Pulmonary-to-Systemic Arterial Shunt to Treat Children With Severe Pulmonary Hypertension

BACKGROUND: The placement of a pulmonary-to-systemic arterial shunt in children with severe pulmonary hypertension (PH) has been demonstrated, in relatively small studies, to be an effective palliation for their disease. OBJECTIVES: The aim of this study was to expand upon these earlier findings using an international registry for children with PH who have undergone a shunt procedure. METHODS: Retrospective data were obtained from 110 children with PH who underwent a shunt procedure collected from 13 institutions in Europe and the United States. RESULTS: Seventeen children died in-hospital postprocedure (15%). Of the 93 children successfully discharged home, 18 subsequently died or underwent lung transplantation (20%); the mean follow-up was 3.1 years (range: 25 days to 17 years). The overall 1- and 5-year freedom from death or transplant rates were 77% and 58%, respectively, and 92% and 68% for those discharged home, respectively. Children discharged home had significantly improved World Health Organization functional class (P < 0.001), 6-minute walk distances (P = 0.047) and lower brain natriuretic peptide levels (P < 0.001). Postprocedure, 59% of children were weaned completely from their prostacyclin infusion (P < 0.001). Preprocedural risk factors for dying in-hospital postprocedure included intensive care unit admission (hazard ratio [HR]: 3.2; P = 0.02), mechanical ventilation (HR: 8.3; P < 0.001) and extracorporeal membrane oxygenation (HR: 10.7; P < 0.001). CONCLUSIONS: A pulmonary-to-systemic arterial shunt can provide a child with severe PH significant clinical improvement that is both durable and potentially free from continuous prostacyclin infusion. Five-year survival is comparable to children undergoing lung transplantation for PH. Children with severely decompensated disease requiring aggressive intensive care are not good candidates for the shunt procedure

National guidelines for cognitive assessment and rehabilitation of Iranian traumatic brain injury patients

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients� conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

Silicon- induced nitric oxide burst modulates systemic defensive responses of Salvia officinalis under copper toxicity

In this study, the role of nitric oxide (NO) burst in modulating Si-induced defensive responses in leaves and roots of Salvia officinalis under copper (Cu) stress were investigated. The result showed that 400 μM Cu markedly reduced shoot dry weight, but increased electrolyte leakage (EL) in leaves and both Si and sodium nitroprusside (SNP as the NO donor) improved these attributes in a dose-dependent manner. Interestingly, Cu toxicity systemically boosted a NO burst in both roots and shoots and applying Si and SNP markedly intensified it. The application of Si and SNP alone as well as their combination improved growth parameters and systemically alleviated Cu-induced lipid peroxidation and H2O2 accumulation through lowering Cu accumulation, increasing proline content, enhancing the activities of catalase (CAT) and superoxide dismutase (SOD) in both roots and leaves and up-regulating expression of SOD gene in leaves of S. officinalis. NO generation was substantially arrested and the responses induced by Si were significantly suppressed by pretreatment with 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxy l-3-oxide (cPTIO) as a NO scavenger, Nx-Nitro- L-arginine methyl ester hydrochloride (L-NAME) as a nitric oxide synthase inhibitor, and tungstate as a nitrate reductase inhibitor. These novel results indicate that Si can induce Cu tolerance through triggering NO generation which systemically modulates defensive reactions in both roots and leaves of Salvia officinalis. © 2021 Elsevier Masson SA

Social well-being of Iranian retired men of the armed forces and their wives

Background: Social well-being is a major component of health, which was somehow neglected until the last few decades. The aim of this study was to determine the state of social well-being of Iranian retired men of the armed forces and their wives in the metropolis of Tehran. Methods: This is a cross-sectional study which was conducted in Tehran, capital of Iran, in 2016. Three hundred retired men of the armed forces and their wives were selected by random sampling. We used the Social Well-Being Scale to collect data. We assessed its internal consistency and validity with Cronbach's alpha and exploratory factor analysis before using it. We used SPSS V.24 software to analyse the data via � 2 , Pearson's correlation, t-test and analysis of variance. Results: The mean age was 66.39±6.98 years; 60 were male. The findings revealed that retired men of the armed forces and their wives report a relatively modest degree of well-being. Social well-being of the participants was significantly related to their marital status (p=0.03), education (p=0.03), employment status (p&lt;0.01), housing status (p&lt;0.01), financial status (p&lt;0.01) and health status (p&lt;0.01). Conclusion: The social well-being of retired men of the armed forces and their wives was moderate and was not different from each other, and it was related to housing ownership, employment, self-rated socioeconomic condition, education, good health and married status. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ

Incidence of platelet dysfunction by thromboelastography-platelet mapping in children supported with ECMO: A Pilot Retrospective Study.

