scholarly journals Reversible Acute Fontan Circulation Failure Secondary to Retroconducted Junctional Rhythm. Clinical Echocardiographic Correlation

2021 ◽  
Author(s):  
Paolo Ferrero ◽  
Isabelle Piazza ◽  
Youcef Sadou ◽  
Matteo Ciuffreda
Keyword(s):  
Heart Rate ◽  
Critical Role ◽  
Circadian Variation ◽  
Fontan Circulation ◽  
Atrial Pacing ◽  
Junctional Rhythm ◽  
Echocardiographic Evaluation ◽  
Low Threshold

Abstract Background: Sequential atrioventricular activation plays a critical role in the physiology of Fontan circulation. Although bradycardia is usually well tolerated, retroconducted junctional rhythm may acutely increase atrial pressure impairing cardiac output. Echocardiographic evaluation can reveal clues of this hemodynamic condition. The clinical impact of arrhythmic disturbance on the follow up of patients who had undergone total cavo-pulmonary connection is well recognized but the role of, transient periods of retroconducted junctional rhythm on the immediate post-operative course is less defined. Case presentation: We describe two cases of acute Fontan circulatory failure due to postoperative retroconducted escaping junctional rhythm despite an adequate heart rate and circadian variation. The patients rapidly improved after atrial pacing, allowing discharge with a minimal dose of diuretic.Conclusion: In the absence of any hemodynamic target, hearth rhythm should be systematically checked after TCPC irrespective of adequacy of heart rate. Likewise, efficiency of temporary atrial pacing should be granted and surgeons should have a low threshold for epicardial lead implantation.

scholarly journals Reversible acute Fontan circulation failure secondary to retrogradely conducted junctional rhythm: clinical echocardiographic correlation

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Paolo Ferrero ◽  
Isabelle Piazza ◽  
Youcef Sadou ◽  
Matteo Ciuffreda
Keyword(s):  
Heart Rate ◽  
Critical Role ◽  
Circadian Variation ◽  
Fontan Circulation ◽  
Atrial Pacing ◽  
Junctional Rhythm ◽  
Echocardiographic Evaluation ◽  
Escape Rhythm ◽  
Low Threshold

Abstract Background Sequential atrioventricular activation plays a critical role in the physiology of Fontan circulation. Although bradycardia is usually well tolerated, retrogradely conducted junctional rhythm may acutely increase atrial pressure impairing cardiac output. Echocardiographic evaluation can reveal clues of this hemodynamic condition. The clinical impact of arrhythmic disturbance on the follow up of patients who had undergone total cavo-pulmonary connection is well recognized but the role of, transient periods of retrogradely conducted junctional rhythm on the immediate post-operative course is less defined. Case presentation We describe two cases of acute Fontan circulatory failure due to postoperative retrogradely conducted junctional escape rhythm despite an adequate heart rate and circadian variation. The patients rapidly improved after atrial pacing, allowing discharge with a minimal dose of diuretic. Conclusion In the absence of any hemodynamic target, hearth rhythm should be systematically checked after TCPC irrespective of adequacy of heart rate. Likewise, efficiency of temporary atrial pacing should be granted and surgeons should have a low threshold for epicardial lead implantation.

scholarly journals Reduced Flow-Mediated Dilatation Is Not Related to COVID-19 Severity Three Months after Hospitalization for SARS-CoV-2 Infection

2021 ◽  
Vol 10 (6) ◽  
pp. 1318
Author(s):  
Marianne Riou ◽  
Walid Oulehri ◽  
Cedric Momas ◽  
Olivier Rouyer ◽  
Fabienne Lebourg ◽  
...  
Keyword(s):  
Vascular Endothelium ◽  
Matched Control ◽  
Acute Infection ◽  
Critical Role ◽  
Lung Damage ◽  
Vascular Effect ◽  
Flow Mediated Dilatation ◽  
Artery Flow

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly worldwide, with more than two million deaths. Evidence indicates the critical role of the vascular endothelium in its pathophysiology but, like potential changes in functional vasodilation, the vascular effect of SARS-CoV-2 at a given distance from the acute infection is largely unknown. We assessed brachial artery flow-mediated dilatation (FMD) in 27 COVID-19 patients needing conventional or intensive care unit hospitalization, three months after SARS-CoV-2 infection diagnosis and in nine age- and sex- matched control subjects. Interestingly, the FMD was lower in COVID-19 patients as compared to controls (8.2 (7.2–8.9) vs. 10.3 (9.1–11.7)); p = 0.002, and half of the hospitalized COVID-19 survivors presented with a reduced FMD < 8% at three months of COVID-19 onset. Impaired FMD was not associated with severe or critical SARS-CoV-2 infection, reflected by ICU hospitalization, total hospitalization duration, or severity of lung damage. In conclusion, reduced FMD is often observed even three months after hospitalization for SARS-CoV-2 infection, but such alteration predominantly appears to not be related to COVID-19 severity. Longer and larger follow-up studies will help to clarify the potential prognosis value of FMD among COVID-19 patients, as well as to further determine the mechanisms involved.

