HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective ...was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry.
We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively).
We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001).
The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.
HeartLogic es un algoritmo multiparamétrico incorporado a desfibriladores automáticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociación entre alertas y eventos clínicos bajo un protocolo de seguimiento común en un registro multicéntrico.
Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activación de HeartLogic, según práctica local y un protocolo común respectivamente).
Se incluyó a 288 pacientes en 15 centros. En fase 1, tras una media de observación de 10 meses, hubo 73 alertas (0,72 alertas/paciente-año), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/año-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/año-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/año-paciente. Fuera del estado de alerta solo hubo una hospitalización y una descompensación menor. La mayoría de las alertas (el 82% en fase 2 y el 81% en fase 3; p=0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de él (7.378 frente a 1.210 pg/ml; p <0,001).
El índice HeartLogic se asoció con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitió detectar y actuar a distancia con seguridad sobre las alertas.
Background:
The aim of this study was to translate and cross-culturally adapt the Olerud-Molander Ankle Score (OMAS) into Spanish and to assess its reliability and validity.
Methods:
The translation ...and adaptation to develop the Spanish version of the OMAS (OMAS-Sp) was performed according to current international guidelines. The OMAS-Sp was administered to 98 patients with a surgically treated ankle fracture, and it was repeated 7-14 days later to assess construct reliability of each question’s score and the total score. Test-retest reliability and the internal consistency were calculated, and concurrent validity was assessed by comparing the OMAS-Sp with the Foot and Ankle Outcome Score (FAOS). The presence of floor and ceiling effects was also analyzed.
Results:
Adequate internal consistency was found with a Cronbach α of 0.821. Excellent test-retest reliability was demonstrated with an interclass correlation coefficient for the total score of 0.970 (95% CI 0.956-0.980; P < .001). Spearman correlation coefficients (r’s) between the OMAS-Sp total score and the 5 FAOS subscales ranged from 0.944 to 0.951 (P < .001). No floor or ceiling effects were found.
Conclusion:
The OMAS-Sp demonstrated adequate psychometric properties and is a valid and reliable tool for assessing outcomes in Spanish-speaking patients with surgically treated ankle fractures.
Level of Evidence:
Level II, prospective cohort study.
Background
The first wave of the COVID‐19 pandemic caused a shortage of health care staff, forcing the hiring of senior nursing students.
Aims
To describe the psychosocial impact and coping ...strategies used by nursing students during the first outbreak of the COVID‐19 pandemic and to understand the coping strategies they employed.
Method
A qualitative exploratory study was conducted, based on Sandelowski's proposal. Purposive sampling was carried out to recruit 18 students hired during the pandemic. The students were interviewed between 18 March and 15 June 2020. Semi‐structured interviews were conducted using a digital platform. An inductive thematic analysis was performed.
Findings
The students lived alone and isolated during their contract to protect their cohabitants from possible contagion. The impact of working during the pandemic leads to experiences of stress, insomnia, nightmares and anxiety. Nursing students coped with the emotional burden through mental disconnection and the support of co‐workers and family members.
Conclusion
Psychological support and tutoring should be provided by health centres. In addition, in these special circumstances, universities should adapt the training provided.
Summary statement
What is already known about this topic?
In Spain, as in many other countries, a state of alarm was declared during the first wave of COVID 19. The Ministry of Health established measures to manage the health crisis and contain infections, including the hiring of senior nursing students to work.
Working conditions had a high physical and psycho‐emotional impact on health professionals.
The lack of prior experience of students in the context of a pandemic and how they enter the workforce could make it difficult to develop adequate coping strategies, enhancing the presence of mental and emotional disorders.
What this paper adds?
During their work, and in order to avoid contagion, the students lived apart from their families, limited their contacts and were isolated in refuge in rooms or homes. Upon entering the home, they showered, changed clothes and disinfected any surfaces they touched.
The students described feeling stressed due to the lack of protective equipment and staff, heavy workloads and lack of knowledge regarding the unit and work protocols. They worried about making mistakes, doing their jobs poorly or being unable to help patients. When they got home, they had episodes of insomnia and anxiety.
Faced with this situation, students used mental disconnection or distraction as coping strategies. Others shared their fears and uncertainties with other health care professionals and family members, seeking support and understanding. Other times, they tried to be strong and hide their suffering.
The implications of this paper:
The incorporation of students as relief for professionals in a situation of extreme need is not exempt from significant psychosocial risks and should include monitoring programs and psychological evaluation.
