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2,335,600
Doxorubicin Blocks Cardiomyocyte Autophagic Flux by Inhibiting Lysosome Acidification.
The clinical use of doxorubicin is limited by cardiotoxicity. Histopathological changes include interstitial myocardial fibrosis and the appearance of vacuolated cardiomyocytes. Whereas dysregulation of autophagy in the myocardium has been implicated in a variety of cardiovascular diseases, the role of autophagy in doxorubicin cardiomyopathy remains poorly defined.</AbstractText>Most models of doxorubicin cardiotoxicity involve intraperitoneal injection of high-dose drug, which elicits lethargy, anorexia, weight loss, and peritoneal fibrosis, all of which confound the interpretation of autophagy. Given this, we first established a model that provokes modest and progressive cardiotoxicity without constitutional symptoms, reminiscent of the effects seen in patients. We report that doxorubicin blocks cardiomyocyte autophagic flux in vivo and in cardiomyocytes in culture. This block was accompanied by robust accumulation of undegraded autolysosomes. We go on to localize the site of block as a defect in lysosome acidification. To test the functional relevance of doxorubicin-triggered autolysosome accumulation, we studied animals with diminished autophagic activity resulting from haploinsufficiency for Beclin 1. Beclin 1(+/-) mice exposed to doxorubicin were protected in terms of structural and functional changes within the myocardium. Conversely, animals overexpressing Beclin 1 manifested an amplified cardiotoxic response.</AbstractText>Doxorubicin blocks autophagic flux in cardiomyocytes by impairing lysosome acidification and lysosomal function. Reducing autophagy initiation protects against doxorubicin cardiotoxicity.</AbstractText>&#xa9; 2016 American Heart Association, Inc.</CopyrightInformation>
2,335,601
Reduced in vivo toxicity of doxorubicin by encapsulation in cholesterol-containing self-assembled nanoparticles.
We previously reported the development of an amphiphilic brush-like block copolymer composed of polynorbornene-cholesterol/polyethylene glycol (P(NBCh9-b-NBPEG)) that self-assembles in aqueous media to form long circulating nanostructures capable of encapsulating doxorubicin (DOX-NPs). Biodistribution studies showed that this formulation preferentially accumulates in tumor tissue with markedly reduced accumulation in the heart and other major organs. The aim of the current study was to evaluate the in vivo efficacy and toxicity of DOX containing self-assembled polymer nanoparticles in a mouse xenograft tumor model and compare its effects with the hydrochloride non-encapsulated form (free DOX). DOX-NPs significantly reduced the growth of tumors without inducing any apparent toxicity. Conversely, mice treated with free DOX exhibited significant weight loss, early toxic cardiomyopathy, acute toxic hepatopathy, reduced hematopoiesis and fatal toxicity. The improved safety profile of the polymeric DOX-NPs can be explained by the low circulating concentration of non-nanoparticle-associated drug as well as the reduced accumulation of DOX in non-target organs. These findings support the use of P(NBCh9-b-NBPEG) nanoparticles as delivery platforms for hydrophobic anticancer drugs intended to reduce the toxicity of conventional treatments.
2,335,602
Ethics and social acceptability of a proposed clinical trial using maternal gene therapy to treat severe early-onset fetal growth restriction.
To evaluate the ethical and social acceptability of a proposed clinical trial using maternal uterine artery vascular endothelial growth factor (VEGF) gene therapy to treat severe early-onset fetal growth restriction (FGR) in pregnant women.</AbstractText>We conducted a literature review on the ethics and legality of experimental treatments in pregnant women, in particular advanced therapeutics. Issues that were identified from the literature helped develop interview guides for semistructured, qualitative interviews, carried out in four European countries, with 34 key stakeholders (disability groups, professional bodies and patient support groups) and 24 women/couples who had experienced a pregnancy affected by severe early-onset FGR.</AbstractText>The literature review identified two main questions: 'is it ethical to give a pregnant woman a potentially risky treatment from which she does not benefit directly?' and 'is it ethical to treat a condition of the unborn child, who may then be born with a serious disability when, without treatment, they would have died?'. The review concluded that there were no ethical or legal objections to the intervention, or to a trial of this intervention. Overall, respondents viewed the proposed trial in positive terms. Women were generally interested in participating in clinical trials that conferred a potential benefit to their unborn child. The risk of disability of the premature child was a concern, but not considered a major stumbling block for maternal VEGF gene therapy.</AbstractText>This study did not identify any fundamental or insurmountable objections to a trial of maternal gene therapy for severe early-onset FGR. Copyright &#xa9; 2016 ISUOG. Published by John Wiley &amp; Sons Ltd.</AbstractText>Copyright &#xa9; 2016 ISUOG. Published by John Wiley &amp; Sons Ltd.</CopyrightInformation>
2,335,603
The dual effect of ephaptic coupling on cardiac conduction with heterogeneous expression of connexin 43.
Decreased and heterogeneous expression of connexin 43 (Cx43) are common features in animal heart failure models. Ephpatic coupling, which relies on the presence of junctional cleft space between the ends of adjacent cells, has been suggested to play a more active role in mediating intercellular electrical communication when gap junctions are reduced. To better understand the interplay of Cx43 expression and ephaptic coupling on cardiac conduction during heart failure, we performed numerical simulations on our model when Cx43 expression is reduced and heterogeneous. Under severely reduced Cx43 expression, we identified three new phenomena in the presence of ephaptic coupling: alternating conduction, in which ephaptic and gap junction-mediated mechanisms alternate; instability of planar fronts; and small amplitude action potential (SAP), which has a smaller potential amplitude than the normal action potential. In the presence of heterogeneous Cx43 expression, ephaptic coupling can either prevent or promote conduction block (CB) depending on the Cx43 knockout (Cx43KO) content. When Cx43KO content is relatively high, ephaptic coupling reduces the probabilities of CB. However, ephaptic coupling promotes CB when Cx43KO and wild type cells are mixed in roughly equal proportion, which can be attributed to an increase in current-to-load mismatch.
2,335,604
A randomized controlled study comparing intrathecal hyperbaric bupivacaine-fentanyl mixture and isobaric bupivacaine-fentanyl mixture in common urological procedures.
Bupivacaine is available in isobaric and hyperbaric forms for intrathecal use and opioids are used as additives to modify their effects. The aim of this study was to compare the efficacy and haemodynamic effect of intrathecal isobaric bupivacaine-fentanyl mixture and hyperbaric bupivacaine-fentanyl mixture in common urological procedures.</AbstractText>One hundred American Society of Anesthesiologists physical status 1 and 2 patients undergoing urological procedures were randomized into two groups. Group 1 received 3 ml of 0.5% isobaric bupivacaine with 25 &#x3bc;g fentanyl while Group 2 received 3 ml of 0.5% hyperbaric bupivacaine with 25 &#x3bc;g fentanyl. The parameters measured include heart rate, blood pressure, respiratory rate, onset and duration of motor and sensory blockade. Student's unpaired t-test and the &#x3c7;(2) test were used to analyse the results, using the SPSS version 11.5 software.</AbstractText>The haemodynamic stability was better with isobaric bupivacaine fentanyl mixture (Group 1) than with hyperbaric bupivacaine fentanyl mixture (Group 2). The mean onset time in Group 1 for both sensory block (4 min) and motor block (5 min) was longer compared with Group 2. The duration of sensory block (127.8 &#xb1; 38.64 min) and motor block (170.4 &#xb1; 27.8 min) was less with isobaric bupivacaine group compared with hyperbaric bupivacaine group (sensory blockade 185.4 &#xb1; 16.08 min and motor blockade 201.6 &#xb1; 14.28 min). Seventy percent of patients in Group 2 had maximum sensory block level of T6 whereas it was 53% in Group 1. More patients in Group 1 required sedation compared to Group 2.</AbstractText>Isobaric bupivacaine fentanyl mixture was found to provide adequate anaesthesia with minimal incidence of haemodynamic instability.</AbstractText>
2,335,605
A prospective, comparative, randomised, double blind study on the efficacy of addition of clonidine to 0.25% bupivacaine in scalp block for supratentorial craniotomies.
Scalp blocks combined with general anaesthesia reduce pin and incision response, along with providing stable perioperative haemodynamics and analgesia. Clonidine has proved to be a valuable additive in infiltrative blocks. We studied the efficacy and safety of addition of clonidine 2 &#x3bc;g/kg to scalp block with 0.25% bupivacaine (Group B) versus plain 0.25% bupivacaine (Group A) for supratentorial craniotomies.</AbstractText>Sixty patients were randomly divided into two groups to receive scalp block: Group A (with 0.25% bupivacaine) and Group B (with 0.25% bupivacaine and clonidine (2 &#x3bc;g/kg). Bilateral scalp block was given immediately after induction. All the patients received propofol based general anaesthesia. Intraoperatively, propofol infusion was maintained at 75 to 100 &#x3bc;g/kg/h up to dura closure and reduced to 50-75 &#x3bc;g/kg/h up to skin closure with atracurium infusion stopped at dura closure. Heart rate (HR) and mean arterial pressure (MAP) were monitored at pin insertion, at 5 minute intervals from incision till dura opening and again at 5 minute interval from dura closure up to skin closure. Fentanyl 0.5 &#x3bc;g/kg was given if a 20% increase in either HR and/or MAP was observed. Postoperative haemodynamics and verbal rating scores (VRS) were recorded. When the VRS score increased above 3, rescue analgesia was given. Any intraoperative haemodynamic complications were noted.</AbstractText>Group A showed a significant increase in haemodynamic variables during the perioperative period as compared to group B (P &lt; 0.05). Addition of clonidine 2 &#x3bc;g/kg in the infiltrative block also provided significantly prolonged postoperative analgesia.</AbstractText>Addition of clonidine to scalp block provided better perioperative haemodynamic stability and significantly prolonged analgesia.</AbstractText>
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Drug-drug interactions and QT prolongation as a commonly assessed cardiac effect - comprehensive overview of clinical trials.
Proarrhythmia assessment is one of the major concerns for regulatory bodies and pharmaceutical industry. ICH guidelines recommending preclinical tests have been established in attempt to eliminate the risk of drug-induced arrhythmias. However, in the clinic, arrhythmia occurrence is determined not only by the inherent property of a drug to block ion currents and disturb electrophysiological activity of cardiac myocytes, but also by many other factors modifying individual risk of QT prolongation and subsequent proarrhythmia propensity. One of those is drug-drug interactions. Since polypharmacy is a common practice in clinical settings, it can be anticipated that there is a relatively high risk that the patient will receive at least two drugs mutually modifying their proarrhythmic potential and resulting either in triggering the occurrence or mitigating the clinical symptoms. The mechanism can be observed either directly at the pharmacodynamic level by competing for the molecular targets, or indirectly by modifying the physiological parameters, or at the pharmacokinetic level by alteration of the active concentration of the victim drug.</AbstractText>This publication provides an overview of published clinical studies on pharmacokinetic and/or pharmacodynamic drug-drug interactions in humans and their electrophysiological consequences (QT interval modification). Databases of PubMed and Scopus were searched and combinations of the following keywords were used for Title, Abstract and Keywords fields: interaction, coadministration, combination, DDI and electrocardiographic, QTc interval, ECG. Only human studies were included. Over 4500 publications were retrieved and underwent preliminary assessment to identify papers accordant with the topic of this review. 76 papers reporting results for 96 drug combinations were found and analyzed.</AbstractText>The results show the tremendous variability of drug-drug interaction effects, which makes one aware of complexity of the problem, and suggests the need for assessment of an additional risk factors and careful ECG monitoring before administration of drugs with anticipated QT prolongation.</AbstractText>DDIs can play significant roles in drugs' cardiac safety, as evidenced by the provided examples. Assessment of the pharmacodynamic effects of the drug interactions is more challenging as compared to the pharmacokinetic due to the significant diversity in the endpoints which should be analyzed specifically for various clinical effects. Nevertheless, PD components of DDIs should be accounted for as PK changes alone do not allow to fully explain the electrophysiological effects in clinic situations.</AbstractText>
2,335,607
Detailed Evaluation of Five 3D Speckle Tracking Algorithms Using Synthetic Echocardiographic Recordings.
A plethora of techniques for cardiac deformation imaging with 3D ultrasound, typically referred to as 3D speckle tracking techniques, are available from academia and industry. Although the benefits of single methods over alternative ones have been reported in separate publications, the intrinsic differences in the data and definitions used makes it hard to compare the relative performance of different solutions. To address this issue, we have recently proposed a framework to simulate realistic 3D echocardiographic recordings and used it to generate a common set of ground-truth data for 3D speckle tracking algorithms, which was made available online. The aim of this study was therefore to use the newly developed database to contrast non-commercial speckle tracking solutions from research groups with leading expertise in the field. The five techniques involved cover the most representative families of existing approaches, namely block-matching, radio-frequency tracking, optical flow and elastic image registration. The techniques were contrasted in terms of tracking and strain accuracy. The feasibility of the obtained strain measurements to diagnose pathology was also tested for ischemia and dyssynchrony.
2,335,608
Comparative evaluation of dexmedetomidine and clonidine with low dose ropivacaine in cervical epidural anesthesia for modified radical mastectomy: A prospective randomized, double-blind study.
Alpha-2 adrenergic agonists clonidine and dexmedetomidine, are well known to produce analgesia through an opioid independent mechanism. Alpha-2 agonists are used as an adjuvant to local anesthetic agents to extend the duration of spinal, epidural and brachial plexus blocks.</AbstractText>We compared clonidine and dexmedetomidine as an adjuvant to Ropivacaine in cervical epidural anesthesia (CEA) with respect to onset and duration of sensory block, duration of analgesia and adverse effects.</AbstractText>A total 150 American Society of Anesthesiologists Class I or II adult female patients who were scheduled to undergo modified radical mastectomy were randomly allocated to the following two groups to receive CEA: Group D receive 15 mL of 0.375% ropivacaine combined with 1 &#x3bc;g/kg of dexmedetomidine; Group C received 15 mL of 0.375% ropivacaine combined with 1.5 &#x3bc;g/kg of clonidine. The onset of sensory block, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), sedation scores, and the incidences of adverse effects, such as hypotension, bradycardia, and oxygen desaturation were recorded.</AbstractText>The addition of dexmedetomidine to ropivacaine (Group D) resulted in faster onset of sensory block time compared with the addition of clonidine to ropivacaine (Group C) (95% confidence interval [CI]: 14.53 &#xb1; 2.96 vs. 16.72 &#xb1; 4.43 P = 0.032). The duration of analgesia block in Group D was significantly longer than that in Group C (95% CI: 234.65 &#xb1; 23.76 vs. 286.76 &#xb1; 34.65; P = 0.037). The Ramsay sedation score at in Group D were significantly higher between 20 and 60 min as compared to Group C (P &lt; 0.022). MAP level and HR level in Group D and Group C were comparable.</AbstractText>The addition of dexmedetomidine to low dose ropivacaine for CEA could shorten the onset of sensory block and extend the duration of analgesia with optimum sedation without episodes of hypoxemia as compared to addition of clonidine to ropivacaine.</AbstractText>
2,335,609
Effects of perineural administration of dexmedetomidine in combination with bupivacaine in a femoral-sciatic nerve block.
Perineural administration of dexmedetomidine, a &#x3b1;2-adrenoceptor agonist, prolongs the duration of analgesia. We hypothesized that adding dexmedetomidine to bupivacaine would prolong postoperative analgesia after below knee surgery.</AbstractText>After ethical approval, 60 patients scheduled for below knee surgery under combined femoral-sciatic nerve block were randomly allocated into two groups to have their block performed using bupivacaine 0.5% alone (group B) or bupivacaine 0.5% combined with 100 &#x3bc;g bupivacaine-dexmedetomidine (group BD). Motor and sensory block onset times; durations of blockades and analgesia were recorded.</AbstractText>Sensory and motor block onset times were shorter by 20% in group BD than in group B (P &lt; 0.01). Sensory and motor blockade durations were longer in group BD (+45% and +40%, respectively) than in group B (P &lt; 0.01). Duration of analgesia was longer in group BD by 75% than in group B (P &lt; 0.01). Systolic, diastolic arterial blood pressure levels, and heart rate were significantly less in group BD, six patients in group BD, and no patients in group B developed bradycardia (P &lt; 0.05).</AbstractText>The addition of dexmedetomidine 100 &#x3bc;g to bupivacaine 0.5% during ultrasound-guided combined femoral and sciatic block for below knee surgery was associated with a prolonged duration of analgesia. However, this may be associated with significant bradycardia requiring treatment.</AbstractText>
2,335,610
Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection.
Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB), which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA) for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection.</AbstractText>Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients) or postoperative intravenous PCA with morphine (group M, 20 patients) for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded.</AbstractText>PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients.</AbstractText>Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection.</AbstractText>
2,335,611
Dexmedetomidine as an additive to local anesthetics compared with intravenous dexmedetomidine in peribulbar block for cataract surgery.
No studies compared parenteral dexmedetomidine with its use as an adjuvant to ophthalmic block. We compared between adding dexmedetomidine to bupivacaine in peribulbar block and intravenous (IV) dexmedetomidine during peribulbar block for cataract surgery.</AbstractText>A prospective, randomized, double-blind study on 90 patients for cataract surgery under peribulbar anesthesia. Study included three groups; all patients received 10 ml of peribulbar anesthesia and IV infusion of drugs as follows: Group I: Received a mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) + 150 IU hyaluronidase + IV infusion of normal saline, Group II: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + dexmedetomidine 50 &#x3bc;g (1 ml) +150 IU hyaluronidase + IV infusion of normal saline and Group III: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) +150 IU hyaluronidase + IV dexmedetomidine 1 &#x3bc;g/kg over 10 min; followed by 0.4 &#x3bc;g/kg/h IV infusion. We recorded onset, duration of block, Ramsay Sedation Score, intra-ocular pressure (IOP), hemodynamics, and adverse effects.</AbstractText>There was a significant decrease in the onset of action and increase in the duration of block in Group II as compared with the Group I and Group III. Mean Ramsay Sedation Score was higher in Group III. The IOP showed a significant decrease in Group II and Group III 10 min after injection (P &lt; 0.01). Heart rate showed a significant decrease in Group III in comparison with the two other groups (P &lt; 0.05). Only two patients in Group III developed bradycardia.</AbstractText>Dexmedetomidine as an additive shortens onset time, prolong block durations and significantly decreases the IOP with minimal side effects. IV dexmedetomidine, in addition, produces intra-operative sedation with hemodynamic stability.</AbstractText>
2,335,612
Comparison of sugammadex and neostigmine-atropine on intraocular pressure and postoperative effects.
During surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18-65 years, with a risk status of the American Society of Anesthesiologists I-II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 &#x3bc;g/kg) plus atropine (15 &#x3bc;g/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine-atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group.
2,335,613
Leukocytes Link Local and Systemic Inflammation in Ischemic Cardiovascular Disease: An Expanded "Cardiovascular Continuum".
Physicians have traditionally viewed ischemic heart disease in a cardiocentric manner: plaques grow in arteries until they block blood flow, causing acute coronary and other ischemic syndromes. Recent research provides new insight into the integrative biology of inflammation as it contributes to ischemic cardiovascular disease. These results have revealed hitherto unsuspected inflammatory signaling networks at work in these disorders that link the brain, autonomic nervous system, bone marrow, and spleen to the atherosclerotic plaque and to the infarcting myocardium. A burgeoning clinical published data indicates that such inflammatory networks-far from a mere laboratory curiosity-operate in our patients and can influence aspects of ischemic cardiovascular disease that determine decisively clinical outcomes. These new findings enlarge the circle of the traditional "cardiovascular continuum" beyond the heart and vessels to include the nervous system, the spleen, and the bone marrow.
2,335,614
Property Values as a Measure of Neighborhoods: An Application of Hedonic Price Theory.
Researchers measuring relationships between neighborhoods and health have begun using property appraisal data as a source of information about neighborhoods. Economists have developed a rich tool kit to understand how neighborhood characteristics are quantified in appraisal values. This tool kit principally relies on hedonic (implicit) price models and has much to offer regarding the interpretation and operationalization of property appraisal data-derived neighborhood measures, which goes beyond the use of appraisal data as a measure of neighborhood socioeconomic status.</AbstractText>We develop a theoretically informed hedonic-based neighborhood measure using residuals of a hedonic price regression applied to appraisal data in a single metropolitan area. We describe its characteristics, reliability in different types of neighborhoods, and correlation with other neighborhood measures (i.e., raw neighborhood appraisal values, census block group poverty, and observed property characteristics). We examine the association between all neighborhood measures and body mass index.</AbstractText>The hedonic-based neighborhood measure was correlated in the expected direction with block group poverty rate and observed property characteristics. The neighborhood measure and average raw neighborhood appraisal value, but not census block group poverty, were associated with individual body mass index.</AbstractText>We draw theoretically consistent methodology from the economics literature on hedonic price models to demonstrate how to leverage the implicit valuation of neighborhoods contained in publicly available appraisal data. Consistent measurement and application of the hedonic-based neighborhood measures in epidemiology will improve understanding of the relationships between neighborhoods and health. Researchers should proceed with a careful use of appraisal values utilizing theoretically informed methods such as this one.</AbstractText>
2,335,615
Effects of Replacing of Inorganic Trace Minerals by Organically Bound Trace Minerals on Growth Performance, Tissue Mineral Status, and Fecal Mineral Excretion in Commercial Grower-Finisher Pigs.
A total of 180 crossbred pigs (Duroc &#xd7; Landrace &#xd7; Large White; BW&#xa0;=&#xa0;47.1&#xa0;&#xb1;&#xa0;4.8&#xa0;kg) were used to investigate the effects of totally replacing inorganic trace minerals (ITMs) by organically bound trace minerals (OTMs) on growth performance, tissue mineral status, liver antioxidant enzyme activities, and fecal mineral excretion in grower-finisher pigs. A randomized complete block design with three treatments and six replicates (n&#xa0;=&#xa0;10 pigs per pen) was used in this 69-day, 2-phase feeding trial. Experimental treatments were as follows: (1) a basal diet without trace mineral supplementation, (2) basal + ITMs (Fe, Mn, and Zn from sulfates, Cu oxychloride, and sodium selenite providing commercially recommended levels in China at 125, 22.5, 117.5, 30, and 0.3&#xa0;mg/kg, respectively), and 3) basal + OTMs (Fe, Mn, Zn, and Cu from Bioplex and Se as Sel-Plex (Alltech Inc., Nicholasville, KY) providing levels identical to ITMs). No significant differences (P&#xa0;&gt;&#xa0;0.05) were observed in ADG, ADFI, or G:F among the treatments during the entire grower-finisher period. Supplementation with minerals, regardless of source, increased (P&#xa0;&lt;&#xa0;0.05) the Fe, Cu, and Se levels in the plasma; Fe and Zn levels in the liver; and Se levels in heart. Furthermore, compared with ITM group, the concentration of Zn and Se in the liver and heart, and Se in plasma and longissimus muscle were greater (P&#xa0;&lt;&#xa0;0.05) in OTM group. Hepatic Cu/Zn-SOD and ALP activities were increased (P&#xa0;&lt;&#xa0;0.05) when either ITMs or OTMs were supplemented. Pigs supplemented with OTMs displayed greater activities of Cu/Zn-SOD, ALP, and GSH-Px in the liver compared to pigs supplemented with ITMs. Dietary mineral supplementation to pig diets greatly increased (P&#xa0;&lt;&#xa0;0.05) fecal mineral (Fe, Mn, Zn, Cu, and Se) excretion in both grower and finisher phases. Fecal concentrations of Zn, Cu, and Se excretion were lower (P&#xa0;&lt;&#xa0;0.05) with OTMs supplementation than that in pigs fed diets containing ITMs. These results indicate that use of organic trace minerals, as well as no trace mineral supplementation, did not influence pig growth performance. Totally replacing ITMs by equivalent levels of OTMs could improve hepatic Cu/Zn-SOD, ALP, and GSH-Px activities and reduce fecal Mn, Cu, and Se excretion for grower-finisher pigs when supplemented at commercially recommended levels.
2,335,616
Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial.
Virtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. However, its usefulness for treating dental phobia is unexplored. The aims of the present study are to determine: (a) the efficacy of VRET versus informational pamphlet (IP) control group in terms of dental trait and state anxiety reductions at 1 week, 3 months and 6 months follow-up (b) the real-time physiological arousal [heart rate (HR)] of VRET group participants during and following therapy (c) the relation between subjective (presence) and objective (HR) measures during VRET.</AbstractText>This study is a single blind, randomized controlled trial with two parallel arms in which participants will be allocated to VRET or IP with a ratio of 1:1. Thirty participants (18-50 years) meeting the Phobia Checklist criteria of dental phobia will undergo block randomization with allocation concealment. The primary outcome measures include participants' dental trait anxiety (Modified Dental Anxiety Scale and Dental Fear Survey) and state anxiety (Visual Analogue Scale) measured at baseline (T0), at intervention (T1), 1-week (T2), 3 months (T3) and 6 months (T4) follow-up. A behavior test will be conducted before and after the intervention. The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively. The data will be analyzed using intention-to-treat and per-protocol analysis.</AbstractText>This study uses novel non-invasive VRET, which may provide a possible alternative treatment for dental anxiety and phobia.</AbstractText>ISRCTN25824611 , Date of registration: 26 October 2015.</AbstractText>
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miR-19b attenuates H2O2-induced apoptosis in rat H9C2 cardiomyocytes via targeting PTEN.
Myocardial ischemia-reperfusion (I-R) injury lacks effective treatments. The miR-17-92 cluster plays important roles in regulating proliferation, apoptosis, cell cycle and other pivotal processes. However, their roles in myocardial I-R injury are&#xa0;largely unknown. In this study, we found that miR-19b was the only member of the miR-17-92 cluster that was downregulated in infarct area of heart samples from a murine model of I-R injury. Meanwhile, downregulation of miR-19b was also detected in H2O2-treated H9C2 cells in vitro mimicking oxidative stress occurring during myocardial I-R injury. Using flow cytometry and Western blot analysis, we found that overexpression of miR-19b decreased H2O2-induced apoptosis and improved cell survival, while downregulation of that had inverse effects. Furthermore, PTEN was negatively regulated by miR-19b at the protein level while silencing PTEN could completely block the aggravated impact of miR-19b inhibitor on H2O2-induced apoptosis in H9C2 cardiomyocytes, indicating PTEN as a downstream target of miR-19b controlling H2O2-induced apoptosis. These data indicate that miR-19b overexpression might be a novel therapy for myocardial I-R injury.
2,335,618
The story of spironolactones from 1957 to now: from sodium balance to inflammation.
