Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Δευτέρα 10 Σεπτεμβρίου 2018
Two Days in New York City
From guidelines to uniform pan-healthcare professional practice: development of an international consensus Care Pathway for the diagnosis and management of Primary Biliary Cholangitis (PBC)
PBC is an infrequent but important, lifelong autoimmune cholestatic liver disease that leads to liver fibrosis, cirrhosis and, ultimately, the need for liver transplantation. Its clinical course is heterogeneous, making it difficult for clinicians to diagnose and risk stratify patients with confidence. Patient management is frequently shared across primary and secondary care, and between physicians, nurse specialists and physician assistants. A key recommendation of recent EASL treatment guidelines was the development of a Care Pathway, to facilitate standardized approaches to management based on current practice.
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Hepatobiliary and non-hepatobiliary malignancies in PSC patients from Southern Europe: a comparative study in two European centers
Primary Sclerosing Cholangitis is a risk factor for the development of hepatobiliary malignancies (HPB) and non-HPB.
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Autoimmune liver disease serology in acute hepatitis E virus infection
Introduction: Existing data show an increased seroprevalence of HEV among AIH patients, raising the question as to whether HEV as a role as a potential AIH trigger. Our aim was to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies.
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A chromosome X-wide association study in primary biliary cholangitis allowed the identification of 5 novel susceptibility loci
Genome-wide association studies (GWAS) in primary biliary cholangitis (PBC) failed to find X chromosome genetic variants associated with the disease, but analytical problems arising from X unique mode of inheritance were not taken in account. Aim of our study was to explore the specific contribution of the X chromosome to the genetic architecture of PBC by performing a chromosome X-wide association study (XWAS).
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Non-invasive B-cell clonality markers may help in the rational approach to HCV SVR cryoglobulinemic patients with persisting manifestations
Background: Mixed cryoglobulinemia (MC), a both autoimmune and lymphoproliferative disorder (LPD), is characterized by the clonal expansion of B-cell populations, mostly in the liver and, less frequently, in the bone marrow or blood. DAAs can improve or heal MC vasculitis, but persistence or recurrence may be observed after SVR. Rituximab (RTX) is the first-choice therapy in such cases. However, MC persistence may also be due to other causes, including the occurrence of irreversible organ/tissue damage.
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Epidemiology of primary biliary cholangitis in Italy: novel insights on gender and comorbidities
Primary biliary cholangitis (PBC) is a rare autoimmune liver disease, that mostly affects females. Usually associated with other autoimmune diseases, very little is known about non-autoimmune comorbidities.
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Epidemiology and clinical impact of non-viral acute hepatitis in a tertiary unit of Hepatology in Italy
Introduction and Aims: Autoimmune hepatitis have a variable occurrence, clinical phenotype and outcome, and the factors contributing to this variability are uncertain. The goal of this study is to evaluate, through a retrospective analysis, data of severe acute hepatitis (SAH) requiring hospital admission between 1/2017 and 6/2018 in a tertiary inpatient Hepatological Unit. Incidence, clinical impact and outcome of non-viral/autoimmune acute hepatitis (AAH) were analyzed. AAH diagnosis was made using AAH scoring: definite diagnosis when AAH score was >15 pre-treatment and >17 post-treatment, or probable diagnosis when it was <15 and <17 respectively.
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Magnetic resonance cholangiography and biochemical predictive criteria of response to endoscopic treatment of severe strictures in patients with primary sclerosing Cholangitis
Background: The aim of this study was to assess whether magnetic resonance cholangiography (MRC), clinical and biochemical criteria are able to predict improvement after endoscopic treatment (ET) for dominant stenosis (DS) in patient with primary sclerosing cholangitis (PSC).
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Two simple magnetic resonance scores are able to predict survival in patients with Primary Sclerosing Cholangitis
Background: Primary sclerosing cholangitis (PSC) has a variable course. To predict clinical outcome in a single patient is a major need. Magnetic resonance (MR) imaging with 3D-MR cholangiography is the modality of choice for diagnosis. Two MR scores are able to predict radiologic progression of PSC.
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Ageing-related expression of Twinfilin-1 regulates cholangiocyte biological response to injury
Background and Aims: Ageing is a complex biological process that affects the functional capacity of multiple organs and is associated to the development of many diseases. Disorders affecting the biliary tree develop and progress differently according to the patient age. The aim of the study was to identify molecular pathways associated to cholangiocytes ageing and to verify their effects in the biological response to injury of biliary epithelial cells.
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Two Days in New York City
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader https://ift.tt/2QiWU9H
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From guidelines to uniform pan-healthcare professional practice: development of an international consensus Care Pathway for the diagnosis and management of Primary Biliary Cholangitis (PBC)
PBC is an infrequent but important, lifelong autoimmune cholestatic liver disease that leads to liver fibrosis, cirrhosis and, ultimately, the need for liver transplantation. Its clinical course is heterogeneous, making it difficult for clinicians to diagnose and risk stratify patients with confidence. Patient management is frequently shared across primary and secondary care, and between physicians, nurse specialists and physician assistants. A key recommendation of recent EASL treatment guidelines was the development of a Care Pathway, to facilitate standardized approaches to management based on current practice.
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Hepatobiliary and non-hepatobiliary malignancies in PSC patients from Southern Europe: a comparative study in two European centers
Primary Sclerosing Cholangitis is a risk factor for the development of hepatobiliary malignancies (HPB) and non-HPB.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2oYyVQw
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Autoimmune liver disease serology in acute hepatitis E virus infection
Introduction: Existing data show an increased seroprevalence of HEV among AIH patients, raising the question as to whether HEV as a role as a potential AIH trigger. Our aim was to investigate whether acute HEV infection is associated with the presence of AIH-relevant autoantibodies.
from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2MhCVoE
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A chromosome X-wide association study in primary biliary cholangitis allowed the identification of 5 novel susceptibility loci
Genome-wide association studies (GWAS) in primary biliary cholangitis (PBC) failed to find X chromosome genetic variants associated with the disease, but analytical problems arising from X unique mode of inheritance were not taken in account. Aim of our study was to explore the specific contribution of the X chromosome to the genetic architecture of PBC by performing a chromosome X-wide association study (XWAS).
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Non-invasive B-cell clonality markers may help in the rational approach to HCV SVR cryoglobulinemic patients with persisting manifestations
Background: Mixed cryoglobulinemia (MC), a both autoimmune and lymphoproliferative disorder (LPD), is characterized by the clonal expansion of B-cell populations, mostly in the liver and, less frequently, in the bone marrow or blood. DAAs can improve or heal MC vasculitis, but persistence or recurrence may be observed after SVR. Rituximab (RTX) is the first-choice therapy in such cases. However, MC persistence may also be due to other causes, including the occurrence of irreversible organ/tissue damage.
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Epidemiology of primary biliary cholangitis in Italy: novel insights on gender and comorbidities
Primary biliary cholangitis (PBC) is a rare autoimmune liver disease, that mostly affects females. Usually associated with other autoimmune diseases, very little is known about non-autoimmune comorbidities.
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Epidemiology and clinical impact of non-viral acute hepatitis in a tertiary unit of Hepatology in Italy
Introduction and Aims: Autoimmune hepatitis have a variable occurrence, clinical phenotype and outcome, and the factors contributing to this variability are uncertain. The goal of this study is to evaluate, through a retrospective analysis, data of severe acute hepatitis (SAH) requiring hospital admission between 1/2017 and 6/2018 in a tertiary inpatient Hepatological Unit. Incidence, clinical impact and outcome of non-viral/autoimmune acute hepatitis (AAH) were analyzed. AAH diagnosis was made using AAH scoring: definite diagnosis when AAH score was >15 pre-treatment and >17 post-treatment, or probable diagnosis when it was <15 and <17 respectively.
