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Sharma R, Johnson V, Pan A, Sellers A, Betensky M, Goldenberg N, Flood VH. Assessment of rare bleeding disorders in adolescents with heavy menstrual bleeding. Haemophilia 2024; 30:490-496. [PMID: 38385952 DOI: 10.1111/hae.14961] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION There are a significant number of patients with mucocutaneous bleeding, specifically heavy menstrual bleeding (HMB), who do not have a diagnosed bleeding disorder. These patients receive nontargeted interventions and may have suboptimal treatments. Functional assays, particularly for fibrinolytic and rare platelet function defects, are not robust and not readily available. AIM We aimed to prospectively evaluate the prevalence of genetic defects associated with rare bleeding disorders and describe alterations of coagulation and fibrinolysis in a cohort of adolescents with HMB. METHODS We performed a prospective observational cohort study of patients with HMB and unexplained bleeding. The study utilized a next generation sequencing panel and investigational global assays of coagulation and fibrinolysis. Additionally, specific functional assays were performed to help characterize novel variants that were identified. RESULTS In 10 of the 17 patients (∼59%), genetic variants were identified on molecular testing. Thrombin generation by calibrated thromboelastography was not significantly altered in this patient population. The clot formation and lysis assay showed a trend towards increased fibrinolysis with rapid phase of decline in 23% of the patients. Further corresponding functional assays and study population are described. CONCLUSION Our study describes a unique correlative model in a homogenous cohort of patients with HMB and unexplained bleeding which may inform future diagnostic algorithms, genotype-phenotype correlations as well as aid in specific targeted treatment approaches. Larger future studies may inform risk stratification of patients and improve health related outcomes in patients with HMB.
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Affiliation(s)
- Ruchika Sharma
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victoria Johnson
- Center for Comprehensive Bleeding Disorders, Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy Pan
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Austin Sellers
- Institute for Clinical and Translational Research, John Hopkins All Childrens Hospital, St. Petersburg, Florida, USA
| | - Marisol Betensky
- Institute for Clinical and Translational Research, John Hopkins All Childrens Hospital, St. Petersburg, Florida, USA
| | - Neil Goldenberg
- Institute for Clinical and Translational Research, John Hopkins All Childrens Hospital, St. Petersburg, Florida, USA
| | - Veronica H Flood
- Center for Comprehensive Bleeding Disorders, Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Kendeou P, Johnson V. The nature of misinformation in education. Curr Opin Psychol 2024; 55:101734. [PMID: 38029642 DOI: 10.1016/j.copsyc.2023.101734] [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: 09/01/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
In this opinion piece, we review and characterize the nature of misinformation in education and discuss the implications for corrective efforts. In education, misinformation manifests at three different levels: the individual, the community, and the system. At the individual level, misinformation manifests as naive beliefs or misconceptions students hold before they receive instruction or because of instruction. At the community level, misinformation manifests as shared flawed views or misconceptions about certain topics often around risk factors and treatments of learning disabilities. At the system level, misinformation manifests as state or district educational policies and practices that have no scientific evidence. Thus, corrective efforts in education must be implemented at all three levels and follow best practices.
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Ray M, Zaborowsky J, Mahableshwarkar P, Vaidyanathan S, Shum J, Viswanathan R, Huang A, Wang SH, Johnson V, Wake N, Conard AM, Conicella AE, Puterbaugh R, Fawzi NL, Larschan E. Dual DNA/RNA-binding factor regulates dynamics of hnRNP splicing condensates. bioRxiv 2024:2024.01.11.575216. [PMID: 38260450 PMCID: PMC10802580 DOI: 10.1101/2024.01.11.575216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Despite decades of research, mechanisms by which co-transcriptional alternative splicing events are targeted to the correct genomic locations to drive cell fate decisions remain unknown. By combining structural and molecular approaches, we define a new mechanism by which an essential transcription factor (TF) targets co-transcriptional splicing through physical and functional interaction with RNA and RNA binding proteins (RBPs). We show that an essential TF co-transcriptionally regulates sex-specific alternative splicing by directly interacting with a subset of target RNAs on chromatin and modulating the dynamics of hnRNPA2 homolog nuclear splicing condensates.
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Weipert KF, Kostic S, Gökyildirim T, Johnson V, Chasan R, Gemein C, Rosenbauer J, Erkapic D, Schmitt J. Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHT TM in Pacemaker Patients. J Clin Med 2023; 13:129. [PMID: 38202136 PMCID: PMC10779836 DOI: 10.3390/jcm13010129] [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: 11/16/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The use of the S-ICD is limited by its inability to provide backup pacing. Combined use of the S-ICD with a pacemaker may be a good choice in certain situations, yet current experience concerning the compatibility is limited. The goal of this study was to determine the safety and efficacy of the S-ICD in patients with a pacemaker. METHODS A total of 74 consecutive patients with a bipolar pacemaker were prospectively enrolled. First, surface rhythm strips were recorded in all possible pacemaker stimulation modes, to screen for T-wave oversensing (TWOS). Second, a S-ICD functional dummy was placed epicutaneously on the patient in the typical implant position. The same standardized pacing protocol was used as mentioned above, and every stimulation mode was recorded via S-ECG in all vectors. RESULTS In 16 patients (21.6%), programmed stimulation would have led to VT/VF detection. Triggered episodes were due to counting of the pacing spike(s), QRS complex, premature ventricular contractions, and/or additional TWOS. Three cases triggered in the bipolar stimulation mode. Oversensing was associated with lung emphysema and a reduced QRS amplitude in the S-ECG. CONCLUSION The combination of an S-ICD and a pacemaker may lead to inadequate shock delivery due to oversensing, even under programmed bipolar stimulation. Oversensing cannot be sufficiently predicted by the screening tool in pacemaker patients. Testing with an epicutaneous S-ICD dummy in all vectors and stimulation settings is recommended in patients with pre-existing pacemakers.