After the discovery of aldosterone (1953), many synthetic steroids were tested for their ability to block the sodium retaining and potassium excreting effect of synthetic mineralocorticoids in adrenalectomized rats. In the same years Kagawa discovered that 17-spirolactone steroids were effective to block mineralocorticoid effects, but when used alone they did not produce any effect in adrenalectomized rats. After the description of the first case of primary aldosteronism (1955), spironolactone (SP) was considered the main treatment before surgery to control blood pressure and kaliemia and for long-term treatment in patients with bilateral adrenal hyperplasia. SP was further used for various clinical situations, such as liver cirrhosis, idiopathic oedema, nephrosis and congestive heart failure. SP also shows an antiandrogen action, effective in polycystic ovary syndrome. In 1985 we demonstrated that human mononuclear leukocytes (MNL) possess mineralocorticoid receptors (MR) and lately we demonstrated that coincubation of MNL with canrenone blocked aldosterone mediated inflammatory, reducing the expression of PAI-1 and p22phox. It is well known that MNL and macrophages are mainly involved in vascular inflammation and atherosclerosis and we have hypothesized that the tissue invasion of MNL brings MR in the site of inflammation starting the process. Recently, aldosterone has been associated with the promotion of many organ-specific autoimmune diseases, inducing Th17 polarization of CD4+ T cells and suggesting new possible therapeutic targets for anti-mineralocorticoid drugs. In conclusion, considering all the benefits of MR-antagonists, their use should be reconsidered not only for the treatment but also for the prevention of many clinical situations.
2,335,619
Role of Ih in differentiating the dynamics of the gastric and pyloric neurons in the stomatogastric ganglion of the lobster, Homarus americanus.
The hyperpolarization-activated inward cationic current (Ih) is known to regulate the rhythmicity, excitability, and synaptic transmission in heart cells and many types of neurons across a variety of species, including some pyloric and gastric mill neurons in the stomatogastric ganglion (STG) in Cancer borealis and Panulirus interruptus However, little is known about the role of Ih in regulating the gastric mill dynamics and its contribution to the dynamical bifurcation of the gastric mill and pyloric networks. We investigated the role of Ih in the rhythmic activity and cellular excitability of both the gastric mill neurons (medial gastric, gastric mill) and pyloric neurons (pyloric dilator, lateral pyloric) in Homarus americanus Through testing the burst period between 5 and 50 mM CsCl, and elimination of postinhibitory rebound and voltage sag, we found that 30 mM CsCl can sufficiently block Ih in both the pyloric and gastric mill neurons. Our results show that Ih maintains the excitability of both the pyloric and gastric mill neurons. However, Ih regulates slow oscillations of the pyloric and gastric mill neurons differently. Specifically, blocking Ih diminishes the difference between the pyloric and gastric mill burst periods by increasing the pyloric burst period and decreasing the gastric mill burst period. Moreover, the phase-plane analysis shows that blocking Ih causes the trajectory of slow oscillations of the gastric mill neurons to change toward the pyloric sinusoidal-like trajectories. In addition to regulating the pyloric rhythm, we found that Ih is also essential for the gastric mill rhythms and differentially regulates these two dynamics.
2,335,620
Comparison of lidocaine, levobupivacaine or ropivacaine for distal paravertebral thoracolumbar anesthesia in ewes.
To compare the effects of lidocaine, levobupivacaine, or ropivacaine on the onset time and duration of anesthesia of the flank of ewes, using the distal paravertebral thoracolumbar approach.</AbstractText>Randomized experimental study.</AbstractText>Twenty-six healthy mixed-breed ewes (46&#xa0;&#xb1;&#xa0;3.1&#xa0;kg).</AbstractText>Thoracolumbar paravertebral nerve blocks were performed using the distal approach in sheep for ruminal fistulation. The 13th thoracic (T13), first lumbar (L1) and second lumbar (L2) nerves were infiltrated with 2% lidocaine (group GLI, n&#xa0;=&#xa0;9), 0.5% levobupivacaine (group GLE, n&#xa0;=&#xa0;8) or 0.5% ropivacaine (group GRO, n&#xa0;=&#xa0;9); 1.5&#xa0;mL on the dorsal branch and 2.5&#xa0;mL on the ventral branch, total volume of 12&#xa0;mL per ewe. Anesthesia onset time and duration were assessed by application of superficial and deep pin pricks, and skin clamping with a hemostat. Heart rate, respiratory rate, rectal temperature and systemic arterial pressures were recorded prior to nerve block (T0), after the anesthetic agent injection and onset time (T1) and predetermined time points during the surgical procedure (T2-T6).</AbstractText>Incomplete nerve blocks were present in five of the 26 ewes enrolled in the study and they were not included in the statistical analyzes. Onset times in GLI, GLE and GRO were 1.5&#xa0;&#xb1;&#xa0;0.5, 3.1&#xa0;&#xb1;&#xa0;1.5 and 2.1&#xa0;&#xb1;&#xa0;0.8&#xa0;minutes, respectively, with GLE significantly longer than GLI. The durations of anesthesia for GLI, GLE and GRO were 80&#xa0;&#xb1;&#xa0;27, 649&#xa0;&#xb1;&#xa0;68 and 590&#xa0;&#xb1;&#xa0;40&#xa0;minutes, respectively, with the duration of GLI significantly shorter than GLE and GRO. There were no clinically important changes in cardiopulmonary variables.</AbstractText>Administration of levobupivacaine and ropivacaine at the distal paravertebral site to block nerves T13, L1 and L2 produced a longer duration of anesthesia of the ewe's flanks compared with lidocaine.</AbstractText>&#xa9; 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.</CopyrightInformation>
2,335,621
Cortical hyper-excitability in healthy children: evidence from habituation and recovery cycle phenomena of somatosensory evoked potentials.
To compare neurophysiological parameters of central nervous system excitability in healthy children/adolescents with those of healthy adults.</AbstractText>Two experimental protocols were used in 19 healthy children/adolescents (10 males and 9 females, mean age 9y 11mo [SD 2y 9mo], range 5-15y) and 19 healthy adults (8 males and 11 females, mean age 36y 6mo [SD 7y 9mo], range 27-51y). First, we administered repetitive trains of innocuous electrical stimulation of the median nerve and analysed habituation (progressive attenuation) of the cervical and cortical responses. Second, we administered several blocks of two closely timed electrical innocuous stimuli of the median nerve (with interstimulus intervals set at 5, 10, and 20ms in each block) and analysed the recovery index (the percentage of the response to the second stimulus with respect to that to the first).</AbstractText>Clear-cut neurophysiological signs of cortical hyper-excitability were found in children/adolescents but not in adults. In contrast with the adults, the children/adolescents did not attenuate cortical responses to repetitive stimulation, and presented with extremely shortened recovery cycle. At baseline, both groups presented with comparable cortical responses.</AbstractText>Healthy children/adolescents present cortical hyper-excitability compared with healthy adults. These findings agree with previous findings that show an overall imbalance of excitatory and inhibitory neuronal and neurochemical mechanisms in favour of excitatory ones, in the healthy developing cerebral cortex.</AbstractText>&#xa9; 2016 Mac Keith Press.</CopyrightInformation>
2,335,622
Paravertebral block versus thoracic epidural for patients undergoing thoracotomy.
Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risks of developing complications such as lung collapse, chest infections and blood clots due to ineffective breathing and clearing of secretions. Effective management of acute pain following thoracotomy may prevent these complications and reduce the likelihood of developing chronic pain. A multi-modal approach to analgesia is widely employed by thoracic anaesthetists using a combination of regional anaesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anaesthesia blockade.There is some evidence that blocking the nerves as they emerge from the spinal column (paravertebral block, PVB) may be associated with a lower risk of major complications in thoracic surgery but the majority of thoracic anaesthetists still prefer to use a thoracic epidural blockade (TEB) as analgesia for their patients undergoing thoracotomy. In order to bring about a change in practice, anaesthetists need a review that evaluates the risk of all major complications associated with thoracic epidural and paravertebral block in thoracotomy.</AbstractText>To compare the two regional techniques of TEB and PVB in adults undergoing elective thoracotomy with respect to:1. analgesic efficacy;2. the incidence of major complications (including mortality);3. the incidence of minor complications;4. length of hospital stay;5. cost effectiveness.</AbstractText>We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 9); MEDLINE via Ovid (1966 to 16 October 2013); EMBASE via Ovid (1980 to 16 October 2013); CINAHL via EBSCO host (1982 to 16 October 2013); and reference lists of retrieved studies. We handsearched the Journal of Cardiothoracic Surgery and Journal of Cardiothoracic and Vascular Anesthesia (16 October 2013). We reran the search on 31st January 2015. We found one additional study which is awaiting classification and will be addressed when we update the review.</AbstractText>We included all randomized controlled trials (RCTs) comparing PVB with TEB in thoracotomy, including upper gastrointestinal surgery.</AbstractText>We used standard methodological procedures expected by Cochrane. Two review authors (JY and SG) independently assessed the studies for inclusion and then extracted data as eligible for inclusion in qualitative and quantitative synthesis (meta-analysis).</AbstractText>We included 14 studies with a total of 698 participants undergoing thoracotomy. There are two studies awaiting classification. The studies demonstrated high heterogeneity in insertion and use of both regional techniques, reflecting real-world differences in the anaesthesia techniques. Overall, the included studies have a moderate to high potential for bias, lacking details of randomization, group allocation concealment or arrangements to blind participants or outcome assessors. There was low to very low-quality evidence that showed no significant difference in 30-day mortality (2 studies, 125 participants. risk ratio (RR) 1.28, 95% confidence interval (CI) 0.39 to 4.23, P value = 0.68) and major complications (cardiovascular: 2 studies, 114 participants. Hypotension RR 0.30, 95% CI 0.01 to 6.62, P value = 0.45; arrhythmias RR 0.36, 95% CI 0.04 to 3.29, P value = 0.36, myocardial infarction RR 3.19, 95% CI 0.13, 76.42, P value = 0.47); respiratory: 5 studies, 280 participants. RR 0.62, 95% CI 0.26 to 1.52, P value = 0.30). There was moderate-quality evidence that showed comparable analgesic efficacy across all time points both at rest and after coughing or physiotherapy (14 studies, 698 participants). There was moderate-quality evidence that showed PVB had a better minor complication profile than TEB including hypotension (8 studies, 445 participants. RR 0.16, 95% CI 0.07 to 0.38, P value &lt; 0.0001), nausea and vomiting (6 studies, 345 participants. RR 0.48, 95% CI 0.30 to 0.75, P value = 0.001), pruritis (5 studies, 249 participants. RR 0.29, 95% CI 0.14 to 0.59, P value = 0.0005) and urinary retention (5 studies, 258 participants. RR 0.22, 95% CI 0.11 to 0.46, P value &lt; 0.0001). There was insufficient data in chronic pain (six or 12 months). There was no difference found in and length of hospital stay (3 studies, 124 participants). We found no studies that reported costs.</AbstractText><AbstractText Label="AUTHORS' CONCLUSIONS" NlmCategory="CONCLUSIONS">Paravertebral blockade reduced the risks of developing minor complications compared to thoracic epidural blockade. Paravertebral blockade was as effective as thoracic epidural blockade in controlling acute pain. There was a lack of evidence in other outcomes. There was no difference in 30-day mortality, major complications, or length of hospital stay. There was insufficient data on chronic pain and costs. Results from this review should be interpreted with caution due to the heterogeneity of the included studies and the lack of reliable evidence. Future studies in this area need well-conducted, adequately-powered RCTs that focus not only on acute pain but also on major complications, chronic pain, length of stay and costs.</AbstractText>
2,335,623
Dexmedetomidine as an Adjuvant to Pre-Emptive Caudal Epidural Ropivacaine for Lumbosacral Spine Surgeries.
Pre-emptive caudal epidural is a proven technique for providing analgesia for spinal surgeries. Prolonged pain relief with no motor blockade is desired for early mobilisation.</AbstractText>Present study aimed to evaluate the effect of addition of Inj dexmedetomidine to caudal ropivacaine on the duration of analgesia, haemodynamic profile and the associated side effects.</AbstractText>In this prospective double-blind study a total of 60 patients undergoing lumbosacral spine surgery were randomised to receive 20 cc of pre-emptive caudal epidural injection of either inj ropivacaine 0.2% (Group R, n =30) or a mixture of Inj ropivacaine 0.2% and Inj dexmedetomidine 1 &#x3bc;g/kg (Group RD, n =30) under general anaesthesia after the patient was positioned prone for surgery. VAS scores, heart rate, blood pressures and time to rescue analgesia were recorded at regular intervals for the first 24 hours. Data analysis was carried out using Statistical Package for Social Science (SPSS, V 10.5 package).</AbstractText>Mean VAS scores were significantly lower in the RD group for up to 12 hours following the caudal block. No clinically significant haemodynamic changes were noted in either of the groups. No other side effects were seen in both the groups.</AbstractText>These results suggest that inj dexmedetomidine is an effective additive to inj ropivacaine for pre-emptive caudal epidural analgesia in lumbosacral spine surgeries.</AbstractText>
2,335,624
Multimodal versus Conventional Approach for Postoperative Pain Relief in Oral Cancer Patients.
Multimodal analgesia includes regional anaesthesia in the form of nerve block may improve recovery along with optimal rehabilitation and early resumption of day-to-day activity following major surgery. Conventional general anaesthesia consists of premedication, induction, intubation and maintenance.</AbstractText>The aim of the study is to compare the multimodal versus conventional approach in oral cancer surgery.</AbstractText>The patients were randomly allocated into three groups, 30 patients in each group using the computer generated random table to one of the following groups: Group A: Fentanyl 1 &#x3bc;g/kg, Group B: Fentanyl 1 &#x3bc;g/kg + bupivacaine local infiltration, Group C: Fentanyl 1 &#x3bc;g/kg + bupivacaine local infiltration + Dexemedetomidine infusion (Loading 0.5 &#x3bc;g/kg, Maintenance 0.2&#x3bc;g/kg/hr).</AbstractText>No significant (p&gt;0.05) difference was found in mean arterial pressure and heart rate at different time intervals among the groups. The VAS was lower in Group C than Group B and A. The ramsay sedation scale was higher in Group C than Group B and A. The rescue analgesic for 24 hour was lower in Group C than Group B and A. The time of first time analgesia requirement was significantly (p=0.001) higher in Group C than Group B and A. The rescue analgesic was significantly (p=0.001) lower in Group C (39.29&#xb1;19.67) than Group B (68.33&#xb1;18.49) and A (160.83&#xb1;35.16).</AbstractText>Multimodal analgesia has beneficial haemodynamic effects during oral cancer surgery with reliable postoperative analgesia and sedation and less postoperative complication. Dose of drugs used in our study is not associated with any major adverse effect.</AbstractText>
2,335,625
Modelling semi-attributable toxicity in dual-agent phase I trials with non-concurrent drug administration.
In oncology, combinations of drugs are often used to improve treatment efficacy and/or reduce harmful side effects. Dual-agent phase I clinical trials assess drug safety and aim to discover a maximum tolerated dose combination via dose-escalation; cohorts of patients are given set doses of both drugs and monitored to see if toxic reactions occur. Dose-escalation decisions for subsequent cohorts are based on the number and severity of observed toxic reactions, and an escalation rule. In a combination trial, drugs may be administered concurrently or non-concurrently over a treatment cycle. For two drugs given non-concurrently with overlapping toxicities, toxicities occurring after administration of the first drug yet before administration of the second may be attributed directly to the first drug, whereas toxicities occurring after both drugs have been given some present ambiguity; toxicities may be attributable to the first drug only, the second drug only or the synergistic combination of both. We call this mixture of attributable and non-attributable toxicity semi-attributable toxicity. Most published methods assume drugs are given concurrently, which may not be reflective of trials with non-concurrent drug administration. We incorporate semi-attributable toxicity into Bayesian modelling for dual-agent phase I trials with non-concurrent drug administration and compare the operating characteristics to an approach where this detail is not considered. Simulations based on a trial for non-concurrent administration of intravesical Cabazitaxel and Cisplatin in early-stage bladder cancer patients are presented for several scenarios and show that including semi-attributable toxicity data reduces the number of patients given overly toxic combinations. &#xa9; 2016 The Authors. Statistics in Medicine Published by John Wiley &amp; Sons Ltd.
2,335,626
Comparison of intravenous labetalol and bupivacaine scalp block on the hemodynamic and entropy changes following skull pin application: A randomized, open label clinical trial.
The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed a study to compare intravenous (IV) labetalol and bupivacaine scalp block in blunting these changes.</AbstractText>Sixty-six patients undergoing elective neurosurgical procedures were randomized into two groups, L (labetalol) and B (bupivacaine) of 33 each. After a standard induction sequence using fentanyl, propofol and vecuronium, patients were intubated. Baseline hemodynamic parameters and entropy levels were noted. Five minutes before, application of the pins, group L patients received IV labetalol 0.25 mg/kg and group B patients received scalp block with 30 ml of 0.25% bupivacaine. Following application of the pins, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and response entropy (RE)/state entropy (SE) were noted at regular time points up to 5 min.</AbstractText>The two groups were comparable with respect to their demographic characteristics. Baseline hemodynamic parameters and entropy levels were also similar. After pinning, the HR, SAP, DAP, MAP, and RE/SE all increased in both groups but were lower in the scalp block group patients. HR increased by 19.8% in group L and by 11% in group B. SAP increased by 11.9% in group L and remained unchanged in group B. DAP increased by 19.7% in group L and by 9.9% in group B, MAP increased by 15.6% in group L and 5% in group B (P &lt; 0.05). No adverse effects were noted.</AbstractText>Scalp block with bupivacaine is more effective than IV labetalol in attenuating the rise in hemodynamic parameters and entropy changes following skull pin application.</AbstractText>
2,335,627
Neighborhood and Acute Myocardial Infarction Mortality as Related to the Driving Time to Percutaneous Coronary Intervention-Capable Hospital.
Driving time to a percutaneous coronary intervention (PCI)-capable hospital is important in timely treatment of acute myocardial infarction (AMI). Our objective was to determine whether driving time from one's residence to a PCI-capable hospital contributes to AMI deaths. We conducted a cross-sectional study of age- and sex-adjusted mortality in census block groups to evaluate this question.</AbstractText>We studied all (14 027) AMI deaths that occurred during 2008-2012 in Arkansas to assess the relationship between driving time from the population center of a block group (neighborhood) to the nearest PCI-capable hospital. We estimated standardized mortality ratios in block groups that were adjusted for education (population over 25 years of age who did not graduate from high school), poverty (population living below federal poverty level), population density (population per square mile), mobility (population residing at the same address as 1 year ago), black (population that is black), rurality (rural households), geodesic distance, and driving time. The median geodesic distance and driving time were 12.8 miles (interquartile range 3.6-30.1) and 28.3 minutes (interquartile range 9.6-58.7), respectively. Risks in neighborhoods with long driving times (90th percentile) were 26% greater than risks in neighborhoods with short driving times (10th percentile), even after adjusting for education, poverty, population density, rurality, and black race (P&lt;0.0001).</AbstractText>AMI mortality increases with increasing driving time to the nearest PCI-capable hospital. Improving the healthcare system by reducing time to arrive at a PCI-capable hospital could reduce AMI deaths.</AbstractText>&#xa9; 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.</CopyrightInformation>
2,335,628
Effect of hypovolemia on efficacy of reflex maintenance of blood pressure on orthostatic challenge.
Blood volume is an important determinant of the efficacy of the negative feedback mechanisms that maintain blood pressure. However, its effect on time profile and magnitude of the responses remain unstudied.</AbstractText>To study the effect of mild hypovolemia on time profiles and magnitude of changes in blood pressure and heart rate in healthy subjects before and after blood donation.</AbstractText>Fifty six healthy volunteer donors who signed up for blood donation were recruited (age 35 &#xb1; 7 years; weight 75 &#xb1; 9 Kg). Baseline beat to beat blood pressure and Lead II ECG was recorded for 5 min followed by orthostatic challenge for 3 min before and after blood donation.</AbstractText>The donation of 450 ml of blood did not lead to any changes in the resting systolic, diastolic or mean blood pressure. However, there was a significant decrease in pulse pressure after blood donation along with an increase in the heart rate. During orthostatic challenge, after blood donation there was a greater fall in systolic, diastolic, mean and pulse pressure along with a greater increase in heart rate as compared to before the blood donation. The latency to response and the total time to recovery of blood pressure and heart rate increased significantly after blood donation.</AbstractText>Maintenance of blood pressure after orthostatic challenge is not compromised after mild hypovolemia produced by donation of 450 ml of blood. However, mild hypovolemia results in increase in latency of response and is accompanied with larger magnitude of fall in blood pressure during orthostatic challenge.</AbstractText>
2,335,629
A case of neonatal lupus erythematosus in a very low-birth-weight infant that suffered intraventricular hemorrhage at birth.
This report describes the case of a very low-birth-weight male infant with neonatal lupus erythematosus. His mother had Sj&#xf6;gren's syndrome, and her previous child had suffered a complete heart block. Accordingly, maternal steroid (betamethasone) therapy was administered to prevent a congenital heart block for 15 weeks (from 13 to 27 weeks' gestation). At 28 weeks' gestation, the mother was weaned off the steroid therapy, and an emergency cesarean section was carried out at 29 weeks and 6 days' gestation because of a nonreassuring fetal status (NRFS). At birth, the infant exhibited grade-III intraventricular hemorrhage (IVH). Although it is unclear why the infant developed a NRFS and IVH, the condition of the fetus should be carefully monitored during and after long-term maternal steroid treatment.
2,335,630
Manifestations of bodily isomerism.
We report the findings present in 49 postmortem specimens from patients with so-called heterotaxy, concentrating on those found in the extracardiac systems of organs. Also known as bodily isomerism, we suggest that it is important to segregate the syndromes into their isomeric subtypes to be able to make inferences regarding likely extracardiac and intracardiac findings to allow for proper surveillance. We demonstrate that this is best done on the basis of the atrial appendages, which were isomeric in all the hearts obtained from the specimens available for our inspection. The abdominal organs do not demonstrate isomerism, and they show variable features when compared to the isomeric atrial appendages.
2,335,631
Focus on Extracellular Vesicles: Therapeutic Potential of Stem Cell-Derived Extracellular Vesicles.
The intense research focus on stem and progenitor cells could be attributed to their differentiation potential to generate new cells to replace diseased or lost cells in many highly intractable degenerative diseases, such as Alzheimer disease, multiple sclerosis, and heart diseases. However, experimental and clinical studies have increasingly attributed the therapeutic efficacy of these cells to their secretion. While stem and progenitor cells secreted many therapeutic molecules, none of these molecules singly or in combination could recapitulate the functional effects of stem cell transplantations. Recently, it was reported that extracellular vesicles (EVs) could recapitulate the therapeutic effects of stem cell transplantation. Based on the observations reported thus far, the prevailing hypothesis is that stem cell EVs exert their therapeutic effects by transferring biologically active molecules such as proteins, lipids, mRNA, and microRNA from the stem cells to injured or diseased cells. In this respect, stem cell EVs are similar to EVs from other cell types. They are both primarily vehicles for intercellular communication. Therefore, the differentiating factor is likely due to the composition of their cargo. The cargo of EVs from different cell types are known to include a common set of proteins and also proteins that reflect the cell source of the EVs and the physiological or pathological state of the cell source. Hence, elucidation of the stem cell EV cargo would provide an insight into the multiple physiological or biochemical changes necessary to affect the many reported stem cell-based therapeutic outcomes in a variety of experimental models and clinical trials.
2,335,632
Saikosaponin-a Attenuates Oxidized LDL Uptake and Prompts Cholesterol Efflux in THP-1 Cells.
Saikosaponins-a (Ssa) is a major bioactive extract of Radix Bupleuri which is a traditional Chinese medicine. The roles of inflammatory response and lipid transportation in the process of atherosclerosis have drawn increasing attention. We explored the regulation of lipid transportation and immune-inflammatory role of Ssa in early atherosclerosis. The antiatherogenic actions and possible molecular mechanisms of Ssa were texted in THP-1 cells. We examined the effect of Ssa on oxidized low-density lipoprotein (ox-LDL)-induced lipid uptake, cholesterol efflux, immune-inflammatory response. THP-1 macrophages were treated with Ssa followed by ox-LDL for 24 hours. Results from western blot showed that Ssa obviously reduced lipoprotein uptake to block foam cell formation and the expression of Density Lipoprotein Receptor-1 and CD36. Ssa also significantly boosted cholesterol efflux and the expression of ATP binding cassettetransporter A1 and peroxisome proliferator-activated receptor &#x3b3;. The results also indicated that Ssa inhibited ox-LDL-induced activation of AKT and nuclear factor-&#x3ba;B, assembly of NLRP3 inflammasome and production of proinflammatory cytokines. It is suggested that the ability against immune inflammatory response of Ssa is due to modulation of the PI3K/AKT/NF-&#x3ba;B/NLRP3 pathway. In conclusion, this study provides new insight into Ssa's molecular mechanism and its therapeutic potential in the treatment of atherosclerosis.
2,335,633
Micro-CT scouting for transmission electron microscopy of human tissue specimens.
Transmission electron microscopy (TEM) provides sub-nanometre-scale details in volumetric samples. Samples such as pathology tissue specimens are often stained with a metal element to enhance contrast, which makes them opaque to optical microscopes. As a result, it can be a lengthy procedure to find the region of interest inside a sample through sectioning. We describe micro-CT scouting for TEM that allows noninvasive identification of regions of interest within a block sample to guide the sectioning step. In a tissue pathology study, a bench-top micro-CT scanner with 10 &#x3bc;m resolution was used to determine the location of patches of the mucous membrane in osmium-stained human nasal scraping samples. Once the regions of interest were located, the sample block was sectioned to expose that location, followed by ultra-thin sectioning and TEM to inspect the internal structure of the cilia of the membrane epithelial cells with nanometre resolution. This method substantially reduced the time and labour of the search process from typically 20 sections for light microscopy to three sections with no added sample preparation.
2,335,634
Lipoxin A4 attenuates LPS-induced mouse acute lung injury via Nrf2-mediated E-cadherin expression in airway epithelial cells.
