Background Low cardiac output syndrome is defined as the need for a postoperative intra-aortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit. Mitral valve ...surgery is increasingly being performed in high-risk patients who might require mechanical circulatory support for low cardiac output syndrome. Therefore the aim of this study was to identify the preoperative predictors of low cardiac output syndrome after mitral valve surgery. Methods We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and February 2008, 3039 patients underwent isolated mitral valve surgery with or without coronary bypass surgery. The independent predictors of low cardiac output syndrome and operative mortality were determined by means of stepwise logistic regression analysis. Results The overall prevalence of low cardiac output syndrome was 7%. The independent predictors of low cardiac output syndrome were urgency of the operation (odds ratio, 2.9), earlier year of operation (odds ratio, 2.4), left ventricular ejection fraction of less than 40% (odds ratio, 2.1), New York Heart Association class IV (odds ratio, 2), body surface area of 1.7 m2 or less (odds ratio, 1.6), ischemic mitral valve pathology (odds ratio, 1.6), and cardiopulmonary bypass time (odds ratio, 1.02). The operative mortality was higher in patients with low cardiac output syndrome (30% vs 1.3%, P < .001). Overall operative mortality was 3.4%. The independent predictors of mortality were urgency of the operation (odds ratio, 7.1), renal failure (odds ratio, 4.3), nonuse of polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Austin, Tex; odds ratio, 2.1), any reoperative surgical intervention (odds ratio, 1.8), increasing age (odds ratio, 1.03), and cardiopulmonary bypass time (odds ratio, 1.02). Conclusions Low cardiac output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of pre-existing heart failure symptoms, and use of artificial polytetrafluoroethylene sutures might reduce the incidence of low cardiac output syndrome and lead to improved results after mitral valve surgery.
The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scale classifies advanced heart failure patients according to hemodynamic status. This study assessed the usefulness ...of the INTERMACS scale to predict outcomes in advanced heart failure patients undergoing mechanical circulatory support (MCS).
Fifty-four patients underwent MCS implantation from 2001 to 2007. Group A included 27 patients at INTERMACS level 1 and 2. Group B included 27 at INTERMACS level 3 and 4. Patient characteristics pre-MCS implant, incidence of complications during support, and survival between groups were compared.
Before MCS implantation, Group A had significantly lower cardiac index, mean arterial blood pressure, systolic pulmonary pressure, higher central venous pressure, and lower urine output (p < .05). After MCS, Group A had a lower incidence of infections (17% vs 46%; odds ratio OR, 0.25, 95% confidence interval CI, 0.06-0.6) and a higher incidence of liver injury (39% vs 11%; OR 5, 95% CI, 1.15-25). Mortality at 30 days was higher in Group A (38% vs 11%; OR, 4.8; 95% CI, 1.1-21); however, the mortality after 30 days post-MCS support was significantly higher in Group B (0% vs 18%, p < .05). Cox model showed overall survival was poorer in Group A (hazard ratio, 2.7; 95% CI, 1.1-7).
INTERMACS levels identified patients at risk for developing complications after MCS support. INTERMACS is a valid score system that should be considered as a tool to assess patient profile and predict complications and mortality after MCS implantation.
A prolonged therapy, primarily responsible for development of drug resistance by
(Mtb), obligates any new TB regimen to not only reduce treatment duration but also escape pathogen resistance ...mechanisms. With the aim of harnessing the host response in providing support to existing regimens, we used sertraline (SRT) to stunt the pro-pathogenic type I IFN response of macrophages to infection. While SRT alone could only arrest bacterial growth, it effectively escalated the bactericidal activities of Isoniazid (H) and Rifampicin (R) in macrophages. This strengthening of antibiotic potencies by SRT was more evident in conditions of ineffective control by these frontline TB drug, against tolerant strains or dormant Mtb. SRT, could significantly combine with standard TB drugs to enhance early pathogen clearance from tissues of mice infected with either drug sensitive/tolerant strains of Mtb. Further, we demonstrate an enhanced protection in acute TB infection of the highly susceptible C3HeB/FeJ mice with the combination therapy signifying the use of SRT as a potent adjunct to standard TB therapeutic regimens against bacterial populations of diverse physiology. This study advocates a novel host directed adjunct therapy regimen for TB with a clinically approved antidepressant to achieve quicker and greater control of infection.
Commentary: The gift of life—With a price Rao, Vivek
The Journal of thoracic and cardiovascular surgery,
September 2020, 2020-09-00, 20200901, Volume:
160, Issue:
3
Journal Article
The HeartMate 3 Left Ventricular Assist System (LVAS) (St. Jude Medical Inc., St Paul, MN) with full magnetic levitation allows for wide and consistent blood flow paths and an artificial pulse ...designed for enhanced hemocompatibility. The HeartMate 3 received market approval in the European Union in 2015 following completion of a multicenter study. After reaching the 6-month study endpoint, patients continue to be followed for 2 years with the 1-year results presented herein.
