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Pubblicazioni recenti - pediatric cardiac
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Dysregulation of Hyaluronan Homeostasis During White Matter Injury.
Neurochem Res2019 Sep;():. doi: 10.1007/s11064-019-02879-1.
Srivastava Taasin, Sherman Larry S, Back Stephen A,
Abstract
Although the extra cellular matrix (ECM) comprises a major proportion of the CNS parenchyma, new roles for the ECM in regeneration and repair responses to CNS injury have only recently been appreciated. The ECM undergoes extensive remodeling following injury to the developing or mature CNS in disorders that -include perinatal hypoxic-ischemic cerebral injury, multiple sclerosis and age-related vascular dementia. Here we focus on recently described mechanisms involving hyaluronan (HA), which negatively impact myelin repair after cerebral white matter injury. Injury induced depolymerization of hyaluronan (HA)-a component of the neural ECM-can inhibit myelin repair through the actions of specific sizes of HA fragments. These bioactive fragments selectively block the maturation of late oligodendrocyte progenitors via an immune tolerance-like pathway that suppresses pro-myelination signaling. We highlight emerging new pathophysiological roles of the neural ECM, particularly of those played by HA fragments (HAf) after injury and discuss strategies to promoter repair and regeneration of chronic myelination failure.
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Comprehensive Assessment of Changes in Left Ventricular Diastolic Function With Contemporary Breast Cancer Therapy.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30729-6.
Upshaw Jenica N, Finkelman Brian, Hubbard Rebecca A, Smith Amanda M, Narayan Hari K, Arndt Linzi, Domchek Susan, DeMichele Angela, Fox Kevin, Shah Payal, Clark Amy, Bradbury Angela, Matro Jennifer, Adusumalli Srinath, Carver Joseph R, Ky Bonnie,
Abstract
OBJECTIVES:
This study determined the effects of doxorubicin and/or trastuzumab on diastolic function and the relationship between diastolic function and systolic dysfunction.
BACKGROUND:
Doxorubicin and trastuzumab can result in left ventricular ejection fraction (LVEF) declines. However, the effects of these therapies on diastolic function remain incompletely defined.
METHODS:
In a rigorously phenotyped, longitudinal cohort study of 362 breast cancer participants treated with doxorubicin, doxorubicin followed by trastuzumab, or trastuzumb alone, changes in diastolic function were evaluated using linear models estimated via generalized estimating equations. Associations between baseline and changes in diastolic function with LVEF and longitudinal strain were also determined using generalized estimating equations. The Kaplan-Meier estimator derived the proportion of participants who experienced incident diastolic dysfunction. Cox proportional hazards models estimated the associations between participant characteristics and diastolic dysfunction risk, and between diastolic function and cancer therapy-related cardiac dysfunction risk, defined by an LVEF decline of ?10% to <50%.
RESULTS:
Over a median of 2.1 years (interquartile range [IQR]: 1.3 to 4.2 years), participants treated with doxorubicin or doxorubicin followed by trastuzumab demonstrated a persistent worsening in diastolic function, with reductions in the E/A ratio, lateral and septal e' velocities, and increases in E/e' (p < 0.01). These changes were not observed with trastuzumab alone. Incident abnormal diastolic function grade occurred in 60% at 1 year, 70% by 2 years, and 80% by 3 years. Abnormal diastolic function grade was associated with a subsequent decrease in LVEF (-2.1%; 95% confidence intervals [CI]: -3.1 to -1.2; p < 0.001) and worsening in longitudinal strain (0.6%; 95% CI: 0.1 to 1.1; p = 0.013) over time. Changes in E/e' ratio were modestly associated with worsening longitudinal strain (0.1%; 95% CI: 0.0 to 0.2; p = 0.022).
CONCLUSIONS:
A modest, persistent worsening of diastolic function is observed with contemporary breast cancer therapy. Abnormal and worsening diastolic dysfunction is associated with a small risk of subsequent systolic dysfunction. (Cardiotoxicity of Cancer Therapy [CCT]; NCT01173341).