scholarly journals Role of Echocardiography in Takotsubo Cardiomyopathy

2016 ◽  
Vol 5 ◽  
Author(s):  
Ming-Jui Hung
Keyword(s):  
Speckle Tracking Echocardiography ◽  
Contractile Function ◽  
Font Size ◽  
Initial Impression ◽  
Echocardiographic Evaluation ◽  
Muscular Function ◽  
Geometric Changes ◽  
Serial Evaluation

Cardiac imaging is the key to make an initial impression of TC and follow-up images confirms the diagnosis of TC. Because of the availability and feasibility in acute medical care, echocardiography plays an important role in the assessment of patients with TC. <span style="font-size: 10px;">The diagnosis of TC needs serial echocardiographic evaluation. The ejection fraction is geometric changes of ventricle rather than contractile function measurements of myocardium. Therefore, it is suggested that standard echocardiography combined with 2-dimensional speckle-tracking echocardiography should be used to evaluate cardiac muscular function especially in TC because the diagnosis needs serial evaluation.</span>

scholarly journals No difference in learning retention in manikin-based simulation based on role

2016 ◽  
Vol 30 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Dominic Giuliano ◽  
Marion McGregor DC
Keyword(s):  
Repeated Measures ◽  
Critical Role ◽  
Learning Retention ◽  
Time Points ◽  
Repeated Measures Analysis ◽  
Significant Difference ◽  
Simulation Based ◽  
Data Points

Objective: We evaluated learning retention in interns exposed to simulation. It was hypothesized that learning would degrade after 6 months and there would be a difference in retention between interns who played a critical role versus those who did not. Methods: A total of 23 groups of 5 to 9 interns underwent a cardiac scenario twice during 1 simulation experience and again 6 months later. We captured 69 recordings (23 before debrief at baseline [PrDV], 23 after debrief at baseline [PoDV], and 23 at 6-month follow-up [FUV]). Students were assigned different roles, including the critical role of “doctor” in a blinded, haphazard fashion. At 6-month follow-up, 12 interns who played the role of doctor initially were assigned that role again, while 11 interns who played noncritical roles initially were newly assigned to doctor. All videos of intern performance were scored independently and in a blinded fashion, by 3 judges using a 15-item check list. Results: Repeated-measures analysis of variance for interns completing all 3 time points indicated a significant difference between time points (F2,22 = 112, p = .00). Contrasts showed a statistically significant difference between PrDV and PoDV (p = .00), and PrDV and FUV (p = .00), but no difference between PoDV and FUV (p = .98). This was consistent with results including all data points. Checklist scores were more than double for PoDV recordings (16) and FUV (15), compared to PrDV recordings (6.6). Follow-up scores comparing old to new doctors showed no statistically significant difference (15.4 vs 15.2 respectively, t21 = 0.26, p = .80, d = .11). Conclusions: Learning retention was maintained regardless of role.

Perceptions of Smoking and Nonsmoking Peers: The Value of Smoker and Nonsmoker Prototypes in Predicting Smoking Onset and Regular Smoking Among Adolescents

2006 ◽  
Vol 34 (6) ◽  
pp. 897-910 ◽  
Author(s):  
Renske Spijkerman ◽  
Regina J. J. M. Van Den Eijnden ◽  
Rutger C. M. E. Engels
Keyword(s):  
Logistic Regression ◽  
High Schools ◽  
Critical Role ◽  
Smoking Behavior ◽  
Regression Analyses ◽  
Smoking Onset ◽  
Reported Data ◽  
Additional Role

Adolescents' perceptions of persons their age who smoke cigarettes (also known as prototypes of smoking peers) play a critical role in an adolescent's decision to start smoking. However, adolescents' perceptions of their peers who do not smoke (prototypes of nonsmoking peers) could be implicated in adolescents' smoking decisions as well. In the present study, the authors examined the additional role of nonsmoker prototypes in adolescents' smoking onset and regular smoking. At seven high schools, Dutch students ( n = 1,035) between the ages of 12 and 15 years who were attending the eighth grade provided self-reported data on their smoker and nonsmoker prototypes and smoking behavior during a baseline and 6-month follow-up measurement. Logistic regression analyses showed that both smoker and nonsmoker prototypes assessed at Time 1 predicted smoking onset by Time 2 among nonsmoking adolescents. However, only nonsmoker prototypes predicted regular smoking among adolescents who smoked occasionally at baseline.

