Bernardo Dolce, Torsten Christ, Nefeli Grammatika Pavlidou, Yalin Yildirim, Hermann Reichenspurner, Thomas Eschenhagen, Viacheslav O Nikolaev, Alberto J Kaumann, Cristina E Molina
Atrial fibrillation (AF)-associated remodeling includes contractile dysfunction whose reasons are only partially resolved. Serotonin (5-HT) increases contractile force and causes arrhythmias in atrial trabeculae from patients in sinus rhythm (SR). In persistent atrial fibrillation (peAF), the force responses to 5-HT are blunted and arrhythmic effects are abolished. Since force but not arrhythmic responses to 5-HT in peAF could be restored by PDE3 + PDE4 inhibition, we sought to perform real-time measurements of cAMP to understand whether peAF alters PDE3 + PDE4-mediated compartmentation of 5-HT4 receptor-cAMP responses...
September 19, 2020: Naunyn-Schmiedeberg's Archives of Pharmacology
Suchitra Ranjit, Rajeswari Natraj, Niranjan Kissoon, Ravi Thiagarajan, Balakrishnan Ramakrishnan, M Ignacio Monge García
BACKGROUND: Fluid boluses aiming to improve the cardiac output and oxygen delivery are commonly administered in children with shock. An increased mean arterial pressure in addition to resolution of tachycardia and improved peripheral perfusion are often monitored as clinical surrogates for improvement in cardiac output. The objective of our study is to describe changes in cardiac index, mean arterial pressure, and their relationship to other indices of cardiovascular performance. OBJECTIVE: The objective of our study is to describe changes in cardiac index, mean arterial pressure, and their relationship to other indices of cardiovascular performance...
September 18, 2020: Critical Care Medicine
Tamara van Donge, Karel Allegaert, Verena Gotta, Anne Smits, Elena Levtchenko, Djalila Mekahli, John van den Anker, Marc Pfister
BACKGROUND: Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging. METHODS: We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling...
September 17, 2020: Pediatric Nephrology
Carlos Durão, Frederico Pedrosa, Ricardo Jorge Dinis-Oliveira
Greenish-blue discoloration of the brain and heart was observed during the autopsy of a 63-year-old woman who had been treated with methylene blue for septic shock following a traffic accident. This "pistachio" or "avatar" discoloration occurs when the colorless metabolite leucomethylene blue is oxidized to methylene blue upon exposure to atmospheric oxygen. Other clinically documented adverse effects of methylene blue include greenish-blue urine and bluish discoloration of the skin and mucosa...
September 17, 2020: Forensic Science, Medicine, and Pathology
Yasumori Sujino, Kensuke Kuroda, Koichi Yoshitake, Nobuichiro Yagi, Eiji Anegawa, Hiroki Mochizuki, Keiichiro Iwasaki, Seiko Nakajima, Takuya Watanabe, Masanobu Yanase, Satsuki Fukushima, Tomoyuki Fujita, Junjiro Kobayashi, Norihide Fukushima
Aortic insufficiency (AI) is an important adverse event in patients with continuous-flow (CF) left ventricular assist device (LVAD) support. AI is often progressive, resulting in elevated 2-year morbidity and mortality. The effectiveness of echocardiographic ramp studies in patients with AI has been unclear. Here, we describe a patient with a CF-LVAD implant who underwent aortic valve replacement (AVR), following assessment of AI using a hemodynamic ramp test with simultaneous echocardiography and right heart catheterization (RHC)...
September 17, 2020: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Ruchit Patel, Shyam Kumar Singh Thingnam, Anand Kumar Mishra, Manoj Kumar Rohit, Vinay Upadhyay, Vikram Halder, Vidur Bansal
OBJECTIVES: Pulmonary hypertension is a common association in children with nonrestrictive ventricular septal defect. It increases perioperative mortality and morbidity. Oral sildenafil is an effective pulmonary vasodilator. In this study, we assessed effects of perioperative oral sildenafil therapy on pulmonary artery pressure and early surgical outcomes. METHODS: This was a single centre, prospective randomized control study. Thirty children with nonrestrictive ventricular septal defects with pulmonary hypertension were divided into two groups...
September 16, 2020: Journal of Cardiac Surgery
Francesca Gioia, Alicia Gomez-Lopez, Maria Elena Alvarez, Elia Gomez-García de la Pedrosa, Pilar Martín-Davila, Manuel Cuenca-Estrella, Santiago Moreno, Jesús Fortun
INTRODUCTION: A possible increase of Candida resistance, specially in C. glabrata, has been speculated according to a poor diffusion of echinocandins to peritoneal fluid. MATERIALS/METHODS: Peritoneal and serum concentrations of Caspofungin, micafungin and anidulafungin were analyzed in surgical patients with suspected candida peritonitis. After four days of starting therapy serum and peritoneal samples (through peritoneal drainage) were obtained at baseline, 1 h, 6 h, 12 h, and 24 h of drug administration...
