Inotropic therapy in patients with advanced heart failure: a clinical consensus statement from the Heart Failure Association of the European Society of Cardiology

This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline-directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end-of-life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support). Cardiolog

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Crop Rotation and Soil Amendment Alters Sorghum Grain Quality

Soybean [Glycine max (L.) Merr.] rotation enhances grain sorghum [Sorghum bicolor (L.) Moench] yield, but infl uence on grain quality has not been measured. The objective was to determine the effect of cropping sequence (CS) and soil amendment (SA) on grain yield and quality. Sorghum grain yield and quality, soil NO3–N and water were measured in a rotation study in 2003 and 2004 on a Sharpsburg silty clay loam (fine, smectitic, mesic Typic Argiudoll). Cropping sequences were continuous sorghum, and sorghum rotated with non-nodulating and nodulating soybean. Soil amendments consisted of no amendment, manure (17–26 Mg dry matter ha−1 yr−1), and N (84 kg ha−1 yr−1). CS × SA interaction effects were found for most parameters. Rotation with non-nodulating soybean without SA increased yield by 2.6 to 2.8 Mg ha−1 over continuous sorghum without SA. Rotation without SA with nodulating soybean further increased yield by 1.7 to 1.8 Mg ha−1 over rotation with non-nodulating soybean. Grain N increased by 0.5 to 1.0, 2.5 to 5.0, and 3.3 to 4.9 g kg−1 for N application to continuous sorghum and sorghum rotated with non-nodulating and nodulating soybean, respectively. Tangential abrasive dehulling device (TADD) removal indicated that continuous sorghum without SA produced the softest grain with 43 to 44% TADD removal, and sorghum rotated with nodulating soybean with manure produced the hardest grain with 22 to 27% TADD removal. As food end-use opportunities for sorghum grain evolve, use of crop rotation and SA application will be important to produce grain with desirable quality attributes. Includes corrected Table 4

Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology

This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline-directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end-of-life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support). © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology