Background
High‐quality Basic Life Support (BLS), the first step in the Utstein formula for survival, needs effective education for all kinds of population groups. The feasibility of BLS courses for ...refugees is not well investigated yet.
Methods
We conducted BLS courses including automated external defibrillator (AED) training for refugees in Austria from 2016 to 2019. Pre‐course and after course attitudes and knowledge towards cardiopulmonary resuscitation (CPR) were assessed via questionnaires in the individuals’ native languages, validated by native speaker interpreters.
Results
We included 147 participants (66% male; 22 17‐34 years; 28% <18 years) from 19 countries (74% from the Middle East). While the availability of BLS courses in the participants’ home countries was low (37%), we noted increased awareness towards CPR and AED use after our courses. Willingness to perform CPR increased from 25% to 99%. A positive impact on the participants’ perception of integration into their new environment was noted after CPR training. Higher level of education, male gender, age <18 years and past traumatizing experiences positively affected willingness or performance of CPR.
Conclusion
BLS education for refugees is feasible and increases their willingness to perform CPR in emergency situations, with the potential to improve survival after cardiac arrest. Individuals with either past traumatizing experiences, higher education or those <18 years might be eligible for advanced life support education. Interestingly, these BLS courses bear the potential to foster resilience and integration. Therefore, CPR education for refuge should be generally offered and further evaluated.
Background
Post‐operative atrial fibrillation (POAF) represents a common complication after cardiac valve or coronary artery bypass surgery. While strain of atrial tissue is known to induce atrial ...fibrillating impulses, less attention has been paid to potentially strain‐promoting values during the peri‐ and post‐operative period. This study aimed to determine the association of peri‐ and post‐operative volume substitution with markers of cardiac strain and subsequently the impact on POAF development and promotion.
Results
A total of 123 (45.4%) individuals were found to develop POAF. Fluid balance within the first 24 hours after surgery was significantly higher in patients developing POAF as compared to non‐POAF individuals (+1129.6 mL POAF vs +544.9 mL non‐POAF, P = .044). Post‐operative fluid balance showed a direct and significant correlation with post‐operative N‐terminal pro‐brain natriuretic peptide (NT‐ProBNP) values (r = .287; P = .002). Of note, the amount of substituted volume significantly proved to be a strong and independent predictor for POAF with an adjusted odds ratio per one litre of 1.44 (95% CI: 1.09‐1.31; P = .009). In addition, we observed that low pre‐operative haemoglobin levels at admission were associated with a higher need of intraoperative transfusions and volume‐demand.
Conclusion
Substitution of larger transfusion volumes presents a strong and independent predictor for the development of POAF. Via the observed distinct association with NT‐proBNP values, it can reasonably be assumed that post‐operative atrial fibrillating impulses are triggered via increased global cardiac strain. Optimized pre‐operative management of pre‐existing anaemia should be considered prior surgical intervention in terms of a personalized patient care.
Nosocomial infections are a common complication in clinical practice with major impact on surgical success and patient outcome. The probability of nosocomial infections is rapidly increasing during ...hospitalization. Therefore, we investigated the impact of a prolonged pre-operative hospital stay on the development of post-operative infection. Within this prospective observational study, 200 patients scheduled for elective cardiac surgery were enrolled. Patients were followed during hospital admission and screened for the development of nosocomial infection. Logistic regression analysis was used to assess the impact of a prolonged pre-operative hospital stay on the development of infection. A total of 195 patients were suitable for the final analysis. We found a strong and direct association of the duration of pre-operative hospital stay and the number of patients developing infection (+23.5%; p = 0.006). Additionally, the length of patients' pre-operative hospital stay was independently associated with the development of post-operative nosocomial infection, with an adjusted OR per day of 1.38 (95%CI: 1.02-1.86; p = 0.036). A prolonged pre-operative hospital stay was significantly associated with the development of nosocomial infection after cardiac surgery. Those findings need to be considered in future clinical patient management in order to prevent unnecessary antibiotic use and potential harm to patients.
