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Pubblicazioni recenti - cardiac surgery
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The effect of idiopathic premature ventricular complexes on left ventricular ejection fraction.
Ann Noninvasive Electrocardiol2019 Sep;():e12702. doi: 10.1111/anec.12702.
Alt?nta? Bernas, Özkalayc? Flora, Çinier Göksel, Kaya ?lyas, Aktan Adem, Küp Ayhan, Onuk Ra?it, Özcan Sevgi, Uslu Abdulkadir, Akyüz Abdurrahman, At?c? Adem, Ekinci Selim, Ak?n Halil, Y?lmaz Mehmet Fatih, Koç ?ahbender, Tan?k Veysel Ozan, Harbal?o?lu Hazar, Barman Hasan Ali, Af?in Abdülmecit, Gümü?da? Ayça, Aliba?iç Hayrudin, Karaba? Yavuz, Cap Murat, Baysal Erkan, Tanbo?a ?brahim Halil,
Abstract
AIM:
Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF).
METHOD:
This multicenter, cross-sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination.
RESULT:
Overall, the median age was 50 (38-60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%-17.4%). Median LVEF was found 60% (55-65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) -0.644 and 95% CI -1.063, -0.225, p < .001), PVC QRS duration (RE-0.191 and 95% CI -0.529, 0.148, p = .049), and age (RE-0.249 and 95% CI -0.442, -0.056, p = .018) were associated with decrease in LVEF. This inverse relationship between the PVC burden and LVEF become more prominent when PVC burden was above 5%. A nomogram developed to estimate the individual risk for decrease in LVEF.
CONCLUSION:
Our study showed that increase in PVC burden %, age, and PVC QRS duration were independently associated with decrease in LVEF in patients with idiopathic PVC. Also, inverse relationship between PVC burden and LVEF was observed in lower PVC burden than previously known.
© 2019 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals, Inc.
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Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience.
Gen Thorac Cardiovasc Surg2019 Sep;():. doi: 10.1007/s11748-019-01210-7.
Dogru Mustafa Vedat, Sezen Celal Bugra, Girgin Oguz, Cansever Levent, Kocaturk Celalettin Ibrahim, Metin Muzaffer, Dincer Seyyit Ibrahim,
Abstract
BACKGROUND:
The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications.
METHODS:
165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life.
RESULTS:
Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p?
CONCLUSION:
Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective.
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Ultrasound and interstitial lung disease: use and limitations.
Radiol Med2019 Sep;():. doi: 10.1007/s11547-019-01084-y.
Frongillo Elisabettamaria, Gaudioso Giulia, Feragalli Beatrice,
Abstract
The Connective Tissue Diseases (CTDs)-related Interstitial Lung Disease (ILD) early diagnosis by Transthoracic Ultrasound (TUS) still arises several issues. Gutierrez et al. clearly underlined the current role of ultrasound artifacts for ILD definition according to some Authors. In this Letter to the Editor, we would like to highlight the proper role of TUS and its pitfalls.
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Elevated Cardiac Troponin in Clinical Scenarios Beyond Obstructive Coronary Artery Disease.
Med Sci Monit2019 Sep;25():7115-7125. doi: 10.12659/MSM.915830.
Sternberg Michael, Pasini Evasio, Chen-Scarabelli Carol, Corsetti Giovannii, Patel Hemang, Linardi Daniele, Onorati Francesco, Faggian Giuseppe, Scarabelli Tiziano, Saravolatz Louis,
Abstract
In this systematic review article, we aim to summarize the most up-to-date evidence regarding elevations of cardiac troponin, especially in clinical scenarios other than obstructive coronary artery disease. The accurate interpretation of raised cardiac troponin is challenging because it relies on unconfirmed postulations and dogmatic knowledge (e.g., the exclusive provenience of cardiac troponin from cardiac myocytes), based on which every troponin elevation is assumed to definitely indicate myocardial damage. Indeed, the investigation of the pathophysiologic mechanism leading to the release in the bloodstream of cardiac biomarkers should be the first step of the diagnostic process to fully understand the clinical significance of the elevated serum levels and identify the best management. A prominent effort should be put in place to identify the contribution of potential confounding factors, both cardiac and non-cardiac in etiology, with the ability to affect synthesis and clearance of cardiac biomarkers. Regardless of the underlying cause, it is well established that cardiovascular biomarkers are increasingly useful to further risk stratification and prognosticate patients. Accordingly, we sought to clarify the meaning and impact of elevated cardiac troponin in those frequently encountered real-world scenarios presenting clinicians with a diagnostic dilemma, with the final goal of facilitating the diagnosis and help optimize individually tailored treatment strategies.
