m) that did not differ by smoking status or history of cardiopulmonary disease. Participants completed a series of assessments including Profile of Mood States (POMS), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), and Godin-Shephard Leisure-Time PA. Significant between-group differences were detected for the POMS total mood disturbance with sub-scale analyses revealing elevated tension, confusion, and lower vigor among SARS-CoV-2 participants (all -values
Copyright © 2022 Carter, Baranauskas, Raglin, Pescosolido and Perry.
Guarda su PubMed
-
Thrombolytic therapy in cardiac arrest caused by cardiac etiologies or presumed pulmonary embolism: An updated systematic review and meta-analysis.
Res Pract Thromb Haemost2022 May;6(4):e12745. doi: 10.1002/rth2.12745.
Alshaya Omar A, Alshaya Abdulrahman I, Badreldin Hisham A, Albalawi Sarah T, Alghonaim Sarah T, Al Yami Majed S,
Abstract
Background:
Many cardiac arrest cases are encountered annually worldwide, with poor survival. The use of systemic thrombolysis during cardiopulmonary resuscitation for the treatment of cardiac arrest remains controversial.
Objectives:
Evaluate the safety and efficacy of systemic thrombolysis in patients with cardiac arrest due to presumed or confirmed pulmonary embolism or cardiac etiology.
Methods:
We searched the PubMed and Cochrane databases from inception through April 2021 to identify relevant randomized controlled trials and observational studies. The primary efficacy and safety outcomes were survival to hospital discharge and reported bleeding, respectively. Sensitivity analysis was performed on the basis of study design and etiology of cardiac arrest.
Results:
Eleven studies were included, with 4696 patients (1178 patients received systemic thrombolysis, and 3518 patients received traditional therapy). There was a higher rate of survival to hospital discharge in patients who received systemic thrombolysis versus no systemic thrombolysis (risk ratio [RR], 1.35; 95% confidence interval [CI], 0.95-1.91). There were also higher rates of survival at 24 hours (RR, 1.24; 95% CI, 0.97-1.59) and hospital admission (RR, 1.53; 95% CI, 1.04-2.24), and return of spontaneous circulation (ROSC) (RR, 1.34; 95% CI, 1.05-1.71) with the use of systemic thrombolysis. Impacts on survival to discharge and survival at 24 hours were not statistically significant. Patients receiving systemic thrombolysis had a 65% increase in bleeding events compared with no systemic thrombolysis (RR, 1.65; 95% CI, 1.20-2.27).
Conclusion:
Systemic thrombolysis in cardiac arrest did not improve survival to hospital discharge and led to more bleeding events. However, it increased the rates of hospital admission and ROSC achievement.
© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
Guarda su PubMed
-
Autoregulation of Cerebral Blood Flow During 3-h Continuous Cardiopulmonary Resuscitation at 27°C.
Front Physiol2022 ;13():925292. doi: 10.3389/fphys.2022.925292.
Valkov Sergei, Nilsen Jan Harald, Mohyuddin Rizwan, Schanche Torstein, Kondratiev Timofei, Sieck Gary C, Tveita Torkjel,
Abstract
Victims of accidental hypothermia in hypothermic cardiac arrest (HCA) may survive with favorable neurologic outcome if early and continuous prehospital cardiopulmonary resuscitation (CPR) is started and continued during evacuation and transport. The efficacy of cerebral autoregulation during hypothermic CPR is largely unknown and is aim of the present experiment. Anesthetized pigs ( = 8) were surface cooled to HCA at 27°C before 3 h continuous CPR. Central hemodynamics, cerebral O delivery (DO) and uptake (VO), cerebral blood flow (CBF), and cerebral perfusion pressure (CPP) were determined before cooling, at 32°C and at 27°C, then at 15 min after the start of CPR, and hourly thereafter. To estimate cerebral autoregulation, the static autoregulatory index (sARI), and the CBF/VO ratio were determined. After the initial 15-min period of CPR at 27°C, cardiac output (CO) and mean arterial pressure (MAP) were reduced significantly when compared to corresponding values during spontaneous circulation at 27°C (-66.7% and -44.4%, respectively), and remained reduced during the subsequent 3-h period of CPR. During the first 2-h period of CPR at 27°C, blood flow in five different brain areas remained unchanged when compared to the level during spontaneous circulation at 27°C, but after 3 h of CPR blood flow in 2 of the 5 areas was significantly reduced. Cooling to 27°C reduced cerebral DO by 67.3% and VO by 84.4%. Cerebral VO was significantly reduced first after 3 h of CPR. Cerebral DO remained unaltered compared to corresponding levels measured during spontaneous circulation at 27°C. Cerebral autoregulation was preserved (sARI > 0.4), at least during the first 2 h of CPR. Interestingly, the CBF/VO ratio during spontaneous circulation at 27°C indicated the presence of an affluent cerebral DO, whereas after CPR, the CBF/VO ratio returned to the level of spontaneous circulation at 38°C. Despite a reduced CO, continuous CPR for 3 h at 27°C provided sufficient cerebral DO to maintain aerobic metabolism and to preserve cerebral autoregulation during the first 2-h period of CPR. This new information supports early start and continued CPR in accidental hypothermia patients during rescue and transportation for in hospital rewarming.
