18 research outputs found
Prognostic biomarker soluble ST2 exhibits diurnal variation in chronic heart failure patients
Aim: Soluble suppression of tumorigenicity-2 (sST2) is a strong prognostic biomarker in heart failure. The emerging understanding of circadian biology in cardiovascular disease may lead to novel applications in prognosis and diagnosis and may provide insight into mechanistic aspects of the disease–biomarker interaction. So far, it is unknown whether sST2 exhibits a diurnal rhythm. Repeated measurements of sST2 may aid in clinical decision making. The goal of this study was to investigate whether sST2 exhibits diurnal variation in patients with heart failure with reduced ejection fraction (HFrEF) and in control subjects, thereby enhancing its diagnostic and prognostic values. Methods and results: The study comprised 32 subjects: 16 HFrEF patients and 16 controls. Blood was collected at seven subsequent time points during a 24 h time period. sST2, N-terminal pro-B-type natriuretic peptide (NT-proBNP), melatonin, and cortisol were measured from serum. Peak values of sST2 clustered at daytime (modal value: 5 p.m.) in 87.6% of all subjects (81.3% of patients, P = 0.021; 93.8% of controls, P = 0.001), and minimum concentrations at night-time (modal value: 5 a.m.) in 84.4% (87.5% of patients, P = 0.004 81.3% of controls, P = 0.021). A cosinor analysis of mean normalized sST2 values revealed significant cosine shaped 24 h oscillations of patients (P = 0.026) and controls (P = 0.037). NT-proBNP in contrast did not show a diurnal rhythm, while melatonin and cortisol patterns were intact in all subjects. Conclusions: sST2 exhibits a diurnal rhythm with lower values in the morning than in the late afternoon. This new insight could lead to refinement of its diagnostic and prognostic values through specified and consistent sampling times with repeated measurements. For example, by measuring sST2 during the afternoon, when levels are at their highest, false negatives on prognosis prediction could be avoided
2019 EACTS Expert Consensus on long-term mechanical circulatory support
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device
Systematic Genetic Nomenclature for Type VII Secretion Systems
CITATION: Bitter, W., et al. 2009. Systematic genetic nomenclature for type VII secretion systems. PLoS Pathogens, 5(10): 1-6, doi: 10.1371/journal.ppat.1000507.The original publication is available at http://journals.plos.org/plospathogensMycobacteria, such as the etiological
agent of human tuberculosis, Mycobacterium
tuberculosis, are protected by an impermeable
cell envelope composed of an inner
cytoplasmic membrane, a peptidoglycan
layer, an arabinogalactan layer, and an
outer membrane. This second membrane
consists of covalently linked, tightly packed
long-chain mycolic acids [1,2] and noncovalently
bound shorter lipids involved in
pathogenicity [3–5]. To ensure protein
transport across this complex cell envelope,
mycobacteria use various secretion pathways,
such as the SecA1-mediated general
secretory pathway [6,7], an alternative
SecA2-operated pathway [8], a twin-arginine
translocation system [9,10], and a
specialized secretion pathway variously
named ESAT-6-, SNM-, ESX-, or type
VII secretion [11–16]. The latter pathway,
hereafter referred to as type VII secretion
(T7S), has recently become a large and
competitive research topic that is closely
linked to studies of host–pathogen interactions
of M. tuberculosis [17] and other
pathogenic mycobacteria [16]. Molecular
details are just beginning to be revealed
[18–22] showing that T7S systems are
complex machineries with multiple components
and multiple substrates. Despite
their biological importance, there has been
a lack of a clear naming policy for the
components and substrates of these systems.
As there are multiple paralogous T7S
systems within the Mycobacteria and
orthologous systems in related bacteria,
we are concerned that, without a unified
nomenclature system, a multitude of redundant
and obscure gene names will be
used that will inevitably lead to confusion
and hinder future progress. In this opinion
piece we will therefore propose and introduce
a systematic nomenclature with
guidelines for name selection of new
components that will greatly facilitate
communication and understanding in this
rapidly developing field of research.http://journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1000507Publisher's versio
Exploiting nonlinear wave propagation to improve the precision of ultrasonic flow meters
Acoustic wave propagation in ultrasonic flow measurements is typically assumed to be linear and reciprocal. However, if the transmitting transducer generates a sufficiently high pressure, nonlinear wave propagation effects become significant. In flow measurements, this would translate into more information to estimate the flow and therefore a higher precision relative to the linear case. In this work, we investigate how the generated harmonics can be used to measure flow. Measurements in a custom-made flow l
Organization and collateralization of a subendocardial plexus in end-stage human heart failure
van den Wijngaard JP, van Horssen P, ter Wee R, Coronel R, de Bakker JM, de Jonge N, Siebes M, Spaan JA. Organization and collateralization of a subendocardial plexus in end-stage human heart failure. Am J Physiol Heart Circ Physiol 298: H158-H162, 2010. First published October 23, 2009; doi:10.1152/ajpheart.00654.2009.-In the failing myocardium a subendocardial plexus can develop. Detection of the presence or function, however, of such a plexus does not form part of the present diagnostic spectrum for heart failure. This may now change as new methods for high-resolution imaging of myocardial perfusion distribution are being developed. A severely hypertrophic heart was harvested during transplantation and analyzed for morphology of the intramural coronary arterial vasculature. The heart only had one coronary ostium, and the main branches of the coronary artery were cannulated. A fluorescent casting material was infused that was allowed to harden under physiological pressure. The entire heart was frozen and placed in a novel imaging cryomicrotome and sequentially cut in 25-mu m slices. High-resolution images of each cutting plane were acquired, allowing a detailed three-dimensional reconstruction of the arterial vasculature. The epicardial layer of the free wall demonstrated a normal vasculature with penetrating branching arteries. The endocardial layer and the septum revealed a highly interconnected vascular plexus with large vessels oriented parallel to the apicobasal axis. An extensive endocardial network with collaterals was detected, forming connections between the main epicardial branches. We conclude that an outward remodeling of transmural vessels did not prevent the generation and growth of subendocardial conduit arteries. The orientation and vascular volume in the plexus provides an opportunity for detection by novel techniques of MRI contrast imaging currently developed. Knowledge of the effect on perfusion studies is required to prevent a misinterpretation of subendocardial perfusion images in heart failure
Organization and collateralization of a subendocardial plexus in end-stage human heart failure
Organization and collateralization of a subendocardial plexus in end-stage human heart failure
The chemokine and chemokine receptor profile of infiltrating cells in the wall of arteries with cardiac allograft vasculopathy is indicative of a memory T-helper 1 response
The role of long-term mechanical circulatory support in patients with advanced heart failure
In patients with end-stage heart failure, advanced therapies such as heart transplantation and long-term mechanical circulatory support (MCS) with a left ventricular assist device (LVAD) have to be considered. LVADs can be implanted as a bridge to transplantation or as an alternative to heart transplantation: destination therapy. In the Netherlands, long-term LVAD therapy is gaining importance as a result of increased prevalence of heart failure together with a low number of heart transplantations due to shortage of donor hearts. As a result, the difference between bridge to transplantation and destination therapy is becoming more artificial since, at present, most patients initially implanted as bridge to transplantation end up receiving extended LVAD therapy. Following LVAD implantation, survival after 1, 2 and 3 years is 83%, 76% and 70%, respectively. Quality of life improves substantially despite important adverse events such as device-related infection, stroke, major bleeding and right heart failure. Early referral of potential candidates for long-term MCS is of utmost importance and positively influences outcome. In this review, an overview of the indications, contraindications, patient selection, clinical outcome and optimal time of referral for long-term MCS is given