SOSTIENICI
Pubblicazioni recenti - pediatric cardiac
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Hepatectomy Versus Sorafenib in Advanced Non-Metastatic Hepatocellular Carcinoma: A Real-Life Multicentric Weighted Comparison.
Ann Surg2022 Jan;():. doi: 10.1097/SLA.0000000000005373.
Famularo Simone, Donadon Matteo, Cipriani Federica, Giuliante Felice, Ferri Silvia, Celsa Ciro, Ferrero Alessandro, Foschi Francesco Giuseppe, Baiocchi Gian Luca, Biasini Elisabetta, Campani Claudia, Valle Raffaele Dalla, Pellizzaro Filippo, Baroni Gianluca Svegliati, Raimondo Giovanni, Mega Andrea, Chiarelli Marco, Maestri Marcello, Gasbarrini Antonio, Jovine Elio, Grazi Gian Luca, Rapaccini Gian Ludovico, Ruzzenente Andrea, Morisco Filomena, Sacco Rodolfo, Memeo Riccardo, Crespi Michele, Antonucci Adelmo, Bernasconi Davide P, Romano Fabrizio, Griseri Guido, Aldrighetti Luca, Torzilli Guido, Trevisani Franco, ,
Abstract
OBJECTIVE:
The aim of the study was to compare surgery (SURG) vs sorafenib (SOR) regarding the overall survival (OS) and progression-free survival (PFS) in a real-world clinical scenario.
BACKGROUND DATA:
The treatment for advanced non-metastatic hepatocellular carcinoma (HCC) belonging to the Barcelona Clinic Liver Cancer stage C (BCLC?C) is still controversial.
METHODS:
BCLC C patients without extra-hepatic spread and tumoral invasion of the main portal trunk were considered. Surgical patients were obtained from the HE.RC.O.LE.S. Register, while sorafenib patients were obtained from the ITA.LI.CA register The inverse probability weighting (IPW) method was adopted to balance the confounders between the two groups.
RESULTS:
Between 2008 and 2019, 478 patients were enrolled: 303 in SURG and 175 in SOR group. ECOG-PS, presence of cirrhosis, steatosis, Child-Pugh grade, HBV and HCV, alcohol intake, collateral veins, bilobar disease, localization of the tumor thrombus, number of nodules, alpha-fetoprotein, age, and Charlson Comorbidity index were weighted by IPW to create two balanced pseudo-populations: SURG=374 and SOR=263. After IPW, 1-3-5?years OS was 83.6%, 68.1%, 55.9% for SURG, and 42.3%, 17.8%, 12.8% for SOR (p 0, and by the intra-hepatic location of portal vein invasion. At Cox regression, sorafenib treatment (HR 4.436; 95%CI 3.19-6.15; p
CONCLUSIONS:
In BCLC C patients without extra-hepatic spread but with intra-hepatic portal invasion, liver resection, if feasible, was followed by better OS and PFS compared with sorafenib.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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SARS-CoV-2 Omicron-B.1.1.529 leads to widespread escape from neutralizing antibody responses.
Cell2022 Jan;():. doi: S0092-8674(21)01578-6.
