The implications of pulmonary vein (PV) flow patterns in patients with heart failure (HF) and mitral regurgitation (MR) are uncertain. We examined PV flow patterns in the Cardiovascular Outcomes ...Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial (NCT01626079), in which patients with HF and moderate-to-severe or severe functional MR were randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip device plus guideline-directed medical therapy (GDMT) vs. GDMT alone. We sought to evaluate the prognostic utility of baseline PV systolic flow reversal (PVSFR) in HF patients with severe MR and to determine whether the presence of PVSFR can discriminate patients most likely to benefit from TEER in COAPT trial patients.
Patients were categorized by the echocardiographic core laboratory-assessed baseline presence of PVSFR. Two-year outcomes were examined according to PVSFR and treatment.
Baseline PV flow patterns were evaluable in 526/614(85.7%) patients, 48.9% of whom had PVSFR. Patients with PVSFR had more severe MR, reduced stroke volume and cardiac output, greater right ventricular dysfunction, and worse hemodynamics. By multivariable analysis, PVSFR was not an independent predictor of 2-year all-cause death, or heart failure hospitalization (HFH). The reductions in the 2-year rates of all-cause death and HFH with TEER compared with GDMT alone were similar in patients with and without PVSFR (Pinteraction = 0.40 and 0.12, respectively). The effect of TEER on improving Kansas City Cardiomyopathy Questionnaire scores and 6-minute walk distance were also independent of PVSFR.
In the COAPT trial, PVSFR identified HF patients with severe MR and more advanced heart disease. Patients with and without PVSFR had consistent reductions in mortality, HFH, and improved quality-of-life and functional capacity after TEER.
ClinicalTrial.gov IdentifierNCT01626079.
•We studied the impact of baseline echocardiographic pulmonary vein systolic flow reversal (PVSFR) in patients with heart failure and severe functional mitral regurgitation enrolled in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation trial.•PVSFR identified patients with especially severe mitral regurgitation and advanced left and right ventricular dysfunction who had a worse prognosis with medical therapy.•Patients with and without PVSFR had consistent reductions in mortality, heart failure hospitalizations, and improved quality-of-life and functional capacity after transcatheter edge-to-edge repair.
Objective
To develop and describe a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog.
Design
Prospective technique development study.
Setting
University teaching ...hospital.
Animals
Six healthy adult male Beagles.
Interventions
Following anesthetic induction, fluoroscopic and ultrasound guidance were used to identify an appropriate gastropexy site on the left lateral abdomen. Gastropexy was performed using gastrointestinal suture anchors. An over‐the‐wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual‐lumen gastrojejunal feeding tube was placed via serial over‐the‐wire dilation of the body wall using an 18F peel‐away introducer kit. Tube location was determined radiographically immediately following placement and on days 2, 4, after emesis on day 4, and at time of gastrojejunal feeding tube removal (day 16–18).
Measurements and Main Results
Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs. Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9–93 minutes). Median total procedure time was 53 minutes (range, 49–113 minutes). Significant tube migration was not observed at any point during the study. One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component. Other complications were minor and included mild‐to‐moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1 dog. Feedings were well tolerated in all dogs.
Conclusions
PRGJ tube placement in the dog is a safe and minimally invasive technique that allows for jejunal feeding without surgery or endoscopy. The high success rates, acceptable procedural times, and minimal complications are appealing for use in critically ill patients. Although additional evaluations are needed, PRGJ tube placement may be considered for dogs that require postpyloric feeding with or without gastric decompression.
The electromagnetic calorimeters of the various magnetic spectrometers in Hall C at Jefferson Lab are presented. For the existing High Momentum Spectrometer (HMS) and Short Orbit Spectrometer (SOS), ...design considerations, relevant construction information, and comparisons of simulated and experimental results are included. The energy resolution of the HMS and SOS calorimeters is better than σ/E∼6%/E and pion/electron (π/e) separation of about 100:1 has been achieved in the energy range of 1–5GeV. Good agreement has been observed between the experimental and simulated energy resolutions, but simulations systematically exceed experimentally determined π− suppression factors by close to a factor of two. For the Super High Momentum Spectrometer (SHMS), presently under construction, details on the design and accompanying GEANT4 simulation efforts are given. The anticipated performance of the new calorimeter is predicted over the full momentum range of the SHMS. Good electron/hadron separation is anticipated by combining the energy deposited in an initial (preshower) calorimeter layer with the total energy deposited in the calorimeter.
•Construction and performance of lead glass calorimeters in JLab/Hall C are presented.•∼5%/E resolution, ∼100:1π/e separation is achieved in HMS calorimeter in GeV range.•Simulated resolution of the HMS calorimeter is in good agreement with experiment.•Simulated pion suppression of the HMS calorimeter exceeds experiment, by less than 2.•Pion suppression of ∼400:1 is predicted in projected SHMS calorimeter by simulations.
Statement of Principle Seaquist, Elizabeth R; Boulton, Andrew J.M; Harrell, R. Mack ...
The journal of clinical endocrinology and metabolism,
12/2014, Letnik:
99, Številka:
12
Journal Article
A diverse view of science to catalyse change Urbina-Blanco, César A; Jilani, Safia Z; Speight, Isaiah R ...