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Spread of hyperplastic pulmonary neuroendocrine cells into air spaces (S.H.I.P.M.E.N.T.S): A proof for artifact.
Lung Cancer2019 Sep;137():43-47. doi: S0169-5002(19)30639-7.
Pelosi Giuseppe, Nesa Francesco, Taietti Davide, Servillo Sascia Pietro, Papanikolaou Nikolaos, Zompatori Maurizio, Meroni Alberto, Harari Sergio, Incarbone Matteo,
Abstract
OBJECTIVES:
Spread through air spaces (STAS) is a recently proposed invasion way of lung cancer, including neuroendocrine (NE) neoplasms. However, if this phenomenon is a real one or an artifact while manipulating lung specimens, it is still matter of debate.
MATERIAL AND METHODS:
Three consecutive patients with newly diagnosed diffuse idiopathic pulmonary NE cell hyperplasia (DIPNECH) were reviewed for STAS.
RESULTS:
In well-fixed lung specimens, DIPNECH was seen to coexist with atypical carcinoid, bifocal typical carcinoid and adenocarcinoma in the three patients, respectively. While STAS was not observed at the growing edges of tumors, a few freely-floating aggregates of hyperplastic NE cells within air spaces were noticed to emanate from foci of NE hyperplasia and tumorlets and in intimate association with normal bronchiolar cells and erythrocytes to denote artifactual derivation upon tissue manipulation.
CONCLUSIONS:
Traveling of hyperplastic NE cells through air spaces is likely to artifactually occur via knife, surgeon or other way, thus challenging invasion by STAS.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Circulating Endometrial Cells in Women with Spontaneous Pneumothorax.
Chest2019 Sep;():. doi: S0012-3692(19)33873-5.
Kiss Imrich, Pospisilova Eliska, Kolostova Katarina, Maly Vilem, Stanek Ivan, Lischke Robert, Schutzner Jan, Pawlak Ireneusz, Bobek Vladimir,
Abstract
BACKGROUND:
The occurrence of catamenial pneumothorax (CP) is rare and the awareness of this diagnosis among clinicians is insufficient. CP is highly correlated with pelvic endometriosis and remains the most common form of thoracic endometriosis syndrome. Circulating Endometrial Cells (CECs) were previously detected in patients with pelvic endometriosis. Could CECs bring new insights into pneumothorax management?
METHODS:
The presented study aims to describe the occurrence and molecular characteristics of CECs in women with spontaneous pneumothorax (SP) (n= 20) with high suspicion of its catamenial character. CECs were enriched from peripheral blood by size-based separation (MetaCell®). In addition to cytomorphology, gene expression profiling of captured cells was performed for 24 endometriosis associated genes.
RESULTS:
CECs were present in all 20 patients with SP. Enriched CECs exhibited four character features: epithelial, stem -cell like, stroma-like, and glandular. However, not all of them were present in every sampling. Gene expression profiling revealed two distinct phenotypes of CECs in SP/CP, whereby one of them refers to the diaphragm openings syndrome and the second to the endometrial tissue pleural implantations. Comparisons of the gene expression profiles of CECs in pneumothorax (CECs-SP) with CECs in pelvic endometriosis (CECs-non-SP) have revealed significantly higher expression of HER2 in CECs-SP compared to CECs-non-SP.
CONCLUSION:
This proof of concept study demonstrates successful isolation and characterization of CECs in patients with SP. Identification of CECs in SP could alert endometriosis involvement and help early referral to gynecologic consultation for further examination and treatment.
Copyright © 2019. Published by Elsevier Inc.
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Early Readmission to Hospital in Cancer Patients with Malignant Pleural Effusions: Analysis of the Nationwide Readmissions Database.
Chest2019 Sep;():. doi: S0012-3692(19)33872-3.
