Initial Use of Endothelial Progenitor Cells Capturing Stents in Paediatric Congenital Heart Disease

INTRODUCTION: Stenosis, mediated by neointimal hyperplasia and thrombosis, is a major limiting factor in successful stent implantation. The introduction of a stent, coated in its endoluminal surface by antihuman CD34 antibodies with endothelial progenitor cell-capturing properties, opens the possibility of promoting a rapid and normal functioning coverage by endothelium and thus avoids both an excessive cell proliferation within stent and the need for long-term dual antiplatelet therapy. These stents, developed for adult coronary artery disease, have not yet been implanted in children or in those with congenital heart disease. OBJECTIVE AND METHODS: In this paper, we describe the implantation of Genous® stents in three children with cyanotic congenital heart disease and obstructed systemic-to-pulmonary shunts. We describe the use of this stent and address its potential feasibility in paediatric congenital heart disease. RESULTS: To maintain the patency of two modified Blalock-Taussig shunts and one ductus arteriosus, four Genous® stents were implanted in three infants with cyanotic heart disease. All procedures were immediately successful, with resolution of stenosis and improvement in transcutaneous oxygen saturation from 66% ± 3.6% to 92% ± 2.6%. In the follow-up, one stent had no occlusion; however, the remaining two had partial occlusion after 5 and 5.5 months, which were successfully managed with balloon dilatation preceding elective definitive surgical correction. CONCLUSION: In our preliminary experience, we demonstrated that Genous® stent implantation was feasible in infants with complex congenital heart disease. Additional studies with larger samples and longer follow-up are required to confirm the potential benefits of this technology in this clinical setting.info:eu-repo/semantics/publishedVersio

Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence

Self-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10-30% of AF-free patients. Presence of AHRE slightly increases stroke risk (0.8% to 1%/year) compared with patients without AHRE. Atrial high-rate episode of longer duration (e.g. those >24 h) could be associated with a higher stroke risk. Oral anticoagulation has the potential to reduce stroke risk in patients with AHRE but is associated with a rate of major bleeding of 2%/year. Oral anticoagulation is not effective in patients with heart failure or survivors of a stroke without AF. It remains unclear whether anticoagulation is effective and safe in patients with AHRE. Atrial high-rate episodes are common and confer a slight increase in stroke risk. There is true equipoise on the best way to reduce stroke risk in patients with AHRE. Two ongoing trials (NOAH-AFNET 6 and ARTESiA) will provide much-needed information on the effectiveness and safety of oral anticoagulation using non-vitamin K antagonist oral anticoagulants in patients with AHRE.info:eu-repo/semantics/publishedVersio

Implantation of a Dual-Chamber Pacemaker in a Patient With Situs Inversus and Dextrocardia Using a Novel Ultrasound Technique

Acesso ao texto integral: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829762/We report a case of a 43-year-old man with situs inversus and dextrocardia who was admitted with syncope in the setting of complete atrioventricular block. The complex anatomy poses a considerable challenge to transvenous permanent pacemaker implantation. We employed a novel technique using vascular ultrasound and agitated saline solution to assist with lead positioning. This technique could be useful in pediatric populations or younger patients, in whom the use of ionizing radiation is an important issue.info:eu-repo/semantics/publishedVersio

Ablação de Fibrilhação Auricular: Isolamento das veias pulmonares Experiência inicial no HFF

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Functionalization of reduced graphene oxide with polysulfone brushes enhance antibacterial properties and reduce human cytotoxicity

The present study reports two routes to modify reduced graphene oxide (rGO) nanosheets with polysulfone (PSU) brushes via nitrene chemistry. The PSU polymer is bonded to rGO at the extremity (rGO-PSU end) and at the middle of the PSU chain (rGO-PSU mid). The resulting rGO-PSU synthetic products are carefully characterized by Raman and FTIR spectroscopy, XPS, TEM, and thermogravimetric analysis, evidencing the successful grafting of PSU onto rGO surfaces. The long-term stability of these nanosheets is also determined in common solvents. The antibacterial properties of polymer-functionalized rGO against the planktonic Bacilus subtilis and Escherichia coli are also investigated. It is established that the antimicrobial properties of these nanocomposites are due to the production of reactive oxygen species. The results also demonstrate that rGO-PSU mid presents better antimicrobial properties due to shorter polymer chains, which improves the contact of the microorganisms with the graphene surface.This work was financially supported by the Spanish Ministry of Economy and Competitiveness (MAT2014-57557-R), and partially supported by the U.S. National Science Foundation Career Award (NSF Award #104093). R.O. would like acknowledge support from U.S. National Science Foundation (CMMI-1538730 and DUE-CMMI-1538730/1003574). Janire Peña wants to acknowledge mobility grant from Carlos III University and Instituto Tecnológico de Química y Materiales “Alonso Barba”. Authors acknowledge Dr. A. Esteban-Arranz for giving access to ATR equipment