Chemical science (Cambridge),
09/2020, Letnik:
11, Številka:
34
Journal Article
Recenzirano
Odprti dostop
Valuing diversity leads to scientific excellence, the progress of science and, most importantly, it is simply the right thing to do. We can value diversity not only in words, but also in actions.
...Valuing diversity leads to scientific excellence, the progress of science and, most importantly, it is simply the right thing to do. We must value diversity not only in words, but also in actions.
Coronary artery bypass graft (CABG) surgery is frequently performed and effective; however, perioperative complications related to ischemia-reperfusion injury, including myocardial infarction (MI), ...remain common and result in significant morbidity and mortality. MC-1, a naturally occurring pyridoxine metabolite and purinergic receptor antagonist, prevents cellular calcium overload and may reduce ischemia-reperfusion injury. Phase 2 trial data suggest that MC-1 may reduce death or MI in high-risk patients undergoing CABG surgery.
To assess the efficacy and safety of MC-1 administered immediately before and for 30 days after surgery in patients undergoing CABG surgery.
The MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II Trial, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial, with 3023 intermediate- to high-risk patients undergoing CABG surgery with cardiopulmonary bypass enrolled between October 2006 and September 2007 at 130 sites in Canada, the United States, and Germany.
Patients received either MC-1, 250 mg/d (n = 1519), or matching placebo (n = 1504) immediately before and for 30 days after CABG surgery.
The primary efficacy outcome was cardiovascular death or nonfatal MI, defined as a creatine kinase (CK) MB fraction of at least 100 ng/mL or new Q waves through postoperative day 30.
The primary efficacy outcome occurred in 140 of 1510 patients (9.3%) in the MC-1 group and 133 of 1486 patients (9.0%) in the placebo group (risk ratio, 1.04; 95% confidence interval, 0.83-1.30; P = .76). All-cause mortality was higher among patients assigned to MC-1 than placebo at 4 days (1.0% vs 0.3%; P = .03) but was similar at 30 days (1.9% vs 1.5%; P = .44). There was no difference in the 8- to 24-hour CK-MB area under the curve between the MC-1 and placebo groups (median, 270 interquartile range, 175-492 vs 268 interquartile range, 170-456 hours x ng/mL; P = .11).
In this population of intermediate- to high-risk patients undergoing CABG surgery, MC-1 did not reduce the composite of cardiovascular death or nonfatal MI.
clinicaltrials.gov Identifier: NCT00402506
Our aim was to investigate the associations between erythrocyte fatty acids and the risk of islet autoimmunity in children. The Environmental Determinants of Diabetes in the Young Study (TEDDY) is a ...longitudinal cohort study of children at high genetic risk for type 1 diabetes (n = 8676) born between 2004 and 2010 in the U.S., Finland, Sweden, and Germany. A nested case-control design comprised 398 cases with islet autoimmunity and 1178 sero-negative controls matched for clinical site, family history, and gender. Fatty acids composition was measured in erythrocytes collected at the age of 3, 6, and 12 months and then annually up to 6 years of age. Conditional logistic regression models were adjusted for HLA risk genotype, ancestry, and weight z-score. Higher eicosapentaenoic and docosapentaenoic acid (n - 3 polyunsaturated fatty acids) levels during infancy and conjugated linoleic acid after infancy were associated with a lower risk of islet autoimmunity. Furthermore, higher levels of some even-chain saturated (SFA) and monounsaturated fatty acids (MUFA) were associated with increased risk. Fatty acid status in early life may signal the risk for islet autoimmunity, especially n - 3 fatty acids may be protective, while increased levels of some SFAs and MUFAs may precede islet autoimmunity.
The Tolerable Upper Intake Levels (UL) for zinc for children were based on limited data and there is concern that the UL may be set too low. The first effect of excessive zinc intake is a reduction ...in copper status. The primary objective of this study was to examine the effect of zinc supplementation on copper status in children. Healthy, 6- to 8-y-old boys from Ontario, Canada were assigned to take a placebo (n = 10) or 5 mg (n = 10), 10 mg (n = 9), or 15 mg (n = 8) of zinc supplement daily for 4 mo in a double-blinded, placebo-controlled, randomized trial. Biochemical measures were evaluated at baseline and after 2 and 4 mo of supplementation. Food records were completed near the baseline and 4-mo visits. Age and anthropometric measurements did not differ (P > 0.05) between treatment groups at baseline. Mean zinc intakes from food alone (10.9–14.8 mg zinc/d) approached or exceeded the UL of 12 mg/d. Compared with the placebo group, the zinc groups had a greater change in the urine zinc:creatinine ratio at 4 mo (P = 0.02). Traditional (plasma copper and ceruloplasmin activity) and more sensitive biomarkers of copper status, including erythrocyte SOD1 activity and the erythrocyte CCS:SOD1 protein ratio, were unchanged in zinc-supplemented boys, demonstrating that copper status was not depressed. Serum lipid measures and hemoglobin concentrations were also unaffected and gastrointestinal symptoms were not reported. These data provide evidence in support of the need for reexamining the current UL for zinc for children.
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