Copyright © 2022 Valkov, Nilsen, Mohyuddin, Schanche, Kondratiev, Sieck and Tveita.
Guarda su PubMed
-
A comparative study on the results of beating and arrested heart isolated tricuspid valve surgery: A cross-sectional study.
Health Sci Rep2022 Jul;5(4):e702. doi: 10.1002/hsr2.702.
Bigdelu Leila, Azari Ali, Mashayekhi Zarrin, Dadgarmoghaddam Maliheh, Baradaran Rahimi Vafa,
Abstract
Background and Aims:
The isolated tricuspid valve surgery is performed using beating or arrested heart surgery. The present study aimed to evaluate and compare the results of patients who underwent isolated tricuspid valve surgery using the beating and arrested heart techniques.
Methods:
In this retrospective observational study, all patients undergoing isolated tricuspid valve surgery between 2011 and 2018 were included. The patient's demographic information, echocardiographic, surgery, and hospitalization results were collected, and the EuroSCORE was calculated from the patient's medical records.
Results:
Fifty-three patients were included in the study of which 21 (39.63%) and 32 (60.37%) underwent a beating heart and arrested heart surgeries, respectively. There were no significant differences between the two studied groups in the echocardiographic results before and after the surgery, total hospitalization days (?=?0.56), and the mortality in the first 30 days after the surgery (?=?0.152). However, the duration of surgery (?0.001), EuroSCORE (?=?0.005), and patients who underwent lateral thoracotomy (?=?0.007) were notably lower in the arrested heart than in the beating heart group. In contrast, the duration of cardiopulmonary bypass and hospitalization in an intensive care unit after the surgery was remarkably lower in the beating heart than in the arrested heart group (?0.001 for both cases).
Conclusion:
Although there were some significant differences between the two kinds of surgery techniques, it seems superficial that made a particular decision to consider each method's superiority. Therefore, further studies with larger populations and meta-analyses are required to recommend the preferred method for the surgeons certainly.
© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.
Guarda su PubMed
-
Early Serum Metabolism Profile of Post-operative Delirium in Elderly Patients Following Cardiac Surgery With Cardiopulmonary Bypass.
Front Aging Neurosci2022 ;14():857902. doi: 10.3389/fnagi.2022.857902.
Huang He, Han Jingjing, Li Yan, Yang Yonglin, Shen Jian, Fu Qiang, Chen Yu,
Abstract
Background:
Cardiac surgery with cardiopulmonary bypass (CPB) is considered to be one of the surgical types with the highest incidence of post-operative delirium (POD). POD has been associated with a prolonged intensive care and hospital stay, long-term neurocognitive deterioration, and increased mortality. However, the specific pathogenesis of POD is still unclear. Untargeted metabolomics techniques can be used to understand the changes of serum metabolites in early POD to discover the relationship between serum metabolites and disease.
Materials and Methods:
The present study recruited 58 elderly patients undergoing cardiac surgery with CPB. Serum was collected within the first 24 h after surgery. The Confusion Assessment Method (CAM) and ICU-CAM assessments were used to identify patients who experienced POD. All patients with normal post-operative cognitive assessment were included in the non-POD groups. Moreover, we collected serum from 20 healthy adult volunteers. We performed untargeted analyses of post-operative serum metabolites in all surgical groups, as well as serum metabolites in healthy non-surgical adults by using liquid chromatography mass spectrometry (LC/MS) and analyzed metabolic profiles and related metabolites.
Results:
The probability of POD after cardiac surgery were 31%. There were statistically significant differences in post-operative mechanical ventilation time, ICU stay time and post-operative hospital stay between POD and non-POD group (
Conclusion:
Our findings suggest that lipid metabolism plays an important role in the serum metabolic profile of elderly patients with POD in the early post-operative period. Low serum lipid metabolic PI was associated with incidence of POD in elderly following cardiac bypass surgery, which may provide new insights into the pathogenesis of POD.
Copyright © 2022 Huang, Han, Li, Yang, Shen, Fu and Chen.
Guarda su PubMed
-
Changes to the European Resuscitation Council guidelines for adult resuscitation.
BJA Educ