Dejnirattisai Wanwisa, Huo Jiandong, Zhou Daming, Zahradník Ji?í, Supasa Piyada, Liu Chang, Duyvesteyn Helen M E, Ginn Helen M, Mentzer Alexander J, Tuekprakhon Aekkachai, Nutalai Rungtiwa, Wang Beibei, Dijokaite Aiste, Khan Suman, Avinoam Ori, Bahar Mohammad, Skelly Donal, Adele Sandra, Johnson Sile Ann, Amini Ali, Ritter Thomas G, Mason Chris, Dold Christina, Pan Daniel, Assadi Sara, Bellass Adam, Omo-Dare Nicola, Koeckerling David, Flaxman Amy, Jenkin Daniel, Aley Parvinder K, Voysey Merryn, Costa Clemens Sue Ann, Naveca Felipe Gomes, Nascimento Valdinete, Nascimento Fernanda, Fernandes da Costa Cristiano, Resende Paola Cristina, Pauvolid-Correa Alex, Siqueira Marilda M, Baillie Vicky, Serafin Natali, Kwatra Gaurav, Da Silva Kelly, Madhi Shabir A, Nunes Marta C, Malik Tariq, Openshaw Peter J M, Baillie J Kenneth, Semple Malcolm G, Townsend Alain R, Huang Kuan-Ying A, Tan Tiong Kit, Carroll Miles W, Klenerman Paul, Barnes Eleanor, Dunachie Susanna J, Constantinides Bede, Webster Hermione, Crook Derrick, Pollard Andrew J, Lambe Teresa, , , Paterson Neil G, Williams Mark A, Hall David R, Fry Elizabeth E, Mongkolsapaya Juthathip, Ren Jingshan, Schreiber Gideon, Stuart David I, Screaton Gavin R,
Abstract
On 24 November 2021, the sequence of a new SARS-CoV-2 viral isolate Omicron-B.1.1.529 was announced, containing far more mutations in Spike (S) than previously reported variants. Neutralization titers of Omicron by sera from vaccinees and convalescent subjects infected with early pandemic Alpha, Beta, Gamma, or Delta are substantially reduced, or the sera failed to neutralize. Titers against Omicron are boosted by third vaccine doses and are high in both vaccinated individuals and those infected by Delta. Mutations in Omicron knock out or substantially reduce neutralization by most of the large panel of potent monoclonal antibodies and antibodies under commercial development. Omicron S has structural changes from earlier viruses and uses mutations that confer tight binding to ACE2 to unleash evolution driven by immune escape. This leads to a large number of mutations in the ACE2 binding site and rebalances receptor affinity to that of earlier pandemic viruses.
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
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Application of the Milan System for Reporting Salivary Gland Cytopathology in pediatric patients: An international, multi-institutional study.
Cancer Cytopathol2022 Jan;():. doi: 10.1002/cncy.22556.
Maleki Zahra, Saoud Carla, Viswanathan Kartik, Kilic Irem, Tommola Erkka, Griffin Daniel T, Heider Amer, Petrone Gianluigi, Jo Vickie Y, Centeno Barbara A, Saieg Mauro, Mikou Panagiota, Fadda Guido, Ali Syed Z, Kholová Ivana, Wojcik Eva M, Barkan Güliz A, Eisele David W, Bellevicine Claudio, Vigliar Elena, Wiles Austin B, Al-Ibraheemi Alyaa, Allison Derek B, Dixon Glen R, Chandra Ashish, Walsh Jonathan M, Baloch Zubair W, Faquin William C, Krane Jeffrey F, Rossi Esther Diana, Pantanowitz Liron, Troncone Giancarlo, Callegari Fabiano M, Klijanienko Jerzy,
Abstract
BACKGROUND:
Pediatric salivary gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a small proportion of malignancies. This international, multi-institutional cohort evaluated the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and the risk of malignancy (ROM) for each diagnostic category.
METHODS:
Pediatric (0- to 21-year-old) salivary gland FNA specimens from 22 international institutions of 7 countries, including the United States, England, Italy, Greece, Finland, Brazil, and France, were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. Cytology-histology correlation was performed where available, and the ROM was calculated for each MSRSGC diagnostic category.
RESULTS:
The cohort of 477 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 10.3%; nonneoplastic, 34.6%; AUS, 5.2%; benign neoplasm, 27.5%; SUMP, 7.5%; SM, 2.5%; and malignant, 12.4%. Histopathologic follow-up was available for 237 cases (49.7%). The ROMs were as follows: nondiagnostic, 5.9%; nonneoplastic, 9.1%; AUS, 35.7%; benign neoplasm, 3.3%; SUMP, 31.8%; SM, 100%; and malignant, 100%. Mucoepidermoid carcinoma was the most common malignancy (18 of 237; 7.6%), and it was followed by acinic cell carcinoma (16 of 237; 6.8%). Pleomorphic adenoma was the most common benign neoplasm (95 of 237; 40.1%).