A fundamental element of acute lung injury (ALI) is the inflammation that is part of the body's immune response to a variety of local or systemic stimuli. Lipoxins (LXs) are important endogenous lipids that mediate resolution of inflammation. Previously, we demonstrated that LXA4 reduced the LPS inhalation-induced pulmonary edema, neutrophil infiltration and TNF-&#x3b1; production in mice. With the same model, the current investigation focused on the role of the airway epithelium, a first-line barrier and a prime target of inhaled toxicants. We report that LXA4 strongly inhibited LPS-induced ALI in mice, in part by protecting the airway epithelium and preserving the E-cadherin expression and airway permeability. Using a cryo-imaging assay and fluorescence detection, LXA4 was shown to block LPS-induced ROS generation and preserve mitochondrial redox status both in vivo and in vitro. To further assess whether and how NF-E2-related factor 2 (Nrf2) was involved in the protective effect of LXA4, fluorescence resonance energy transfer (FRET) analysis was employed in human epithelial cell line (16HBE), to determine the relative distance between Nrf2 and its negative regulator or cytosolic inhibitor, Kelch-like ECH-associated protein 1 (Keap1). It provided us the evidence that LXA4 further promoted the dissociation of Nrf2 and Keap1 in LPS-treated 16HBE cells. The results also showed that LXA4 activates Nrf2 by phosphorylating it on Ser40 and triggering its nuclear translocation. Moreover, when the plasmid expression dominant negative mutation of Nrf2 was transfected as an inhibitor of wild-type Nrf2, the protective effect of LXA4 on E-cadherin expression was almost completely blocked. These results provide a new mechanism by which LXA4 inhibits LPS-induced ALI through Nrf2-mediated E-cadherin expression.
2,335,635
Prolonged Mouse Cardiac Graft Cold Storage via Attenuating Ischemia-Reperfusion Injury Using a New Antioxidant-Based Preservation Solution.
One of the major events in ischemia-reperfusion (I/R)-induced heart injury in cardiac transplantation is the generation of reactive oxygen species. We hypothesized that a novel preservation solution called SBI-SEIIKU II (SS-II) contains 3 antioxidant reagents: L-cysteine, glycine, ascorbic acid/ascorbic acid-2-phosphate magnesium, which can block the generation of reactive oxygen species to result in a prolongation of the cold storage time via attenuating I/R injury.</AbstractText>C57BL/6CrSlc(B6) mice underwent syngeneic mice heterotopic heart transplantation, and the animals were derived into 3 groups: recipients with nonpreserved grafts (control group), recipients with grafts preserved in histidine-tryptophan-ketoglutarate (HTK) for 24 and 48 hours (HTK group), and recipients with grafts preserved in SS-II for 24 and 48 hours (SS-II group).</AbstractText>After 48 hours of preservation, there were no grafts that survived in the HTK group; however, the SS-II group had a high survival rate. After 24 hours of preservation, SS-II decreased the oxidative damage, myocardial apoptosis, and the infiltration of macrophages and neutrophils in the cardiac grafts in the early phase and suppressed the development of myocardial fibrosis in long-term grafts compared with HTK.</AbstractText>The SS-II prolongs the acceptable cold storage time and protects the myocardium from I/R injury via inhibiting oxidative stress-associated damage. We believe that this novel preservation solution may be simple and safe for use in the clinical transplantation field.</AbstractText>
2,335,636
The high incidence of anti-Ro/SSA and anti-p200 antibodies in female patients with connective tissue diseases confirms the importance of screening for congenital heart block-associated autoantibodies during pregnancy.
It is known that anti-Ro/SSA positivity leads to higher risk of miscarriage and fetal cardiac malformations. Particularly, anti-p200 antibodies against a finer specificity of the Ro/SSA antigen, have been associated with congenital heart block. The aim of the study was to assess the frequency of anti-p200 among female patients with different connective tissue diseases and, among these, the relevance of anti-p200 values in patients with cutaneous diseases compared to systemic diseases. Anti-p200 were investigated in 110 anti-Ro/SSA positive female sera, sent to our laboratory between 2008 and 2014 with suspect of connective disease, by using ELISA testing. Positivity was found in 40.9 % samples, 34 of them showed a strong positivity (values &#x2265; 1.0, cut off = 0.7). Patients with systemic diseases were anti-p200 positive in the 45.9 % of cases while patients with cutaneous diseases were positive in the 24.0 % of cases. Positivity for anti-p200 antibodies was revealed in 24.0 % of patients with discoid lupus erythematosus; 100 % of patients with dermatomyositis; 40.0 % of patients with mixed connective tissue disease; 25.0 % of patients with rheumatoid arthritis; 100 % of patients with Sj&#xf6;gren's syndrome; 33.3 % of patients with subacute cutaneous lupus erythematosus; 42.9 % of patients with systemic lupus erythematosus; 80.0 % of patients with systemic sclerosis. No significant difference in anti-p200 prevalence was found between systemic and cutaneous involvement, nevertheless, considering only positive sera, the antibody titer was higher in systemic diseases rather than in cutaneous diseases (2.6 &#xb1; 1.7 and 1.7 &#xb1; 1.9; p = 0.041). The authors think screenings for anti-Ro/SSA and anti-p200 antibodies should be included in the laboratory checklist for pregnancy.
2,335,637
Further evidence for the role of histamine H3, but not H1, H2 or H4, receptors in immepip-induced inhibition of the rat cardioaccelerator sympathetic outflow.
Since histamine H3 and H4 receptors are coupled to heterotrimeric Gi/o proteins, a signal transduction pathway associated with inhibition of neurotransmitter release, the present study has investigated the inhibition of the rat cardioaccelerator sympathetic outflow induced by the H3/H4 receptor agonist immepip by using antagonists for histamine H1 (ketotifen), H2 (ranitidine), H3 (thioperamide) and H4 (JNJ7777120) receptors. For this purpose, 102 male Wistar rats were pithed, artificially ventilated and prepared for either preganglionic spinal (C7-T1) stimulation of the cardioaccelerator sympathetic outflow (n=90) or i.v. bolus injections of noradrenaline (n=12). This approach resulted in frequency-dependent and dose-dependent tachycardic responses, respectively. I.v. continuous infusions of immepip (3 and 10 &#x3bc;g/kg min), but not of saline (0.02 ml/min), dose-dependently inhibited the sympathetically-induced tachycardic responses. Moreover, the cardiac sympatho-inhibition induced by 10 &#x3bc;g/kg min immepip (which failed to affect the tachycardic responses to i.v. noradrenaline) was: (i) unaltered after i.v. treatment with 1 ml/kg vehicle, 100 &#x3bc;g/kg ketotifen, 3000 &#x3bc;g/kg ranitidine, 30 &#x3bc;g/kg thioperamide or 300 &#x3bc;g/kg JNJ7777120; and (ii) abolished after 100 &#x3bc;g/kg thioperamide (i.v.). These doses of antagonists, which did not affect per se the sympathetically-induced tachycardic responses, were high enough to block their respective receptors. In conclusion, the cardiac sympatho-inhibition induced by 10 &#x3bc;g/kg.min immepip involves histamine H3 receptors, with further pharmacological evidence excluding the involvement of H1, H2 and H4 receptors.
2,335,638
Relation of QRS Duration to Clinical Benefit of Cardiac Resynchronization Therapy in Mild Heart Failure Patients Without Left Bundle Branch Block: The Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy Substudy.<Pagination><StartPage>e002667</StartPage><MedlinePgn>e002667</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1161/CIRCHEARTFAILURE.115.002667</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">There are conflicting data regarding the efficacy of cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and without left bundle branch block.</AbstractText><AbstractText Label="METHODS AND RESULTS" NlmCategory="RESULTS">We evaluated the long-term clinical outcomes of 537 non-left bundle branch block patients with mild HF enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study by QRS duration or morphology further stratified by PR interval. At 7 years of follow-up, the cumulative probability of HF hospitalization or death was 45% versus 56% among patients randomized to implantable cardioverter-defibrillator and CRT with defibrillator (CRT-D), respectively (P=0.209). Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile QRS duration group (&#x2264; 134 ms) experienced 2.4-fold (P=0.015) increased risk for HF hospitalization or death with CRT-D versus implantable cardioverter-defibrillator only therapy, whereas the effect of CRT-D in patients from the upper quartiles group (QRS&gt;134 ms) was neutral (hazard ratio [HR] =0.97, P=0.86; P value for interaction =0.024). In a second analysis incorporating PR interval, patients with prolonged QRS (&gt;134 ms) and prolonged PR (&gt;230 ms) were protected with CRT-D (HR=0.31, P=0.003), whereas the association was neutral with prolonged QRS (&gt;134 ms) and shorter PR (&#x2264; 230 ms;, HR=1.19, P=0.386; P value for interaction =0.002). The effect was neutral, regardless of morphology, right bundle branch block (HR=1.01, P=0.975), and intraventricular conduction delay (HR=1.31, P=0.172).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Overall, patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter-defibrillator -only.</AbstractText><AbstractText Label="CLINICAL TRIAL REGISTRATION" NlmCategory="BACKGROUND">URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.</AbstractText><CopyrightInformation>&#xa9; 2016 American Heart Association, Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Biton</LastName><ForeName>Yitschak</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.). [email protected] [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kutyifa</LastName><ForeName>Valentina</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cygankiewicz</LastName><ForeName>Iwona</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Goldenberg</LastName><ForeName>Ilan</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Klein</LastName><ForeName>Helmut</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>McNitt</LastName><ForeName>Scott</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Polonsky</LastName><ForeName>Bronislava</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ruwald</LastName><ForeName>Anne Christine</ForeName><Initials>AC</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ruwald</LastName><ForeName>Martin H</ForeName><Initials>MH</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Moss</LastName><ForeName>Arthur J</ForeName><Initials>AJ</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zareba</LastName><ForeName>Wojciech</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.).</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><DataBankList CompleteYN="Y"><DataBank><DataBankName>ClinicalTrials.gov</DataBankName><AccessionNumberList><AccessionNumber>NCT00180271</AccessionNumber><AccessionNumber>NCT01294449</AccessionNumber><AccessionNumber>NCT02060110</AccessionNumber></AccessionNumberList></DataBank></DataBankList><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Circ Heart Fail</MedlineTA><NlmUniqueID>101479941</NlmUniqueID><ISSNLinking>1941-3289</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000200" MajorTopicYN="N">Action Potentials</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058406" MajorTopicYN="Y">Cardiac Resynchronization Therapy</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016009" MajorTopicYN="N">Chi-Square Distribution</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017147" MajorTopicYN="N">Defibrillators, Implantable</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004554" MajorTopicYN="Y">Electric Countershock</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000295" MajorTopicYN="N">instrumentation</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006329" MajorTopicYN="N">Heart Conduction System</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006333" MajorTopicYN="N">Heart Failure</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006339" MajorTopicYN="N">Heart Rate</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053208" MajorTopicYN="N">Kaplan-Meier Estimate</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018579" MajorTopicYN="N">Patient Selection</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016016" MajorTopicYN="N">Proportional Hazards Models</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016032" MajorTopicYN="N">Randomized Controlled Trials as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">bundle-branch block</Keyword><Keyword MajorTopicYN="N">heart failure</Keyword><Keyword MajorTopicYN="N">implanted cardioverter&#x2013;defibrillator</Keyword><Keyword MajorTopicYN="N">morbidity/mortality</Keyword><Keyword MajorTopicYN="N">resynchronization</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>1</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>1</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>6</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">26823498</ArticleId><ArticleId IdType="doi">10.1161/CIRCHEARTFAILURE.115.002667</ArticleId><ArticleId IdType="pii">CIRCHEARTFAILURE.115.002667</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">26820557</PMID><DateCompleted><Year>2016</Year><Month>05</Month><Day>10</Day></DateCompleted><DateRevised><Year>2022</Year><Month>04</Month><Day>08</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1469-493X</ISSN><JournalIssue CitedMedium="Internet"><Issue>1</Issue><PubDate><Year>2016</Year><Month>Jan</Month><Day>28</Day></PubDate></JournalIssue><Title>The Cochrane database of systematic reviews</Title><ISOAbbreviation>Cochrane Database Syst Rev</ISOAbbreviation></Journal>Beta-blockers for congestive heart failure in children.
There are conflicting data regarding the efficacy of cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and without left bundle branch block.</AbstractText>We evaluated the long-term clinical outcomes of 537 non-left bundle branch block patients with mild HF enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study by QRS duration or morphology further stratified by PR interval. At 7 years of follow-up, the cumulative probability of HF hospitalization or death was 45% versus 56% among patients randomized to implantable cardioverter-defibrillator and CRT with defibrillator (CRT-D), respectively (P=0.209). Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile QRS duration group (&#x2264; 134 ms) experienced 2.4-fold (P=0.015) increased risk for HF hospitalization or death with CRT-D versus implantable cardioverter-defibrillator only therapy, whereas the effect of CRT-D in patients from the upper quartiles group (QRS&gt;134 ms) was neutral (hazard ratio [HR] =0.97, P=0.86; P value for interaction =0.024). In a second analysis incorporating PR interval, patients with prolonged QRS (&gt;134 ms) and prolonged PR (&gt;230 ms) were protected with CRT-D (HR=0.31, P=0.003), whereas the association was neutral with prolonged QRS (&gt;134 ms) and shorter PR (&#x2264; 230 ms;, HR=1.19, P=0.386; P value for interaction =0.002). The effect was neutral, regardless of morphology, right bundle branch block (HR=1.01, P=0.975), and intraventricular conduction delay (HR=1.31, P=0.172).</AbstractText>Overall, patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter-defibrillator -only.</AbstractText>URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.</AbstractText>&#xa9; 2016 American Heart Association, Inc.</CopyrightInformation>
2,335,639
[Cardiac arrest after epidural anesthesia for a esthetic plastic surgery: a case report].
Cardiac arrest during neuraxial anesthesia is a serious adverse event, which may lead to significant neurological damage and death if not treated promptly. The associated mechanisms are neglected respiratory failure, extensive sympathetic block, local anaesthetic toxicity, total spinal block, in addition to the growing awareness of the vagal predominance as a predisposing factor. In the case reported, the patient was 25 years old, ASA I, scheduled for aesthetic lipoplasty. After sedation with midazolam and fentany, epidural anesthesia in interspaces T12-L1 and T2-T3 and catheter insertion into inferior puncture were performed. The patient remained in the supine position for 10minutes. Then, she was placed in the prone position, developing asystolic cardiac arrest 20minutes after the completion of neuraxial blockade. The medical team immediately placed the patient in the supine position and began cardiopulmonary resuscitation. Spontaneous circulation was achieved after twenty minutes of resuscitation. We discuss in this report the exacerbated vagal response as the main event mechanism. The patient's successful outcome emphasizes the importance of anaesthetic monitoring by anesthesiologists, prompt recognition and treatment of rhythm changes on the electrocardiogram.
2,335,640
Evaluating Femoral-Sciatic Nerve Blocks, Epidural Analgesia, and No Use of Regional Analgesia in Dogs Undergoing Tibia-Plateau-Leveling-Osteotomy.
This is a retrospective study evaluating femoral-sciatic nerve blocks (FSBs), epidural analgesia, and non-regional analgesia (NRA) in dogs undergoing tibia-plateau-leveling-osteotomy surgery. Thirty-five records met the criteria for each of the FSB and epidural analgesia groups. Seventeen anesthesia records met the criteria for the NRA or control group. The parameters reported were: isoflurane vaporizer setting, rescue analgesia/anesthesia drugs received, heart rate, systolic blood pressure, and recovery quality (0-4, with 0 being poor and 4 being good). Rescue analgesia-anesthesia during surgery was performed with either fentanyl, ketamine, or propofol. A larger percentage of dogs in the NRA group required rescue analgesia during surgery. The FSB group had a higher recovery quality with median (95% confidence interval of four (&#xb1;0.3) when compared to two (&#xb1;0.8) in NRA (p &lt; 0.01). No difference between groups was observed on any other parameter reported. As part of a multimodal analgesia approach for tibia-plateau-leveling-osteotomy surgery, the use of femoral and sciatic nerves blocks with bupivacaine appears to be an alternative technique to help with analgesia and anesthesia during surgery.
2,335,641
Workplace Health Promotion: Assessing the Cardiopulmonary Risks of the Construction Workforce in Hong Kong.
Health needs of different employee subgroups within an industry can differ. We report the results of a workplace cardiopulmonary risk assessment targeting workers and support staff in the construction industry.</AbstractText>A free worksite-based cardiopulmonary risk assessment for 1,903 workers on infrastructural contracts across Hong Kong was initiated in May 2014. Cardiopulmonary risk screening was performed in 60-minute blocks for approximately 30 workers/block with individualized feedback and lifestyle counseling. Risk profiles stratified by occupational roles are differentiated using the &#x3c7;2-test for categorical and Student's t-test for continuous variables.</AbstractText>Most construction workers and clerks/professionals were male (83.2% and 71.2%, respectively) and Chinese (78.7% and 90.9%, respectively). Construction workers were older (mean: 44.9 years, SD 11.5) and less well-educated (6.1% received tertiary education) than clerks/professionals (35.0 years, 10.7; 72.6% received tertiary education), but more likely to be hypertensive (22.6% vs. 15.4%, p&lt;0.001), overweight/obese (71.7% vs. 56.6%, p&lt;0.001), centrally obese (53.1% vs. 35.5%, p&lt;0.001), and have undesirable levels of high-density lipoprotein (41.6% vs. 35.8%, p&lt;0.05) and diabetic levels of non-fasting blood glucose (4.3% vs. 1.6%, p&lt;0.05). Up to 12.6% of construction workers and 9.7% of office clerks/professions had three or more metabolic syndrome risk factors. While construction workers were more likely than clerks/professionals to be daily smokers, they reported better work-related physical activity and diet.</AbstractText>Simple worksite health risk screening can identify potentially high-cardiopulmonary-risk construction industry employee subgroups for onward confirmatory referral. Separate cardiopulmonary health promotion strategies that account for the varying lifestyle profiles of the two employee subgroups in the industry appear justified.</AbstractText>
2,335,642
Pregnancy and Electroconvulsive Therapy: A Multidisciplinary Approach.
To scrutinize a series of pregnant women treated with electroconvulsive therapy (ECT) at a tertiary treatment center and combine these data with a literature review to refine the treatment guidelines for ECT during pregnancy.</AbstractText>A retrospective chart review of mentally ill pregnant patients treated with ECT since the establishment of a formal women's mental health program.</AbstractText>A total of 8 pregnant women treated with ECT were identified from January 2012 to August 2014. Information was extracted from the medical records of a total of 30 ECT treatments across this group. Subjects received an average of 3.75 ECT treatments (range, 1-7). All women were diagnosed as having a mood disorder (either unipolar or bipolar), and 5 of the 8 women had suicidal ideation. The treatment team for ECT was consistent across all treatments. Two women experienced significant complications after the initial treatment: 1) an acute episode of complete heart block; and 2) acute onset of mania after ECT. Obstetrical complications included 2 women with preterm delivery-one secondary to premature rupture of membranes. No other complications or adverse outcomes were recorded. The 5 women with suicidal ideation had symptom resolution, and significant symptom improvement was noted in 6 of the 8 women.</AbstractText>Electroconvulsive therapy is a safe and effective treatment during pregnancy and of particular benefit in the acute treatment of suicidal ideation.</AbstractText>
2,335,643
The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure.
The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket.</AbstractText>An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling.</AbstractText>Twiddler's syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.</AbstractText>
2,335,644
The Cardiac Electrophysiology Web Lab.
Computational modeling of cardiac cellular electrophysiology has a long history, and many models are now available for different species, cell types, and experimental preparations. This success brings with it a challenge: how do we assess and compare the underlying hypotheses and emergent behaviors so that we can choose a model as a suitable basis for a new study or to characterize how a particular model behaves in different scenarios? We have created an online resource for the characterization and comparison of electrophysiological cell models in a wide range of experimental scenarios. The details of the mathematical model (quantitative assumptions and hypotheses formulated as ordinary differential equations) are separated from the experimental protocol being simulated. Each model and protocol is then encoded in computer-readable formats. A&#xa0;simulation tool runs virtual experiments on models encoded in CellML, and a website (https://chaste.cs.ox.ac.uk/WebLab) provides a friendly interface, allowing users to store and compare results. The system currently contains a sample of 36 models and 23 protocols, including current-voltage curve generation, action potential properties under steady pacing at different rates, restitution properties, block of particular channels, and hypo-/hyperkalemia. This resource is publicly available, open source, and free, and we invite the community to use it and become involved in future developments. Investigators interested in comparing competing hypotheses using models can make a more informed decision, and those developing new models can upload them for easy evaluation under the existing protocols, and even add their own protocols.
2,335,645
Relationships Between Gum-Chewing and Stress.
Studies have shown that chewing is thought to affect stress modification in humans. Also, studies in animals have demonstrated that active chewing of a wooden stick during immobilization stress ameliorates the stress-impaired synaptic plasticity and prevents stress-induced noradrenaline release in the amygdala. On the other hand, studies have suggested that the right prefrontal cortex (PFC) dominates the regulation of the stress response system, including the hypothalamic-pituitary-adrenal (HPA) axis. The International Affective Digitized Sounds-2 (IADS) is widely used in the study of emotions and neuropsychological research. Therefore, in this study, the effects of gum-chewing on physiological and psychological (including PFC activity measured by NIRS) responses to a negative stimulus selected from the IADS were measured and analyzed. The study design was approved by the Ethics Committee of Tokyo Dental College (No. 436). We studied 11 normal adults using: cerebral blood oxygenation in the right medial PFC by multi-channel NIRS; alpha wave intensity by EEG; autonomic nervous function by heart rate; and emotional conditions by the State-Trait Anxiety Inventory (STAI) test and the 100-mm visual analogue scale (VAS). Auditory stimuli selected were fewer than 3.00 in Pleasure value. Sounds were recorded in 3 s and reproduced at random using software. Every task session was designed in a block manner; seven rests: Brown Noise (30 s) and six task blocks: auditory stimuli or auditory stimuli with gum-chewing (30 s). During the test, the participants' eyes were closed. Paired Student's t-test was used for the comparison (P&lt;0.05). Gum-chewing showed a significantly greater activation in the PFC, alpha wave appearance rate and HR. Gum-chewing also showed a significantly higher VAS score and a smaller STAI level indicating 'pleasant'. Gum-chewing affected physiological and psychological responses including PFC activity. This PFC activation change might influence the HPA axis and ANS activities. In summary, within the limitations of this study, the findings suggest that gum-chewing reduced stress-related responses. Gum-chewing might have a possible effect on stress coping.
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Influence of Pleasant and Unpleasant Auditory Stimuli on Cerebral Blood Flow and Physiological Changes in Normal Subjects.
The prefrontal cortex (PFC) plays an important role in emotion and emotional regulation. The valence asymmetry hypothesis, proposes that the left/right asymmetry of the PFC activity is correlated with specific emotional responses to stressors. However, this hypothesis still seems to leave room for clarifying neurophysiological mechanisms. The purpose of the present study was to investigate the effects of stimuli with positive and negative valence sounds (hereafter PS, NS) selected from the International Affective Digitized Sounds-2 on physiological and physiological responses, including PFC activity in normal participants. We studied the effect of both stimuli using 12 normal subjects (mean age 26.8 years) on cerebral blood oxygenation in the bilateral PFC by a multi-channel NIRS, alpha wave appearance rate in theta, alpha, beta by EEG, autonomic nervous function by heart rate, and emotional conditions by the State-Trait Anxiety Inventory (STAI) and the visual analogue scale (VAS). PS was selected over 7.00 and NS were fewer than 3.00 in the Pleasure values. Sounds were recorded during 3 s and reproduced at random using software. Every task session was designed in a block manner: seven rests with Brown Noise (30 s) and six tasks (30 s) blocks. All participants performed each session in random order with eyes closed. A paired Student's t-test was used for comparisons (P&lt;0.05). PFC activity showed increases bilaterally during both stimuli with a greater activation of the left side in PS and a tendency of more activation by NS in the right PFC. Significantly greater alpha wave intensity was obtained in PS. Heart rate tended to show smaller values in PS. The STAI level tended to show smaller values in PS, and a significantly greater VAS score was obtained in PS which indicated 'pleasant'. Despite the limitations of this study such as the low numbers of the subjects, the present study indicated that PS provided pleasant psychological and physiological responses and NS unpleasant responses. The PFC was activated bilaterally, implying a valence effect with the possibility of a dominant side.
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Prior hospital admission predicts thirty-day hospital readmission for heart failure patients.
Hospital readmission is a significant health burden. More than 20% of heart failure (HF) patients are readmitted within 30 days of discharge leading to billions of dollars in health care expenditures. However, the role of prior hospital admissions to predict 30-day readmission for HF patients is not fully understood.</AbstractText>We retrospectively analyzed HF hospitalization data for 4 years at a single medical center. Association between prior admission and 30-day readmission after HF hospitalization was assessed using a multivariate logistic regression model.</AbstractText>A total of 1,999 patients with index HF hospitalizations were identified, and 366 of them (18%) were readmitted within 30 days. The rate of readmission was 14%, 20%, and 33% in patients with 0, 1, &#x2265; 2 prior admissions. Patients with one prior admission had a 50% higher risk (confidence interval [CI] 1.10-2.05, p = 0.011) for readmission, while those with &#x2265; 2 prior admissions had a more than 3-fold increase in readmission (CI 2.27-4.09, p &lt; 0.001), after adjustments for relevant clinical covariates. Prior hospital admission provided incremen-tal value in predicting readmissions, shown by the significant improvement in the readmission predictive model (C-statistics increased from 0.57 to 0.63). However, neither the length of stay nor recency of prior admission was a significant factor in predicting readmissions.</AbstractText>Hospital admission prior to an index HF hospitalization is associated with a significantly increased risk for 30-day hospital readmission and could be used to identify patients at high-risk for readmission and potentially target interventions to reduce the risk of readmission for these patients.</AbstractText>
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Efficacy and safety of enzalutamide versus bicalutamide for patients with metastatic prostate cancer (TERRAIN): a randomised, double-blind, phase 2 study.
