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Boele HJ, Jung C, Sherry S, Roggeveen LEM, Dijkhuizen S, Öhman J, Abraham E, Uvarov A, Boele CP, Gultig K, Rasmussen A, Vinueza-Veloz MF, Medina JF, Koekkoek SKE, De Zeeuw CI, Wang SSH. Accessible and reliable neurometric testing in humans using a smartphone platform. Sci Rep 2023; 13:22871. [PMID: 38129487 PMCID: PMC10739701 DOI: 10.1038/s41598-023-49568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Tests of human brain circuit function typically require fixed equipment in lab environments. We have developed a smartphone-based platform for neurometric testing. This platform, which uses AI models like computer vision, is optimized for at-home use and produces reproducible, robust results on a battery of tests, including eyeblink conditioning, prepulse inhibition of acoustic startle response, and startle habituation. This approach provides a scalable, universal resource for quantitative assays of central nervous system function.
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Affiliation(s)
- H J Boele
- Princeton Neuroscience Institute, Princeton, USA.
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.
| | - C Jung
- Princeton Neuroscience Institute, Princeton, USA
| | - S Sherry
- Princeton Neuroscience Institute, Princeton, USA
| | - L E M Roggeveen
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
| | - S Dijkhuizen
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - J Öhman
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - E Abraham
- Princeton Neuroscience Institute, Princeton, USA
| | | | - C P Boele
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - K Gultig
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - A Rasmussen
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M F Vinueza-Veloz
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - J F Medina
- Department of Neuroscience, Baylor College of Medicine, Houston, USA
| | - S K E Koekkoek
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - C I De Zeeuw
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - S S-H Wang
- Princeton Neuroscience Institute, Princeton, USA.
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Dallmann J, Freitag J, Jung C, Khinvasara K, Merz L, Peters D, Schork M, Beck J. CIMT 2023: report on the 20th Annual Meeting of the Association for Cancer Immunotherapy. Immunooncol Technol 2023; 20:100397. [PMID: 37876518 PMCID: PMC10590812 DOI: 10.1016/j.iotech.2023.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The Association for Cancer Immunotherapy (CIMT) celebrated the 20th anniversary of the CIMT Annual Meeting. CIMT2023 was held 3-5 May 2023 in Mainz, Germany. 1051 academic and clinical professionals from over 30 countries attended the meeting and discussed the latest advances in cancer immunology and immunotherapy research. This report summarizes the highlights of CIMT2023.
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Affiliation(s)
- J. Dallmann
- Immunotherapies & Preclinical Research, BioNTech SE, Mainz
| | - J. Freitag
- TRON-Translational Oncology, University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - C. Jung
- BioNTech Cell & Gene Therapies GmbH, Mainz
| | - K. Khinvasara
- TRON-Translational Oncology, University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - L. Merz
- TRON-Translational Oncology, University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - D. Peters
- Immunotherapies & Preclinical Research, BioNTech SE, Mainz
| | - M. Schork
- TRON-Translational Oncology, University Medical Center of the Johannes Gutenberg University Mainz gGmbH, Mainz, Germany
| | - J.D. Beck
- Immunotherapies & Preclinical Research, BioNTech SE, Mainz
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Cosimini M, Shah P, Jung C, Bennett A, Fang K, Solomon O, Espinoza J. Cute Kid? Patient Obesity Status and the Use of Nonmedical Descriptors in Presentations by Pediatric Residents. Child Obes 2023; 19:565-569. [PMID: 36350335 DOI: 10.1089/chi.2022.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nonmedical descriptors, adjectives that are not related to a medical condition, such as "cute," are often used in presentations in pediatrics. We hypothesize that patterns of their use may reflect obesity bias. Descriptors used by pediatric residents presenting cases of children <9 years in an outpatient clinic during the 2018-2019 and 2019-2020 academic years were recorded. The primary outcome was the association of the use of positive nonmedical descriptors with children's obesity status using logistic regression. Positive descriptors were used in 14% of 994 presentations. Most addressed the appearance of the child with variations of "cute" and "adorable." There was no variation in use of positive descriptors by obesity status. On multivariate logistic regression, the odds of using positive descriptors were higher among female residents, and positive descriptor use declined with patient age. Negative descriptors were rare and often focused on weight.
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Affiliation(s)
- Michael Cosimini
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Payal Shah
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christina Jung
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ashely Bennett
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kevin Fang
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Olga Solomon
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Juan Espinoza
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Jung C, Nippita S. Self-managed Medication Abortion in the United States. Clin Obstet Gynecol 2023; 66:739-748. [PMID: 37750672 DOI: 10.1097/grf.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
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Blasberg T, Hochberger J, Meiborg M, Jung C, Weber M, Brunk T, Leifeld L, Seif Amir Hosseini A, Wedi E. Prophylactic clipping using the over-the-scope clip (OTSC) system after complex ESD and EMR of large colon polyps. Surg Endosc 2023; 37:7520-7529. [PMID: 37418148 DOI: 10.1007/s00464-023-10235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Delayed bleeding is the most frequent complication after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) of large colon polyps. Today, prophylactic clipping with through-the-scope clips (TTSCs) is commonly used to reduce the risk of bleeding. However, the over-the-scope clip (OTSC) system might be superior to TTSCs in achieving hemostasis. This study aims to evaluate the efficacy and safety of prophylactic clipping using the OTSC system after ESD or EMR of large colon polyps. METHODS This is a retrospective analysis of a prospective collected database from 2009 until 2021 of three endoscopic centers. Patients with large (≥ 20 mm) colon polyps were enrolled. All polyps were removed by either ESD or EMR. After the resection, OTSCs were prophylactically applied on parts of the mucosal defect with a high risk of delayed bleeding or/and perforation. The main outcome measurement was delayed bleeding. RESULTS A total of 75 patients underwent ESD (67%, 50/75) or EMR (33%, 25/75) in the colorectum. The mean resected specimen diameter was 57 mm ± 24.1 (range 22-98 mm). The mean number of OTSCs placed on the mucosal defect was 2 (range 1-5). None of the mucosal defects were completely closed. Intraprocedural bleeding occurred in 5.3% (ESD 2.0% vs. EMR 12.0%; P = 0.105), and intraprocedural perforation occurred in 6.7% (ESD 8% vs. EMR 4%; P = 0.659) of the patients. Hemostasis was achieved in 100% of cases of intraprocedural bleeding, whereas two patients required surgical conversion due to intraprocedural perforation. Among the remaining 73 patients who received prosphylactic clipping, delayed bleeding occurred in 1.4% (ESD 0% vs. EMR 4.2%; P = 0.329), and delayed perforation occurred in 0%. CONCLUSIONS The prophylactic partial closure of large post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation. The prophylactic partial closure of large complex post-ESD/EMR mucosal defects using OTSCs could serve as an effective strategy to reduce the risk of delayed bleeding and perforation.
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Affiliation(s)
- T Blasberg
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - J Hochberger
- Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany
| | - M Meiborg
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - C Jung
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
| | - M Weber
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - T Brunk
- Department of Gastroenterology, Vivantes Hospital Friedrichshain Berlin, Berlin, Germany
| | - L Leifeld
- Department of Internal Medicine III, St. Bernward Hospital, Hildesheim, Germany
| | - A Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - E Wedi
- Division of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
- Clinic for Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany.
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Schneckmann R, Döring M, Gerfer S, Gorressen S, Heitmeier S, Helten C, Polzin A, Jung C, Kelm M, Fender AC, Flögel U, Grandoch M. Rivaroxaban attenuates neutrophil maturation in the bone marrow niche. Basic Res Cardiol 2023; 118:31. [PMID: 37580509 PMCID: PMC10425524 DOI: 10.1007/s00395-023-01001-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
Pharmacological inhibition of factor Xa by rivaroxaban has been shown to mediate cardioprotection and is frequently used in patients with, e.g., atrial fibrillation. Rivaroxaban's anti-inflammatory actions are well known, but the underlying mechanisms are still incompletely understood. To date, no study has focused on the effects of rivaroxaban on the bone marrow (BM), despite growing evidence that the BM and its activation are of major importance in the development/progression of cardiovascular disease. Thus, we examined the impact of rivaroxaban on BM composition under homeostatic conditions and in response to a major cardiovascular event. Rivaroxaban treatment of mice for 7 days markedly diminished mature leukocytes in the BM. While apoptosis of BM-derived mature myeloid leukocytes was unaffected, lineage-negative BM cells exhibited a differentiation arrest at the level of granulocyte-monocyte progenitors, specifically affecting neutrophil maturation via downregulation of the transcription factors Spi1 and Csfr1. To assess whether this persists also in situations of increased leukocyte demand, mice were subjected to cardiac ischemia/reperfusion injury (I/R): 7 d pretreatment with rivaroxaban led to reduced cardiac inflammation 72 h after I/R and lowered circulating leukocyte numbers. However, BM myelopoiesis showed a rescue of the leukocyte differentiation arrest, indicating that rivaroxaban's inhibitory effects are restricted to homeostatic conditions and are mainly abolished during emergency hematopoiesis. In translation, ST-elevation MI patients treated with rivaroxaban also exhibited reduced circulating leukocyte numbers. In conclusion, we demonstrate that rivaroxaban attenuates neutrophil maturation in the BM, which may offer a therapeutic option to limit overshooting of the immune response after I/R.
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Affiliation(s)
- R Schneckmann
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - M Döring
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - S Gerfer
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - S Gorressen
- Institute for Pharmacology Düsseldorf, Medical Faculty, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - S Heitmeier
- Research & Development Pharmaceuticals, Bayer AG, Acute Hospital Research, Wuppertal, Germany
| | - C Helten
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - A Polzin
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - C Jung
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - M Kelm
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - A C Fender
- Institute of Pharmacology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - U Flögel
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Experimental Cardiovascular Imaging, Institute for Molecular Cardiology, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - M Grandoch
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany.
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
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Malhotra S, Dasgupta-Tsinikas S, Yumul J, Kaneta K, Lenz A, Kizzee R, Bihm D, Jung C, Neely M, Guevara RE, Higashi J, Bender JM. Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings. J Pediatr 2023; 259:113419. [PMID: 37044372 DOI: 10.1016/j.jpeds.2023.113419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county. STUDY DESIGN A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin. RESULTS We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9). CONCLUSIONS The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.
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Affiliation(s)
- Sanchi Malhotra
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA.
| | - Shom Dasgupta-Tsinikas
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Josephine Yumul
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Kelli Kaneta
- Children's Hospital Los Angeles, Pediatric Residency Program, Los Angeles, CA
| | - Annika Lenz
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Richard Kizzee
- Children's Hospital Los Angeles, Pediatric Residency Program, Los Angeles, CA
| | - Dustin Bihm
- Children's Hospital Los Angeles, Pediatric Residency Program, Los Angeles, CA
| | - Christina Jung
- Children's Hospital Los Angeles, Division of General Pediatrics, Los Angeles, CA
| | - Michael Neely
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ramon E Guevara
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Julie Higashi
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Jeffrey M Bender
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
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Massin N, Porcu-Buisson G, Chevalier N, Descat E, Jung C. Reply: Evidence from a randomized controlled trial in the landscape of non-randomized studies in dual stimulation strategy. Hum Reprod 2023; 38:1647-1648. [PMID: 37279882 DOI: 10.1093/humrep/dead109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- N Massin
- Reproductive Medicine Department, Intercommunal Hospital of Creteil, Creteil, France
| | - G Porcu-Buisson
- Reproductive Medicine, Institut de Médecine de la Reproduction, Marseille, France
| | - N Chevalier
- Reproductive Medicine, Clinique Saint Roch, Montpellier, France
| | - E Descat
- Reproductive Medicine, Clinique Jean Villar, Bruges, France
| | - C Jung
- Clinical Research Centre, Intercommunal Hospital of Creteil, Creteil, France
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Sulger E, Jung C, Nippita S. Avoiding unintended pregnancy during transition from copper intrauterine device to etonogestrel contraceptive implant: A case report. Contraception 2023:110085. [PMID: 37257551 DOI: 10.1016/j.contraception.2023.110085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
We present a patient who experienced an unintended pregnancy after transitioning from the copper intrauterine device to the etonogestrel subdermal implant. When switching from contraceptive methods that do not reliably suppress ovulation, clinicians should consider backup contraception and additional counseling, depending on specific timing of removal.
