Right ventricular failure is one of the most common complications encountered after left ventricular assist device implantation and heart transplantation. It has been reported to have an incidence up ...to 30%. It increases morbidity and short‐term mortality. Impella RP is a small pump that can provide up to 4L/min of flow. We analyzed all the patients with right ventricular failure that were treated with Impella RP in our institution. The Impella RP was implanted percutaneously in the catheterization laboratory guided by fluoroscopy. Overall, 7 patients required the implantation of an Impella RP due to right ventricular failure: 2 after long‐term LVAD, 3 presented with acute right ventricular failure immediately after LVAD implantation, and 2 needed it after heart transplantation. Regarding complications, we report 2 patients with hemolysis. Hemodynamic parameters as well as end‐organ perfusion and inotropic requirements improved after the insertion of the Impella. Overall, 30‐day survival is 58%. Median time of support was 9 (5–19) days. RV failure is one of the most challenging complications after LVAD implantation and heart transplantation. The major challenge is the timing of implantation. The minimally invasive nature of the Impella RP facilitates de‐escalation of treatment and paves the road to recovery. Impella RP proved useful in facilitating ECMO wean. Used in a prompt manner alongside the ease of implantation and the minimal rate of complications, Impella RP seems to be an appropriate device to tackle RV failure providing enough flow to allow for recovery or escalation decision‐making.
Objectives
Development in device technology and the scarcity of donor’s hearts have increased the number of patients with advanced heart failure receiving durable left ventricular assist devices ...(LVADs) as a bridge to transplantation and destination therapy, with improved prognosis compared with guideline‐directed medical therapy. We sought to examine the impact of modern durable LVADs on the quality of life (QoL) of the recipients.
Methods
We carried out a systematic review of articles on QoL following the implantation of third‐generation LVADs published between January 2010 and February 2021. Included studies were critically analyzed and evidence synthesis was carried out into a meta‐analysis.
Results
The systematic search yielded 269 articles, 11 of which met the search predefined criteria. Three of them reported results of randomized trials and eight were retrospective and registry studies. Statistically significant QoL improvement from baseline was observed in all published reports. When using the EuroQol 5L questionnaire (scale 0–100) as a QoL tool 6 months post‐LVAD implantation, a meta‐analysis of four included studies demonstrated a mean difference increase of 28.9 points (95% confidence interval: 26.71–31.14).
Conclusions
Third‐generation LVADs confer a significant improvement in QoL and their use can be supported not only for prognosis but also for symptom control. Although methodological limitations should be considered, the available QoL outcomes can be a useful tool in patient selection and the decision‐making process.
The use of third‐generation left ventricular assist devices confer a significant improvement in quality of life.
These outcomes are a useful tool in patient selection and the decision‐making process for left ventricular assist device implantation.
The role of quality of life assessment in future trials is important.
Antibiotics from predatory bacteria Korp, Juliane; Vela Gurovic, María S; Nett, Markus
Beilstein journal of organic chemistry,
03/2016, Letnik:
12, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Bacteria, which prey on other microorganisms, are commonly found in the environment. While some of these organisms act as solitary hunters, others band together in large consortia before they attack ...their prey. Anecdotal reports suggest that bacteria practicing such a wolfpack strategy utilize antibiotics as predatory weapons. Consistent with this hypothesis, genome sequencing revealed that these micropredators possess impressive capacities for natural product biosynthesis. Here, we will present the results from recent chemical investigations of this bacterial group, compare the biosynthetic potential with that of non-predatory bacteria and discuss the link between predation and secondary metabolism.