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Neonatal Supraventricular Tachycardia.
Indian Pacing Electrophysiol J2019 Sep;():. doi: S0972-6292(19)30115-9.
Srinivasan Chandra, Balaji Seshadri,
Abstract
Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergency cardiac care in neonates. Atrioventricular reentrant tachycardia utilizing an atrioventricular bypass tract is the most common form of SVT presenting in the neonatal period. There is high likelihood for spontaneous resolution for most of the common arrhythmia substrates in infancy. Pharmacological agents remain as the primary therapy for neonates.
Copyright © 2019 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.
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Role of 3D transesophageal echocardiography in transcatheter closure of atrial septal aneurysms.
Echocardiography2019 Sep;():. doi: 10.1111/echo.14482.
Taha Fatma, Elshedoudy Sahar,
Abstract
BACKGROUND:
Three dimensional transesophageal echocardiography (3DTEE) is superior to two dimensional transesophageal echocardiography (2DTEE) as it provides all atrial septal information from a single view.
AIM:
To evaluate 3DTEE role in analysis of atrial septal aneurysm (ASA) and in device closure guiding.
METHODS:
Three dimensional transesophageal echocardiography were recorded with Vivid*E9,GE system over 14 months. ASAs were classified into 4 types (A: with PFO, B: with one ASD, C: with 2 ASDs, and D: with multiple fenestrations). Each aneurysm was assessed according to its type, shape, dimensions, orientation, aneurysmal tissue, and the surrounding rims. All patients passed to transcatheter aneurysm closure.
RESULTS:
A total of 26 patients with ASAs were assessed (7 imperforated aneurysms excluded). The remaining 19 patients' age was 12.84 ± 5.82years. Four patients had type A aneurysms, 6 had type B, 4 had type C, and 5 had type D. 3DTEE demonstrated oval aneurysms in 17 patients. The orientation was oblique in 8 patients, vertical in 7, and horizontal in 4. The ASAs dimensions were 23.5 ± 5.1, 23.2 ± 5.1, and 22.0 ± 4.0 mm for oblique, vertical, and horizontal axes. Percutaneous closure succeeded in 18 patients. Balloon sizing was used in 4 patients. Devices used were: In type A:PFO devices, in type B:ASO devices, in type C:two patients required two ASO devices in each patient and two patients required one cribriform device, and in type D:Cribriform devices used for three patients, PFO for one and ASO for one. LA, LUPV, and RUPV approaches were used. Aspirin was received for 6 months.
CONCLUSION:
Three dimensional transesophageal echocardiography helps to select aneurysms suitable for transcatheter closure, select the suitable devices, and guide the transcatheter procedure.
© 2019 Wiley Periodicals, Inc.
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T Cell-Specific Adaptor Protein Regulates Mitochondrial Function and CD4 T Regulatory Cell Activity In Vivo following Transplantation.
J Immunol2019 Sep;():. doi: ji1801604.
Wedel Johannes, Stack Maria P, Seto Tatsuichiro, Sheehan Matthew M, Flynn Evelyn A, Stillman Isaac E, Kong Sek Won, Liu Kaifeng, Briscoe David M,
Abstract
The T cell-specific adaptor protein (TSAd), encoded by the gene, is an intracellular molecule that binds Lck to elicit signals that result in cytokine production in CD4 T effector cells (Teff). Nevertheless, using Sh2d2a knockout (KO; also called TSAd) mice, we find that alloimmune CD4 Teff responses are fully competent in vivo. Furthermore, and contrary to expectations, we find that allograft rejection is accelerated in KO recipients of MHC class II-mismatched B6.C-H-2 heart transplants versus wild-type (WT) recipients. Also, KO recipients of fully MHC-mismatched cardiac allografts are resistant to the graft-prolonging effects of costimulatory blockade. Using adoptive transfer models, we find that KO T regulatory cells (Tregs) are less efficient in suppressing Teff function and they produce IFN-? following mitogenic activation. In addition, pyrosequencing demonstrated higher levels of methylation of CpG regions within the Treg-specific demethylated region of KO versus WT Tregs, suggesting that TSAd, in part, promotes Treg stability. By Western blot, Lck is absent in the mitochondria of KO Tregs, and reactive oxygen species production by mitochondria is reduced in KO versus WT Tregs. Full transcriptomic analysis demonstrated that the key mechanism of TSAd function in Tregs relates to its effects on cellular activation rather than intrinsic effects on mitochondria/metabolism. Nevertheless, KO Tregs compensate for a lack of activation by increasing the number of mitochondria per cell. Thus, TSAd serves as a critical cell-intrinsic molecule in CD4Foxp3 Tregs to regulate the translocation of Lck to mitochondria, cellular activation responses, and the development of immunoregulation following solid organ transplantation.
