Marked activation of complement and leukocytes and an increase in the concentrations of soluble endothelial adhesion molecules during cardiopulmonary resuscitation and early reperfusion after cardiac arrest in humans

OBJECTIVE: Animal studies have demonstrated that reperfusion disorders occurring after cardiac arrest affect outcome. Reperfusion injury can be caused by activation of complement, polymorphonuclear leukocytes (PMN), and PMN-endothelial interaction. We studied different specific markers of these processes during and after cardiopulmonary resuscitation in humans. DESIGN: Prospective clinical trial. SETTING: University hospital. PATIENTS: A total of 55 patients who underwent out-of-hospital cardiopulmonary resuscitation for nontraumatic causes. INTERVENTIONS: Blood samples were drawn immediately, 15 mins, and 30 mins after initiation of cardiopulmonary resuscitation. In the case of restoration of spontaneous circulation, additional blood samples were taken at serial time points until 7 days after cardiac arrest. MEASUREMENTS AND MAIN RESULTS: A marked activation of complement and PMN was found in all patients investigated. Serum concentrations of specific activation markers of the complement system, anaphylatoxin C3a and the soluble membrane attack complex SC5b-9, and PMN elastase were increased during cardiopulmonary resuscitation and for 相似文献   

Indikationen für kardiovaskul?re Magnetresonanztomographie

Zusammenfassung   Die kardiovaskuläre Magnetresonanztomographie (CMR) hat sich von einem Nischenverfahren zur Darstellung angeborener Herzfehler, zur Diagnostik großer Gefäße sowie zur Untersuchung von Perikard und Tumoren zu einem breit nutzbaren, hochgradig genauen und schnellen Untersuchungsverfahren entwickelt. Neue Indikationen finden sich insbesondere im Bereich der ischämischen Herzerkrankungen, für deren Erkennung Dobutamin-Stress, Adenosin-Perfusion, Narben- und Vitalitätsdarstellung und zunehmend auch die Koronararteriendarstellung durchgeführt werden können.     

Estimation of choroid perfusion by colour Doppler imaging vs. other methods

Ocular haemodynamics play a prominent role in several ocular diseases. Recently, new methods for the determination of ocular perfusion were developed. Colour Doppler imaging (CDI) of orbital vessels has come up in the past decade and was shown to be useful in ophthalmological diagnostics. Little is known about measurement of choroid perfusion by CDI in comparison with other methods. Therefore, 49 eyes were examined with CDI, laser Doppler flowmetry (LDF) and the method of Langham (LOBF). Correlations between the methods were identified by the Spearman correlation coefficient (r). LDF readings correlated with time-averaged mean velocity assessed by CDI in the long posterior ciliary artery (r = 0.47; p = 0.039; n = 20), but not in the short posterior ciliary artery. LOBF measurements correlated with pulsatility index (PI) of CDI in short (r = 0.50; p = 0.005; n = 30) and long posterior ciliary arteries (r = 0.41; p = 0.024; n = 30). Methods strengthened each other by partial correlation. The study demonstrates that CDI allows a more detailed insight into ocular perfusion.     

Evaluation of New Software for Angiographic Determination of Right Ventricular Volumes

Objectives: The scope of the study was to evaluate a recent software for angiographic volume determination as compared to cardiovascular magnetic resonance imaging. Background: A new right ventricular analysis software closes a diagnostic gap in quantitative angiography. Cardiovascular magnetic resonance imaging short axis multi slice summation is a validated reference standard. Methods: Right ventricular angiograms were acquired in frontal and lateral projection in 15 pediatric and 17 adult patients. Additional angiograms were acquired in RAO30°/LAO60° projections in 10 adult patients. The tested models comprised area length with different regressions, multi-slice with different regressions, Boak, and pyramid method. Original regressions were used to calculate angiographic right ventricular volume. Right ventricular reference volumes were determined by multi-slice summation from cardiac magnetic resonance short-axis images. Results: Mean inter-observer difference was −1 ml (95% confidence: −35–34 ml) and mean intra-observer difference was 0 ml (95% confidence: −22–22 ml). There was no significant difference (4 ml, 95% confidence: −22–30 ml) between geometric calibration and calibration by a sphere. The area length and multi-slice models demonstrated the best agreement with the cardiac magnetic resonance reference. Performance was best for the Onnasch Lange models. Conclusion: The evaluated software provides acceptably accurate volume estimates for the majority of ventricles. In a few cases larger errors may occur, however. The area length and multi-slice models preferably with Onnasch Lange regressions may be recommended. Inter- and intra-observer agreement were excellent. Geometric calibration using data from DICOM header files may be used.     

Color-Encoded Semiautomatic Analysis of Multi-Slice First-Pass Magnetic Resonance Perfusion: Comparison to Tetrofosmin Single Photon Emission Computed Tomography Perfusion and X-Ray Angiography

BACKGROUND AND PURPOSE: Cardiovascular magnetic resonance (CMR) perfusion can accurately detect coronary artery disease (CAD). However, the absence of efficient, easy-to-use and reliable image analysis software is an obstacle to its introduction into clinical practice. The aim of this study was to evaluate new color-encoded semiautomatic software for analysis of first-pass CMR perfusion in comparison to tetrofosmin myocardial single photon emission computed tomography (SPECT), using X-ray angiography as the standard of truth for the detection of CAD. METHODS: Thirty-two patients underwent both SPECT and CMR perfusion at rest and adenosine stress. Twenty of these patients also underwent X-ray angiography. Off-line CMR image analysis consisted of six steps to generate a color display of the myocardial perfusion reserve index (MPRI). The MPRI color-maps were analyzed visually and compared to SPECT. RESULTS: In comparison to X-ray angiography overall accuracy was 87% for CMR and 77% for SPECT perfusion to detect significant CAD (stenosis > or =70%). In comparison with SPECT sensitivity was 80%, specificity 91%, and the overall agreement 89% for CMR. CONCLUSIONS: Post-processing of CMR perfusion data using new semiautomatic software to generate and display the MPRI visually as color-encoded images is feasible and fast. In this study it yielded higher accuracy than SPECT to detect significant CAD on X-ray angiography. Correlation between SPECT and CMR accuracy for detection of perfusion defects was high. This method may accelerate the time-consuming analysis of CMR perfusion data, thus enabling a more widespread clinical utility.     