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Affiliation(s)
- Kay F. Weipert
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Srdjan Kostic
- Department of Cardiology, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Timur Gökyildirim
- Department of Cardiology, Lahn-Dill Kliniken, 35578 Wetzlar, Germany
| | - Victoria Johnson
- Department of Cardiology and Angiology, Medizinische Klinik I, Universitätsklinikum Gießen und Marburg, 35392 Giessen, Germany
| | - Ritvan Chasan
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Christopher Gemein
- Department of Cardiology, Nephrology, Pneumology and Rhythmology, Klinikum Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
| | - Josef Rosenbauer
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Jörn Schmitt
- Department of Cardiology, Pneumology and Angiology, Medizinische Klinik II, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany;
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Reinhardt A, Jansen H, Althoff T, Estner H, Iden L, Busch S, Rillig A, Johnson V, Sommer P, Tilz RR, Steven D, Duncker D. [Lead extraction in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:339-350. [PMID: 37917360 DOI: 10.1007/s00399-023-00963-2] [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: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.
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Affiliation(s)
- Adrian Reinhardt
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland.
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Barcelona, Spanien
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie. Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Roland R Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Alim E, Stone L, Sharma N, McMahon S, Allen Z, Aceto P, Victor P, Mitchell LF, Raulerson A, Schepke C, Grabowski J, Valera R, Kalia K, Fernandez M, Kouba K, Shannon M, Johnson V, Forestal C, Pongo I, Ospina S, Fontanez N, Rosenberg M, Levin M, Martinez D, Betancourt YP, Rhodes LV, Lee KJ. Single Live Cell Imaging of Multidrug Resistance Using Silver Ultrasmall Nanoparticles as Biosensing Probes in Triple-Negative Breast Cancer Cells. ACS Appl Bio Mater 2023; 6:4672-4681. [PMID: 37844294 DOI: 10.1021/acsabm.3c00451] [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] [Indexed: 10/18/2023]
Abstract
Silver ultrasmall nanoparticles (Ag UNPs) (size < 5 nm) were used as biosensing probes to analyze the efflux kinetics contributing to multidrug resistance (MDR) in single live triple-negative breast cancer (TNBC) cells by using dark-field optical microscopy to follow their size-dependent localized surface plasmon resonance. TNBC cells lack expression of estrogen (ER-), progesterone (PR-), and human epidermal growth factor 2 (HER2-) receptors and are more likely to acquire resistance to anticancer drugs due to their ability to transport harmful substances outside the cell. The TNBC cells displayed greater nuclear and cytoplasmic efflux, resulting in less toxicity of Ag UNPs in a concentration-independent manner. In contrast, more Ag UNPs and an increase in cytotoxic effects were observed in the receptor-positive breast cancer cells that have receptors for ER+, PR+, and HER2+ and are known to better respond to anticancer therapies. Ag UNPs accumulated in receptor-positive breast cancer cells in a time-and concentration-dependent mode and caused decreased cellular growth, whereas the TNBC cells due to the efflux were able to continue to grow. The TNBC cells demonstrated a marked increase in survival due to their ability to have MDR determined by efflux of Ag UNPs outside the nucleus and the cytoplasm of the cells. Further evaluation of the nuclear efflux kinetics of TNBC cells with Ag UNPs as biosensing probes is critical to gain a better understanding of MDR and potential for enhancement of cancer drug delivery.
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Affiliation(s)
- Ece Alim
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Logan Stone
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Naina Sharma
- College of Medicine, University of Central Florida, Orlando, Florida 32827, United States
| | - Shane McMahon
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Zachary Allen
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Peter Aceto
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Paige Victor
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Luisa F Mitchell
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Arial Raulerson
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Connor Schepke
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Jamie Grabowski
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Rebecca Valera
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Karishma Kalia
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Mirtha Fernandez
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Kalli Kouba
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Matthew Shannon
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Victoria Johnson
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Christopher Forestal
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Immanuelle Pongo
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Sebastian Ospina
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Neysha Fontanez
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Madison Rosenberg
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Madison Levin
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Danna Martinez
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Yanel Pena Betancourt
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Lyndsay V Rhodes
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
| | - Kerry J Lee
- Department of Biological Sciences, Florida Gulf Coast University, Fort Myers, Florida 33965, United States
- College of Medicine, University of Central Florida, Orlando, Florida 32827, United States
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O’Connell LC, Johnson V, Hutton AK, Otis JP, Murthy AC, Liang MC, Wang SH, Fawzi NL, Mowry KL. Intrinsically disordered regions and RNA binding domains contribute to protein enrichment in biomolecular condensates in Xenopus oocytes. bioRxiv 2023:2023.11.10.566489. [PMID: 37986933 PMCID: PMC10659413 DOI: 10.1101/2023.11.10.566489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Proteins containing both intrinsically disordered regions (IDRs) and RNA binding domains (RBDs) can phase separate in vitro, forming bodies similar to cellular biomolecular condensates. However, how IDR and RBD domains contribute to in vivo recruitment of proteins to biomolecular condensates remains poorly understood. Here, we analyzed the roles of IDRs and RBDs in L-bodies, biomolecular condensates present in Xenopus oocytes. We show that a cytoplasmic isoform of hnRNPAB, which contains two RBDs and an IDR, is highly enriched in L-bodies. While both of these domains contribute to hnRNPAB self-association and phase separation in vitro and mediate enrichment into L-bodies in oocytes, neither the RBDs nor the IDR replicate the localization of full-length hnRNPAB. Our results suggest a model where the additive effects of the IDR and RBDs regulate hnRNPAB partitioning into L-bodies. This model likely has widespread applications as proteins containing RBD and IDR domains are common biomolecular condensate residents.
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Affiliation(s)
- Liam C. O’Connell
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Victoria Johnson
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Anika K. Hutton
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Jessica P. Otis
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Anastasia C. Murthy
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Mark C. Liang
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Szu-Huan Wang
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Nicolas L. Fawzi
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
| | - Kimberly L. Mowry
- Department of Molecular Biology, Cell Biology & Biochemistry, Brown University Providence, RI 02912, USA
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8
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Martens E, Sommer P, Johnson V, Tilz RR, Althoff T, Jansen H, Steven D, Steger A, Iden L, Estner H, Rillig A, Duncker D. [Venous access routes for cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:250-255. [PMID: 37460626 DOI: 10.1007/s00399-023-00954-3] [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: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 08/29/2023]
Abstract
Various venous access routes in the region of the clavicle are available for cardiac device treatment. After many years of choosing access via the subclavian vein, current data explicitly show that lateral approaches such as preparation of the cephalic vein or puncture of the axillary vein are clearly superior in terms of probe durability and risk of complications. This article describes the preparation and performance of the various access techniques and is intended to provide a practical guide for the work in cardiac pacemaker operations. This work continues a series of articles designed for advanced training in specialized rhythmology.