Copyright © 2019 by The American Association of Immunologists, Inc.
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Cerebral Oxygenation During Respiratory Events in Children with Sleep-Disordered Breathing and Associated Disorders.
J Pediatr2019 Sep;():. doi: S0022-3476(19)30892-3.
Tabone Laurence, Khirani Sonia, Olmo Arroyo Jorge, Amaddeo Alessandro, Sabil Abdelkebir, Fauroux Brigitte,
Abstract
OBJECTIVES:
To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders.
STUDY DESIGN:
Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age.
RESULTS:
There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those <7 years old. TOI decreases correlated significantly with SpO decreases, duration of event, and age, regardless of the type of event. In a multivariable regression model, predictive factors of TOI decreases were the type of respiratory event, SpO decrease, apnea-hypopnea index, and age.
CONCLUSIONS:
In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Pediatric Hemoptysis without Bronchiectasis or Cardiac Disease: Etiology, Recurrence, and Mortality.
J Pediatr2019 Sep;():. doi: S0022-3476(19)30957-6.
Chiel Laura, Welsh Sebastian, Andren Kristofer, Mecklosky Jessica, Alexander Peta M A, Casey Alicia, Fishman Martha P,
Abstract
OBJECTIVES:
To describe the etiologies of hemoptysis in patients without pre-existing bronchiectasis or cardiac disease; to assess odds of recurrent hemoptysis by diagnostic category; and to assess odds of mortality by diagnostic category.
STUDY DESIGN:
This retrospective case series included all patients with hemoptysis documented during an admission to Boston Children's Hospital from January 1, 2007 to June 1, 2017. Patients with bronchiectasis, congenital heart disease, primary pulmonary hypertension, bleeding above the glottis, hemoptysis before 38 weeks of corrected gestational age, hematemesis, foreign body, and trauma were excluded. Patients were also characterized by coagulation status. Primary outcomes were recurrent hemoptysis and death. Univariate analysis was performed to determine ORs for recurrence and death per diagnostic category with infection as the reference category.
RESULTS:
In total, 257 patients met study criteria and were analyzed. The most common causes of hemoptysis were infection (n = 122), neoplasm (n = 58), and other diagnoses (n = 49). Of the patients with infection, recurrence was 28% and all-cause mortality was 12%. Neoplasm had lower odds of recurrence (OR 0.3, P = .012) but higher odds of mortality (OR 15.8, P < .001). Thrombocytopenia had lower odds of recurrence (OR 0.2, P = .005) but higher odds of mortality (OR 5.9, P < .001). Patients with a tracheostomy had higher odds of recurrence (OR 6.3, P < .001), but lower odds of death (OR 0.4, P = .042).
CONCLUSIONS:
This study confirms that infection is the most common cause of hemoptysis in patients without severe underlying pulmonary or cardiac disease. Hemoptysis associated with neoplasm and/or thrombocytopenia confers mortality risk. Tracheostomy confers risk of recurrence. Future prospective research on diagnoses associated with hemoptysis is warranted.
Copyright © 2019 Elsevier Inc. All rights reserved.