Merkel cell carcinoma (MCC) is a highly malignant neuroendocrine tumor of the skin whose molecular pathogenesis is not completely understood, despite the role that Merkel cell polyomavirus can play ...in 55–90% of cases. To study potential mechanisms driving this disease in clinically characterized cases, we searched for somatic mutations using whole-exome sequencing, and extrapolated our findings to study functional biomarkers reporting on the activity of the mutated pathways. Confirming previous results, Merkel cell polyomavirus-negative tumors had higher mutational loads with UV signatures and more frequent mutations in TP53 and RB compared with their Merkel cell polyomavirus-positive counterparts. Despite important genetic differences, the two Merkel cell carcinoma etiologies both exhibited nuclear accumulation of oncogenic transcription factors such as NFAT or nuclear factor of activated T cells (NFAT), P-CREB, and P-STAT3, indicating commonly deregulated pathogenic mechanisms with the potential to serve as targets for therapy. A multivariable analysis identified phosphorylated CRE-binding protein as an independent survival factor with respect to clinical variables and Merkel cell polyomavirus status in our cohort of Merkel cell carcinoma patients.
Total antigens from Leishmania braziliensis promastigotes, solubilized with sodium cholate (dsLp), were formulated within ultradeformable nanovesicles (dsLp-ultradeformable archaeosomes, (dsLp-UDA), ...and dsLp-ultradeformable liposomes (dsLp-UDL)) and topically administered to Balb/c mice. Ultradeformable nanovesicles can penetrate the intact stratum corneum up to the viable epidermis, with no aid of classical permeation enhancers that can damage the barrier function of the skin. Briefly, 100 nm unilamellar dsLp-UDA (soybean phosphatidylcholine: Halorubrum tebenquichense total polar lipids (TPL): sodium cholate, 3:3:1 w:w) of -31.45 mV Z potential, containing 4.84 ± 0.53% w/w protein/lipid dsLp, 235 KPa Young modulus were prepared. In vitro, dsLp-UDA was extensively taken up by J774A1 and bone marrow derive cells, and the only that induced an immediate secretion of IL-6, IL-12p40 and TNF-α, followed by IL-1β, by J774A1 cells. Such extensive uptake is a key feature of UDA ascribed to the highly negatively charged archaeolipids of the TPL, which are recognized by a receptor specialized in uptake and not involved in downstream signaling. Despite dsLp alone was also immunostimulatory on J774A1 cells, applied twice a week on consecutive days along 7 weeks on Balb/c mice, it raised no measurable response unless associated to UDL or UDA. The highest systemic response, IgGa2 mediated, 1 log lower than im dsLp Al2O3, was elicited by dsLp-UDA. Such findings suggest that in vivo, UDL and UDA acted as penetration enhancers for dsLp, but only dsLp-UDA, owed to its pronounced uptake by APC, succeeded as topical adjuvants. The actual TPL composition, fully made of sn2,3 ether linked saturated archaeolipids, gives the UDA bilayer resistance against chemical, physical and enzymatic attacks that destroy ordinary phospholipids bilayers. Together, these properties make UDA a promising platform for topical drug targeted delivery and vaccination, that may be of help for countries with a deficient healthcare system.
Abstract
Objective
To assess the efficacy of tocilizumab (TCZ) in refractory uveitis of Behçet's disease (BD).
Methods
Multicentre study of patients with BD-associated uveitis. Patients were ...refractory to conventional and biologic immunosuppressive drugs. The main outcome measures were intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects.
Results
We studied 11 patients (7 men) (20 affected eyes); median age 35 years. Uveitis was bilateral in nine patients. The patterns of ocular involvement were panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1). Cystoid macular oedema was present in seven patients. The clinical course was recurrent (n = 7) or chronic (n = 4). Before TCZ, patients had received systemic corticosteroids, conventional immunosuppressants and the following biologic agents: adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1). TCZ was used as monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1). At TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2). TCZ yielded rapid and maintained improvement in all ocular parameters of the patients, with complete remission in eight of them. However, this was not the case for the extraocular manifestations, since TCZ was only effective in three of them. After a mean (s.d.) follow-up of 9.5 (8.05) months, TCZ was withdrawn in two cases, due to a severe infusion reaction and arthritis impairment, respectively.
Conclusion
TCZ could be a therapeutic option in patients with BD and refractory uveitis.