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Magnetic resonance cholangiography and biochemical predictive criteria of response to endoscopic treatment of severe strictures in patients with primary sclerosing Cholangitis
Background: The aim of this study was to assess whether magnetic resonance cholangiography (MRC), clinical and biochemical criteria are able to predict improvement after endoscopic treatment (ET) for dominant stenosis (DS) in patient with primary sclerosing cholangitis (PSC).
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Two simple magnetic resonance scores are able to predict survival in patients with Primary Sclerosing Cholangitis
Background: Primary sclerosing cholangitis (PSC) has a variable course. To predict clinical outcome in a single patient is a major need. Magnetic resonance (MR) imaging with 3D-MR cholangiography is the modality of choice for diagnosis. Two MR scores are able to predict radiologic progression of PSC.
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Ageing-related expression of Twinfilin-1 regulates cholangiocyte biological response to injury
Background and Aims: Ageing is a complex biological process that affects the functional capacity of multiple organs and is associated to the development of many diseases. Disorders affecting the biliary tree develop and progress differently according to the patient age. The aim of the study was to identify molecular pathways associated to cholangiocytes ageing and to verify their effects in the biological response to injury of biliary epithelial cells.
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An EEG nicotinic acetylcholine index to assess the efficacy of pro-cognitive compounds
The cholinergic system is involved in cognitive processes such as attention, memory and learning (Jones et al., 1999, Terry et al., 2003, Levin et al., 2006, Nees, 2015) and it holds promise as a therapeutic target due to its role in the pathophysiology of neurodegenerative and psychiatric disorders (Court et al., 2000, Sacco et al., 2004, Parri et al., 2011). Hence, anti-cholinergic pharmacological challenges have been used to induce temporary cognitive disturbances mimicking Alzheimer's disease (AD), scopolamine being the most frequently used challenge drug.
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Systems Genetics Approach to Biomarker Discovery: GPNMB and Heart Failure
We describe a simple bioinformatics method for biomarker discovery that is based on the analysis of global transcript levels in a population of inbred mouse strains showing variation for disease-related traits. This method has advantages such as controlled environment and accessibility to heart and plasma tissue in the preclinical selection stage. We illustrate the approach by identifying candidate heart failure (HF) biomarkers by overlaying mouse transcriptome and clinical traits from 91 Hybrid Mouse Diversity Panel (HMDP) inbred strains and human HF transcriptome from the Myocardial Applied Genomics Network (MAGNet) consortium. We found that some of the top differentially expressed genes correlated with known human HF biomarkers, such as galectin-3 and tissue inhibitor of metalloproteinase 1. Using ELISA assays, we investigated one novel candidate, Glycoprotein NMB, in a mouse model of chronic β-adrenergic stimulation by isoproterenol (ISO) induced HF. We observed significantly lower GPNMB plasma levels in the ISO model compared to the control group (p-value=0.007). In addition, we assessed GPNMB plasma levels among 389 HF cases and controls from the METabolic Syndrome In Men (METSIM) study. Lower levels of GPNMB were also observed in patients with HF from the METSIM study compared to non-HF controls (p-value<0.0001). In summary, we have identified several candidate biomarkers for HF using the cardiac transcriptome data in a population of mice that may be directly relevant and applicable to human populations.
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Volunteer EMT - East Windsor Township Rescue Squad District II Inc
**East Windsor Township Rescue Squad District 2 Inc** _Squad 146 serves the dual functions of both public safety and public service. The squad is responsible for responding to all Fire Department and EMS assignments on the eastern half of East Windsor Township._ Physical address: 73 Twin Rivers Drive East Windsor, NJ 08520 Mailing address: P.O. BOX 783 East Windsor, NJ 08520 Website: [http://www.squad146.com](http://www.squad146.com/) ...
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Application of CRISPR/Cas9 technologies combined with iPSCs in the study and treatment of retinal degenerative diseases
Abstract
Retinal degeneration diseases, such as age-related macular degeneration and retinitis pigmentosa, affect millions of people worldwide and are major causes of irreversible blindness. Effective treatments for retinal degeneration, including drug therapy, gene augmentation or transplantation approaches, have been widely investigated. Nevertheless, more research should be dedicated to therapeutic methods to improve future clinical treatments. Recently, with the rapid development of genome-editing technology, gene therapy has become a potentially effective treatment for retinal degeneration diseases. A clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) system has been developed as a powerful genome-editing tool in ophthalmic studies. The CRISPR/Cas9 system has been widely applied in basic research to develop animal models and gene therapies in vivo. With the ability to self-renew and the potential to differentiate into different types of cells, induced pluripotent stem cells (iPSCs) have already been used as a promising tool for understanding disease pathophysiology and evaluating the effect of drug and gene therapeutics. iPSCs are also a cell source for autologous transplantation. In this review, we compared genome-editing strategies and highlighted the advantages and concerns of the CRISPR/Cas9 system. Moreover, the latest progress and applications of the CRISPR/Cas9 system and its combination with iPSCs for the treatment of retinal degenerative diseases are summarized.
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Olfactory sensitivity for mold-associated odorants in CD-1 mice and spider monkeys
Abstract
Using operant conditioning procedures, we assessed the olfactory sensitivity of six CD-1 mice and three spider monkeys for mold-associated odorants. We found that with all eight stimuli, the mice detected concentrations as low as 0.1 ppm (parts per million), and with two of them individual animals even detected concentrations as low as 1 ppt (parts per trillion). The spider monkeys detected concentrations as low as 4 ppm with all eight stimuli, and with four of them individual animals even detected concentrations as low as 4 ppb (parts per billion). Between-species comparisons showed that with all eight odorants, the mice displayed significantly lower threshold values, that is, a higher sensitivity than the spider monkeys, but not than human subjects tested in previous studies. Analysis of odor structure–activity relationships showed that in both species, the type of oxygen-containing functional group and the presence versus absence of a double bond as well as the length of the carbon backbone of the odor stimuli had a systematic effect on detectability. We conclude that both mice and spider monkeys are clearly able to detect the presence of molds and thus to assess the palatability of potential food using the volatiles produced by molds during putrefaction.
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Prove it: Administering NTG to patients with inferior wall myocardial infarction
A new study suggests there may not be any clinical benefits to administering NTG to treat chest pain caused by myocardial ischemia
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Efficacy and safety of sofosbuvir–velpatasvir with or without ribavirin in HCV-infected Japanese patients with decompensated cirrhosis: an open-label phase 3 trial
Abstract
Background
In Japan, hepatitis C virus (HCV)-infected patients with decompensated cirrhosis currently have no treatment options. In this Phase 3 study, we evaluated sofosbuvir–velpatasvir with or without ribavirin for 12 weeks in patients with any HCV genotype and decompensated cirrhosis [Child–Pugh–Turcotte (CPT) class B or C] in Japan.
Methods
Patients were randomized 1:1 to receive sofosbuvir–velpatasvir with or without ribavirin for 12 weeks. Randomization was stratified by CPT class and genotype. Sustained virologic response 12 weeks following completion of treatment (SVR12) was the primary efficacy endpoint.
Results
Of the 102 patients enrolled, 57% were treatment naive, 78% and 20% had genotype 1 and 2 HCV infection, respectively, and 77% and 20% had CPT class B and C cirrhosis, respectively, at baseline. Overall, 61% of patients were female and the mean age was 66 years (range 41–83). SVR12 rates were 92% (47/51) in each group. Among patients who achieved SVR12, 26% had improved CPT class from baseline to posttreatment week 12. Most adverse events (AEs) were consistent with clinical sequelae of advanced liver disease or known toxicities of ribavirin. Four patients (8%) who received sofosbuvir–velpatasvir and seven (14%) who received sofosbuvir–velpatasvir plus ribavirin experienced a serious AE. The 3 deaths (bacterial sepsis, gastric varices hemorrhage, hepatocellular carcinoma) were attributed to liver disease progression.
