Outcomes of Durable Mechanical Circulatory Support in Myocarditis: Analysis of the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support Registry

Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support (MCS). The characteristics and outcomes of these patients are not known. We identified all patients with clinically-diagnosed or pathology-proven myocarditis who underwent mechanical circulatory support in the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support registry (2013-2016). The characteristics and outcomes of these patients were compared to those of patients with nonischemic cardiomyopathy (NICM). Out of 14,062 patients in the registry, 180 (1.2%) had myocarditis and 6,602 (46.9%) had NICM. Among patients with myocarditis, duration of heart failure was22%, 1-12 months in 22.6%, and \u3e1 year in 55.4%. Compared with NICM, patients with myocarditis were younger (45 vs. 52 years, P \u3c 0.001) and were more often implanted with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30% vs. 15%, P \u3c 0.001). Biventricular mechanical support ( biventricular ventricular assist device [BIVAD] or total artificial heart) was implanted more frequently in myocarditis (18% vs. 6.7%, P \u3c 0.001). Overall postimplant survival was not different between myocarditis and NICM (left ventricular assist device: P = 0.27, BIVAD: P = 0.50). The proportion of myocarditis patients that have recovered by 12 months postimplant was significantly higher in myocarditis compared to that of NICM (5% vs. 1.7%, P = 0.0003). Adverse events (bleeding, infection, and neurologic dysfunction) were all lower in the myocarditis than NICM. In conclusion, although myocarditis patients who receive durable MCS are sicker preoperatively with higher needs for biventricular MCS, their overall MCS survival is noninferior to NICM. Patients who received MCS for myocarditis are more likely than NICM to have MCS explanted due to recovery, however, the absolute rates of recovery were low

Modeling Depression Treatment Strategies for Human Immunodeficiency Virus (HIV) Positive Patients

This dissertation empirically examines the associations between depression and HIV-related outcomes, simulates both care and outcomes under different depression care strategies, and compares the cost effectiveness of various depression care strategies to the current care strategy. The empirical investigations reveal the negative associations between depression and HIV-related outcomes using two longitudinal patient-level databases. Furthermore, the patterns and outcomes of depression care are identified and simulated using agent-based modeling. Finally, simulated costs and effectiveness are used to evaluate different depression care strategies for reducing new HIV infections and improving quality of life. The current standard of care for depression among patients living with HIV can be characterized as low intensity in terms of screening and treatment; enhanced depression care strategies are proposed and evaluated to be cost-saving. Recommendations are offered to enhance depression care in HIV care settings

‘Isomorphic’ behavior of corporate greenwashing

In the implementation of corporate environmental responsibility,‘greenwashing’ is a pseudo-social behavior which is theopposite of ‘genuine green’ behaviors. With the improvement of the public awareness of environmental protection and the strengthening of the government environmental supervision, more and more enterprises are learning the green behavior adaptively. The frequentoccurrence of greenwashing has become a‘disharmonious’ voice in the construction of ecological civilization. Institutional theory holdsthat institutional factors make organizations become more similar in structure and performance due to institutional forces. This paper describes an exploratory research on the law of group behavior in corporate greenwashing, analyzes the isomorphic mechanism of corporate greenwashing based on the institutional theory, and carries out an empirical test by using the data of A-share listed companiesin heavily polluting industries during the period of 2010-2016. The research in this paper shows that corporate greenwashing behavioris significantly affected by neighboring enterprises in the same region, and proves the existence of the‘bandwagon’ effect. The results of analysis based on the nature of property rights show that state-owned enterprises have more significant regional isomorphic behaviors, indicating that state-owned enterprises are more inclined to claim legitimacy through the institutional isomorphism of greenwashing. Results of further analysis show that, greenwashing isomorphism does not significantly improve the operating performance of enterprises, but the similarity strengthens the ability of these enterprises to bear risks under an uncertain environment. As such, this provides empirical evidence support for the hypothesis that‘organizational isomorphism is usually for legitimacy rather than efficiency’in the institutional theory. The research in this paper reveals the land-derived characteristic of greenwashing behavior, and provides adecisive reference for policy implication. For the control of greenwashing, the central government should enforce and standardize theenterprise environmental report in terms of institutional arrangement, unify the form and content of disclosure, and improve the credibility and comparability of environmental information disclosure. The local governments need to strengthen the supervision of enterprises within their jurisdiction, as well as the coordination, cooperation and information sharing between departments, increase the punishment of violations, break the legal for enterprises to obtain socialrecognition by greenwashing. Meanwhile, it is necessary for the promotion of ‘genuine green’ large companies and state-owned enterprises as role models

