Search Results (10)

Objective: To elucidate the pattern of the influence of the port angle of the superior vena cava supplying cannula (SVCS) on hemodynamics within the right atrium in VV-ECMO. Methods: A three-dimensional model of the right atrium was established based on CT images of a real patient. The 3D models of the SVCS and inferior vena cava draining cannula (IVCD) were established based on the Edwards 18Fr and Medos 22Fr real intubation models, respectively. Based on these models, three-dimensional models of the SVCS ports with bending angles of −90°, −60°, −30°, 0°, 30°, 60°, and 90° in the plane formed by the centerline of the SVCS and the center point of the tricuspid valve (TV) were established. Transient-state computational fluid dynamics (CFD) was performed to clarify the right atrium blood flow pattern and hemodynamic states at different SVCS port orientation angles. The velocity clouds, wall pressure, wall shear stress (WSS), relative residence time (RRT), and recirculation fraction (RF) were calculated to assess hemodynamic changes in the right atrium at different angles of the port of the SVCS. Results: As the angle of the port of the superior chamber cannula changed, the location of the high-velocity blood impingement from the SVCS changed, and the pattern of blood flow within the right atrium was dramatically altered. The results for the maximum right atrial wall pressure were 13,472 pa, 13,424 pa, 10,915 pa, 7680.2 pa, 5890.3 pa, 5597.6 pa, and 7883.5 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), and the results for the mean right atrial wall pressure were 6788.9 pa, 8615.1 pa, 8684.9 pa, 6717.2 pa, 5429.2 pa, 5455.6 pa, and 7117.8 pa ( −90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°). The results of the maximum right atrial wall WSS in the seven cases were 63.572 pa, 55.839 pa, 31.705 pa, 39.531 pa, 40.11 pa, 28.474 pa, and 35.424 (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), respectively, and the results of the mean right atrial wall WSS results were 3.8589 pa, 3.6706 pa, 3.3013 pa, 3.2487 pa, 2.3995 pa, 1.3304 pa, and 2.0747 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), respectively. The results for the area percentage of high RRT in the seven cases were 3.44%, 2.23%, 4.24%, 1.83%, 3.69%, 7.73%, and 3.68% (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), and the results for the RF were 21.57%, 23.24%, 19.78%, 12.57%, 10.24%, 5.07%, and 8.05% (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°). Conclusions: The more the port of the SVCS is oriented toward the TV, the more favorable it is for reducing RF and the impingement of blood flow in the right atrial wall, but there may be an increased risk of RRT. The opposite orientation of the SVCS port to the TV is not conducive to reducing flow impingement on the right atrial wall and RF. Full article

Background and Objectives: Left ventricular hypertrophy (LVH) represents a significant cardiovascular risk in patients undergoing chronic hemodialysis (CHD). A large inferior vena cava diameter (IVCD), potentially indicative of fluid overload and a contributing factor to elevated cardiovascular risk, has not been sufficiently explored. Therefore, our study aims to gain further insights into this aspect. Materials and Methods: A retrospective cohort study enrolled patients receiving CHD in a single medical center with available echocardiography from October to December 2018. They were categorized into four groups based on LVH geometry and IVCD. Cox proportional hazard models assessed the risk of major adverse cardiovascular effects (MACEs) and cardiovascular and overall mortality after multivariate adjustments. Kaplan–Meier analysis depicted MACE-free events and survival during the follow-up time. Results: Of the 175 CHD patients, 38, 42, 45, and 50 exhibited small IVCD with eccentric and concentric LVH and large IVCD with eccentric and concentric LVH, respectively. Compared to small IVCD and eccentric LVH, large IVCD and eccentric LVH had the highest risk of MACEs, followed by large IVCD and concentric LVH (aHR: 4.40, 3.60; 95% CI: 1.58–12.23, 1.28–10.12, respectively). As for cardiovascular mortality, large IVCD and concentric LVH had the highest risk, followed by large IVCD and eccentric LVH, and small IVCD and concentric LVH. (aHR: 14.34, 10.23, 8.87; 95% CI: 1.99–103.35, 1.41–74.33; 1.01–77.87). The trend in overall mortality risk among the groups was similar to that of cardiovascular mortality. Conclusions: LVH geometry and IVCD co-modify the risk of MACEs and cardiovascular and overall mortality in CHD patients. The highest risk of MACEs is associated with large IVCD and eccentric LVH, while the highest risk of cardiovascular and overall mortality is linked with large IVCD and concentric LVH. Full article

