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Archive for category: E-News

E-News

Immunotherapy reduces cardiovascular risk in rheumatoid arthritis

, 26 August 2020/in E-News /by 3wmedia

Extra-low dose combinat ion of two anticytokines reduces disease activity and cardiovascular events Immunotherapy reduces cardiovascular risk in patients with rheumatoid arthritis, according to research presented by Professor Aida Babaeva, head of the Department of Internal Medicine, Volgograd State Medical University, Volgograd, Russia. The combination of two extralow dose anticytokine drugs reduced rheumatoid arthritis disease activity and cardiovascular events.
‘Rheumatoid arthritis is an autoimmune disease in which cytokines such as tumour necrosis factor (TNF) and interferon (IFN), which normally protect the
body, attack healthy cells,’ said Professor Babaeva. ‘Patients have painful and inflamed joints. They are also at increased cardiovascular risk, particularly if their rheumatoid arthritis is not controlled.’
Professor Babaeva’s previous research showed that treatment with anticytokine drugs can decrease the activity of rheumatoid arthritis. Extra-low dose anti-TNFα reduced levels of inflammatory mediators and cytokines including C-reactive protein (CRP), rheumatoid factor, TNF, interleukin-1 (IL-1), and interleukin-6 (IL-6). The effect was more apparent and developed earlier when patients were treated with a combination of anti-TNFα and anti-IFNγ both at extra-low doses.
The current study investigated the impact of the combination of drugs on cardiovascular events. It included 68 patients who had suffered from active rheumatoid arthritis for at least five years. Patients were randomized to receive the combination of anti-TNFα and anti-IFNγ plus standard disease-modifying therapy (38 patients) or placebo plus standard therapy (30 patients). During the three year follow up period the investigators monitored rheumatoid arthritis disease activity and cardiovascular events.
Patients taking the combination of anticytokines had a lower rheumatoid arthritis disease activity score, as measured by the DAS28,2 and more dramatic decreases in IL-1, IL-6 and TNFα than the group on standard therapy alone.
The incidence of cardiovascular events (unstable angina, severe hypertensive crisis, and deterioration of chronic heart failure) was more than double in the group on conventional disease-modifying drugs alone (37percent) compared to those also taking the combination of anticytokines (13percent).
Professor Babaeva said: ‘Our findings suggest that the decreased  rheumatoid arthritis disease activity with the combination of anticytokines translates into decreased cardiovascular risk. Rheumatoid arthritis promotes the development of cardiovascular disease in a number of ways. Therefore, decreasing disease activity may also reduce cardiovascular risk by slowing down or halting these processes.’
For example, rheumatoid arthritis is associated with dysfunction of the blood  vessel lining (called endothelium), which leads to lipid accumulation in the artery wall, plaque formation and atherosclerosis. Increased disease activity is also linked with a pro-coagulant state in which patients are more prone to blood clots and thrombosis. Patients with active disease have an increase in molecules that promote inflammation, which has been associated with an increased risk of cardiovascular disease.
In patients with hypertension, target blood pressure was reached in 71percent of those taking the combination of anticytokines compared to just 32percent of patients on standard therapy alone.
Professor Babaeva said: ‘This doesn’t mean that the two drugs directly impact on blood pressure. But the combination can improve endothelial function and it could be that blood pressure is more stable when disease activity is low.’
‘We found that the combination of two anticytokines containing extra-low doses of antibodies against TNFα and IFNγ can improve the efficacy of standard rheumatoid arthritis therapy and decrease cardiovascular risk,’ said Professor Babaeva.

