Cardiogenic Shock

Cardiogenic shock is the second most common cause of circulatory shock, occurs secondary to myocardial infarction, which accounts for 80% of the cases, and remains one of the leading causes of death in patients with acute myocardial infarction. Cardiogenic shock carries a high morbidity and mortality despite recent advances in medical and mechanical therapies. Cardiogenic shock also occurs in non-acute coronary syndrome conditions, such as Takotsubo cardiomyopathy, fulminant myocarditis, end stage heart failure, and others. In this chapter, we provide a brief review on the pathophysiology, diagnosis, and acute management of cardiogenic shock patients. We will focus more on the management of acute coronary syndrome related cardiogenic shock, given that it is the most common etiology

UM receives $1 million seed money for new business building

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is used in patients with thoracic aortic aneurysms (TAA) and uncomplicated type B acute aortic dissection (B-AAD) to reduce morbidity and mortality. Limited data are available for comparing outcomes of TEVAR in TAA vs B-AAD. METHODS: 49 patients with TAA and 37 patients with B-AAD between January 2005 and January 2015 were retrospectively identified. Baseline characteristics, thrombosis status of the false lumen with the extent of dissection, aortic pathologies including prior aortic surgeries, emergent vs elective procedures, landing zone location, extra anatomical major vessel bypass, types of grafts and outcome variables were reviewed by two physicians. T-test, Wilcoxon rank-sum test and chi-square test were used to generate pvalues. RESULTS: The sample population with TAA had a higher median age than those with B-AAD (72 years vs 59 years, p¼0.0001) (Table). Early events, 30-day mortality and 5-year outcomes were not significantly different between groups. Endoleak and all-cause mortality with TEVAR were not significantly different in the groups (Fig). CONCLUSION: This study confirms the feasibility of TEVAR for uncomplicated type B aortic dissection in the acute setting with no difference in short- or long-term outcomes of TEVAR between TAA and B-AAD populations

Mechanisms controlling anaemia in Trypanosoma congolense infected mice.

Trypanosoma congolense are extracellular protozoan parasites of the blood stream of artiodactyls and are one of the main constraints on cattle production in Africa. In cattle, anaemia is the key feature of disease and persists after parasitaemia has declined to low or undetectable levels, but treatment to clear the parasites usually resolves the anaemia. The progress of anaemia after Trypanosoma congolense infection was followed in three mouse strains. Anaemia developed rapidly in all three strains until the peak of the first wave of parasitaemia. This was followed by a second phase, characterized by slower progress to severe anaemia in C57BL/6, by slow recovery in surviving A/J and a rapid recovery in BALB/c. There was no association between parasitaemia and severity of anaemia. Furthermore, functional T lymphocytes are not required for the induction of anaemia, since suppression of T cell activity with Cyclosporin A had neither an effect on the course of infection nor on anaemia. Expression of genes involved in erythropoiesis and iron metabolism was followed in spleen, liver and kidney tissues in the three strains of mice using microarrays. There was no evidence for a response to erythropoietin, consistent with anaemia of chronic disease, which is erythropoietin insensitive. However, the expression of transcription factors and genes involved in erythropoiesis and haemolysis did correlate with the expression of the inflammatory cytokines Il6 and Ifng. The innate immune response appears to be the major contributor to the inflammation associated with anaemia since suppression of T cells with CsA had no observable effect. Several transcription factors regulating haematopoiesis, Tal1, Gata1, Zfpm1 and Klf1 were expressed at consistently lower levels in C57BL/6 mice suggesting that these mice have a lower haematopoietic capacity and therefore less ability to recover from haemolysis induced anaemia after infection

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Controlling complexity: the clinical relevance of mouse complex genetics.

Experimental animal models are essential to obtain basic knowledge of the underlying biological mechanisms in human diseases. Here, we review major contributions to biomedical research and discoveries that were obtained in the mouse model by using forward genetics approaches and that provided key insights into the biology of human diseases and paved the way for the development of novel therapeutic approaches