Enzalutamide is an oral androgen-receptor inhibitor that has been shown to improve survival in two placebo-controlled phase 3 trials, and is approved for patients with metastatic castration-resistant prostate cancer. The objective of the TERRAIN study was to compare the efficacy and safety of enzalutamide with bicalutamide in patients with metastatic castration-resistant prostate cancer.</AbstractText>TERRAIN was a double-blind, randomised phase 2 study, that recruited asymptomatic or minimally symptomatic men with prostate cancer progression on androgen-deprivation therapy (ADT) from academic, community, and private health-care provision sites across North America and Europe. Eligible patients were randomly assigned (1:1) via an interactive voice response system to receive enzalutamide 160 mg/day or bicalutamide 50 mg/day, both taken orally, in addition to ADT, until disease progression. Patients were stratified by a permutated block method (block size of four), by whether bilateral orchiectomy or receipt of luteinising hormone-releasing hormone agonist or antagonist therapy started before or after the diagnosis of metastases, and by study site. Participants, investigators, and those assessing outcomes were masked to group assignment. The primary endpoint was progression-free survival, analysed in all randomised patients. Safety outcomes were analysed in all patients who received at least one dose of study drug. The open-label period of the trial is in progress, wherein patients still on treatment at the end of the double-blind treatment period were offered open-label enzalutamide at the discretion of the patient and study investigator. This trial is registered with ClinicalTrials.gov, number NCT01288911.</AbstractText>Between March 22, 2011, and July 11, 2013, 375 patients were randomly assigned, 184 to enzalutamide and 191 to bicalutamide. 126 (68%) and 168 (88%) patients, respectively, discontinued their assigned treatment before study end, mainly due to progressive disease. Median follow-up time was 20&#xb7;0 months (IQR 15&#xb7;0-25&#xb7;6) in the enzalutamide group and 16&#xb7;7 months (10&#xb7;2-21&#xb7;9) in the bicalutamide group. Patients in the enzalutamide group had significantly improved median progression-free survival (15&#xb7;7 months [95% CI 11&#xb7;5-19&#xb7;4]) compared with patients in the bicalutamide group (5&#xb7;8 months [4&#xb7;8-8&#xb7;1]; hazard ratio 0&#xb7;44 [95% CI 0&#xb7;34-0&#xb7;57]; p&lt;0&#xb7;0001). Of the most common adverse events, those occurring more frequently with enzalutamide than with bicalutamide were fatigue (51 [28%] of 183 patients in the enzalutamide group vs 38 [20%] of 189 in the bicalutamide group), back pain (35 [19%] vs 34 [18%]), and hot flush (27 [15%] vs 21 [11%]); those occurring more frequently with bicalutamide were nausea (26 [14%] vs 33 [17%]), constipation (23 [13%] vs 25 [13%]), and arthralgia (18 [10%] vs 30 [16%]). The most common grade 3 or worse adverse events in the enzalutamide or bicalutamide treatment groups, respectively, were hypertension (13 [7%] vs eight [4%]), hydronephrosis (three [2%] vs seven [4%]), back pain (five [3%] vs three [2%]), pathological fracture (five [3%] vs two [1%]), dyspnoea (four [2%] vs one [1%]), bone pain (one [1%] vs four [2%]), congestive cardiac failure (four [2%] vs two [1%]), myocardial infarction (five [3%] vs none), and anaemia (four [2%] vs none]). Serious adverse events were reported by 57 (31%) of 183 patients and 44 (23%) of 189 patients in the enzalutamide and bicalutamide groups, respectively. One of the nine deaths in the enzalutamide group was thought to be possibly related to treatment (due to systemic inflammatory response syndrome) compared with none of the three deaths in the bicalutamide group.</AbstractText>The data from the TERRAIN trial support the use of enzalutamide rather than bicalutamide in patients with asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer.</AbstractText>Astellas Pharma, Inc and Medivation, Inc.</AbstractText>Copyright &#xa9; 2016 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease: Efficacy and Safety.
Mineralocorticoid receptor antagonists (MRAs) that block aldosterone's effects on both epithelial and non-epithelial receptors have become a mainstay of therapy for chronic heart failure. Given that cardiovascular events remain the leading cause of death for patients with end-stage renal disease (ESRD), the question of whether these MRAs can be employed in dialysis patients arises. This review summarizes the rationale for blocking aldosterone in patients with chronic and end-stage kidney disease and surveys the data on both the efficacy and safety of using MRAs in the ESRD population. A small but growing body of literature suggests that use of MRAs by ESRD patients is associated with lower blood pressure, reduced left ventricular (LV) mass, and improved LV ejection fraction. Recently, a large randomized trial found an overall 3-year mortality rate of 6.4% in ESRD patients on spironolactone 25 mg daily vs. 19.7% in ESRD patients on no MRA therapy (p = 0.002), without a significantly increased risk of hyperkalemia.
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Femoral and sciatic nerve blockades and incision site infiltration in rabbits undergoing stifle joint arthrotomy.
This study was designed to determine whether perineural injections of local anaesthetics decreases intraoperative nociception and improves postoperative analgesia in New Zealand White rabbits undergoing experimental stifle arthrotomy. All animals were anaesthetized using isoflurane and received morphine intramuscularly. The sciatic and femoral nerves of the leg to be operated on were located using a nerve stimulator (1&#x2009;Hz, 0.5&#x2009;mA). Rabbits were assigned to a treatment group (LB; n&#x2009;=&#x2009;12) or a placebo group (P; n&#x2009;=&#x2009;12) in a randomized blinded fashion. Group LB received lidocaine 2% (1&#x2009;mg/kg) combined with bupivacaine 0.5% (0.25&#x2009;mg/kg) injections around the sciatic and femoral nerves (0.1&#x2009;mL/kg total volume per site) and subcutaneous infiltration of the incision site with lidocaine 1% (1.25&#x2009;mg/kg). Group P received the same volume of 0.9% NaCl. Rabbits in group P required higher doses of intraoperative fentanyl and propofol to reduce heart rate and suppress increase in systolic blood pressure, and maintain an adequate anaesthetic plane. Interventional analgesia (buprenorphine and carprofen) was required significantly earlier in rabbits in group P (2 and 6&#x2009;h after the first nerve blockade, respectively) based on assessment of their pain-related behaviour and range of motion. Using a visual analogue scale (0&#x2009;mm=&#x2009;no pain to 100&#x2009;mm=&#x2009;maximal possible pain), rabbits in group LB were judged to show significantly less pain compared with rabbits in group P (14&#x2009;&#xb1;&#x2009;10&#x2009;mm and 37&#x2009;&#xb1;&#x2009;25&#x2009;mm, respectively) 2&#x2009;h after nerve blockade. In conclusion, this technique of perineural analgesia combined with incision site infiltration reduced intraoperative fentanyl requirements and improved postoperative analgesia in rabbits.
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Dual HER2 Targeting with Trastuzumab and Liposomal-Encapsulated Doxorubicin (MM-302) Demonstrates Synergistic Antitumor Activity in Breast and Gastric Cancer.
Trastuzumab is the standard of care for HER2-positive breast cancer patients, markedly improving disease-free and overall survival. Combined with chemotherapy, it enhances patient outcomes, but cardiotoxicity due to the trastuzumab treatment poses a serious adverse effect. MM-302 is a HER2-targeted PEGylated liposome that encapsulates doxorubicin to facilitate its delivery to HER2-overexpressing tumor cells while limiting exposure to nontarget tissues, including the heart. In this study, we evaluated the feasibility and preclinical activity of combining MM-302 with trastuzumab. MM-302 and trastuzumab target different domains of the HER2 receptor and thus could simultaneously bind HER2-overexpressing tumor cells in vitro and in vivo. Furthermore, trastuzumab did not disrupt the mechanism of action of MM-302 in delivering doxorubicin to the n0ucleus and inducing DNA damage. Reciprocally, MM-302 did not interfere with the ability of trastuzumab to block prosurvival p-Akt signaling. Interestingly, coadministration of the two agents acutely increased the deposition of MM-302 in human xenograft tumors and subsequently increased the expression of the DNA damage marker p-p53. Finally, the combination of MM-302 and trastuzumab induced synergistic antitumor activity in HER2-overexpressing xenograft models of breast and gastric cancer. Collectively, our findings highlight a novel combination therapy that efficiently targets HER2-overexpressing cells through multiple mechanisms and support the ongoing investigation of combined MM-302/trastuzumab therapy for HER2-positive metastatic breast cancer in a randomized phase II clinical trial.
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Failed caudal block due to physiologic changes associated with a cerebrospinal fluid leak: a case report.
The sum of the volumes of brain tissue, cerebrospinal fluid (CSF), and intracranial blood remain constant. This tenet of the Monroe-Kellie hypothesis is most often considered in the setting of intracranial hypertension, but it can also be applied in the setting of CSF volume depletion. We used this hypothesis to explain a case of failed caudal block in a patient with an iatrogenic CSF leak.</AbstractText>A one-month-old baby (3 kg) born at 35 weeks' gestation presented for right inguinal hernia repair. His past medical history was significant for arthrogryposis (congenital joint contractures in two or more areas of the body) as well as ongoing apneic episodes that required continuous positive airway pressure therapy and neonatal intensive care. An ultrasound confirmed caudal block was completed and within five minutes of the procedure, the patient's heart rate increased, with an accompanying slight increase in T-wave amplitude. Pinch tests revealed anesthesia to the feet bilaterally but insufficient anesthesia to the abdomen. The surgery was delayed but successfully completed under general anesthesia the following week. Magnetic resonance imaging of the brain and spine following the surgery showed a significant CSF leak with engorgement of the epidural venous plexus along the entire spine. These findings were consistent with a CSF leak likely secondary to a prior lumbar puncture (at age 13 days) that was part of the investigation of his respiratory issues.</AbstractText>The possible mechanism of this failed caudal block was high systemic absorption of anesthetic given the epidural venous plexus engorgement thus leaving less anesthetic acting within the CSF and on the exiting spinal nerves. Decreased CSF flow in the thecal sac might also have contributed, as might dilution of the remaining local anesthetic caused by large amounts of leaking CSF within the epidural space.</AbstractText>
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Permanent Pacemaker Implantation Early After Cardiac Surgery: A Descriptive Study of Pacemaker Utility After One Year of Follow-Up.
Complete heart block (CHB) is a common complication of cardiac surgery, which may resolve spontaneously. The optimal number of days to wait for resolution of CHB prior to proceeding with a permanent pacemaker (PPM) and the long-term utility of PPMs placed in this setting remain uncertain.</AbstractText>This was a retrospective cohort study, which included members of Kaiser Permanente Northern California who had cardiac surgery, a PPM placed within 30 days after surgery, and one year of follow-up time. Chart review was performed to determine the frequency of ventricular pacing at each PPM interrogation visit up to one year after surgery. A PPM was categorized as underutilized at the time of an interrogation if none of the following were present: underlying rhythm &lt;40&#x2009;bpm, persistent CHB, or &gt;1% ventricular pacing. The study included 247 patients with a mean time from cardiac surgery to PPM of 6.5 days. In 33 cases (13%), underutilized status was confirmed. The time from surgery to PPM implant was significantly higher in the underutilized group (8.1&#x2009;&#xb1;&#x2009;4.2 days vs. 6.2&#x2009;&#xb1;&#x2009;4.2 days, p&#x2009;=&#x2009;0.003).</AbstractText>The majority of PPMs placed early after cardiac surgery are not underutilized. In this retrospective, observational study, longer delay from surgery to PPM implantation was not associated with a greater likelihood that the PPM would be utilized long term. A prospective study is required to determine optimal timing of PPM implantation in this setting.</AbstractText>&#xa9; 2016 Wiley Periodicals, Inc.</CopyrightInformation>
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A multi-factorial analysis of response to warfarin in a UK prospective cohort.
Warfarin is the most widely used oral anticoagulant worldwide, but it has a narrow therapeutic index which necessitates constant monitoring of anticoagulation response. Previous genome-wide studies have focused on identifying factors explaining variance in stable dose, but have not explored the initial patient response to warfarin, and a wider range of clinical and biochemical factors affecting both initial and stable dosing with warfarin.</AbstractText>A prospective cohort of 711 patients starting warfarin was followed up for 6 months with analyses focusing on both non-genetic and genetic factors. The outcome measures used were mean weekly warfarin dose (MWD), stable mean weekly dose (SMWD) and international normalised ratio (INR) &gt;&#xa0;4 during the first week. Samples were genotyped on the Illumina Human610-Quad chip. Statistical analyses were performed using Plink and R.</AbstractText>VKORC1 and CYP2C9 were the major genetic determinants of warfarin MWD and SMWD, with CYP4F2 having a smaller effect. Age, height, weight, cigarette smoking and interacting medications accounted for less than 20 % of the variance. Our multifactorial analysis explained 57.89 % and 56.97 % of the variation for MWD and SMWD, respectively. Genotypes for VKORC1 and CYP2C9*3, age, height and weight, as well as other clinical factors such as alcohol consumption, loading dose and concomitant drugs were important for the initial INR response to warfarin. In a small subset of patients for whom data were available, levels of the coagulation factors VII and IX (highly correlated) also played a role.</AbstractText>Our multifactorial analysis in a prospectively recruited cohort has shown that multiple factors, genetic and clinical, are important in determining the response to warfarin. VKORC1 and CYP2C9 genetic polymorphisms are the most important determinants of warfarin dosing, and it is highly unlikely that other common variants of clinical importance influencing warfarin dosage will be found. Both VKORC1 and CYP2C9*3 are important determinants of the initial INR response to warfarin. Other novel variants, which did not reach genome-wide significance, were identified for the different outcome measures, but need replication.</AbstractText>
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Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease.
Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p &lt; 0.001), and unplanned postoperative cardiac catheterization (p &lt; 0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1-2.2, p = 0.014), 1.7 (95 % CI 1.2-2.3, p = 0.001), 1.8 (95 % CI 1.4-2.3, p &lt; 0.001), and 2.0 (95 % CI 1.7-2.4, p &lt; 0.001) times as long, respectively. These effects equated to an additional 4.5-7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.
2,335,656
Adiposity, physical activity and neuromuscular performance in children.
We investigated the associations of body fat percentage (BF%), objectively assessed moderate-to-vigorous physical activity (MVPA) and different types of physical activity assessed by a questionnaire with neuromuscular performance. The participants were 404 children aged 6-8&#xa0;years. BF% was assessed using dual-energy x-ray absorptiometry and physical activity by combined heart rate and movement sensing and a questionnaire. The results of 50-m shuttle run, 15-m sprint run, hand grip strength, standing long jump, sit-up, modified flamingo balance, box-and-block and sit-and-reach tests were used as measures of neuromuscular performance. Children who had a combination of higher BF% and lower levels of physical activity had the poorest performance in 50-m shuttle run, 15-m sprint run and standing long jump tests. Higher BF% was associated with slower 50-m shuttle run and 15-m sprint times, shorter distance jumped in standing long jump test, fewer sit-ups, more errors in balance test and less cubes moved in box-and-block test. Higher levels of physical activity and particularly MVPA assessed objectively by combined accelerometer and heart rate monitor were related to shorter 50-m shuttle run and 15-m sprint times. In conclusion, higher BF% and lower levels of physical activity and particularly the combination of these two factors were associated with worse neuromuscular performance.
2,335,657
The residue I257 at S4-S5 linker in KCNQ1 determines KCNQ1/KCNE1 channel sensitivity to 1-alkanols.
KCNQ1 and KCNE1 form a complex in human ventricular cardiomyocytes, which are important in maintaining a normal heart rhythm. In the present study we investigated the effects of a homologous series of 1-alkanols on KCNQ1/KCNE1 channels expressed in Xenopus oocytes.</AbstractText>ECG recording was made in rats injected with ethanol-containing solution (0.3 mL, ip). Human KCNQ1 channel and its auxiliary subunit KCNE1 were heterologously coexpressed in Xenopus oocytes, which were superfused with ND96 solution; 1-alkanols (ethanol, 1-butanol and 1-hexanol) were delivered through a gravity-driven perfusion device. The slow-delayed rectifier potassium currents IKs (KCNQ1/KCNE1 currents) were recorded using a two-electrode voltage clamp method. Site-directed mutations (I257A) were made in KCNQ1.</AbstractText>In ECG recordings, a low concentration of ethanol (3%, v/v) slightly increased the heart rate of rats, whereas the higher concentrations of ethanol (10%, 50%, v/v) markedly reduced it. In oocytes coexpressing KCNQ1/KCNE1 channels, ethanol, 1-butanol and 1-hexanol dose-dependently inhibited IKs currents with IC50 values of 80, 11 and 2.7 mmol/L, respectively. Furthermore, the 1-alkanols blocked the KCNQ1 channel in both open and closed states, and a four-state model could adequately explain the effects of 1-alkanols on the closed-state channel block. Moreover, the mutation of I257A at the intracellular loop between S4 and S5 in KCNQ1 greatly decreased the sensitivity to 1-alkanols; and the IC50 values of ethanol, 1-butanol and 1-hexanol were increased to 634, 414 and 7.4 mmol/L, respectively. The mutation also caused the ablation of closed-state channel block.</AbstractText>These findings provide new insight into the intricate mechanisms of the blocking effects of ethanol on the KCNQ1 channel.</AbstractText>
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[LISHUTA EXTRANODAL INVOLVEMENT OF THE HEART IN LYMPHOMAS: A CLINICAL CASE OF LARGE B-CELL LYMPHOMA AND LITERATURE REVIEW].
The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestations of heart lesions in lymphoma and modern methods of their diagnostics and treatment.
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The athletic ECG.<Pagination><StartPage>50</StartPage><EndPage>55</EndPage><MedlinePgn>50-5</MedlinePgn></Pagination><Abstract><AbstractText>The electrocardiogram (ECG) is the most frequently performed basic cardiology investigation. Correct interpretation of the ECG is vital, both to confirm acute diagnoses such as myocardial infarction, and in the elective setting to diagnose previous or underlying cardiac abnormalities. Normal electrocardiographic parameters for the multiple components of the ECG have been identified and are applied to the general population, but it is acknowledged that cardiac conditioning occurs with frequent and sustained aerobic exercise, in turn leading to physiological changes in the ECG. Service personnel may perform exercise at a level that leads to cardiac conditioning with associated ECG changes. This clinical review will briefly address the normal ECG and consider changes associated with aerobic cardiac conditioning. By identifying what constitutes physiological non-pathological changes in the athletic ECG, this clinical review aims to assist those who interpret ECGs in Service personnel.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Proffitt</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Rees</LastName><ForeName>P</ForeName><Initials>P</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J R Nav Med Serv</MedlineTA><NlmUniqueID>7503111</NlmUniqueID><ISSNLinking>0035-9033</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002037" MajorTopicYN="N">Bundle-Branch Block</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008889" MajorTopicYN="Y">Military Personnel</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010809" MajorTopicYN="N">Physical Fitness</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>7</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>1</Month><Day>1</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>8</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29984978</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29870184</PMID><DateCompleted><Year>2018</Year><Month>07</Month><Day>03</Day></DateCompleted><DateRevised><Year>2018</Year><Month>07</Month><Day>03</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0037-9247</ISSN><JournalIssue CitedMedium="Print"><Issue>2</Issue><PubDate><Year>2016</Year></PubDate></JournalIssue><Title>Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg</Title><ISOAbbreviation>Bull Soc Sci Med Grand Duche Luxemb</ISOAbbreviation></Journal>Retrospective analysis of cardiac events during cardiac rehabilitation at Centre Hospitalier de Luxembourg during 2014 and 2015.
The electrocardiogram (ECG) is the most frequently performed basic cardiology investigation. Correct interpretation of the ECG is vital, both to confirm acute diagnoses such as myocardial infarction, and in the elective setting to diagnose previous or underlying cardiac abnormalities. Normal electrocardiographic parameters for the multiple components of the ECG have been identified and are applied to the general population, but it is acknowledged that cardiac conditioning occurs with frequent and sustained aerobic exercise, in turn leading to physiological changes in the ECG. Service personnel may perform exercise at a level that leads to cardiac conditioning with associated ECG changes. This clinical review will briefly address the normal ECG and consider changes associated with aerobic cardiac conditioning. By identifying what constitutes physiological non-pathological changes in the athletic ECG, this clinical review aims to assist those who interpret ECGs in Service personnel.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Proffitt</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Rees</LastName><ForeName>P</ForeName><Initials>P</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J R Nav Med Serv</MedlineTA><NlmUniqueID>7503111</NlmUniqueID><ISSNLinking>0035-9033</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002037" MajorTopicYN="N">Bundle-Branch Block</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008889" MajorTopicYN="Y">Military Personnel</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010809" MajorTopicYN="N">Physical Fitness</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>7</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>1</Month><Day>1</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>8</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29984978</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29870184</PMID><DateCompleted><Year>2018</Year><Month>07</Month><Day>03</Day></DateCompleted><DateRevised><Year>2018</Year><Month>07</Month><Day>03</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0037-9247</ISSN><JournalIssue CitedMedium="Print"><Issue>2</Issue><PubDate><Year>2016</Year></PubDate></JournalIssue><Title>Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg</Title><ISOAbbreviation>Bull Soc Sci Med Grand Duche Luxemb</ISOAbbreviation></Journal><ArticleTitle>Retrospective analysis of cardiac events during cardiac rehabilitation at Centre Hospitalier de Luxembourg during 2014 and 2015.</ArticleTitle><Pagination><StartPage>13</StartPage><EndPage>25</EndPage><MedlinePgn>13-25</MedlinePgn></Pagination><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The benefits of cardiac rehabilitation are well accepted. However, there still remains a debate concerning the risk of cardiac events, especially arrhythmias, during exercise training. The goal of the study was to retrospectively analyze events, including arrhythmias, in the cardiac rehabilitation unit of the Centre Hospitalier de Luxembourg during 2014-2015 and to identify if there was a link between patients stratified as high-risk patients and events.<AbstractText Label="METHODS" NlmCategory="METHODS">This analysis included each patient that participated in cardiac rehabilitation at the Centre Hospitalier de Luxembourg during 2014 and 2015. Major and minor cardiac events during exercise training in this period were retraced by retrospectively looking at patient files. These events were related to the potential risk of the patients, assessed by the "Risk stratification for cardiac events", edited by the American Association of Cardiovascular and Pulmonary Rehabilitation.<AbstractText Label="RESULTS" NlmCategory="RESULTS">628 patients were recruited for cardiac rehabilitation at the Centre Hospitalier de Luxembourg during 2014 and 2015. They exercised for a combined total of 15065 training hours. There were no major cardiac events during exercise training in this period; the number of minor events was low (n=24; 1 minor event/628 training hours). About two thirds of our patients are considered as low risk patients, one third of the patients were at intermediate or high risk. We found no relationship between events and risk stratification.<AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">There were no major cardiac events in our patients and the rate of minor cardiac events was low and not related to risk stratification.
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The hitchhiker's guide to the voltage-gated sodium channel galaxy.
Eukaryotic voltage-gated sodium (Nav) channels contribute to the rising phase of action potentials and served as an early muse for biophysicists laying the foundation for our current understanding of electrical signaling. Given their central role in electrical excitability, it is not surprising that (a) inherited mutations in genes encoding for Nav channels and their accessory subunits have been linked to excitability disorders in brain, muscle, and heart; and (b) Nav channels are targeted by various drugs and naturally occurring toxins. Although the overall architecture and behavior of these channels are likely to be similar to the more well-studied voltage-gated potassium channels, eukaryotic Nav channels lack structural and functional symmetry, a notable difference that has implications for gating and selectivity. Activation of voltage-sensing modules of the first three domains in Nav channels is sufficient to open the channel pore, whereas movement of the domain IV voltage sensor is correlated with inactivation. Also, structure-function studies of eukaryotic Nav channels show that a set of amino acids in the selectivity filter, referred to as DEKA locus, is essential for Na(+) selectivity. Structures of prokaryotic Nav channels have also shed new light on mechanisms of drug block. These structures exhibit lateral fenestrations that are large enough to allow drugs or lipophilic molecules to gain access into the inner vestibule, suggesting that this might be the passage for drug entry into a closed channel. In this Review, we will synthesize our current understanding of Nav channel gating mechanisms, ion selectivity and permeation, and modulation by therapeutics and toxins in light of the new structures of the prokaryotic Nav channels that, for the time being, serve as structural models of their eukaryotic counterparts.
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Unruptured Sinus of Valsalva Aneurysm Obstructing the Left Ventricular Outflow Tract: An Uncommon Presentation in Childhood.
Congenital aneurysms of the sinus of Valsalva are uncommon abnormalities that are usually silent and slowly progressive without symptoms of cardiac dysfunction unless catastrophic rupture occurs. However, in rare cases, unruptured aneurysms can produce symptoms resulting from compression of adjacent structures, ventricular outflow tract obstruction, heart block, and coronary and valvular insufficiency. We report a case of a single unruptured sinus of Valsalva aneurysm producing left ventricular outflow tract obstruction in an 8-year-old boy who presented with chest pain on exertion.
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Outcome of stand-alone thoracoscopic epicardial left atrial posterior box isolation with bipolar radiofrequency energy for longstanding persistent atrial fibrillation.
Catheter ablation of longstanding (&gt;&#x2009;1 year) persistent atrial fibrillation (AF) is associated with poor outcome. This might be due to remodelling and fibrosis formation, mainly located in the posterior left atrial (LA) wall. Therefore, we adopted a thoracoscopic epicardial box isolation of the posterior left atrium using bipolar RF energy with intraoperative testing of conduction block.</AbstractText>Bilateral thoracoscopic box isolation was performed with a bipolar RF clamp. Entrance block was defined as absence of a conducted electrogram within the box, while exit block was confirmed by pacing at 10.0&#xa0;V/2&#xa0;ms. Ablation outcome was evaluated after 3, 6, 12 and 24 months with 12-lead ECGs and 24-hour Holter recordings. Twenty-five consecutive patients were included (58&#x2009;&#xb1;&#x2009;7 years, persistent AF duration 1.8&#x2009;&#xb1;&#x2009;0.9 years). Entrance block was achieved in all patients and exit block confirmed if sinus rhythm was achieved. After 17&#x2009;&#xb1;&#x2009;7 months, 76&#x2009;% of the patients (n&#x2009;=&#x2009;19) were free of AF recurrence. One patient died within 1 month and was considered an ablation failure. Four patients with AF recurrences regained sinus rhythm with additional catheter ablation or antiarrhythmic drugs.</AbstractText>Treatment of longstanding persistent AF with thoracoscopic epicardial LA posterior box isolation using bipolar RF energy with intraoperative testing of conduction block is feasible and highly effective.</AbstractText>
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Anesthetic Complications in Pregnancy.
Anesthesia complications in the parturient can be divided into 2 categories: those related to airway manipulation and those related to neuraxial anesthesia. Physiologic changes of pregnancy can lead to challenging intubating conditions in a patient at risk of aspiration. Neuraxial techniques are used to provide analgesia for labor and anesthesia for surgical delivery. Therefore, complications associated with neuraxial techniques are often seen in this population. In the event of maternal cardiac arrest, modification to advanced cardiac life support algorithms must be made to accommodate the gravid uterus and to deliver the fetus if return of maternal circulation is not prompt.
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Regional Anesthesia to Scalp for Craniotomy: Innovation With Innervation.