CONCLUSIONS:
The MSRSGC can be reliably applied to pediatric salivary gland FNA. The ROM of each MSRSGC category in pediatric salivary gland FNA is relatively similar to the ROM of each category in adult salivary gland FNA, although the reported rates for the different MSRSGC categories are variable across institutions.
© 2022 American Cancer Society.
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Tracheostomy Practices and Outcomes in Children During Respiratory Extracorporeal Membrane Oxygenation.
Pediatr Crit Care Med2022 Jan;():. doi: 10.1097/PCC.0000000000002902.
Kohne Joseph G, MacLaren Graeme, Rider Erica, Carr Benjamin D, Mallory Palen, Gebremariam Acham, Friedman Matthew L, Barbaro Ryan P,
Abstract
OBJECTIVES:
Children receiving prolonged extracorporeal membrane oxygenation (ECMO) support may benefit from tracheostomy during ECMO by facilitating rehabilitation; however, the procedure carries risks, especially hemorrhagic complications. Knowledge of tracheostomy practices and outcomes of ECMO-supported children who undergo tracheostomy on ECMO may inform decision-making.
DESIGN:
Retrospective cohort study.
SETTING:
ECMO centers contributing to the Extracorporeal Life Support Organization registry.
PATIENTS:
Children from birth to 18 years who received ECMO support for greater than or equal to 7 days for respiratory failure from January 1, 2015, to December 31, 2019.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Three thousand six hundred eighty-five children received at least 7 days of ECMO support for respiratory failure. The median duration of ECMO support was 13.0 days (interquartile range [IQR], 9.3-19.9 d), and inhospital mortality was 38.7% (1,426/3,685). A tracheostomy was placed during ECMO support in 94/3,685 (2.6%). Of those who received a tracheostomy on ECMO, the procedure was performed at a median 13.2 days (IQR, 6.3-25.9 d) after initiation of ECMO. Surgical site bleeding was documented in 26% of children who received a tracheostomy (12% after tracheostomy placement). Among children who received a tracheostomy, the median duration of ECMO support was 24.2 days (IQR, 13.0-58.7 d); inhospital mortality was 30/94 (32%). Those that received a tracheostomy before 14 days on ECMO were older (median age, 15.8 yr [IQR, 4.7-15.5] vs 11.7 yr [IQR, 11.5-17.3 yr]; p =0.002) and more likely to have been supported on venovenous-ECMO (84% vs 52%; p = 0.001). Twenty-two percent (11/50) of those who received a tracheostomy before 14 days died in the hospital, compared with 19/44 (43%) of those who received a tracheostomy at 14 days or later (p = 0.03).
CONCLUSIONS:
Tracheostomies during ECMO were uncommon in children. One in four patients who received a tracheostomy on ECMO had surgical site bleeding. Children who had tracheostomies placed after 14 days were younger and had worse outcomes, potentially representing tracheostomy as a "secondary" strategy for prolonged ECMO support.
Copyright ©2022The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
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Efficacy and Safety of Combination Therapy with Tolvaptan and Furosemide in Children with Nephrotic Syndrome and Refractory Edema: A Prospective Interventional Study.
Indian J Pediatr2022 Jan;():. doi: 10.1007/s12098-021-03988-y.
Meena Jitendra, Hari Pankaj, Sinha Aditi, Bagga Arvind,
Abstract
OBJECTIVE:
Severe edema in children with nephrotic syndrome is often refractory to conventional diuretics. Tolvaptan has been used satisfactorily for managing edema in patients with heart failure and cirrhosis. The safety and efficacy of combination therapy with oral tolvaptan and intravenous (IV) furosemide was assessed in patients with furosemide refractory edema.
METHODS:
Patients, aged 5-18 y with nephrotic syndrome and severe edema, were screened for eligibility. After excluding hypovolemia, patients received IV furosemide (3-4 mg/kg/d) for 48 h. Those refractory to IV furosemide (weight loss?3%) received tolvaptan (0.5-1 mg/kg once daily) and IV furosemide for the next 48 h. Parameters were compared between 48 h of furosemide alone and combination therapy.