Mitchell Michael A, Dhaliwal Inderdeep, Mulpuru Sunita, Amjadi Kayvan, Chee Alex,
Abstract
BACKGROUND:
Hospital readmissions are costly to healthcare systems and represent a measure of quality care. Cancer patients with malignant pleural effusions (MPE) are at high risk for rehospitalization, yet risk factors for readmissions in this population are not well described. Understanding the incidence and risk factors for readmission could facilitate the development of a readmission reduction strategy in this patient population.
METHODS:
We conducted a retrospective cohort study using the Nationwide Readmissions Database (NRD) (2014 sample) to determine the proportion of all-cause, unplanned, 30-day readmissions to hospital among patients with MPE. Survey weighting methods that accounted for the NRD sampling design were used to generate nationally representative estimates. We used multivariable logistic regression to determine predictors of early readmission.
RESULTS:
There were 27,900 unplanned readmissions after 108,824 index hospitalizations for MPE, a rate of 25.6% (95% CI, 25.0% - 26.3%). The mortality rate during readmission to hospital was 17.3% (n = 4840; 95% CI, 16.6% - 18.1%)). Mean cost per readmission was $15,452 USD (SD ± $415) with total aggregate costs of greater than $400 million USD. Predictors of early readmission included having Medicaid insurance status, treatment with thoracentesis only, and discharge to a care-facility or home healthcare.
CONCLUSIONS:
One in 4 patients with cancer and MPE are readmitted to hospital within 30-days of discharge, and nearly one in five died during the readmission. Non-definitive management with thoracentesis led to more readmissions. A further understanding of factors that drive preventable readmissions could significantly improve quality of care in this population.
Copyright © 2019. Published by Elsevier Inc.
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Feasibility and Challenges of Microsurgical Resection of Colloid Cysts in Patients with Pre-Existing Ventriculoperitoneal Shunts.
World Neurosurg2019 Sep;():. doi: S1878-8750(19)32494-5.
Majmundar Neil, Ward Max, Liu James K,
Abstract
INTRODUCTION:
Colloid cysts are the most common third ventricular tumor and may present with symptoms related to obstructive hydrocephalus. Though definitive endoscopic or microsurgical resection is the standard of care, patients may receive temporizing ventriculoperitoneal shunts when definitive management is deferred. Subsequent definitive treatment can be challenging due to the ventricular collapse and narrowing of the operative corridor. There is currently no literature evaluating the feasibility of definitive colloid cyst resection in patients with pre-existing ventriculoperitoneal shunts.
METHODS:
We retrospectively reviewed records for patients undergoing colloid cyst resection between 2009 and 2019 to identify patients with pre-existing shunts prior to surgery.
RESULTS:
Three patients had pre-existing ventriculoperitoneal shunts. Two patients had been shunted at outside institutions where microsurgical or endoscopic resection was not available. One patient received a shunt from an outside surgeon when she was deemed a poor surgical candidate due to cardiac instability. All three patients underwent successful gross total colloid cyst resection via the transcallosal approach without recurrences during a mean follow-up of 4.2 years. All patients had intact cognitive and memory function and returned to work.
CONCLUSION:
Surgical resection of colloid cysts is possible despite a pre-existing ventriculoperitoneal shunt. As the ventricular space may be collapsed postoperatively due to CSF diversion, a transcortical route (either endoscopic or microscopic) can be complicated by a small operative corridor with reduced visibility. The transcallosal approach was safe and feasible in these cases for providing midline access with adequate visualization for complete resection despite ventricular collapse.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Prognostic effect of troponin elevation in patients undergoing carotid endarterectomy with regional anesthesia - A prospective study.
Int J Surg2019 Sep;():. doi: S1743-9191(19)30246-8.
Pereira-Macedo Juliana, Rocha-Neves João P, Dias-Neto Marina F, Andrade José Paulo V,
Abstract
BACKGROUND:
Myocardial injury after noncardiac surgery (MINS) occurs in 15% of patients undergoing carotid endarterectomy (CEA) with general anesthesia. Short and long-term risk of myocardial infarction (MI) and stroke have been strongly associated with the presence of MINS, with an associated mortality rate superior to 10% in the first year. Due to the absence of studies concerning CEA with regional anesthesia (RA), the present study aimed to evaluate the incidence of MINS in patients with RA and its prognostic value on cardiovascular events or death.