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Affiliation(s)
- Eimo Martens
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Victoria Johnson
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Giessen, Giessen, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Carrer de Villarroel 170, 08036, Barcelona, Spanien
| | | | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Gula AL, Merkel E, Bouchelle Z, Nelin T, Rojas CR, Hwang J, Johnson V, Ronan J, Bamat T. Primary Palliative Care for Pediatric Residents: A Curricular Framework and Pilot. Acad Pediatr 2023; 23:1133-1137. [PMID: 36935040 DOI: 10.1016/j.acap.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/21/2023]
Abstract
PROBLEM Palliative care (PC) is high-value, holistic care for a child and their family across the entire arc of an illness. All physicians should be competent in symptom management and providing goal-concordant care that acknowledges the quality of life; however, there is insufficient education in pediatric residency to develop competence in basic or ..úPrimary..Ñ PC. APPROACH We completed a needs assessment and developed a longitudinal, comprehensive, and integrated primary PC curriculum for pediatric residents with the goal of developing foundational primary PC skills regardless of eventual career trajectory. After 1 year of implementation, we assessed resident comfort with primary PC skills via a retrospective pre-post survey. OUTCOMES We found a statistically significant (P.ß<.ß.05) increase in residents... comfort with pain management, delivering serious news, and discussing goals of care. An increase in comfort with the management of other symptoms was not statistically significant. NEXT STEPS After 1 year of implementation, residents describe an increase in comfort with primary PC skills. The next steps include more rigorous evaluation and expansion to include more education in medical ethics. While the educational need is universal, resident needs are constantly evolving and each institution should tailor this curriculum to fit their specific trainee needs and institutional expertise.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tara Bamat
- Children...s Hospital of Philadelphia, Pa.
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10
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Fries B, Johnson V, Schneider N, Dörr O, Chasan R, Mathew S, Hamm CW, Schmitt J. Electroanatomic visualization of coronary arteries: a case series to elicit safety, feasibility, and diagnostic value in complex ablation procedures. Europace 2023; 25:1339-1344. [PMID: 36607137 PMCID: PMC10105871 DOI: 10.1093/europace/euac258] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS The goal of this case series was to evaluate the feasibility, safety, and advantages of a wire-based approach for the live visualization of coronary arteries (CAs) in an electroanatomic mapping (EAM) system and to assess its diagnostic information. METHODS AND RESULTS For this single-centre case series, we included procedures in which close proximity of a possible ablation site to any epicardial vessel was suspected. An uncoated-tip guidewire was introduced into the relevant CAs after exclusion of critical CA stenosis by coronary angiography. By connecting this wire to the EAM system using a clip and pin connection, mapping and live visualization of the wire tip is possible, as well as the assessment of the local electrograms within the respective CAs. Procedural wire insertion and intracoronary mapping was performed by EP specialists and was assisted to judge the relevance of CA disease by an interventional cardiologist. A total of nine procedures in nine patients were included in this case series, four ventricular tachycardia ablation procedures and five procedures for the ablation of premature ventricular contractions. The left CAs were mapped in eight cases and the right CA was mapped in one case. In two cases, epicardial mapping was combined with visualization of the right or left CAs. There were no complications attributed to coronary wiring and mapping in this case. CONCLUSION We demonstrated the feasibility and safety of CA visualization and integration in an EAM. The live visualization of the CAs added valuable information without the need for preprocedural planning or the purchase of separate software. Electroanatomic visualization was achieved intraprocedurally in a safe and straightforward manner, adding critical diagnostic information without excessive costs or risks.
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Affiliation(s)
- Bastian Fries
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Victoria Johnson
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Nikita Schneider
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Oliver Dörr
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Ritvan Chasan
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Shibu Mathew
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Joern Schmitt
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
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11
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Shi L, Popova M, Erdmann RM, Pellegrini A, Johnson V, Le B, Popple T, Nelson Z, Gaston MU, Stains M. Exploring the Complementarity of Measures of Instructional Practices. CBE Life Sci Educ 2023; 22:ar1. [PMID: 36488199 PMCID: PMC10074280 DOI: 10.1187/cbe.22-03-0047] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 06/17/2023]
Abstract
The assessment of instructional quality has been and continues to be a desirable, yet difficult endeavor in higher education. The development of new teaching evaluation frameworks along with instruments to measure various aspects of teaching practices holds promise. The challenge rests in the implementation of these frameworks and measures in authentic settings. Part of this challenge is for instructors, researchers, and administrators to parse through and select a meaningful set of tools from the plethora of existing instruments. In this study, we aim to start clarifying the landscape of measures of instructional practice by exploring the complementarity of two existing instruments: the Classroom Observation Protocol for Undergraduate STEM (COPUS) and the Learner-Centered Teaching Rubrics (LCTR). We collected classroom observations and course artifacts from 28 science instructors from research-intensive institutions across the United States. Results show the need to use both instruments to capture nuanced and comprehensive description of a faculty member's instructional practice. This study highlights the messiness of measuring instructional quality and the need to explore the implementation of teaching evaluation frameworks and measures of instructional practices in authentic settings.