Critical Role of IL-8 Targeting in Gliomas

2018 ◽  
Vol 25 (17) ◽  
pp. 1954-1967 ◽  
Author(s):  
Marinos Kosmopoulos ◽  
Anthos Christofides ◽  
Dimitrios Drekolias ◽  
Phaedon D. Zavras ◽  
Antonios N. Gargalionis ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Molecular Mechanisms ◽  
Critical Role ◽  
Response To Therapy ◽  
Molecular Pathways ◽  
Cns Disorders ◽  
Potential Biomarker

Background: Glioma is a heterogeneous, highly complicated central nervous system (CNS) tumor with uncertain mechanism of initiation and progression, resulting in an unfavorable outcome. An extended network of cytokines is recognized as a major regulator of glioma pathogenesis, either promoting or inhibiting glioma progression based on their type and specificity. Interleukin-8 (IL-8) has been revealed as a critical regulator of CNS function and development with participation in many CNS disorders including gliomas. Objective: The aim of the present review is to address the role of IL-8 in glioma pathogenesis focusing on the implicated molecular pathways as well as on its potential targeting for glioma therapy. Methods and Results: PubMed-Medline, SCOPUS, and Google Scholar databases were searched for pre-clinical and clinical studies related to IL-8 implication in gliomagenesis and IL-8 targeting strategies for gliomas. Literature data indicate that IL-8 participates in glioma angiogenesis and cell migration and it can serve as a potential biomarker, for early diagnosis, follow-up and response to therapy. Conclusion: Several promising approaches that target directly or indirectly IL-8 effects in gliomas are currently in progress while more-in-depth studies are needed to validate its biomarker role and elucidate the underlying molecular mechanisms.

scholarly journals The Role of Additional K-Wires on AO Type C Distal Radius Fracture Treatment with External Fixator in Young Population

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Ivan Micic ◽  
Erica Kholinne ◽  
Yucheng Sun ◽  
Jae-Man Kwak ◽  
In-Ho Jeon
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
External Fixator ◽  
Critical Role ◽  
Radius Fracture ◽  
Significant Difference ◽  
Type C ◽  
K Wires

Objectives. Several methods have been proposed to treat AO type C distal radius fracture. External fixator has gained popularity for its simple procedure and rapid recovery. Some surgeons suggested that additional K-wires may play a critical role in the outcome. The purpose of study is to evaluate the role of additional K wires in treating distal radial fracture with external fixator regarding its outcome. Material and Methods. From January 2006 to January 2010, 40 patients with AO type C distal radius fracture were treated with external fixator, with (EF) or without additional K wires (EFK). Radiologic outcome parameters include radial inclination, volar tilt, radial length, and the presence of radiocarpal arthritis according to Knirk and Jupiter. Clinical outcomes include New York Orthopedic Hospital (NYOH) wrist scoring scale. Results. Radiographic outcome showed significant difference in regard of articular congruency at the final follow-up with the EFK group showing the advantage in maintaining the articular incongruity. NYOH wrist scoring scale showed no significant difference between both groups at final follow-up. The amount of articular step-off was less in EFK group with significant statistical finding on the final follow up. Conclusion. Both EF and EFK technique were able to provide satisfactory result in treating AO type C distal radius fractures. We observed that EFK is superior in reducing the number of radiocarpal arthritic changes compared to EF group due to its superiority in reducing articular step-off.

scholarly journals Response of Transitional Mixtures Retaining Memory of In-Situ Overburden Pressure Monitored Using Electromagnetic and Piezo Crystal Sensors

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2570
Author(s):  
Sang Yeob Kim ◽  
Jong-Sub Lee ◽  
Junghee Park
Keyword(s):  
Shear Wave ◽  
Shear Wave Velocity ◽  
Classification System ◽  
Critical Role ◽  
Soil Classification ◽  
Engineering Properties ◽  
Overburden Pressure ◽  
Low Threshold

The major and minor components in granular soil materials determine their properties and behavior. This study explores the transitional behavior within threshold fines fraction of soil mixtures based on the data from the literature and experiments. From the literature survey, the void ratio, shear wave velocity, compression index, and friction angle capture the transitional turning point between the low and data-adjusted high threshold fines fractions. In particular, there is a dramatic change in hydraulic conductivity below the low threshold fines fraction that highlights the critical role of small amounts of fines in the fluid flow (e.g., clogging). From an experimental study, the engineering properties of natural soil samples identified using deformation and elastic wave sensors show transitional trends within the Revised Soil Classification System framework. The evolution of compressibility and shear wave velocity indicate that either coarse, fine, or both particles are likely to contribute to large and small strain stiffnesses when the effective stress is below 400 kPa. Thereafter, both engineering properties indicate that the soil sample retains a memory of in-situ overburden pressure when the effective stress is around 400 kPa. There is a critical role of fines that are slightly higher than low threshold fines fraction on engineering properties that promote the application of Revised Soil Classification System RSCS to natural soils.

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