Abstract
Post-operative atrial fibrillation (POAF) is postulated as a complex interaction of different pathogenic factors, suggesting inflammatory processes as a main trigger of this particular type ...of atrial fibrillation. Therefore, the study sought to assess the impact of cellular immunity on the development of POAF. Comparing patients developing POAF to individuals free of POAF the fraction of CD4
+
CD28
null
T Lymphocytes was significantly higher in individuals developing POAF (11.1% POAF vs. 1.9% non-POAF; p < 0.001). CD4
+
CD28
null
cells were independently associated with the development of POAF with an adjusted odds ratio per one standard deviation of 4.89 (95% CI: 2.68–8.97; p < 0.001). Compared to N-terminal Pro-Brain Natriuretic Peptide, the fraction of CD4
+
CD28
null
cells demonstrated an increased discriminatory power for the development of POAF (NRI: 87.9%, p < 0.001; IDI: 30.9%, p < 0.001). Interestingly, a pre-operative statin-therapy was associated with a lower fraction of CD4
+
CD28
null
cells (p < 0.001) and showed an inverse association with POAF (p < 0.001). CD4
+
CD28
null
cells proved to be predictive for the development of POAF after cardiac surgery. Our results potentially indicate an auto-immune impact of this preexisting, highly cytotoxic T cell subset in the pathogenesis of POAF, which might be modified via the anti-inflammatory potential of a pre-operative statin-therapy.
Post-operative atrial fibrillation (POAF) is postulated as a complex interaction of different pathogenic factors, suggesting inflammatory processes as a main trigger of this particular type of atrial ...fibrillation. Therefore, the study sought to assess the impact of cellular immunity on the development of POAF. Comparing patients developing POAF to individuals free of POAF the fraction of CD4
CD28
T Lymphocytes was significantly higher in individuals developing POAF (11.1% POAF vs. 1.9% non-POAF; p < 0.001). CD4
CD28
cells were independently associated with the development of POAF with an adjusted odds ratio per one standard deviation of 4.89 (95% CI: 2.68-8.97; p < 0.001). Compared to N-terminal Pro-Brain Natriuretic Peptide, the fraction of CD4
CD28
cells demonstrated an increased discriminatory power for the development of POAF (NRI: 87.9%, p < 0.001; IDI: 30.9%, p < 0.001). Interestingly, a pre-operative statin-therapy was associated with a lower fraction of CD4
CD28
cells (p < 0.001) and showed an inverse association with POAF (p < 0.001). CD4
CD28
cells proved to be predictive for the development of POAF after cardiac surgery. Our results potentially indicate an auto-immune impact of this preexisting, highly cytotoxic T cell subset in the pathogenesis of POAF, which might be modified via the anti-inflammatory potential of a pre-operative statin-therapy.
In mice, the specificity of longterm-habituation (LTH) of startle was tested in two experiments. In two strains of mice (C57Bl/6 and C3H) there was pronounced LTH over 10 days of acoustic stimulation ...in two different contexts of startle measurement. (We found LTH to be greater after stimulation with 14 kHz sine stimuli compared to noise or tactile stimuli). A change of context showed LTH to be independent of context, i.e., startle LTH in mice is a non-associative learning process. In the second experiment, 9 days of acoustic or tactile stimulation were given to C57B/6 mice. Both stimulus modalities produced LTH. When on the 10th day stimuli of the other modality were given, in both cases the long term habituated group showed no lower startle amplitude than a non-stimulated control group. This indicates LTH is stimulus-modality specific. Altogether, our results show that in mice-very similar to rats-LTH of startle is stimulus modality, but not context specific. In addition we found two indications that the LTH action site is on the sensory branch of the startle circuit.
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Ludwig Boltzmann Institute for Cardiovascular Research
Introduction
Sodium glucose ...cotransporter 2 inhibitors (SGLT2i) are a class of oral antidiabetic drugs. Recent clinical trials demonstrated and proved the cardiovascular benefit of SGLT2i in patients suffering from ischemic heart disease. In addition, left ventricular hypertrophy (LVH) is associated with cardiovascular events and using SGLT2i alleviated LVH in diabetic patients. However, only few studies investigated the effect of SGLT2i on regression of LVH in absence of diabetes.
Aim of the study
This study aimed to investigate whether the SGLT2i Dapagliflozin (DAPA) could attenuate LVH and cardiac dysfunction in a mouse model of pressure overload-induced LVH.
Methods
Male C57BL/6J mice (body weight 20-25g) were used. LVH was induced surgically by transverse aortic constriction (TAC). DAPA (1 mg/kg bodyweight/day) was administered through drinking water. The animals were divided in four groups: Group 1 underwent TAC for eight weeks (n=8). Group 2 concomitantly received DAPA for eight weeks after TAC (n=5). Group 3 received DAPA for only two weeks (in week 7 and 8 after TAC, n=5) to clarify if DAPA treatment could alleviate LVH at a later timepoint. Group 4 served as a sham control group (no LVH, n=8). Cardiac function was assessed using transthoracic echocardiography and invasive LV hemodynamic measurements.
Results
TAC resulted in a significant reduction in LV ejection fraction (LVEF) and significant increase in heart weight to body weight ratio (HW/BW) compared to sham (p<0.001). In addition, TAC mice showed a significant increase of LV systolic pressure and end-diastolic pressure compared to sham (p<0.01). Both the LVEF and LV functional parameters were markedly improved in mice treated with DAPA for eight weeks (p<0.05). LV mass decreased compared to the untreated group. More importantly, DAPA treatment for only two weeks also improved LVEF and alleviated LVH compared to untreated TAC mice (p<0.05). Furthermore, we also found that mice with only two weeks of DAPA treatment showed a tendency to improve LV hemodynamics.
Conclusions
DAPA was cardioprotective in a mouse model of pressure overload-induced LVH in absence of diabetes. It improved LV contractile function and LVH. DAPA also alleviated LVH and induced LV regression. Our findings uncovered that the SGLT2i DAPA contributed to the regression of LVH and cardiac fibrosis. Thus, administration of SLGT2i may be a novel adjunct therapy to boost reverse remodeling e.g. in patients with elective cardiac surgery and hypertrophic cardiomyopathy.
Muscle LIM protein (MLP) is an essential nuclear regulator of myogenic differentiation. Additionally, it may act as an integrator of protein assembly of the actin-based cytoskeleton. MLP-knockout ...mice develop a marked cardiac hypertrophy reaction and dilated cardiomyopathy (DCM). MLP is therefore a candidate gene for heritable forms of hypertrophic cardiomyopathy (HCM) and DCM in humans.
We analyzed 1100 unrelated individuals (400 patients with DCM, 200 patients with HCM, and 500 controls) for mutations in the human CRP3 gene that encodes MLP. We found 3 different missense mutations in 3 unrelated patients with familial HCM but detected no mutation in the DCM group or the controls. All mutations predicted an amino acid exchange at highly conserved residues in the functionally important LIM1 domain, which is responsible for interaction with alpha-actinin and with certain muscle-specific transcription factors. Protein-binding studies indicate that mutations in the CRP3 gene lead to a decreased binding activity of MLP to alpha-actinin. All 3 index patients were characterized by typical asymmetrical septal hypertrophy. Family studies revealed cosegregation of clinically affected individuals with the respective mutations in MLP.
Here, we present evidence that mutations in the CRP3/MLP gene can cause HCM.
Background Of the newer antiepileptic drugs, lamotrigine (LTG) and levetiracetam (LEV) are popular first choice drugs for epilepsy. The authors compared these drugs with regard to their efficacy and ...tolerability in the initial monotherapy for epilepsy. Methods A randomised, open-label, controlled, parallel group, multicenter trial was conducted to test the superiority of the LEV arm over the LTG arm. The primary endpoint was the rate of seizure-free patients in the first 6 weeks (two-sided Fisher's exact test, α=0.05, intent-to-treat set). Furthermore, efficacy, tolerability and quality of life were evaluated. The authors included 409 patients aged ≥12 years with newly diagnosed focal or generalised epilepsy defined by either two or more unprovoked seizures or one first seizure with high risk for recurrence. Patients were titrated to 2000 mg/day of LEV or 200 mg/day of LTG reached on day 22 or 71, respectively. Two dose adjustments by 500/50 mg were allowed. Results The proportions of seizure-free patients were 67.5% (LEV) versus 64.0% (LTG) 6 weeks after randomisation (p=0.47), and 45.2% (LEV) versus 47.8% (LTG) during the whole treatment period of 26 weeks. The HR (LEV vs LTG) for seizure-free time was 0.86 (95% CI, 0.61 to 1.22). Adverse events occurred in 74.5% (LEV) versus 70.6% (LTG) of the patients (p=0.38). Adverse events associated with study discontinuation occurred in 17/204 (LEV) versus 8/201 (LTG) patients (p=0.07). Conclusions There were no significant differences with regard to efficacy and tolerability of LEV and LTG in newly diagnosed focal and generalised epilepsy despite more rapid titration in the LEV arm. Clinical trial registration number ClinicalTrials.gov identifier NCT00242606.
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