The hospitals should monitor and mentor students to facilitate their adaptation to similar situations in the future.
The students required greater support from the administration, including offering them housing where they could live away from family and relatives.
A recent genome-wide association study conducted by the International Multiple Sclerosis Genetic Consortium (IMSGC) identified, among others, a number of putative multiple sclerosis (MS) ...susceptibility variants at position 1p22. Twenty-one SNPs positively associated with MS were located at the GFI-EVI5-RPL5-FAM69A locus. In this study, we performed an analysis and fine mapping of this locus, genotyping eight Tag-SNPs in 732 MS patients and 974 controls from Spain. We observed an association with MS in three of eight Tag-SNPs: rs11804321 (P=0.008, OR=1.29; 95% CI=1.08-1.54), rs11808092 (P=0.048, OR=1.19; 95% CI=1.03-1.39) and rs6680578 (P=0.0082, OR=1.23; 95% CI=1.07-1.41). After correcting for multiple comparisons and using logistic regression analysis to test the addition of each SNP to the most associated SNPs, we observed that rs11804321 alone was sufficient to model the association. This Tag-SNP captures two SNPs in complete linkage disequilibrium (r(2)=1), both located within the 17th intron of the EVI5 gene. Our findings agree with the corresponding data of the recent IMSGC study and present new genetic evidence that points to EVI5 as a factor of susceptibility to MS.
Antecedentes: el objetivo de este trabajo es estudiar la estructura tetrafactorial (publicidad, información, entorno familiar y entorno de las amistades) del Cuestionario de Influjos Socioculturales ...sobre el Autoconcepto Físico (CIAF) y su invarianza en función del sexo, edad y de la actividad física. Método: participaron en la investigación un total de 579 estudiantes (339 hombres y 240 mujeres), de entre 12 y 23 años de edad, divididos en tres grupos (137 menores de 14 años, 338 de entre 15 y 18 años y 104 mayores de 18 años), quienes cumplimentaron el Cuestionario de Influjos Socioculturales sobre el Autoconcepto Físico (CIAF). Resultados: tanto los análisis factoriales confirmatorios como las pruebas de invarianza factorial refrendan la estructura tetrafactorial del CIAF y por tanto la diferenciación de cuatro tipos de influjos socioculturales autopercibidos. Conclusiones: estos resultados permiten aproximar a la comprensión del autoconcepto físico la abundante información previa acerca de la presión sociocultural sobre la imagen corporal. Palabras clave: autoconcepto físico, presión sociocultural, imagen corporal, invarianza factorial. Background: The aim of this study is to analyze the four-factor structure (advertising, information, family environment and friendship setting) of the Cuestionario de Influjos Socioculturales sobre el Autoconcepto Físico (CIAF) Sociocultural Influences on Physical Self-concept Questionnaire and its invariance in relation to sex, age and physical activity. Method: Participants were 579 students (339 men and 240 women) aged between 12 and 23, divided into three groups (137 under 14 years, 338 aged between 15 and 18 and 104 over 18 years). All completed the CIAF. Results: Both the confirmatory factor analyses and the factor invariance tests support the four-factor structure of the CIAF and, therefore, the identification of four different types of sociocultural perceived influence. Conclusions: These results allow us to apply the abundant data found by previous studies on sociocultural pressure on body image to our understanding of physical self-concept. Keywords: Physical self-concept, sociocultural pressure, body image, factor invariance.
La insuficiencia cardíaca congestiva aparece en cardiopatías congénitas (CC) tras agotar los tratamientos convencionales médico-quirúrgicos. En adecuados candidatos, el trasplante cardíaco mejora su ...calidad y cantidad de vida.
Presentamos los resultados a corto-medio plazo de nuestros trasplantes cardíacos en CC durante los últimos 20 años, centrándonos en las modificaciones técnicas que requiere el trasplante.
Revisión retrospectiva de 44 pacientes con CC trasplantados durante 2001-2021 en nuestro centro especializado en CC. Estudio estadístico: SPSS-15.0.
Edad mediana, 17,5 años (RIC: 3,2-40,6); 22 niños y 22 adultos. Tienen cirugías previas el 93% y asistencia ventricular previa el 25%. Diagnósticos iniciales más frecuentes: ventrículo único (45%) y trasposición de grandes vasos (20%).
Trasplante bicavo 43 (98%), biatrial 1 (2%). Técnicas quirúrgicas adicionales requeridas con más frecuencia: retirada de material protésico (marcapasos-desfibriladores-asistencia ventricular-stents) y reconstrucción de ramas pulmonares. Mediana de tiempos de circulación extracorpórea 208min (RIC: 160-245), e isquemia del órgano 271min (RIC: 220-302).Mortalidad hospitalaria, 9 (20%). Las cirugías previas (p=0,01), el ECMO (p=0,007) y hemofiltro por fallo renal postoperatorios (p=0,003) asocian mayor mortalidad hospitalaria.Seguimiento mediano 21 meses (RIC: 9-72), 4 fallecimientos tardíos. La supervivencia tras el alta hospitalaria es del 93% al año, 87% a los 3 años y 80% a partir de los 5 años.
El trasplante de pacientes con CC en nuestro entorno especializado tiene buenos resultados. Frecuentemente son reintervenciones que prolongan los tiempos quirúrgicos y requieren modificaciones técnicas.
Las cirugías previas y la necesidad de ECMO o hemofiltro en el postoperatorio inmediato asocian significativamente una mayor mortalidad al trasplante de CC. La supervivencia tras el alta hospitalaria es favorable.
Congestive heart failure develops in congenital heart disease (CHD) after failure of conventional medical-surgical treatments. In suitable candidates, heart transplantation improves their quality and quantity of life.
We present our heart transplants in CHD performed in the last 20 years, focusing on technical modifications required, and transplant short-medium-term results.
Retrospective analysis of 44 patients with CHD transplanted during 2001-2021 in our specialized CHD hospital. Statistical study: SPSS-15.0.
Median age 17.5 years (IQR: 3.2-40.6), 22 children and 22 adults. Previous surgeries: 93% and mechanical circulatory support: 25%. Most frequent initial diagnoses: single ventricle-45%, and transposition of the great vessels-20%.
Transplant was bicaval: 43 (98%), biatrial: 1 (2%). Additional surgical techniques needed more frequently: removal of prosthetic material (pacemakers-defibrillators-ventricular assist-stents) and reconstruction of pulmonary arteries. Median cardiopulmonary bypass time: 208min (IQR: 160-245), and heart ischemia 271min (IQR: 220-302).
Inhospital mortality: 9 (20%). Previous surgeries (p=0.01), postoperative ECMO (p=0.007) and hemofiltration for acute renal failure (p=0.003) are statistically associated with inhospital mortality.
Median follow-up: 21 months (IQR: 9-72), 4 late deaths. Survival after hospital discharge is 93% at 1 year, 87% at 3 years, and 80% after 5 years.
Transplantation of patients with CHD with our multidisciplinary approach in a specialized setting has good results. Reoperations that prolong surgical times and transplant with technical modifications are frequent.
Previous surgeries, postoperative need of ECMO or hemofiltration are significantly associated with higher inhospital mortality in these patients. Survival after hospital discharge is favourable.
In this report we show that exogenous NO added to human neuroblastoma NB69 cells inhibits cell proliferation and downregulates the epidermal growth factor receptor (EGFR) and its downstream signaling ...pathways. These comprise the 3-phosphoinositide-dependent kinase 1/Akt/glycogen synthase kinase-3β pathway, the mitogen-activated protein kinase (MAPK)/extracellular-regulated kinases 1 and 2 pathway, and the phospholipase Cγ pathway. In contrast, NO enhances the EGFR-controlled p38MAPK pathway. We also show that NO enhances the activation of the cAMP-responsive element binding protein, a transcription factor controlled by p38MAPK, as demonstrated using 4-(4-fluorophenyl)-2-(4-hydroxyphenyl)-5-(4-pyridyl)1
H-imidazole (SB202190), a p38MAPK inhibitor. These processes are accompanied by the NO-mediated hypophosphorylation of the retinoblastoma protein (pRb), preferentially at Ser795 compared to Ser780 and Ser807/811, and the downregulation of p27
KIP1, p21
CIP1/WAF1, and p16
INK4a, although NO downregulated p16
INK4a only when the p38MAPK activity was suppressed. The p38MAPK pathway controls the phosphorylation status of pRb as SB202190 enhances the hypophosphorylation of pRb. We reverted the inhibitory action of NO on EGFR and pRb phosphorylation in living cells using cell-permeable reducing agents, which suggested that reversible S-nitrosation controls these proteins. Our results support the notion that NO negatively modulates the p38MAPK-controlled phosphorylation of pRb, inducing the subsequent arrest of the cell cycle at the G1/S transition.
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