The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia

PURPOSE: Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population. METHODS: Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures). RESULTS: The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study. CONCLUSIONS: AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10557-020-07098-3) contains supplementary material, which is available to authorized users

Quality of life of arabic-speaking refugees in Greece. The case of City Plaza squat.

Εισαγωγή: Οι πρόσφατες αυξημένες μεταναστευτικές ροές προς την Ελλάδα, αποτέλεσμα κυρίως συγκρούσεων στη Μέση Ανατολή, σε συνδυασμό με το κλείσιμο των συνόρων των Ευρωπαϊκών κρατών, παγίδευσαν σημαντικό αριθμό προσφύγων στην Ελλάδα. Οι συνθήκες διαβίωσης τους στους καταυλισμούς επηρεάζουν αρνητικά την ποιότητα της ζωής τους και την υγεία τους. Η χρήση του αυτοαναφερόμενου δείκτη της ποιότητας της ζωής έχει αποδειχθεί εξαιρετικά χρήσιμο εργαλείο για την εκτίμηση της υγείας του ατόμου. Σκοπός αυτής της μελέτης είναι η εκτίμηση της ποιότητας ζωής των αραβόφωνων προσφύγων που διαμένουν στην Ελλάδα. Μέθοδοι: Η έρευνα αυτή επικεντρώνεται σε μία κατάληψη της Αττικής όπου διαμένουν 400 πρόσφυγες. Τα δεδομένα συλλέχθηκαν με το ερωτηματολόγιο Ποιότητας Ζωής του WHO (WHOQOL-Bref) και συγκρίνονται με αντίστοιχα από καταυλισμούς της Αττικής και συγκεκριμένα από τους καταυλισμούς του Ελαιώνα και του Σκαραμαγκά, προκειμένου να συγκριθεί η ποιότητα ζωής μεταξύ αυτών των ομάδων. Αποτελέσματα: Διαπιστώθηκε πως η ποιότητα ζωής των κατοίκων που διαμένουν στην κατάληψη City Plaza δεν είναι υψηλότερη από αυτή εκείνων που διαμένουν στους καταυλισμούς, όπως αρχικά είχε υποτεθεί. Μόνο στην ενότητα περιβάλλον, η βαθμολογία που έδωσαν οι κάτοικοι του City Plaza ήταν υψηλότερη από αυτή των κατοίκων του Σκαραμαγκά. Συμπεράσματα: Στην παρούσα μελέτη έγινε προσπάθεια σύγκρισης της ποιότητας ζωής των προσφύγων που διαμένουν σε καταυλισμούς με αυτή των κατοίκων μιας κατάληψης, με σκοπό να εξετάσει την πιθανή συγκριτική υπεροχή της ποιότητας ζωής των κατοίκων της κατάληψης. Αντίθετα με τις προβλέψεις μας οι κάτοικοι της κατάληψης σημείωσαν μικρότερη βαθμολογία στις περισσότερες από τις ενότητες του ερωτηματολογίου WHOQOL-BREF. Ωστόσο θα έπρεπε να γίνει πιο εκτεταμένη έρευνα καθώς τα άτομα που κατοικούν σε χώρους αυτοοργανωμένους και αλληλέγγυους έχουν την τάση να ενσωματώνονται περισσότερο στην κοινωνία, γεγονός που βελτιώνει την ποιότητα της ζωής τους.Introduction: The recent increased refugee flows towards Greece, which are mainly a result of Middle East conflicts, along with the sealing of the borders of European countries, trapped a sound number of refugees in Greece. Their living conditions in camps influence negatively their quality of life and their health. The use of self-reported quality of life indicator has been proved to be a very useful tool in evaluation of a person’s health. Scope of this study is the evaluation of quality of life of Arabic-speaking refugees who live in Greece. Methods: The present study focuses on a squat in Attica, where 400 refugees live. Data were collected with the use of WHO Quality of Life questionnaire and were compared to corresponding data collected in camps and namely in the camps of Eleonas and Skaramagas, in order to compare the quality of life among these groups. Results: Quality of life of the refugees living in City Plaza squat was not found to be higher than the one of those living in camps, as was initially supposed. The ratings of City Plaza residents were higher than the ones of Skaramagas residents only in the environmental unit. Conclusion: In the present study there was an attempt of comparison between the quality of life of refugees living in camps and the one of the residents of a squat, in order to examine the potential superiority of the quality of life of those who live in the squat. Contrary to our assumptions, the ratings of the squat residents were inferior in most of the units of WHOQOL-BREF questionnaire. However, a more thorough research is needed, as it seems that people who dwell in self-organized and solidarity areas tend to become more incorporated in the society, a fact that improves their quality of life

The use of angiotensin II for the treatment of post-cardiopulmonary bypass vasoplegia

Purpose Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population. Methods Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures). Results The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study. Conclusions AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available.Thoracic Surger

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Background: In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors’ profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. Presentation of the Hypothesis: This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. Implications of the hypothesis tested: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different subpopulations in order to establish a definite relationship. A comprehensive approach based on the aspects of biosocial life may result in more accurate CVD risk management

Cardiac and Vascular α1-Adrenoceptors in Congestive Heart Failure: A Systematic Review