RESULTS:
A total of 24 patients (18 boys) with mean age of 8.0?±?3.0 y were enrolled. Urine volume significantly increased with combination therapy as compared to furosemide therapy (mean difference: 1.2 mL/kg/h; 95% CI: 0.8-1.65 mL/kg/h) (p?0.001). Compared to therapy with furosemide alone, combination therapy resulted in significant reduction in body weight from 26.9?±?10.3 kg to 24.8?±?9.7 kg (p?0.001). Estimated glomerular filtration rate did not change (p?=?0.81) but serum sodium increased from 135.7?±?3.3 mEq/L to 140.4?±?4.8 mEq/L (p?0.001) with combination therapy; 2 patients showed asymptomatic hypernatremia.
CONCLUSION:
The combination of oral tolvaptan and IV furosemide is effective in augmenting diuresis and reducing weight in patients with furosemide refractory edema but requires monitoring of electrolytes and volume status.
© 2021. Dr. K C Chaudhuri Foundation.
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Lipids: a Potential Molecular Pathway Towards Diastolic Dysfunction in Youth-Onset Type 2 Diabetes.
Curr Atheroscler Rep2022 Jan;():. doi: 10.1007/s11883-022-00989-w.
Shah Amy S, Sadayappan Sakthivel, Urbina Elaine M,
Abstract
PURPOSE OF THE REVIEW:
Obesity and type 2 diabetes (T2D) with onset in youth are emerging public health concerns. Youth with obesity and T2D are at risk for the development of heart failure with preserved ejection fraction (HFpEF) due to diabetes-related cardiomyopathy with evidence of precursor stages, namely diastolic dysfunction, present in youth. We review the literature regarding diastolic dysfunction in youth with obesity and T2D; discuss the potential mechanisms including the role of lipids, contractile proteins and their post-translational modifications, and conclude with studies to guide future treatments.
RECENT FINDINGS:
The diabetes milieu namely hyperglycemia, hyperinsulinemia, and lipotoxicity favor development of diastolic dysfunction and HFpEF. Recent studies show HFpEF is associated with slow left ventricular relaxation and sarcomere stiffness induced by reduced calcium (Ca) and ?-adrenergic responses. There are currently no effective therapies available for treating HFpEF. Targeting the sarcomere is an area of ongoing research.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Anesthetic Management in Adults with Congenital Heart Disease.
Curr Cardiol Rep2022 Jan;():. doi: 10.1007/s11886-022-01639-y.
Andrews Jon S, Hashmi Nazish K,
Abstract
PURPOSE OF REVIEW:
Adults with congenital heart disease (ACHD) are a complex and growing population that presents numerous challenges for anesthetic management. This review summarizes special considerations for anesthetic management in ACHD.
RECENT FINDINGS:
The adult patient with congenital heart disease may require anesthetic care for multiple surgeries and interventions throughout their lifetime. The cardiac and extracardiac manifestations of ACHD have important perioperative implications that affect anesthetic management. Recent American Heart Association/American College of Cardiology and European Society of Cardiology guidelines endorse a multidisciplinary, team-based approach to care. The cardiac anesthesiologist, endorsed as part of this multidisciplinary team, must have a thorough understanding of congenital heart disease pathophysiology and common extra-cardiac manifestations of ACHD. Safe anesthetic management in adult congenital heart disease should incorporate a multi-disciplinary approach to patient care. Anesthesiologists and centers with special expertise in ACHD care should be utilized or consulted whenever possible.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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2021 ELSO Adult and Pediatric Anticoagulation Guidelines.
ASAIO J2022 Jan;():. doi: 10.1097/MAT.0000000000001652.
McMichael Ali B V, Ryerson Lindsay M, Ratano Damian, Fan Eddy, Faraoni David, Annich Gail M,
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A Novel De Novo Frameshift Variation in the SON Gene Causing Severe Global Developmental Delay and Seizures in a Chinese Female.