Introduction: Data on the prevalence and clinical significance of interventricular conduction disturbances (IVCDs) in children are scarce. While incomplete right bundle branch blocks (IRBBBs) seem to be the most frequent and benign findings, complete bundle blocks and fascicular blocks are often seen in children with congenital/acquired cardiac conditions. This study aims to delineate the prevalence and the diagnostic accuracy of IVCD in children admitted to a paediatric cardiology unit. Methods: Children admitted to the paediatric cardiology unit between January 2010 and December 2020 who had an ECG were included in the study. IVCDs were diagnosed according to standard criteria adjusted for age. Results: Three thousand nine hundred and ninety-three patients were enrolled. The median age was 3.1 years (IQR: 0.0–9.2 years), and 52.7% were males. IVCDs were present in 22.5% of the population: 17.4% of the population presented with IRBBBs, 4.8% with a complete right bundle branch block (CRBBB), 0.1% with a complete left bundle branch block (CLBBB), 0.2% with a left anterior fascicular block (LAFB) and 0.2% with a combination of CRBBB and LAFB. Also, 26% of children with congenital heart disease had an IVCD, and 18% of children with an IVCD had previous cardiac surgery. The overall sensitivity of IVCD in detecting a cardiac abnormality was 22.2%, with a specificity of 75.5%, a PPV of 83.1% and an NPV of 15.1%, but the values were higher for CLBBB and LAFB. Conclusions: IVCDs were present in one-fifth of children admitted to the cardiology unit. IRBBB was the most frequent disturbance, while CRBBB, CLBBB and fascicular blocks were much rarer, though they had a higher predictive value for cardiac abnormalities. Full article

Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP and CSP resynchronization using the interventricular conduction delays (IVCD) as a guide. Methods: Consecutive patients from January 2018 to December 2020 with an indication for CRT were prospectively enrolled in the study group (delays-guided resynchronization group, DRG). A treatment algorithm based on IVCD was used to decide whether to leave the left ventricular (LV) lead to perform BiVP or pull it out and perform CSP. Outcomes from the DRG group were compared to a historical cohort of CRT patients who underwent CRT procedures between January 2016 and December 2017 (resynchronization standard guide group, SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or HF event at 1 year after the date of intervention. Results: The study population consisted of 292 patients, of which 160 (54.8%) were in the DRG and 132 (45.2%) in the SRG. In the DRG, 41 of 160 patients underwent CSP based on the treatment algorithm (25.6%). The primary endpoint was significantly higher in the SRG (48/132, 36.4%) compared to the DRG (35/160, 21.8%) (hazard ratio (HR): 1.72; 95% confidence interval (CI): 1.12–2.65; p = 0.013). Conclusions: A treatment algorithm based on IVCD shifted one patient out of every four from BiVP to CSP, with consequent reduction in the primary endpoint after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP. Full article

Coronaviruses interact with protein or carbohydrate receptors through their spike proteins to infect cells. Even if the known protein receptors for these viruses have no evolutionary relationships, they do share ontological commonalities that the virus might leverage to exacerbate the pathophysiology. ANPEP/CD13, DPP IV/CD26, and ACE2 are the three protein receptors that are known to be exploited by several human coronaviruses. These receptors are moonlighting enzymes involved in several physiological processes such as digestion, metabolism, and blood pressure regulation; moreover, the three proteins are expressed in kidney, intestine, endothelium, and other tissues/cell types. Here, we spot the commonalities between the three enzymes, the physiological functions of the enzymes are outlined, and how blocking either enzyme results in systemic deregulations and multi-organ failures via viral infection or therapeutic interventions is addressed. It can be difficult to pinpoint any coronavirus as the target when creating a medication to fight them, due to the multiple processes that receptors are linked to and their extensive expression. Full article

Background and Objectives: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. In many patients with heart failure that could benefit from resynchronization, the QRS morphology is often IVCD and atypical, or non-LBBB, which further diminishes the CRT response. In those cases, we established His pacing combined with LV pacing as a feasible option to reduce the impact of AF on the CRT response and regain partially physiological ventricular activation to improve the electromechanical sequence. Materials and Methods: We implanted two patients with AF, HF, EF < 35%, NYHA II-III and QRS > 150 ms with CRT-D systems modified to HOT-CRT and observed their clinical, ECG and echocardiographic improvements over a follow-up period of three months. Results: In both patients we observed improvements of the initial parameters. We were able to shorten the QRS duration to approx. 120 ms, improve NYHA functional class, increase the EF by approximately 12% and distinctly reduce mitral regurgitation. Conclusion: Since the conventional CRT reaches its limits within this specific patient group, we need to consider alternative pacing sites and the effective combination of them. Our results and respectively other studies that are also mentioned in the current guidelines, support the feasibility of HOT-CRT in the above mentioned patient group. Full article