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Affiliation(s)
- Elisabeth Sulger
- Department of Obstetrics and Gynecology, NYU Long Island School of Medicine, 259 1st St, Mineola, NY 11501, USA.
| | - Christina Jung
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, 550 1st Ave, New York, NY 10016, USA
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, 550 1st Ave, New York, NY 10016, USA
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Jung C, Oviedo J, Nippita S. Abortion Care in the United States - Current Evidence and Future Directions. NEJM Evid 2023; 2:EVIDra2200300. [PMID: 38320010 DOI: 10.1056/evidra2200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Abortion Care in the United StatesAbortion services are a vital component of reproductive health care. Jung and colleagues review medication abortion and procedural abortion as well as implications of increasing restrictions on access in the United States.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine
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11
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Jung C, Hunter A, Saleh M, Quinn GP, Nippita S. Breaking the Binary: How Clinicians Can Ensure Everyone Receives High Quality Reproductive Health Services. Open Access J Contracept 2023; 14:23-39. [PMID: 36814801 PMCID: PMC9939798 DOI: 10.2147/oajc.s368621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
The gender binary has historically defined the study and practice of reproductive and sexual healthcare. However, the male and female binary categorization of sex does not adequately define patients seeking reproductive and sexual health. Comprehensive sexual healthcare should consider diverse gender identity and non-heteronormative sexual practices, family planning, sexually transmitted infections, cancer prevention, and sexual function. Recent research suggests clinicians do not feel prepared to provide care for sexual and gender minority (SGM) patients. In this narrative review, we focus on reproductive and sexual health within the scope of obstetric and gynecologic (OB/GYN) clinical practice. We used traditional medical subject headings to summarize data from publications in peer-reviewed journals published in the last 10 years and identified barriers, facilitators and best practices for de-gendering reproductive healthcare. Following a roughly chronological care path across the lifespan, we categorized findings into the following topics: Early Care for SGM, Sexual Health, Family Planning, and Care Later in Life for SGM. We include recommendations for creating a welcoming environment, SGM inclusive training for clinicians and staff, and best practices for individualized counseling. We review suggested practices related to service delivery and clinical considerations in the provision of sexual and reproductive health care for gender and sexual minority patients.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Adam Hunter
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mona Saleh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA,Correspondence: Gwendolyn P Quinn, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1st Ave NBV N91-F, New York, NY, 10016, USA, Tel +1-646-501-6878, Email
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
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Jung C, Fiastro A, Cornell A, Steward R, Rible R, Gipson JD. Patient perspectives on barriers in obtaining timely abortion care in Los Angeles, California. Contraception 2023; 117:50-54. [PMID: 36055362 DOI: 10.1016/j.contraception.2022.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Although California is a state with supportive abortion policies, recent evidence suggests people may still encounter barriers to obtaining timely abortion care. To provide an in-depth understanding of these barriers and augment existing literature focusing on restrictive and hostile states, we sought to understand the patient perspectives of barriers to timely abortion care in Los Angeles, California. STUDY DESIGN We recruited participants from two, high-volume urban clinical sites and conducted semi-structured interviews with 17 individuals who visited three or more clinics and/or encountered more than 2 weeks between seeking and obtaining their abortion. Using thematic analysis, we analyzed deidentified transcripts by first developing and applying codes, then identifying overarching themes to describe barriers to timely abortion care. RESULTS Participants described three primary barriers leading to abortion care delay: (1) difficulties in ensuring insurance coverage or securing authorization for abortion care from private/employer-sponsored insurance, (2) inadequate screening resulting in multiple appointments where desired care could not be provided, and (3) difficulties with expeditious referrals to appropriate clinical sites. Participants also described accumulated fatigue from facing layers of resistance when pursuing avenues for care. CONCLUSIONS Even in supportive abortion policy states, barriers to abortion care from insurance, screening, and referral-related issues may result in delayed or unaccessed care, negatively impacting patient experience. Understanding and mitigating reasons for delays are critical to improving patient experience with abortion care. IMPLICATIONS Standardized telephone triage at local clinic facilities and streamlined MediCal authorization of abortion services may mitigate barriers to timely abortion care.
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Affiliation(s)
- Christina Jung
- Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States.
| | - Anna Fiastro
- Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States
| | - Alia Cornell
- Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States
| | - Rachel Steward
- Family Planning Associates, Women's Health, Los Angeles, CA, United States
| | - Radhika Rible
- Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States
| | - Jessica D Gipson
- Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States
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13
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Stern M, Schremmer J, Scharm S, Baasen S, Heinen Y, Sansone R, Polzin A, Jung C, Heiss C, Kelm M, Busch L. Microvascular tissue perfusion after postcatheterization pseudoaneurysm treatment. Clin Hemorheol Microcirc 2022; 82:275-282. [PMID: 35938240 DOI: 10.3233/ch-221438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events. OBJECTIVE Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment. METHODS In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps. RESULTS Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (p = 0.121) or the untreated (p = 0.198) leg during follow up. CONCLUSIONS In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.
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Affiliation(s)
- M Stern
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - J Schremmer
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Scharm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Baasen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Y Heinen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - R Sansone
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - A Polzin
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - C Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - C Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Department of Vascular Medicine, Surrey and Sussex NHS Healthcare Trust, Redhill, United Kingdom
| | - M Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID)Duesseldorf, Germany
| | - L Busch
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
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14
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Excoffier JB, Salaün-Penquer N, Ortala M, Raphaël-Rousseau M, Chouaid C, Jung C. Analyse des patients hospitalisés pour COVID-19 lors du premier confinement de 2020 à l'aide de méthodes d'explicabilité. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634428 DOI: 10.1016/j.respe.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction La pandémie de COVID-19 a rapidement mis une forte pression sur les centres hospitaliers et en particulier sur les services de réanimation [1]. Il y eut lors du premier confinement un besoin urgent d'outils permettant d'identifier les patients hospitalisés les plus à risque de subir une aggravation de leur état, ainsi qu'une meilleure compréhension de la typologie des patients COVID-19. Méthodes Les données contiennent des informations sur des patients hospitalisés au Centre Hospitalier Intercommunal de Créteil à cause de la COVID-19 lors de la première vague de l'épidémie (printemps 2020). Les variables explicatives disponibles sur les patients étaient l'âge, le sexe, plusieurs comorbidités et les résultats des examens radiologiques et biologiques. Un modèle d'ensemble d'arbres stimulé (« Boosted Tree Ensemble » [2, 3]) a été appliqué pour détecter si l'état du patient allait s'aggraver pendant l'hospitalisation. L'analyse des effets de chaque variable explicative ainsi que des effets d'interaction entre deux variables ont été effectuées en utilisant des méthodes d'explicabilité, domaine aussi appelée intelligence artificielle explicable [4]. Une stratification de la typologie des patients [5] a été réalisée en utilisant techniques de regroupement (clustering) et de sélection d'instances. Résultats Il y avait 409 patients, dont 176 (43 %) avaient subi une aggravation pendant leur séjour hospitalier. La précision globale (« accuracy ») du modèle prédictif était de 75 % pour le modèle de risque tandis que le score ROC AUC était de 81 %. Les variables explicatives les plus importantes étaient l'âge, la gravité du scanner thoracique et les variables biologiques telles que la CRP, la saturation en oxygène et les éosinophiles. Plusieurs variables ont montré de forts effets non linéaires, en particulier pour la sévérité du scanner, comme indiqué dans la Figure 1. Des effets d'interaction ont également été détectés entre l'âge et le sexe ainsi qu'entre l'âge et les éosinophiles. Trois principaux sous-groupes de patients ont été identifiés. Le patient le plus représentatif de chaque groupe est indiqué dans la Figure 2. Le premier groupe présentait un risque très faible d'aggravation de l'état de santé (pas de facteur de risque), le deuxième groupe présentait un risque plus élevé d'aggravation, mais toujours inférieur à 50 % (leur seul facteur de risque était un âge avancé), tandis que le troisième groupe avait le pronostic le plus défavorable (plusieurs facteurs de risque comprenant un âge avancé, plusieurs comorbidités, une sévérité CT élevée et des valeurs biologiques anormales). Discussion Les méthodes d'explicabilité ainsi que les techniques de regroupement et de sélection d'instances ont permis de mieux comprendre les effets des variables explicatives. Cela a aussi permis de déterminer les principales typologies des patients hospitalisés, facilitant ainsi la définition et l'amélioration des protocoles médicaux pour fournir les soins les plus appropriés à chaque profil [6]. Mots clés COVID19; Intelligence artificielle; Explicabilité; Clustering Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
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Affiliation(s)
| | | | | | - M. Raphaël-Rousseau
- Centre hospitalier intercommunal de Créteil (CHIC) - Site web, Créteil, France
| | - C. Chouaid
- Centre hospitalier intercommunal de Créteil (CHIC) - Site web, Créteil, France
| | - C. Jung
- Centre hospitalier intercommunal de Créteil (CHIC) - Site web, Créteil, France
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15
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Jung C, Excoffier JB, Raphaël-Rousseau M, Salaun-Penquer N, Ortala M, Chouaid C. Evolution du profil des patients hospitalisés au cours des trois premières vagues de COVID-19 par des techniques d'apprentissage automatique. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634431 DOI: 10.1016/j.respe.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction La COVID-19 a rapidement évolué d'une épidémie locale à une pandémie mondiale, obligeant la plupart des pays à prendre de fortes mesures pour contenir la propagation au cours des différentes vagues et soulager la pression sur les centres hospitaliers, en particulier sur les unités de soins intensifs. Une abondante littérature a détaillé les caractéristiques des patients et les facteurs de protection et de risque lors du l'éclatement de la pandémie [1]. Malheureusement, très peu d'études ont ensuite été menées pour décrire l'évolution de ces caractéristiques au cours des vagues ultérieures [2,3]. De plus, comme les premiers facteurs de risque identifiés étaient pluriels (de l'âge aux comorbidités, multiples interactions) les méthodes classiques d'analyse ne suffisent pas à obtenir une compréhension précise de la population à risque de développer des formes sévères de COVID-19. Méthodes Les données ont été recueillies prospectivement au Centre hospitalier intercommunal de Créteil sur plus d'un an, correspondant aux trois premières vagues de COVID-19 en France. Les caractéristiques disponibles étaient l'âge, le sexe et de nombreuses comorbidités. La variable cible indiquant si le patient avait développé une forme sévère (ventilation mécanique, réanimation, décès) de COVID-19 pendant son l'hospitalisation. L'évolution des caractéristiques entre les cas non sévères et sévères au fil des vagues a été analysée en couplant un modèle d'apprentissage automatique [4] à une méthode d'explicabilité produisant des influences locales [5]. Ainsi, chaque patient se voit associé un niveau de risque (une probabilité d'être un cas sévère) et un score de contribution de chacune de ses variables explicatives, permettant de repérer les facteurs de protection et de risque. Résultats Il y avait 1076 patients sur les trois vagues: 429 pour la première vague, 214 pour la deuxième et 433 pour la troisième. Les formes sévères concernaient respectivement 29 %, 31 % et 18 % de chaque vague. Les facteurs de risque de la première vague comprenaient l'âge avancé (≥70 ans), être un homme et des comorbidités telles que le diabète et l'obésité, tandis que les problèmes cardiovasculaires apparaissaient comme un léger facteur de protection. Il y avait de plus des effets d'interaction entre l'âge et les autres variables importantes. La deuxième vague présentait moins de facteurs de risque, puisque seuls l'âge avancé (≥70 ans) et le fait d'être un homme étaient des informations importantes. Lors de la troisième vague, l'âge avancé (≥70 ans) a également été identifié comme un facteur de risque mais de manière plus hétérogène que pour les vagues précédentes. Être un homme et les comorbidités telles que l'obésité, la grossesse ainsi que les problèmes cardiovasculaires et pulmonaires sont également apparus comme des facteurs de risque mais il n'y avait pas d'interaction avec l'âge. Discussion La typologie des patients hospitalisés atteints de formes sévères de COVID-19 a rapidement évolué au fil des vagues. L'analyse a notamment mis en évidence que les facteurs de risque étaient beaucoup plus hétérogènes pour la troisième vague. Cette évolution peut être due aux changements des pratiques hospitalières à mesure que la maladie était mieux comprise ainsi qu'à la campagne de vaccination [6] ciblant en premier lieu les personnes comme à haut risque telles les personnes âgées ou présentant des comorbidités. Mots clés COVID; 19; Intelligence artificielle; Explicabilité Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
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Affiliation(s)
- C. Jung
- Centre de Recherche Clinique, CHI Créteil, France
| | | | | | | | | | - C. Chouaid
- Service de pneumologie, CHI Créteil, France,Inserm U955, UPEC, IMRB, Créteil, France
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16
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Polzin A, Dannenberg L, Helten C, Metzen D, Duecker C, Marschall U, L Hoest H, Hennig B, Petzold T, Jung C, Levkau B, Zeus T, Schroer K, Hohlfeld T, Kelm M. Excess mortality in Aspirin and Dipyrone (Metamizole) co-medicated in patients with cardiovascular disease: a nationwide study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pain is a serious issue in our aging society. Metamizole is one of the most commonly used analgesics. In addition, metamizole has been shown to attenuate the pharmacodynamics response to aspirin as measured by platelet function tests. However, the extent to which this laboratory effect translates to clinical outcome in patients is unknown.
