Surgical ventricular reconstruction with different myocardial protection strategies. A propensity matched analysis☆

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In vivo validation of the adequacy calculator for continuous renal replacement therapies

INTRODUCTION: The study was conducted to validate in vivo the Adequacy Calculator, a Microsoft Excel-based program, designed to assess the prescription and delivery of renal replacement therapy in the critical care setting. METHODS: The design was a prospective cohort study, set in two intensive care units of teaching hospitals. The participants were 30 consecutive critically ill patients with acute renal failure treated with 106 continuous renal replacement therapies (CRRT). Urea clearance computation was performed with the Adequacy Calculator (K(CALC)). Simultaneous blood and effluent urea samples were collected to measure the effectively delivered urea clearance (K(DEL)) at the beginning of each treatment and, during 73 treatments, between the 18th and 24th treatment hour. The correlation between 179 computed and 179 measured clearances was assessed. Fractional clearances for urea were calculated as spKt/V (where sp represents single pool, K is clearance, t is time, and V is urea volume of distribution) obtained from software prescription and compared with the delivered spKt/V obtained from empirical data. RESULTS: We found that the value of clearance predicted by the calculator was strongly correlated with the value obtained from computation on blood and dialysate determination (r = 0.97) during the first 24 treatment hours, regardless of the renal replacement modality used. The delivered spKt/V (1.25) was less than prescribed (1.4) from the Adequacy Calculator by 10.7%, owing to therapy downtime. CONCLUSION: The Adequacy Calculator is a simple tool for prescribing CRRT and for predicting the delivered dose. The calculator might be a helpful tool for standardizing therapy and for comparing disparate treatments, making it possible to perform large multi-centre studies on CRRT

Study protocol: The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI)

INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration

Clinical and hemodynamic outcomes after aortic valve replacement with stented and stentless pericardial xenografts: a propensity-matched analysis

Pericardial aortic xenografts have demonstrated excellent durability, and also freedom from tissue failure and from endocarditis. The aim of this single-center propensity-matched study was to compare the clinical and hemodynamic results of aortic valve replacement (AVR) with that for stented and stentless pericardial bioprostheses

Cardiac wasting in head and neck cancer and in cardiac autopsies from different cancer types. A study in a chemo-naïve setting Sara Calamelli, Samantha Noto, Alessandra Baldoni, Alessandra Casarin, Alessandro Calzavara, Irene Bolgan, Silvia Coccato, Salvatore Saccà, Licia Laurino, Giuseppe Azzarello, Simonetta Ausoni

Background: Cardiac wasting is a detrimental consequence of cancer that has been traditionally ignored and often misinterpreted as an iatrogenic effect. Methods: We conducted a retrospective study on 42 chemo-naive patients affected by locally advanced head and neck cancer (HNC). Based on unintentional weight loss, patients were divided into cachectic and non-cachectic. Left ventricular mass (LVM), LV-wall thickness (LV-WT), interventricular septal (IVS) thickness, left ventricular internal diameter diastolic (LVIDd), left ventricular internal diameter systolic (LVIDs), internal ventricular septum diastolic (IVSd), left ventricular posterior wall thickness diastolic (LVPWd) and LV-ejection fraction (LV-EF) were analyzed by ecocardiography. In parallel, we retrospectively analyzed 28 cardiac autoptic specimens of patients who either died of cancer before chemotherapy or with a diagnosis of cancer at autopsy. Presence or absence of myocardial fibrosis at microscopic observation was used for sample stratification. Conventional histology was performed. Results: Cachectic and non-cachectic patients had a significantly different value of LV-WT and IVS thickness and LVPWd. LV-WT was 9.08 ± 1.57 vs 10.35 ± 1.41 mm (p=0.011) in cachectic and non-cachectic patients, IVS was 10.00 mm (8.50-11.00) vs 11.00 mm (10.00-12.00) (p=0.035) and LVPWd was 9.0 mm (8.5-10.0) and 10.00 mm (9.5-11.0) (p=0.019) in cachectic and non-cachectic patients. LVM adjusted for body surface area or height squared did not differ between the two populations. Similarly, LV-EF did not show any significant decline. At multivariate logistic regression analysis for some independent predictors of weight loss, only LV-WT maintained significant difference between cachectic and non-cachectic patients (p=0.035, OR=0.240; p=0.019). The secondary analysis on autoptic specimens showed no significant change in heart weight, whereas LV-WT declined from 9.50mm (7.25 – 11.00) to 7.50 mm (6.00 –9.00) in cardiac specimens with myocardial fibrosis (p=0.043). This data was confirmed in multivariate logistic regression analysis (p=0.041, OR=0.502). Histopathological analysis confirmed severe atrophy of cardiomyocytes, fibrosis and edema as compared to controls. Conclusion: Subtle changes in heart structure and function occur early in HNC patients. These can be detected with routine echocardiography and may help to select appropriate cancer treatment regimens for these patients. Histopathological analysis provided conclusive evidence that atrophy of cardiomyocytes, edema and fibrosis occur during cancer progression and may precede the onset of overt cardiac pathology. To our knowledge, this is the first clinical study that establishes a direct relationship between tumor progression and cardiac remodeling in HNCs, and the first pathological study conducted on human cardiac autopsies from selected chemo-naïve cancer patients