European Society of Cardiology http://tinyurl.com/gny3vyg

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Cycling in bed is safe for ICU patients

, 26 August 2020/in E-News /by 3wmedia

Early bicycle exercise during their stay in a hospital intensive care unit (ICU) may help some patients recover more quickly.
Researchers at McMaster University and St. Joseph’s Healthcare Hamilton have demonstrated that physiotherapists can safely start in-bed cycling sessions with critically ill, mechanically ventilated patients early on in their ICU stay.
‘People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling two weeks into their ICU stay, they will walk farther at hospital discharge,’ says the study’s lead author Michelle Kho, an assistant professor with the School of Rehabilitation Science at McMaster University and physiotherapist at St. Joseph’s Healthcare Hamilton.
‘Our TryCYCLE study builds on this previous work and finds it is safe and feasible to systematically start in-bed cycling within the first four days of mechanical ventilation and continue throughout a patient’s ICU stay.’
Patients who survive their ICU stay are at high risk for muscle weakness and disability, and muscle atrophy and weakness starts within days of a patient’s admission to the ICU. Cycling targets the legs, especially the hip flexors, which are most vulnerable to these effects during bed rest.
By strengthening their muscles and overall health, patients may go home sooner, stronger and happier. This not only benefits the patient, but could alleviate the high cost of critical care for the healthcare system. TryCYCLE is the first of a series of studies that will determine the effects of early in-bed cycling with critically ill patients.
Over a year, Kho and her team conducted a study of 33 patients in the ICU at St. Joseph’s Healthcare Hamilton. The special in-bed cycling equipment was provided by the St. Joseph’s Healthcare Foundation.
Patients were 18 years of age or older, receiving mechanical ventilation, and walking independently prior to admission to the ICU. The treatment in the ICU was 30 minutes of supine cycling using a motorized stationary bicycle affixed to the bed, six days a week.
The researchers found that early cycling within the first four days of mechanical ventilation among patients with stable blood flow is safe and feasible. Patients started cycling within the first three days of ICU admission and cycled about 9 km on average during their ICU stay.

McMaster University http://tinyurl.com/h7bqgbv

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Remarkable recovery in patients diagnosed with newly defined movement disorder

, 26 August 2020/in E-News /by 3wmedia

Researchers from the UCL GOS Institute of Child Health have discovered a new gene change that identifies a type of the movement disorder, muscle dystonia. This new discovery will allow doctors to more easily identify patients who can benefit from treatment so effective that it can restore the ability to walk.
The team from UCL Great Ormond Street Institute of Child Health, along with colleagues at the University of Cambridge and the NIHR Rare Disease Bioresource, identified a change in a gene, called KMT2B, in 28 patients who had dystonia.

Dystonia is one of the most common movement disorders and is thought to affect 70,000 people in the UK. It can cause a wide range of disabling symptoms, including painful muscle spasms and abnormal postures, and can affect walking and speech. In most of the 28 cases, the patients – many of whom were young children who were thought to have a diagnosis of cerebral palsy – were unable to walk.

For some patients, treatment with Deep Brain Stimulation, in which electrical impulses are delivered to a specific area in the brain, either restored or significantly improved independent walking and improved hand and arm movement. In one patient, improvements have been sustained over six years.

Given the findings, the team now suggest that testing for these changes in the gene should form part of standard testing for patients with dystonia. This will allow the most effective treatment to be offered to patients early on.

Dr Manju Kurian, paediatric neurologist at Great Ormond Street Hospital and lead researcher on the paper, says ‘Through DNA sequencing, we have identified a new genetic movement disorder that can be treated with Deep Brain Stimulation. This can dramatically improve the lives of children with the condition and enable them to have a wider range of movement with long-lasting effects,’

‘Remarkably nearly all patients who had Deep Brain Stimulation showed considerable improvements. One patient was able to walk independently within two weeks; in five patients, the improvement has lasted for more than three years. It is an astounding result.’

Former GOSH patient, Dominika, aged 21, was diagnosed with dystonia when she was 13 and had deep brain stimulation treatment two years ago:

When I was young I was able to speak and write normally but I started to have problems with walking when I was about 10. By the time I was 11 or 12, my walking had got worse and I started to notice my writing and speech was deteriorating.
Throughout high school, I had lots of different tests to try and find out what was wrong with me and I first came to GOSH just after my 13th birthday. They gave me lots more tests and told me that I had a type of dystonia which means my muscles aren’t working properly and I can’t move my body as well as I should.