Int J Dev Neurosci2022 Jan;():. doi: 10.1002/jdn.10170.
Yi Zhi, Song Zhenfeng, Li Fei, Yang Chengqing, Xue Jiao, Li Lei, Zhang Mengxue, Zhang Ying,
Abstract
BACKGROUND:
With the rapid development of genetic detection technology, especially next-generation sequencing, identification of the etiology of unexplained intellectual disabilities accompanied by seizures and other dysmorphic features has become possible. The purpose of our paper is to make a definitive diagnosis of a girl with neonatal hypotonia, severe global developmental delay, seizures and mild facial dysmorphism.
METHODS:
The clinical data of the patient were retrospectively studied. Whole-exome sequencing was performed on a blood sample from the patient. Subsequently, Sanger sequencing was utilized for validation of variants and parental validation.
RESULTS:
The patient had hypotonia since the neonatal period. She showed a significant delay in physical and psychomotor development. She did not have any speech until the age of 2 years and 6 months. She had seizures that were easy to control with levetiracetam. The craniocerebral MRI then showed mild delayed myelination, enlarged bilateral ventricles and widened frontotemporal extracerebral space. Interictal VEEG was normal. She had esotropia and mild facial abnormalities with a flat nasal bridge and a short nose. She showed no abnormalities in the heart, genitourinary or skeletal systems. Whole-exome sequencing revealed a novel de novo variant c.5334_5335delAG (p. Arg1778Serfs*11) in the SON gene.
CONCLUSION:
Our paper reports a novel variant in the SON gene and provides a definitive diagnosis of a female with neonatal hypotonia, severe global developmental delay, seizures and mild facial abnormalities, which are symptoms consistent with Zhu-Tokita-Takenouchi-Kim syndrome (ZTTK syndrome).
This article is protected by copyright. All rights reserved.
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Trends in Survival for Pediatric Transplantation.
Pediatrics2022 Jan;():. doi: e2020049632.
Hickner Brian, Anand Adrish, Godfrey Elizabeth L, Dunson Jordan, Reul Ross M, Cotton Ronald, Galvan Nhu Thao Nguyen, O'Mahony Christine, Goss John A, Rana Abbas,
Copyright © 2022 by the American Academy of Pediatrics.
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4D-flow cardiac magnetic resonance imaging after aortic root replacement with long-valved decellularized aortic homografts: comparison to valve-sparing aortic root replacement and healthy controls.
Eur J Cardiothorac Surg2022 Jan;():. doi: ezac016.
Cvitkovic Tomislav, Bobylev Dmitry, Horke Alexander, Avsar Murat, Beerbaum Philipp, Martens Andreas, Böthig Dietmar, Petenà Elena, Gutberlet Marcel, Beyer Frerk Hinnerk, Wacker Frank, Cebotari Serghei, Haverich Axel, Vogel-Claussen Jens, Sarikouch Samir, Czerner Christoph,
Abstract
OBJECTIVES:
Long-valved decellularized aortic homografts (DAH) may be used in young patients to treat aortic valve disease associated with aortic root dilatation, thereby eliminating the need for prosthetic material and anticoagulation.
METHODS:
Thirty-three male subjects in 3 equally sized cohorts were compared: patients following DAH implantation with a median age of 29 years [interquartile range (IQR) 27.5-37.5], patients post-valve-sparing aortic root replacement (VSARR), median 44 years (IQR 31.5-49) and healthy controls, median 33 years (IQR 28-40, P = 0.228). Time-resolved three-dimensional phase-contrast cardiac magnetic resonance imaging was performed to assess maximum blood flow velocity, pulse wave velocity, mechanical energy loss (EL), wall shear stress and flow patterns (vorticity, eccentricity, helicity) in 5 different planes of the aorta.