September 13, 2020: International Journal of Infectious Diseases: IJID
Atif Irfan Khan, Gopal Kumar Patidar, R Lakshmy, Neeti Makhija, Sachin Talwar, Anjali Hazarika
OBJECTIVES: In this study, we aimed to determine the consequences of different amounts of leukocyte transfusion on the outcome of patients undergoing cardiac surgery. DESIGN: This was a prospective, single-blinded cohort study conducted for 1 year from July 2018 to June 2019. SETTING: The study setting was the Department of Transfusion Medicine, along with Cardiac Anaesthesia, Cardiac Surgery and Cardiac biochemistry departments in a tertiary care cardiac centre...
September 15, 2020: Transfusion Medicine
Sarfaraz Rahiman, Remi Kowalski, Sit Yee Kwok, Sunit Matha, Bryn Jones, Joseph J Smolich, Jonathan P Mynard, Warwick Butt, Johnny Millar
OBJECTIVES: Milrinone is an inodilator widely used in the postoperative management of children undergoing cardiac surgery. The literature supporting its inotropic effect is sparse. We sought to study the effect of milrinone on the vasculature and its effects on the ventricular function using wave intensity analysis. We also intended to evaluate the feasibility of using wave intensity analysis by the bedside. DESIGN: prospective single-center observational study...
September 15, 2020: Critical Care Medicine
Li Gao, Yuwei Wang, Wenhui Zhang, Xiaojia Zhu, Qianwen Gao, Yujie Xiao, Kesu Chen, Fuming Liu, Long Chen
This study was to investigate the inotropic effect of atractylodin and its underlying mechanism. The cardiac Pressure-Volume loop (P-V loop), Langendroffperfused isolated rat heart, patch-clamp, Ca2+ transient and western blot techniques were used. The results demonstrated that atractylodin (3 mg/kg, ip) remarkably increased the left ventricularstroke work, cardiac output, stroke volume, heart rate, ejection fraction, end-systolic pressure, peakrates ofrise and fall of left ventricular pressures (+dP/dtmax , -dP/dtmax ),the slopes of end-systolic pressure-volume relationship (also named as end-systolic elastance, Ees) and reducing end-systolic volume and end-diastolic volume in the in vivo rat study...
September 15, 2020: Clinical and Experimental Pharmacology & Physiology
Emily A Vail, Meng-Shiou Shieh, Penelope S Pekow, Hayley B Gershengorn, Allan J Walkey, Peter K Lindenauer, Hannah Wunsch
RATIONALE: Patients undergoing cardiac surgery often require vasopressor or inotropic ('vasoactive') medications, but patterns of postoperative use are not well described. OBJECTIVES: This study aimed to describe vasoactive medication administration throughout hospitalization for cardiac surgery, to identify patient and hospital-level factors associated with postoperative use, and to quantify variation in treatment patterns among hospitals. METHODS: Retrospective study using the Premier Healthcare Database...
September 14, 2020: Annals of the American Thoracic Society
Amit Saha, Paul Kurlansky, Yuming Ning, Joseph Sanchez, Justin Fried, Lucas J Witer, Yuji Kaku, Hiroo Takayama, Yoshifumi Naka, Koji Takeda
Post-cardiotomy shock (PCS) is associated with substantial morbidity and mortality. We reviewed our 12-year experience of venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy for PCS. Between July 2007 and June 2018, 156 consecutive patients underwent VA-ECMO for PCS. We retrospectively investigated patient characteristics, indications, and management to determine factors affecting outcomes. Secondary analysis was performed by dividing the cohort into Era 1 (2007-2012, n = 52) and Era 2 (2013-2018, n = 104) for comparison...
September 14, 2020: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Ashlesha Kaushik, Sandeep Gupta, Mangla Sood, Seema Sharma, Shikha Verma
BACKGROUND: Recently, severe manifestations associated with coronavirus disease 2019 (COVID-19) called multisystem inflammatory syndrome in children (MIS-C) have been recognized. Analysis of studies for this novel syndrome is needed for a better understanding of effective management among affected children. METHODS: An extensive search strategy was conducted by combining the terms multisystem inflammatory syndrome in children and coronavirus infection or using the term multisystem inflammatory syndrome in children in bibliographic electronic databases (PubMed, EMBASE, and CINAHL) and in preprint servers (BioRxiv...
September 8, 2020: Pediatric Infectious Disease Journal
Sara Zaher, Raghad Al-Subaihi, Aeshah Al-Alshaya, Manar Al-Saggaf, Mariam O Al Amoudi, Hala Babtain, Arwa Neyaz
BACKGROUND: Enteral-nutrition (EN) is an essential therapeutic intervention. Many studies internationally have reviewed the feeding practices in intensive-care units (ICU) and recorded the incidence of underfeeding in these settings, yet none were performed in the Middle-East including Saudi-Arabia. The purpose of the study is to assess the adequacy of EN delivery and to investigate the enteral-feeding practices in ICU at a specialised tertiary-care hospital in Saudi-Arabia. METHODOLOGY: In this observational study we prospectively monitored energy and protein delivery for 6 consecutive days in critically-ill patients...
September 14, 2020: JPEN. Journal of Parenteral and Enteral Nutrition
Hongbai Wang, Qipeng Luo, Yinan Li, Liang Zhang, Xie Wu, Fuxia Yan
Background: Levosimendan, a calcium sensitizer, enhances the myocardial function by generating more energy-efficient myocardial contractility than that achieved through adrenergic stimulation with catecholamines. We conducted this meta-analysis to primarily investigate the effects of levosimendan on all-cause mortality in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass. Methods: The databases of Pubmed, Embase, and Cochrane Library were searched till 21st March 2020. The eligible criteria were participants with age<18 year and undergoing cardiac surgery for congenital heart disease (CHD), and studies of comparison between levosimendan and placebo or other inotropes...
2020: Frontiers in Pediatrics
Alessandro Parodi, Laura Costanza De Angelis, Martina Re, Sarah Raffa, Mariya Malova, Andrea Rossi, Mariasavina Severino, Domenico Tortora, Giovanni Morana, Maria Grazia Calevo, Maria Pia Brisigotti, Francesca Buffelli, Ezio Fulcheri, Luca Antonio Ramenghi
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement...
2020: Frontiers in Neurology
Huw Garland, Alain Vuylsteke
Biased agonism, which is the concept that different ligands activate different downstream signalling partners in different ratios to cause different functional effects, is yet to gain appropriate appreciation in the field of inotropic pharmacology. Biased agonism has already proven to be a clinically translatable technology in analgesic pharmacology, but this development is yet to be translated into inotropes. A better appreciation of bias in clinically used inotropes and a focus on bias when developing novel inotropes has the potential to lead to more targeted, personalized, and cleaner inotropes...
August 7, 2020: Journal of Cardiothoracic and Vascular Anesthesia
M T Yap, P Yubbu, S W Yong, W V Hing, Y S Ong, N K Devaraj, A G Ani Suraya, G T Koh, H Leman
BACKGROUND: The long waiting time for Tetralogy of Fallot (TOF) operation may potentially increase the risk of hypoxic insult. Therefore, the objective of this study is to determine the frequency of acute neurological complications following primary TOF repair and to identify the peri-operative risk factors and predictors for the neurological sequelae. METHODS: A retrospective review of the medical and surgical notes of 68 patients who underwent TOF repair in Hospital Serdang, from January 2013 to December 2017 was done...
September 2020: Medical Journal of Malaysia
Kevin C Pan, Sai Shankar, Johnny Millar, Roberto Chiletti, Warwick Butt, Yves d'Udekem, Siva P Namachivayam
OBJECTIVES: Levosimendan use is associated with more successful decannulation from veno-arterial extracorporeal membrane oxygenation (VA ECMO) in adults. We sought to determine the role of levosimendan in children who required VA ECMO after cardiac surgery. METHODS: This observational study compares the outcomes of children who required VA ECMO after cardiac surgery and received levosimendan for weaning with those who did not receive the drug. A doubly robust estimation methodology (inverse probability of treatment weighting with regression adjustment) was used to balance study covariates (age, weight, sex, lactate pre-ECMO, vasoactive-inotropic score pre-ECMO, ECMO indication, ECMO modality, Risk Adjustment for Congenital Heart Surgery-1 category), and the final model was further adjusted for duration of ECMO...
September 10, 2020: European Journal of Cardio-thoracic Surgery
Yojiro Koda, Hiroto Kitahara, Hidefumi Nishida, Valluvan Jeevanandam, Takeyoshi Ota
BACKGROUND: Recently, del Nido cardioplegia solution (DN) has been utilized in adult cardiac surgery. However, adequate interval of maintenance dose(s) is still unclear. The purpose of this study was to assess the safety and efficacy of our DN protocol by comparing with conventional cold whole blood cardioplegia (CWB). METHODS: A total of 1003 consecutive patients (DN group, N = 350 vs. CWB group, N = 653) underwent cardiovascular surgery between July 2013 and September 2018 were included in this study...
September 10, 2020: Perfusion
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