Conclusion
Sofosbuvir–velpatasvir for 12 weeks provides a highly effective and well-tolerated therapy for Japanese patients with HCV and decompensated cirrhosis. Ribavirin did not improve efficacy but increased toxicity.
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Emergency Reporting Teams Up with National Volunteer Fire Council to Release Volunteer Firefighter Recruitment Guide
The guide contains helpful tips and advice on how leaders in the fire service can build a volunteer recruitment program that maximizes their agency's resources and expands the reach they have within their communities. It includes information on how to develop a successful marketing campaign, as well as specific strategies to get more recruits interested in joining the department.
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Association of glutathione S-transferase M1 and T1 null/present polymorphism with physical performance in the Korean population
Abstract
Human physical performance is a highly complex phenotype that is influenced by various factors. In particular, genetic factors related to muscle fiber type, bone density, muscle performance, and metabolic processes are known to contribute in varying degrees to athlete status and physical performance in various ethnic groups. To investigate the relationship between these genetic factors and physical performances, we genotyped five genetic polymorphisms (ACE Ins/Del, ACTN3 R577X, ER-α C/T, GSTM1 null/present, and GSTT1 null/present) in 111 Korean athletes and 145 controls. We examined genotype and allele frequency differences between athletes and control groups, along with the odds ratios, using Chi square. One-way analysis of variance (ANOVA) was used to test the significance of differences in continuous variables between the multiple genetic polymorphisms and physical performance test results. The GSTM1 polymorphism exhibited a highly significant association in athletes (p = 0.017). Combined analysis of GSTM1 and GSTT1 also revealed significant differences between athletes and controls (p < 0.05). In the analysis of physical performance within athletes, the ER-α gene polymorphism was associated with the sargent jump and the side-step (p < 0.05), and the GSTM1 gene polymorphism was significantly associated with the 20 m shuttle run and sit-up (p < 0.05). Thus, our data imply that GSTM1 and ER-α gene polymorphisms were associated with physical performance in Korean athletes, although functional studies with larger sample sizes are necessary to elaborate upon these findings.
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Association study of the three functional polymorphisms ( TAS2R46 G>A, OR4C16 G>A, and OR4X1 A>T) with recurrent pregnancy loss
Abstract
This study was purposed to investigate whether genetic polymorphisms in the function of stop-gain are associated with a fetal or placental development play roles and a development of idiopathic recurrent pregnancy loss (RPL) in Korean females. Three stop-gain polymorphisms were selected using next-generation sequencing screening, which allows for the rigorous examination and discovery of previously uncharacterized stop-gain genes and stop-gain expression profiles. Accordingly, we investigated the association of stop-gain polymorphisms in Korean women with RPL. Three functional polymorphisms in the TAS2R46G>A (rs2708381), OR4C16G>A (rs1459101), and OR4X1A>T (rs10838851) genes were genotyped using polymerase chain reaction (PCR)—restriction fragment length polymorphism assays and real-time PCR analysis. We determined that the OR4C16G>A polymorphism was associated with idiopathic RPL in Korean women (Adjusted odds ratio [AOR] 1.782; 95% confidence interval [CI] 1.004–3.163; P = 0.048, and AOR 1.766; 95% CI 1.020–3.059; P = 0.042). In addition, the prevalence of RPL was increased in women with the OR4C16GA + AA genotype and blood coagulation measures of prothrombin time (PT) > 10.4 s (AOR 8.292; 95% CI 2.744–25.054). We suggest that the OR4C16G>A polymorphism might serve as a clinically useful biomarker for the development, prevention, and prognosis of RPL.
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Takayasu's aorto-arteritis: Not your regular lesion for angioplasty
Navdeep Singh, Vivek Athwani, Vikas Bansal, Shaveta Kundra
Annals of Pediatric Cardiology 2018 11(3):312-314
We report a case of a 6-year-old female child with Takayasu's aorto-arteritis (TA) with severe coarctation of the aorta which resulted in an aortic dissection post-ballooning. This happened despite ensuring that markers for disease activity were negative, with appropriate corticosteroid therapy started before the procedure, and using a low-profile, low-pressure, and slightly undersized balloon for dilating the stenotic segment. It required immediate endovascular stenting to tide over the crisis. Following the procedure, she became normotensive with well-palpable lower limb pulses.
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Annals of Pediatric Cardiology 2018 11(3):312-314
We report a case of a 6-year-old female child with Takayasu's aorto-arteritis (TA) with severe coarctation of the aorta which resulted in an aortic dissection post-ballooning. This happened despite ensuring that markers for disease activity were negative, with appropriate corticosteroid therapy started before the procedure, and using a low-profile, low-pressure, and slightly undersized balloon for dilating the stenotic segment. It required immediate endovascular stenting to tide over the crisis. Following the procedure, she became normotensive with well-palpable lower limb pulses.
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Repaired congenital heart disease and our social milieu
Krishna S Iyer
Annals of Pediatric Cardiology 2018 11(3):233-234
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Annals of Pediatric Cardiology 2018 11(3):233-234
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Is transposition a defect of laterality?
Robert H Anderson, John Stickley
Annals of Pediatric Cardiology 2018 11(3):235-236
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Annals of Pediatric Cardiology 2018 11(3):235-236
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Anomalous origin of the right coronary artery from the pulmonary artery associated with an aortopulmonary window
Padebettu Subramanya Seetharama Bhat, Chandana Nirmala Chandrashekar, Divya Mallikarjun, SL Girish Gowda
Annals of Pediatric Cardiology 2018 11(3):325-327
Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a rare entity that causes chronic left-to-right shunting of blood from the RCA, through the coronary collaterals into the pulmonary artery. This results in persistent myocardial ischemia and ventricular dysfunction. Association of this anomaly with an aortopulmonary window worsens the condition further due to an additional shunt. We encountered a combination of these two anomalies along with an ostium secundum atrial septal defect in a 10-month-old baby who presented with excessive crying and failure to thrive. Evaluation by transthoracic echocardiography and cardiac computed tomography scan confirmed the diagnosis. Intrapulmonary baffle was done using a pericardial patch to connect the RCA origin to ascending aorta through the aortopulmonary window, similar to Takeuchi procedure. Concomitantly, ostium secundum atrial septal defect was also closed.
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Annals of Pediatric Cardiology 2018 11(3):325-327
Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a rare entity that causes chronic left-to-right shunting of blood from the RCA, through the coronary collaterals into the pulmonary artery. This results in persistent myocardial ischemia and ventricular dysfunction. Association of this anomaly with an aortopulmonary window worsens the condition further due to an additional shunt. We encountered a combination of these two anomalies along with an ostium secundum atrial septal defect in a 10-month-old baby who presented with excessive crying and failure to thrive. Evaluation by transthoracic echocardiography and cardiac computed tomography scan confirmed the diagnosis. Intrapulmonary baffle was done using a pericardial patch to connect the RCA origin to ascending aorta through the aortopulmonary window, similar to Takeuchi procedure. Concomitantly, ostium secundum atrial septal defect was also closed.
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Transposition of the great arteries: A laterality defect in the group of heterotaxy syndromes or an outflow tract malformation?