Effective management and pain prevention is of great importance to avoid postoperative complications such as hypertension, agitation, and vomiting. All these adverse events may lead to elevation in intracranial pressure and, in turn, unfavorable outcome and prolonged hospital stay. Development of multiple methods of analgesia may contribute to the alleviation of problems due to pain. We tested the effectiveness of bilateral maxillary block with greater and lesser occipital nerve block for providing analgesia to the scalp.</AbstractText>This study was undertaken in 40 patients scheduled for craniotomy. Before skin incision, patients were assigned randomly to receive either bilateral maxillary (group M) or scalp block (group S). Data on intraoperative hemodynamics, postoperative analgesia, and sedation were collected and analyzed for statistical significance.</AbstractText>The primary outcome was the visual analog pain score. It was similar between the 2 groups at 1, 2, and 4 hours after extubation. At 12 hours, the maxillary block group had better analgesia (mean visual analog score: 3.4 cm for group M and 4.1 cm for group S with P-value of 0.0002) and sedation scores. Intraoperatively, there was no difference in the heart rate, blood pressure, and the anesthetic requirements between both the groups. Three patients in group S required fentanyl supplementation in the intraoperative period. There were no adverse events noted in the perioperative period among both the groups.</AbstractText>Maxillary block along with greater and lesser occipital nerve block is an effective alternative to scalp block for craniotomy and has longer duration of analgesia.</AbstractText>
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Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy.
Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated.</AbstractText>We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 &#x3bc;g/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block.</AbstractText>The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9&#xb1;0.9 and 1.1&#xb1;0.4 &#x3bc;g/mL, respectively. No acute anesthetic toxicity symptom was observed.</AbstractText>Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.</AbstractText>
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Do Anterior Cervical Osteophytes Prevent Dynamization of Cervical Dynamic Plates?
A retrospective study.</AbstractText>To evaluate radiographic changes of patients with osteophytes at the anterior border of the caudal vertebral body who were treated with anterior cervical discectomy and fusion using dynamic rotational plates.</AbstractText>Dynamic cervical plates are widely used in surgeries of the anterior cervical spine. One concern in using dynamic plates is that the subjacent anterior osteophytes might act as a bony block and prevent dynamization of the plate. To our knowledge, there are no studies that have investigated the validity of this concern.</AbstractText>Twenty-eight patients were selected for the study out of patients who had undergone 1-level anterior cervical discectomy and fusion using a dynamic rotational plate. They were divided into 2 groups on the basis of the presence of osteophytes located at the anterior border of the subjacent vertebrae. Thirteen patients had osteophytes and 15 control patients did not. The mean follow-up period was 10.8&#xb1;8.4 months (range, 6-36 mo). Lateral radiographs were taken preoperatively, immediately postoperatively, and at the final follow-ups to assess changes in the following radiographic parameters: Cobb angle of the adjacent segments and fused segment, horizontal distance between C2 and C7 plumb lines, height of the bone graft, vertebral heights of the operated segment, and migration distance of the plate.</AbstractText>No statistical significance was found in the Cobb angles of the adjacent segments and fused segment, distance between the C2-C7 plumb lines, height of the graft, height of vertebral bodies of the operated segment, and migration distance of the plate through the preoperative, postoperative, and final follow-ups between the 2 groups.</AbstractText>Osteophytes did not appear to affect the dynamization of plates in any of the measured radiographic parameters.</AbstractText>
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Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and its Renal Sonological and Functional Correlation: A Prospective Observational Study.
This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients.</AbstractText>A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters.</AbstractText>The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD &lt;30 mm and SRF &gt;40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD &gt;30 mm and SRF &lt;40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction.</AbstractText>The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.</AbstractText>Copyright: &#xa9; 2022 Journal of Indian Association of Pediatric Surgeons.</CopyrightInformation>
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A case report of high-degree AV block in pregnancy.
Complete heart block is seldom seen in pregnant women and poses a challenge for further management. The available literature on this is scarce, and the management usually varies as per the discretion of the obstetrician and severity of the presenting symptoms. Here, we report a case of a G2P0 primi with a high-degree AV block that was managed with a temporary cardiac pacemaker, which resulted in the successful delivery of twins. Clinically, we suspected a mitochondrial genetic defect to be the underlying cause of the conduction defect. Through this case, we would like to emphasize on the involvement of a multidisciplinary approach for the management of every pregnancy complicated by a medical disorder and the provision of timely interventions to reduce maternal and perinatal mortality.
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Comparison of Ultrasound-Guided Superior Laryngeal Nerve Block with the Traditional Method for Direct Laryngoscopic Biopsy of Supraglottic Masses: A Clinical Trial.
A bilateral superior laryngeal nerve block (SLNB) can provide complete anesthesia for laryngeal sampling and by providing this block we can manage the biopsy of supraglottic masses without the complications of general anesthesia.</AbstractText>This study aimed to compare 2 superior laryngeal nerve block (SLNB) methods using ultrasound and the traditional method for direct laryngoscopic surgery for the biopsy of supraglottic masses.</AbstractText>In this single-blind clinical trial, 50 patients undergoing supraglottic laryngeal mass biopsy under direct laryngoscopy were divided into 2 groups. The first group was anatomical landmark bilateral SLNB (C group), and the second group was sono-guided bilateral SLNB (U group). Hemodynamic changes, pain, oxygen desaturation, surgeon satisfaction, and the complication obtained and noted.</AbstractText>There was no significant difference in the success rate of the procedure (P = 0.99), as well as the surgeon's satisfaction with the procedure (P = 0.337). Mean arterial pressure (MAP), oxygen saturation, and their changes in the studied groups were compared before the block, after the block, after the biopsy, and in the recovery room, showing no significant difference between the 2 groups (P &gt; 0.05). Only the heart rate (HR) after the biopsy and in the recovery room showed significant differences between the 2 groups (P &lt; 0.05). There was no significant difference between the 2 groups in the level of patient and surgeon satisfaction and pain during and after the procedure (P &gt; 0.005).</AbstractText>SLNB for direct laryngoscopic surgery for biopsy of supraglottic masses using ultrasound was not significantly superior to the traditional method, and there was no significant difference between the 2 methods in terms of procedure success, surgeon's satisfaction, and patients' pain.</AbstractText>Copyright &#xa9; 2022, Author(s).</CopyrightInformation>
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Update on Pediatric Acute Kidney Injury.
Acute kidney injury (AKI) is common in children and is associated with significant morbidity and mortality. In the last decade our understanding of AKI has improved significantly, and it is now considered a systemic disorder that affects other organs including heart, lung, and brain. In spite of its limitations, serum creatinine remains the mainstay in the diagnosis of AKI. However, newer approaches such as urinary biomarkers, furosemide stress test, and clinical decision support are being increasingly used and have the potential to improve the accuracy and timeliness of AKI diagnosis.
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Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis.
Adrenaline or clonidine is used as adjuncts in conjunction with lignocaine to improve the depth of local anaesthesia in dental procedures.</AbstractText>This systematic review and meta-analysis intends to compare the haemodynamic parameters when clonidine or adrenaline is used in conjunction with lignocaine for third-molar surgical removal.</AbstractText>Cochrane, PubMed and Ovid SP databases were searched using "MeSH" terms (((nerve block) OR (IANB)) AND ((clonidine) OR (adrenaline))) AND (lignocaine)</i>.</AbstractText>Clinical studies where Clonidine + lignocaine and Adrenaline + lignocaine were compared directly during nerve block administration exclusively for third molar surgical removal were selected.</AbstractText>This current systematic review is registered in Prospero database CRD42021279446. Two independent reviewers were involved in collection, segregation and analysis of electronic data. The data were compiled in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search was conducted till June 2021.</AbstractText>Qualitative analysis of the selected articles was performed for systematic review. Meta-analysis is performed using RevMan 5 Software. Heterogeneity through the I2</sup> statistics. Change in the haemodynamic parameters was the primary outcome evaluated, and secondary outcomes evaluated were onset and duration of anaesthesia in both the groups.</AbstractText>In all databases, 1141 records were screened, out of which a total of 21 articles were included for the evaluation for full-text analysis. Out of these, 16 articles were excluded and 5 articles were included for the final systematic review. Meta-analysis was performed only for 4 studies.</AbstractText>Amongst the evaluated haemodynamic parameters, there was a significant reduction in the heart rate (baseline to intraoperative period) in clonidine and lignocaine groups than in adrenaline and lignocaine groups during nerve block administration for third molar surgical removal. There was no significant difference between other primary and secondary outcomes evaluated.</AbstractText>Blinding was not performed in all the studies, randomisation was performed in only three studies. The volume of local anaesthesia deposited varied in the studies (2 mL in three studies and 2.5 mL in two studies). Most of the studies (n</i> = 4) were evaluated on normal adults and only one study evaluated mild hypertensive patients.</AbstractText>Copyright: &#xa9; 2023 Annals of Maxillofacial Surgery.</CopyrightInformation>
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Perfusion index as a predictor of working pediatric caudal block under general anesthesia- A prospective observational study.
Advances in pulse oximeter technology have enabled us to measure parameters such as perfusion index (PI). We aimed to ascertain the utility of PI in the lower limb for evaluating the onset and adequacy of the pediatric caudal block under general anesthesia. The primary objective was to monitor PI trends after caudal block. The secondary objective was to compare the role of PI, heart rate (HR), and mean arterial pressure (MAP) in detecting onset and adequacy of caudal block and to ascertain whether PI was an earlier indicator in detecting adequate block.</AbstractText>Twenty-five children between 1 and 6 years, who underwent general anesthesia (GA) with caudal block were included. Baseline PI, HR, and MAP were recorded prior to and post caudal block at 5, 10, 15, 20 min and on skin incision. The onset of adequate block was defined as 100% increase of PI from baseline, 15% decrease of MAP or HR from baseline. T-test was used to compare trends of PI with baseline and the number of patients who met or failed these criteria for each of these three parameters at various time intervals wasnoted.</AbstractText>PI increased at all time intervals in 23 of 25 patients with working caudal block (P</i> &lt; 0.0001). By 10 min all those with a working caudal showed a 100% increase in PI. In contrast, 15% decrease in HR was not attained until 15 min where only 8 out of 23 achieved the above criteria, reaching a maximum of 20 patients at the time of incision; a 15% decrease in MAP was observed only in one patient at 5 min, reaching a maximum of eight patients at the time of incision.</AbstractText>PI is an earlier and more sensitive indicator of the onset of the caudal block under general anesthesia (GA) than HR and MAP.</AbstractText>Copyright: &#xa9; 2022 Journal of Anaesthesiology Clinical Pharmacology.</CopyrightInformation>
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Neonatal lupus erythematosus - prevention is better than cure.
Neonatal lupus erythematosus (NLE) is a congenital autoimmune condition in which the transplacental passage of immunoglobulin G (IgG) directed against auto-antigens causes clinical symptoms in the foetus or neonate. Anti-Ro/SS-A, anti-La/SS-B, and to a lesser extent, anti-U1RNP autoantibodies (aAbs) have the strongest association with NLE. However, ~ 50% of affected mothers are asymptomatic despite carrying those aAbs. The clinical picture of the disease is very diverse. Cardiac manifestations are the most severe, including congenital heart block (CHB), with a mortality rate of ~18%. Preventative therapy with hydroxychloroquine (HCQ) reduces the recurrence rate of CHB in subsequent pregnancies by ~50%.
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Tracking the Biostimulatory Effect of Fractions from a Commercial Plant Protein Hydrolysate in Greenhouse-Grown Lettuce.
Protein hydrolysate biostimulants are environmentally friendly options for the reduction of nitrogen input, but their plant growth-promoting mechanisms are still not completely unveiled. Here, to put the &#x201c;signaling peptide theory&#x201d; to the test, a greenhouse experiment was undertaken using low (1 mM) and optimal (8 mM) NO3-treated butterhead lettuce and three molecular fractions (PH1 (&gt;10 kDa), PH2 (1&#x2212;10 kDa) and PH3 (&lt;10 kDa) fractions), in addition to the whole product Vegamin&#xae;: PH, in a randomized block design. PH1 and PH3 significantly increased fresh yield (+8%) under optimal (lighter leaves), but not under low (darker leaves) NO3 conditions. Total ascorbic acid, lutein and &#x3b2;-carotene increased with PH3, and disinapoylgentobiose and kaempferol-3-hydroxyferuloyl-sophorosie-7-glucoside content increased with PH (whole/fractions) treatments, particularly under low NO3 conditions. The complete hydrolysate and analyzed peptide fractions have differential biostimulatory effects, enhancing the growth and nutritional quality of lettuce.
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The Effect of Caudal Anesthesia Block on Perioperative Pain Control and Reduction of the Anesthetic Agent in Pediatric Infraumbilical Surgery: A Prospective Randomized Trial Study.
Caudal epidural block (CEB) is a commonly performed neuraxial block to provide effective pain relief and analgesia in pediatric patients undergoing infraumbilical surgery.</AbstractText>This study aimed to compare the effectiveness of adding CEB to general anesthesia (GA) in terms of intra- and postoperative pain management.</AbstractText>Prospective, randomized case-controlled trial study.</AbstractText>Operation theater, and postoperative recovery rooms at Salmaniya Medical Complex, Bahrain.</AbstractText>A total of 74 patients aged 2 months to 6 years with American Society of Anesthesiologists physical status classification I were recruited over a 6-month period between December 2019 and May 2020. Patients were allocated into two groups (Group A, with CEB) or (Group B, without CEB). Both groups were compared based on hemodynamic stability, pain scores, level of sedation, analgesia need, and parental satisfaction.</AbstractText>Data were analyzed using SPSS program. Categorical and numerical variables of both the groups were compared.</AbstractText>Patients with CEB had better hemodynamic stability during the surgical procedure based on heart rate (P</i> = 0.039). Pain intensity scores were less in patients with CEB than those without (P</i> &lt; 0.001). Fentanyl consumption was lower in Group A compared to Group B at the end of surgery (P</i> = 0.002). They were also ambulated earlier and discharged sooner than those without CEB. Parental satisfaction was 92.1% in Group A compared to 63.9% in Group B (P</i> = 0.012).</AbstractText>Adding CEB to GA for intraoperative and perioperative pain control in pediatric patients undergoing infraumbilical surgery makes it more effective, safe, and with better parental satisfaction.</AbstractText>Copyright: &#xa9; 2022 Anesthesia: Essays and Researches.</CopyrightInformation>
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Comparing Efficacy of Intravenous Dexmedetomidine and Lidocaine on Perioperative Analgesic Consumption in Patients Undergoing Laparoscopic Surgery.
Perioperative pain management is a major challenge for anaesthesiologists. IV lidocaine and dexmedetomidine have been utilised for peri-operative pain management.</AbstractText>To analyse the effects of intraoperative intravenous lignocaine/dexmedetomidine on pain relief, opioid consumption, peri-operative hemodynamic and side-effect profiles/unique interactions in patients undergoing laparoscopic surgeries.</AbstractText>Prospective, interventional, single-centric, double-blind, randomised, active-controlled, Helsinki protocol-compliant clinical study was conducted on 90 ASA I/II class patients aged 18-60 yrs. This Patients were block-randomised to Group-L (2% Lignocaine), Group-D (dexmedetomidine) and Group C (Control/Placebo/0.9% normal saline). Hemodynamic were noted at pre-defined time frames intra-/post-operatively. Post-operative VAS score and Richmond Agitation Sedation Score monitoring was done.</AbstractText>Demographic parameters of were comparable. Mean intra-operative fentanyl consumption amongst the three groups were 20.5 &#xb1; 20.05 mcg, 26.5 &#xb1; 17.57 mcg and 46.83 + 21.31 mcg (Group-L, Group-D, Group-C; P</i> value Group-L vs Group-D:0.22, Group L/D vs Group C: &lt;0.0001). Group-D exhibited the lower heart rates and MAP (P</i> &lt; 0.05). Extubation- First rescue analgesic phase was comparable for the Group-C and Group-L (59.17 &#xb1; 46.224 min vs 61.64 &#xb1; 53.819 min) and significantly greater in Group-D (136.07 + 55.350 min; P</i> &lt; 0.0001).</AbstractText>Both Dexmedetomidine and lignocaine can be useful intra-operative pain relief adjuncts. Dexmedetomidine delayed First rescue analgesic and total analgesic consumption more than lignocaine. Dexmedetomidine patients exhibited bradycardia intraoperatively more than the other groups. we recommend, Dexmedetomidine in the intra-operative phase and lignocaine in the post-operative phase can be an alternative in patients who are poor candidates for post-operative opioids/sedation/contraindicated regional anaesthesia regimes.</AbstractText>Copyright: &#xa9; 2022 Anesthesia: Essays and Researches.</CopyrightInformation>
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The Use of Unilateral Erector Spinae Plane Block in Minimally Invasive Cardiac Surgery.<Pagination><StartPage>432</StartPage><EndPage>436</EndPage><MedlinePgn>432-436</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1053/j.jvca.2022.11.039</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S1053-0770(22)00888-6</ELocationID><Abstract><AbstractText Label="OBJECTIVES">To examine the efficacy of continuous unilateral erector spinae plane (ESP) blocks in minimally invasive cardiac surgery patients.</AbstractText><AbstractText Label="DESIGN">A retrospective nonrandomized study.</AbstractText><AbstractText Label="SETTING">At a single-center, tertiary academic institution.</AbstractText><AbstractText Label="PARTICIPANTS">The study comprised 129 adult patients undergoing minimally invasive cardiac surgery with cardiopulmonary bypass or extracorporeal membrane oxygenation.</AbstractText><AbstractText Label="INTERVENTIONS">Patient data were retrospectively collected and compared. Group 1 patients received ultrasound-guided ESP blocks, and group 2 patients underwent conventional intraoperative management without ESP blocks. After intubation in the group 1 cohort, 20-to- 25 mL of 0.25% ropivacaine were deposited beneath the erector spinae plane, along with catheter placement for continuous postoperative infusion.</AbstractText><AbstractText Label="MEASUREMENTS AND MAIN RESULTS">Patient characteristics (ie, age, sex, and comorbidities) were well-matched between both cohorts. The total 48-hour opioid consumption, as measured in morphine equivalents (mg), was significantly decreased in patients receiving erector spinae plane blocks compared to patients receiving conventional therapy (30.24 mg &#xb1; 23.8 v 47.82 mg &#xb1; 53.6, p&#xa0;=&#xa0;0.04). The length of stay in the intensive care unit (ICU) also was reduced in the treatment group in comparison to the control group (1.99 days &#xb1; 1.7 v 2.65 days &#xb1; 2.4, p&#xa0;=&#xa0;0.03). Lastly, patients receiving the blocks benefitted from a decrease in overall hospital length of stay when compared to the control group (5.93 days &#xb1; 2.4 v 7.35 days &#xb1; 5.8, p&#xa0;=&#xa0;0.04).</AbstractText><AbstractText Label="CONCLUSION">Erector spinae plane catheter use may safely improve postoperative measures, including decreased opioid consumption and improved pain relief, as well as reductions in ICU and hospital lengths of stay in patients undergoing minimally invasive cardiac surgery.</AbstractText><CopyrightInformation>Copyright &#xa9; 2022 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Morkos</LastName><ForeName>Michael</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>DeLeon</LastName><ForeName>Aidan</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Koeckert</LastName><ForeName>Michael</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Cardiothoracic Transplantation &amp; Circulatory Support, Baylor College of Medicine, Houston, TX.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gray</LastName><ForeName>Zachary</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Division of Cardiothoracic Transplantation &amp; Circulatory Support, Baylor College of Medicine, Houston, TX.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Liao</LastName><ForeName>Kenneth</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Division of Cardiothoracic Transplantation &amp; Circulatory Support, Baylor College of Medicine, Houston, TX.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pan</LastName><ForeName>Wei</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tolpin</LastName><ForeName>Daniel A</ForeName><Initials>DA</Initials><AffiliationInfo><Affiliation>Department of Cardiovascular Anesthesiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>12</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Cardiothorac Vasc Anesth</MedlineTA><NlmUniqueID>9110208</NlmUniqueID><ISSNLinking>1053-0770</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000701">Analgesics, Opioid</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000701" MajorTopicYN="N">Analgesics, Opioid</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010149" MajorTopicYN="N">Pain, Postoperative</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="N">prevention &amp; control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009407" MajorTopicYN="Y">Nerve Block</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006348" MajorTopicYN="Y">Cardiac Surgical Procedures</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018084" MajorTopicYN="N">Ultrasonography, Interventional</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">cardiac surgery</Keyword><Keyword MajorTopicYN="N">enhanced recovery after cardiac surgery</Keyword><Keyword MajorTopicYN="N">erector spinae plane block</Keyword><Keyword MajorTopicYN="N">minimally invasive</Keyword><Keyword MajorTopicYN="N">regional anesthesia</Keyword></KeywordList><CoiStatement>Conflict of Interest None.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2022</Year><Month>9</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2022</Year><Month>11</Month><Day>5</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>11</Month><Day>30</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2023</Year><Month>1</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2023</Year><Month>2</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2023</Year><Month>1</Month><Day>4</Day><Hour>21</Hour><Minute>55</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">36599778</ArticleId><ArticleId IdType="doi">10.1053/j.jvca.2022.11.039</ArticleId><ArticleId IdType="pii">S1053-0770(22)00888-6</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM" IndexingMethod="Automated"><PMID Version="1">36591976</PMID><DateCompleted><Year>2023</Year><Month>01</Month><Day>03</Day></DateCompleted><DateRevised><Year>2023</Year><Month>01</Month><Day>11</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1940-087X</ISSN><JournalIssue CitedMedium="Internet"><Issue>190</Issue><PubDate><Year>2022</Year><Month>Dec</Month><Day>16</Day></PubDate></JournalIssue><Title>Journal of visualized experiments : JoVE</Title><ISOAbbreviation>J Vis Exp</ISOAbbreviation></Journal>A Pipeline to Characterize Structural Heart Defects in the Fetal Mouse.
Congenital heart diseases (CHDs) are major causes of infant death in the United States. In the 1980s and earlier, most patients with moderate or severe CHD died before adulthood, with the maximum mortality during the first week of life. Remarkable advances in surgical techniques, diagnostic approaches, and medical management have led to marked improvements in outcomes. To address the critical research needs of understanding congenital heart defects, murine models have provided an ideal research platform, as they have very similar heart anatomy to humans and short gestation rates. The combination of genetic engineering with high-throughput phenotyping tools has allowed for the replication and diagnosis of structural heart defects to further elucidate the molecular pathways behind CHDs. The use of noninvasive fetal echocardiography to screen the cardiac phenotypes in mouse models coupled with the high fidelity of Episcopic fluorescence image capture (EFIC) using Episcopic confocal microscopy (ECM) histopathology with three-dimensional (3D) reconstructions enables a detailed view into the anatomy of various congenital heart defects. This protocol outlines a complete workflow of these methods to obtain an accurate diagnosis of murine congenital heart defects. Applying this phenotyping protocol to model organisms will allow for accurate CHD diagnosis, yielding insights into the mechanisms of CHD. Identifying the underlying mechanisms of CHD provide opportunities for potential therapies and interventions.
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Efficacy of dexmedetomidine as adjuvant to bupivacaine in femoral-sciatic nerve blocks in dogs undergoing tibial plateau levelling osteotomy (TPLO).
The aim of this randomized, prospective clinical study was to evaluate the efficacy of dexmedetomidine combined with bupivacaine on sciatic and femoral nerve blocks in dogs. Thirty dogs were selected for elective unilateral tibial plateau levelling osteotomy, and each subject was assigned randomly to receive perineural bupivacaine 0.5% (0.1&#xa0;mL/kg) and intramuscular dexmedetomidine (0.5&#xa0;&#x3bc;g/kg) in the BDs group, perineural bupivacaine 0.5% (0.1&#xa0;mL/kg) plus dexmedetomidine (0.5&#xa0;&#x3bc;g/kg) in the BDloc group, and perineural bupivacaine 0.5% (0.1&#xa0;mL/kg) plus intramuscular administration of saline solution the in Bupi group. Nerve blocks were guided by electrolocation. The main intraoperative parameters were registered 10&#xa0;min before the start of surgery (BASE) and during the skin incision (SKIN), the osteotomy (BONE) and the suture (SUTURE). At 2, 4, 6, 8, 10, 15, 20 and 24&#xa0;h after blocks, the Glasgow Composite Pain scale (GPCs) was used to identify the degree of pain during the postoperative period. Patients with scores &#x2265;5/20 received rescue analgesia and were excluded. Furthermore, heart rate, mean arterial pressure, footstep capacity, reaction to wound touch and femoral and sciatic skin sensitivity were registered. Parametric data were compared at each time point of the study with the one-way ANOVA for repeated measures and Fisher's test for yes/no variables analysis (p&#xa0;&lt;&#xa0;0.05). No subject required intraoperative rescue analgesia. In BDloc group, the GCPs score was &lt;5/20 for all dogs at all times of the study, and 70% of dogs did not need systemic analgesia. In the Bupi and BDs groups, 100% of subjects achieved a score&#xa0;&#x2265;&#xa0;5/20 between 8 and 10&#xa0;h after the blocks, and 100% of subjects showed femoral and sciatic skin sensitivity and required rescue analgesia within 10&#xa0;h. Our results showed that the addition of dexmedetomidine as an adjuvant to bupivacaine in SF blocks may prolong the sensory block and ensure sufficient analgesia for up to 24&#xa0;h in dogs undergoing TPLO surgery.
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Effects of Tegoprazan Versus Esomeprazole on Nighttime Heartburn and Sleep Quality in Gastroesophageal Reflux Disease: A Multicenter Double-blind Randomized Controlled Trial.
<AbstractText Label="BACKGROUND/AIMS" NlmCategory="UNASSIGNED">Patients with gastroesophageal reflux disease (GERD) frequently experience nighttime heartburn and sleep disturbance. Tegoprazan is a new potassium-competitive acid blocker that can rapidly block acid secretion. This study aims to evaluate the efficacy of tegoprazan compared with esomeprazole in relieving nighttime heartburn and sleep disturbances.</AbstractText>Patients with erosive esophagitis, nighttime heartburn, and sleep disturbances were randomized to receive tegoprazan 50 mg or esomeprazole 40 mg for 2 weeks. The primary endpoint was time to first nighttime heartburn-free interval. The percentage of nighttime heartburn-free days was also compared between the 2 groups.</AbstractText>A total of 46 patients were enrolled in this study. Time to the first nighttime heartburn-free interval was shorter with tegoprazan than with esomeprazole but the difference was not statistically significant (1.5 days vs 3 days, P</i> = 0.151). The percentage of nighttime heartburn-free days was higher in the tegoprazan group but the difference was insignificant (57.8% vs 43.1%, P</i> = 0.107). Adverse events occurred in 2 patients. They were mild in severity.</AbstractText>Tegoprazan may induce faster relief of nighttime heartburn symptoms and may improve sleep disorders associated with nighttime heartburn. Further large-scale studies are required to validate our findings.</AbstractText>
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Effects of thoracic paravertebral block combined with s-ketamine on postoperative pain and cognitive function after thoracoscopic surgery.