MATERIALS AND METHODS:
From January 2009 to January 2018, 156 patients from a Portuguese tertiary care medical center who underwent CEA under RA were retrieved from a prospectively gathered database. Troponin I or high-sensitive troponin I values were systematically measured in the postoperative period and studied as a binary outcome in a logistic regression model. Survival analysis was used to study the impact of MINS in time-dependent clinical outcomes such as stroke and MI.
RESULTS:
The incidence of MINS after CEA was 15.3%. Multivariate analysis confirmed that chronic heart failure was strongly associated with MINS (OR: 4.458, 95% CI: 1,689 - 11.708, P < 0.001). A previously diagnosed MINS was associated with the long-term risk of MI and major adverse cardiovascular events (MACE) with hazard ratios (HR) of 3.318 (95% CI: 0.97-13.928, Breslow: P = 0.025) and 1.955 (95% CI: 1.01 - 4.132, Breslow: P = 0.046), respectively.
CONCLUSIONS:
MINS is a long-term predictor of MI and MACE. Troponin assessment after CEA should be routinely monitored in patients with a cardiovascular risk superior to 5%. Further studies concerning prophylaxis and management of MINS should be carried on, focusing on the effect of anesthetic procedure in postoperative troponin elevation.
Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
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Evaluation of tricuspid valve repair without annuloplasty ring in Intravenous drug abusers.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31406-7.
Al Jawad Mohammed Abd, Ammar Ayman, Nahas Yasser, Ahmed Ahmed, Kilany Ibrahim, El Kerdany Ahmed,
Abstract
BACKGROUND:
Tricuspid valve endocarditis among intravenous drug abusers is increasing in prevalence in modern societies. The increased risk of reinfection in such patients makes surgical reintervention a risky decision. Repair is preferred over replacement to minimize the presence of foreign material in a potentially infected field.
METHODS:
A retrospective, observational, comparative, non-randomized study included all living patients presenting with isolated tricuspid valve endocarditis due to IV drug abuse who had undergone tricuspid valve intervention in the form of repair or replacement. Two hundred twenty-three patients were operated on between January 2014 and January 2016; 128 patients underwent tricuspid valve replacement (replacement group n = 128), and 95 patients underwent tricuspid valve repair (repair group n = 95).
RESULTS:
Before hospital discharge, 87 patients of the repair group had mild TR, and eight patients had moderate TR by TTE. The six-month follow-up showed that 86 patients still had mild TR, seven patients had moderate TR, and only one patient progressed to severe TR. After one year, 84 patients still had mild TR, six patients had moderate TR, and four patients had severe TR. At the two-year follow-up, 78 patients still had mild TR, 11patients had moderate TR, and only five had severe TR.
CONCLUSIONS:
Valve repair can be considered a proper surgical plan in isolated endocarditis among IV drug abusers with results comparable to a replacement, ensuring the minimal use of foreign material in such patients.
Copyright © 2019. Published by Elsevier Inc.
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Acupuncture and trigger point injection in the management of poststernotomy pain syndrome: A case series study.
Explore (NY)2019 Aug;():. doi: S1550-8307(19)30452-5.
Allam Hemat,
Abstract
BACKGROUND:
Poststernotomy pain syndrome (PSPS) is defined as chronic pain after thoracic surgery persisting for at least 2 months and without apparent cause. The incidence of PSPS after surgery is reported to be between 7% and 66%. Currently, there is no standard protocol for management of such cases, and treatment modalities are mainly directed towards the use of various analgesics. Numerous other approaches have been tried in order to relieve this pain, including osteopathy, trigger point infiltration and acupuncture.
METHODS:
A case series study was conducted; data were collected from 20 patients seeking pain relief for poststernotomy pain, at the Outpatient Pain Clinic, National Research Center, Cairo, Egypt. Treatment consisted of local wound infiltration with lidocaine 1% and acupuncture. Each patient was scheduled for twice weekly sessions over a period of 4 weeks. Pain was measured using visual analogue scales (VAS) pre and post each treatment session.
RESULTS:
Out of the 20 patients, 15 participants completed all 8 sessions. They reported improvement in their chest wall pain, compared to their initial presenting state. There was a significant decrease in pain score from initial VAS to first measurement (p?=?0.001), between 3 and 4 (p?=?0.014), 4 and 5 (p?=?0.013), 5 and 6 (p?=?0.014) and between 6 and 7 measurement (p?=?0.008).
