Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

Heart failure; Left ventricular assist device; Right ventricleInsuficiencia cardiaca; Dispositivo de asistencia ventricular izquierda; Ventrículo derechoInsuficiència cardíaca; Dispositiu d'assistència ventricular esquerre; Ventricle dretLeft ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.ER-A has received funding from the Spanish Society of Cardiology (Magda Heras grant, SEC/MHE-MOV-INT 21/001). DB is supported by TRANSFORM HF

Scoring method of a Situational Judgment Test:influence on internal consistency reliability, adverse impact and correlation with personality?

textabstractSituational Judgment Tests (SJTs) are increasingly used for medical school selection. Scoring an SJT is more complicated than scoring a knowledge test, because there are no objectively correct answers. The scoring method of an SJT may influence the construct and concurrent validity and the adverse impact with respect to non-traditional students. Previous research has compared only a small number of scoring methods and has not studied the effect of scoring method on internal consistency reliability. This study compared 28 different scoring methods for a rating SJT on internal consistency reliability, adverse impact and correlation with personality. The scoring methods varied on four aspects: the way of controlling for systematic error, and the type of reference group, distance and central tendency statistic. All scoring methods were applied to a previously validated integrity-based SJT, administered to 931 medical school applicants. Internal consistency reliability varied between .33 and .73, which is likely explained by the dependence of coefficient alpha on the total score variance. All scoring methods led to significantly higher scores for the ethnic majority than for the non-Western minorities, with effect sizes ranging from 0.48 to 0.66. Eighteen scoring methods showed a significant small positive correlation with agreeableness. Four scoring methods showed a significant small positive correlation with conscientiousness. The way of controlling for systematic error was the most influential scoring method aspect. These results suggest that the increased use of SJTs for selection into medical school must be accompanied by a thorough examination of the scoring method to be used

Mammal responses to global changes in human activity vary by trophic group and landscape

Wildlife must adapt to human presence to survive in the Anthropocene, so it is critical to understand species responses to humans in different contexts. We used camera trapping as a lens to view mammal responses to changes in human activity during the COVID-19 pandemic. Across 163 species sampled in 102 projects around the world, changes in the amount and timing of animal activity varied widely. Under higher human activity, mammals were less active in undeveloped areas but unexpectedly more active in developed areas while exhibiting greater nocturnality. Carnivores were most sensitive, showing the strongest decreases in activity and greatest increases in nocturnality. Wildlife managers must consider how habituation and uneven sensitivity across species may cause fundamental differences in human–wildlife interactions along gradients of human influence.Peer reviewe

Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course

Does the level of socioeconomic deprivation at the location of cardiac arrest in an English region influence the likelihood of receiving bystander-initiated cardiopulmonary resuscitation?

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Administration of cardiopulmonary resuscitation (CPR) by a bystander witnessing a cardiac arrest has been shown to increase the likelihood of return of spontaneous circulation and survival. This study analyses the association between the socioeconomic status of the location where a person suffers a cardiac arrest and the proportion of victims with OHCA receiving bystander CPR. Methods: Retrospective analysis of all OHCAs occurring in North East England from 1 January 2011 to 31 December 2011: data obtained from the North East Cardiac Arrest Network Registry. Results: Of 3179 OHCAs with an attempt at resuscitation, 623 patients received bystander-initiated CPR (19.6%). From quintile (Q) 1 to Q5 (most deprived to least deprived), bystander-initiated CPR rates increased from 14.5% to 23.3% (p for trend <0.001). Patients in the least deprived quintile were significantly more likely to receive bystander-initiated CPR when compared with those in the most deprived quintile (OR=1.78, 95% CI 1.32 to 2.39, p≤0.001). Conclusions: Increasing socioeconomic status at the location of cardiac arrest is positively associated with the likelihood of bystander CPR for OHCA in this region of England

Semi-xenotransplantation: the regenerative medicine-based approach to immunosuppression-free transplantation and to meet the organ demand.