Terapêutica de Ressincronização Cardíaca e Efeito Pró-Arrítmico: um Problema que Deve Ser Lembrado

The demonstrated benefits of cardiac resynchronization therapy (CRT) in reducing mortality and hospitalizations for heart failure, improving NYHA functional class and inducing reverse remodeling have led to its increasing use in clinical practice. However, its potential contribution to complex ventricular arrhythmias is controversial.We present the case of a female patient with valvular heart failure and severe systolic dysfunction, in NYHA class III and under optimal medical therapy, without previous documented ventricular arrhythmias. After implantation of a CRT defibrillator, she suffered an arrhythmic storm with multiple episodes of monomorphic ventricular tachycardia (VT), requiring 12 shocks. Subsequently, a pattern of ventricular bigeminy was observed, as well as reproducible VT runs induced by biventricular pacing. Since no other vein of the coronary sinus system was accessible, it was decided to implant an epicardial lead to stimulate the left ventricle, positioned in the left ventricular mid-lateral wall. No arrhythmias were detected in the following six months. This case highlights the possible proarrhythmic effect of biventricular pacing with a left ventricular lead positioned in the coronary sinus venous system

New RPC front-end electronics for hades

Time-of-flight (TOF) detectors are mainly used for both particle identification and triggering. Resistive Plate Chamber (RPC) detectors are becoming widely used because of their excellent TOF capabilities and reduced cost. The new ESTRELA* RPC wall, which is being installed in the HADES detector at Darmstadt GSI, will contain 1024 RPC modules, covering an active area of around 7 m2. It has excellent TOF and good charge resolutions. Its Front-End electronics is based on a 8-layer Mother-Board providing impedance matched paths for the output signals of each of the eight 4-channel Daughter-Boards to the TDC

Utility of Pacemaker With Sleep Apnea Monitor to Predict Left Ventricular Overload and Acute Decompensated Heart Failure

Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively) and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver operating characteristic curve analysis revealed an area under the curve of 0.804 (95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management

HADES experiment: di-lepton spectroscopy in p + p (2.2 GeV) and C+C (1 and 2 A GeV) collisions

The HADES (High Acceptance Di-Electron Spectrometer) is a tool designed for lepton pair (e+e−) spectroscopy in pion, proton and heavy ion induced reactions in the 1–2AGeV energy range. One of the goals of the HADES experiment is to study in-medium modifications of hadron properties like effective masses, decay widths, electromagnetic form factors etc. Such effects can be probed with vector mesons ( ρ,ω,ɸ ) decaying into e+e− channel. The identification of vector mesons by means of a HADES spectrometer is based on invariant mass reconstruction of e+e− pairs. The combined information from all spectrometer sub-detectors is used to reconstruct the di-lepton signal. The recent results from 2.2GeV p + p, 1AGeV and 2AGeV C+C experiments are presented.Diaz Medina, Jose, [email protected]

Occupational stress in health professionals: a study with Portuguese Nurses

Este trabalho analisa o estresse ocupacional em 286 enfermeiros de hospitais e centros de saúde portugueses. Avaliaram-se as fontes de estresse, o burnout, os problemas de saúde física, a satisfação e a realização profissional. Os resultados apontaram 30% de enfermeiros com experiências significativas de estresse e 15% com problemas de exaustão emocional. As análises de regressão múltipla apontaram maior capacidade preditiva das dimensões de estresse na exaustão emocional, na saúde física, na satisfação e na realização profissional. As análises comparativas evidenciaram maiores problemas de stresse e reacções mais negativas ao trabalho nas mulheres, nos enfermeiros mais novos e com menor experiência, nos trabalhadores com contratos a prazo, nos profissionais que realizam trabalho por turnos e nos que trabalham mais horas.This work analyses occupational stress in 286 nurses from hospitals and health care centres in Portugal. The following dimensions were evaluated: stress, burnout, physical health problems, satisfaction and professional fulfilment. Results revealed significant stress experiences in 30% of the professionals, and emotional exhaustion problems in 15%. Multiple regression analysis pointed out stress as an important predictor of emotional exhaustion, physical health, satisfaction and professional fulfilment. Comparative analysis suggested more occupational stress and professional negative experiences in the following groups: female nurses, younger and less experienced nurses, those with short-term working contracts, nurses working on a shift-basis system, and nurses working during long hours.(undefined