CONCLUSION:
The dual approach of acupuncture and trigger point injection for PSPS patients offer a promising means of pain relief. Controlled studies with larger numbers of patients are required.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Apical Periodontitis Is Associated with Elevated Concentrations of Inflammatory Mediators in Peripheral Blood: A Systematic Review and Meta-analysis.
J Endod2019 Sep;():. doi: S0099-2399(19)30583-7.
Georgiou Athina Christina, Crielaard Wim, Armenis Iakovos, de Vries Ralph, van der Waal Suzette V,
Abstract
INTRODUCTION:
Apical periodontitis (AP), except for the local known consequences, may also be a systemic burden. Circulating inflammatory mediators that are released to sustain the AP lesion can in theory harm other bodily tissues. The aim of this systematic review was to summarize the existing evidence on the influence of AP on the peripheral blood levels of inflammatory mediators and markers of systemic stress.
METHODS:
A search of MEDLINE-PubMed, Embase, and Cochrane was conducted up to and including February 2019 to identify studies in 5 different languages. The Newcastle-Ottawa Scale was used for quality assessment of the included studies.
RESULTS:
Twelve of the 20 included studies were case-control studies, and 8 were intervention studies. The data of all the included studies were analyzed descriptively, whereas the data of 11 studies were available for meta-analyses. The study designs were heterogeneous. Nevertheless, the meta-analyses revealed statistically significant differences in C-reactive protein, interleukin 6, and asymmetric dimethylarginine levels between AP subjects and controls in peripheral blood. In addition, the concentration of C3 complement fragment in peripheral blood was significantly lower after the treatment and resolution of AP than before.
CONCLUSIONS:
The existing literature indicates that AP adds on to systemic inflammation by elevating C-reactive protein, interleukin 6, asymmetric dimethylarginine, and C3 levels. In order to overcome the issue of large variation between study designs, future studies should have clear inclusion criteria, preferably larger cohorts, adequate follow-up of all subjects, and a thorough presentation of the data to enable further exploration of the possible burden of AP on general human health. Nevertheless, there is now stronger evidence that AP contributes to low-grade systemic inflammation.
Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
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"Cheese Wire" Fenestration of Dissection Intimal Flap to Facilitate Thoracic Endovascular Aortic Repair in Chronic Dissection.
J Vasc Interv Radiol2019 Sep;():. doi: S1051-0443(19)30549-4.
Iwakoshi Shinichi, Watkins Claire A, Ogawa Yukihisa, Fischbein Michael, Lee Anson, Lee Jason T, Hiesinger William, Dake Michael D,
Abstract
Thoracic endovascular aortic repair (TEVAR) for aneurysmal chronic dissection is often complicated by retrograde filling of the false lumen and dissected distal landing zone. A "cheese wire"-style fenestration of the dissection intimal flap can create a landing zone facilitating TEVAR. This technique successfully aided TEVAR in 3 patients with an average age of 57.3 years. Complications included type III endoleak requiring relining and renal artery occlusion requiring stent placement. Average duration of clinical follow-up was 19 ± 4 months. Imaging follow-up was 8 ± 10 months. All patients have survived for more than 1 year without aneurysm enlargement.
Copyright © 2019 SIR. All rights reserved.
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STYK1/NOK correlates with ferroptosis in non-small cell lung carcinoma.
Biochem Biophys Res Commun2019 Sep;():. doi: S0006-291X(19)31753-X.