By the time I got to the last year in high school, I was finding walking very difficult and so I started using a wheelchair because it was easier and less painful.

I was given a drug treatment for my dystonia but it didn’t seem to be making things much better so when I was 19, I was offered deep brain stimulation surgery.

Since the operation, life has been good and the surgery has really changed things for me. It has allowed me to walk around mostly unaided. I have seen a big difference with my hands – I can now write and draw, something I wasn’t able to do before. Now, I just do physiotherapy exercises at home to keep my movement as strong as possible. This has meant that I have been able to go to university and I am currently in my final year studying Computer Game Art. I get to practise my drawing using traditional and digital media, and hopefully one day I can get a job doing the two things I love best, drawing and playing video games.

Great Ormond Street Hospital for Children www.gosh.nhs.uk/news/latest-press-releases/2016-press-releases/remarkable-recovery-patients-diagnosed-newly-defined-movement-disorder-0

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Novel imaging technique with potential for medical diagnostics

, 26 August 2020/in E-News /by 3wmedia

A unique new imaging method, called ‘polarized nuclear imaging’ – combining powerful aspects of both magnetic resonance imaging and gamma-ray imaging and developed by physicists in the University of Virginia’s departments of Physics and Radiology – has potential for new types of high-resolution medical diagnostics as well as industrial and physics research applications.
‘This method makes possible a truly new, absolutely different class of medical diagnostics,’ said Wilson Miller, who, along with his colleague Gordon Cates, directed the research. ‘We’re combining the advantages of using highly detectable nuclear tracers with the spectral sensitivity and diagnostic power of MRI techniques.’
‘We have demonstrated the feasibility of the new technique by producing a proof-of-principle image in a manner never before accomplished,’ Cates said. ‘In our technique, rather than imaging protons in water, as in MRI, we image a radioactive isotope of xenon that has been polarized using laser techniques.’
Cates and his colleagues believe that the technique, once refined, could provide a new, relatively inexpensive way to visualize the gas space of the lungs by having patients inhale a gas containing the isotopes and using PNI to produce an image. The method likewise might work to image targeted areas of the body by injecting isotopes into the bloodstream. Because the technique would use such small quantities of tracer material, when it comes to medical use, the radioactivity would pose little to no danger to people.
MRI, is effective because it uses a variety of contrast mechanisms to sort out specific characteristics in an image. And highly sensitive gamma-ray detectors can resolve minuscule amounts of radioactive tracer material, key to homing in on points of particular interest.
The new UVA technique uses magnetic resonance to obtain the spatial information, and then collects image information by detecting gamma rays produced by the tracer material – an isotope of xenon Xe-131m, which is a by-product of Iodine 131 (used for treatment of thyroid problems).
‘Unlike MRI, which detects faint radio waves, we detect gamma rays that are emitted from the xenon isotope,’ Cates said. ‘Since it is possible to detect a gamma ray from even a single atom, we gain an enormous increase in imaging sensitivity, and dramatically reduce the amount of material needed for performing magnetic-resonance techniques.’
As an example, had Cates and Miller filled their imaging subject – in this case a small glass cell shaped like the Chinese symbol for the word ‘middle’ – with water rather than the radioactive isotope, they would have needed about 10 billion times more water molecules than the number of isotope atoms they used to achieve the same image quality.
This means that with minute quantities of material, they can achieve detailed imagery using magnetic-resonance techniques that would otherwise be
impossible using a radioactive tracer.
The authors note that considerable work still needs to be done to demonstrate the utility of the new technique in living subjects, but the unique approach ‘represents an exciting new technology.’
To develop it for practical use, the researchers say they would need to increase the size of the detectors or the amounts of tracer material, and they are seeking alternative radioactive isotopes that would retain their polarization once inside a living subject.