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FGF23-Mediated Activation of Local RAAS Promotes Cardiac Hypertrophy and Fibrosis.
Int J Mol Sci2019 Sep;20(18):. doi: E4634.
Böckmann Ineke, Lischka Jonas, Richter Beatrice, Deppe Jennifer, Rahn Anja, Fischer Dagmar-Christiane, Heineke Jörg, Haffner Dieter, Leifheit-Nestler Maren,
Abstract
Patients with chronic kidney disease (CKD) are prone to developing cardiac hypertrophy and fibrosis, which is associated with increased fibroblast growth factor 23 (FGF23) serum levels. Elevated circulating FGF23 was shown to induce left ventricular hypertrophy (LVH) via the calcineurin/NFAT pathway and contributed to cardiac fibrosis by stimulation of profibrotic factors. We hypothesized that FGF23 may also stimulate the local renin-angiotensin-aldosterone system (RAAS) in the heart, thereby further promoting the progression of FGF23-mediated cardiac pathologies. We evaluated LVH and fibrosis in association with cardiac FGF23 and activation of RAAS in heart tissue of 5/6 nephrectomized (5/6Nx) rats compared to sham-operated animals followed by in vitro studies with isolated neonatal rat ventricular myocytes and fibroblast (NRVM, NRCF), respectively. Uremic rats showed enhanced cardiomyocyte size and cardiac fibrosis compared with sham. The cardiac expression of and RAAS genes were increased in 5/6Nx rats and correlated with the degree of cardiac fibrosis. In NRVM and NRCF, FGF23 stimulated the expression of RAAS genes and induced indicating mineralocorticoid receptor activation. The FGF23-mediated hypertrophic growth of NRVM and induction of NFAT target genes were attenuated by cyclosporine A, losartan and spironolactone. In NRCF, FGF23 induced and , which were suppressed by losartan and spironolactone, only. Our data suggest that FGF23-mediated activation of local RAAS in the heart promotes cardiac hypertrophy and fibrosis.
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Prognostic Factors for Event-Free Survival in Pediatric Patients with Hepatoblastoma Based on the 2017 PRETEXT and CHIC-HS Systems.
Cancers (Basel)2019 Sep;11(9):. doi: E1387.
Yoon Hee Mang, Hwang Jisun, Kim Kyung Won, Namgoong Jung-Man, Kim Dae Yeon, Koh Kyung-Nam, Kim Hyery, Cho Young Ah,
Abstract
This study aimed to evaluate the prognostic value of variables used in the 2017 PRE-Treatment EXTent of tumor (PRETEXT) system and the Children's Hepatic tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system in pediatric patients with hepatoblastoma. A retrospective analysis of data from the pediatric hepatoblastoma registry of a tertiary referral center was conducted to evaluate the clinical and imaging variables (annotation factors) of the PRETEXT staging system. The primary outcome was event-free survival (EFS). Data from 84 patients (mean age: 2.9 ± 3.5 years) identified between 1998 and 2017 were included. Univariable Cox proportional hazards analysis revealed that PRETEXT annotation factors P (portal vein involvement), F (multifocality of tumor), and M (distant metastasis) showed a significant negative association with EFS. Multivariable Cox proportional hazard analysis showed that factor F was the strongest predictor (HR (hazard ratio), 2.908; 95% CI (confidence interval), 1.061-7.972; = 0.038), whereas factor M showed borderline significance (HR, 2.416; 95% CI, 0.918-6.354; = 0.074). The prediction model based on F and M (F + M) showed good performance to predict EFS (C-statistic, 0.734; 95% CI, 0.612-0.854). In conclusion, the PRETEXT annotation factor F was the strongest predictor of EFS, and the F + M model showed good performance to predict EFS in pediatric patients with hepatoblastoma.
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Glutathione Blood Concentrations: A Biomarker of Oxidative Damage Protection during Cardiopulmonary Bypass in Children.