Lai Yuanyang, Zhang Zhipei, Li Jianzhong, Li Weimiao, Huang Zhao, Zhang Chenxi, Li Xiaofei, Zhao Jinbo,
Abstract
Serine Threonine Tyrosine Kinase 1 (STYK1) presents oncogenic properties in many studies, and emerging evidence suggests that ferroptosis serve as a novel tumor suppressor. However, the interplay between STYK1 and ferroptosis in NSCLC remains unclear. Our aim is to illustrate the expression of ferroptotic regulator Glutathione peroxidase 4 (GPX4) in NSCLC and the relationship between STYK1 and ferroptosis. Herein, results based on ONCOMINE database, clinical specimens, and cellular manipulation revealed GPX4 was upregulated in NSCLC tissues and cell lines, and high GPX4 expression predicted worse prognosis. High STYK1 expression predicted worse OS and was related to high GPX4 in NSCLC tissues; overexpression of STYK1 in lung cancer cell line SW900 upregulated the expression of GPX4, promoted proliferation, and attenuated diverse mitochondrial abnormalities specific to ferroptosis, whereas knockdown of GPX4 exacerbated such attenuations without affecting cell proliferation. Taken together, ferroptosis as an anti-tumor factor is inhibited in NSCLC, and targeting ferroptosis could be a novel therapeutic strategy for the management of NSCLC; furthermore, regulating ferroptosis could be another cancerous mechanism of STYK1.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Critical Structural Defects Explain Filamin A Mutations Causing Mitral Valve Dysplasia.
Biophys J2019 Aug;():. doi: S0006-3495(19)30749-0.
Haataja Tatu J K, Capoulade Romain, Lecointe Simon, Hellman Maarit, Merot Jean, Permi Perttu, Pentikäinen Ulla,
Abstract
Mitral valve diseases affect ?3% of the population and are the most common reasons for valvular surgery because no drug-based treatments exist. Inheritable genetic mutations have now been established as the cause of mitral valve insufficiency, and four different missense mutations in the filamin A gene (FLNA) have been found in patients suffering from nonsyndromic mitral valve dysplasia (MVD). The filamin A (FLNA) protein is expressed, in particular, in endocardial endothelia during fetal valve morphogenesis and is key in cardiac development. The FLNA-MVD-causing mutations are clustered in the N-terminal region of FLNA. How the mutations in FLNA modify its structure and function has mostly remained elusive. In this study, using NMR spectroscopy and interaction assays, we investigated FLNA-MVD-causing V711D and H743P mutations. Our results clearly indicated that both mutations almost completely destroyed the folding of the FLNA5 domain, where the mutation is located, and also affect the folding of the neighboring FLNA4 domain. The structure of the neighboring FLNA6 domain was not affected by the mutations. These mutations also completely abolish FLNA's interactions with protein tyrosine phosphatase nonreceptor type 12, which has been suggested to contribute to the pathogenesis of FLNA-MVD. Taken together, our results provide an essential structural and molecular framework for understanding the molecular bases of FLNA-MVD, which is crucial for the development of new therapies to replace surgery.
Copyright © 2019 Biophysical Society. Published by Elsevier Inc. All rights reserved.
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Commentary: Keep the head cool. Keep the spine cooler.
J Thorac Cardiovasc Surg -
Reply: Dissecting the wrapping issue.
J Thorac Cardiovasc Surg -
Propranolol protects cerebral autoregulation and reduces hippocampal neuronal cell death through inhibition of interleukin-6 upregulation after traumatic brain injury in pigs.
Br J Anaesth2019 Sep;():. doi: S0007-0912(19)30581-1.
Armstead William M, Vavilala Monica S,
Abstract
BACKGROUND:
Traumatic brain injury (TBI) is associated with reduced cerebral blood flow and impaired autoregulation after TBI, which may lead to poor outcome. Clinical evidence has implicated neurological injuries and associated neuroinflammation as causes of cardiac dysfunction. Studies on newborn pigs show an association of elevated catecholamines with a sex-dependent impairment of cerebral autoregulation after TBI. One strategy to decrease sympathetic hyperactivity is pharmacological intervention with beta blockade. We tested the hypothesis that propranolol would prevent the impairment of cerebral autoregulation and tissue changes after TBI via inhibition of interleukin-6 (IL-6) upregulation.
METHODS:
Using newborn pigs of both sexes equipped with a closed cranial window, TBI was induced via lateral fluid percussion injury. Propranolol was administered at 1 h post-TBI. Analyses included cerebral autoregulation (pial artery reactivity) before and 4 h post-TBI, CSF IL-6 analysed (enzyme-linked immunosorbent assay), and histopathology at 4 h post-TBI.
RESULTS:
Propranolol administration prevented impairment of hypotensive dilation in both male and female newborn pigs after fluid percussion injury, which was paralleled by reduced upregulation of IL-6 in the CSF. Moreover, propranolol prevented neuronal cell death in cornu amonis (CA)1 and CA3 hippocampus equivalently in male and female pigs after TBI. Papaverine-induced dilation was unchanged by TBI and propranolol.