Targeted Imaging and Proteomic Analysis of Tumor-Associated Glycans in Living Animals

Although it has been well known that dynamic changes in glycosylation are associated with tumor progression, it remains challenging to selectively visualize the cancer glycome in vivo. Herein, a strategy for the targeted imaging of tumor-associated glycans by using ligand-targeted liposomes encapsulating azidosugars is described. The intravenously injected liposomal nanoparticles selectively bound to the cancer-cell-specific receptors and installed azides into the melanoma glycans in a xenograft mouse model in a tissue-specific manner. Subsequently, a copper-free click reaction was performed in vivo to chemoselectively conjugate the azides with a near-infrared fluorescent dye. The glycosylation dynamics during tumor growth were monitored by in vivo fluorescence imaging. Furthermore, the newly synthesized sialylated glycoproteins were enriched during tumor growth and identified by glycoproteomics. Compared with the labeling methods using free azidosugars, this method offers improved labeling efficiency and high specificity and should facilitate the elucidation of the functional role of glycans in cancer biology

Why Is Hyperparathyroidism Underdiagnosed and Undertreated in Older Adults?

Introduction: Hyperparathyroidism significantly decreases quality of life, yet elderly patients are underdiagnosed and undertreated even though parathyroidectomy offers definitive cure with minimal morbidity. The purpose of this study is to determine why older patients with hyperparathyroidism are not appropriately diagnosed and referred for parathyroidectomy. Methods: We reviewed charts for a random sample of 25 patients aged 75 and older who had hyperparathyroidism and were referred for surgical evaluation, and 25 who were not referred. Two reviewers independently evaluated medical records to identify reasons for delayed diagnosis of hyperparathyroidism and reasons for nonreferral for parathyroidectomy. Results: The median age of our cohort was 84 (80-96) years, 90% were women, 60% were white, and median follow-up was 5.5 (1-17) years. In 58% of all patients, an elevated serum calcium was not acknowledged. Even when calcium and parathyroid hormone levels were both elevated, the diagnosis was missed in 28% of patients, and 16% with clear symptoms of hyperparathyroidism remained undiagnosed. For 42% of patients, a nonsurgeon informed them that surgery offered no benefit. Surgery was also rejected as a treatment for 36% of patients despite the development of new symptoms or rising calcium. Conclusions: Substantial gaps exist in processes for diagnosis and referral of patients with hyperparathyroidism that lead to underdiagnosis and undertreatment. To improve rates of diagnosis and treatment, strategies are needed to educate nonsurgeons and patients about the benefits of surgery and to modify care processes to more efficiently diagnose and refer patients

Effect of elevated HbA1c on outcomes in on-pump versus off-pump coronary artery bypass grafting

Abstract Background Diabetic patients are at an increased risk of cardiovascular morbidities. We aimed to examine if elevated pre-operative glycosylated hemoglobin (HbA1c) levels are associated with higher likelihood of experiencing adverse events in on-pump (ONCAB) versus off-pump (OPCAB) coronary artery bypass graft (CABG) procedures. We examined characteristics of patients undergoing CABG using our institutional STS Adult Cardiac Surgery Database (ACSD) from 2014 to 2020. Descriptive statistics and univariate analyses were used to compare postoperative outcomes between ONCAB and OPCAB based on preoperative HbA1c levels: (1) HbA1c ≤ 6.0%, (2) 6.0% 8.5%. Multivariable models were built to assess risk factors associated with adverse events. Primary outcomes were operative mortality and stroke. Results For ONCAB, statistically significant associations were found between increasing HbA1c and new post-operative dialysis (p=0.01), rates of readmission (p=0.003) and greater lengths of stay (p=0.002). For OPCAB, statistically significant associations were found between increasing HbA1c and rates of operative mortality (p=0.04), post-operative renal failure (p=0.0001), new post-operative dialysis (p=0.0001), sternal wound infection (p=0.01), and greater lengths of stay (p=0.03). No significant relationship was noted between HbA1c and stroke, reoperation due to bleeding, or post-operative transfusion. Conclusions Increasing HbA1c positively correlated with numerous adverse patient outcomes in both ONCAB and OPCAB, and differences were noted in which outcomes were most impacted between the two techniques. Pre-operative medical optimization from a diabetes standpoint is paramount to improve CABG outcomes in both on-pump or off-pump techniques

Comparative analysis of regional outcomes and adverse events after continuous-flow left ventricular assist device implantation:An IMACS analysis