University of Virginia http://tinyurl.com/zpobeo7

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New method reduces adverse effects of rectal cancer treatment

, 26 August 2020/in E-News /by 3wmedia

A new study from Karolinska Institutet shows that short-course preoperative radiotherapy combined with delayed surgery reduces the adverse side-effects of rectal cancer surgery without compromising its efficacy.

Rectal cancer affects some 2,000 men and women in Sweden every year. Preoperative radiotherapy was gradually introduced in the early 1990s, with a consequent improvement in prognosis for people with rectal cancer and reduction in the risk of local recurrence.

‘Back then we showed that preoperative radiotherapy reduces the risk of local recurrence by over 50 per cent for patients with rectal cancer,’ says principal investigator Anna Martling, senior consultant surgeon and professor at Karolinska Institutet’s Department of Molecular Medicine and Surgery. ‘Thanks to our results, radiotherapy is recommended to many rectal cancer patients.’
However, radiotherapy can cause adverse reactions and the optimal radiotherapeutic method and the interval between it and the ensuing surgery have been mooted.

The study is based on the claim that the adverse effects of rectal cancer treatment can be reduced by administering more but lower doses of radiation for a longer time, or by increasing the interval between radiotherapy and surgery. These hypotheses have now been tested in a study in which rectal cancer patients were randomly assigned to three different treatment arms:

  • Standard therapy, i.e. short-course (5×5 Gy) radiotherapy with direct surgery within a week.
  • Delayed surgery with short-course (5×5 Gy) radiotherapy followed by surgery after 4-8 weeks.
  • Delayed surgery with long-course (25×2 Gy) radiotherapy followed by surgery after 4-8 weeks.

The results of the study show that patients with delayed surgery develop fewer complications with equally good oncological outcomes. It also showed that there is no difference between long-course and short-course radiotherapy other than that the former considerably lengthens the time for treatment.
Improved therapeutic strategies
‘The results of the study will give rise to improved therapeutic strategies, fewer complications with a sustained low incidence of local recurrence, and better survival rates for rectal cancer patients,’ says Professor Martling. ‘The results can now be immediately put to clinical use to the considerable benefit of the patients.’

Karolinska Institute ki.se/en/news/new-method-reduces-adverse-effects-of-rectal-cancer-treatment

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No association between sex-discordant blood transfusions and risk of death

, 26 August 2020/in E-News /by 3wmedia

New research from Karolinska Institutet refutes the findings of a previous study indicating a possible higher risk of death after sex-discordant blood transfusions for cardiac surgery.

In a study researchers from Karolinska Institutet and Lund University examined how sex-discordant blood transfusions (i.e. blood from a woman to a man or vice versa) affected survival following cardiac surgery. The study was conducted on data from the SWEDEHEART registry and the SCANDAT2 database on almost 50,000 patients who underwent cardiac surgery from 1997 to 2012 in Sweden.
This study was done after a previous Swedish study from earlier in the year indicated a possible increased risk of death after cardiac surgery from sex-discordant blood transfusions.

‘The consequences of the findings from this first study, if proved true, would have been immense and necessitated radical changes to how blood transfusions are managed around the world,’ says Martin Holzmann from Karolinska Institutet.

In the new study, however, the team found no association between sex-discordant blood transfusions and post-cardiac surgery survival.

Martin Holzmann, lead author of the new study continues:
‘Our results clearly show that there is no real connection between sex-discordant blood transfusions and the risk of death.’
The reason for the difference between the studies is that the new one fully compensated for the fact that more transfusions increase the risk of death and of a mismatch between the sex of the donor and the patient. The researchers conclude from their results that current gender-blind blood transfusion procedures are safe and do not need changing.

Karolinska Institute ki.se/en/news/no-association-between-sex-discordant-blood-transfusions-and-risk-of-death

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Improved method for healing burns

, 26 August 2020/in E-News /by 3wmedia

Full thickness skin grafts are the golden standard for treating burn wounds. But most skin grafts for severe burns require a donor, and for large or complicated injury sites, a full thickness skin graft is hard to come by. Split thickness skin grafts that use tissue from the patient may be a solution-but not by themselves.