CONCLUSIONS:
These data indicate that sympathetic hyperactivity noted after TBI can be limited by propranolol administration to result in improved brain outcome post-injury via block of IL-6 upregulation, and this effect is irrespective of sex.
Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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An In-hospital Mortality Risk Model for Patients Undergoing Coronary Artery Bypass Grafting in China.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31404-3.
Hu Zhan, Chen Sipeng, Du Junzhe, Gu Dachuan, Wang Yun, Hu Shengshou, Zheng Zhe,
Abstract
BACKGROUND:
To meet the demand of increasing surgical volume and changing of patient's risk profiles of coronary artery bypass grafting in China, we develop a new risk model that predicts in-hospital mortality.
METHODS:
The analysis included patients who underwent coronary artery bypass grafting between January 2013 and December 2016 at 87 hospitals in the Chinese Cardiac Surgery Registry. Patients in years 2013-2015 were randomly divided into training (n=31297, 75%) and test (n=10432, 25%) samples; 2016 patients (n=15047) comprised the validation sample. Demographic and clinical risk factors were identified . Harrell's C-statistic was used to evaluate model discrimination, and the Hosmer-Lemeshow goodness-of-fit test was used to assess calibration.
RESULTS:
The 56776 patients had a mean age of 61.8 (standard deviation 8.8) years, and 24.6% were female. Overall, in-hospital mortality was 2.1%. The final model included 21 risk factors represented by 16 unique variables. The model achieved good discrimination, with a C-statistic of 0.79 (95% CI 0.77-0.80) in the training sample, 0.79 (95% CI 0.76-0.82) in the test sample, and0.78 (95% CI 0.76-0.81) in the validation sample. Model calibration was good according to the Hosmer-Lemeshow test (P>0.05 in the three samples). When compared with the SinoSCORE and EuroSCORE II, the model had better discrimination and calibration.
CONCLUSIONS:
We developed and evaluated a model with 16 risk factors that predicted in-hospital mortality risk after coronary artery bypass grafting in China. This updated model may help surgeons and hospitals better identify high-risk patient.
Copyright © 2019. Published by Elsevier Inc.
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Utilising Benchmarking Standards to Evaluate Transition to Minimally Invasive Esophagectomy.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31403-1.
Carroll Paul A, Jacob Nithin, Yeung Jonathan C, Darling Gail E,
Abstract
BACKGROUND:
Minimally Invasive Esophagectomy (MIE) is performed in nearly 50% of cases worldwide. The effectiveness of the technique arises from a single randomised control trial and multiple single series cohorts. Consistent reporting of complications is varied. We describe our experience of transitioning to MIE compared to Open Esophagectomy (OE) using ECCG standardised complication benchmark definitions.
METHODS:
Between 2007-2017, all patients undergoing esophagectomy were identified using a prospectively curated database. Complications were defined by the Esophageal Complications Consensus Group (ECCG) and graded using the Clavien-Dindo(CD-most severe complication) and Comprehensive Complication Index (CCI-complexity of complications during hospital stay).
RESULTS:
Of 383 patients, 299 (76%) were male with a median age of 64.5 (56-72). MIE was performed in 49.6%. There were no differences in age, histology (p=0.222), pT Stage (p=0.136) or nodal positivity (p=0.918). Stage 3 cancers accounted for 42.0% of OE and 47.9% of MIE. A thoracic anastomosis was more frequently in MIE (156/190,82.1%) compared to OE (113/193,58.5%), p=0.001. Frequency, severity(CD) and complexity(CCI) of complications were better in the MIE group, without compromising operative outcomes. No differences were identified in individual complication groupings or grade in MIE compared to OE: Pneumonia 19.5% vs 26.9%,( p=0.09); ICU readmission 7.4% vs 9.3%,( p=0.519); Atrial Fibrillation 11.1% vs 6.7%,( p=0.082) or grade of leak, ( p=0.99).
CONCLUSIONS:
These results compare favourably to those reported by ECCG. Minimally Invasive esophagectomy can be the standard approach for surgical management of esophageal cancer. Introduction of the approach in each surgeon's practice should be benchmarked to international standards.
Copyright © 2019. Published by Elsevier Inc.
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