INTRODUCTION: Regional outcomes after implantation of continuous-flow left ventricular assist devices (LVADs) have not been described. We examined differences in patient selection, survival, and adverse events across 3 geographic regions of the world: the Americas, Asia-Pacific, and Europe. METHODS: Using data from The International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support registry, all adult patients implanted with a continuous-flow LVADs were included in this International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support analysis (n = 15,560), of whom, 9,988 (64%) received axial-flow devices and 5,572 (36%) received centrifugal-flow devices. RESULTS: There were significant interregional differences in the rate of implantation of patients aged \u3e70 years (Americas: 14%, Asia-Pacific: 1%, Europe: 5%; p \u3c 0.0001), morbidly obese (Americas: 5%, Asia-Pacific: 1%, Europe: 1%; p \u3c 0.0001), male (Americas: 79%, Asia-Pacific: 77%, Europe: 85%; p \u3c 0.0001), and implanted as destination therapy (Americas: 48%, Asia-Pacific: 4%, Europe: 22%; p \u3c 0.0001). The rates of centrifugal pump usage varied by region (Americas: 30%, Asia-Pacific: 34%, Eu: 74%; p \u3c 0.0001). Survival rates varied by region and the type of pump flow, with survival at 12 and 48 months (axial flow vs centrifugal flow) being 82% vs 82% and 52% vs 53 in Americas; 92% vs 86% and 83% vs 74% in Asia-Pacific; and 80% vs 75% and 69% vs 53% in Europe, respectively (regional survival p \u3c 0.0001). CONCLUSION: There are marked global differences in LVAD recipient characteristics, device utilization, and post-operative care. These heterogeneities along with differences in patient management and transplantation rates may impact long-term survival. Regional differences in adverse event incidence warrant further investigation

Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry: A comparison of centrifugal and axial continuous-flow left ventricular assist devices

BACKGROUND: The IMACS Registry compiles and analyzes worldwide data from patients undergoing implantation of durable left ventricular assist devices. METHODS: Data encompassing 16,286 LVAD recipients from 4 collectives and 24 individual hospitals was collected and analyzed. In this 3rd annual report we compare and contrast outcomes, adverse events and risks factors between axial flow and centrifugal flow device recipients. RESULTS: Significant differences were found in the baseline characteristics of axial vs centrifugal flow LVAD recipients. Survival was similar between pump types. INTERMACS profile 1-3 constitute 85% of implants. A survival gap persists in destination therapy compared to bridge patients. RVAD need and delay impact survival dramatically. Centrifugal flow outperforms axial flow recipients in regards to GI bleeding and freedom from hemocompatibility related adverse events. No significant difference in the actuarial freedom from all strokes or either stroke subtype (hemorrhagic or ischemic) was seen among the two types of pumps. New end points to guide decision making are proposed. CONCLUSIONS: We demonstrate a transition from axial to centrifugal flow with four-year survival that approximates 60%. A high frequency of adverse events remains an impediment to the wider adoption of these technologies. In the future, composite study endpoints examining life quality and adverse events beyond survival may help in shared decision making prior to MCS implant, and may provide the requisite data to support extension of MCS therapy into the lesser ill heart failure population

Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry: A comparison of centrifugal and axial continuous-flow left ventricular assist devices

BACKGROUND: The IMACS Registry compiles and analyzes worldwide data from patients undergoing implantation of durable left ventricular assist devices. METHODS: Data encompassing 16,286 LVAD recipients from 4 collectives and 24 individual hospitals was collected and analyzed. In this 3rd annual report we compare and contrast outcomes, adverse events and risks factors between axial flow and centrifugal flow device recipients. RESULTS: Significant differences were found in the baseline characteristics of axial vs centrifugal flow LVAD recipients. Survival was similar between pump types. INTERMACS profile 1-3 constitute 85% of implants. A survival gap persists in destination therapy compared to bridge patients. RVAD need and delay impact survival dramatically. Centrifugal flow outperforms axial flow recipients in regards to GI bleeding and freedom from hemocompatibility related adverse events. No significant difference in the actuarial freedom from all strokes or either stroke subtype (hemorrhagic or ischemic) was seen among the two types of pumps. New end points to guide decision making are proposed. CONCLUSIONS: We demonstrate a transition from axial to centrifugal flow with four-year survival that approximates 60%. A high frequency of adverse events remains an impediment to the wider adoption of these technologies. In the future, composite study endpoints examining life quality and adverse events beyond survival may help in shared decision making prior to MCS implant, and may provide the requisite data to support extension of MCS therapy into the lesser ill heart failure population.status: publishe