Although xenografts have always held immeasurable potential as an inexhaustible source of donor organs, immunological barriers and physiological incompatibility have proved to be formidable obstacles to clinical utility. An exciting, new regenerative medicine-based approach termed "semi-xenotransplantation" (SX) seeks to overcome these obstacles by combining the availability and reproducibility of animal organs with the biocompatibility and functionality of human allografts. Compared to conventional xenotransplantation wherein the whole organ is animal-derived, SX grafts are cleansed of their antigenic cellular compartment to produce whole-organ extracellular matrix scaffolds that retain their innate structure and vascular channels. These scaffolds are then repopulated with recipient or donor human stem cells to generate biocompatible semi-xenografts with the structure and function of native human organs. While numerous hurdles must be still overcome in order for SX to become a viable treatment option for end-stage organ failure, the immense potential of SX for meeting the urgent needs for a new source of organs and immunosuppression-free transplantation justifies the interest that the transplant community is committing to the field

Cell replacement strategies aimed at reconstitution of the β-cell compartment in type 1 diabetes

Emerging technologies in regenerative medicine have the potential to restore the β-cell compartment in diabetic patients, thereby overcoming the inadequacies of current treatment strategies and organ supply. Novel approaches include: 1) Encapsulation technology that protects islet transplants from host immune surveillance; 2) stem cell therapies and cellular reprogramming, which seek to regenerate the depleted β-cell compartment; and 3) whole-organ bioengineering, which capitalizes on the innate properties of the pancreas extracellular matrix to drive cellular repopulation. Collaborative efforts across these subfields of regenerative medicine seek to ultimately produce a bioengineered pancreas capable of restoring endocrine function in patients with insulin-dependent diabetes

Ozone stress in woody plants assessed with chlorophyll a fluorescence. A critical reassessment of existing data

This paper proposes an overall reassessment of results from fluorescence transient (FT) and modulated fluorescence (MF) analysis on tree species subjected to treatment with ozone. Findings from literature and open-top chamber experiments were used in this review, in order to identify damage mechanisms and repair/avoidance strategies. Main results are summarised below. (i) The most widely used parameter to assess the response to ozone treatment was the quantum yield of primary photochemistry in the dark-adapted state (\u3d5Po, or FV/FM). This parameter proved to be very stable in stress and control conditions. Ozone-induced stress \u2013 and the related loss of photosynthetic efficiency and performance \u2013 was characterized by the change occurring in all parameters connected with the controlled dissipation: reduction of FM, FV/FM, RC/CS0 (in the fluorescence transient analysis) andNPQ(in theMFanalysis). This can be considered as a down-regulationmechanismaimed at lowering the electron supply as a consequence of a reduced demand from the Calvin cycle. (ii) The FT analysis revealed a change in the I\u2013P region shape, indicating that events beyond PSI are affected. These events include a lesser density of PSI itself and the compromised ability of the end acceptors of electrons (ferredoxine, NADP+) and RuBP to manage effectively the flux of electrons. This behaviour may create an imbalance between electrons sent by the electron transport chain and those reaching the acceptors beyond PSI. Free electrons (those coming from PSI, but that do not reach the end acceptors) can activate the oxygen from fundamental to excited status, with production of ROS (Reactive Oxygen Species), thus inducing photo-oxidation processes of the cellular content. (iii) In many cases a temporarily enhanced efficiency of electron trapping and transport (expressed by the parameters FV/FM, ET/TR, PIABS, pQ) in PSII system has been observed. That efficiency has been connected to the triggering of repair processes, but when it is connected to a reduced end acceptor capacity in combination with reduced Calvin cycle energy demand lead to over-excitation of the photosynthetic apparatus and initiates response towards visible foliar injury. (iv) The behaviour of F0 can help us distinguish between different response strategies. The increase of F0 observed in some ozone-treated plant species is considered an expression of irreversible damage in PSII, whereas lowered values of this parameter may indicate the activation of PSII in the cells surrounding the damaged one, as part of a compensative process. Future directions for the research in this field concern: (i) the possibility to combine fluorescence parameters with carbon assimilation and growth to support the study on critical levels and (ii) the analysis of the events concerning the activity of PSI and the events leading to the fixation of CO2, by using innovative technologies