Rana S Al-Zahrani, Samaher H Alharbi, Rawan M A Tuwaijri, Bayan T Alzomaili, Alaa Althubaiti, Talat Mesud Yelbuz
Annals of Pediatric Cardiology 2018 11(3):237-249
Background/Aim: Transposition of the great arteries (TGA) is traditionally classified as a "conotruncal heart defect", implying that TGA evolves from abnormal development of the outflow tract (OFT) of the embryonic heart. However, recently published genetic data suggest that TGA may be linked to laterality gene defects rather than OFT gene defects. The aim of our study was to clarify whether there is any statistically significant link between TGA and clinically diagnosed laterality defects (heterotaxy). Methods: Retrospective cross-sectional analysis of 533 patients diagnosed with TGA at our cardiac center over a period of 13 years (2002-2015). Hospital informatics and digital data recording systems were used for collecting patients' data and all patients were reviewed to check the echocardiograms for verification of the diagnosis, type (TGA, congenitally corrected TGA (ccTGA), and levo-position of the great arteries (LGA)), complexity of TGA, and all other variables (e.g., abdominal organ arrangement, cardiac position, presence or absence of other cardiac defects). Results: Of 533 TGA patients, 495 (92.9%) had the usual arrangement of the internal organs, 21 (3.9%) had mirror-imagery, 7 (1.3%) had left and 10 (1.8%) had right isomerism. 444 (83.3%) patients had TGA. The number of patients who had usual visceral arrangement in each TGA type was: 418 (94.1%) in TGA, 49 (92.4%) in ccTGA, and 28 (77.7%) in LGA. 6 (1.4%) TGA patients, 4 (11.1%) patients with LGA were found to have right isomerism, while no ccTGA patient presented with this asymmetry. 4 (0.9%) TGA patients, 1 (1.9%) ccTGA patient and 2 (5.6%) patients with LGA had left isomerism. Heterotaxy (mirror-imagery, left and right isomerism) was more associated with LGA than TGA or ccTGA with a statistically significant difference (P value of 0.001). Conclusion: In contrast to recently published genetic data, our morphological data do not disclose a significant link between TGA and heterotaxy.
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Annals of Pediatric Cardiology 2018 11(3):237-249
Background/Aim: Transposition of the great arteries (TGA) is traditionally classified as a "conotruncal heart defect", implying that TGA evolves from abnormal development of the outflow tract (OFT) of the embryonic heart. However, recently published genetic data suggest that TGA may be linked to laterality gene defects rather than OFT gene defects. The aim of our study was to clarify whether there is any statistically significant link between TGA and clinically diagnosed laterality defects (heterotaxy). Methods: Retrospective cross-sectional analysis of 533 patients diagnosed with TGA at our cardiac center over a period of 13 years (2002-2015). Hospital informatics and digital data recording systems were used for collecting patients' data and all patients were reviewed to check the echocardiograms for verification of the diagnosis, type (TGA, congenitally corrected TGA (ccTGA), and levo-position of the great arteries (LGA)), complexity of TGA, and all other variables (e.g., abdominal organ arrangement, cardiac position, presence or absence of other cardiac defects). Results: Of 533 TGA patients, 495 (92.9%) had the usual arrangement of the internal organs, 21 (3.9%) had mirror-imagery, 7 (1.3%) had left and 10 (1.8%) had right isomerism. 444 (83.3%) patients had TGA. The number of patients who had usual visceral arrangement in each TGA type was: 418 (94.1%) in TGA, 49 (92.4%) in ccTGA, and 28 (77.7%) in LGA. 6 (1.4%) TGA patients, 4 (11.1%) patients with LGA were found to have right isomerism, while no ccTGA patient presented with this asymmetry. 4 (0.9%) TGA patients, 1 (1.9%) ccTGA patient and 2 (5.6%) patients with LGA had left isomerism. Heterotaxy (mirror-imagery, left and right isomerism) was more associated with LGA than TGA or ccTGA with a statistically significant difference (P value of 0.001). Conclusion: In contrast to recently published genetic data, our morphological data do not disclose a significant link between TGA and heterotaxy.
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Endovascular management of vein of Galen aneurysmal malformation in a neonate
Siddharthan Deepti, Rajnish Juneja, Leve Joseph Devarajan Sebastian
Annals of Pediatric Cardiology 2018 11(3):304-307
A term baby presented on the 7th day of life in cardiogenic shock due to vein of Galen aneurysmal malformation. A successful embolization of the malformation was performed through transarterial route on day 12 of life after a period of initial stabilization.
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Annals of Pediatric Cardiology 2018 11(3):304-307
A term baby presented on the 7th day of life in cardiogenic shock due to vein of Galen aneurysmal malformation. A successful embolization of the malformation was performed through transarterial route on day 12 of life after a period of initial stabilization.
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Validation of the accuracy of handheld echocardiography for diagnosis of congenital heart disease
Sulafa Ali, Tajudeen Bushari
Annals of Pediatric Cardiology 2018 11(3):250-254
Background: Handheld echocardiography (HHE) has been increasingly used for rheumatic heart disease screening and in adult emergency room settings. Aims: This study aimed to validate the accuracy of HHE in the diagnosis of congenital heart disease (CHD). Settings and Design Methodology: This is a prospective study carried out at three pediatric cardiology outpatient clinics in Khartoum, Sudan. All patients with suspected CHD were evaluated by clinical examination followed by HHE, performed using a modified segmental approach. Then, a complete study was performed using a standard echocardiography machine. The results were then compared using appropriate statistical tools. Results: A total of eighty cases were included with the following diagnoses either in isolation or combination: ventricular septal defect (n = 23), atrial septal defect (n = 10), pulmonary stenosis (n = 7), tetralogy of Fallot (n = 7), patent ductus arteriosus (n = 6), atrioventricular septal defect (n = 6), transposition of the great arteries (n = 6), and other diagnoses (n = 15). Agreement between HHE and SE was excellent both for visualizing heart segments (κ =77%–100% with a mean of 92.9%) and for diagnosis of CHD (κ =66%–100% with a mean of 91.7%). The sensitivity of HHE was 69.2%–100% (mean = 90.2%) and specificity was 98.5%–100% (mean = 99.3%). Conclusion: This study supports extending the utility of HHE in children for screening of CHD in addition to its current role in rheumatic heart disease screening.
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Annals of Pediatric Cardiology 2018 11(3):250-254
Background: Handheld echocardiography (HHE) has been increasingly used for rheumatic heart disease screening and in adult emergency room settings. Aims: This study aimed to validate the accuracy of HHE in the diagnosis of congenital heart disease (CHD). Settings and Design Methodology: This is a prospective study carried out at three pediatric cardiology outpatient clinics in Khartoum, Sudan. All patients with suspected CHD were evaluated by clinical examination followed by HHE, performed using a modified segmental approach. Then, a complete study was performed using a standard echocardiography machine. The results were then compared using appropriate statistical tools. Results: A total of eighty cases were included with the following diagnoses either in isolation or combination: ventricular septal defect (n = 23), atrial septal defect (n = 10), pulmonary stenosis (n = 7), tetralogy of Fallot (n = 7), patent ductus arteriosus (n = 6), atrioventricular septal defect (n = 6), transposition of the great arteries (n = 6), and other diagnoses (n = 15). Agreement between HHE and SE was excellent both for visualizing heart segments (κ =77%–100% with a mean of 92.9%) and for diagnosis of CHD (κ =66%–100% with a mean of 91.7%). The sensitivity of HHE was 69.2%–100% (mean = 90.2%) and specificity was 98.5%–100% (mean = 99.3%). Conclusion: This study supports extending the utility of HHE in children for screening of CHD in addition to its current role in rheumatic heart disease screening.