An advanced driver simulator methodology facilitates a well-connected interaction between the environment and drivers. Multiple traffic information environment language processing aims to help drivers accommodate travel demand: safety prewarning, destination navigation, hotel/restaurant reservation, and so on. Task-oriented dialogue systems generally aim to assist human users in achieving these specific goals by a conversation in the form of natural language. The development of current neural network based dialogue systems relies on relevant datasets, such as KVRET. These datasets are generally used for training and evaluating a dialogue agent (e.g., an in-vehicle assistant). Therefore, a simulator for the human user side is necessarily required for assessing an agent system if no real person is involved. We propose a new end-to-end simulator to operate as a human driver that is capable of understanding and responding to assistant utterances. This proposed driver simulator enables one to interact with an in-vehicle assistant like a real person, and the diversity of conversations can be simply controlled by changing the assigned driver profile. Results of our experiment demonstrate that this proposed simulator achieves the best performance on all tasks compared with other models. Full article

Background: Little is known about the association of inferior vena cava diameter (IVCD) and left ventricular end-systolic diameter (LVESD) with mortality in patients undergoing hemodialysis (HD). Methods: The single medical center observational cohort study enrolled 241 adult chronic HD patients from 1 October 2018 to 31 December 2018. Echocardiography results of IVCD and LVESD prior to dialysis were retrieved and patients were divided into high IVCD and low IVCD groups. Patients who received HD via a tunneled cuffed catheter were excluded. Study outcomes included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Subgroup analyses of HD patients with high and low LVESD were also performed. Results: The incidence of all-cause mortality, cardiovascular mortality, and MACE were higher in chronic HD patients with high IVCD (p < 0.01). High IVCD patients had significantly greater all-cause mortality, cardiovascular mortality, and MACE (log-rank test; p < 0.05). High IVCD patients are also associated with an increased risk of all-cause mortality and MACE relative to low IVCD patients (aHRs, 2.88 and 3.42; 95% CIs, 1.06–7.86 and 1.73–6.77, respectively; all p < 0.05). In the subgroup analysis of patients with high or low LVESD, the high IVCD remained a significant risk factor for all-cause mortality and MACE, and the HR is especially high in the high LVESD group. Conclusions: Dilated IVCD is a risk factor for all-cause mortality and MACE in chronic HD patients. In addition, these patients with high LVESD also have a significantly higher HR of all-cause mortality and MACE. Full article

This study contributes to the growing interest in hybrid organisations, sustainable business models and inclusive value chain development (IVCD). Recent work has identified that of some 570 million farmers in the world, more than 475 million farmers are smallholders in low-middle-income countries experiencing increasing food insecurity and rural poverty. Research argues that there is a lack of research that provides work on appropriate solutions for smallholders. This paper answers this call by a qualitative study of ten case studies, which draws on hybrid organising, sustainable business model and IVCD research to identify the novel business model characteristics that hybrid organisations use to create and manage more inclusive value chains for smallholders. These hybrid organisations are designed to create a value proposition that delivers sustainability upgrading for smallholders via both product, process and governance upgrades, empowers smallholders to achieve development goals and creates multiple value for social impact. We therefore identify the important characteristics of the hybrid business model to provide appropriate solutions for smallholders and overcome the challenges identified in the inclusive value chain development literature. Full article

CXC chemokine ligand (CXCL)9, CXCL10 and CXCL11 direct chemotaxis of mainly T cells and NK cells through activation of their common CXC chemokine receptor (CXCR)3. They are inactivated upon NH₂-terminal cleavage by dipeptidyl peptidase IV/CD26. In the present study, we found that different glycosaminoglycans (GAGs) protect the CXCR3 ligands against proteolytic processing by CD26 without directly affecting the enzymatic activity of CD26. In addition, GAGs were shown to interfere with chemokine-induced CXCR3 signaling. The observation that heparan sulfate did not, and heparin only moderately, altered CXCL10-induced T cell chemotaxis in vitro may be explained by a combination of protection against proteolytic inactivation and altered receptor interaction as observed in calcium assays. No effect of CD26 inhibition was found on CXCL10-induced chemotaxis in vitro. However, treatment of mice with the CD26 inhibitor sitagliptin resulted in an enhanced CXCL10-induced lymphocyte influx into the joint. This study reveals a dual role for GAGs in modulating the biological activity of CXCR3 ligands. GAGs protect the chemokines from proteolytic cleavage but also directly interfere with chemokine–CXCR3 signaling. These data support the hypothesis that both GAGs and CD26 affect the in vivo chemokine function. Full article