To assess the effects of thoracic paravertebral block and s-ketamine on postoperative pain and perioperative neurocognitive disorder (PND) in video-assisted thoracoscopic surgery.</AbstractText>Patients (n = 120) aged 45-65 undergoing video-assisted thoracoscopic surgery were allocated randomly into the following three groups: patients in the C group received general anaesthesia; patients in the thoracic paravertebral block group, i.e. the TP group, received general anaesthesia and ultrasound-guided paravertebral block; and patients in the s-ketamine combined with ultrasound-guided thoracic paravertebral nerve block group, i.e. the TS group, received combined anaesthesia, which was administered as follows: general anaesthesia + ultrasound-guided paravertebral block + perioperative s-ketamine (a bolus of 0.3 mg/kg, followed by an infusion of 0.2 mg/kg/h until 30 min before the end of the surgical procedure).</AbstractText>Cognitive function was measured using the Mini-Mental State Examination 1 day preoperatively, 1 day postoperatively, and 3 months postoperatively. Z-score was used to determine the incidence of PND. Postoperative pain was assessed using the visual analogue scale at 0.5 and 24 h postoperatively. The use of opioid drugs, intraoperative vital signs, and other secondary outcomes were also recorded. The final analysis included a total of 110 patients. The intraoperative heart rate and mean arterial pressure in the TS and TP groups were lower than that for group C (P</i>&#xff1c;0.05). After surgery, patients in the TS group exhibited significantly lower pain scores at 0.5 h and 24 h (P</i>&#xff1c;0.001 and P</i> = 0.004,respectively) as well as significantly lower rates of postoperative nausea, vomiting, and pulmonary complications (P</i>&#xff1c;0.05). The incidence of PND in the TP and TS groups was lower than those who received general anaesthesia. However, there was no significant difference in the incidence of PND between the TP and TS groups (P</i>&#xff1e;0.05).</AbstractText>Ultrasound-guided paravertebral nerve block combined with s-ketamine decreased acute postoperative pain and improved the quality of recovery. However, perioperative s-ketamine did not improve cognitive function in patients under general anaesthesia with thoracic paravertebral block.</AbstractText>&#xa9; 2022 The Author(s).</CopyrightInformation>
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Effectiveness of a peanut ball device during labour on maternal and neonatal outcomes: protocol for a randomised controlled trial.
Frequent positional changes and movements during labour is one of the recommendations by the World Health Organization (WHO) to prevent prolonged labour, thereby avoiding cesarean sections. However, labour induction, continuous fetal monitoring in supine position and immobilising the women during labour are standard practices in most private hospitals. To combat these problems and to implement WHO recommendations, the peanut ball is an effective device through which frequent positional changes will be achieved without disrupting the labour procedures.&#xa0;The current study aims to evaluate the effectiveness of the peanut ball device during labour on maternal and neonatal outcomes and assess the stress response induced by labour in terms of maternal and neonatal cortisol in low-risk primigravid women. The study is a prospective, block randomised controlled trial with parallel arms. A total of 768&#xa0;study participants will be randomised to the peanut-ball group (intervention) and standard care group (control). The intervention group will receive different peanut ball positions during labour at or after 4 cm of cervical dilatation.&#xa0;The&#xa0;primary outcomes of the study are&#xa0;maternal&#xa0;outcome that includes measurement of&#xa0;duration of the active and the second stage of labour, stress level as measured by serum cortisol level at 3-4 cm and at 10 cm of cervical dilatation, mode of delivery, perception of pain, behavioural response during the active stage of labour&#xa0;and neonatal outcomes, which includes the pattern of fetal heart rate, APGAR score, birth injuries, and umbilical serum and salivary cortisol level. The collected data will be compared between the&#xa0;intervention&#xa0;and control groups.&#xa0; <b>Trial Registration:</b> This research is registered under the CTRI (Clinical Trials Registry of India) ( CTRI/2019/08/020802) (21/8/2019).
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Lumbar Plexus Nerve Blocks for Perioperative Pain Management in Cerebral Palsy Patients Undergoing Hip Reconstruction: More Effective Than General Anesthesia and Epidurals.
Hip reconstruction in patients with cerebral palsy (CP) is associated with. significant postoperative pain. However, adequate analgesia can be difficult to achieve. in this population due to spasticity, communication barriers, and postoperative. spasticity. Recently, multimodal pain management techniques such as epidurals and. regional nerve blocks have been described for postoperative pain control, but it is unclear if 1 technique is more beneficial. The purpose of this study was to compare the outcomes of different perioperative pain management techniques.</AbstractText>This study is a retrospective review of a consecutive series of children with CP over a 5-year period at a single pediatric tertiary-care hospital who underwent hip reconstruction (proximal femoral osteotomy with or without a pelvic osteotomy). Patients were subdivided based on their anesthetic protocol into the following groups: general anesthesia alone (G), general anesthesia with an epidural (E), and general anesthesia with lumbar plexus block (LPB). Our primary outcome was cumulative postoperative narcotic consumption (converted to morphine equivalents). Secondary outcomes included length of stay (LOS), average postoperative heart rate, and pain scores. analysis of variance testing was utilized to compare differences between the groups.</AbstractText>Fifty-four patients who underwent hip reconstruction were included: 19 in the G group, 18 in the E group, and 17 in the LPB group. LOS was significantly higher in the E group compared with the G and LPB groups: F(2,51)=3.58, P=0.04. The average pain score was significantly lower in the LPB group compared with the others: F(2,51)=4.26, P=0.02. The average postoperative heart rate was significantly lower in the LPB group: F(2,51)=7.08, P&lt;0.01. Postoperative narcotic consumption was significantly lower in the LPB group: F(2,51)=11.57, P&lt;0.01.</AbstractText>The LPB patients required the least amount of narcotics compared with the other groups. This, combined with a lower perioperative heart rate and shorter LOS would suggest these patients experienced less pain over the time of their in-patient stay. In comparison to general anesthesia alone and epidural anesthesia, lumbar plexus nerve blocks are an effective pathway for postoperative pain control after hip reconstruction in a CP population.</AbstractText>Level III-Case control or retrospective comparative study.</AbstractText>Copyright &#xa9; 2022 Wolters Kluwer Health, Inc. All rights reserved.</CopyrightInformation>
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Effect of adding dexmedetomidine to 0.75% ropivacaine in peribulbar block for vitreoretinal surgery.
Peribulbar anesthesia is suitable for vitreoretinal (VR) surgery. Dexmedetomidine has been used in peribulbar block (PBB) to improve akinesia and analgesia. We aimed to study the efficacy of adding dexmedetomidine to 0.75% Ropivacaine in PBB for VR surgery. The primary outcome was the requirement of block supplementation and secondary outcome was post-operative analgesic requirement.</AbstractText>100 adult patients undergoing VR surgery were included in this prospective randomized double-blinded controlled study. The composition of the drug used for PBB in the 3 groups was Group R (8 ml of 0.75% Ropivacaine +0.5 ml normal saline (NS)), Group D25 (8 ml of 0.75% Ropivacaine +25&#x3bc;g Dexmedetomidine) and Group D50 (8 ml of 0.75% Ropivacaine +50 &#x3bc;g Dexmedetomidine).</AbstractText>The groups were comparable in terms of patient demographics. The requirement for block supplementation was 16.7% in Group R (5/30), 12.5% in Group D25 (4/32) and 8.8% in group D50 (3/34) (P</i> = 0.64). The mean time to first request for post-operative analgesia was432 &#xb1; 362 min in Group R, 572 &#xb1; 339 min in Group D25 and 614 &#xb1; 394 min for Group D50 (P</i> = 0.26). There was significant difference in the heart rate (P</i> = 0.047), mean arterial pressure (P</i> = 0.012) at 30 min and sedation (RASS) score at 15, 30, 60 (P</i> &lt; 0.001) and 120 (P</i> = 0.019) min between the D50 and group R. Patients undergoing buckling procedures had significantly shorter time to request for analgesia (P</i> = 0.003).</AbstractText>Addition of dexmedetomidine does not offer advantage over 0.75% Ropivacaine in PBB for vitrectomy. Its benefit in more painful procedures like scleral buckle needs further validation.</AbstractText>Copyright: &#xa9; 2022 Journal of Anaesthesiology Clinical Pharmacology.</CopyrightInformation>
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Regional nerve blocks for relieving postoperative pain in arthroscopic rotator cuff repair.
Rotator cuff tear is the most common cause of shoulder pain in middle-age and older people. Arthroscopic rotator cuff repair (ARCR) is the most common treatment method for rotator cuff tear. Early postoperative pain after ARCR is the primary concern for surgeons and patients and can affect postoperative rehabilitation, satisfaction, recovery, and hospital day. There are numerous methods for controlling postoperative pain including patient-controlled analgesia, opioid, interscalene block, and local anesthesia. Regional blocks including interscalene nerve block, suprascapular nerve block, and axillary nerve block have been successfully and commonly used. There is no difference between interscalene brachial plexus block (ISB) and suprascapular nerve block (SSNB) in pain control and opioid consumption. However, SSNB has fewer complications and can be more easily applied than ISB. Combination of axillary nerve block with SSNB has a stronger analgesic effect than SSNB alone. These regional blocks can be helpful for postoperative pain control within 48 hours after ARCR surgery.
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A comparison of anesthetic efficacy between dorsal penile nerve block (DPNB) with lidocaine and eutectic mixture of local anesthetics (EMLA) cream during neonatal circumcision.
Circumcision is often performed in neonates and is associated with significant pain. This study was conducted to compare the anesthetic efficacy of two methods of local anaesthesia for neonatal circumcision: topical eutectic mixture of local anesthetics (EMLA) cream and dorsal penile nerve block (DPNB) with lidocaine.</AbstractText>Male neonates who presented for circumcision and met the eligibility criteria were recruited for the study and were randomly assigned to one of the two methods of anesthesia before the procedure. Anesthetic efficacy was compared by pain assessment during four standardized steps of the procedure (clamping, crushing, tying, and cutting of the foreskin, respectively) using the modified Neonatal Infant Pain Scale (NIPS), changes in transcutaneous oxygen saturation (SpO2</sub>), heart rate (HR), and preoperative and postoperative salivary cortisol levels. Patients also were evaluated after 24 hours to assess for complications.</AbstractText>Totally, 138 babies were recruited. Significantly higher NIPS scores were observed among babies who had EMLA cream during tying (p=0.019) and cutting (p=0.043). The rise in mean HR from baseline was statistically significant throughout the procedure in the EMLA group. In the DPNB group, there was no significant rise in mean HR during crushing (p=0.919) and cutting (p=0.197). There was a significant decrease in mean SpO2</sub> from baseline in both groups. Salivary cortisol showed significant increase in mean levels in both groups. No significant untoward effects were observed.</AbstractText>DPNB with lidocaine has a better pain control compared with EMLA cream during neonatal circumcision. Both methods are safe in neonates.</AbstractText>&#xa9; Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
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Comparison of dorsal penile nerve block alone and in combination with lidocaine-prilocaine cream in neonates undergoing circumcision: a randomized controlled study.
Suboptimal neonatal circumcision analgesia causes a significant stress response. There is continued search for more effective analgesia for neonatal circumcision. We aimed to determine whether lidocaine-prilocaine cream (LPC) prior to dorsal penile nerve block (DPNB) offers better analgesia than DPNB alone.</AbstractText>A prospective randomized study of 72 neonates undergoing plastibell circumcision was randomized into two groups of 36 each. Group I received DPNB alone with 4&#x2009;mg/kg plain lidocaine. Group II had 1&#x2009;g LPC applied to the phallus 1&#x2009;hour before DPNB. Serum cortisol levels were measured 30&#x2009;min preoperatively and 30&#x2009;min postoperatively. Heart rate (HR) and peripheral arterial oxygen saturation (SpO2</sub>) were noted at 30&#x2009;min preoperatively, after DPNB injection, after excising the prepuce, and at 30&#x2009;min thereafter. The primary outcome measure was change in serum cortisol levels, while secondary outcomes were changes in HR and SpO2</sub>.</AbstractText>Both groups had increased mean serum cortisol levels, decreased mean SpO2</sub> and increased mean HR from baseline. The rise in mean serum cortisol level was significantly lower in group II (8.09&#xb1;4.53&#x2009;&#xb5;g/dL) than that in group I (11.42&#xb1;7.83&#x2009;&#xb5;g/dL) (p=0.034). Changes in SpO2</sub> and HR were significantly less in group II than that in group I patients (p&lt;0.05), except for HR changes at 30&#x2009;min after excision of the prepuce (p=0.086).</AbstractText>These data suggest that neonates who received LPC prior to DPNB experienced significantly less pain from plastibell circumcision than those who had DPNB alone.</AbstractText>PACTR201906554747665.</AbstractText>&#xa9; Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
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Sounding the alarmins-The role of alarmin cytokines in asthma.
The alarmin cytokines thymic stromal lymphopoietin (TSLP), interleukin (IL)-33, and IL-25 are epithelial cell-derived mediators that contribute to the pathobiology and pathophysiology of asthma. Released from airway epithelial cells exposed to environmental triggers, the alarmins drive airway inflammation through the release of predominantly T2 cytokines from multiple effector cells. The upstream positioning of the alarmins is an attractive pharmacological target to block multiple T2 pathways important in asthma. Blocking the function of TSLP inhibits allergen-induced responses including bronchoconstriction, airway hyperresponsiveness, and inflammation, and subsequent clinical trials of an anti-TSLP monoclonal antibody, tezepelumab, in asthma patients demonstrated improvements in lung function, airway responsiveness, inflammation, and importantly, a reduction in the rate of exacerbations. Notably, these improvements were observed in patients with T2-high and with T2-low asthma. Clinical trials blocking IL-33 and its receptor ST2 have also shown improvements in lung function and exacerbation rates; however, the impact of blocking the IL-33/ST2 axis in T2-high versus T2-low asthma is unclear. To date, there is no evidence that IL-25 blockade is beneficial in asthma. Despite the considerable overlap in the cellular functions of IL-25, IL-33, and TSLP, they appear to have distinct roles in the immunopathology of asthma.
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Evaluation of lidocaine for brachial plexus blockade in eastern box turtles (Terrapene carolina carolina).
To evaluate latency and duration of a brachial plexus block technique in eastern box turtles performed with 2% lidocaine at three dose rates.</AbstractText>Prospective, randomized, blinded crossover study.</AbstractText>Adult eastern box turtles, two for drug dose evaluation and a group of six (three male, three female) weighing 432 &#xb1; 40 g (mean &#xb1; standard deviation) for the main study.</AbstractText>Animals were randomly assigned to four brachial plexus blocks with lidocaine at 5, 10 and 20 mg kg-1</sup> or 0.9% saline (treatments LID5, LID10, LID20 and CON, respectively), separated by 1 week. Treatment side was randomized and blocks were performed unilaterally. Baseline observations of mentation, heart rate (HR), respiratory rate (fR</sub>), skin temperature and limb response to manipulation or toe pinch were evaluated. Assessments were made every 10 minutes until 1 hour of normal sensory and motor function to the treated thoracic limb, or for a total of 2 hours if no block was evident.</AbstractText>Motor and sensory blockade was achieved in treatments LID10 and LID20 in one turtle, with a latency of 10 minutes and duration of 50 minutes for both doses. Raising of the ipsilateral lower palpebra occurred with both blocks. Turtles administered lidocaine experienced higher HR compared with CON, and HR decreased over time for all individuals. Mentation and fR</sub> were not changed with any lidocaine dose.</AbstractText>The technique was unreliable in producing brachial plexus motor and sensory blockade at the lidocaine doses evaluated in this study. HR was higher in lidocaine-administered turtles but remained within normal limits for the species. No change in mentation or fR</sub> was observed among treatments.</AbstractText>General anesthesia with systemic analgesia is recommended for surgical procedures involving the chelonian thoracic limb. Further studies are needed to optimize a brachial plexus block in this species.</AbstractText>Copyright &#xa9; 2022 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation>
2,335,689
Combined method of whole mount and block-face imaging: Acquisition of 3D data of gene expression pattern from conventional in situ hybridization.
Visualization of spatiotemporal expression of a gene of interest is a fundamental technique for analyzing the involvements of genes in organ development. In situ hybridization (ISH) is one of the most popular methods for visualizing gene expression. When conventional ISH is performed on sections or whole-mount specimens, the gene expression pattern is represented in 2-dimensional (2D) microscopic images or in the surface view of the specimen. To obtain 3-dimensional (3D) data of gene expression from conventional ISH, the "serial section method" has traditionally been employed. However, this method requires an extensive amount of time and labor because it requires researchers to collect a tremendous number of sections, label all sections by ISH, and image them before 3D reconstruction. Here, we proposed a rapid and low-cost 3D imaging method that can create 3D gene expression patterns from conventional ISH-labeled specimens. Our method consists of a combination of whole-mount ISH and Correlative Microscopy and Blockface imaging (CoMBI). The whole-mount ISH-labeled specimens were sliced using a microtome or cryostat, and all block-faces were imaged and used to reconstruct 3D images by CoMBI. The 3D data acquired using our method showed sufficient quality to analyze the morphology and gene expression patterns in the developing mouse heart. In addition, 2D microscopic images of the sections can be obtained when needed. Correlating 2D microscopic images and 3D data can help annotate gene expression patterns and understand the anatomy of developing organs. These results indicated that our method can be useful in the field of developmental biology.
2,335,690
Comparative Evaluation of Intrathecal Dexmedetomidine and Fentanyl as an Adjuvant for Combined Spinal-Epidural Analgesia for Labor.
Combined spinal-epidural technique is a widely accepted and popular modality for labor analgesia. Opioids are being used as adjuvants since long time. Dexmedetomidine is a new drug that is being used as an intrathecal adjuvant.</AbstractText>The study aims to compare the safety and efficacy of fentanyl and dexmedetomidine as intrathecal adjuvants in labor analgesia.</AbstractText>This was a continuous, prospective, randomized controlled trial with 120 parturients.</AbstractText>After ethical approval and written consent, participants were divided randomly into two groups: Group A - bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 20 &#x3bc;g of dexmedetomidine in 1 mL saline intrathecally (total volume: 3 mL) and Group B - bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 15 &#x3bc;g of fentanyl in 1 mL saline intrathecally (total volume: 3 mL). Primary outcomes were satisfactory analgesia, mode of delivery, and neonatal outcome. Participants were monitored for the onset and duration of analgesia, degree of motor block, and maternal and fetal side effects.</AbstractText>A total of 108 parturients reported sufficient analgesia (Group A: 57; Group B: 51), and 74 patients delivered vaginally (Group A: 41; Group B: 44). The rates of normal vaginal delivery were higher in Group B. Group A reported earlier onset of analgesia (61.26 &#xb1; 18.23 s) that lasted for longer duration (124.16 &#xb1; 26.23 min) than in Group B. There were no serious side effects in any of the groups. Fetal ultrasound revealed attenuation of fetal heart rate variability. The heart rate of newborns was also found to be low in Group A.</AbstractText>Chances of vaginal delivery are higher with intrathecal fentanyl as an adjuvant. Intensity and duration of analgesia are better with intrathecal dexmedetomidine.</AbstractText>Copyright: &#xa9; 2022 Anesthesia: Essays and Researches.</CopyrightInformation>
2,335,691
The &#x394;WaveECG: The differences to the normal 12&#x2011;lead ECG amplitudes.<Pagination><StartPage>45</StartPage><EndPage>54</EndPage><MedlinePgn>45-54</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jelectrocard.2022.10.014</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0022-0736(22)00213-8</ELocationID><Abstract><AbstractText Label="BACKGROUND">The QRS, ST segment, and T-wave waveforms of electrocardiogram are difficult to interpret, especially for non-ECG experts readers, like general practitioners. As the ECG waveforms are influenced by many factors, like body build, age, sex, electrode placement, even for experience ECG readers the waveform is difficult to interpret. In this research we have created a novel method to distinguish normal from abnormal ECG waveforms for an individual ECG based on the ECG amplitude distribution derived from normal standard 12&#x2011;lead ECG recordings.</AbstractText><AbstractText Label="AIM">Creation of a normal ECG amplitude distribution to enable the distinction by non-ECG experts of normal from abnormal waveforms of the standard 12&#x2011;lead ECG.</AbstractText><AbstractText Label="METHODS">The ECGs of healthy normal controls in the PTB-XL database were used to construct a normal amplitude distribution of the 12 lead ECG for males and females. All ECGs were resampled to have the same number of samples to enable the classification of an individual ECG as either normal or abnormal, i.e. within the normal amplitude distribution or outside, the &#x394;WaveECG.</AbstractText><AbstractText Label="RESULTS">From the same PTB-XL database six ECG's were selected, normal, left and right bundle branch block, and three with a myocardial infarction. The normal ECG was obviously within the normal distribution, and all other five showed clear abnormal ECG amplitudes outside the normal distribution in any of the ECG segments (QRS, ST segment and remaining STT segment).</AbstractText><AbstractText Label="CONCLUSION">The &#x394;WaveECG can distinguish the abnormal from normal ECG waveform segments, making the ECG easier to classify as normal or abnormal. Conduction disorders and ST changes due to ischemia and abnormal T-waves are effortless to detect, also by non-ECG expert readers, thus improving the early detection of cardiac patients.</AbstractText><CopyrightInformation>Copyright &#xa9; 2022 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Proniewska</LastName><ForeName>Klaudia K</ForeName><Initials>KK</Initials><AffiliationInfo><Affiliation>Jagiellonian University Medical College, Krak&#xf3;w, Poland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ab&#xe4;cherli</LastName><ForeName>Roger</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Lucerne University of Applied Sciences and Arts, HSLU, Lucerne, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>van Dam</LastName><ForeName>Peter M</ForeName><Initials>PM</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Automation and Robotics, AGH University of science and technology, Krak&#xf3;w, Poland. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>11</Month><Day>05</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Electrocardiol</MedlineTA><NlmUniqueID>0153605</NlmUniqueID><ISSNLinking>0022-0736</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="Y">Electrocardiography</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="Y">Myocardial Infarction</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002037" MajorTopicYN="N">Bundle-Branch Block</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004566" MajorTopicYN="N">Electrodes</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">ECG amplitude distribution</Keyword><Keyword MajorTopicYN="N">Normal ECG</Keyword><Keyword MajorTopicYN="N">&#x394;WaveECG</Keyword></KeywordList><CoiStatement>Declaration of Competing Interest Peter van Dam is the owner of Peacs BV and ECG-Excellence BV. Roger Ab&#xe4;cherli is owner of Ara-Nova GmbH</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2022</Year><Month>5</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2022</Year><Month>10</Month><Day>17</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>10</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>11</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2023</Year><Month>1</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>11</Month><Day>27</Day><Hour>18</Hour><Minute>22</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">36436474</ArticleId><ArticleId IdType="doi">10.1016/j.jelectrocard.2022.10.014</ArticleId><ArticleId IdType="pii">S0022-0736(22)00213-8</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">36436005</PMID><DateRevised><Year>2022</Year><Month>11</Month><Day>27</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1432-1971</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Nov</Month><Day>27</Day></PubDate></JournalIssue><Title>Pediatric cardiology</Title><ISOAbbreviation>Pediatr Cardiol</ISOAbbreviation></Journal>Exercise Stress Electrocardiography Using the Two-Minute Jump Test in Children.
Although the treadmill and cycle ergometer are commonly used for exercise stress electrocardiography (ECG) testing, they are often difficult to perform with children. We herein evaluated the utility and safety of the 2-minute jump test (2MJT) as a simple, alternative exercise test. One hundred patients, including 60 male patients, with an average age at study commencement of 10.7&#xb1;3.5&#xa0;years (mean&#xb1;standard deviation) and with no exercise restriction who underwent a cardiac check-up between November 2020 and March 2022 at the study center were included. After recording their resting ECG, they jumped for 2&#xa0;minutes during ECG recording, and the change in heart rate (HR), ECG findings, and occurrence of adverse events were investigated. As a result, patients jumped 185&#xb1;60 times in two minutes, and their HR increased from 76&#xb1;13 beats/min at rest to 172&#xb1;18 beats/min at peak during the test. Ninety (90%) patients attained the ideal target HR of&#x2009;&gt;&#x2009;150 beats/minute. During the recovery period after loading, five patients had abnormal ECG findings (ventricular extrasystoles, second-degree atrioventricular block, and atrial extrasystoles in two, two, and one patient, respectively) but completely resolved spontaneously within three minutes. Our findings suggested that the 2MJT is a useful and safe exercise test capable of inducing sufficient increase in HR in a short time in children.
2,335,692
A Comparison Between Intrathecal Levobupivacaine and Bupivacaine for Quality and Safety During Infraumbilical Surgeries.
Background Levobupivacaine toxicity reports are rare, and when they do occur, toxic symptoms are frequently treatable with minimal morbidity and mortality. However, levobupivacaine has not entirely replaced bupivacaine in clinical practice. Moreover, the experience of intrathecal anesthesia with levobupivacaine is not well documented. Hence, the purpose of this study is to assess the quality and duration of sensory and motor blockade of levobupivacaine and its side effects, if any, compared to intrathecal bupivacaine during infraumbilical surgeries. Methods After approval by the Institutional Ethical Committee of Kurunji Venkatramana Gowda (KVG) Medical College and Hospital, Sullia, 90 patients aged between 18 and&#xa0;65 years, of either sex, who were scheduled for elective abdominoperineal, urological, or lower limb surgeries under intrathecal anesthesia were enrolled in this prospective study from&#xa0;January 2013 to June 2014. The selected patients were randomly assigned to three groups of 30 each: group HB (3 mL of 0.5% hyperbaric bupivacaine), group IB (3 mL of 0.5% isobaric bupivacaine),&#xa0;and group IL (3 mL of 0.5% isobaric levobupivacaine). Motor blockade was assessed using the modified Bromage scale. Intergroup comparison was done using Tukey's post hoc test. The incidence of adverse effects was analyzed using a chi-squared test. Significance was defined as P&lt;0.05. Results In our study, the mean age of patients in the three groups was comparable (P&gt;0.05), i.e., group IB was 39.23&#xb1;11.78 years, group HB was 43.63&#xb1;11.33 years, and group IL was 39.8&#xb1;12.07 years. The time of onset of&#xa0;sensory block was 6.57&#xb1;1.794 minutes in group IB, 2.30&#xb1;1.343 minutes in group HB, and 4.57&#xb1;1.960 minutes in group IL, and this variation was statistically highly significant (P&lt;0.001). A total of 15 patients suffered hypotension intraoperatively, of which eight belonged to group HB, four to group IB, and the rest to group IL. Intraoperative or postoperative nausea/vomiting was seen in five patients in group IB, two patients in group HB, and one patient in group IL. In the postoperative period, the mean heart rate (HR) was 77.47&#xb1;4.88/minute in group IB, 68.78&#xb1;7.88/minute&#xa0;in group HB, and 72.15&#xb1;8.83/minute in group IL. The data was statistically highly significant (P&lt;0.001). Conclusion Our study revealed that 15 mg of isobaric levobupivacaine (3 mL of 0.5%), the new racemic isomer of bupivacaine, was intermediate in its anesthetic properties when compared to isobaric bupivacaine and hyperbaric bupivacaine. The onset of sensory and motor blockade is slower than hyperbaric bupivacaine but faster than isobaric bupivacaine with a higher level of maximum sensory block.