Methods
We conducted a nationwide analysis based on health insurance database including 9.2 million patients in Germany. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting (IPTW) analysis was performed to examine mortality rates between patients on aspirin-metamizole co-medication and aspirin medication alone. Myocardial infarction (MI) and stroke/transient ischemic attack (TIA) events were also documented.
Results
26,200 patients received continuous aspirin medication alone and 5,946 received co-medication with aspirin and metamizole. In the IPTW analysis, significantly increased mortality was observed in the co-medication group (15.6% vs. 24.4%, hazard ratio (HR)=1.66, 95% confidence interval (CI) 1.56–1.76; p<0.0001). MI and stroke/TIA were also increased (MI: 1,370 [5.2%] vs. 355 [5.9%]; HR=1.18, 95% CI 1.05–1.32; p=0.0066, relative risk (RR) 1.14, absolute risk increase (ARI) 0.71%, number needed to harm (NNH) 140. Stroke/TIA: 1,901 [7.3%] vs. 506 [8.5%]; HR=1.22, 95% CI 1.11–1.35; p<0.0001, RR 1.17, ARI 1.21%, NNH 82).
Conclusion
In this nationwide observational study, aspirin-metamizole co-medication was associated with excess mortality. This was partly due to ischemic events (MI and stroke/TIA), which were also more frequent in the co-medication patients. Therefore, metamizole should be used with caution in aspirin-treated patients for secondary prevention
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Polzin
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - L Dannenberg
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - C Helten
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - D Metzen
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - C Duecker
- Georg-August University, Institute for Clinical Pharmacology , Goettingen , Germany
| | - U Marschall
- BARMER Statutory Health Insurance Fund , wuppertal , Germany
| | - H L Hoest
- BARMER Statutory Health Insurance Fund , wuppertal , Germany
| | - B Hennig
- BARMER Statutory Health Insurance Fund , wuppertal , Germany
| | - T Petzold
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - C Jung
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - B Levkau
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - T Zeus
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - K Schroer
- Heinrich Heine University, Institute for Pharmacology and Clinical Pharmacology , Duesseldorf , Germany
| | - T Hohlfeld
- Heinrich Heine University, Institute for Pharmacology and Clinical Pharmacology , Duesseldorf , Germany
| | - M Kelm
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
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17
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Marjani K, Erkens R, Kramser N, Ipek R, Nienhaus F, Haberkorn W, Wischmann P, Polzin A, Roden M, Jung C, Kelm M, Boenner F, Cramer M. Development of CMR-derived aortic stiffness parameters in patients with metabolic comorbidities after ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stiffness has demonstrated an independent prediction of adverse cardiovascular events after ST-segment elevation myocardial infarction (STEMI) [1]. The general impact of the comorbidities diabetes mellitus (DM), chronic kidney disease (CKD), anemia on aortic stiffness is well known [2,3]. Therefore, the present study aimed to investigate the influence of metabolic comorbidities on cardiovascular magnetic resonance (CMR)-derived aortic parameters early and 6 months after STEMI.
Methods
From the prospective STEMI pathway, 161 patients (mean age: 63.7 years; 75% male) with initial CMR 5 days after STEMI were included. 105 patients pursued in a 6-month follow-up CMR. Aortic stiffness was assessed using different parameters: 1) pulse wave velocity (PWV) from velocity-encoded phase-contrast images, 2) aortic distensibility, and 3) radial strain from the ascending aorta obtained from cine images. DM was diagnosed when either pre-existing, HbA1c ≥6.5% at index hospitalization or 2-hour OGCT ≥200 mg/dl. CKD was present when glomeruli filtration rate (GFR) was less than 60 ml/min/m2, Anemia was defined according to WHO classifications.
Results
Of the 161 patients, 46 presented with anemia at admission, 79 with anemia at day 5, 26 with CKD and 57 with DM. Initial anemia resulted in a significantly lower distensibility (p=0.003) and aortic strain (p=0.02). A correlation between initial haemoglobin levels and distensibility (r=0.253; p=0.002) was found. CKD Patients showed a lower distensibility (p=0.012). There were correlations between GFR and PWV (r=−0.298; p<0.001), distensibility (r=0.370; p<0.001), and radial strain (r=−0.388; p<0.001). After 6 month this significant correlation remained. The DM group showed higher PWV values (p=0.02) and a lower radial strain (p=0.003). PWV showed a correlation with the 2-hour OGCT value (r=0.249; p=0.011) while the radial strain correlated with HbA1c (r=0.216; p=0.007). After multivariable analyses, diabetes remained the only significant predictor to show higher PWV (p=0.004) and poorer radial strain values (p=0.0045) while initial anemia remained the only significant predictor of lower distensibility (p=0.0033). Aortic stiffness parameters did not show any changes after 6 months in all groups. Only NTproBNP 5 days after STEMI correlated significantly with 6-months PWV (r=0.247; p=0.02), radial strain (r=0.36; p=0.001), distensibility (r=−0.226; p=0.018).
Conclusion
Anemia, DM and CKD show a detrimental impact on values of aortic stiffness early after STEMI. Diabetes remains the only significant predictor of higher PWV and poorer radial strain values after multivariable analysis while initial anemia remains significant predictor of lower distensibility. After 6 months none of the groups showed improvement in aortic stiffness parameters.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Sonderforschungsbereich 1116
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Affiliation(s)
- K Marjani
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - R Erkens
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - N Kramser
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - R Ipek
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - F Nienhaus
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - W Haberkorn
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - P Wischmann
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - A Polzin
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - M Roden
- Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research , Duesseldorf , Germany
| | - C Jung
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - M Kelm
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - F Boenner
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - M Cramer
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
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18
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Bruno RR, Wernly B, Wolff G, Artigas A, Pinto BB, Schefold JC, Kindgen-Milles D, Baldia PH, Kelm M, Beil M, Leaver S, De Lange DW, Guidet B, Flaatten H, Jung C. The impact of pre-existing chronic heart failure on the intensive care treatment and outcome of old intensive care patients suffering from COVID-19. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients suffering from COVID-19 with pre-existing chronic heart failure (CHF) are considered to have a significant risk regarding morbidity and mortality. Similarly, older patients on the intensive care unit (ICU) constitute another vulnerable subgroup. This study investigated the association between pre-existing CHF and clinical practice in critically ill older ICU patients with COVID-19.
Methods
Patients with severe COVID-19 and who were ≥70 years old were recruited from this prospective multicenter international study. Patients' treatment, follow-up, and pre-existing heart failure data were collected during ICU stay. Univariate and multivariate logistic regression analyses examined the association between pre-existing heart failure and the primary endpoint of 30-day mortality.
Results
The study included 3,917 patients, with 407 patients (17%) evidencing pre-existing CHF. These patients were older (77±5 versus 76±5, p<0.001) and more frail (Clinical Frailty Scale 4±2 versus 3±2, p<0.0001). The other comorbidities were also significantly more common in CHF patients. Before hospital admission, CHF patients suffered fewer days from symptoms (5 days (3–8) versus 7 days (4–10), p<0.001), but there was no difference in the days in the hospital before ICU admission (2 days (1–5) versus 2 (1–5) days, p=0.21). At ICU admission, disease severity assessed by SOFA scores was significantly higher in CHF patients (7±3 versus 5±3). During ICU-stay, intubation, mechanical ventilation, and tracheostomy occurred significantly more often in patients without CHF (63% versus 69%, p=0.017; and 13% versus 18%, p=0.002, respectively). In contrast, there was no difference regarding non-invasive ventilation (28% versus 27%, p=0.20), and the need for vasoactive drugs (66% versus 64, p=0.30). Regarding the limitation of life-sustaining therapy, therapy was significantly more often withheld (32% versus 25%, p=0.001) but not withdrawn (18% versus 17%, p=0.21) in CHF patients. Length of ICU stay was significantly shorter in CHF patients (166 (72–336) hours versus 260 hours (120–528), p<0.001). CHF patients had significantly higher ICU- (52% versus 46%, p=0.007), 30-day mortality (60% vs. 48%, p<0.001; OR 1.87, 95% CI 1.5–2.3) and 3-month mortality (69% vs. 56%, p<0.001). In the univariate regression analysis, having pre-existing CHF was significantly associated with 30-day mortality (OR 1.89, 95% CI 1.5–2.3; p<0.001), but after adjusting for confounders (SOFA, age, gender, frailty), heart failure was not independently associated any more (aOR 1.2, 95% CI 0.5–1.5; p=0.137).
Conclusion
In critically ill old COVID-19 patients, pre-existing chronic heart failure is associated with significantly increased short- and long-term mortality, but heart failure is not independently associated with increased 30-day mortality when adjusted for confounders.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. The support of the study in France by a grant from “Fondation Assistance Publique-Hôpitaux de Paris pour la recherche” is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union's Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf, No. 2018-32 to GW and No. 2020-21 to RRB for a Clinician Scientist Track.
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Affiliation(s)
- R R Bruno
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - B Wernly
- Paracelsus Private Medical University, Department of Anaesthesiology , Salzburg , Austria
| | - G Wolff
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - A Artigas
- Hospital Universitari Parc Tauli de Sabadell , Sabadell , Spain
| | - B B Pinto
- Geneva University Hospitals , Geneva , Switzerland
| | - J C Schefold
- Bern University Hospital, Inselspital , Bern , Switzerland
| | | | - P H Baldia
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Beil
- Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - S Leaver
- St George's University Hospital NHS Foundation Trust , London , United Kingdom
| | - D W De Lange
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - B Guidet
- Sorbonne University , Paris , France
| | - H Flaatten
- Haukeland University Hospital , Bergen , Norway
| | - C Jung
- University Hospital Duesseldorf , Duesseldorf , Germany
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19
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Leentjens J, Middeldorp S, Jung C. A short review of ciraparantag in perspective of the currently available anticoagulant reversal agents. Drug Discov Today 2022; 27:103332. [PMID: 35933085 DOI: 10.1016/j.drudis.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Despite the improved safety-profile of direct oral anticoagulants (DOACs), bleeding complications remain an important side effect of anticoagulant treatment. Although anticoagulant-specific antidotes are available, an universal anticoagulant reversal agent in case of life-threatening bleeding or emergency surgery is not yet available. Ciraparantag, a synthetic small molecule that inactivates heparins and DOAC, is a promising new reversal agent that has been investigated in phase 2 trials. In this short review we provide an overview of the preclinical and clinical evidence of ciraparantag, and compare strengths and weaknesses of ciraparantag and the currently available anticoagulant reversal strategies.