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Affiliation(s)
- Lu Shi
- Department of Chemistry, University of Virginia, Charlottesville, VA 22904
| | - Maia Popova
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC 27412
| | - Robert M. Erdmann
- Campus Learning Data and Technology, University of Minnesota Rochester, Rochester, MN 55904
| | | | | | | | | | | | | | - Marilyne Stains
- Department of Chemistry, University of Virginia, Charlottesville, VA 22904
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Meder B, Duncker D, Helms TM, Leistner DM, Goss F, Perings C, Johnson V, Freund A, Reich C, Ledwoch J, Rahm AK, Milles BR, Perings S, Pöss J, Dieterich C, Fleck E, Breitbart P, Dutzmann J, Diller G, Thiele H, Frey N, Katus HA, Radke P. eCardiology: a structured approach to foster the digital transformation of cardiovascular medicine. Kardiologie 2023. [PMCID: PMC9936476 DOI: 10.1007/s12181-022-00592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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13
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Johnson V, Labruyère J. Self-regulation needed for artificial intelligence tools. Vet Rec 2023; 192:39-40. [PMID: 36607673 DOI: 10.1002/vetr.2621] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Victoria Johnson
- VetCT, Hauser Forum, The Broers Building, 21 JJ Thomson Avenue, Cambridge, CB3 0FA
| | - Julien Labruyère
- VetCT, Hauser Forum, The Broers Building, 21 JJ Thomson Avenue, Cambridge, CB3 0FA
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15
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Gunawardene MA, Hartmann J, Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Willems S. [Focal atrial tachycardias: diagnostics and therapy]. Herzschrittmacherther Elektrophysiol 2022; 33:467-475. [PMID: 36342506 DOI: 10.1007/s00399-022-00907-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
In this article, typical characteristics of focal atrial tachycardias are described and a systematic approach regarding diagnostics and treatment options in the field of invasive cardiac electrophysiology (EP) is presented. Subjects of this article include the definition of focal atrial tachycardias, knowledge about localizing the origin of such, and guidance on how to approach an invasive EP study (e.g., administration of medication during the EP study to provoke tachycardias). Further, descriptions will be found on how to localize the origin of focal atrial tachycardias with the help of the 12-lead ECG and invasive three-dimensional mapping to successfully treat focal atrial tachycardias with catheter ablation.
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Affiliation(s)
- Melanie A Gunawardene
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - Jens Hartmann
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CL.NIC-University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Klinik für Elektrophysiologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Stephan Willems
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
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16
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Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Ewertsen C, Reents T. Erratum to: Atypical atrial flutter: Diagnostics and therapy. Herzschrittmacherther Elektrophysiol 2022; 33:486. [PMID: 36205786 PMCID: PMC9691488 DOI: 10.1007/s00399-022-00901-8] [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: 06/16/2023]
Affiliation(s)
- Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland.
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- University Faculty of Health, Center for Clinical Medicine Witten-Herdecke, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | - Tilko Reents
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland
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Rajkumar CA, Bello O, McInerney A, Tilsted HH, Johnson V, Fovino LN, Fitzsimons D, Al-Lamee R, Byrne R. Consenting practices in interventional cardiology: an analysis from the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2032] [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
Consenting practices in interventional cardiology vary across different procedures, operators, centres and nations.
Purpose
In order to define best practice for obtaining informed patient consent, it is first necessary to understand how consenting practice differs.
Methods
An online survey of 20 questions was sent to all members of the European Association of Percutaneous Cardiovascular Interventions, addressing consenting practices in elective and emergency scenarios.
Results
We received 483 responses from 74 countries. The majority of respondents (77%) were European operators. Responses were received from consultant cardiologists (n=370), fellows in training (n=55), allied health professionals (n=36) and others (n=21).
Across all respondents, in elective practice, 427 (88.4%) operators obtain written consent for every procedure, the remainder (9.5%) obtain verbal consent only. Consent is obtained by the consultant or fellow who directly performs the procedure in 56.9% cases. For coronary angiography, pre-emptive consent for possible additional procedures (pressure wire and PCI) is taken by operators in all cases (58.6%), some cases (30.6%) and never (11.0%). Prior to interventional therapies, written information detailing the risk of the procedure is provided in every case by 63.8% of operators, sometimes by 25.1% of operators, and is never provided by 11.0% of operators.
In emergency settings, where patients are conscious and have capacity to consent, 274 (56.7%) of respondents obtain written consent, 155 (33.1%) obtain verbal consent only and 52 (10.8%) stated that a consent process was not required. Where consciousness and capacity are impaired, 218 (45.1%) always, 118 (24.4%) sometimes and 145 (30%) never document a written capacity and best interests' assessment.
When asked to rate the overall quality of consenting practices in their own institution, 279 (57.8%) stated these were “excellent” or “above average”, 165 (34.2%) were “average” and 39 operators described consenting practices in their institution as “below average” or “poor”.
Conclusions
Diversity in consenting practice spans elective and emergency procedures. These results suggest that there is substantial variation in the understanding of the rationale, legal requirement, and perceived best practices for consent. Further work should consider the merits of standardisation of consent processes across Europe.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C A Rajkumar
- Imperial College London , London , United Kingdom
| | - O Bello
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - A McInerney
- Hospital Clinico San Carlos , Madrid , Spain
| | - H H Tilsted
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - V Johnson
- University Hospital Giessen and Marburg , Giessen , Germany
| | | | - D Fitzsimons
- Queen's University of Belfast , Belfast , United Kingdom
| | - R Al-Lamee
- Imperial College London , London , United Kingdom
| | - R Byrne
- Royal College of Surgeons in Ireland , Dublin , Ireland
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Johnson V, Brondani M, von Bergmann H, Grossman S, Donnelly L. Dental Service and Resource Needs during COVID-19 among Underserved Populations. JDR Clin Trans Res 2022; 7:315-325. [PMID: 35298308 PMCID: PMC9203663 DOI: 10.1177/23800844221083965] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination. Objectives: To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services. Methods: Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed. Results: The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers. Conclusion: Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities. Knowledge Transfer Statement: This study depicts ways of addressing unmet oral health–related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.