By combining the graft technique with a specially engineered sheet of stem cells, researchers from Michigan Tech and the First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China demonstrate an improved skin graft process. Their work focuses on creating engineered tissue that maximizes a body’s natural healing power.

Veins, arteries and capillaries move oxygen and nutrients to tissue and the lymphatic system removes waste-vascularized tissue is crosscut with many of these tiny tubes. Healing burn wounds then is not only about re-growing skin, but also about making sure these vascular systems are hooked up. The more vasculature, the more healing can happen.

Feng Zhao, an associate professor of biomedical engineering at Michigan Tech, works on creating engineered tissues that are pre-vascularized. In other words, the tissue gets a head start on the healing process. This is key when coupling the technology with split thickness skin grafts, or STSG for short.

‘STSG can be used under unfavourable conditions, such as a recipient’s wound having moderate infection or less vasculature, where full thickness skin grafts would fail,’ Zhao says. ‘However, STSG are more fragile than full thickness skin grafts and can contract significantly during the healing process.’

To help prevent graft contraction and encourage early vascularization to improve wound repair, Zhao and her team turned to the most basic of cells.

Stem cells are unique because of their potential. Unlike neurons in a brain or beta cells in a liver, stem cells lack a defining cellular purpose. In terms of healing, this means they can adapt to their surroundings; when modified to increase vascularization, they can do wonders.

The team’s transplantation in a rat model showed promising results. Not only did the implantations show less contracted and puckered skin, but also less cellular inflammation and a thinner outer skin (epidermal) thickness along with more robust blood micro-circulation in the skin tissue. The combined STSG and stem cell sheet grafts also preserved features like hair follicles and sebaceous glands that secrete a lubricating oil for skin and hair.

The team attributes the success to the vascularized stem cell sheet’s elevated levels of growth factors and proteins called cytokines used in healing tissue.

‘The engineered stem cell sheet will overcome the limitation of current treatments for extensive and severe wounds, such as for acute burn injuries,’ Zhao says, ‘and significantly improve the quality of life for patients suffering from burns.’

Michigan Technological University www.mtu.edu/news/stories/2016/october/skin-graft-for-bad-burns.html

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Ovarian removal to prevent ovarian cancer should not be an option for most premenopausal women

, 26 August 2020/in E-News /by 3wmedia

A Mayo Clinic research team has found evidence suggesting that the controversial practice of ovary removal in premenopausal women to prevent ovarian cancer should be discontinued in women who are not at high risk of cancer. The study showed that women under 46 who had both ovaries removed experienced a significantly elevated risk of multiple chronic health conditions that included depression, hyperlipidemia, cardiac arrhythmias, coronary artery disease, arthritis, asthma, chronic obstructive pulmonary disease and osteoporosis.

Bilateral oophorectomy is the formal term for removal of both ovaries, often used as a preventive measure against ovarian cancer. For the first time, the team of nine Mayo researchers from multiple disciplines linked bilateral oophorectomy to a marked increase in 8 of the 18 chronic health conditions that were measured.

‘This study provides new and stronger evidence against the use of bilateral oophorectomy for prevention in young women,’ says Walter Rocca, M.D., lead author of the study. ‘Bilateral oophorectomy should not be considered an ethically acceptable option for the prevention of ovarian cancer in the majority of women who do not carry a high-risk genetic variant.’

The study followed two groups of women for a period of approximately 14 years. There were 1,653 women who underwent bilateral oophorectomy and an equal number of women of the same age who did not. The study was made possible by using the records linkage system of the Rochester Epidemiology Project.

Results showed that women under 46 who underwent bilateral oophorectomy experienced a higher incidence of the 18 chronic conditions considered one at a time, except cancer, and an accelerated rate of accumulation of combined conditions, or multi-morbidity. Oestrogen therapy reduced some of the risk in women who had undergone the procedure.