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Affiliation(s)
- J Leentjens
- Department of Internal Medicine & Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S Middeldorp
- Department of Internal Medicine & Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Jung
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
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Cohen R, Rybak A, Ouldali N, Angoulvant F, Béchet S, Gajdos V, Hau I, Sellam A, El Aouane El Ghomari I, Elmerich F, Batard C, Auvrignon A, Grimprel E, Favier M, Jung C, Levy C. From the original SARS-CoV-2 strain to the Omicron variant: predictors of COVID-19 in ambulatory symptomatic children. Infect Dis Now 2022; 52:432-440. [PMID: 36116761 PMCID: PMC9477611 DOI: 10.1016/j.idnow.2022.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the predictors of a positive SARS-CoV-2 test in a pediatric ambulatory setting. PATIENTS AND METHODS We performed a cross-sectional prospective study (November 2020-February 2022) of 93 ambulatory settings in France. We included symptomatic children < 15 years old tested for SARS-CoV-2. For each period corresponding to the spread of the original strain and its variants (period 1: original strain; period 2: Alpha, period 3: Delta; period 4: Omicron), we used a multivariate analysis to estimate adjusted odds ratios (aORs) associated with COVID-19 among age, signs, symptoms or contact, and 95 % confidence intervals (95CIs). RESULTS Of 5,336 children, 13.9 % (95CI 13.0-14.8) had a positive test. During the first three periods, the positivity rate ranged from 5.6 % (95CI 4.6-6.7) to 12.6 % (95CI 10.8-14.6). The main factors associated with a positive test were contact with an infected adult at home or outside the home (aOR 11.5 [95CI 4.9-26.9] to 38.9 [95CI 19.3-78.7]) or an infected household child (aOR 15.0 [95CI 4.8-47.1] to 28.4 [95CI 8.7-92.6]). By contrast, during period 4, aORs for these predictors were substantially lower (2.3 [95CI 1.1-4.5] to 5.5 [95CI 3.2-7.7]), but the positivity rate was 45.7 % (95CI 42.3-49.2). CONCLUSIONS In pediatric ambulatory settings, before the Omicron period, the main predictor of a positive test was contact with an infected person. During the Omicron period, the odds of these predictors were substantially lower while the positivity rate was higher. An accurate diagnostic strategy should only rely on testing and not on age, signs, symptoms or contact.
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Affiliation(s)
- R Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France
| | - A Rybak
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France; Unité d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France.
| | - N Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Unité d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France; Assistance Publique - Hôpitaux de Paris, Pediatric Department, Robert Debré Hospital, France
| | - F Angoulvant
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Assistance Publique - Hôpitaux de Paris, Pediatric Department, Robert Debré Hospital, France; INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France
| | - S Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - V Gajdos
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Centre for Research in Epidemiology and Population Health, INSERM UMR1018, Villejuif, France; Assistance Publique-Hôpitaux de Paris, Pediatric Department, Antoine Béclère University Hospital, Université de Paris Saclay, Clamart, France
| | - I Hau
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Service de pédiatrie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - A Sellam
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | | | - F Elmerich
- CHU Reims, Urgences Pédiatriques, France
| | - C Batard
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - A Auvrignon
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - E Grimprel
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Service de pédiatrie, Hôpital Trousseau, Paris, France
| | - M Favier
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Urgences Pédiatriques CHU de Bordeaux, Bordeaux, France
| | - C Jung
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - C Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France.
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Kim DY, Baik SH, Jung C, Kim JY, Han SG, Kim BJ, Kang J, Bae HJ, Kim JH. Predictors and Impact of Sulcal SAH after Mechanical Thrombectomy in Patients with Isolated M2 Occlusion. AJNR Am J Neuroradiol 2022; 43:1292-1298. [PMID: 35902120 PMCID: PMC9451639 DOI: 10.3174/ajnr.a7594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/17/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Data on SAH after M2 mechanical thrombectomy are limited. We aimed to determine the prevalence of sulcal SAH after mechanical thrombectomy for M2 occlusion, its associated predictors, and the resulting clinical outcome. MATERIALS AND METHODS The study retrospectively reviewed the data of patients with acute ischemic stroke who underwent mechanical thrombectomy for isolated M2 occlusion. The patients were divided into 2 groups according to the presence of sulcal SAH after M2 mechanical thrombectomy. Angiographic and clinical outcomes were compared. Multivariable analysis was performed to identify independent predictors of sulcal SAH and unfavorable outcome (90-day mRS, 3-6). RESULTS Of the 209 enrolled patients, sulcal SAH was observed in 33 (15.8%) patients. The sulcal SAH group showed a higher rate of distal M2 occlusion (69.7% versus 22.7%), a higher of rate of superior division occlusion (63.6% versus 43.8%), and a higher M2 angulation (median, 128° versus 106°) than the non-sulcal SAH group. Of the 33 sulcal SAH cases, 23 (66.7%) were covert without visible intraprocedural contrast extravasation. Distal M2 occlusion (OR, 12.04; 95% CI, 4.56-35.67; P < .001), superior division (OR, 3.83; 95% CI, 1.43-11.26; P = .010), M2 angulation (OR, 1.02; 95% CI, 1.01-1.04; P < .001), and the number of passes (OR, 1.58; 95% CI, 1.22-2.09; P < .001) were independent predictors of sulcal SAH. However, covert sulcal SAH was not associated with an unfavorable outcome (P = .830). CONCLUSIONS After mechanical thrombectomy for M2 occlusion, sulcal SAH was not uncommon and occurred more frequently with distal M2 occlusion, superior division, acute M2 angulation, and multiple thrombectomy passes (≥3). The impact of covert sulcal SAH was mostly benign and was not associated with an unfavorable outcome.
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Affiliation(s)
- D Y Kim
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - S H Baik
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
| | - C Jung
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
| | - J Y Kim
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - S-G Han
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - B J Kim
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - J Kang
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - H-J Bae
- Neurology (D.Y.K, J.Y.K, S.-G.H., B.J.K, J.K., H-.J.B), Seoul National University Bundang Hospital, Seongnam, South Korea
| | - J H Kim
- From the Departments of Radiology (D.Y.K., S.H.B., C.J., J.H.K.)
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22
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Ducasse D, Alacreu-Crespo A, Lacourt L, Jung C, Hidalgo M, Brand-Arpon V, Courtet P, Olié E. Sexual orientation, gender: Where is the problem? Nowhere! Correct self-identification and minority stigma. Encephale 2022; 48:714-718. [DOI: 10.1016/j.encep.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 10/15/2022]
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Nippita S, Jung C, Oviedo JD, Quinn GP. Private Conversations, Public Debate. Am J Bioeth 2022; 22:47-49. [PMID: 35917426 DOI: 10.1080/15265161.2022.2089285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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24
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Yuan ML, Jung C, Bell RC, Nelson JL. Aposematic patterns shift continuously throughout the life of poison frogs. J Zool (1987) 2022. [DOI: 10.1111/jzo.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. L. Yuan
- Center for Population Biology University of California Davis CA USA
- Department of Evolution and Ecology University of California Davis CA USA
| | - C. Jung
- Department of Environmental Science, Policy, and Management University of California Berkeley CA USA
| | - R. C. Bell
- Department of Herpetology California Academy of Sciences San Francisco CA USA
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Rousseau M, Excoffier JB, Salaun-Penquer N, Ortala M, Chouaid C, Jung C. Evolution des facteurs de risque de forme grave de la COVID-19 à travers les trois vagues à partir des données du PMSI. Rev Epidemiol Sante Publique 2022. [PMCID: PMC8907805 DOI: 10.1016/j.respe.2022.01.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction De nombreuses études ont établi une typologie des patients à risque de développer une forme grave de COVID-19. La grande majorité de ces études ne portent que sur la première vague de la COVID-19 alors que les profils à risque de développer des formes graves évoluent après les campagnes de vaccination. Cette étude a pour but d'analyser l’évolution des facteurs de risque cliniques de COVID-19 graves lors des différentes vagues afin d'ajuster l'offre de soins au contexte actuel. Méthodes Les données du PMSI du Centre hospitalier intercommunal de Créteil ont été analysées pendant les trois premières vagues de l'épidémie. Les variables cliniques disponibles étaient l’âge, le sexe et les comorbidités connues comme à risque de forme grave. Les formes graves étaient définies par le passage en réanimation, le recours à un support ventilatoire non invasif ou le décès du patient. L'évolution de la typologie des patients à risque a été analysée avec des méthodes classiques comme la régression multivariée ainsi qu'avec des techniques provenant de l'apprentissage automatique et de son sous-domaine qu'est l'explicabilité. Résultats Sur 1076 patients hospitalisés, les formes sévères concernaient 29 % (123/429) des patients de la vague 1, 31 % (66/214) de la vague 2 et 18 % (79/433) de la vague 3. Les facteurs de risque de la vague 1 étaient l'âge élevé ( ≥ 70 ans), le sexe masculin, le diabète et l'obésité, tandis que les problèmes cardiovasculaires apparaissaient comme des facteurs protecteurs. Les impacts de l'âge, du sexe étaient moins marqués pour la vague 3, de même que l'interaction entre l'âge et les comorbidités. Discussion/Conclusion Le profil des patients à risque a rapidement évolué au cours des vagues, la troisième vague ayant eu un écart bien moins net entre les formes sévères et non-sévères. Cette évolution peut provenir des changements des procédures médicales hospitalières ainsi que du début de la campagne de vaccination ciblant en premier lieu les personnes avec un risque élevé telles les personnes âgées ou présentant certaines comorbidités.
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Mitschke T, yGonzalez MG, Jung C, Follmann P, Kaltschmidt J, Jux C, Kriebel T. Erfolgreiche Antiarrhythmische Therapie mit Ivabradin bei fokalen atrialen und ventrikulären Rhythmusstörungen bei zwei erwachsenen Fontan-Patienten. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Mitschke
- Kinderkardiologie, Westpfalz-Klinikum GmbH
- Standort I Kaiserslautern, Kaiserslautern, Deutschland
| | | | - C. Jung
- Kinderkardiologie, Westpfalz-Klinikum GmbH
- Standort I Kaiserslautern, Kaiserslautern, Deutschland
| | - P. Follmann
- Kinderkardiologie, Westpfalz-Klinikum GmbH
- Standort I Kaiserslautern, Kaiserslautern, Deutschland
| | - J. Kaltschmidt
- Kinderkardiologie, Westpfalz-Klinikum GmbH
- Standort I Kaiserslautern, Kaiserslautern, Deutschland
| | - C. Jux
- Kinderherzzentrum Giessen, Gießen, Deutschland
| | - T. Kriebel
- Kinderkardiologie, Westpfalz-Klinikum GmbH
- Standort I Kaiserslautern, Kaiserslautern, Deutschland
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27
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yGonzalez MG, Khalil M, Mitschke T, Jung C, Kriebel T, Jux C. Is There a Role for Electrophysiological Studies for Risk Stratification in Asymptomatic Patients with Congenital Heart Disease Prior to Percutaneous Pulmonary Valve Implantation? Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - T. Mitschke
- Hellmut-Harter- Str. 1, Kaiserslautern, Deutschland
| | - C. Jung
- Westpfalz Klinikum, Kaiserslautern, Deutschland
| | - T. Kriebel
- Hellmut-Harter- Str. 1, Kaiserslautern, Deutschland
| | - C. Jux
- Feulgenstr. 10-12, Gießen, Deutschland
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Maier O, Binneboessel S, Klein K, Piayda K, Polzin A, Westenfeld R, Jung C, Berisha N, Zeus T, Kelm M, Veulemans V. Real-world experience with the cusp overlap deployment technique for procedural optimization during self-expanding transcatheter aortic valve implantation: our city best practice trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic valve stenosis treated by transcatheter aortic valve implantation (TAVI) is a fast-growing section in interventional cardiology. Optimal implantation depth (ID) of self-expanding TAVI devices is an important condition for hemodynamic and clinical outcomes. The cusp overlap technique (COT) offers optimized fluoroscopic projections for TAVI with self-expanding devices due to improved anatomic discrimination by elongation of the left ventricular outflow tract and isolation of the non-coronary cusp (NCC) for better assessment of ID.