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Affiliation(s)
- V Johnson
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - M Brondani
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - H von Bergmann
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - S Grossman
- Centre for Community Engaged Learning, University of British Columbia, Vancouver, BC, Canada
| | - L Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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19
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Johnson V, Butterfuss R, Kim J, Orcutt E, Harsch R, Kendeou P. The ‘Fauci Effect’: Reducing COVID-19 Misconceptions and Vaccine Hesitancy Using an Authentic Multimodal Intervention. Contemporary Educational Psychology 2022; 70:102084. [PMID: 35765462 PMCID: PMC9221368 DOI: 10.1016/j.cedpsych.2022.102084] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Social media environments enable users to proliferate misinformation surrounding COVID-19. Expert sources, such as Dr. Anthony Fauci have leveraged social media to present corrective multimedia messages. However, little is known about the efficacy of these messages in revising common misconceptions about COVID-19 and influencing behavior. In this study, we examined the efficacy of a multimodal intervention using authentic social media messages that directly addressed common COVID-19 misconceptions. Going further, we identified individual differences that influenced the effectiveness of the intervention, as well as whether those factors predicted individuals’ willingness to receive a COVID-19 vaccine. The results showed that the intervention was successful in increasing knowledge when compared to a baseline control. Those who were older and reported less vaccine hesitancy showed greater learning from the intervention. Factors that significantly predicted intention to vaccinate included receiving the intervention, vaccine confidence, vaccine hesitancy, prior flu vaccination history, age, and fear of COVID-19. These findings indicate that multimodal messages can be effectively leveraged in social media to both fight misinformation and increase intention to be vaccinated - however, these interventions may not be as effective for all individuals.
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20
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Johnson V, Israel C, Schmitt J. How to: Basics der Schrittmacherprogrammierung. Herzschrittmacherther Elektrophysiol 2022; 33:247-254. [PMID: 35604450 PMCID: PMC9177472 DOI: 10.1007/s00399-022-00864-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
Die Programmierung von Schrittmachersystemen, insbesondere von Zweikammerschrittmachersystemen kann die untersuchenden Ärzte vor große Herausforderungen stellen. Eine genaue Kenntnis der zu programmierenden Parameter sowie der herstellerspezifischen Algorithmen ist essentiell. Bei der Programmierung sollte darauf geachtet werden, die Programmierung den individuellen Bedürfnissen der Patient:innen anzupassen und „Out-of-the-box“-Programmierungen zu vermeiden. Ein weiteres wichtiges Ziel der Programmierung ist es, unnötige Stimulation im rechten Ventrikel zu vermeiden und dem Patienten eine gute Belastbarkeit zu ermöglichen sowie zu vermeiden, dass er eine Stimulation wahrnimmt. Algorithmen der Hersteller können hierbei helfen, müssen jedoch verstanden und bei inadäquatem Verhalten ggf. deaktiviert werden.
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Affiliation(s)
- V Johnson
- Med. Klinik I, Abteilung für Kardiologie, UKGM Gießen, Universitätsklinik Gießen, Klinikstr. 33, 35392, Gießen, Deutschland.
| | - C Israel
- Klinik für Innere Medizin, Kardiologie, Diabetologie und Nephrologie, Ev. Krankenhaus Bielefeld, Bielefeld, Deutschland
| | - J Schmitt
- Med. Klinik I, Abteilung für Kardiologie, UKGM Gießen, Universitätsklinik Gießen, Klinikstr. 33, 35392, Gießen, Deutschland
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21
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Fries B, Johnson V, Schneider N, Fraebel C, Doerr O, Mathew S, Hamm CW, Schmitt J. Electroanatomic visualization of coronary arteries: a case series to elicit safety, feasibility and diagnostic value in complex ablation procedures. Europace 2022. [DOI: 10.1093/europace/euac053.354] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although three dimensional (3D) electroanatomic mapping systems allow detailed assessment of anatomy and substrates, ablation still carries substantial risk when close proximity to coronary arteries is suspected. 3D integration of coronary anatomy in mapping systems is still cumbersome, highlighting the need for an option of ad hoc acquirement of coronary artery anatomy. The goal of this case series was to evaluate the feasibility of a wire-based approach to the live visualization of coronary arteries and to assess its diagnostic information regarding procedure guiding.
Methods
For this single center case series, we included procedures in which close proximity of an ablation site to an epicardial vessel had to be suspected. An uninsulated-tip wire was then introduced into the relevant coronaries via diagnostic catheters after exclusion of critical stenosis by coronary angiography. The wire was connected to an impedance based 3D mapping system using a clamp and standard pin connection. Integrating this setup in the mapping system allows for live visualization of the wire tip, as well as the assessment of local electrograms within the respective vessel.
Results
We included a total of 9 procedures (4 ventricular tachycardia (VT) ablation procedures and 5 procedures for the ablation of premature ventricular contractions (PVCs)). The left coronary arteries were mapped in 8 cases, the right coronary artery was mapped in one case. In the majority of cases, the arrhythmogenic substrate was found in the left ventricle (5/9) or left ventricular summit area and the distal coronary sinus respectively (3/9). In two cases, epicardial mapping was performed combined with visualization of the right or left coronary arteries, respectively. There were no complications attributed to coronary wiring and mapping in this case series.
In two cases, the diagnostic information from mapping of the coronary arteries could be used to rule out an epicardial origin of arrhythmia. In the majority of cases, coronary visualization was used to ascertain a proper distance between the ablation site and the vessel.
Discussion
In this case series, we could demonstrate the feasibility and safety of coronary artery visualization and its integration in a 3D mapping system. The data obtained was used for diagnostic, as well as safety aspects. The electrograms from the wire were used to quickly assess relative timing of arrhythmias, thus allowing for an estimation of possible epicardial origin.
