1079-102 Correlation between norepinephrine and epinephrine myocardial spillover and tumor necrosis factor-alpha in conventional versus off-pump coronary artery bypass surgery

Background: Complete revascularization obtained by coronary artery bypass surgery does not prevent long term left ventricular remodeling and heart failure development. Periprocedural events linked to different surgical techniques, such as cardiopulmonary bypass with cardioplegic arrest (CABG) versus off-pump procedures may trigger an irreversible microvascular dysfunction or myocytes necrosis and apoptosis. Methods: To test this hypothesis we measured norepinephrine and epinephrine coronary sinus and aortic spillover before and after surgery, simultaneously with Tumor Necrosis Factor-alpha (TNF-alpha) measurements in 30 patients randomized to CABG (n=15), or off-pump (n=15) coronary surgery. Plasma catecholamines were assessed by high performance liquid chromatography and TNF-alpha by ELISA. Results: Norepinephrine and epinephrine spillover was similar in the two groups before surgery, being 1.38\ub10.62 and 1.08\ub10.45, respectively. After surgery norepinephrine spillover was 1.43\ub10.56, 0.72\ub10.49 in CABG and off-pump, respectively (P<0.05 CABG versus off-pump, means \ub1SD ). Epinephrine spillover was 1.27\ub10.16 and 0.65\ub10.15 respectively (P<0.05, CABG versus off-pump). TNF-alpha significantly increased only in CABG patients being 22.17\ub16.79 and 35.4\ub15.98, pg/mL, before and after surgery (P<0.05), respectively. After surgery norepinephrine spillover correlated with TNF-alpha levels (P=0.01, R=0.553). Conclusions: Patients undergoing off-pump interventions showed significantly lower catecholamines spillover as compared to CABG, suggesting that the off-pump technique may result less invasive, not only for a lower local and whole body inflammatory response but also for a lower sympathetic drive. For the first time in humans we have detected an increase in epinephrine-spillover after cardiac surgery. Further studies are necessary to evaluate if the short-term advantages observed after off-pump coronary surgery translate into a long-term attenuation of left ventricular remodeling and in the prevention of heart failure progression

No harm from angiotensin-converting enzyme inhibitors or angiotensin receptor inhibitors in patients with COVID-19. Results of a prospective study on a hospital-based cohort

This study aims to assess the effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor inhibitors (ARBs) on the course of COVID-19. It is a prospective study on 221 (M/F ratio= 143/78, mean age 72±13) consecutive hypertensive patients with COVID-19: 76 (34.4%) treated with ACEIs, 63 (28.5%) with ARBs and 82 (37.1%) with antihypertensives OTHER than ACEIs or ARBs. They were all followed up until discharge or death. BAD outcome was defined as the need for invasive mechanical ventilation or death. The three classes of medication were well balanced for confounding variables. BAD outcome was overall recorded in 63/221 (28%) patients, in 20/76 (26%) of ACEI, in 17/63 (27%) of ARB and in 26/82 (32%) of OTHER users, with no statistically significant difference in any comparison. These findings refute the hypothesis that treatment with ACEIs or ARBs may negatively affect the course of COVID-19

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

One-Step Photolithographic Surface Patterning of Nanometer-Thick Gold Surfaces by Using a Commercial DLP Projector and the Fabrication of a Microheater

ISSN:1520-5045ISSN:0888-588

[Donor and recipient selection in living donor kidney transplantation: eligibility]

This review is intended to be a guide for the physician to evaluate and prepare a donor / recipient couple for living kidney transplantation. Although it is intended to be exhaustive, it will not be able to respond at all possible and different cases, but it may apply at most of them. Renal transplantation is considered the choice treatment for patients with chronic renal failure and if the kidney transplant is performed pre-emptive it is associated with better organ and patient survival. The main aim of the program is to evaluate the risks of donor and recipient and to ensure the donor safety and well-being. Eligibility for living transplant can only be granted when the risks are acceptable, well defined and the couple is adequately informed. The review includes clinical and legal procedures needed to transplantation. Early conditions that contraindicate the transplant must be removed, to avoid unnecessary exams, excessive waste of time, money. The sequence of the exams has been ordered so that costly and invasive surveys are carried out only after other simple and essential investigations have confirmed the transplant suitability. Special attention should be paid to the renal function measurement, proteinuria, hematuria, hypertension, obesity, pre diabetes, renal calculus, and cancers. To give eligibility for living transplant is often not easy, but a careful study can avoid many complications and improve the transplant outcome

Rapid Identification of SARS-CoV-2 Variants of Concern Using a Portable peakPCR Platform

The need for tools that facilitate rapid detection and continuous monitoring of SARS-CoV-2 variants of concern (VOCs) is greater than ever, as these variants are more transmissible and therefore increase the pressure of COVID-19 on healthcare systems. To address this demand, we aimed at developing and evaluating a robust and fast diagnostic approach for the identification of SARS-CoV-2 VOC-associated spike gene mutations. Our diagnostic assays detect the E484K and N501Y single-nucleotide polymorphisms (SNPs) as well as a spike gene deletion (HV69/70) and can be run on standard laboratory equipment or on the portable rapid diagnostic technology platform peakPCR. The assays achieved excellent diagnostic performance when tested with RNA extracted from culture-derived SARS-CoV-2 VOC lineages and clinical samples collected in Equatorial Guinea, Central-West Africa. Simplicity of usage and the relatively low cost are advantages that make our approach well suitable for decentralized and rapid testing, especially in resource-limited settings.ISSN:1520-6882ISSN:0003-270

Development and evaluation of PlasmoPod: A cartridge-based nucleic acid amplification test for rapid malaria diagnosis and surveillance.

Malaria surveillance is hampered by the widespread use of diagnostic tests with low sensitivity. Adequate molecular malaria diagnostics are often only available in centralized laboratories. PlasmoPod is a novel cartridge-based nucleic acid amplification test for rapid, sensitive, and quantitative detection of malaria parasites. PlasmoPod is based on reverse-transcription quantitative polymerase chain reaction (RT-qPCR) of the highly abundant Plasmodium spp. 18S ribosomal RNA/DNA biomarker and is run on a portable qPCR instrument which allows diagnosis in less than 30 minutes. Our analytical performance evaluation indicates that a limit-of-detection as low as 0.02 parasites/μL can be achieved and no cross-reactivity with other pathogens common in malaria endemic regions was observed. In a cohort of 102 asymptomatic individuals from Bioko Island with low malaria parasite densities, PlasmoPod accurately detected 83 cases, resulting in an overall detection rate of 81.4%. Notably, there was a strong correlation between the Cq values obtained from the reference RT-qPCR assay and those obtained from PlasmoPod. In an independent cohort, using dried blood spots from malaria symptomatic children living in the Central African Republic, we demonstrated that PlasmoPod outperforms malaria rapid diagnostic tests based on the PfHRP2 and panLDH antigens as well as thick blood smear microscopy. Our data suggest that this 30-minute sample-to-result RT-qPCR procedure is likely to achieve a diagnostic performance comparable to a standard laboratory-based RT-qPCR setup. We believe that the PlasmoPod rapid NAAT could enable widespread accessibility of high-quality and cost-effective molecular malaria surveillance data through decentralization of testing and surveillance activities, especially in elimination settings