Purpose
This single-center observational study aims to investigate short-term clinical performance, safety, and efficiency outcomes regarding optimized ID in patients undergoing transfemoral TAVI with self-expanding prostheses and COT.
Methods
From September 2020 to December 2020, a total of 71 patients underwent TAVI with a newer-generation self-expanding device and COT. The optimal fluoroscopic projection was generated by overlapping the right (RCC) and left coronary cusps (LCC) on the multidetector computed tomography annular plane. Final ID was assessed by the arithmetic mean of distances measured from NCC and LCC to the distal prosthesis end. Outcomes were compared with a control cohort of 339 patients who underwent TAVI from January 2016 to August 2020 with a three-cusp coplanar view only during valve deployment.
Results
ID was significantly reduced in the COT cohort (4.3±1.9 vs. 5.0±2.3 mm; p=0.012) with better achievement of optimal ID (2–4 mm) (63.4% vs. 49.9%; p=0.03) and optimization of delta NCC-LCC ID symmetry (1.4±1.3 vs. 1.7±1.3 mm; p=0.026). The rate of pacemaker implantation following TAVI could be reduced (9.9% vs. 19.4%; p=0.05). Six of the seven patients receiving pacemaker in the COT cohort (85.7%) showed ID above membranous septum length. COT resulted in notably higher rates of device repositioning by recapturing (57.8% vs. 16.2%; p<0.001) compared to control cohort. Though, procedure time was prolonged in the COT cohort (82.0±26.5 vs. 74.9±27.5 min; p=0.05) while radiation dose and amount of contrast medium did not differ between the cohorts. No difference was observed in hemodynamic outcomes regarding transvalvular pressure gradients and at least moderate paravalvular leak. Patients implanted with COT had a shorter length of hospital stay (7.1±6.0 vs. 10.3±6.8 days; p<0.001), possibly due to a lower complication rate regarding new conduction disturbances and pacemaker implantation.
Conclusion
TAVI using the cusp overlap deployment technique is associated with an optimized implantation depth and a low rate of procedural complications. Therefore, a reduction of new pacemaker implantations and shortened length of hospital stay could be achieved.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O Maier
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - K Klein
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Polzin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - N Berisha
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
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Singerer I, Gruen K, Schrepper A, Baez L, Schwarzer M, Bauer R, Jung C, Berndt A, Schulze PC, Franz M. Crucial role of extra-domain A containing fibronectin for the development of pulmonary hypertension and associated right heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary vascular and right ventricular myocardial remodelling are unique phenomena in PH progression. Both processes are accompanied by an abundant re-expression of the extra-domain A of fibronectin (ED-A+ Fn) therefore qualifying as promising biomarker or even therapeutic target. Nevertheless, its functional role in PH pathogenesis remains unclear until now. Objective: The purpose of our study was to analyse the development of PH and RHF in a mouse model of monocrotaline (MCT)-induced PH comparing C57BL/6 ED-A+ Fn knockout (KO) and wild-type (WT) mice.
Methods
PH was induced by subcutaneous injection of a single dose of MCT (60 mg/kg body weight). Subgroups were additionally treated with the dual endothelin receptor antagonist Macitentan (MAC, 15mg/kg body weight per day from day 14 to 28). There were 6 experimental groups: sham-treated control WT mice (WTco, n=4); MCT induced PH WT mice (WTPH, n=6); MCT induced PH WT mice treated with MAC (WTPH_MAC, n=6); sham-treated control KO mice (KOco, n=4); MCT induced PH KO mice (KOPH, n=6); MCT induced PH KO mice treated with MAC (KOPH_MAC, n=6). Between day 26 and 28, transthoracic echocardiography and right heart catheterization were performed. Both, lung and cardiac tissue samples were subjected to histological analyses.
Results
Right heart catheterization revealed significantly increased RVPsys values in WTPH (87.0±16.4mmHg) compared to WTco (36.1±9.4mmHg; p=0.034) animals, which showed, at least in trend, a diminution in the WTPH_MAC group (67.1±20.9mmHg; p=n.s.). There was a non-significant increase in RVPsys in the KOPH (55.6±14.9mmHg) compared to KOco mice (37.2±5.6mmHg; p=n.s.) without any differences compared to the KOPH_MAC group (60.9±14.0mmHg; p=n.s.). When comparing the WTPH and the KOPH group, RVPsys was significantly lower in the KO animals (p=0.014), while there were no differences between the WTPH_MAC and the KOPH_MAC group (p=n.s.). Echocardiographic evaluation including surrogate parameters of right ventricular (RV) overload and failure were significantly altered in WTPH compared to WTco animals (p<0.05) and could not be shown to be relevantly improved in the WTPH_MAC group (p=n.s.). The majority of echocardiographic parameters did not significantly differ between the KOPH and the KOco group (p=n.s.). Lung tissue analysis revealed significant alterations in both, the WTPH and the KOPH group, each compared to the corresponding control (p<0.05). The level of lung tissue damage was significantly decreased in KOPH compared to WTPH mice (p<0.05). In RV, the amount of interstitial fibrosis was increased in the WTPH (p=0.009) but not in the KOPH group (p=n.s.), each compared to the corresponding controls.
Conclusions
The findings of the current study underline the hypothesis that ED-A+ Fn is a key player in the pathogenesis of PH and associated RHF. Thus, it might represent a promising therapeutic target, e.g., by the administration of neutralizing antibodies.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Jena
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Affiliation(s)
- I Singerer
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - K Gruen
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - A Schrepper
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - L Baez
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - M Schwarzer
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - R Bauer
- University Hospital Jena, Institute of Molecular Cell Biology, Jena, Germany
| | - C Jung
- Heinrich-Heine-University, Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - A Berndt
- University Hospital of Jena, Institut of Legal Medicine, Section of Pathology, Jena, Germany
| | - P C Schulze
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - M Franz
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
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Veulemans V, Maier O, Piayda K, Berning KL, Binneboessel S, Polzin A, Afzal S, Dannenberg L, Horn P, Jung C, Westenfeld R, Kelm M, Zeus T. Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated.
Purpose
Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID.
Methods
562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.
Results
The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p<0.0001*).
Conclusion
Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Veulemans
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - O Maier
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - K Piayda
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - K L Berning
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - S Binneboessel
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - A Polzin
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - S Afzal
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - L Dannenberg
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - P Horn
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - C Jung
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - R Westenfeld
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - M Kelm
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - T Zeus
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
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Maier O, Afzal S, Piayda K, Polzin A, Westenfeld R, Jung C, Zeus T, Kelm M, Veulemans V. Electrocardiographic predictors of recovery from pacemaker dependency after transcatheter aortic valve implantation: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The occurrence of electrical conduction disturbances with the need for permanent pacemaker (PPM) implantation remains one of the most frequent complications of the procedure. But PPM dependency after TAVI is often transient and conduction abnormalities may improve over time.
Purpose
We performed a meta-analysis to summarize available studies that reported the incidence of new PPM after TAVI and investigated the rate and possible predictors of recovery from PPM dependency during follow-up.
Methods
The authors conducted a literature search in PubMed and MEDLINE databases from January of 2012 until February of 2021. Eleven observational studies (n=6794) met inclusion criteria for the final analysis. The effect size was estimated using a random-effects model with 95% confidence interval (CI).
Results
PPM implantation was performed in 902 patients after TAVI (13.3%), mostly due to high degree atrioventricular (AV) block (81.3%). A follow-up of 683 patients was performed after a median period of 139 days. 322 of the patients examined during follow-up (48.6%) showed recovery from PPM dependency. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) predictors of PPM recovery during follow-up were female sex (RR 1.37; 95% CI 1.10–1.71; p=0.006), preexisting coronary artery disease (RR 1.12; 95% CI 0.99–1.27; p=0.08) and reduced left ventricular ejection fraction (MD −2.08%; 95% CI 0.23–3.93%; p=0.03). ECG predictors for long-term PPM dependency after TAVI appeared to be preexisting right bundle branch block (RBBB) (RR 1.84; 95% CI 1.38–2.45; p<0.0001), bifascicular block (RR 4.41; 95% CI 1.64–11.86; p=0.003) and prolonged QRS duration (MD 8.69 ms; 95% CI 0.11–17.28 ms; p=0.05). While postprocedural complete heart block was highly predictive for long-term PPM dependency after TAVI (RR 1.35; 95% CI 0.97–1.89; p<0.0001), patients with recovery of PPM dependency showed more indications other than complete heart block for PPM implantation like lower degree AV block or sick sinus syndrome (RR 2.28; 95% CI 1.53–3.38; p<0.0001). Especially postprocedural AV block grade I (RR 1.73; 95% CI 0.96–3.14; p=0.07) and new left bundle branch block (LBBB) (RR 1.94; 95% CI 1.22–3.08; p=0.005) turned out to be predictors of PPM recovery during follow-up.
Conclusion
This structured meta-analysis proved new PPM implantation in 13.3% of patients following TAVI with half of the cases (48.6%) recovering from PPM dependency during follow-up. Therefore, it should be considered to carefully reassess the indication for PPM rather than to immediately implant PPM after TAVI, especially regarding postprocedural ECG predictors for early pacemaker recovery (lower degree AV block, postprocedural LBBB).
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O Maier
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Afzal
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Polzin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
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Razafintsalama-Bourdet M, Bah M, Amand G, Vienet-Lègue L, Pietin-Vialle C, Bry-Gauillard H, Pinto M, Pasquier M, Vernet T, Jung C, Levaillant JM, Massin N. Random antral follicle count performed on any day of the menstrual cycle has the same predictive value as AMH for good ovarian response in IVF cycles. J Gynecol Obstet Hum Reprod 2021; 51:102233. [PMID: 34571198 DOI: 10.1016/j.jogoh.2021.102233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/28/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether the predictive value of AFC for ovarian response to stimulation for IVF depends on the day of the menstrual cycle when ultrasound is performed. METHODS 410 women undergoing their first IVF cycle were included. All the women had AFC performed twice. The first measurement, random AFC (r-AFC), was performed during the fertility workup whatever the day of their menstrual cycle. Three groups were constituted according to the period of ultrasound performance: at early follicular phase i.e., day 1 to day 6 (eFP-AFC); at mid follicular phase i.e., day 7 to 12 (mFP-AFC) and at luteal phase i.e., day 13 or after (LP-AFC). A second AFC measurement was performed before the start of the ovarian stimulation (SD1-AFC). AMH dosing was done in the early follicular phase. RESULTS Random AFC (r-AFC) was correlated to AMH (r = 0.69; p<0.001), SD1-AFC (r = 0.75; p<0.001) and number of oocytes retrieved (r = 0.49; p<0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was 0.65, 0.66 and 0.85 for the eFP-AFC, the mFP-AFC and the LP-AFC respectively (all p were <0.001). The ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively; p = 0.28). The AUC of r-AFC (0.76) were similar to those of AMH (0.74) and SD1-AFC (0.74) (p = 0.21 and 0.92 respectively). CONCLUSION AFC is strongly correlated with AMH and highly predictive of good ovarian response during the whole menstrual cycle.
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Affiliation(s)
- M Razafintsalama-Bourdet
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - M Bah
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - G Amand
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - L Vienet-Lègue
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - C Pietin-Vialle
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - H Bry-Gauillard
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - M Pinto
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - M Pasquier
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - T Vernet
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France
| | - C Jung
- Clinical Research Center, Intercommunal Hospital- University Paris XII, Creteil, France
| | - J M Levaillant
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France; Hopital privé Armand Brillard, Nogent sur Marne, France
| | - N Massin
- Department of Gynecology-Obstetrics and Reproductive Medicine, Intercommunal Hospital- University Paris XII, Creteil, France.