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Neonatal supraventricular extrasystole as early clinical debut of cardiac rhabdomyoma
Roger Esmel-Vilomara, Amparo Castellote, Luz Santana, Dimpna Calila Albert
Annals of Pediatric Cardiology 2018 11(3):318-321
We are reporting the case of a newborn with a diagnosis of frequent supraventricular extrasystoles, up to 25% of beats at Holter monitoring, and partial response to beta-blockers. Initial echocardiographic studies were normal until the identification of a right atrial mass at 4 months of life. Given the progressive growth of the mass and the suspicion of myxoma or thrombus in the magnetic resonance study, surgical resection of the tumor was performed. The surgical specimen was histologically diagnostic of rhabdomyoma. Currently, the patient remains asymptomatic after a 6-year follow-up period. A single rhabdomyoma is described, located in an atypical situation, near the crista terminalis, and diagnosed from frequent extrasystoles which appeared before the echocardiographic resolution was able to identify it. Magnetic resonance showed nondiagnostic tissue enhancement characteristics.
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Annals of Pediatric Cardiology 2018 11(3):318-321
We are reporting the case of a newborn with a diagnosis of frequent supraventricular extrasystoles, up to 25% of beats at Holter monitoring, and partial response to beta-blockers. Initial echocardiographic studies were normal until the identification of a right atrial mass at 4 months of life. Given the progressive growth of the mass and the suspicion of myxoma or thrombus in the magnetic resonance study, surgical resection of the tumor was performed. The surgical specimen was histologically diagnostic of rhabdomyoma. Currently, the patient remains asymptomatic after a 6-year follow-up period. A single rhabdomyoma is described, located in an atypical situation, near the crista terminalis, and diagnosed from frequent extrasystoles which appeared before the echocardiographic resolution was able to identify it. Magnetic resonance showed nondiagnostic tissue enhancement characteristics.
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Predictors of abnormal electrocardiograms in the pediatric emergency department
Shiv Gandhi, Miranda Lin, Sharon R Smith, Jesse J Sturm
Annals of Pediatric Cardiology 2018 11(3):255-260
Background: Electrocardiograms (ECGs) are ordered in the pediatric emergency room for a wide variety of chief complaints. Objectives: Criteria are lacking as to when physicians should obtain ECGs. This study uses a large retrospective cohort of 880 pediatric emergency department (ED) patients to highlight objective criteria including significant medical history and specific vital sign abnormalities to guide clinicians as to which patients might have an abnormal ECG. Methods: Retrospective review of Pediatric ED charts in all patients aged < 18 years who had ECG performed during ED stay. Pediatric ED physician interpretation of the ECG, clinical data on vital signs and past medical history was collected from the medical record for analysis. Results: Of 880 ECGs performed in the ED, 17.4% were abnormal. When controlled for medical history and demographic differences, abnormal ECGs were associated with age-adjusted abnormal ED vital signs including increased heart rate (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.1–3.09) and increased respiratory rate (OR 1.74, CI 1.42–2.62). In a logistic regression analysis, certain chief complaints and history components were less likely to have abnormal ECGs including complaints of chest pain (OR 0.38, CI 0.18–0.80) and known history of gastrointestinal or respiratory condition (i.e., asthma) (OR 0.48, CI 0.29–0.79). Conclusions: In this cohort of patients, those with a chief complaint of chest pain or known respiratory conditions and normal age-adjusted vital signs in the ED have low likelihood of an abnormal ECG.
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Annals of Pediatric Cardiology 2018 11(3):255-260
Background: Electrocardiograms (ECGs) are ordered in the pediatric emergency room for a wide variety of chief complaints. Objectives: Criteria are lacking as to when physicians should obtain ECGs. This study uses a large retrospective cohort of 880 pediatric emergency department (ED) patients to highlight objective criteria including significant medical history and specific vital sign abnormalities to guide clinicians as to which patients might have an abnormal ECG. Methods: Retrospective review of Pediatric ED charts in all patients aged < 18 years who had ECG performed during ED stay. Pediatric ED physician interpretation of the ECG, clinical data on vital signs and past medical history was collected from the medical record for analysis. Results: Of 880 ECGs performed in the ED, 17.4% were abnormal. When controlled for medical history and demographic differences, abnormal ECGs were associated with age-adjusted abnormal ED vital signs including increased heart rate (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.1–3.09) and increased respiratory rate (OR 1.74, CI 1.42–2.62). In a logistic regression analysis, certain chief complaints and history components were less likely to have abnormal ECGs including complaints of chest pain (OR 0.38, CI 0.18–0.80) and known history of gastrointestinal or respiratory condition (i.e., asthma) (OR 0.48, CI 0.29–0.79). Conclusions: In this cohort of patients, those with a chief complaint of chest pain or known respiratory conditions and normal age-adjusted vital signs in the ED have low likelihood of an abnormal ECG.
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Professor Ivatury Mritunjay Rao
Krishna Subramony Iyer
Annals of Pediatric Cardiology 2018 11(3):330-331
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Annals of Pediatric Cardiology 2018 11(3):330-331
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Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery
Supratim Sen, Sandeep Garg, Suresh G Rao, Snehal Kulkarni
Annals of Pediatric Cardiology 2018 11(3):261-266
Background: Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature. Methods: The study design was a retrospective record review. Patients with coarctation aged <1 year who underwent balloon or surgical coarctoplasty at our center (January 2010–January 2016) with >6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted. Results: Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan–Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028). Conclusion: In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.
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Annals of Pediatric Cardiology 2018 11(3):261-266
Background: Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature. Methods: The study design was a retrospective record review. Patients with coarctation aged <1 year who underwent balloon or surgical coarctoplasty at our center (January 2010–January 2016) with >6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted. Results: Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan–Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028). Conclusion: In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.
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Successful Angiojet® aortic thrombectomy of extracorporeal membrane oxygenation-related thrombus in a newborn
Maria Elena Gutierrez, Jeffrey A Alten, Mark A Law
Annals of Pediatric Cardiology 2018 11(3):300-303
Thrombosis and systemic embolization are important complications of extracorporeal membrane oxygenation (ECMO). We present a 2.5 kg neonate born at 37.4 weeks with hypoplastic left heart supported on ECMO that developed an acute, occlusive distal aortic thrombus that was emergently managed by transcatheter Angiojet® (Boston Scientific, Boston, MA) thrombectomy. The procedure successfully restored perfusion to the lower extremities with sustained result upon 1-week follow-up. This case highlights the Angiojet® thrombectomy as a treatment option for limb- or organ-threatening acute thrombus in even the most complex ECMO patients.
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Annals of Pediatric Cardiology 2018 11(3):300-303
Thrombosis and systemic embolization are important complications of extracorporeal membrane oxygenation (ECMO). We present a 2.5 kg neonate born at 37.4 weeks with hypoplastic left heart supported on ECMO that developed an acute, occlusive distal aortic thrombus that was emergently managed by transcatheter Angiojet® (Boston Scientific, Boston, MA) thrombectomy. The procedure successfully restored perfusion to the lower extremities with sustained result upon 1-week follow-up. This case highlights the Angiojet® thrombectomy as a treatment option for limb- or organ-threatening acute thrombus in even the most complex ECMO patients.
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Early outcomes of modification of end to side repair of coarctation of aorta with arch hypoplasia in neonates and infants
Anil Kumar Dharmapuram, Nagarajan Ramadoss, Sudeep Verma, Goutami Vejendla, Rao Mrutyunjaya Ivatury
Annals of Pediatric Cardiology 2018 11(3):267-274
Background: In coarctation of aorta associated with proximal arch hypoplasia, extended end-to-end anastomosis through a thoracotomy would result in a residual gradient between the origins of the innominate and the left common carotid arteries. To eliminate this, we modified the surgical technique. Patients and Methods: Between March 2012 and May 2017, 50 patients (14 neonates) underwent repair of coarctation of aorta through a thoracotomy. The age ranged from 6 days to 2 years (median 2 months) and the weight from 1.8 to 8.0 kg (median 4.3 kg). A total of 15 patients (Group A) underwent repair by the extended end-to-end anastomosis. Among them, two patients developed early restenosis at the proximal arch requiring surgical reintervention. Hence, in the second half of the study, 35 patients (Group B) who were identified to have significant hypoplasia of the proximal arch underwent a modified end-to-side anastomosis of the descending aorta to the proximal arch incorporating the distal ascending aorta in the anastomosis and leaving the left subclavian artery end of the isthmus as an end-on vessel. Results: One neonate in Group B died due to a cause not related to the repair. All the other patients in Group B are doing well without a residual gradient during a median follow-up of 23 months. There were no airway issues related to extensive mobilization of the aorta. Conclusion: End-to-side anastomosis of the descending aorta to the proximal arch and side of the ascending aorta is possible through a thoracotomy and can be achieved with good outcome in neonates and infants.