Diagnostics (Basel)2019 Sep;9(3):. doi: E118.
Satriano Angela, Franchini Simone, Lapergola Giuseppe, Pluchinotta Francesca, Anastasia Luigi, Baryshnikova Ekaterina, Livolti Giovanni, Gazzolo Diego,
Abstract
BACKGROUND:
Pediatric open-heart surgery with cardiopulmonary bypass (CPB) still remains a risky interventional procedure at high mortality/morbidity. To date, there are no clinical, laboratory, and/or monitoring parameters providing useful information on perioperative stress. We therefore investigated whether blood concentrations of glutathione (GSH), a powerful endogenous antioxidant, changed in the perioperative period.
METHODS:
We conducted an observational study in 35 congenital heart disease (CHD) children in whom perioperative standard laboratory and monitoring parameters and GSH blood levels were assessed at five monitoring time points.
RESULTS:
GSH showed a pattern characterized by a progressive increase from pre-surgery up to 24 h after surgery, reaching its highest peak at the end of CPB. GSH measured at the end of CPB correlated with CPB duration, cross-clamping, arterial oxygen partial pressure, and with body core temperature.
CONCLUSIONS:
The increase in GSH levels in the perioperative period suggests a compensatory mechanism to oxidative damage during surgical procedure. Caution is needed in controlling different CPB phases, especially systemic reoxygenation in a population that is per se more prone to oxidative stress/damage. The findings may point the way to detecting the optimal temperature and oxygenation target by biomarker monitoring.
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Cannabidiol Interacts Significantly with Everolimus-Report of a Patient with Tuberous Sclerosis Complex.
Neuropediatrics2019 Sep;():. doi: 10.1055/s-0039-1695786.
Wiemer-Kruel Adelheid, Stiller Brigitte, Bast Thomas,
Abstract
A 6.5-year-old female patient with a TSC2 mutation had been given everolimus (EVE) for 3?years for pharmacoresistant focal epilepsy and for life-threatening, severe ventricular dysrhythmia. EVE had been started with daily dose of 0.15?mg/kg/day and was increased up to 0.6?mg/kg/day. Target blood trough levels of around 9?µg/L had been documented. Although EVE therapy revealed no effect on seizure activity, cardiac rhythm normalized completely. Thus, EVE was reduced to a dose of 0.3?mg/kg/day leading to stable blood trough levels of 4 to 5?µg/L. Due to refractory tonic seizures with a frequency of 1 to 4 per day, we initiated cannabidiol (CBD) treatment, raising it to a daily dose of 200?mg. After 6?weeks, the EVE blood trough levels rose to 12.0?µg/L. Although we halved the EVE dose, her EVE blood trough level continued increasing up to 16.0?µg/L.The CBD dose was increased to 500?mg/day (20.4?g/kg/day), but EEG parameters and seizures failed to respond. Serum concentrations of EVE were unstable under the co-medication with CBD. Depending on the CBD dose, they varied between 1.7 and 12.3?µg/L, while EVE was always administered at the same dose.Although never before reported, CBD and EVE appear to interact, due to the metabolic pathway through CYP 450 3A4. Although we detected no side effects in our patient, we strongly recommend drug monitoring using the combination of CBD with EVE to prevent harmful overdosing.
Georg Thieme Verlag KG Stuttgart · New York.
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The novel coronary artery disease risk gene JCAD/KIAA1462 promotes endothelial dysfunction and atherosclerosis.
Eur Heart J2019 Aug;40(29):2398-2408. doi: 10.1093/eurheartj/ehz303.
Xu Suowen, Xu Yanni, Liu Peng, Zhang Shuya, Liu Huan, Slavin Spencer, Kumar Sandeep, Koroleva Marina, Luo Jinque, Wu Xiaoqian, Rahman Arshad, Pelisek Jaroslav, Jo Hanjoong, Si Shuyi, Miller Clint L, Jin Zheng Gen,
Abstract
AIMS:
Recent genome-wide association studies (GWAS) have identified that the JCAD locus is associated with risk of coronary artery disease (CAD) and myocardial infarction (MI). However, the mechanisms whereby candidate gene JCAD confers disease risk remain unclear. We addressed whether and how JCAD affects the development of atherosclerosis, the common cause of CAD.