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Baik SH, Jung C, Kim JY, Shin DW, Kim BJ, Kang J, Bae HJ, Kim JH. Local Intra-arterial Thrombolysis during Mechanical Thrombectomy for Refractory Large-Vessel Occlusion: Adjunctive Chemical Enhancer of Thrombectomy. AJNR Am J Neuroradiol 2021; 42:1986-1992. [PMID: 34475193 DOI: 10.3174/ajnr.a7264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Data on adjunctive intra-arterial thrombolysis during mechanical thrombectomy for refractory thrombus are sparse. The aim of this study was to evaluate the efficacy and safety of local intra-arterial urokinase as an adjunct to mechanical thrombectomy for refractory large-vessel occlusion. MATERIALS AND METHODS We retrospectively evaluated patients with acute ischemic stroke who underwent mechanical thrombectomy for anterior circulation large-vessel occlusion between January 2016 and December 2019. Patients were divided into 2 groups based on the use of intra-arterial urokinase as an adjunctive therapy during mechanical thrombectomy for refractory thrombus: the urokinase and nonurokinase groups. Herein, refractory thrombus was defined as the target occlusion with minimal reperfusion (TICI 0 or 1) despite >3 attempts with conventional mechanical thrombectomy. The baseline characteristics, procedural outcomes, and clinical outcome were compared between the 2 groups. RESULTS One hundred fourteen cases of refractory thrombus were identified. A total of 45 and 69 patients were in the urokinase and the nonurokinase groups, respectively. The urokinase group compared with the nonurokinase group showed a higher rate of successful reperfusion (82.2% versus 63.8%, P = .034), with lower procedural times (54 versus 69 minutes, P = .137). The rates of good clinical outcome, distal embolism, and symptomatic intracranial hemorrhage were similar between the 2 groups. The use of intra-arterial urokinase (OR = 3.682; 95% CI, 1.156-11.730; P = .027) was an independent predictor of successful reperfusion. CONCLUSIONS The use of local intra-arterial urokinase as an adjunct to mechanical thrombectomy may be an effective and safe method that provides better recanalization than the conventional mechanical thrombectomy for refractory thrombus in patients with embolic large-vessel occlusion.
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Affiliation(s)
- S H Baik
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
| | - C Jung
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
| | - J Y Kim
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - D-W Shin
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
| | - B J Kim
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J Kang
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - H-J Bae
- Department of Neurology (J.Y.K., B.J.K., J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J H Kim
- From the Department of Radiology (S.H.B., C.J., D.-W.S., J.H.K.,)
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Razafintsalama M, Bah M, Amand G, Vienet-Lègue L, Pietin-Vialle C, Bry-Gauillard H, Pinto M, Pasquier M, Jung C, Levaillant JM, Massin N. P–599 random antral follicle count, performed at any day of the menstrual cycle, demonstrates the same predictive value for ovarian response in in vitro fertilization cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does antral follicle count (AFC) retains its predictive value for ovarian response to stimulation for in vitro fertilization (IVF) throughout the whole menstrual cycle?
Summary answer
AFC is strongly correlated to anti-mullerian hormone (AMH) and highly predictive of good ovarian response whatever the day of cycle the ultrasound is performed.
What is known already
Usually performed in the early follicular phase (at day 2–3 of the menstrual cycle), AFC and AMH are the most accurate markers of ovarian reserve. They are routinely used to predict ovarian response to ovarian stimulation for IVF and eventually to individualize the gonadotropin starting dose.
Study design, size, duration
Retrospective cohort study performed between January, 2017 and December, 2019.
Participants/materials, setting, methods
410 consecutive women aged 20 to 42 years were included. Random AFC (r-AFC) was performed during the fertility workup whatever the day of their menstrual cycle was: early follicular phase i.e. day 1 to day 6 (eFP-AFC), mid follicular phase i.e. day 7 to 12 (mFP-AFC) and luteal phase i.e. day 13 or after (LP-AFC). A second AFC was performed before the start of the stimulation (SD1-AFC). AMH was measured in the early follicular phase.
Main results and the role of chance
Random AFC (r-AFC) was correlated to AMH (r = 0.692; p < 0.001), SD1-AFC (r = 0.756; p < 0.001) and number of oocytes retrieved (r = 0.491; p < 0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was significantly higher for the LP-AFC, (LP-AFC) (r = 0.853) than for the eFP-AFC (r = 0.657; p < 0.001) and for the mFP-AFC (r = 0.668). The correlation with SD1-AFC was similar regardless of the time of performance of r-AFC (r = 0.739, 0.783, 0.733, respectively for eFP, mFP and LP-AFC). Moreover, the ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively) as well as for AMH and SD1-AFC (AUC 0.74 and 0.74, respectively).
Limitations, reasons for caution
This is a retrospective analysis, however data were prospectively collected and the method for ultrasound acquisition of AFC was standardized.
Wider implications of the findings: The absence of significant variation of AFC across the menstrual cycle allows to its random performance. Ultrasound performed besides early follicular phase discloses informations on ovaries, the uterus and the endometrium. It is more comfortable and convenient for women and physicians by limiting targeted appointment during menstruation and reiterated examination.
Trial registration number
Not applicable
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Affiliation(s)
- M Razafintsalama
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - M Bah
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - G Amand
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - L Vienet-Lègue
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - C Pietin-Vialle
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - H Bry-Gauillard
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - M Pinto
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - M Pasquier
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
| | - C Jung
- Intercommunal Hospital- University Paris XII, Clinical Research Center, Creteil- France, France
| | - J M Levaillant
- Hôpital Privé Armand Brillard, Echographie, Nogent-Sur-Marne, France
| | - N Massin
- Intercommunal Hospital- University Paris XII, Gynecology-Obstetrics and Reproductive Medecine-, Creteil- France, France
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Amoroso F, Pedinielli A, Colantuono D, Jung C, Capuano V, Souied EH, Miere A. Selective Photocoagulation of Capillary Macroaneurysms by Navigated Focal Laser. Ophthalmic Surg Lasers Imaging Retina 2021; 52:366-373. [PMID: 34309425 DOI: 10.3928/23258160-20210628-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the anatomical and functional outcome of selective photocoagulation of capillary macroaneurysms (CMAs) by navigated focal laser. PATIENTS AND METHODS Consecutive patients with solitary or secondary CMAs greater than 150 mm in diameter were included in this analysis. All patients were treated with navigated focal laser and received multimodal imaging. RESULTS Seventeen eyes of 17 patients were retrospectively analyzed. Navigated laser photocoagulation of the CMAs successfully occluded 100% of the CMAs, inducing significative improvement in best-corrected visual acuity at 3 (P = .002) and 6 months (P = .001) and a decrease in central macular thickness (CMT) at 3 (P = .0004) and 6 months (P = .0004). CONCLUSIONS Solitary or secondary CMAs arising from retinal capillaries are candidates for navigated laser treatment. Navigated focal treatment was able to close all CMAs in this series with an improvement in vision and CMT. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:366-373.].
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Sebban S, Evenou D, Jung C, Fausser C, Durand S, Bibal M, Geninasca V, Saux M, Jeulin J. Bronchial Clearance Physiotherapy in Pediatrics. A Controlled, Randomized, Multicenter Study of the Short-Term Effects on Respiration during Outpatient Care for Infants with Acute Bronchiolitis. Journal of Child Science 2021. [DOI: 10.1055/s-0041-1731304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S. Sebban
- Department of Physiotherapy, Association des Réseaux Bronchiolite. Teaching Hospital (CHU) Robert-Debré-APHP, Paris, France
| | - D. Evenou
- Department of Physiotherapy, Association des Réseaux Bronchiolite, Teaching Hospital (CHU) Robert-Debré- APHP, Paris, France
| | - C. Jung
- Department of Paediatrics, Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Department of Massage Therapy/Physiotherapy, Paris Pubic Hospitals Group (APHP), Paris, France
| | - C. Fausser
- Department of Physiotherapy, Association des Réseaux Bronchiolite. Teaching Hospital (CHU) Robert-Debré-APHP, Paris, France
| | - S. Durand
- Department of Massage Therapy/Physiotherapy, Réseau bronchiolite Ile de France
| | - M. Bibal
- Department of Massage Therapy/Physiotherapy, Réseau bronchiolite Ile de France
| | - V. Geninasca
- Department of Massage Therapy/Physiotherapy, Réseau Bronchiolite Ile de France
| | - M. Saux
- Department of Massage Therapy/Physiotherapy, Réseau Bronchiolite Ile de France
| | - J.C. Jeulin
- Department of Massage Therapy/Physiotherapy, Réseau Bronchiolite, France
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Lazzati A, Raphael Rousseau M, Bartier S, Dabi Y, Challine A, Haddad B, Herta N, Souied E, Ortala M, Epaud S, Masson M, Salaün-Penquer N, Coste A, Jung C. Impact of COVID-19 on surgical emergencies: nationwide analysis. BJS Open 2021; 5:6280342. [PMID: 34021327 PMCID: PMC8140197 DOI: 10.1093/bjsopen/zrab039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. Methods This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. Results During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). Conclusion A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.
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Affiliation(s)
- A Lazzati
- Department of General and Digestive Surgery, Intercommunal Hospital of Créteil, Créteil, France.,INSERM U955, IMRB, Créteil, France
| | - M Raphael Rousseau
- Department of Medical Informatics, Intercommunal Hospital of Créteil, Créteil, France
| | - S Bartier
- INSERM U955, IMRB, Créteil, France.,University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Henri Mondor Hospital, France.,CNRS, ERL 7240, Créteil, France
| | - Y Dabi
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Obstetrics and Gynaecology, Intercommunal Hospital of Créteil, Créteil, France
| | - A Challine
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, AP-HP, Université de Paris, Cochin Hospital, France
| | - B Haddad
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Obstetrics and Gynaecology, Intercommunal Hospital of Créteil, Créteil, France
| | - N Herta
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Ophthalmology, Intercommunal Hospital of Créteil, Créteil, France
| | - E Souied
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Ophthalmology, Intercommunal Hospital of Créteil, Créteil, France
| | | | - S Epaud
- Kaduceo SAS, Toulouse, France
| | | | | | - A Coste
- INSERM U955, IMRB, Créteil, France.,University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Henri Mondor Hospital, France.,CNRS, ERL 7240, Créteil, France
| | - C Jung
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
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Eskander E, Levy C, Batard C, Bonnel A, Jung C, Béchet S, Gillet Y, Cahn-Sellem F, Kochert F, Elbez A, Ryback A, Cohen R. Infection SARS CoV-2 en ambulatoire chez l’enfant. Perfectionnement en Pédiatrie 2021. [PMCID: PMC7997596 DOI: 10.1016/j.perped.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bellaiche M, Arnould B, Benmedjahed K, Arnould M, Bocquet A, Leblanc V, Penvern-Cortes S, Tugaut B, Jung C. Assessment of the severity of infant crying and its impact on parents: Development and validation of the ColiQ Questionnaire in France. Arch Pediatr 2021; 28:264-272. [PMID: 33812728 DOI: 10.1016/j.arcped.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/21/2020] [Accepted: 02/09/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purpose of this study was to develop and validate a questionnaire that comprehensively assesses symptoms and severity of crying, symptoms suggesting infant functional gastrointestinal discomfort, and its impact on parents' quality of life: the Infant Colic Questionnaire (ColiQ©). For the first time, parents had access to a web application to follow their infants' evolving symptoms with a daily questionnaire. METHODS The ColiQ was developed with a board of clinical experts (physicians and psychologists) based on extensive parent input. A longitudinal, observational study was conducted in France for 3 months. ColiQ assessments were collected online at six different time points. Psychometric testing demonstrated that ColiQ has acceptable psychometric properties (reliability, internal consistency, construct validity, and responsiveness). RESULTS The ColiQ is a 16-question instrument developed in French including ten questions describing symptoms (Infant score) and six questions describing impacts (Parent score). The ColiQ demonstrated good test-retest reliability (ICC >0.70), internal consistency for both the Symptom and Impact subscale scores (Cronbach's α >0.70), and construct validity. Responsiveness was good; the ColiQ was able to detect significant improvement in the target population as early as 1 month (p<0.05). The global ColiQ score discriminated between severity levels (mild, medium, severe). CONCLUSIONS The ColiQ was developed with input from parents and healthcare professionals and has shown validity, reliably, and responsiveness to change. Parents can use the web application to follow how their infants' symptoms evolve. The ColiQ can help parents quantify and verbalize their concerns during consultations, and provides an opportunity to facilitate conversations between the physician and parents.