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Annals of Pediatric Cardiology 2018 11(3):267-274
Background: In coarctation of aorta associated with proximal arch hypoplasia, extended end-to-end anastomosis through a thoracotomy would result in a residual gradient between the origins of the innominate and the left common carotid arteries. To eliminate this, we modified the surgical technique. Patients and Methods: Between March 2012 and May 2017, 50 patients (14 neonates) underwent repair of coarctation of aorta through a thoracotomy. The age ranged from 6 days to 2 years (median 2 months) and the weight from 1.8 to 8.0 kg (median 4.3 kg). A total of 15 patients (Group A) underwent repair by the extended end-to-end anastomosis. Among them, two patients developed early restenosis at the proximal arch requiring surgical reintervention. Hence, in the second half of the study, 35 patients (Group B) who were identified to have significant hypoplasia of the proximal arch underwent a modified end-to-side anastomosis of the descending aorta to the proximal arch incorporating the distal ascending aorta in the anastomosis and leaving the left subclavian artery end of the isthmus as an end-on vessel. Results: One neonate in Group B died due to a cause not related to the repair. All the other patients in Group B are doing well without a residual gradient during a median follow-up of 23 months. There were no airway issues related to extensive mobilization of the aorta. Conclusion: End-to-side anastomosis of the descending aorta to the proximal arch and side of the ascending aorta is possible through a thoracotomy and can be achieved with good outcome in neonates and infants.
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Morphology of intramural ventricular septal defects: Clinical imaging and autopsy correlation
Neil D Patel, Richard W Kim, Suwanna Pornrattanarungsi, Pierre C Wong
Annals of Pediatric Cardiology 2018 11(3):308-311
An intramural ventricular septal defect (IVSD) is a type of interventricular communication that can occur following biventricular repair of a conotruncal malformation. There have been no previous reports depicting the actual pathologic anatomy of this defect. We describe two cases of IVSDs with their clinical imaging and postmortem pathology.
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Annals of Pediatric Cardiology 2018 11(3):308-311
An intramural ventricular septal defect (IVSD) is a type of interventricular communication that can occur following biventricular repair of a conotruncal malformation. There have been no previous reports depicting the actual pathologic anatomy of this defect. We describe two cases of IVSDs with their clinical imaging and postmortem pathology.
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Modified technique for uncommon coarctation of the aorta with arch hypoplasia
Brijesh Parayaru Kottayil, Praveen R Bayya, Luis Baquero, Amitabh C Sen, Raman K Kumar
Annals of Pediatric Cardiology 2018 11(3):275-277
A true presubclavian coarctation of the aorta with arch hypoplasia without major intracardiac anomaly can result in a surgical dilemma. Theoretically, one can avoid repair through median sternotomy using selective cerebral perfusion and its sequelae since no major intracardiac repair is needed. Repair through thoracotomy is technically challenging if arch reconstruction is required and precise surgical planning is required to avoid spinal hypoperfusion and to maintain cerebral perfusion. Moreover, inadequate repair often has resulted in hypoplastic aortic arch or residual coarctation on follow-up requiring future intervention. We have employed a modified surgical repair through thoracotomy avoiding cardiopulmonary bypass to address presubclavian coarctation of the aorta with diffuse arch hypoplasia with theoretically less chance for future stenosis.
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Annals of Pediatric Cardiology 2018 11(3):275-277
A true presubclavian coarctation of the aorta with arch hypoplasia without major intracardiac anomaly can result in a surgical dilemma. Theoretically, one can avoid repair through median sternotomy using selective cerebral perfusion and its sequelae since no major intracardiac repair is needed. Repair through thoracotomy is technically challenging if arch reconstruction is required and precise surgical planning is required to avoid spinal hypoperfusion and to maintain cerebral perfusion. Moreover, inadequate repair often has resulted in hypoplastic aortic arch or residual coarctation on follow-up requiring future intervention. We have employed a modified surgical repair through thoracotomy avoiding cardiopulmonary bypass to address presubclavian coarctation of the aorta with diffuse arch hypoplasia with theoretically less chance for future stenosis.
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Balloon angioplasty for supravalvular aortic stenosis as an early complication following arterial switch operation
Kaitlin Carr, Osamah Aldoss, Bijoy Thattaliyath, Manish Bansal
Annals of Pediatric Cardiology 2018 11(3):315-317
Supravalvular aortic stenosis as an early complication of transposition of the great artery repair is rare with few cases reported. Furthermore, transcatheter intervention is uncommon as surgical re-intervention has been traditionally done. We describe two cases of supravalvular aortic stenosis at the anastomotic site as an early complication of the arterial switch operation. Both patients underwent balloon angioplasty of the supravalvular aorta with improvement in postangioplasty gradients and angiographic appearance. Both patients at short-term follow-up had persistent improved gradient without need for further intervention.
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Annals of Pediatric Cardiology 2018 11(3):315-317
Supravalvular aortic stenosis as an early complication of transposition of the great artery repair is rare with few cases reported. Furthermore, transcatheter intervention is uncommon as surgical re-intervention has been traditionally done. We describe two cases of supravalvular aortic stenosis at the anastomotic site as an early complication of the arterial switch operation. Both patients underwent balloon angioplasty of the supravalvular aorta with improvement in postangioplasty gradients and angiographic appearance. Both patients at short-term follow-up had persistent improved gradient without need for further intervention.
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Descending aortic translocation procedure for relief of bronchial compression in left aortic arch and right descending aorta
Roy Varghese, Ronak Sheth, Sivakumar Kothandam
Annals of Pediatric Cardiology 2018 11(3):278-281
Compression of the left bronchus by a right-sided descending aorta arising from a left aortic arch constitutes an exceedingly rare form of vascular ring. This manuscript describes the surgical technique that involves translocation of the descending aorta directly to the proximal ascending aorta, thereby relieving the bronchial compression.
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Annals of Pediatric Cardiology 2018 11(3):278-281
Compression of the left bronchus by a right-sided descending aorta arising from a left aortic arch constitutes an exceedingly rare form of vascular ring. This manuscript describes the surgical technique that involves translocation of the descending aorta directly to the proximal ascending aorta, thereby relieving the bronchial compression.
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Total anomalous pulmonary venous connection masking an aortopulmonary window: A rare combination of defects
Shyamajit Samaddar, Dheeraj Bhatt, Munish Guleria, Dinesh Kumar Yadav, Anubhav Gupta
Annals of Pediatric Cardiology 2018 11(3):322-324
The association of aortopulmonary (AP) window with total anomalous pulmonary venous connection (TAPVC) has so far not been reported. We report a unique case of an 8-month-old child who presented with congestive cardiac failure and severe pulmonary arterial hypertension. Initial echocardiography revealed supracardiac TAPVC. Cardiac computed tomography showed the presence of Type I AP window along with the TAPVC. In the presence of severe pulmonary hypertension and dilated right ventricle, AP window may easily be missed if not actively looked for.