RESULTS:
The mean time between surgery and cardiovascular magnetic resonance was 2.56 ± 2.0 years in DAH vs 2.67 ± 2.1 in VSARR, P = 0.500. No significant differences in maximum velocity and pulse wave velocity were found between healthy controls and DAH across all planes. Velocity in the proximal aorta was significantly higher in VSARR (182.91 ± 53.91 cm/s, P = 0.032) compared with healthy controls. EL was significantly higher in VSARR in the proximal aorta with 1.85 mW (IQR 1.39-2.95) compared with healthy controls, 1.06 mW (0.91-1.22, P = 0.016), as well as in the entire thoracic aorta. In contrast, there was no significant EL in DAH in the proximal, 1.27 m/W (0.92-1.53, P = 0.296), as well as in the thoracic aorta, 7.7 m/W (5.25-9.90, P = 0.114), compared with healthy controls. There were no significant differences in wall shear stress parameters for all 5 regions of the thoracic aorta between the 3 groups. DAH patients, however, showed more vorticity, helicity and eccentricity in the ascending aorta compared with healthy controls (P
CONCLUSIONS:
Decellularized long aortic homografts exhibit near to normal haemodynamic parameters 2.5 years postoperatively compared with healthy controls and VSARR.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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Design Considerations for Interacting and Navigating with 2 Dimensional and 3 Dimensional Medical Images in Virtual, Augmented and Mixed Reality Medical Applications.
Virtual Augment Mixed Real (2021)2021 Jul;12770():117-133. doi: 10.1007/978-3-030-77599-5_10.
Silva Jennifer N Avari, Southworth Michael K, Andrews Christopher M, Privitera Mary Beth, Henry Alexander B, Silva Jonathan R,
Abstract
The extended realities, including virtual, augmented, and mixed realities (VAMR) have recently experienced significant hardware improvement resulting in an expansion in medical applications. These applications can be classified by the target end user (for instance, classifying applications as patient-centric, physician-centric, or both) or by use case (for instance educational, diagnostic tools, therapeutic tools, or some combination). When developing medical applications in VAMR, careful consideration of both the target end user and use case must heavily influence design considerations, particularly methods and tools for interaction and navigation. Medical imaging consists of both 2-dimensional and 3-dimensional medical imaging which impacts design, interaction, and navigation. Additionally, medical applications need to comply with regulatory considerations which will also influence interaction and design considerations. In this manuscript, the authors explore these considerations using three VAMR tools being developed for cardiac electrophysiology procedures.
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Systemic administration of dendrimer N-acetyl cysteine improves outcomes and survival following cardiac arrest.
Bioeng Transl Med2022 Jan;7(1):e10259. doi: 10.1002/btm2.10259.
Modi Hiren R, Wang Qihong, Olmstead Sarah J, Khoury Elizabeth S, Sah Nirnath, Guo Yu, Gharibani Payam, Sharma Rishi, Kannan Rangaramanujam M, Kannan Sujatha, Thakor Nitish V,
Abstract
Cardiac arrest (CA), the sudden cessation of effective cardiac pumping function, is still a major clinical problem with a high rate of early and long-term mortality. Post-cardiac arrest syndrome (PCAS) may be related to an early systemic inflammatory response leading to exaggerated and sustained neuroinflammation. Therefore, early intervention with targeted drug delivery to attenuate neuroinflammation may greatly improve therapeutic outcomes. Using a clinically relevant asphyxia CA model, we demonstrate that a single (i.p.) dose of dendrimer-N-acetylcysteine conjugate (D-NAC), can target "activated" microglial cells following CA, leading to an improvement in post-CA survival rate compared to saline (86% vs. 45%). D-NAC treatment also significantly improved gross neurological score within 4 h of treatment (?0.05) and continued to show improvement at 48?h (?0.05). Specifically, there was a substantial impairment in motor responses after CA, which was subsequently improved with D-NAC treatment (?0.05). D-NAC also mitigated hippocampal cell density loss seen post-CA in the CA1 and CA3 subregions (?0.001). These results demonstrate that early therapeutic intervention even with a single D-NAC bolus results in a robust sustainable improvement in long-term survival, short-term motor deficits, and neurological recovery. Our current work lays the groundwork for a clinically relevant therapeutic approach to treating post-CA syndrome.