ABSTRACT
The Impella (Abiomed, Danvers, MA, USA) has become an important adjunct treatment modality in bridging patients with end‐stage heart failure to recovery or orthotopic heart transplantation ...(HTx). We compared the outcome of patients directly bridged to HTx with the Impella 5.0 versus patients without mechanical circulatory support (MCS). Patients with no previous sternotomy or MCS, who were transplanted between September 2014 and March 2019 were included in this retrospective analysis. Impella 5.0 was implanted using surgical access and transesophageal echocardiography guidance. Forty‐two out of 155 transplanted patients fulfilled the insertion criteria. Eight (19%) were bridged with Impella 5.0 to HTx. Recipient and donor baseline characteristics were comparable in both groups. There were no significant differences in survival between the groups at 30‐day (94% no MCS vs. 87.5% Impella group, P = .47) or 6 months (94% vs. 87.5%, P = .51). Patients on Impella 5.0 showed a significant recovery of hemodynamic parameters and end‐organ function. Average duration of support to HTx was 16 ± 17 days. Impella 5.0, when used in suitable patients in a timely fashion can be a good strategy for bridging patients to HTx. The axillary approach allows for early extubation and mobilization. Outcomes of patients bridged to HTx with Impella 5.0 in acute cardiogenic shock are comparable to those of patients with no MCS.
•Mathematical model for low grade gliomas that fits well to medical data.•Net growth coefficient is split in proliferation and natural death rates.•Global stability of tumour free equilibrium under ...suitable assumptions is proved.•Sensitivity analysis reveals the impact of model parameters on the solution.
Gliomas are the most frequent type of primary brain tumour. Low-grade gliomas (LGGs) in particular are infiltrative and incurable with a slow evolution that eventually causes death. In this paper, we propose a mathematical model for the growth of LGGs and its response to chemotherapy. We validate our model with medical data and show that the proposed model describes real patients’ data quite well. A mathematical analysis of the model shows the existence of a unique non-negative solution. We further investigate the stability of steady-state solutions. In particular, we demonstrate the global stability of a tumour-free equilibrium in the case of sufficiently strong constant and asymptotically periodic treatment. A sensitivity analysis of the model indicates that the proliferation rate has the biggest impact on solutions of the model. We also numerically investigate the stability of the fitting procedure.
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•A resin concentration of 40 g·L-1 and a 50% v/v ethanol–water solution were found to be as the best options to recover phenolic compounds.•Pseudo-second order kinetic model best the ...experimental data, Langmuir isotherm modelled the adsorption process for the MN resins and Freundlich isotherm for the PAD resins.•The MN resins were more suitable, presenting higher percentages of adsorption/desorption.•It is possible to recover 90% of the initial phenolic compounds, with a low presence of sugars the MN200 resin.
Agroindustry wastewater represents an opportunity to recover high added value antioxidants such as phenolic compounds. An adsorption/desorption process was investigated to recuperate these compounds using Purolite non-ionic resins (MN200, MN202, PAD900 and PAD950). The study was conducted with a model solution containing 1.1 g∙L-1 of tyrosol and 0.2 g∙L-1 of catechin, which are two of the main phenolic compounds found in olive mill wastewaters, and with a real olive mill wastewater. The main objective was to determine the optimal concentration of resin and the best desorption solvent for the maximum recovery of phenolic compounds. For it, the process kinetics were determined, and the adsorption mechanisms were characterized by means of isotherm models. Results showed that the pseudo-second order kinetic model fitted to the experimental data, while the Langmuir isotherm correctly modelled the adsorption process for the MN resins, whereas the Freundlich isotherm was the model that best described the adsorption process with PAD resins. A resin concentration of 40 g·L-1 and a 50% v/v ethanol–water solution were selected as the best options for recovering the phenolic compounds. The tests with olive oil washing wastewater showed that, for some of the resins, other compounds present, such as sugars, interfered with the adsorption of phenolic compounds, reducing the effectiveness of their recovery. Finally, the MN200 resin was selected as the best adsorbent. It achieved a recovery of 91% of the phenolic compounds present in the initial wastewater, finding only 5% of the sugars measured in the initial OOWW sample, in the final stream.
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