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Annals of Pediatric Cardiology 2018 11(3):322-324
The association of aortopulmonary (AP) window with total anomalous pulmonary venous connection (TAPVC) has so far not been reported. We report a unique case of an 8-month-old child who presented with congestive cardiac failure and severe pulmonary arterial hypertension. Initial echocardiography revealed supracardiac TAPVC. Cardiac computed tomography showed the presence of Type I AP window along with the TAPVC. In the presence of severe pulmonary hypertension and dilated right ventricle, AP window may easily be missed if not actively looked for.
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Rationale and design of long-term outcomes and vascular evaluation after successful coarctation of the aorta treatment study
Jose D Martins, Justin Zachariah, Elif Seda Selamet Tierney, Uyen Truong, Shaine A Morris, Shelby Kutty, Sarah D de Ferranti, Jonathan Rhodes, Marta Antonio, Maria Guarino, Boban Thomas, Diana Oliveira, Kimberlee Gauvreau, Nuno Jalles, Tal Geva, Miguel Carmo, Ashwin Prakash
Annals of Pediatric Cardiology 2018 11(3):282-296
Background: Coarctation of the aorta (CoA) can be treated using surgery, balloon angioplasty, or stent implantation. Although short-term results are excellent with all three treatment modalities, long-term cardiovascular (CV) morbidity and mortality remain high, likely due to persistently abnormal vascular function. The effects of treatment modality on long-term vascular function remain uncharacterized. The goal of this study is to assess vascular function in this patient population for comparison among the treatment modalities. Methods: We will prospectively assess vascular Afunction in large and small arteries fusing multiple noninvasive modalities and compare the results among the three groups of CoA patients previously treated using surgery, balloon angioplasty, or stent implantation after frequency matching for confounding variables. A comprehensive vascular function assessment protocol has been created to be used in 7 centers. Our primary outcome is arterial stiffness measured by arterial tonometry. Inclusion and exclusion criteria have been carefully established after consideration of several potential confounders. Sample size has been calculated for the primary outcome variable. Conclusion: Treatment modalities for CoA may have distinct impact on large and small arterial vascular function. The results of this study will help identify the treatment modality that is associated with the most optimal level of vascular function, which, in the long term, may reduce CV risk.
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Annals of Pediatric Cardiology 2018 11(3):282-296
Background: Coarctation of the aorta (CoA) can be treated using surgery, balloon angioplasty, or stent implantation. Although short-term results are excellent with all three treatment modalities, long-term cardiovascular (CV) morbidity and mortality remain high, likely due to persistently abnormal vascular function. The effects of treatment modality on long-term vascular function remain uncharacterized. The goal of this study is to assess vascular function in this patient population for comparison among the treatment modalities. Methods: We will prospectively assess vascular Afunction in large and small arteries fusing multiple noninvasive modalities and compare the results among the three groups of CoA patients previously treated using surgery, balloon angioplasty, or stent implantation after frequency matching for confounding variables. A comprehensive vascular function assessment protocol has been created to be used in 7 centers. Our primary outcome is arterial stiffness measured by arterial tonometry. Inclusion and exclusion criteria have been carefully established after consideration of several potential confounders. Sample size has been calculated for the primary outcome variable. Conclusion: Treatment modalities for CoA may have distinct impact on large and small arterial vascular function. The results of this study will help identify the treatment modality that is associated with the most optimal level of vascular function, which, in the long term, may reduce CV risk.
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Coronary-to-pulmonary artery collaterals in pulmonary atresia
Deepa Sasikumar, Bijulal Sasidharan, Anoop Ayyappan, Arun Gopalakrishnan, Kavasseri M Krishnamoorthy
Annals of Pediatric Cardiology 2018 11(3):328-329
A 2-month-old baby with ventricular septal defect and pulmonary atresia was found to have coronary-to-pulmonary artery collaterals. Cardiac computed tomography confirmed the coronary collaterals and showed the absence of other systemic to pulmonary artery collaterals. Although these collaterals do not cause coronary ischemia, it is important to delineate them by accurate imaging to plan the appropriate surgical strategy.
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Annals of Pediatric Cardiology 2018 11(3):328-329
A 2-month-old baby with ventricular septal defect and pulmonary atresia was found to have coronary-to-pulmonary artery collaterals. Cardiac computed tomography confirmed the coronary collaterals and showed the absence of other systemic to pulmonary artery collaterals. Although these collaterals do not cause coronary ischemia, it is important to delineate them by accurate imaging to plan the appropriate surgical strategy.
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Protective and therapeutic effects of exercise on stress-induced memory impairment
Abstract
The objective of this paper was to systematically evaluate the potential preventive and therapeutic effects of exercise in attenuating stress-induced memory impairment. A systematic review was employed, searching PubMed, PsychInfo, Sports Discus and Google Scholar databases. For eligibility, studies had to be published in English, employ an experimental design, have the acute or chronic bout of exercise occur prior to, during or after the stressor, implement a psychophysiological stressor, and have an assessment of memory function occurring after the stressor. In total, 23 studies were evaluated, all of which were conducted among animal models. All 23 studies employed a chronic exercise protocol and a chronic stress protocol. Eight studies evaluated a preventive model, three employed a concurrent model, ten studies employed a therapeutic model, and two studies evaluated both a preventive and therapeutic model within the same study. Among the eight studies employing a preventive model, all eight demonstrated that the stress regimen impaired memory function. In all eight of these studies, when exercise occurred prior to the stressor, exercise attenuated the stress-induced memory impairment effect. Among the ten studies employing a therapeutic model, one study showed that the stress protocol enhanced memory function, one showed that the stress protocol did not influence memory, and eight demonstrated that the stress regimen impaired memory function. Among the eight studies showing that the stress protocol impaired memory function, all eight studies demonstrated that exercise, after the stressor, attenuated stress-induced memory impairment. Within animal models, chronic stress is associated with memory impairment and chronic exercise has both a preventive and therapeutic effect in attenuating stress-induced memory impairment. Additional experimental work in human studies is needed. Such work should also examine acute exercise and stress protocols.
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The effect of antioxidants on Helicobacter pylori eradication: A systematic review with meta-analysis
Helicobacter
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Endoscopic vs percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: A multicentre, randomised controlled trial
The Lancet: Gastroenterology & Hepatology
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Efficacy, immunogenicity, and safety of a parenteral vaccine against Helicobacter pylori in healthy volunteers challenged with a Cag-positive strain: A randomised, placebo-controlled phase 1/2 study
The Lancet: Gastroenterology & Hepatology
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Risankizumab in patients with moderate to severe Crohn's disease: An open-label extension study
The Lancet: Gastroenterology & Hepatology
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Vitamin D levels are associated with metabolic syndrome in adolescents and young Adults: The BCAMS Study
Clinical Nutrition
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Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care
Abstract
We examine the impact of insurance expansion under the Affordable Care Act's Dependent Care Expansion (DCE) on allocation of mental health care across illness severity, types of care and racial/ethnic groups. Evidence suggests that the increase in mental health care utilization resulting from the DCE was restricted to individuals with clinically significant mental health conditions. There is no evidence suggesting that the increase occurred disproportionately in medication-only treatment or that it increased racial/ethnic disparities. The DCE appears to have been successful in increasing utilization of mental health care among a high need group without lowering quality or increasing disparities.
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Comparison of inhibitory neuromuscular transmission in the Cynomolgus monkey IAS and rectum: special emphasis on differences in purinergic transmission
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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The effect of hot and cold drinks on thermoregulation, perception, and performance: the role of the gut in thermoreception
Abstract
Purpose
Hot compared to cold drinks alter sweating responses during very low intensity exercise in temperate conditions. The thermoregulatory, perceptual, and performance effects of hot compared to cold drinks in hot, dry conditions during high-intensity exercise have not been examined.