© 2021 The Authors. Bioengineering & Translational Medicine published by Wiley Periodicals LLC on behalf of American Institute of Chemical Engineers.
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Transcatheter balloon dilatation of cor triatriatum dexter with percutaneous atrial septal defect closure.
J Cardiol Cases2022 Feb;25(2):68-71. doi: 10.1016/j.jccase.2021.06.016.
Hasnie Usman A, Prejean Shane P, Ahmed Asmaa N, Ahmed Mustafa I, Law Mark A,
Abstract
Cor triatriatum dexter is an extremely rare congenital heart defect and cause of hypoxia in adults. We describe a case of cor triatriatum dexter discovered incidentally due to an iatrogenic atrial septal defect. The cor triatriatum dexter resolved with balloon dilation - a novel technique to manage this rare clinical condition. .
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Racism as a leading cause of death in the United States.
BMJ2022 Jan;376():o213. doi: 10.1136/bmj.o213.
Krumholz Harlan M, Massey Daisy S, Dorsey Karen B,
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Delivery of modified mRNA to damaged myocardium by systemic administration of lipid nanoparticles.
J Control Release2022 Jan;():. doi: S0168-3659(22)00041-4.
Evers Martijn J W, Du Wenjuan, Yang Qiangbing, Kooijmans Sander A A, Vink Arjan, van Steenbergen Mies, Vader Pieter, de Jager Saskia C A, Fuchs Sabine A, Mastrobattista Enrico, Sluijter Joost P G, Lei Zhiyong, Schiffelers Raymond,
Abstract
Lipid Nanoparticles (LNPs) are a promising drug delivery vehicle for clinical siRNA delivery. Modified mRNA (modRNA) has recently gained great attention as a therapeutic molecule in cardiac regeneration. However, for mRNA to be functional, it must first reach the diseased myocardium, enter the target cell, escape from the endosomal compartment into the cytosol and be translated into a functional protein. However, it is unknown if LNPs can effectively deliver mRNA, which is much larger than siRNA, to the ischemic myocardium. Here, we evaluated the ability of LNPs to deliver mRNA to the myocardium upon ischemia-reperfusion injury functionally. By exploring the bio-distribution of fluorescently labeled LNPs, we observed that, upon reperfusion, LNPs accumulated in the infarct area of the heart. Subsequently, the functional delivery of modRNA was evaluated by the administration of firefly luciferase encoding modRNA. Concomitantly, a significant increase in firefly luciferase expression was observed in the heart upon myocardial reperfusion when compared to sham-operated animals. To characterize the targeted cells within the myocardium, we injected LNPs loaded with Cre modRNA into Cre-reporter mice. Upon LNP infusion, Tdtomato+ cells, derived from Cre mediated recombination, were observed in the infarct region as well as the epicardial layer upon LNP infusion. Within the infarct area, most targeted cells were cardiac fibroblasts but also some cardiomyocytes and macrophages were found. Although the expression levels were low compared to LNP-modRNA delivery into the liver, our data show the ability of LNPs to functionally deliver modRNA therapeutics to the damaged myocardium, which holds great promise for modRNA-based cardiac therapies.
Copyright © 2021. Published by Elsevier B.V.
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Decellularized human amniotic membrane reinforced by MoS-Polycaprolactone nanofibers, a novel conductive scaffold for cardiac tissue engineering.
J Biomater Appl2022 Jan;():8853282211063289. doi: 10.1177/08853282211063289.
