Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

BackgroundThe recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day. MethodsAccordingly, we evaluated 5026 first kidney transplant recipients from deceased heart-beating donors. In a cause-specific multivariable analysis, we compare delayed graft function (DGF) and graft survival according to the time of kidney clamping and declamping. Participants were divided into clamping between midnight and noon (AM clamping group, 65%) or clamping between noon and midnight (PM clamping group, 35%), and similarly, AM declamping or PM declamping (25% / 75%). ResultsDGF occurred among 550 participants (27%) with AM clamping and 339 (34%) with PM clamping (adjusted OR = 0.81, 95%CI: 0.67 to 0.98, p= 0.03). No significant association of clamping time with overall death censored graft survival was observed (HR = 0.92, 95%CI: 0.77 to 1.10, p= 0.37). No significant association of declamping time with DGF or graft survival was observed. ConclusionsClamping between midnight and noon was associated with a lower incidence of DGF whilst the declamping time was not associated with kidney graft outcomes.

Beating pulmonary vein sign during catheter ablation

The beating of a pulmonary vein during cardiac catheterization is a rare phenomenon caused by the heart beating through the pericardial effusion when a cardiac tamponade occurs. This “beating pulmonary vein” sign is useful for early detection of a tamponade before circulatory collapse occurs.

Connecting different heart diseases through intercellular communication

ABSTRACT Well-orchestrated intercellular communication networks are pivotal to maintaining cardiac homeostasis and to ensuring adaptative responses and repair after injury. Intracardiac communication is sustained by cell–cell crosstalk, directly via gap junctions (GJ) and tunneling nanotubes (TNT), indirectly through the exchange of soluble factors and extracellular vesicles (EV), and by cell–extracellular matrix (ECM) interactions. GJ-mediated communication between cardiomyocytes and with other cardiac cell types enables electrical impulse propagation, required to sustain synchronized heart beating. In addition, TNT-mediated organelle transfer has been associated with cardioprotection, whilst communication via EV plays diverse pathophysiological roles, being implicated in angiogenesis, inflammation and fibrosis. Connecting various cell populations, the ECM plays important functions not only in maintaining the heart structure, but also acting as a signal transducer for intercellular crosstalk. Although with distinct etiologies and clinical manifestations, intercellular communication derailment has been implicated in several cardiac disorders, including myocardial infarction and hypertrophy, highlighting the importance of a comprehensive and integrated view of complex cell communication networks. In this review, I intend to provide a critical perspective about the main mechanisms contributing to regulate cellular crosstalk in the heart, which may be considered in the development of future therapeutic strategies, using cell-based therapies as a paradigmatic example. This Review has an associated Future Leader to Watch interview with the author.

What is Interoception and Why is it Important?

What is the word for the sense of signals that come from inside your body, such as feeling your heart beating and your breathing, or knowing when you are hungry? This is called interoception. Interoception is one of our senses, like vision, hearing, taste, smell, and touch. In this article, we talk about what interoception is and how information about these feelings is sent from the body to the brain. We will also talk a little about how interoception is measured and the different types of interoception. Finally, we will discuss why interoception might be important for things like recognising emotions in ourselves and in other people, our physical and mental health, and why understanding how interoception changes throughout our lives might help us to understand where differences in interoception across different people come from.

Deep Neural Network Based Real Time Multi-Class Arrhythmia Classification in IoT-Cloud Platform

An arrhythmia is a condition which represents irregular beating of the heart, beating of the heart too fast, too slow, or too early compared to a normal heartbeat. Diagnosis of various cardiac conditions can be done by the proper analysis, detection, and classification of life-threatening arrhythmia. Computer aided automatic detection can provide accurate and fast results when compared with manual processing. This paper proposes a reliable and novel arrhythmia classification approach using deep learning. A Deep Neural Network (DNN) with three hidden layers has been developed for arrhythmia classification using MIT-BIH arrhythmia database. The network classifies the input ECG signals into six groups: normal heartbeat and five arrhythmia classes. The proposed model was found to be very promising with an accuracy of 99.45 percent. The real time signal classification and the application of internet of things (IOT) are the other highlights of the work.

Donor organ management

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead 'heart-beating donors', referred to as DBD (donation after brain death), and the warm ischaemic 'non-heart-beating donors', referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.