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Affiliation(s)
- M Bellaiche
- Hôpital Robert-Debré, Assistance Public Hôpitaux de Paris, Paris, France
| | - B Arnould
- ICON plc, 27, rue de la Villette, 69003 Lyon, France.
| | - K Benmedjahed
- ICON plc, 27, rue de la Villette, 69003 Lyon, France
| | - M Arnould
- General practitioner, Villiers St Georges, France
| | | | - V Leblanc
- Hôpital Robert-Debré, Assistance Public Hôpitaux de Paris, Paris, France
| | | | - B Tugaut
- ICON plc, 27, rue de la Villette, 69003 Lyon, France
| | - C Jung
- Pediatric, CHI Creteil, Creteil, France; Clinical research center, CHI Creteil, Creteil, France
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Jung C, Jung C, Jongyotha K, De I, Brennan M, Naumovski J. Using Virtual Pet to Replace Pet Therapy Visits in Our Nursing Facility During the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:B18. [PMID: 34287164 PMCID: PMC7902228 DOI: 10.1016/j.jamda.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Baik SH, Jung C, Kim BM, Han K, Kim DJ. Clot Meniscus Sign: An Angiographic Clue for Choosing between Stent Retriever and Contact Aspiration in Acute Basilar Artery Occlusion. AJNR Am J Neuroradiol 2021; 42:732-737. [PMID: 33541894 DOI: 10.3174/ajnr.a6988] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of mechanical thrombectomy methods may differ depending on the characteristics of the occlusion. The purpose of this study was to compare the recanalization efficacy and treatment outcome of a stent retriever versus contact aspiration in patients with acute basilar artery occlusion according to the angiographic characteristics of the occlusion. MATERIALS AND METHODS One hundred sixty-one patients with acute basilar artery occlusion who underwent mechanical thrombectomy were retrospectively analyzed. A stent retriever was compared with contact aspiration thrombectomy according to the clot meniscus sign, defined as a meniscoid/tram-track-like sidewall contrast opacification of the thrombus. A propensity score matching analysis was performed. Clinical/angiographic characteristics and treatment and clinical outcomes were compared. RESULTS Overall, a stent retriever (n = 118) and contact aspiration (n = 43) did not show significant differences in the successful recanalization (82.2% versus 86.0%) and good clinical outcome rates (32.2% versus 39.5%). In patients with the positive meniscus sign, contact aspiration was associated with shorter procedural time (44 versus 26 minutes, P = .018), a lower number of passes (2 versus 1, P = .041), a higher complete recanalization rate (58.8% versus 85.7%, P = .021), and a higher rate of first-pass effect (27.9% versus 53.6%, P = .031) compared with a stent retriever. After propensity score matching, contact aspiration was associated with higher complete recanalization rates (59.3% versus 85.7%, P = .033). No significant differences in the outcomes were noted between a stent retriever and contact aspiration in patients negative for the meniscus sign. CONCLUSIONS The efficacy of the mechanical thrombectomy techniques may differ according to the angiographic characteristics of occlusion in patients with basilar artery occlusion. Contact aspiration may be more effective in terms of recanalization compared with a stent retriever in patients with the clot meniscus sign.
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Affiliation(s)
- S H Baik
- From the Department of Radiology (S.H.B., C.J.), Seoul National University Bundang Hospital, Seongnam, Korea
| | - C Jung
- From the Department of Radiology (S.H.B., C.J.), Seoul National University Bundang Hospital, Seongnam, Korea
| | - B M Kim
- Department of Radiology (B.M.K., K.H., D.J.K.), Yonsei University College of Medicine, Seoul, Korea
| | - K Han
- Department of Radiology (B.M.K., K.H., D.J.K.), Yonsei University College of Medicine, Seoul, Korea
| | - D J Kim
- Department of Radiology (B.M.K., K.H., D.J.K.), Yonsei University College of Medicine, Seoul, Korea
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Maier O, Bosbach G, Hellhammer K, Afzal S, Piayda K, Zeus T, Jung C, Westenfeld R, Polzin A, Kelm M, Veulemans V. Stroke after transcatheter aortic valve implantation: new insights into risk prediction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Stroke is still a feared complication following transcatheter aortic valve implantation (TAVI), associated with increased mortality and severe impact on patients' daily living. Despite technological development and knowledge improvement, cerebrovascular events (CVE) are still not predictable so far and simple risk scores are lacking.
Purpose
This study aimed to evaluate different preprocedural factors that may favour stroke after TAVI, especially regarding severity of aortic calcification.
Methods
From May 2011 to January 2018 a total of 1365 patients underwent TAVI with a balloon-expandable (n=442, 32.4%) or self-expandable (n=923, 67.6%) device at our institution. All patients underwent multi-slice computed tomography (MSCT) before TAVI. To obtain the significant factors for stroke risk prediction we performed multivariate regression analysis and selected the optimal cut-off values according to the maximum Youden index for dichotomization of the risk score items. Finally, we used receiver operating characteristics (ROC) analysis and areas under the ROC curves (AUC) to validate our risk score in comparison to other existing models.
Results
60 of 1365 patients (4.4%) had new neurological impairment after TAVI during hospital stay (mean 11.2±6.7 days). We performed propensity score matching (1:10) to balance baseline characteristics between patients with and without stroke following TAVI, resulting in 56 patients with in-hospital stroke and 521 patients without. Preprocedural factors associated with stroke turned out to be history of prior stroke (OR 1.94; 95% CI 0.85–4.43; p=0.114), aortic valve area ≥0.545 cm2 (OR 3.11; 95% CI 1.16–8.34; p=0.024), atrioventricular angle ≥48.5° (OR 2.32; 95% CI 1.20–4.49; p=0.013), RCC Agatston Score ≥447.2 AU (OR 1.8; 95% CI 0.94–3.44; p=0.077), LVOT Agatston Score ≥262.4 AU (OR 2.01; 95% CI 1.08–3.75; p=0.028) and ascending thoracic aorta Agatston Score ≥116.4 AU (OR 2.21; 95% CI 1.17–4.17; p=0.015). ROC analysis showed that our risk model had an AUC of 0.73 (95% CI 0.66–0.80; p<0.001), a sensitivity of 70.6%, a specificity of 69.0%, a positive predictive value of 19.5% and a high negative predictive value of 95.7%. Our risk model appeared to be the best for stroke prediction after TAVI compared to other risk scores used in literature before like EuroSCORE II (AUC 0.50; 95% CI 0.43–0.58; p=0.950) or CHA2DS2-VASc Score (AUC 0.62; 95% CI 0.55–0.70; p=0.004).
Conclusion
Especially aortic root calcium volume assessed by MSCT predicts CVE after TAVI and could be integrated into a six items risk model for preprocedural prediction of stroke after TAVI. This model could guide us in identifying those patients who are most likely to benefit from transcatheter cerebral embolic protection devices.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Maier
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - G Bosbach
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Hellhammer
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Afzal
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Polzin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
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Haurand J, Bueter S, Jung C, Kelm M, Westenfeld R, Horn P. Mechanical circulatory support with impella in patients with non-acute myocardial infarction related cardiogenic shock. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous left ventricular assist devices such as the Impella pump, are used to hemodynamically stabilize patients with cardiogenic shock (CS) caused by acute myocardial infarction (AMI) until cardiac function has recovered after revascularization. Whether Impella mechanical circulatory support (MCS) is effective in stabilizing patients with CS not caused by AMI has so far not been thoroughly investigated.
Purpose
The aim of this study is to analyze whether MCS with Impella is effective to stabilize patients with non-AMI related CS compared to patients with AMI related CS.
Method
We retrospectively analyzed 106 patients with CS and Impella support in the years from 2011 to 2018. Efficacy to stabilize the patient was assessed by laboratory values such as lactate, hemodynamic parameters and clinical scores. The difference in mortality was calculated with the Log-Rank-Test, comparing Kaplan-Meier curves.
Results
36 patients suffered from non-AMI CS and in 70 patients CS was caused by AMI. Regarding the clinical scores and hemodynamic parameters, both groups were severely ill, with no significant difference in APACHE II score, with a mean score of 17.9 in the non-AMI group compared to 20.5 in the AMI-group (p=0.103), the SOFA score (mean score of 6.3 in non-AMI group vs 6.8 in AMI group, p=0.467) and cardiac index (mean CI of 1.9 l/min/m2 in non-AMI group vs 2.2 l/min/m2 in AMI group, p=0.176). There was a comparable mean decrease in lactate levels in both groups 48 hours after initiation of MCS, from initially 4.1 mmol/l to 1.7 mmol/l (p<0.001) in the non-AMI group and from initially 3.6 mmol/l to 2.2 mmol/l (p=0.025) in the AMI group. The non-ACS group exhibited a trend of lower mortality compared to the AMI group, with 47% in the non-AMI group and 57% in the AMI group (p=0.067). In multivariate analysis, age, lactate levels, cardiopulmonary resuscitation, low platelets and higher doses of inotropes and vasopressors were independent predictors for mortality. An upgrade to LVAD was performed for 22% of the non-AMI group and for 6% of the AMI group (p=0.020).
Conclusion
Impella support is effective to hemodynamically stabilize patients with non-AMI related CS. Therefore, MCS can be used as bridge to recovery or enables further treatment options as upgrade to longterm mechanical support devices.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Haurand
- Universitaets Klinikum Duesseldorf, Duesseldorf, Germany
| | - S Bueter
- Universitaets Klinikum Duesseldorf, Duesseldorf, Germany
| | - C Jung
- Universitaets Klinikum Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- Universitaets Klinikum Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- Universitaets Klinikum Duesseldorf, Duesseldorf, Germany
| | - P Horn
- Universitaets Klinikum Duesseldorf, Duesseldorf, Germany
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Piayda K, Wimmer A, Sievert H, Hellhammer K, Afzal S, Veulemans V, Jung C, Kelm M, Zeus T. Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure.
Purpose
To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS).
Methods
Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up.
Results
One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p<0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p<0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p<0.001).
Conclusion
In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192)
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Wimmer
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - K Hellhammer
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Afzal
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
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Fuernau G, Lehrke M, Jung C, Kahles F, Lebherz C, Eitel I, Thelemann N, Desch S, Werdan K, Zeymer U, Adams V, Marx N, Thiele H. GLP-1 is an independent predictor of long-term mortality in patients with myocardial infarction complicated by cardiogenic shock – a substudy of the IABP-SHOCK II trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The incretin hormone Glucagon-like-peptide 1 (GLP-1) is a major stimulus for glucose dependent insulin secretion and holds cardioprotective efficacy. This has made the GLP-1 system a preferred target for diabetes therapy. Secretion of GLP-1 happens in response to nutritional but also inflammatory stimuli. Consequently, marked elevation of circulating GLP-1 levels were found in critically ill patients featuring marked association to markers of inflammation.
Purpose
Our study sought to investigate GLP-1 levels in patients with cardiogenic shock (CS) complicating myocardial infarction and a possible prognostic correlation to short- and long-term outcome.
Methods
We serially assessed circulating GLP-1 levels in a prospectively planned biomarker substudy in the IABP-SHOCK II trial. Blood samples were drawn during index PCI and at day 2. The blood was centrifuged immediately, and serum was frozen at −87°C. GLP-1 was measured with a standard ELISA-kit. All-cause mortality at short- (30 days), intermediate- (1 year) and long-term (6 years) follow-up was used for outcome assessment.