2,335,693
Effect of cup,&#xa0;syringe, and finger feeding on&#xa0;time of oral feeding&#xa0;of preterm neonate's: a randomized controlled clinical trial.
The oral nutrition is big challenge for preterm neonates. Since the best oral feeding method for preterm neonates is not yet known, the present study aimed to evaluate the effect of cup, syringe, and finger feeding methods on reaching the time of full oral feeding and weight gain among preterm neonates.</AbstractText>This randomized clinical trial study was conducted on 99 preterm neonate's, born at 30-34&#xa0;weeks gestation, admitted to the neonatal intensive care unit (NICU) of Al-Zahra and Taleghani Therapeutic-Educational Centers in Tabriz, Iran. Subjects were assigned into finger feeding (n&#x2009;=&#x2009;33), cup feeding (n&#x2009;=&#x2009;33), and syringe feeding (n&#x2009;=&#x2009;33) groups in the allocation ratio of 1:1:1 using block randomization with a block size 6 and 9. They were studied in terms of reaching the time of full oral feeding and weight gain. The data were analyzed using SPSS/version21 software, and ANOVA, chi-square, and ANCOVA tests.</AbstractText>There was no significant difference in the mean score of reaching the time of full oral feeding among cup, finger, and syringe feeding groups (p&#x2009;=&#x2009;0.652). The mean score of daily weight gain, oxygen saturation (SaO2</sub>), and heart rate after feeding was not significantly different among the three groups (p&#x2009;&gt;&#x2009;0.05). The effect of confounding variables, including birth weight and age, arterial oxygen saturation, and heart rate before feeding, was controlled.</AbstractText>Based on the results, one of the cup, finger, and syringe feeding methods can be applied in the NICU, considering the staff's proficiency in feeding neonates. Trial registration IRCT20150424021917N11.</AbstractText>&#xa9; 2022. The Author(s).</CopyrightInformation>
2,335,694
Suspecting and diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM) in India: An Indian expert consensus.<Pagination><StartPage>441</StartPage><EndPage>449</EndPage><MedlinePgn>441-449</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ihj.2022.11.006</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0019-4832(22)00372-8</ELocationID><Abstract><AbstractText>Transthyretin cardiac amyloidosis (ATTR-CM) is a rare and under-recognized disorder characterized by the aggregation of transthyretin-derived insoluble amyloid fibrils in the myocardium. Heterogeneity of symptoms at presentation, makes its diagnosis often delayed. An expert panel gathered on a virtual platform across India to conduct a meeting for developing a guiding tool for ATTR-CM diagnosis. The panel recommended younger age (&#x2265;40 years) for suspecting ATTR-CM and thick-walled non-dilated hypokinetic ventricle was considered as one of the important red flags. Electrocardiogram (ECG) and echocardiography (ECHO) findings were recommended as primary tests to raise the suspicion while nuclear scintigraphy and hematological tests were recommended to confirm the diagnosis and rule out amyloid light-chain (AL) amyloidosis. Cardiac magnetic resonance (CMR) and biopsy were recommended in case of ambiguity in the presence of red flags. Considering the lack of expert guidelines in the Indian scenario, a standardized diagnostic algorithm was also proposed.</AbstractText><CopyrightInformation>Copyright &#xa9; 2022. Published by Elsevier, a division of RELX India, Pvt. Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chander Mohan</LastName><ForeName>Jagdish</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Jaipur Golden Hospital, Sector 3, Rohini, Delhi, 110085, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dalal</LastName><ForeName>Jamshed</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Kokilaben Dhirubhai Ambani Hospital, Rao Saheb Achutrao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, 400053, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chopra</LastName><ForeName>Vijay Kumar</ForeName><Initials>VK</Initials><AffiliationInfo><Affiliation>Max Super Speciality Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, SakCet, New Delhi, Delhi 110017, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Narasimhan</LastName><ForeName>Calambur</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>AIG Hospitals, 1-66/AIG/2 to 5, Mindspace Road, Gachibowli, Hyderabad, Telangana, 500032, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kerkar</LastName><ForeName>Prafulla</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Asian Heart Institute, G / N Block, Bandra Kurla Complex, Bandra East, Mumbai, 400051, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Oomman</LastName><ForeName>Abraham</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Apollo Hospitals, 21, Greams Lane, Off Greams Road Chennai, 600 006, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ray Fcsi</LastName><ForeName>Saumitra</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>AMRI Hospital, Block-A, Scheme-L11, P-4&amp;5, Gariahat Rd, Dhakuria, Ward Number 90, Kolkata, West Bengal, 700029, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sharma</LastName><ForeName>Anshu Rajnish</ForeName><Initials>AR</Initials><AffiliationInfo><Affiliation>Kokilaben Dhirubhai Ambani Hospital, Rao Saheb Achutrao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, 400053, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dougall</LastName><ForeName>Pankaj</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Max Super Speciality Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, SakCet, New Delhi, Delhi 110017, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Simon</LastName><ForeName>Shelley</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Apollo Hospitals, 21, Greams Lane, Off Greams Road Chennai, 600 006, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Verma Drm</LastName><ForeName>Atul</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Fortis Escorts Heart Institute, Okhla Road, New Delhi, 110025, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Radhakrishnan</LastName><ForeName>Vivek</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Tata Medical Centre, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal, 700160, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>11</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>India</Country><MedlineTA>Indian Heart J</MedlineTA><NlmUniqueID>0374675</NlmUniqueID><ISSNLinking>0019-4832</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011228">Prealbumin</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D028227" MajorTopicYN="Y">Amyloid Neuropathies, Familial</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011228" MajorTopicYN="N">Prealbumin</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D032921" MajorTopicYN="N">Consensus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007194" MajorTopicYN="N" Type="Geographic">India</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009202" MajorTopicYN="Y">Cardiomyopathies</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Amyloidosis</Keyword><Keyword MajorTopicYN="N">Cardiac dysfunction</Keyword><Keyword MajorTopicYN="N">Rare disorder</Keyword><Keyword MajorTopicYN="N">Transthyretin cardiac amyloidosis (ATTR-CM)</Keyword></KeywordList><CoiStatement>Declaration of competing interest None of the authors have any conflicts of interest to declare. All authors have received honorarium from Pfizer for their services as a member of the ATTR-CM Expert Panel Meeting.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2022</Year><Month>8</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2022</Year><Month>11</Month><Day>8</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>11</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>12</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>11</Month><Day>21</Day><Hour>19</Hour><Minute>32</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">36410415</ArticleId><ArticleId IdType="pmc">PMC9773277</ArticleId><ArticleId IdType="doi">10.1016/j.ihj.2022.11.006</ArticleId><ArticleId IdType="pii">S0019-4832(22)00372-8</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Witteles R.M., Bokhari S., Damy T., et al. Screening for transthyretin amyloid cardiomyopathy in everyday practice. JACC Hear Fail. 2019;7(8):709&#x2013;716. doi: 10.1016/j.jchf.2019.04.010.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jchf.2019.04.010</ArticleId><ArticleId IdType="pubmed">31302046</ArticleId></ArticleIdList></Reference><Reference><Citation>Ruberg F.L., Grogan M., Hanna M., Kelly J.W., Maurer M.S. Transthyretin amyloid cardiomyopathy: JACC state-of-the-art review. J&#xa0;Am Coll Cardiol. 2020;73(22):2872&#x2013;2891. doi: 10.1016/j.jacc.2019.04.003. [Transthyretin]</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2019.04.003</ArticleId><ArticleId IdType="pmc">PMC6724183</ArticleId><ArticleId IdType="pubmed">31171094</ArticleId></ArticleIdList></Reference><Reference><Citation>Zeldenrust S.R., Benson M.D. Familial and senile amyloidosis caused by transthyretin. Protein Misfolding Dis Curr Emerg Princ Ther. 2010:795&#x2013;815. doi: 10.1002/9780470572702.ch36. Published online.</Citation><ArticleIdList><ArticleId IdType="doi">10.1002/9780470572702.ch36</ArticleId></ArticleIdList></Reference><Reference><Citation>Gonz&#xe1;lez-L&#xf3;pez E., L&#xf3;pez-Sainz &#xc1;, Garcia-Pavia P. Diagnosis and treatment of transthyretin cardiac amyloidosis. Progress and hope. Rev Espa&#xf1;ola Cardiol. 2017;70(11):991&#x2013;1004. doi: 10.1016/j.rec.2017.05.036. English Ed.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.rec.2017.05.036</ArticleId><ArticleId IdType="pubmed">28870641</ArticleId></ArticleIdList></Reference><Reference><Citation>Ruberg F.L., Berk J.L. Transthyretin (TTR) cardiac amyloidosis. Circulation. 2012;126(10):1286&#x2013;1300. doi: 10.1161/CIRCULATIONAHA.111.078915.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.111.078915</ArticleId><ArticleId IdType="pmc">PMC3501197</ArticleId><ArticleId IdType="pubmed">22949539</ArticleId></ArticleIdList></Reference><Reference><Citation>Ma G. Hereditary ATTR amyloidosis: burden of illness and diagnostic challenges. Am J Manag Care. 2017;(23):S107&#x2013;S112.</Citation><ArticleIdList><ArticleId IdType="pubmed">28978215</ArticleId></ArticleIdList></Reference><Reference><Citation>Rapezzi C., Quarta C.C., Obici L., et al. Disease profile and differential diagnosis of hereditary transthyretin-related amyloidosis with exclusively cardiac phenotype: an Italian perspective. Eur Heart J. 2013;34(7):520&#x2013;528. doi: 10.1093/eurheartj/ehs123.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehs123</ArticleId><ArticleId IdType="pubmed">22745357</ArticleId></ArticleIdList></Reference><Reference><Citation>Arbustini E., Merlini G. Early identification of transthyretin-related hereditary cardiac amyloidosis. JACC Cardiovasc Imaging. 2014;7(5):511&#x2013;514. doi: 10.1016/j.jcmg.2014.03.007.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jcmg.2014.03.007</ArticleId><ArticleId IdType="pubmed">24831211</ArticleId></ArticleIdList></Reference><Reference><Citation>Donnelly J.P., Hanna M. Cardiac amyloidosis: an update on diagnosis and treatment. Cleve Clin J Med. 2017;84:12&#x2013;26. doi: 10.3949/CCJM.84.S3.02.</Citation><ArticleIdList><ArticleId IdType="doi">10.3949/CCJM.84.S3.02</ArticleId><ArticleId IdType="pubmed">29257735</ArticleId></ArticleIdList></Reference><Reference><Citation>Hawkins P.N., Ando Y., Dispenzeri A., Gonzalez-Duarte A., Adams D., Suhr O.B. Evolving landscape in the management of transthyretin amyloidosis. Ann Med. 2015;47(8):625&#x2013;638. doi: 10.3109/07853890.2015.1068949.</Citation><ArticleIdList><ArticleId IdType="doi">10.3109/07853890.2015.1068949</ArticleId><ArticleId IdType="pmc">PMC4720049</ArticleId><ArticleId IdType="pubmed">26611723</ArticleId></ArticleIdList></Reference><Reference><Citation>Agarwal H., Ghosh T., Arava S., Ray R., Seth S. Cardiac amyloidosis in India: a clinicopathological study. J&#xa0;Pract Cardiovasc Sci. 2021;7(2):121. doi: 10.4103/jpcs.jpcs_35_21.</Citation><ArticleIdList><ArticleId IdType="doi">10.4103/jpcs.jpcs_35_21</ArticleId></ArticleIdList></Reference><Reference><Citation>Ghosh S., Khanra D., Krishna V., Thakur A.K. Wild type transthyretin cardiac amyloidosis in a young individual: a case report. Medicine (Baltim) 2021;100(17) doi: 10.1097/MD.0000000000025462.</Citation><ArticleIdList><ArticleId IdType="doi">10.1097/MD.0000000000025462</ArticleId><ArticleId IdType="pmc">PMC8084012</ArticleId><ArticleId IdType="pubmed">33907095</ArticleId></ArticleIdList></Reference><Reference><Citation>Lane T., Fontana M., Martinez-Naharro A., et al. Natural history, quality of life, and outcome in cardiac transthyretin amyloidosis. Circulation. 2019;140(1):16&#x2013;26. doi: 10.1161/CIRCULATIONAHA.118.038169.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.118.038169</ArticleId><ArticleId IdType="pubmed">31109193</ArticleId></ArticleIdList></Reference><Reference><Citation>Rozenbaum M.H., Large S., Bhambri R., et al. Impact of delayed diagnosis and misdiagnosis for patients with transthyretin amyloid cardiomyopathy (ATTR-CM): a targeted literature review. Cardiol Ther. 2021;10(1):141&#x2013;159. doi: 10.1007/s40119-021-00219-5.</Citation><ArticleIdList><ArticleId IdType="doi">10.1007/s40119-021-00219-5</ArticleId><ArticleId IdType="pmc">PMC8126532</ArticleId><ArticleId IdType="pubmed">33877591</ArticleId></ArticleIdList></Reference><Reference><Citation>Ladefoged B., Dybro A., Povlsen J.A., Vase H., Clemmensen T.S., Poulsen S.H. Diagnostic delay in wild type transthyretin cardiac amyloidosis &#x2013; a clinical challenge. Int J Cardiol. 2020;304:138&#x2013;143. doi: 10.1016/j.ijcard.2019.12.063.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.ijcard.2019.12.063</ArticleId><ArticleId IdType="pubmed">32033783</ArticleId></ArticleIdList></Reference><Reference><Citation>Nativi-Nicolau J.N., Karam C., Khella S., Maurer M.S. Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness. Heart Fail Rev. 2021 doi: 10.1007/s10741-021-10080-2. Published online.</Citation><ArticleIdList><ArticleId IdType="doi">10.1007/s10741-021-10080-2</ArticleId><ArticleId IdType="pmc">PMC9033715</ArticleId><ArticleId IdType="pubmed">33609196</ArticleId></ArticleIdList></Reference><Reference><Citation>Vera-Llonch M., Reddy S.R., Chang E., Tarbox M.H., Pollock M. The patient journey toward a diagnosis of hereditary transthyretin (ATTRv) amyloidosis. Orphanet J Rare Dis. 2021;16(1):1&#x2013;11. doi: 10.1186/s13023-020-01623-1.</Citation><ArticleIdList><ArticleId IdType="doi">10.1186/s13023-020-01623-1</ArticleId><ArticleId IdType="pmc">PMC7798313</ArticleId><ArticleId IdType="pubmed">33430941</ArticleId></ArticleIdList></Reference><Reference><Citation>Garcia-Pavia P., Rapezzi C., Adler Y., et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J. 2021;42(16):1554&#x2013;1568. doi: 10.1093/eurheartj/ehab072.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehab072</ArticleId><ArticleId IdType="pmc">PMC8060056</ArticleId><ArticleId IdType="pubmed">33825853</ArticleId></ArticleIdList></Reference><Reference><Citation>Gonz&#xe1;lez-L&#xf3;pez E., Gallego-Delgado M., Guzzo-Merello G., et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015;36(38):2585&#x2013;2594. doi: 10.1093/eurheartj/ehv338.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehv338</ArticleId><ArticleId IdType="pubmed">26224076</ArticleId></ArticleIdList></Reference><Reference><Citation>L&#xf3;pez-Sainz &#xc1;, de Haro-del Moral F.J., Dominguez F., et al. Prevalence of cardiac amyloidosis among elderly patients with systolic heart failure or conduction disorders. Amyloid. 2019;26(3):156&#x2013;163. doi: 10.1080/13506129.2019.1625322.</Citation><ArticleIdList><ArticleId IdType="doi">10.1080/13506129.2019.1625322</ArticleId><ArticleId IdType="pubmed">31210553</ArticleId></ArticleIdList></Reference><Reference><Citation>Damy T., Costes B., Hag&#xe8;ge A.A., et al. Prevalence and clinical phenotype of hereditary transthyretin amyloid cardiomyopathy in patients with increased left ventricular wall thickness. Eur Heart J. 2016;37(23):1826&#x2013;1834. doi: 10.1093/eurheartj/ehv583.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehv583</ArticleId><ArticleId IdType="pubmed">26537620</ArticleId></ArticleIdList></Reference><Reference><Citation>Treibel T.A., Fontana M., Gilbertson J.A., et al. Occult transthyretin cardiac amyloid in severe calcific aortic stenosis. Circ Cardiovasc Imaging. 2016;9(8):1&#x2013;10. doi: 10.1161/CIRCIMAGING.116.005066.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCIMAGING.116.005066</ArticleId><ArticleId IdType="pubmed">27511979</ArticleId></ArticleIdList></Reference><Reference><Citation>Castano A., Narotsky D.L., Hamid N., et al. Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Heart J. 2017;38(38):2879&#x2013;2887. doi: 10.1093/eurheartj/ehx350.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehx350</ArticleId><ArticleId IdType="pmc">PMC5837725</ArticleId><ArticleId IdType="pubmed">29019612</ArticleId></ArticleIdList></Reference><Reference><Citation>Bokhari S., Casta&#xf1;o A., Pozniakoff T., Deslisle S., Latif F.M.M. (99m)Tc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging. 2013 Mar 1;6(2):195&#x2013;201. doi: 10.1007/978-1-4419-6848-7_5.</Citation><ArticleIdList><ArticleId IdType="doi">10.1007/978-1-4419-6848-7_5</ArticleId><ArticleId IdType="pmc">PMC3727049</ArticleId><ArticleId IdType="pubmed">23400849</ArticleId></ArticleIdList></Reference><Reference><Citation>Perugini E., Guidalotti P.L., Salvi F., et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J&#xa0;Am Coll Cardiol. 2005;46(6):1076&#x2013;1084. doi: 10.1016/j.jacc.2005.05.073.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2005.05.073</ArticleId><ArticleId IdType="pubmed">16168294</ArticleId></ArticleIdList></Reference><Reference><Citation>Hutt D.F., Fontana M., Burniston M., et al. Prognostic utility of the Perugini grading of 99m Tc-DPD scintigraphy in transthyretin (ATTR) amyloidosis and its relationship with skeletal muscle and soft tissue amyloid. Eur Heart J Cardiovasc Imaging. 2017;18(12):1344&#x2013;1350. doi: 10.1093/ehjci/jew325.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/ehjci/jew325</ArticleId><ArticleId IdType="pubmed">28159995</ArticleId></ArticleIdList></Reference><Reference><Citation>Gillmore J.D., Maurer M.S., Falk R.H., et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016;133(24):2404&#x2013;2412. doi: 10.1161/CIRCULATIONAHA.116.021612.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.116.021612</ArticleId><ArticleId IdType="pubmed">27143678</ArticleId></ArticleIdList></Reference><Reference><Citation>Maurer M.S., Elliott P., Comenzo R., Semigran M.R.C. Addressing common questions encountered in the diagnosis and management of cardiac amyloidosis. Circulation. 2017;135(14):1357&#x2013;1377. doi: 10.1161/CIRCULATIONAHA.116.024438. [Addressing]</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.116.024438</ArticleId><ArticleId IdType="pmc">PMC5392416</ArticleId><ArticleId IdType="pubmed">28373528</ArticleId></ArticleIdList></Reference><Reference><Citation>Concei&#xe7;&#xe3;o I., Coelho T., Rapezzi C., et al. Assessment of patients with hereditary transthyretin amyloidosis&#x2013;understanding the impact of management and disease progression. Amyloid. 2019;26(3):103&#x2013;111. doi: 10.1080/13506129.2019.1627312.</Citation><ArticleIdList><ArticleId IdType="doi">10.1080/13506129.2019.1627312</ArticleId><ArticleId IdType="pubmed">31339362</ArticleId></ArticleIdList></Reference><Reference><Citation>Maurer M.S., Bokhari S., Damy T., et al. Expert consensus recommendations for the suspicion and diagnosis of transthyretin cardiac amyloidosis. Circ Hear Fail. 2019;12(9) doi: 10.1161/CIRCHEARTFAILURE.119.006075.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCHEARTFAILURE.119.006075</ArticleId><ArticleId IdType="pmc">PMC6736650</ArticleId><ArticleId IdType="pubmed">31480867</ArticleId></ArticleIdList></Reference><Reference><Citation>Kittleson MM, Maurer MS, Ambardekar A V., et&#xa0;al. Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American heart association. Circulation. Published online 2020:E7-E22. doi:10.1161/CIR.0000000000000792.</Citation><ArticleIdList><ArticleId IdType="pubmed">32476490</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">36409744</PMID><DateRevised><Year>2022</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1538-4683</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Nov</Month><Day>21</Day></PubDate></JournalIssue><Title>Cardiology in review</Title><ISOAbbreviation>Cardiol Rev</ISOAbbreviation></Journal>Splanchnic Nerve Block: An Emerging Treatment for Heart Failure.