METHODS AND RESULTS:
By mining data in the Genotype-Tissue Expression (GTEx) database, we found that CAD-associated risk variants at the JCAD locus are linked to increased JCAD gene expression in human arteries, implicating JCAD as a candidate causal CAD gene. We therefore generated global and endothelial cell (EC) specific-JCAD knockout mice, and observed that JCAD deficiency attenuated high fat diet-induced atherosclerosis in ApoE-deficient mice. JCAD-deficiency in mice also improved endothelium-dependent relaxation. Genome-wide transcriptional profiling of JCAD-depleted human coronary artery ECs showed that JCAD depletion inhibited the activation of YAP/TAZ pathway, and the expression of downstream pro-atherogenic genes, including CTGF and Cyr61. As a result, JCAD-deficient ECs attracted fewer monocytes in response to lipopolysaccharide (LPS) stimulation. Moreover, JCAD expression in ECs was decreased under unidirectional laminar flow in vitro and in vivo. Proteomics studies suggest that JCAD regulates YAP/TAZ activation by interacting with actin-binding protein TRIOBP, thereby stabilizing stress fiber formation. Finally, we observed that endothelial JCAD expression was increased in mouse and human atherosclerotic plaques.
CONCLUSION:
The present study demonstrates that the GWAS-identified CAD risk gene JCAD promotes endothelial dysfunction and atherosclerosis, thus highlighting the possibility of new therapeutic strategies for CAD by targeting JCAD.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
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Cardiac MRI Evaluation of Neonatal Bronchopulmonary Dysplasia Associated Pulmonary Hypertension.
Am J Respir Crit Care Med2019 Sep;():. doi: 10.1164/rccm.201904-0826OC.
Critser Paul J, Higano Nara S, Tkach Jean A, Olson Emilia S, Spielberg David R, Kingma Paul S, Fleck Robert J, Lang Sean M, Moore Ryan A, Taylor Michael D, Woods Jason C,
Abstract
RATIONALE:
Patients with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) have increased morbidity and mortality. Noninvasive assessment relies on echocardiograms (echo), which is technically challenging in this population. Improved assessment could augment decisions regarding PH therapies.
OBJECTIVES:
We hypothesized that neonatal cardiac magnetic resonance imaging (MRI) will correlate with BPD severity and predict short term clinical outcomes, including need for PH therapies for infants with BPD.
METHODS:
52 infants (31 severe BPD, 9 moderate BPD, and 12 with either mild or no BPD) were imaged between 39 and 47 weeks post-menstrual age on a neonatal-sized, NICU-sited 1.5T MR scanner. MR left-ventricular eccentricity index (MR-EI), main pulmonary artery to aorta diameter (PA/AO) ratio, and pulmonary arterial blood flow (PBF) were determined. Echos obtained for clinical indications were reviewed. MRI and echo indices were compared to BPD severity and clinical outcomes including length of stay (LOS), duration of respiratory support, respiratory support at discharge, and PH therapy.
MEASUREMENTS AND MAIN RESULTS:
PA/AO increased with BPD severity. Increased PA/AO, MR-EI, and echo-EIs were associated with increased LOS and duration of respiratory support. No correlation was seen between PBF and BPD outcomes. Controlling for gestational age, birth weight, and BPD severity, MR-EI was associated with LOS and duration of respiratory support. Increased PA/AO and MR-EI were associated with PH therapy during hospitalization and at discharge.
CONCLUSIONS:
MRI can provide important image-based measures of cardiac morphology that relate to disease severity and clinical outcomes in neonates with BPD.
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The application of dexmedetomidine combined with dezocine in thoracoscopic radical resection of lung cancer and its effect on awakening quality of patients.