The investigators suggest that the premature loss of oestrogen caused by the oophorectomy may affect a series of aging mechanisms at the cellular and tissue level across the whole body leading to diseases in multiple systems and organs. In summary, the effects of oophorectomy in premenopausal women are much broader and more severe than previously documented.

‘The clinical recommendation is simple and clear,’ Dr. Rocca concludes. ‘In the absence of a documented high-risk genetic variant, bilateral oophorectomy before the age of 50 years (or before menopause) is never to be considered and should not be offered as an option to women.’

Mayo Clinic newsnetwork.mayoclinic.org/discussion/ovarian-removal-to-prevent-ovarian-cancer-should-not-be-an-option-for-premenopausal-women-mayo-research-finds/

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One-third of patients with low flow aortic stenosis do not improve with transcatheter aortic valve replacement

, 26 August 2020/in E-News /by 3wmedia

Aortic stenosis (AS), the narrowing of the aortic valve in the heart which causes restricted blood flow, is one of the most common and serious valve disease problems. For patients with one type of AS – low flow – transcatheter aortic valve replacement (TAVR), a minimally invasive procedure which corrects the damaged aortic valve, is often the best option for restoring the heart’s normal pumping function. However, approximately one-third of low flow AS patients treated with TAVR continue to suffer persistent low flow AS even after the procedure, ultimately increasing their risk of death. Now, researchers from the Perelman School of Medicine at the University of Pennsylvania have examined this high-risk patient population to determine the cause of this persistent low flow AS and to evaluate their risk of dying during the year following the procedure.
‘There has been a lot of interest in these patients with low flow AS, as their surgical mortality is higher than other patients. TAVR is often a good option, but not all of them will be able to normalize flow following the procedure and these persistently low flow patients have a 60 percent higher rate of mortality at one year,’ said Howard C. Herrmann, MD, FACC, MSCAI, John W. Bryfogle Professor of Cardiovascular Medicine and Surgery, and director of Penn Medicine’s Interventional Cardiology Programme. ‘Low flow before TAVR is one of the most important predictors of mortality following TAVR, but it is one of the harder qualities to measure. This presents a challenge to properly treating patients with low flow AS, and can leave some patients at higher risk.’
To better understand the potential benefits of TAVR for low flow AS, researchers conducted an analysis of 984 patients with low flow AS from the PARTNER trial and continued access registry from April 2014 through January 2016. A baseline and followup echocardiogram, evaluation of post-TAVR hemodynamics – blood flow – and one year outcomes were assessed.
Through this analysis, researchers identified the large subgroup of patients who, following TAVR, failed to regain normal flow despite a successful procedure. In the first six months following TAVR, flow improved in roughly 66 percent of the patients evaluated. However, those with severe low flow AS had the highest mortality rate – 26 percent – at one year, as compared to approximately 20 percent for those with moderate low flow and even less for those with normal flow.
‘Unfortunately, many centres do not routinely measure flow, but rather focus more on a patient’s pressure gradient or valve area when evaluating aortic stenosis pre-and post-TAVR,’ said Herrmann. ‘While low flow is more challenging to monitor, this measurement can better inform the patient’s risk of mortality, and in turn lead to better treatment.’
The researchers noted that the identification of remedial, or treatable, causes of persistent low flow following TAVR, such as severe mitral regurgitation and atrial fibrillation, may represent an opportunity to improve the outcomes of these patients.

Penn Medicine http://tinyurl.com/htz5gvj

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Long-acting cardioplegia solution results in better outcomes for pediatric patients