As heart failure (HF) is a devastating health problem worldwide, a better understanding and the development of more effective therapeutic approaches are required. HF is characterized by sympathetic system activation which stimulates α- and β-adrenoceptors (ARs). The exposure of the cardiovascular system to the increased locally released and circulating levels of catecholamines leads to a well-described downregulation and desensitization of β-ARs. However, information on the role of α-AR is limited. We have performed a systematic literature review examining the role of both cardiac and vascular α1-ARs in HF using 5 databases for our search. All three α1-AR subtypes (α1A, α1B and α1D) are expressed in human and animal hearts and blood vessels in a tissue-dependent manner. We summarize the changes observed in HF regarding the density, signaling and responses of α1-ARs. Conflicting findings arise from different studies concerning the influence that HF has on α1-AR expression and function; in contrast to β-ARs there is no consistent evidence for down-regulation or desensitization of cardiac or vascular α1-ARs. Whether α1-ARs are a therapeutic target in HF remains a matter of debate

Systematic search for putative new domain families in Mycoplasma gallisepticum genome

<p>Abstract</p> <p>Background</p> <p>Protein domains are the fundamental units of protein structure, function and evolution. The delineation of different domains in proteins is important for classification, understanding of structure, function and evolution. The delineation of protein domains within a polypeptide chain, namely at the genome scale, can be achieved in several ways but may remain problematic in many instances. Difficulties in identifying the domain content of a given sequence arise when the query sequence has no homologues with experimentally determined structure and searching against sequence domain databases also results in insignificant matches. Identification of domains under low sequence identity conditions and lack of structural homologues acquire a crucial importance especially at the genomic scale.</p> <p>Findings</p> <p>We have developed a new method for the identification of domains in unassigned regions through indirect connections and scaled up its application to the analysis of 434 unassigned regions in 726 protein sequences of <it>Mycoplasma gallisepticum </it>genome. We could establish 71 new domain relationships and probable 63 putative new domain families through intermediate sequences in the unassigned regions, which importantly represent an overall 10% increase in PfamA domain annotation over the direct assignment in this genome.</p> <p>Conclusions</p> <p>The systematic analysis of the unassigned regions in the <it>Mycoplasma gallisepticum </it>genome has provided some insight into the possible new domain relationships and putative new domain families. Further investigation of these predicted new domains may prove beneficial in improving the existing domain prediction algorithms.</p

Comparative Genomics of Mycoplasma: Analysis of Conserved Essential Genes and Diversity of the Pan-Genome

Mycoplasma, the smallest self-replicating organism with a minimal metabolism and little genomic redundancy, is expected to be a close approximation to the minimal set of genes needed to sustain bacterial life. This study employs comparative evolutionary analysis of twenty Mycoplasma genomes to gain an improved understanding of essential genes. By analyzing the core genome of mycoplasmas, we finally revealed the conserved essential genes set for mycoplasma survival. Further analysis showed that the core genome set has many characteristics in common with experimentally identified essential genes. Several key genes, which are related to DNA replication and repair and can be disrupted in transposon mutagenesis studies, may be critical for bacteria survival especially over long period natural selection. Phylogenomic reconstructions based on 3,355 homologous groups allowed robust estimation of phylogenetic relatedness among mycoplasma strains. To obtain deeper insight into the relative roles of molecular evolution in pathogen adaptation to their hosts, we also analyzed the positive selection pressures on particular sites and lineages. There appears to be an approximate correlation between the divergence of species and the level of positive selection detected in corresponding lineages

Specific Evolution of F1-Like ATPases in Mycoplasmas

F1F0 ATPases have been identified in most bacteria, including mycoplasmas which have very small genomes associated with a host-dependent lifestyle. In addition to the typical operon of eight genes encoding genuine F1F0 ATPase (Type 1), we identified related clusters of seven genes in many mycoplasma species. Four of the encoded proteins have predicted structures similar to the α, β, γ and ε subunits of F1 ATPases and could form an F1-like ATPase. The other three proteins display no similarity to any other known proteins. Two of these proteins are probably located in the membrane, as they have three and twelve predicted transmembrane helices. Phylogenomic studies identified two types of F1-like ATPase clusters, Type 2 and Type 3, characterized by a rapid evolution of sequences with the conservation of structural features. Clusters encoding Type 2 and Type 3 ATPases were assumed to originate from the Hominis group of mycoplasmas. We suggest that Type 3 ATPase clusters may spread to other phylogenetic groups by horizontal gene transfer between mycoplasmas in the same host, based on phylogeny and genomic context. Functional analyses in the ruminant pathogen Mycoplasma mycoides subsp. mycoides showed that the Type 3 cluster genes were organized into an operon. Proteomic analyses demonstrated that the seven encoded proteins were produced during growth in axenic media. Mutagenesis and complementation studies demonstrated an association of the Type 3 cluster with a major ATPase activity of membrane fractions. Thus, despite their tendency toward genome reduction, mycoplasmas have evolved and exchanged specific F1-like ATPases with no known equivalent in other bacteria. We propose a model, in which the F1-like structure is associated with a hypothetical X0 sector located in the membrane of mycoplasma cells