Cardiac wasting in head and neck cancer and in cardiac autopsies from different cancer types: A study in a chemo‐naïve setting

Abstract Background Cardiac wasting is a detrimental consequence of cancer that has been traditionally ignored and often misinterpreted as an iatrogenic effect. Methods We conducted a retrospective study on 42 chemo‐naive patients affected by locally advanced head and neck cancer (HNC). Based on unintentional weight loss, patients were divided into cachectic and non‐cachectic. Left ventricular mass (LVM), LV wall thickness (LVWT), interventricular septal (IVS) thickness, left ventricular internal diameter diastolic (LVIDd), left ventricular internal diameter systolic (LVIDs), internal ventricular septum diastolic (IVSd), left ventricular posterior wall thickness diastolic (LVPWd) and LV ejection fraction (LVEF) were analysed by echocardiography. In parallel, we retrospectively analysed 28 cardiac autoptic specimens of patients who either died of cancer before chemotherapy or with a diagnosis of cancer at autopsy. Presence or absence of myocardial fibrosis at microscopic observation was used for sample stratification. Conventional histology was performed. Results Cachectic and non‐cachectic patients had a significantly different value of LVWT and IVS thickness and LVPWd. LVWT was 9.08 ± 1.57 versus 10.35 ± 1.41 mm (P = 0.011) in cachectic and non‐cachectic patients, IVS was 10.00 mm (8.50–11.00) versus 11.00 mm (10.00–12.00) (P = 0.035), and LVPWd was 9.0 (8.5–10.0) and 10.00 mm (9.5–11.0) (P = 0.019) in cachectic and non‐cachectic patients. LVM adjusted for body surface area or height squared did not differ between the two populations. Similarly, LVEF did not show any significant decline. At multivariate logistic regression analysis for some independent predictors of weight loss, only LVWT maintained significant difference between cachectic and non‐cachectic patients (P = 0.035, OR = 0.240; P = 0.019). The secondary analysis on autoptic specimens showed no significant change in heart weight, whereas LVWT declined from 9.50 (7.25–11.00) to 7.50 mm (6.00–9.00) in cardiac specimens with myocardial fibrosis (P = 0.043). These data were confirmed in multivariate logistic regression analysis (P = 0.041, OR = 0.502). Histopathological analysis confirmed severe atrophy of cardiomyocytes, fibrosis and oedema as compared with controls. Conclusions Subtle changes in heart structure and function occur early in HNC patients. These can be detected with routine echocardiography and may help to select appropriate cancer treatment regimens for these patients. Histopathological analysis provided conclusive evidence that atrophy of cardiomyocytes, oedema and fibrosis occur during cancer progression and may precede the onset of overt cardiac pathology. To our knowledge, this is the first clinical study that establishes a direct relationship between tumour progression and cardiac remodelling in HNCs and the first pathological study conducted on human cardiac autopsies from selected chemo‐naïve cancer patients