Conclusion
Applying the same caveats as for any other wiring of coronary arteries, their electroanatomic visualization is achieved in a safe and straightforward manner, with minimal technical requirements. Mapping of the coronary arteries adds critical diagnostic information and their real-time visualization is feasible without exceeding costs or risks
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Affiliation(s)
- B Fries
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - V Johnson
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - N Schneider
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - C Fraebel
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - O Doerr
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - S Mathew
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - CW Hamm
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - J Schmitt
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
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22
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Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
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23
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Czerwińska-Jelonkiewicz K, Beneria A, Bañeras J, Kwasiborski P, Velagapudi P, Ijioma N, Trêpa M, Fekadu C, Vandenbriele C, Stratinaki M, Tun HN, Garaygordobil DA, Verdoia M, Moscatelli S, Shchendrygina A, Wood A, Johnson V, Reinstadler S, Aleksic M, Pazdernik M, Rosenberg A. Psychological burden of the COVID-19 pandemic 6 months after the outbreak - the voice of the young doctors' generation: An international survey. Kardiol Pol 2022; 80:485-488. [PMID: 35235998 DOI: 10.33963/kp.a2022.0065] [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] [Received: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Katarzyna Czerwińska-Jelonkiewicz
- Cardiothoracic Intensive Care Unit, Harefield Hospital, Royal Brompton and Harefield hospitals NHS Foundation Trust, London, United Kingdom. .,Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
| | - Anna Beneria
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jordi Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulacio´ Clı´nica Avancada VHISCA, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Przemysław Kwasiborski
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
| | | | | | - Maria Trêpa
- Cardiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Chala Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Maria Stratinaki
- Department of Cardiology, General Hospital Venizeleio, Heraklion, Crete, Greece
| | - Han Naung Tun
- Heart and Vascular Centre, Victoria Hospital, Yangon, Myanmar and Tufts Medical Center, Boston, US
| | | | - Monica Verdoia
- Cardiology and ICU, Ospedale degli Infermi, ASL Biella, Università del Piemonte Orientale, Biella, Italy
| | - Sara Moscatelli
- Department of Pediatric Cardiology, Royal Brompton and Harefield hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Alice Wood
- Cardiology Department, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Sebastian Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Milica Aleksic
- Department of Cardiology, University Hospital Medical Center Bezanijska kosa Belgrade, Serbia
| | - Michał Pazdernik
- Department of Cardiology, Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Alex Rosenberg
- Cardiothoracic Intensive Care Unit, Harefield Hospital, Royal Brompton and Harefield hospitals NHS Foundation Trust, London, United Kingdom
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24
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Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Bertagnolli L, Iden L, Deneke T, Tilz R, Metzner A, Chun J, Steven D. [Catheter ablation of ventricular tachycardias in patients with ischemic cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2022; 33:88-97. [PMID: 35157112 DOI: 10.1007/s00399-022-00845-z] [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: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
Radiofrequency (RF) ablation is an effective treatment option of scar-related ventricular tachycardias (VT) in patients with ischemic cardiomyopathy. Several studies proved the benefit of VT catheter ablation, which has become routine in most electrophysiology laboratories. This article provides practical instructions to perform a VT catheter ablation. The authors describe conventional and substrate-based mapping and ablation strategies as well as concepts for image integration. This article continues a series of publications created for education in advanced electrophysiology.
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Affiliation(s)
- Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland.
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Thomas Deneke
- Klinik für Kardiologie, Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt a. d. Saale, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
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25
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Nelson EA, Kraguljac NV, Maximo JO, Briend F, Armstrong W, Ver Hoef LW, Johnson V, Lahti AC. Hippocampal Dysconnectivity and Altered Glutamatergic Modulation of the Default Mode Network: A Combined Resting-State Connectivity and Magnetic Resonance Spectroscopy Study in Schizophrenia. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:108-118. [PMID: 32684484 PMCID: PMC7904096 DOI: 10.1016/j.bpsc.2020.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Converging lines of evidence point to hippocampal dysfunction in schizophrenia. It is thought that hippocampal dysfunction spreads across hippocampal subfields and to cortical regions by way of long-range efferent projections. Importantly, abnormalities in the excitation/inhibition balance could impair the long-range modulation of neural networks. The goal of this project was twofold. First, we sought to identify replicable patterns of hippocampal dysconnectivity in patients with a psychosis spectrum disorder. Second, we aimed to investigate a putative link between glutamatergic metabolism and hippocampal connectivity alterations. METHODS We evaluated resting-state hippocampal functional connectivity alterations in two cohorts of patients with a psychosis spectrum disorder. The first cohort consisted of 55 medication-naïve patients with first-episode psychosis and 41 matched healthy control subjects, and the second cohort consisted of 42 unmedicated patients with schizophrenia and 41 matched control subjects. We also acquired measurements of glutamate + glutamine in the left hippocampus using magnetic resonance spectroscopy for 42 patients with first-episode psychosis and 37 healthy control subjects from our first cohort. RESULTS We observed a pattern of hippocampal functional hypoconnectivity to regions of the default mode network and hyperconnectivity to the lateral occipital cortex in both cohorts. We also show that in healthy control subjects, greater hippocampal glutamate + glutamine levels predicted greater hippocampal functional connectivity to the anterior default mode network. Furthermore, this relationship was reversed in medication-naïve subjects with first-episode psychosis. CONCLUSIONS These results suggest that an alteration in the relationship between glutamate and functional connectivity may disrupt the dynamic of major neural networks.
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Affiliation(s)
- Eric A. Nelson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nina V. Kraguljac
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose O Maximo
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frederic Briend
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Armstrong
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence W. Ver Hoef
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victoria Johnson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adrienne C. Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Correspondence: Adrienne C. Lahti, MD, University of Alabama at Birmingham, Sparks Center, Room 501, 1720 7 Ave. S, Birmingham, Al 35233, Telephone: 205-996-6776, Fax: 205-975-4879,
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26
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Chun J, Maurer T, Rillig A, Bordignon S, Iden L, Busch S, Steven D, Tilz RR, Shin DI, Estner H, Bourier F, Duncker D, Sommer P, Ewertsen NC, Jansen H, Johnson V, Bertagnolli L, Althoff T, Metzner A. [Practical guide for safe and efficient cryoballoon ablation for atrial fibrillation : Practical procedure, tips and tricks]. Herzschrittmacherther Elektrophysiol 2021; 32:550-562. [PMID: 34735629 DOI: 10.1007/s00399-021-00820-0] [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: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
In the current guidelines on treatment of atrial fibrillation, cryoballoon-based catheter ablation of atrial fibrillation is recommended in addition to radiofrequency ablation and has become established as a standard procedure in the clinical routine of many centers for index pulmonary vein isolation. A safe, simplified and often durable pulmonary vein isolation can be achieved by a systematic approach. This review article provides a practical guide for all steps of cryoballoon-based pulmonary vein isolation, including preprocedural preparation and postinterventional follow-up. Both cryoballoon systems currently available on the market are considered.