Background: Bleeding complications are common and decrease the odds of survival in children supported with extracorporeal membrane oxygenation (ECMO). The role of platelet dysfunction on ECMO-induced coagulopathy and resultant bleeding complications is not well understood. The primary objective of this pilot study was to determine the incidence and magnitude of platelet dysfunction according to thromboelastography (TEG®)-platelet mapping (PM) testing. Methods: Retrospective chart review of children <18 years old who required ECMO at a tertiary level hospital. We collected TEG®-PM and conventional coagulation tests data. We also collected demographic, medications, blood products administered, and clinical outcome data. We defined severe platelet dysfunction as less than 50 % aggregation in response to an agonist. Results: We identified 24 out of 46 children on ECMO, who had TEG®-PM performed during the study period. We found the incidence of severe bleeding was 42%, and mortality was 54% in our study cohort. In all samples measured, severe qualitative platelet dysfunction was more common for adenosine diphosphate (ADP)-mediated aggregation (92%) compared to arachidonic acid (AA)-mediated aggregation (75%), (p=0.001). Also, ADP-mediated percent of platelet aggregation was significant lower than AA-mediated platelet aggregation (15% [IQR 2.8-48] vs 49% [IQR 22-82.5], p<0.001). There was no difference in kaolin-activated heparinase TEG® parameters between the bleeding group and the non-bleeding group. Only absolute platelet count and TEG®-PM had increased predictive value on receiver operating characteristics analyses for severe bleeding and mortality compared to ACT. Conclusions: We found frequent and severe qualitative platelet dysfunction on TEG®-PM testing in children on ECMO. Larger studies are needed to determine if the assessment of qualitative platelet function by TEG®-PM can improve prediction of bleeding complications for children on ECMO

Near-surface mean and gust wind speeds in ERA5 across Sweden: towards an improved gust parametrization

The ERA5 reanalysis product has been compared with hourly near-surface wind speed and gust observations across Sweden for 2013–2017. ERA5 shows closer agreement than the previous ERA-Interim reanalysis with regard to both mean wind speed and gust measurements, although signifcant discrepancies are still found for inland and mountainous regions. Therefore, attempts have been made to improve formulations of the gust parametrization used in ERA5 by adding an elevationdependency and by adjusting the convective gust contribution. Major improvements, especially over mountain regions, are achieved when the elevation diferences among the stations are considered. Closer agreement between the observed and parametrized gusts is reached when the convective gust contribution is also tuned. The newly designed gust parametrization was also tested for Norway, which is characterized by more complex topography. Wind gusts from the selected Norwegian stations are more realistically simulated when both the elevation-dependency and the tuned convective contribution are implemented, although the parametrized gusts are still negatively biased. Such biases are not explained by the diferent in gust duration in recorded wind gusts between Sweden and NorwayPeer reviewe

Near-surface mean and gust wind speed in ERA5 across Sweden: towards and improved gust parametrization

Trabajo presentado en EGU General Assembly, celebrada en modalidad virtual del 4 al 8 de mayo de 2020.Driven by the twenty-century surface air temperature rise, extreme wind events could change in their frequency and magnitude of occurrence, with drastic impacts on human and ecosystems. As a matter of fact, windstorms and extreme wind conditions contribute to more than half of the economic losses associated with natural disasters in Europe. Across Scandinavia, the occurrence of wind gust events can affect aviation security, as well as damage buildings and forests, representing severe hazards to people, properties and transport. Comprehensive extreme wind datasets and analysis can help improving our understanding of these changes and help the society to cope with these changes. Unfortunately, due to the difficulty in measuring wind gust and the lack of homogeneous and continuous datasets across Sweden, it is challenging to assess and attribute their changes. Global reanalysis products represent a potential tool for assessing changes and impact of extreme winds, only if their ability in representing observed near-surface wind statistics can be demonstrated. In this study the new ERA5 reanalysis product has been compared with hourly near-surface wind speed and gust observations across Sweden for 2013-2017. We found that ERA5 shows better agreement with both mean wind speed and gust measurements compared to the previous ERAInterim reanalysis dataset. Especially across coastal regions, ERA5 has a closer agreement with observed climate statistics. However, significant discrepancies are still found for inland and highaltitude regions. Therefore, the gust parametrization used in ERA5 is further analyzed to better understand if the adopted gust formulation matches the physical processes behind the gust occurrence. Finally, an improved formulation of the gust parametrization is developed across Sweden and further tested for Norway, which is characterized by more complex topography

Oral TNFα Modulation Alters Neutrophil Infiltration, Improves Cognition and Diminishes Tau and Amyloid Pathology in the 3xTgAD Mouse Model.

Cytokines such as TNFα can polarize microglia/macrophages into different neuroinflammatory types. Skewing of the phenotype towards a cytotoxic state is thought to impair phagocytosis and has been described in Alzheimer's Disease (AD). Neuroinflammation can be perpetuated by a cycle of increasing cytokine production and maintenance of a polarized activation state that contributes to AD progression. In this study, 3xTgAD mice, age 6 months, were treated orally with 3 doses of the TNFα modulating compound isoindolin-1,3 dithione (IDT) for 10 months. We demonstrate that IDT is a TNFα modulating compound both in vitro and in vivo. Following long-term IDT administration, mice were assessed for learning & memory and tissue and serum were collected for analysis. Results demonstrate that IDT is safe for long-term treatment and significantly improves learning and memory in the 3xTgAD mouse model. IDT significantly reduced paired helical filament tau and fibrillar amyloid accumulation. Flow cytometry of brain cell populations revealed that IDT increased the infiltrating neutrophil population while reducing TNFα expression in this population. IDT is a safe and effective TNFα and innate immune system modulator. Thus small molecule, orally bioavailable modulators are promising therapeutics for Alzheimer's disease