Results
In this study we found circulating GLP-1 to be markedly elevated in patients with myocardial infarction complicated by CS (n=172) at time of index PCI. Patients with fatal short-term outcome (n=70) exhibited higher GLP-1 levels (86 [45–130] pM) at ICU admission in comparison to patients with 30-day survival (48 [33–78] pM; p<0.001) (n=102). In repeated measures ANOVA the course of GLP-1 levels between baseline and day 2 showed a significant interaction between survivors and non-survivors (p=0.04). By univariate Cox-regression analysis GLP-1 levels >median were predictive of short- (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.50–3.94; p<0.001), intermediate- (HR 2.46; 95% CI 1.62–3.76; p<0.001) and long-term (HR 2.12; 95% CI 1.44–3.11; p<0.001) outcome. This association remained after multivariable correction (HR 2.01; 95% CI 1.37–3.07; p<0.001). In a landmark analysis we found a significant higher mortality in patients with GLP-1 levels >median from day 30 to 1 year (HR 2.56; 95% CI 1.08–6.09; p=0.03). In contrast, beyond 1 year up to 6 years no difference has been observed anymore (HR 1.02; 95% CI 0.41–2.58; p=0.96).
Conclusions
Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS at short-, intermediate and long-term follow-up. In a landmark analysis this prognostic effect is sustained up to 1 year. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG), German Heart Research Foundation
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Affiliation(s)
- G Fuernau
- University Heart Center, Luebeck, Germany
| | - M Lehrke
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - F Kahles
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Lebherz
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - I Eitel
- University Heart Center, Luebeck, Germany
| | | | - S Desch
- University of Leipzig, Heart Center, Leipzig, Germany
| | - K Werdan
- University Clinic Halle (Saale), Halle, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - V Adams
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - N Marx
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - H Thiele
- University of Leipzig, Heart Center, Leipzig, Germany
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Piayda K, Hellhammer K, Veulemans V, Afzal S, Heidari H, Jung C, Kelm M, Zeus T. Performance of the Corevalve Evolut R and PRO in severely calcified anatomies: a propensity-score matched analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Corevalve Evolut R and PRO belong to the newer generation of self-expandable valves and are increasingly used to treat patients with severe aortic stenosis. Over the years, technical advancements and increasing experience with the procedure itself are responsible for excellent clinical and hemodynamic results. Patients with severely calcified native aortic valve anatomies still pose a special task to the implanting team since the risk for intraprocedural complications might be increased.
Purpose
To evaluate the hemodynamic and clinical performance of the CoreValve Evolut R and PRO in patients with severely calcified native aortic valve anatomies.
Methods
Baseline characteristics, imaging data and procedural outcome of patients undergoing transfemoral transcatheter aortic valve implantation with the CoreValve Evolut R and PRO from 09/2015 to 03/2018 were prospectively collected. Patients underwent high-resolution multisclice computed tomography (MSCT). A pre-specific threshold of 600 Hounsfield units was set to account for the hyperdensity of the applied contrast medium and to enable comparability with MSCT thresholds, derived by non-contrast enhanced MSCT scans. Patients were divided by the extent of calcification into a severely calcified anatomy group (men >2062AU, woman >1377AU) or a not severely calcified anatomy group (men <2062AU, woman <1377AU). Propensity score matching with the variables log EuroSCORE, LVOT calcium load and the cover index in a 1:2 fashion was performed and clinical and hemodynamic results in accordance with VARC II were collected.
Results
Ninety-eight patients with severely calcified anatomies (SC) could be identified and were matched with 196 patients with lower calcified (LC) anatomies. Patients with severely calcified anatomies were older (SC: 83.1 years vs. LC: 80.3 years, p<0.001) and had a smaller aortic valve area (SC: 0.63cm2 vs. LC: 0.70cm2, p=0.028). The mean implantation depth did not differ (SC 5.4mm±2.4 vs. LC: 5.1±2.2, p=0.554). Pre-dilatation was more often performed in the SC group (SC: 30.6% vs. LC: 15.8%, p=0.003) and the stroke/TIA rate did not differ (SC: 5.1% vs. LC: 3.5%, p=0.532). In SC patients, a permanent pacemaker implantation was significantly more often needed (SC: 28.5% vs. LC:7.6%, p<0.001). The mean pressure gradient after the procedure was effectively reduced (SC: 7.1mmHg±3.9 vs. LC: 7.8±3.7mmHg, p=0.477). No aortic regurgitation (AR) was more often present in patients with SC anatomies (SC: 72.5% vs. LC: 85.2%, p=0.011). The aortic regurgitation index numerically differed between groups without reaching statistical significance (SC: 24.1±7.1 vs. LC: 27.3±6.7, p=0.067).
Conclusion
The CoreValve Evolut R and PRO show a good clinical safety profile and excellent hemodynamic results even in patients with severely calcified anatomies. In those patients, a permanent pacemaker implantation was more often necessary.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Hellhammer
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Afzal
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - H Heidari
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
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Maier O, Zeus T, Jung C, Westenfeld R, Polzin A, Kelm M, Veulemans V. Computed tomography derived predictors of permanent pacemaker implantation after transcatheter aortic valve implantation: a meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. Unfortunately, the occurrence of electrical conduction disturbances remains one of the most frequent complications of the procedure. While the impact of electrocardiographic and procedural predictors on PPI is well examined, there is still a lack of knowledge regarding anatomical predictors screened by multislice computed tomography (MSCT).
Purpose
We performed a meta-analysis to summarize available studies that reported the incidence of PPI after TAVI with new-generation devices and provided raw data for preprocedural MSCT.
Methods
The authors conducted a literature search in PubMed database until December 31, 2019 to identify studies that investigated preprocedural MSCT data and rate of PPI following TAVI with new-generation devices. Twelve observational studies (n=3133) met inclusion criteria for final analysis.
Results
PPI was performed in 509 patients (16.2%) after TAVI, mostly due to high degree atrioventricular (AV) block (80.8%). The rate of PPI varied widely from 7.9% to 35.8% in individual studies. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) electrocardiographic PPI-predictors after TAVI appeared to be pre-existing atrial fibrillation (AF) (RR 1.21; 95% CI 1.05–1.40; p=0.008), right bundle branch block (RBBB) (RR 4.22; 95% CI 3.30–5.41; p<0.0001) and AV block grade I (RR 1.63; 95% CI 1.16–2.29; p=0.005). Patients requiring PPI had larger annulus perimeter (MD 1.66 mm; 95% CI 0.67–2.66 mm; p=0.001) and shorter membranous septum length (MD −0.86 mm; 95% CI −1.74–0.02 mm; p=0.05) assessed by preprocedural MSCT. Concerning calcium load of device landing zone, pacemaker dependent patients showed increased calcification of the non-coronary cusp (MD 39.76 mm3; 95% CI 18.60–60.93 mm3; p=0.0002), the left-coronary cusp (LCC) (MD 47.60 mm3; 95% CI 19.40–75.81 mm3; p=0.0009) and the total left ventricular outflow tract (LVOT) (MD 19.17 mm3; 95% CI 6.68–31.66 mm3; p=0.003). Lower implantation depth (MD 0.83 mm from NCC; 95% CI 0.20–1.47 mm; p=0.01) and oversizing by annulus diameter/area (MD 1.76%; 95% CI 0.68–2.84%; p=0.001) were procedural predictors of PPI following TAVI.
Conclusion
This structured meta-analysis proved PPI rate in 16.2% of patients following TAVI. Beside well-known electrocardiographic (AF, RBBB, AV block grade I) and procedural predictors (implantation depth, oversizing) this meta-analysis showed for the first time that MSCT derived anatomical values (annulus perimeter, membranous septum length) and distribution of device landing zone's calcification (NCC, LCC, LVOT) are associated with increased risk of PPI following TAVI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Maier
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Polzin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
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Neuenschwander M, Fischer K, Jung C, Hurni S, Winkler B, Jung B, Vogt A, Eberle B, Guensch D. Ventricular strain is compromised outside of the coronary autoregulatory range – assessment by cardiovascular magnetic resonance. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wollborn J, Jung C, Göbel U, Bruno RR. [Evaluation of the microcirculation in critically ill patients : Relevance, practical possibilities and scientific evidence]. Anaesthesist 2020; 69:753-757. [PMID: 32803320 PMCID: PMC7653807 DOI: 10.1007/s00101-020-00832-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Für die Aufrechterhaltung der Organdurchblutung ist eine intakte Makro- und Mikrozirkulation essentiell. Sowohl das wachsende Verständnis um die Bedeutung der Mikrozirkulation im Organversagen als auch die Möglichkeit, diese zu visualisieren, lenken die Aufmerksamkeit der Intensivmedizin auf die mikrovaskuläre Endstrombahn. Als Surrogat-Parameter sind die Rekapillarisierungszeit, der „mottling score“ und die Messung des Serum-Laktats bereits lange in der klinischen Praxis etabliert. Neuere Studien messen der Echtzeit-Darstellung der sublingualen Mikrozirkulation mittels Intravital-Videomikroskopie eine immer größere Bedeutung bei. Verschiedene Studien unterstreichen hierbei die Mikrozirkulation als prognostischen Parameter. Darüber hinaus ermöglicht die Erhebung von objektivierbaren Messwerten, diese in der Zukunft zur individuellen Therapiesteuerung weitergehend zu untersuchen.
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Affiliation(s)
- J Wollborn
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - C Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - U Göbel
- Klinik für Anästhesiologie und operative Intensivmedizin, St. Franziskus-Hospital Münster, Münster, Deutschland
| | - R R Bruno
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Rath B, Swenshon S, Haase K, Szeles T, Jung C, Jacobi F, Myles P. Using a mobile application to detect health needs among children and adolescents who are newly arrived migrants in Europe. J Public Health (Oxf) 2020; 41:840-849. [PMID: 30423143 DOI: 10.1093/pubmed/fdy191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/15/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Unprecedented numbers of migrants have arrived in Europe, including children and adolescents. Little is known about their unique health needs. Prospective data collection has been sparse. Mobile applications may help to facilitate global health surveillance. METHODS A pre-validated survey instrument was converted into a mobile application covering self-reported exposures and disruptions of healthcare before/during migration, communicable and non-communicable diseases. Participation was voluntary, anonymous and confidential. RESULTS Data were obtained from 405 migrant children and adolescents in Berlin, Germany, between 7 October 2015 and 15 March 2016 (median age 19 years, range: 1-24; 80.7% males) with the majority from Syria (62.5%), Afghanistan (9.1%) and Iraq (8.2%). In total, 55% were without family, 64% registered asylum-seekers with access to healthcare; 54% had seen a doctor since arrival, with colds or respiratory complaints (37.5 and 13.6%), followed by pain (26.7%) gastrointestinal (12.4%) and skin problems (11.1%). Underlying conditions were reported in 15.6%, predominantly asthma. Overall, 73% reported being up-to date on immunizations, but only 22% held a vaccination record with 46.4% having lost it during migration. CONCLUSIONS The lack of medical and immunization records among newly arrived migrants provides a challenge to healthcare systems. Mobile applications offer rapid screening tools in times of crisis, helping stakeholders with timely information.
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Affiliation(s)
- B Rath
- Department of Public Health, Vienna Vaccine Safety Initiative, Berlin, Germany.,Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
| | - S Swenshon
- Department of Clinical Psychology, Psychologische Hochschule Berlin, Berlin, Germany
| | - K Haase
- Department of Clinical Psychology, Psychologische Hochschule Berlin, Berlin, Germany
| | - T Szeles
- Department of Clinical Psychology, Psychologische Hochschule Berlin, Berlin, Germany
| | - C Jung
- Department of Clinical Psychology, Psychologische Hochschule Berlin, Berlin, Germany
| | - F Jacobi
- Department of Clinical Psychology, Psychologische Hochschule Berlin, Berlin, Germany
| | - P Myles
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, UK
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