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Affiliation(s)
- Julian Chun
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland. .,Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland.
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Stefano Bordignon
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Medizinische Klinik II, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Felix Bourier
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Nils-Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | | | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
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27
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Owen I, Yee D, Wyne H, Perdikari TM, Johnson V, Smyth J, Kortum R, Fawzi NL, Shewmaker F. The oncogenic transcription factor FUS-CHOP can undergo nuclear liquid-liquid phase separation. J Cell Sci 2021; 134:272045. [PMID: 34357401 DOI: 10.1242/jcs.258578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/24/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022] Open
Abstract
Myxoid liposarcoma is caused by a chromosomal translocation resulting in a fusion protein comprised of the N terminus of FUS (fused in sarcoma) and the full-length transcription factor CHOP (CCAAT/enhancer-binding protein homologous protein, also known as DDIT3). FUS functions in RNA metabolism, and CHOP is a stress-induced transcription factor. The FUS-CHOP fusion protein causes unique gene expression and oncogenic transformation. Although it is clear that the FUS segment is required for oncogenic transformation, the mechanism of FUS-CHOP-induced transcriptional activation is unknown. Recently, some transcription factors and super enhancers have been proposed to undergo liquid-liquid phase separation and form membraneless compartments that recruit transcription machinery to gene promoters. Since phase separation of FUS depends on its N terminus, transcriptional activation by FUS-CHOP could result from the N terminus driving nuclear phase transitions. Here, we characterized FUS-CHOP in cells and in vitro, and observed novel phase-separating properties relative to unmodified CHOP. Our data indicate that FUS-CHOP forms phase-separated condensates that colocalize with BRD4, a marker of super enhancer condensates. We provide evidence that the FUS-CHOP phase transition is a novel oncogenic mechanism and potential therapeutic target for myxoid liposarcoma. This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Izzy Owen
- Department of Biochemistry and Molecular Biology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Debra Yee
- Department of Biochemistry and Molecular Biology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Hala Wyne
- Department of Biochemistry and Molecular Biology, Uniformed Services University, Bethesda, MD 20814, USA
| | | | - Victoria Johnson
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, RI 02912, USA
| | - Jeremy Smyth
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Robert Kortum
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Nicolas L Fawzi
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, RI 02912, USA
| | - Frank Shewmaker
- Department of Biochemistry and Molecular Biology, Uniformed Services University, Bethesda, MD 20814, USA
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Borrelli N, Brida M, Cader A, Sabatino J, Czerwińska-Jelonkiewicz K, Shchendrygina A, Wood A, Allouche E, Avesani M, Gok G, Marchenko O, Calvieri C, Baritussio A, Ilardi F, Caglar N, Moscatelli S, Kotlar I, Trêpa M, Rubini MG, Chrysohoou C, Jovovic L, Prokšelj K, Simkova I, Babazade N, Siller-Matula J, Chikhi F, Kovačević-Preradović T, Srbinovska E, Johnson V, Farrero M, Moharem-Elgamal S, Gimelli A. Women leaders in Cardiology. Contemporary profile of the WHO European region. European Heart Journal Open 2021; 1:oeab008. [PMID: 35919091 PMCID: PMC9242062 DOI: 10.1093/ehjopen/oeab008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/02/2021] [Accepted: 07/10/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Women’s participation is steadily growing in medical schools, but they are still not sufficiently represented in cardiology, particularly in cardiology leadership positions. We present the contemporary distribution of women leaders in cardiology departments in the World Health Organization European region.
Methods and results
Between August and December 2020, we applied purposive sampling to collect data and analyse gender distribution of heads of cardiology department in university/third level hospitals in 23 countries: Austria, Azerbaijan, Belgium, Bosnia-Herzegovina, Croatia, France, Germany, Greece, Italy, North Macedonia, Morocco, Poland, Portugal, Russia, Serbia, Slovakia, Slovenia, Spain, Switzerland, Tunisia, Turkey, Ukraine, and the UK. Age, cardiology subspecialty, and number of scientific publications were recorded for a subgroup of cardiology leaders for whom data were available. A total of 849 cardiology departments were analysed. Women leaders were only 30% (254/849) and were younger than their men counterpart (♀ 52.2 ± 7.7 years old vs. ♂ 58.1 ± 7.6 years old, P = 0.00001). Most women leaders were non-interventional experts (♀ 82% vs. ♂ 46%, P < 0.00001) and had significantly fewer scientific publications than men {♀ 16 [interquartile range (IQR) 2–41] publications vs. ♂ 44 (IQR 9–175) publications, P < 0.00001}.
Conclusion
Across the World Health Organization European region, there is a significant gender disparity in cardiology leadership positions. Fostering a diverse and inclusive workplace is a priority to achieve the full potential and leverage the full talents of both women and men.