Eur Rev Med Pharmacol Sci2019 Sep;23(17):7694-7702. doi: 18893.
Zhou Z-G, Liu R, Tan H-L, Ji X-Y, Yi X-L, Song J-F,
Abstract
OBJECTIVE:
The paper aims to explore the application of dexmedetomidine combined with dezocine in thoracoscopic radical resection of lung cancer and its effect on the awakening quality.
PATIENTS AND METHODS:
122 patients undergoing thoracoscopic radical resection of lung cancer in The Affiliated Hospital of Qingdao University from April 2009 to January 2012 were selected as the subjects of the study. Among them, 68 patients were anesthetized with dexmedetomidine combined with dezocine as a study group, 54 patients with midazolam combined with fentanyl as a control group. The onset of anesthetic, operation time, awakening time, extubation time, and recovery time was compared. The mean arterial pressure (MAP), central venous pressure (CVP), and heart rate (HR) were compared before anesthesia (t0), at extubation (t1), 10 min after extubation (t2), and when patients left anesthesia recovery room (t3). The postoperative sedation score (Ramsay), modified the objective pain score (MOPS), and the pediatric anesthesia emergence delirium (PAED) score were compared at the time of the postoperative awakening (b1), 30 min after awakening (b2), 1 hour after awakening (b3), and 3 hours after awakening (b4).
RESULTS:
There was no significant difference in MAP, CVP, and HR between the study group and the control group at t0 (p > 0.05). The scores of PAED at b3 and b4 in the study group were lower than those in the control group (p < 0.05).
CONCLUSIONS:
The anesthesia effect of dexmedetomidine combined with dezocine in thoracoscopic radical resection of lung cancer is better and safer than other drugs, and it can produce good sedation and analgesic effect.
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Comment on hybrid stage I management in: Anesthesia for high-risk procedures in the catheterization laboratory, an educational review by Daaboul DG, DiNardo J, and Nasr V.
Paediatr Anaesth2019 Sep;29(9):973. doi: 10.1111/pan.13701.
Müller Matthias, Mann Valesco, Akintürk Hakan,
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Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome.
Yonsei Med J2019 Oct;60(10):960-968. doi: 10.3349/ymj.2019.60.10.960.
Kim Minji, Ahn Youngmin, Yoo Young, Kim Dong Kyu, Yang Hyeon Jong, Park Hae Sim, Lee Hyun Jong, Kim Mi Ae, Jeong Yi Yeong, Kim Bong Seong, Bae Woo Yong, Jang An Soo, Park Yang, Koh Young Il, Lee Jaechun, Lim Dae Hyun, Kim Jeong Hee, Lee Sang Min, Kim Yong Min, Jun Young Joon, Kim Hyo Yeol, Kim Yunsun, Choi Jeong Hee, ,
Abstract
PURPOSE:
Many studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis.
MATERIALS AND METHODS:
Data were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130).
RESULTS:
The most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25-10.23; =0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79-15.53; =0.003), timothy (OR, 11.8; 95% CI, 2.70-51.64; =0.001), or ragweed (OR, 3.18; 95% CI, 1.03-9.87; =0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15-1.37; <0.001) were related to the development of anaphylaxis in PFAS.
CONCLUSION:
The most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.
© Copyright: Yonsei University College of Medicine 2019.
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The importance of real-life research in respiratory medicine: manifesto of the Respiratory Effectiveness Group: Endorsed by the International Primary Care Respiratory Group and the World Allergy Organization.
Eur Respir J2019 Sep;54(3):. doi: 1901511.
Roche Nicolas, Anzueto Antonio, Bosnic Anticevich Sinthia, Kaplan Alan, Miravitlles Marc, Ryan Dermot, Soriano Joan B, Usmani Omar, Papadopoulos Nikolaos G, Canonica G Walter, ,
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HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans.
Heart2019 Sep;():. doi: heartjnl-2019-315346.