COVID-19 myocarditis and prospective heart failure burden

ABSTRACT

Introduction: COVID-19 is causing considerable morbidity and mortality worldwide. Serious respiratory complications aside, the heart is also frequently involved. The mechanisms and the extent of the myocardial injury, along with the short and long-term cardiovascular (CV) outcomes in COVID-19 survivors remain unclear.

Areas covered: myocardial injury has been found in a considerable proportion of hospitalized COVID-19 patients and is associated with a worse prognosis. The late onset of CV complications with myocarditis-like changes revealed by CMR has been reported in COVID-19 survivors. Previous observational studies on viral myocarditis provide evidence of a significant incomplete recovery with residual dysfunction and remodeling of left ventricle. Incomplete recovery is thought to be the result of persistent myocardial inflammation due to a post-viral autoimmune response. Considering the significant inflammatory nature of COVID-19, COVID-19 survivors may be at risk of developing persistent residual myocardial injury, the sequelae of which are unclear.

Expert commentary: COVID-19 is an emerging threat for the heart. The extent of CV injury, along with the short and long-term sequelae, requires further investigation. The early detection of residual myocardial changes in COVID-19 survivors is of utmost importance in order to identify those patients at risk of CV complication development.     

Increased cortisol levels and anticholinergic activity in cognitively unimpaired patients

Increased patients' serum anticholinergic activity (SAA) is described as a marker of cognitive dysfunction and can be influenced by different exogenous and endogenous factors. The role of cortisol in relation to SAA and cognition in perioperative conditions has not been investigated so far. In 30 men scheduled for urological surgery, the authors determined SAA and cortisol levels in blood and CSF and conducted neuropsychological testing in two subgroups with comparable pre- and intraoperative characteristics, one group with low SAA (mean=2.4 [SD=0.9], n=23) and the other with high SAA (mean=5.1 [SD=2.4], n=7) values. Increased SAA was associated with two times the number of anticholinergic medications but not with patients' age, medical history or impaired cognition. A significant linear correlation was detected between anticholinergic activities and cortisol levels. Thus, endogenous factors such as patients' stress levels should be taken into account for interpretation of the role of SAA.     

Readthrough of nonsense mutations in Rett syndrome: evaluation of novel aminoglycosides and generation of a new mouse model

Thirty-five percent of patients with Rett syndrome carry nonsense mutations in the MECP2 gene. We have recently shown in transfected HeLa cells that readthrough of nonsense mutations in the MECP2 gene can be achieved by treatment with gentamicin and geneticin. This study was performed to test if readthrough can also be achieved in cells endogenously expressing mutant MeCP2 and to evaluate potentially more effective readthrough compounds. A mouse model was generated carrying the R168X mutation in the MECP2 gene. Transfected HeLa cells expressing mutated MeCP2 fusion proteins and mouse ear fibroblasts isolated from the new mouse model were treated with gentamicin and the novel aminoglycosides NB30, NB54, and NB84. The localization of the readthrough product was tested by immunofluorescence. Readthrough of the R168X mutation in mouse ear fibroblasts using gentamicin was detected but at lower level than in HeLa cells. As expected, the readthrough product, full-length Mecp2 protein, was located in the nucleus. NB54 and NB84 induced readthrough more effectively than gentamicin, while NB30 was less effective. Readthrough of nonsense mutations can be achieved not only in transfected HeLa cells but also in fibroblasts of the newly generated Mecp2 ^R168X mouse model. NB54 and NB84 were more effective than gentamicin and are therefore promising candidates for readthrough therapy in Rett syndrome patients.     

Do short-stemmed-prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs

Introduction  The causes of periprosthetic fractures of the femur due to the design of the prosthesis and the individual parameters of the patient are unexplored. By different anchorage techniques in cementless total hip arthroplasties, it is assumed that there are various load limits of the implant’s bearing femur. Materials and methods  In the present study, we compared a standard hip stem (cementless Spotorno^?) and a short-stemmed design (Mayo^?) by an artificial reproduction of periprosthetic fractures in 20 femur specimens. Results  The measured fracture loads showed an extensive range, with higher maximum loads in the standard stem group. The bone mineral density and the subsiding pattern of the standard stems showed a significant correlation to the incidence of the periprosthetic fractures. In the experimental setup, a slightly lower fracture resistance was shown for the short-stemmed prosthesis. Additionally, it was shown that donors with a higher body mass index had a significantly increased fracture risk. Conclusions  Short-stemmed prostheses, especially the Mayo^? hip, do not constitute a higher fracture risk. In general, an increased body mass index among patients with a cementless hip stem is associated with an increased fracture risk, particularly at high load values, i.e., resulting from a step during stumbling. Taking into account the ascertained results, the danger of provoking a femoral periprosthetic fracture can be reduced.