Method
Ten participants [mean ± SD characteristics age 25 ± 5 years, height 1.81 ± 0.07 m, body mass 73.5 ± 10.6 kg, maximal power output (PMax) 350 ± 41 W] completed two conditions, where they drank four boluses (ingested at − 9, 15, 30, and 45 min, respectively) of 3.2 mL kg− 1 (~ 960 mL total) of either a COLD (5.3 °C) or a HOT drink (49.0 °C), which were contrasted to a no-drink CONTROL. They cycled for 60-min [55% PMax in hot (34.4 °C) dry (34% RH)] ambient conditions followed by a test to exhaustion (TTE; 80% PMax). The thermoregulatory, performance, and perceptual implications of drink temperature were measured.
Results
TTE was worse in the CONTROL (170 ± 132 s) than the COLD drink (371 ± 272 s; p = 0.021) and HOT drink conditions (367 ± 301 s; p = 0.038) which were not different (p = 0.965). Sweat responses [i.e., reflex changes in mean skin temperature (Tmsk) and galvanic skin conductance] indicated transient reductions in sweating response after COLD drink ingestion. The COLD drink improved thermal comfort beyond the transient changes in sweating.
Conclusion
Only COLD drink ingestion changed thermoregulation, but improved perceptual response. Accordingly, we conclude a role for gut thermoreception in thermal perception during exercise in hot, dry conditions.
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Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears
Purpose Treatment of partial-thickness rotator cuff tears (PTRCTs) remains controversial. Few studies have focused on the conservative and new measurements of small to medium PTRCTs. The use of sodium hyaluronate (SH) or platelet-rich plasma (PRP) as a method for rotator cuff repair requires further investigation. The aim of this study was to evaluate the combined use of SH and PRP in the treatment of small to medium PTRCTs. Study design Double-blinded randomized trial. Methods Individuals with PTRCTs detected by clinical examination and magnetic resonance imaging (MRI) were included in this study. The patients were randomly assigned to receive subacromial injections of normal saline (NS), SH, PRP or SH+PRP once a week for four weeks. The primary outcome measure was the Constant score, and the secondary outcomes included the American shoulder and elbow surgeons (ASES) and visual analog scale (VAS) scores. All of the clinical outcomes were assessed at pretreatment and 1, 3, 6, and 12 months posttreatment. MRI was used to evaluate the evolution of the cuff defect after 1 year. Results PRP group and SH+PRP group showed a significantly higher Constant score and ASES score after the treatments. There were significant differences between the SH+PRP group and SH or PRP group at 12 months in the Constant, VAS and ASES scores. MRI results showed that the tear size significantly decreased in both the PRP and SH+PRP groups, especially in the SH+PRP group. Conclusion Our study provided evidence of the efficacy of PRP injection in the healing of small to medium PTRCTs. Moreover, the combined injection of SH and PRP yielded a better clinical outcome than SH or PRP alone. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. *Contributed equally to this work Corresponding author: Pengfei Zhu, HanZheng Street 473, QiaoKou District, 430030, Wuhan, China, E-mail addresses: happyzhupengfei@163.com, Tel: 0086-13720162185. Competing interests None. Fundings Fundings were received from National Natural Science Foundation of Wuhan (Grant No. WX18Q21 to YC) and by the National Natural Science Foundation of Hubei (Grant No. 2018CFB568 to ZXS) and by the National Natural Science Foundation of China (Grant Nos. 81701716 to ZXS). The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and the results of the study do not constitute endorsement by the American College of Sports Medicine. © 2018 American College of Sports Medicine
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Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: 2-Year Results of MiDAS ENCORE
Background and Objectives This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients. Methods This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Follow-up occurred at 6 months and at 1 year for the randomized phase and at 2 years for MILD subjects only. Oswestry Disability Index, Numeric Pain Rating Scale, and Zurich Claudication Questionnaire were used to evaluate function and pain. Safety was evaluated by assessing incidence of device-/procedure-related adverse events. Results All outcome measures demonstrated clinically meaningful and statistically significant improvement from baseline through 6-month, 1-year, and 2-year follow-ups. At 2 years, Oswestry Disability Index improved by 22.7 points, Numeric Pain Rating Scale improved by 3.6 points, and Zurich Claudication Questionnaire symptom severity and physical function domains improved by 1.0 and 0.8 points, respectively. There were no serious device-/procedure-related adverse events, and 1.3% experienced a device-/procedure-related adverse event. Conclusions MILD showed excellent long-term durability, and there was no evidence of spinal instability through 2-year follow-up. Reoperation and spinal fracture rates are lower, and safety is higher for MILD versus other lumbar spine interventions, including interspinous spacers, surgical decompression, and spinal fusion. Given the minimally invasive nature of this procedure, its robust success rate, and durability of outcomes, MILD is an excellent choice for first-line therapy for select patients with central spinal stenosis suffering from neurogenic claudication symptoms with hypertrophic ligamentum flavum. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02093520. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication June 8, 2018. Address correspondence to: Peter S. Staats, MD, MBA, National Spine and Pain Centers, 170 Avenue at the Common, Ste 6, Shrewsbury, NJ 07702 (e-mail: peterstaats@hotmail.com). P.S.S. and R.M.B. are study principal investigators for MiDAS ENCORE. In this role, they have been responsible for study oversight. Responsibilities include protocol review, assistance with site selection, site investigator support, oversight of patient enrollment and protocol compliance, and adjudication of adverse events. This trial was sponsored by Vertos Medical. The sponsorship includes study-related supplies and expenses, as well as funding for statistical analysis services by an independent provider. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
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Best perioperative practice in management of ambulatory patients with obstructive sleep apnea
Purpose of review The perioperative outcome in obstructive sleep apnea (OSA) patients undergoing ambulatory surgery can be potentially impacted by the type of anesthetic technique, fluid management and choice of anesthetic agents. This review highlights the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures. Recent findings A recent meta-analysis found that STOP-Bang might be used as a perioperative risk stratification tool. Patients with high-risk OSA (STOP-Bang ≥3) were found to be associated with an increased risk of postoperative complications and prolonged length of hospital stay compared with low-risk OSA (STOP-Bang 0-2) patients undergoing noncardiac surgical procedures. A bidirectional relationship exists between OSA and difficult airway. Both suspected or diagnosed OSA may be associated with either difficult intubation or difficult mask ventilation or both. A recent meta-analysis identified OSA as an important risk factor for opioid-induced respiratory depression. A dose–response relationship was shown between the morphine equivalent daily dose and death or near-death events in OSA patients undergoing surgery. Postoperative continuous monitoring is recommended for high-risk OSA patients receiving opioids. Minimising the dose of muscle relaxant, neuromuscular monitoring and ensuring complete reversal of neuromuscular blockade before extubation is essential in OSA patients to avoid postoperative complications. Whenever feasible, regional anesthesia with multimodal analgesia may be considered as a better alternative to general anesthesia in OSA patients. Summary Patients with OSA and associated comorbidities present a challenge to anesthesiologists as they are at a high risk of perioperative complications. It is important to identify patients with OSA, with the goal to raise awareness among providers, mitigate risk and improve outcomes. Correspondence to Frances Chung, Professor, Department of Anesthesia, Toronto Western Hospital, University Health Network, 399 Bathurst Street, MCL 2-405, Toronto, ON M5T 2S8, Canada. E-mail: Frances.chung@uhn.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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State of Nevada selects ImageTrend for connected health records
LAKEVILLE, Minn. — ImageTrend, Inc. announced the Nevada Department of Health and Human Services has selected ImageTrend for multiple solutions for the state's health information technology. The interconnected software will provide documentation and reporting for EMS, licensure of EMS care providers and healthcare data interoperability among hospitals, healthcare registries, EMS and...
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