Buggey Jonathan, Yun Leo, Hung Chung-Lieh, Kityo Cissy, Mirembe Grace, Erem Geoffrey, Truong Tiffany, Ssinabulya Isaac, Tang W H Wilson, Hoit Brian D, McComsey Grace A, Longenecker Chris T,
Abstract
OBJECTIVES:
To examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered fat distribution and an elevated risk for heart failure. Whether altered quantity and radiodensity of fat surrounding the heart relates to cardiac dysfunction in this population is unknown.
METHODS:
One hundred HIV-positive Ugandans on antiretroviral therapy were compared with 100 age and sex-matched HIV-negative Ugandans; all were >45 years old with >1 cardiovascular disease risk factor. Subjects underwent ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging. Multivariable linear and logistic regression models were used to explore the association of PCF with echocardiographic outcomes.
RESULTS:
Median age was 55% and 62% were female. Compared with uninfected controls, PLHIV had lower body mass index (27 vs 30, p=0.02) and less diabetes (26% vs 45%, p=0.005). Median left ventricular (LV) ejection fraction was 67%. In models adjusted for traditional risk factors, HIV was associated with 10.3?g/m higher LV mass index (LVMI) (95%?CI 3.22 to 17.4; p=0.005), 0.87% worse LV global longitudinal strain (GLS) (95%?CI -1.66 to -0.07; p=0.03) and higher odds of diastolic dysfunction (OR 1.96; 95%?CI 0.95 to 4.06; p=0.07). In adjusted models, PCF volume was significantly associated with increased LVMI and worse LV GLS, while PCF radiodensity was associated with worse LV GLS (all p<0.05).
CONCLUSIONS:
In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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Rheumatic heart disease and socioeconomic development.
Lancet Glob Health2019 Oct;7(10):e1297-e1299. doi: S2214-109X(19)30369-9.
Nascimento Bruno R, Beaton Andrea Z,
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The Effect of Left Cardiac Sympathetic Denervation on Exercise in Patients With Long QT Syndrome.
JACC Clin Electrophysiol2019 Sep;5(9):1084-1090. doi: S2405-500X(19)30418-9.
Anderson Heather N, Bos J Martijn, Rohatgi Ram K, Ackerman Michael J,
Abstract
OBJECTIVES:
This study evaluated the effect of left cardiac sympathetic denervation (LCSD) on heart rate, cardiac contractility, and cardiopulmonary fitness in human subjects.
BACKGROUND:
The primary treatment for long QT syndrome (LQTS) is beta-blocker (BB) therapy, but some patients experience breakthrough cardiac events or intolerable side effects. LCSD provides a significant antifibrillatory, protective effect in LQTS. However, the effect of LCSD on cardiopulmonary fitness in humans has not been previously described.
METHODS:
A retrospective analysis of patients with LQTS and LCSD (2006 to 2017) who had both pre- and post-LCSD exercise stress tests (N = 55; 39 females; mean age at LCSD 22 ± 12 years; mean follow-up 5.1 ± 2.5 years; 36 patients with LQT1; 15 patients with LQT2). Forty patients (73%) were receiving BBs pre-LCSD.
RESULTS:
Mean peak heart rate before LCSD was 143 ± 23 beats/min, mean peak oxygen consumption (VO) was 32 ± 10 ml/kg/min, and mean peak respiratory exchange ratio was 1.14 ± 0.12. There was no difference in peak heart rate, peak VO, peak QTc, or respiratory exchange ratio pre- and post-LCSD. To evaluate the isolated effect of LCSD, the study performed a subset analysis of patients with LCSD monotherapy (n = 10) or no change in BB dose (n = 12). Patient-matched pre- and post-LCSD exercise testing showed no difference in heart rate, VO, or left ventricular function following LCSD.
CONCLUSIONS:
LCSD provides increased protection from an LQTS-triggered event without negatively affecting peak heart rate, cardiopulmonary fitness, or cardiac contractility, as assessed by both treadmill exercise stress testing and echocardiography.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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