Baseline risk factors of in-hospital mortality after surgery for acute type A aortic dissection: an ERTAAD study

Background Surgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy.Methods Subjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD).Results Out of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729-0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction <= 50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667-0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613-0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614-0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018-1.031; Harrell's C 0.630; Somer's D 0.261).Conclusions The present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD.Clinical Trial Registration https://clinicaltrials.gov, identifier NCT04831073

Carl von Linné fil. to Peter Simon Pallas

Square planar cobalt­(II) complexes of salen ligands <i>N</i>,<i>N</i>′-bis­(3-<i>tert</i>-butyl-5<i>R</i>-salicylidene)-1,2-cyclohexanediamine), where R = OMe (<b>1</b>) and <i>tert</i>-butyl (<b>2</b>), were prepared. <b>1</b> and <b>2</b> were electrochemically reversibly oxidized into cations <b>[1-H</b>_<b>2</b><b>O]</b>^<b>+</b> and <b>[2-H</b>_<b>2</b><b>O]</b>^<b>+</b> in CH₂Cl₂. The chemically generated <b>[1-H</b>_<b>2</b><b>O]­(SbF</b>_<b>6</b><b>)·0.68 H</b>_<b>2</b><b>O·0.82CH</b>_<b>2</b><b>Cl</b>_<b>2</b> and <b>[2-H</b>_<b>2</b><b>O]­(SbF</b>_<b>6</b><b>)·0.3H</b>_<b>2</b><b>O·0.85CH</b>_<b>2</b><b>Cl</b>_<b>2</b> were characterized by X-ray diffraction and NIR spectroscopy. Both complexes are paramagnetic species containing a square pyramidal cobalt ion coordinated at the apical position by an exogenous water molecule. They exhibit remarkable NIR bands at 1220 (7370 M^–1 cm^–1) and 1060 nm (5560 M^–1 cm^–1), respectively, assigned to a CT transition. DFT calculations and magnetic measurements confirm the paramagnetic (<i>S</i> = 1) ground spin state of the cations. They show that more than 70% of the total spin density in <b>[1-H</b>_<b>2</b><b>O]</b>^<b>+</b> and <b>[2-H</b>_<b>2</b><b>O]</b>^<b>+</b> is localized on the metal, the remaining spin density being distributed over the aromatic rings (30% phenoxyl character). In the presence of <i>N</i>-methylimidazole <b>1</b> and <b>2</b> are irreversibly oxidized by air into the genuine octahedral cobalt­(III) bis­(phenolate) complexes <b>[1-im</b>_<b>2</b><b>]</b>^<b>+</b> and <b>[2-im</b>_<b>2</b><b>]</b>^<b>+</b>, the former being structurally characterized. Neither <b>[1-im</b>_<b>2</b><b>]</b>^<b>+</b> nor <b>[2-im</b>_<b>2</b><b>]</b>^<b>+</b> exhibits a NIR feature in its electronic spectrum. <b>1</b> and <b>2</b> were electrochemically two-electron oxidized into <b>[1]</b>^<b>2+</b> and <b>[2]</b>^<b>2+</b>. The cations were identified as Co­(III)–phenoxyl species by their characteristic absorption band at ca. 400 nm in the UV–vis spectrum. Coordination of the phenoxyl radical to the cobalt­(III) metal ion is evidenced by the EPR signal centered at <i>g</i> = 2.00

The impact of cutting branches on lepidopteran larval community composition and herbivory.

A group III metabotropic glutamate (mGlu) receptor agonist (PCEP) was identified by virtual HTS. This orthosteric ligand is composed by an l-AP4-derived fragment that mimics glutamate and a chain that binds into a neighboring pocket, offering possibilities to improve affinity and selectivity. Herein we describe a series of derivatives where the distal chain is replaced by an aromatic or heteroaromatic group. Potent agonists were identified, including some with a mGlu₄ subtype preference, e.g., <b>17m</b> (LSP1-2111) and <b>16g</b> (LSP4-2022). Molecular modeling suggests that aromatic functional groups may bind at either one of the two chloride regulatory sites. These agonists may thus be considered as particular bitopic/dualsteric ligands. <b>17m</b> was shown to reduce GABAergic synaptic transmission at striatopallidal synapses. We now demonstrate its inhibitory effect at glutamatergic parallel fiber–Purkinje cell synapses in the cerebellar cortex. Although these ligands have physicochemical properties that are markedly different from typical CNS drugs, they hold significant therapeutic potential

Increased Potency and Selectivity for Group III Metabotropic Glutamate Receptor Agonists Binding at Dual sites

A group III metabotropic glutamate (mGlu) receptor agonist (PCEP) was identified by virtual HTS. This orthosteric ligand is composed by an l-AP4-derived fragment that mimics glutamate and a chain that binds into a neighboring pocket, offering possibilities to improve affinity and selectivity. Herein we describe a series of derivatives where the distal chain is replaced by an aromatic or heteroaromatic group. Potent agonists were identified, including some with a mGlu₄ subtype preference, e.g., <b>17m</b> (LSP1-2111) and <b>16g</b> (LSP4-2022). Molecular modeling suggests that aromatic functional groups may bind at either one of the two chloride regulatory sites. These agonists may thus be considered as particular bitopic/dualsteric ligands. <b>17m</b> was shown to reduce GABAergic synaptic transmission at striatopallidal synapses. We now demonstrate its inhibitory effect at glutamatergic parallel fiber–Purkinje cell synapses in the cerebellar cortex. Although these ligands have physicochemical properties that are markedly different from typical CNS drugs, they hold significant therapeutic potential

Early stage litter decomposition across biomes

[Departement_IRSTEA]Territoires [TR1_IRSTEA]SEDYVINInternational audienceThrough litter decomposition enormous amounts of carbon is emitted to the atmosphere. Numerous large-scale decomposition experiments have been conducted focusing on this fundamental soil process in order to understand the controls on the terrestrial carbon transfer to the atmosphere. However, previous studies were mostly based on site-specific litter and methodologies, adding major uncertainty to syntheses, comparisons and meta-analyses across different experiments and sites. In the TeaComposition initiative, the potential litter decomposition is investigated by using standardized substrates (Rooibos and Green tea) for comparison of litter mass loss at 336 sites (ranging fro