, 26 August 2020/in E-News /by 3wmedia

During heart surgery, it is sometimes necessary to temporarily stop cardiac activity, a process known as cardioplegia. Specific myocardial protection techniques are necessary for pediatric use. At the 96th AATS Annual Meeting, cardiac surgeons present the results of a prospective, randomized trial of pediatric heart surgery patients that shows that the del Nido cardioplegia solution, a new, longacting agent, offers significant advantages over conventional cardioplegia, including reduced cardiopulmonary bypass and aortic cross-clamp times and faster onset of action. ‘Overall, del Nido cardioplegic solution is a simple and safe cardioprotective strategy. Cardiac performance is satisfactory in the postoperative period with a better cardiac index profile, lesser troponin-I release, and decreased morbidity,’ explained Sachin Talwar, MCh, of the Department of Cardiothoracic and Vascular Surgery at the All India Institute of Medical Sciences (New Delhi, India).
The del Nido solution was first proposed by researchers at the University of Pittsburgh in 1990. It offers several advantages, including prolonged action with
single dose administration, which helps to avoid the harmful effects of dose repetition.
It also contains lidocaine to slow down energy consumption and calciumcompeting ions like magnesium to prevent damaging intracellular build-up of calcium. In practice, it can be given as a single dose through the aortic root. In comparison, the conventional method of cardioplegia tested was St. Thomas cold blood cardioplegia. This requires an initial dose of solution, followed by repeated dosing at 25-30 minute intervals during surgery.
In the first study of its kind, the investigators randomized 100 pediatric patients
younger than 12 years old to del Nido and cold blood cardioplegia (STH) groups.
The patients underwent elective repair of ventricular septal defects and tetralogy of Fallot between August 2014 and July 2015. Intraoperative parameters and postoperative events were recorded. Cardiac index was calculated at four different time points, while troponin-I, interleukin-6, and tissue necrosis factor-alpha were estimated. The right ventricle was biopsied in order to examine the ultra-structural changes using electron microscopy.
The del Nido group had significantly shorter mean cardiopulmonary bypass
time (67 min vs. 78 min) and mean aortic cross-clamp time (40 min vs. 48 min)
than the STH group, respectively. ‘This is very important because long aortic crossclamp time is an independent risk factor for increased duration of mechanical ventilation, high incidence of low cardiac output syndrome, renal complications, and immediate post-operative mortality,’ commented Dr. Talwar.
The total amount of cardioplegia given was significantly higher in STH group
(673 mL), compared with the del Nido group (372 mL), according to Dr. Talwar.
Overall, the postoperative course was better in the del Nido group with shorter
mechanical ventilatory time and ICU stay, faster recovery of cardiac index,
and less need for inotropic support. The researchers biopsied the heart muscle to see if there were microscopic effects of the different cardioplegia agents. Ultrastructural study of myocardium showed no statistically significant difference in data obtained for nuclear changes, mitochondrial changes, sarcoplasmic reticulum, and glycogen depletion. Myofibrillar disarray was significantly more evident in the STH group, while cellular edema was significantly greater in the del Nido group.

American Association for Thoracic Surgery http://tinyurl.com/jcqsqvd

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Because these cookies are strictly necessary to provide the website, refusing them will affect the functioning of our site. You can always block or delete cookies by changing your browser settings and block all cookies on this website forcibly. But this will always ask you to accept/refuse cookies when you visit our site again.

We fully respect if you want to refuse cookies, but to avoid asking you each time again to kindly allow us to store a cookie for that purpose. You are always free to unsubscribe or other cookies to get a better experience. If you refuse cookies, we will delete all cookies set in our domain.

We provide you with a list of cookies stored on your computer in our domain, so that you can check what we have stored. For security reasons, we cannot display or modify cookies from other domains. You can check these in your browser's security settings.

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Google Analytics Cookies

These cookies collect information that is used in aggregate form to help us understand how our website is used or how effective our marketing campaigns are, or to help us customise our website and application for you to improve your experience.

If you do not want us to track your visit to our site, you can disable this in your browser here:

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Other external services

We also use various external services such as Google Webfonts, Google Maps and external video providers. Since these providers may collect personal data such as your IP address, you can block them here. Please note that this may significantly reduce the functionality and appearance of our site. Changes will only be effective once you reload the page

Google Webfont Settings:

Google Maps Settings:

Google reCaptcha settings:

Vimeo and Youtube videos embedding:

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Privacy Beleid

U kunt meer lezen over onze cookies en privacy-instellingen op onze Privacybeleid-pagina.

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