A prospective, non-randomized study included adults with advanced heart failure and ejection fraction (EF) ≤ 25%, cardiac index (CI) ≤ 2.2 L/min/m2 while not on inotropes, or inotrope dependent, or on optimal medical management for 45/60 days.
Fifty patients-54% bridge to transplant (BTT) and 46% destination therapy (DT)-were enrolled and implanted with the HeartMate 3. At baseline, 92% of the patients were INTERMACS profiles 2-4, with cardiac index 1.8 + 0.5 L/min/m
and 58% were supported with inotropes. At 1 year, 74% of the patients remain on support, 18% expired, 6% transplanted, and 2% explanted. The adverse events include 12% gastrointestinal bleeding, 16% driveline infections, 18% strokes, and 2% outflow graft thrombosis. There was no hemolysis, pump thrombosis or pump malfunction through 1 year. The six-minute walk test distance increased from a mean of 273 m to 371 m (P <0.0001). EQ-5D quality-of-life score increased from a mean of 52.7 to 70.8 (P = 0.0006).
The 1-year HeartMate 3 LVAS results show survival and adverse-event profile are similar to other approved devices, with no pump thrombosis or pump failure. Patient's functional status and quality of life significantly improved over time.
Clinicaltrials.gov registration number: NCT02170363 . Registered June 19, 2014.
In addition to their role in cellular energy production, mitochondria are increasingly recognized as regulators of the innate immune response of phagocytes. Here, we demonstrate that altering ...expression levels of the mitochondria-associated enzyme, cytidine monophosphate kinase 2 (CMPK2), disrupts mitochondrial physiology and significantly deregulates the resting immune homeostasis of macrophages. Both CMPK2 silenced and constitutively overexpressing macrophage lines portray mitochondrial stress with marked depolarization of their membrane potential, enhanced reactive oxygen species (ROS), and disturbed architecture culminating in the enhanced expression of the pro-inflammatory genes IL1β, TNFα, and IL8. Interestingly, the long-term modulation of CMPK2 expression resulted in an increased glycolytic flux of macrophages akin to the altered physiological state of activated M1 macrophages. While infection-induced inflammation for restricting pathogens is regulated, our observation of a total dysregulation of basal inflammation by bidirectional alteration of CMPK2 expression only highlights the critical role of this gene in mitochondria-mediated control of inflammation.
Lipid metabolism plays a complex and dynamic role in host-pathogen interaction during
infection. While bacterial lipid metabolism is key to the success of the pathogen, the host also offers a lipid ...rich environment in the form of necrotic caseous granulomas, making this association beneficial for the pathogen. Accumulation of the neutral lipid triglyceride, as lipid droplets within the cellular cuff of necrotic granulomas, is a peculiar feature of pulmonary tuberculosis. The role of triglyceride synthesis in the TB granuloma and its impact on the disease outcome has not been studied in detail. Here, we identified diacylglycerol O-acyltransferase 1 (DGAT1) to be essential for accumulation of triglyceride in necrotic TB granulomas using the C3HeB/FeJ murine model of infection. Treatment of infected mice with a pharmacological inhibitor of DGAT1 (T863) led to reduction in granuloma triglyceride levels and bacterial burden. A decrease in bacterial burden was associated with reduced neutrophil infiltration and degranulation, and a reduction in several pro-inflammatory cytokines including IL1β, TNFα, IL6, and IFNβ. Triglyceride lowering impacted eicosanoid production through both metabolic re-routing and
transcriptional control. Our data suggests that manipulation of lipid droplet homeostasis may offer a means for host directed therapy in Tuberculosis.
Multi-walled carbon nanotubes (MWCNTs) were used as a substrate for nickel nanoparticles production. Nickel nanoparticles of average sizes between 9 and 16nm were synthesized by gamma irradiation of ...aqueous solutions containing nickel sulfate or nickel chloride as precursors. MWCNTs were acid treated and poly vinyl pyrrolidone (PVP, m∼44,000) or sodium dodecyl sulfate (SDS) were used as stabilizers. Isopropanol was used as a scavenger of hydroxyl radicals, and deionized (DI) water as a solvent. Gamma irradiation was carried out at room temperature and ambient pressure in a 60Co gamma source at doses of 30, 40, 50, and 60kGy. The nickel nanoparticles were characterized by transmission electron microscopy (TEM), scanning transmission electron microscopy (STEM), and X-ray photoelectron spectroscopy (XPS). By controlling the dose and stabilizer's concentrations, nanoparticles with different sizes were obtained. Poly vinyl pyrrolidone (PVP) was found to be more efficient at preventing coalescence of Ni seeds than sodium dodecyl sulfate (SDS).
•Nickel nanoparticles were deposited on multi-walled carbon nanotubes by gamma irradiation.•The effect of dose on size distribution of the nanoparticles was evaluated.•Between 30 and 60kGy, as dose increases the average size of the nanoparticles decrease from 16 to 12nm.
OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a ...tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.
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