Nazari Hojjallah, Heirani-Tabasi Asieh, Esmaeili Elaheh, Kajbafzadeh Abdol-Mohammad, Hassannejad Zahra, Boroomand Safiye, Shahsavari Alavijeh Mohammad Hossein, Mishan Mohammad Amir, Ahmadi Tafti Seyed Hossein, Warkiani Majid Ebrahimi, Dadgar Neda,
Abstract
In order to regenerate myocardial tissues with functional characteristics, we need to copy some properties of the myocardium, such as its extracellular matrix and electrical conductivity. In this study, we synthesized nanosheets of Molybdenum disulfide (MoS), and integrated them into polycaprolactone (PCL) and electrospun on the surface of decellularized human amniotic membrane (DHAM) with the purpose of improving the scaffolds mechanical properties and electrical conductivity. For studies, we seeded the mouse embryonic cardiac cells, mouse Embryonic Cardiac Cells (mECCs), on the scaffolds and then studied the MoS nanocomposites by scanning electron microscopy and Raman spectroscopy. In addition, we characterized the DHAM/PCL and DHAM/PCL-MoS by SEM, transmission electron microscopy, water contact angle measurement, electrical conductivity, and tensile test. Besides, we confirmed the scaffolds are biocompatible by 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, MTT assay. Furthermore, by means of SEM images, it was shown that mECCs attached to the DHAM/PCL-MoS scaffold have more cell aggregations and elongated morphology. Furthermore, through the Real-Time PCR and immunostaining studies, we found out cardiac genes were maturated and upregulated, and they also included GATA-4, c-TnT, NKX 2.5, and alpha-myosin heavy chain in cells cultured on DHAM/PCL-MoS scaffold in comparison to DHAM/PCL and DHAM. Therefore, in terms of cardiac tissue engineering, DHAM nanofibrous scaffolds reinforced by PCL-MoS can be suggested as a proper candidate.
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Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes.
Otolaryngol Head Neck Surg2022 Jan;():1945998211071020. doi: 10.1177/01945998211071020.
Garza Nathan, Chorney Stephen R, Kou Yann-Fuu, Johnson Romaine F,
Abstract
OBJECTIVE:
To compare outcomes after tracheostomy between children from Spanish- and English-speaking families.
STUDY DESIGN:
Prospective cohort study.
SETTING:
Tertiary care children's hospital.
METHODS:
All children
RESULTS:
A total of 339 children met inclusion, with 11% (37/339) from families identifying Spanish as their primary language and 33% (112/339) identifying as Hispanic. Spanish-speaking families were more likely to have tracheostomy-dependent children with cardiac conditions (65% vs 42%, = .008) and high complexity (72% vs 49%, = .007). Outcomes were similar regardless of language preference, with 45% (153/339) still tracheostomy dependent, 28% (94/339) decannulated, and 6.8% (23/339) deceased at a median follow-up of 1.77 years (interquartile range, 0.65-3.43). Severe neurocognitive disabilities were similar between Spanish- and English-language families ( > .05). Spanish language was not associated with times to decannulation or death in univariate or multiple regression models. A sensitivity analysis of self-identified Hispanic or Latino patients did not show significant differences for time to decannulation, death, or neurocognitive disability rates ( > .05).
CONCLUSION:
Spanish language and Hispanic ethnicity appear to have minimal impact on pediatric tracheostomy outcomes.
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Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study.
Tomography2022 Jan;8(1):142-157. doi: 10.3390/tomography8010012.
Rodriguez-Gonzalez Moises, Rodriguez-Campoy Patricia, Estalella-Mendoza Ana, Castellano-Martinez Ana, Flores-Gonzalez Jose Carlos,
Abstract
We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants
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Massive Pericardial Effusion in a 14-Year-Old Girl with Mild Fatigue and Neck Pain.
Pediatr Rep2022 Jan;14(1):8-12. doi: 10.3390/pediatric14010002.
Corsini Ilaria, Leardini Davide, Carfagnini Filomena, Pession Andrea, Lanari Marcello,
Abstract
Pericardial effusion is rare in pediatric patients and is characterized by a variable clinical presentation. Mild symptoms may be present despite severe effusion. We here report the case of a patient with massive pericardial effusion with mild clinical presentation. Our case points out the need not to exclude this diagnosis in patients with mild general impairment. This clinical suspicion can be lifesaving.
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