Transthyretin cardiac amyloidosis (ATTR-CM) is a rare and under-recognized disorder characterized by the aggregation of transthyretin-derived insoluble amyloid fibrils in the myocardium. Heterogeneity of symptoms at presentation, makes its diagnosis often delayed. An expert panel gathered on a virtual platform across India to conduct a meeting for developing a guiding tool for ATTR-CM diagnosis. The panel recommended younger age (&#x2265;40 years) for suspecting ATTR-CM and thick-walled non-dilated hypokinetic ventricle was considered as one of the important red flags. Electrocardiogram (ECG) and echocardiography (ECHO) findings were recommended as primary tests to raise the suspicion while nuclear scintigraphy and hematological tests were recommended to confirm the diagnosis and rule out amyloid light-chain (AL) amyloidosis. Cardiac magnetic resonance (CMR) and biopsy were recommended in case of ambiguity in the presence of red flags. Considering the lack of expert guidelines in the Indian scenario, a standardized diagnostic algorithm was also proposed.<CopyrightInformation>Copyright &#xa9; 2022. Published by Elsevier, a division of RELX India, Pvt. Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chander Mohan</LastName><ForeName>Jagdish</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Jaipur Golden Hospital, Sector 3, Rohini, Delhi, 110085, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dalal</LastName><ForeName>Jamshed</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Kokilaben Dhirubhai Ambani Hospital, Rao Saheb Achutrao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, 400053, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chopra</LastName><ForeName>Vijay Kumar</ForeName><Initials>VK</Initials><AffiliationInfo><Affiliation>Max Super Speciality Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, SakCet, New Delhi, Delhi 110017, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Narasimhan</LastName><ForeName>Calambur</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>AIG Hospitals, 1-66/AIG/2 to 5, Mindspace Road, Gachibowli, Hyderabad, Telangana, 500032, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kerkar</LastName><ForeName>Prafulla</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Asian Heart Institute, G / N Block, Bandra Kurla Complex, Bandra East, Mumbai, 400051, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Oomman</LastName><ForeName>Abraham</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Apollo Hospitals, 21, Greams Lane, Off Greams Road Chennai, 600 006, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ray Fcsi</LastName><ForeName>Saumitra</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>AMRI Hospital, Block-A, Scheme-L11, P-4&amp;5, Gariahat Rd, Dhakuria, Ward Number 90, Kolkata, West Bengal, 700029, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sharma</LastName><ForeName>Anshu Rajnish</ForeName><Initials>AR</Initials><AffiliationInfo><Affiliation>Kokilaben Dhirubhai Ambani Hospital, Rao Saheb Achutrao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, 400053, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dougall</LastName><ForeName>Pankaj</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Max Super Speciality Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, SakCet, New Delhi, Delhi 110017, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Simon</LastName><ForeName>Shelley</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Apollo Hospitals, 21, Greams Lane, Off Greams Road Chennai, 600 006, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Verma Drm</LastName><ForeName>Atul</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Fortis Escorts Heart Institute, Okhla Road, New Delhi, 110025, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Radhakrishnan</LastName><ForeName>Vivek</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Tata Medical Centre, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal, 700160, India. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>11</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>India</Country><MedlineTA>Indian Heart J</MedlineTA><NlmUniqueID>0374675</NlmUniqueID><ISSNLinking>0019-4832</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011228">Prealbumin</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D028227" MajorTopicYN="Y">Amyloid Neuropathies, Familial</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011228" MajorTopicYN="N">Prealbumin</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D032921" MajorTopicYN="N">Consensus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007194" MajorTopicYN="N" Type="Geographic">India</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009202" MajorTopicYN="Y">Cardiomyopathies</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Amyloidosis</Keyword><Keyword MajorTopicYN="N">Cardiac dysfunction</Keyword><Keyword MajorTopicYN="N">Rare disorder</Keyword><Keyword MajorTopicYN="N">Transthyretin cardiac amyloidosis (ATTR-CM)</Keyword></KeywordList><CoiStatement>Declaration of competing interest None of the authors have any conflicts of interest to declare. All authors have received honorarium from Pfizer for their services as a member of the ATTR-CM Expert Panel Meeting.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2022</Year><Month>8</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2022</Year><Month>11</Month><Day>8</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>11</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>12</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>11</Month><Day>21</Day><Hour>19</Hour><Minute>32</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">36410415</ArticleId><ArticleId IdType="pmc">PMC9773277</ArticleId><ArticleId IdType="doi">10.1016/j.ihj.2022.11.006</ArticleId><ArticleId IdType="pii">S0019-4832(22)00372-8</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Witteles R.M., Bokhari S., Damy T., et al. Screening for transthyretin amyloid cardiomyopathy in everyday practice. JACC Hear Fail. 2019;7(8):709&#x2013;716. doi: 10.1016/j.jchf.2019.04.010.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jchf.2019.04.010</ArticleId><ArticleId IdType="pubmed">31302046</ArticleId></ArticleIdList></Reference><Reference><Citation>Ruberg F.L., Grogan M., Hanna M., Kelly J.W., Maurer M.S. Transthyretin amyloid cardiomyopathy: JACC state-of-the-art review. J&#xa0;Am Coll Cardiol. 2020;73(22):2872&#x2013;2891. doi: 10.1016/j.jacc.2019.04.003. [Transthyretin]</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2019.04.003</ArticleId><ArticleId IdType="pmc">PMC6724183</ArticleId><ArticleId IdType="pubmed">31171094</ArticleId></ArticleIdList></Reference><Reference><Citation>Zeldenrust S.R., Benson M.D. Familial and senile amyloidosis caused by transthyretin. Protein Misfolding Dis Curr Emerg Princ Ther. 2010:795&#x2013;815. doi: 10.1002/9780470572702.ch36. Published online.</Citation><ArticleIdList><ArticleId IdType="doi">10.1002/9780470572702.ch36</ArticleId></ArticleIdList></Reference><Reference><Citation>Gonz&#xe1;lez-L&#xf3;pez E., L&#xf3;pez-Sainz &#xc1;, Garcia-Pavia P. Diagnosis and treatment of transthyretin cardiac amyloidosis. Progress and hope. Rev Espa&#xf1;ola Cardiol. 2017;70(11):991&#x2013;1004. doi: 10.1016/j.rec.2017.05.036. English Ed.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.rec.2017.05.036</ArticleId><ArticleId IdType="pubmed">28870641</ArticleId></ArticleIdList></Reference><Reference><Citation>Ruberg F.L., Berk J.L. Transthyretin (TTR) cardiac amyloidosis. Circulation. 2012;126(10):1286&#x2013;1300. doi: 10.1161/CIRCULATIONAHA.111.078915.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.111.078915</ArticleId><ArticleId IdType="pmc">PMC3501197</ArticleId><ArticleId IdType="pubmed">22949539</ArticleId></ArticleIdList></Reference><Reference><Citation>Ma G. Hereditary ATTR amyloidosis: burden of illness and diagnostic challenges. Am J Manag Care. 2017;(23):S107&#x2013;S112.</Citation><ArticleIdList><ArticleId IdType="pubmed">28978215</ArticleId></ArticleIdList></Reference><Reference><Citation>Rapezzi C., Quarta C.C., Obici L., et al. Disease profile and differential diagnosis of hereditary transthyretin-related amyloidosis with exclusively cardiac phenotype: an Italian perspective. Eur Heart J. 2013;34(7):520&#x2013;528. doi: 10.1093/eurheartj/ehs123.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehs123</ArticleId><ArticleId IdType="pubmed">22745357</ArticleId></ArticleIdList></Reference><Reference><Citation>Arbustini E., Merlini G. Early identification of transthyretin-related hereditary cardiac amyloidosis. JACC Cardiovasc Imaging. 2014;7(5):511&#x2013;514. doi: 10.1016/j.jcmg.2014.03.007.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jcmg.2014.03.007</ArticleId><ArticleId IdType="pubmed">24831211</ArticleId></ArticleIdList></Reference><Reference><Citation>Donnelly J.P., Hanna M. Cardiac amyloidosis: an update on diagnosis and treatment. Cleve Clin J Med. 2017;84:12&#x2013;26. doi: 10.3949/CCJM.84.S3.02.</Citation><ArticleIdList><ArticleId IdType="doi">10.3949/CCJM.84.S3.02</ArticleId><ArticleId IdType="pubmed">29257735</ArticleId></ArticleIdList></Reference><Reference><Citation>Hawkins P.N., Ando Y., Dispenzeri A., Gonzalez-Duarte A., Adams D., Suhr O.B. Evolving landscape in the management of transthyretin amyloidosis. Ann Med. 2015;47(8):625&#x2013;638. doi: 10.3109/07853890.2015.1068949.</Citation><ArticleIdList><ArticleId IdType="doi">10.3109/07853890.2015.1068949</ArticleId><ArticleId IdType="pmc">PMC4720049</ArticleId><ArticleId IdType="pubmed">26611723</ArticleId></ArticleIdList></Reference><Reference><Citation>Agarwal H., Ghosh T., Arava S., Ray R., Seth S. Cardiac amyloidosis in India: a clinicopathological study. J&#xa0;Pract Cardiovasc Sci. 2021;7(2):121. doi: 10.4103/jpcs.jpcs_35_21.</Citation><ArticleIdList><ArticleId IdType="doi">10.4103/jpcs.jpcs_35_21</ArticleId></ArticleIdList></Reference><Reference><Citation>Ghosh S., Khanra D., Krishna V., Thakur A.K. Wild type transthyretin cardiac amyloidosis in a young individual: a case report. Medicine (Baltim) 2021;100(17) doi: 10.1097/MD.0000000000025462.</Citation><ArticleIdList><ArticleId IdType="doi">10.1097/MD.0000000000025462</ArticleId><ArticleId IdType="pmc">PMC8084012</ArticleId><ArticleId IdType="pubmed">33907095</ArticleId></ArticleIdList></Reference><Reference><Citation>Lane T., Fontana M., Martinez-Naharro A., et al. Natural history, quality of life, and outcome in cardiac transthyretin amyloidosis. Circulation. 2019;140(1):16&#x2013;26. doi: 10.1161/CIRCULATIONAHA.118.038169.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.118.038169</ArticleId><ArticleId IdType="pubmed">31109193</ArticleId></ArticleIdList></Reference><Reference><Citation>Rozenbaum M.H., Large S., Bhambri R., et al. Impact of delayed diagnosis and misdiagnosis for patients with transthyretin amyloid cardiomyopathy (ATTR-CM): a targeted literature review. Cardiol Ther. 2021;10(1):141&#x2013;159. doi: 10.1007/s40119-021-00219-5.</Citation><ArticleIdList><ArticleId IdType="doi">10.1007/s40119-021-00219-5</ArticleId><ArticleId IdType="pmc">PMC8126532</ArticleId><ArticleId IdType="pubmed">33877591</ArticleId></ArticleIdList></Reference><Reference><Citation>Ladefoged B., Dybro A., Povlsen J.A., Vase H., Clemmensen T.S., Poulsen S.H. Diagnostic delay in wild type transthyretin cardiac amyloidosis &#x2013; a clinical challenge. Int J Cardiol. 2020;304:138&#x2013;143. doi: 10.1016/j.ijcard.2019.12.063.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.ijcard.2019.12.063</ArticleId><ArticleId IdType="pubmed">32033783</ArticleId></ArticleIdList></Reference><Reference><Citation>Nativi-Nicolau J.N., Karam C., Khella S., Maurer M.S. Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness. Heart Fail Rev. 2021 doi: 10.1007/s10741-021-10080-2. Published online.</Citation><ArticleIdList><ArticleId IdType="doi">10.1007/s10741-021-10080-2</ArticleId><ArticleId IdType="pmc">PMC9033715</ArticleId><ArticleId IdType="pubmed">33609196</ArticleId></ArticleIdList></Reference><Reference><Citation>Vera-Llonch M., Reddy S.R., Chang E., Tarbox M.H., Pollock M. The patient journey toward a diagnosis of hereditary transthyretin (ATTRv) amyloidosis. Orphanet J Rare Dis. 2021;16(1):1&#x2013;11. doi: 10.1186/s13023-020-01623-1.</Citation><ArticleIdList><ArticleId IdType="doi">10.1186/s13023-020-01623-1</ArticleId><ArticleId IdType="pmc">PMC7798313</ArticleId><ArticleId IdType="pubmed">33430941</ArticleId></ArticleIdList></Reference><Reference><Citation>Garcia-Pavia P., Rapezzi C., Adler Y., et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J. 2021;42(16):1554&#x2013;1568. doi: 10.1093/eurheartj/ehab072.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehab072</ArticleId><ArticleId IdType="pmc">PMC8060056</ArticleId><ArticleId IdType="pubmed">33825853</ArticleId></ArticleIdList></Reference><Reference><Citation>Gonz&#xe1;lez-L&#xf3;pez E., Gallego-Delgado M., Guzzo-Merello G., et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015;36(38):2585&#x2013;2594. doi: 10.1093/eurheartj/ehv338.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehv338</ArticleId><ArticleId IdType="pubmed">26224076</ArticleId></ArticleIdList></Reference><Reference><Citation>L&#xf3;pez-Sainz &#xc1;, de Haro-del Moral F.J., Dominguez F., et al. Prevalence of cardiac amyloidosis among elderly patients with systolic heart failure or conduction disorders. Amyloid. 2019;26(3):156&#x2013;163. doi: 10.1080/13506129.2019.1625322.</Citation><ArticleIdList><ArticleId IdType="doi">10.1080/13506129.2019.1625322</ArticleId><ArticleId IdType="pubmed">31210553</ArticleId></ArticleIdList></Reference><Reference><Citation>Damy T., Costes B., Hag&#xe8;ge A.A., et al. Prevalence and clinical phenotype of hereditary transthyretin amyloid cardiomyopathy in patients with increased left ventricular wall thickness. Eur Heart J. 2016;37(23):1826&#x2013;1834. doi: 10.1093/eurheartj/ehv583.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehv583</ArticleId><ArticleId IdType="pubmed">26537620</ArticleId></ArticleIdList></Reference><Reference><Citation>Treibel T.A., Fontana M., Gilbertson J.A., et al. Occult transthyretin cardiac amyloid in severe calcific aortic stenosis. Circ Cardiovasc Imaging. 2016;9(8):1&#x2013;10. doi: 10.1161/CIRCIMAGING.116.005066.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCIMAGING.116.005066</ArticleId><ArticleId IdType="pubmed">27511979</ArticleId></ArticleIdList></Reference><Reference><Citation>Castano A., Narotsky D.L., Hamid N., et al. Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Heart J. 2017;38(38):2879&#x2013;2887. doi: 10.1093/eurheartj/ehx350.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/eurheartj/ehx350</ArticleId><ArticleId IdType="pmc">PMC5837725</ArticleId><ArticleId IdType="pubmed">29019612</ArticleId></ArticleIdList></Reference><Reference><Citation>Bokhari S., Casta&#xf1;o A., Pozniakoff T., Deslisle S., Latif F.M.M. (99m)Tc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging. 2013 Mar 1;6(2):195&#x2013;201. doi: 10.1007/978-1-4419-6848-7_5.</Citation><ArticleIdList><ArticleId IdType="doi">10.1007/978-1-4419-6848-7_5</ArticleId><ArticleId IdType="pmc">PMC3727049</ArticleId><ArticleId IdType="pubmed">23400849</ArticleId></ArticleIdList></Reference><Reference><Citation>Perugini E., Guidalotti P.L., Salvi F., et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J&#xa0;Am Coll Cardiol. 2005;46(6):1076&#x2013;1084. doi: 10.1016/j.jacc.2005.05.073.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2005.05.073</ArticleId><ArticleId IdType="pubmed">16168294</ArticleId></ArticleIdList></Reference><Reference><Citation>Hutt D.F., Fontana M., Burniston M., et al. Prognostic utility of the Perugini grading of 99m Tc-DPD scintigraphy in transthyretin (ATTR) amyloidosis and its relationship with skeletal muscle and soft tissue amyloid. Eur Heart J Cardiovasc Imaging. 2017;18(12):1344&#x2013;1350. doi: 10.1093/ehjci/jew325.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/ehjci/jew325</ArticleId><ArticleId IdType="pubmed">28159995</ArticleId></ArticleIdList></Reference><Reference><Citation>Gillmore J.D., Maurer M.S., Falk R.H., et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016;133(24):2404&#x2013;2412. doi: 10.1161/CIRCULATIONAHA.116.021612.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.116.021612</ArticleId><ArticleId IdType="pubmed">27143678</ArticleId></ArticleIdList></Reference><Reference><Citation>Maurer M.S., Elliott P., Comenzo R., Semigran M.R.C. Addressing common questions encountered in the diagnosis and management of cardiac amyloidosis. Circulation. 2017;135(14):1357&#x2013;1377. doi: 10.1161/CIRCULATIONAHA.116.024438. [Addressing]</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.116.024438</ArticleId><ArticleId IdType="pmc">PMC5392416</ArticleId><ArticleId IdType="pubmed">28373528</ArticleId></ArticleIdList></Reference><Reference><Citation>Concei&#xe7;&#xe3;o I., Coelho T., Rapezzi C., et al. Assessment of patients with hereditary transthyretin amyloidosis&#x2013;understanding the impact of management and disease progression. Amyloid. 2019;26(3):103&#x2013;111. doi: 10.1080/13506129.2019.1627312.</Citation><ArticleIdList><ArticleId IdType="doi">10.1080/13506129.2019.1627312</ArticleId><ArticleId IdType="pubmed">31339362</ArticleId></ArticleIdList></Reference><Reference><Citation>Maurer M.S., Bokhari S., Damy T., et al. Expert consensus recommendations for the suspicion and diagnosis of transthyretin cardiac amyloidosis. Circ Hear Fail. 2019;12(9) doi: 10.1161/CIRCHEARTFAILURE.119.006075.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCHEARTFAILURE.119.006075</ArticleId><ArticleId IdType="pmc">PMC6736650</ArticleId><ArticleId IdType="pubmed">31480867</ArticleId></ArticleIdList></Reference><Reference><Citation>Kittleson MM, Maurer MS, Ambardekar A V., et&#xa0;al. Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American heart association. Circulation. Published online 2020:E7-E22. doi:10.1161/CIR.0000000000000792.</Citation><ArticleIdList><ArticleId IdType="pubmed">32476490</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">36409744</PMID><DateRevised><Year>2022</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1538-4683</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Nov</Month><Day>21</Day></PubDate></JournalIssue><Title>Cardiology in review</Title><ISOAbbreviation>Cardiol Rev</ISOAbbreviation></Journal><ArticleTitle>Splanchnic Nerve Block: An Emerging Treatment for Heart Failure.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.1097/CRD.0000000000000505</ELocationID><Abstract>Heart failure (HF) is a disease syndrome whose management is increasingly challenging given the aging population and efficacious management of acute cardiac events. The current treatment options within our armamentarium incompletely address the unmet needs of HF. Splanchnic nerve block (SNB) is a novel technique that targets the greater splanchnic nerve, a potential therapeutic target in HF. However, the technique confers potential adverse side effects and complications that warrant further investigations. In this review paper, we aim to discuss the inextricable role of splanchnic nerve in HF by highlighting their physiological interplay, clinical studies that have exhibited favorable hemodynamic parameters in the context of acute and chronic HF, and common side effects and possible complications from SNB.
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Two Electrocardiographic Aberrations Important for All Caring for Patients to Know about.<Pagination><StartPage>58</StartPage><EndPage>61</EndPage><MedlinePgn>58-61</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1159/000528173</ELocationID><Abstract><AbstractText>Two electrocardiographic (ECG) aberrations encountered daily in ECG interpretation/overreading, which appear to be either unknown or ignored, by all caring for patients, are described herein: the 1st is the transient increase in the amplitude of QRS complexes in the right precordial ECG leads, leading to the erroneous diagnosis of left ventricular hypertrophy, often encountered in patients with episodes of supraventricular tachycardia, rapid sinus tachycardia, and atrial fibrillation; the 2nd is the spurious ST-segment elevations in lateral and/or inferior ECG leads in patients with right bundle branch block, interpreted by the automated ECG diagnostic algorithms as due to "acute myocardial infarction," "ischemic injury," "pericarditis," and "early repolarization," in the absence of such pathologies or electrophysiological explanations.</AbstractText><CopyrightInformation>&#xa9; 2022 S. Karger AG, Basel.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Madias</LastName><ForeName>John E</ForeName><Initials>JE</Initials><AffiliationInfo><Affiliation>Icahn School of Medicine at Mount Sinai, New York, New York, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>The Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016422">Letter</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>11</Month><Day>18</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Cardiology</MedlineTA><NlmUniqueID>1266406</NlmUniqueID><ISSNLinking>0008-6312</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002037" MajorTopicYN="N">Bundle-Branch Block</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="Y">Myocardial Infarction</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005791" MajorTopicYN="N">Patient Care</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Atrial fibrillation</Keyword><Keyword MajorTopicYN="N">Complete right bundle branch block</Keyword><Keyword MajorTopicYN="N">Early repolarization</Keyword><Keyword MajorTopicYN="N">Electrocardiogram</Keyword><Keyword MajorTopicYN="N">Electrophysiology</Keyword><Keyword MajorTopicYN="N">Ischemic injury</Keyword><Keyword MajorTopicYN="N">Left ventricular hypertrophy</Keyword><Keyword MajorTopicYN="N">Myocardial infarction</Keyword><Keyword MajorTopicYN="N">Pericarditis</Keyword><Keyword MajorTopicYN="N">ST-segment elevation</Keyword><Keyword MajorTopicYN="N">Sinus tachycardia</Keyword><Keyword MajorTopicYN="N">Supraventricular tachycardia</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2022</Year><Month>11</Month><Day>7</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>11</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2023</Year><Month>3</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>11</Month><Day>21</Day><Hour>2</Hour><Minute>22</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">36404701</ArticleId><ArticleId IdType="doi">10.1159/000528173</ArticleId><ArticleId IdType="pii">000528173</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">36403975</PMID><DateRevised><Year>2022</Year><Month>11</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1347-4820</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Nov</Month><Day>18</Day></PubDate></JournalIssue><Title>Circulation journal : official journal of the Japanese Circulation Society</Title><ISOAbbreviation>Circ J</ISOAbbreviation></Journal>Fascia Iliaca Block Reduces Remifentanil Requirement in Conscious Sedation for Transcatheter Aortic Valve Implantation&#x3000;- A Randomized Clinical Trial.
Two electrocardiographic (ECG) aberrations encountered daily in ECG interpretation/overreading, which appear to be either unknown or ignored, by all caring for patients, are described herein: the 1st is the transient increase in the amplitude of QRS complexes in the right precordial ECG leads, leading to the erroneous diagnosis of left ventricular hypertrophy, often encountered in patients with episodes of supraventricular tachycardia, rapid sinus tachycardia, and atrial fibrillation; the 2nd is the spurious ST-segment elevations in lateral and/or inferior ECG leads in patients with right bundle branch block, interpreted by the automated ECG diagnostic algorithms as due to "acute myocardial infarction," "ischemic injury," "pericarditis," and "early repolarization," in the absence of such pathologies or electrophysiological explanations.<CopyrightInformation>&#xa9; 2022 S. Karger AG, Basel.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Madias</LastName><ForeName>John E</ForeName><Initials>JE</Initials><AffiliationInfo><Affiliation>Icahn School of Medicine at Mount Sinai, New York, New York, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>The Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016422">Letter</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>11</Month><Day>18</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Cardiology</MedlineTA><NlmUniqueID>1266406</NlmUniqueID><ISSNLinking>0008-6312</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002037" MajorTopicYN="N">Bundle-Branch Block</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="Y">Myocardial Infarction</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005791" MajorTopicYN="N">Patient Care</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Atrial fibrillation</Keyword><Keyword MajorTopicYN="N">Complete right bundle branch block</Keyword><Keyword MajorTopicYN="N">Early repolarization</Keyword><Keyword MajorTopicYN="N">Electrocardiogram</Keyword><Keyword MajorTopicYN="N">Electrophysiology</Keyword><Keyword MajorTopicYN="N">Ischemic injury</Keyword><Keyword MajorTopicYN="N">Left ventricular hypertrophy</Keyword><Keyword MajorTopicYN="N">Myocardial infarction</Keyword><Keyword MajorTopicYN="N">Pericarditis</Keyword><Keyword MajorTopicYN="N">ST-segment elevation</Keyword><Keyword MajorTopicYN="N">Sinus tachycardia</Keyword><Keyword MajorTopicYN="N">Supraventricular tachycardia</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2022</Year><Month>11</Month><Day>7</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>11</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2023</Year><Month>3</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>11</Month><Day>21</Day><Hour>2</Hour><Minute>22</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">36404701</ArticleId><ArticleId IdType="doi">10.1159/000528173</ArticleId><ArticleId IdType="pii">000528173</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">36403975</PMID><DateRevised><Year>2022</Year><Month>11</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1347-4820</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Nov</Month><Day>18</Day></PubDate></JournalIssue><Title>Circulation journal : official journal of the Japanese Circulation Society</Title><ISOAbbreviation>Circ J</ISOAbbreviation></Journal><ArticleTitle>Fascia Iliaca Block Reduces Remifentanil Requirement in Conscious Sedation for Transcatheter Aortic Valve Implantation&#x3000;- A Randomized Clinical Trial.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.1253/circj.CJ-22-0580</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Whether nerve block improves the quality of conscious sedation (CS) in patients undergoing transcatheter aortic valve implantation (TAVI) is unclear. This study investigated whether fascia iliaca block (FIB) reduced the remifentanil requirement and relieved pain in CS for TAVI.Methods&#x2004;and&#x2004;Results: This prospective study randomized 72 patients scheduled for elective TAVI under CS into 2 groups, with (FIB) and without (control) FIB (n=36 in each group). The sedation targeted a Bispectral Index &lt;90 with a Richmond Agitation-Sedation Scale of -2 to -1. Dexmedetomidine (0.7 &#xb5;g/kg, i.v.) combined with remifentanil (0.03 &#xb5;g/kg/min, i.v.) and propofol (0.3 mg/kg/h, i.v.) was used to commence sedation. FIB using 30 mL of 0.185% ropivacaine was implemented 2 min before TAVI. Patient sedation was maintained with dexmedetomidine (0.4 &#xb5;g/kg/h, i.v.) supplemented with remifentanil (0-0.02 &#xb5;g/kg/min, i.v.). Remifentanil (20 &#xb5;g, i.v.) was used as a rescue dose for intraprocedural pain. Compared with the control group, FIB reduced the both the total (median [interquartile range] 83.0 [65.0-98.0] vs. 34.5 [26.0/45.8)] &#xb5;g; P&lt;0.001) and continuous (25.3 [20.9/31.5] vs. 9.5 [6.8/12.5] ng/kg/min; P&lt;0.001) doses of remifentanil administered.<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">FIB reduced the remifentanil requirement and relieved pain in patients undergoing TAVI with CS. Therefore, FIB improved the quality of CS in TAVI.
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Sodium alginate-hydrogel coatings on extracorporeal membrane oxygenation for anticoagulation.
Thromboembolism caused by the use of extracorporeal membrane oxygenation (ECMO) remains common among patients with existing heart diseases and contributes to significant morbidity and mortality during the COVID-19 pandemic. Various surface modification strategies have been proposed, showing that the methacrylated alginate (MA-SA) hydrogel layer is transparent, which aids the observation of the thromboembolism from the inner wall of the tubing. In the combined dynamic and static blood of ECMO tubing inner surface <i>in vitro</i> experiments, it was also demonstrated that the adhesion of blood clots to the surface of vessels was remarkably reduced, and the MA-SA-based hydrogel coating could significantly prolong the activated partial thrombin time and block the endogenous coagulation. The favorable properties of natural polysaccharides of hydrogel coatings make them the best surface material choices to be applied for blood-contacting medical devices and significantly improve anticoagulant performance.
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Correction: Cardiovascular Risk Factors and Clinical Outcomes among Patients Hospitalized with COVID-19: Findings from the World Heart Federation COVID-19 Study.
[This corrects the article DOI: 10.5334/gh.1128.].
2,335,698
Sj&#xf6;gren's syndrome and pregnancy: a Portuguese case-control study.
Pregnancy in patients with autoimmune disorders is associated with an increased risk of adverse outcomes. Sj&#xf6;gren's syndrome (SS) is one of the most common among autoimmune diseases. Presently data regarding the impact of SS on obstetric outcomes are scarce and inconclusive. This study aims to evaluate the impact of SS on maternal-fetal and neonatal outcomes compared with pregnancy outcomes in the general population.</AbstractText>A retrospective case-control study included 26 pregnancies in SS patients and a healthy control group (CG), followed in a Portuguese tertiary center, between 2015 and 2020. Baseline maternal data were collected, and maternal-fetal and neonatal outcomes were evaluated. Statistical analysis used SPSS 25.0, and a p</i>-value of 0.05 was considered statistically significant.</AbstractText>All pregnancies occurred after the diagnosis of SS, with a mean exposure time between diagnosis and pregnancy of 4.92 &#xb1;2.78 years. In the SS group, the incidence of ANA, anti-Ro/SSA, and anti-La/SSB antibodies positivity was 80.8%, 61.5%, and 46.2%, respectively. Hydroxychloroquine (HCQ) was used in 57.7%.Miscarriage was significantly higher in the SS group (19.2% vs. 1.8%, p</i> &lt; 0.01). There was a higher prevalence of fetal growth restriction (OR 11.16, 95% CI: 0.96-129.26). Preterm delivery (9.5% vs. 5.6%, p</i> = 0.503) and mean birth weight (2998.16 g vs. 3155.79 g, p</i> = 0.178) did not differ significantly between the groups. In the SS group, admission to the neonatal intensive care unit (NICU) rate was increased (OR 71.67, 95% CI: 3.78-1357.16). Three pregnancies were complicated by congenital heart block (CHB) (14.3% vs. 0%, p</i> = 0.015). In all cases, the diagnosis was performed during second trimester of pregnancy, and betamethasone was administered.</AbstractText>Women with SS had a significantly higher incidence of miscarriage, admission to NICU, and CHB than controls. Congenital heart block was the most critical condition that affects the offspring of mothers with SS. Successful pregnancy in the study group was possible with prenatal monitoring and a multidisciplinary approach.</AbstractText>Copyright: &#xa9; 2022 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie.</CopyrightInformation>
2,335,699
Bioinformatics Approaches to Predict Mutation Effects in the Binding Site of the Proangiogenic Molecule CD93.
The transmembrane glycoprotein CD93 has been identified as a potential new target to inhibit tumor angiogenesis. Recently, Multimerin-2 (MMRN2), a pan-endothelial extracellular matrix protein, has been identified as a ligand for CD93, but the interaction mechanism between these two proteins is yet to be studied. In this article, we aim to investigate the structural and functional effects of induced mutations on the binding domain of CD93 to MMRN2. Starting from experimental data, we assessed how specific mutations in the C-type lectin-like domain (CTLD) affect the binding interaction profile. We described a four-step workflow in order to predict the effects of variations on the inter-residue interaction network at the PPI, based on evolutionary information, complex network metrics, and energetic affinity. We showed that the application of computational approaches, combined with experimental data, allowed us to gain more in-depth molecular insights into the CD93-MMRN2 interaction, offering a platform for developing innovative therapeutics able to target these molecules and block their interaction. This comprehensive molecular insight might prove useful in drug design in cancer therapy.