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Affiliation(s)
- Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AORN Dei Colli—Monaldi Hospital , Via Leonardo Bianchi, snc, Naples 80131, Italy
| | - Margarita Brida
- Division for Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kišpatićeva ul. 12, 10000, Zagreb , Croatia
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney St, SW3 6NP, London , United Kingdom
| | - Aaysha Cader
- Ibrahim Cardiac Hospital & Research Institute, 122 Kazi Nazrul Islam Ave, Dhaka 1000 , Bangladesh
| | - Jolanda Sabatino
- Magna Graecia University, Viale Europa, 88100, Catanzaro , Italy
| | - Katarzyna Czerwińska-Jelonkiewicz
- Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Kraków , Poland
- Harefield Hospital, Hill End Rd, Harefield, Uxbridge UB9 6JH, Royal Brompton & Harefield NHS Foundation Trust, London , United Kingdom
| | - Anastasia Shchendrygina
- Department of Hospital Therapy No. 1, I.M., Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 2, стр. 4, Moscow , Russia
| | - Alice Wood
- University of Leicester, University Rd, Leicester LE1 7RH , United Kingdom
| | - Emna Allouche
- Cardiology Departement, Charles Nicolle Hospital Tunis, Faculté de Médecine, Tunis-El Manar University, Bd du 9 Avril 1938 , Tunisia
| | - Martina Avesani
- University of Padua, Via Giustiniani, 2 - 35128, Padua , Italy
| | - Gulay Gok
- Department of Cardiology, Medipol University hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No:, D:1, 34214, İstanbul , Turkey
| | - Oksana Marchenko
- Ukrainian Children’s Cardiac Center, Clinic for Adults, Shuliavka, 02000, Kyiv , Ukraine
- Shupyk National Healthcare University of Ukraine, 9, Dorohozhytska St, 04112, Kyiv , Ukraine
| | - Camilla Calvieri
- Bambino Gesù Children’s Hospital, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome , Italy
- Department of Internal Clinical Sciences, Anesthesiology and Cardiology, “La Sapienza” University of Rome, Piazzale Aldo Moro, 5, 00185, Rome , Italy
| | - Anna Baritussio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedale Università Padova, Via Giustiniani, 2, 35128, Padua , Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via Sergio Pansini, 5, 80131, Naples , Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122, Naples , Italy
| | - Nihan Caglar
- Cardiology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Cd No:11, 34147, Istanbul , Turkey
| | - Sara Moscatelli
- Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 6, 16132 , Italy
| | - Irina Kotlar
- University Clinic of Cardiology, Мајка Тереза 17, Mother Teresa 17, Skopje , Republic of North Macedonia
| | - Maria Trêpa
- Cardiology Department, Porto University Hospital Centre, Largo do Prof. Abel Salazar, 4099-001, Porto , Portugal
| | - Maria Gimenez Rubini
- Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Strümpellstraße 39, 04289, Leipzig , Germany
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel , Switzerland
| | - Christina Chrysohoou
- First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, 114 Vass Sofias Ave, 11527, Athens , Greece
| | - Ljiljana Jovovic
- Faculty of Medicine, University of Belgrade, dr Subotića starijeg 8, 11000, Belgrade , Serbia
| | - Katja Prokšelj
- Department of Cardiology, University Medical Center, Zaloška cesta 7, 1000, Ljubljana , Slovenia
| | - Iveta Simkova
- ACHD Centre, Department of Cardiology and Angiology of Medical Faculty, Slovak Medical University and National Institute of Cardiovascular Diseases, 831 01, Bratislava , Slovakia
| | | | - Jolanta Siller-Matula
- Department of Cardiology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna , Austria
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-091, Warsaw , Poland
| | - Fatima Chikhi
- Cardiology “B” Department, Ibn Sina Hospital Med V University, 62, Jbran Khalil Jbran Street, Souissi, Rabat , Morocco
| | - Tamara Kovačević-Preradović
- School of Medicine, University of Banja Luka, Save Mrkalja 14, Banja Luka, 78000, Republic of Srpska , Bosnia and Herzegovina
| | | | - Victoria Johnson
- Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen , Germany
| | - Marta Farrero
- Heart Failure and Heart Transplant Unit, Cardiology, Hospital Clínic, C. de Villarroel, 170, 08036, Barcelona , Spain
| | - Sarah Moharem-Elgamal
- Cardiology Department, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE , United Kingdom
- Cardiology Department, National Heart Institute, 5 Ibn Nafise Square, Mit Akaba, Agouza, Giza , Egypt
| | - Alessia Gimelli
- CNR—Regione Toscana, Fondazione Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa , Italy
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Johnson V, Birgitta Johnson LS, Napiorkowski NE, Ewa Slusarczyk M, Dziubinski MJ, Assmus B. B-PO05-039 MET SCORE IN PATIENTS WITH AND WITHOUT ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.959] [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: 11/26/2022]
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30
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Johnson V, Duncker D. [#AbMorgenRhythmologie-a new section for young cardiologists]. Herzschrittmacherther Elektrophysiol 2021; 32:133. [PMID: 34057582 DOI: 10.1007/s00399-021-00765-4] [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] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria Johnson
- Abteilung für Kardiologie und Angiologie, Medizinische Klinik I, Klinikstraße 33, 35392, Gießen, Deutschland.
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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31
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Sullivan PZ, AlBayar A, Burrell JC, Browne KD, Arena J, Johnson V, Smith DH, Cullen DK, Ozturk AK. Implantation of Engineered Axon Tracts to Bridge Spinal Cord Injury Beyond the Glial Scar in Rats. Tissue Eng Part A 2021; 27:1264-1274. [PMID: 33430694 DOI: 10.1089/ten.tea.2020.0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
Regeneration after spinal cord injury (SCI) is limited by the presence of a glial scar and inhibitory cell signaling pathways that favor scar formation over regrowth of endogenous neurons. Tissue engineering techniques, including the use of allografted neural networks, have shown promise for nervous system repair in prior studies. Through the use of a minimally invasive injury model in rats, we describe the implantation of micro-tissue engineered neural networks (micro-TENNs) across a region of SCI, spanning the glial scar to promote axonal regeneration. Forty-three female Sprague-Dawley rats were included in this study. Micro-TENNs were preformed in vitro before implant, and comprised rat sensory dorsal root ganglion (DRG) neurons projecting long bundled axonal tracts within the lumen of a biocompatible hydrogel columnar encasement (1.2 cm long; 701 μm outer diameter × 300 μm inner diameter). Animals were injured using a 2F embolectomy catheter inflated within the epidural space. After a 2-week recovery period, micro-TENNs were stereotactically implanted across the injury. Animals were euthanized at 1 week and 1 month after implantation, and the tissue was interrogated for the survival of graft DRG neurons and outgrowth of axons. No intraoperative deaths were noted with implantation of the micro-TENNs to span the injury cavity. Graft DRG axons were found to survive at 1 week postimplant within the hydrogel encasement. Graft-derived axonal outgrowth was observed within the spinal cord up to 4.5 mm from the implant site at 1 month postinjury. Limited astroglial response was noted within the host, suggesting minimal trauma and scar formation in response to the graft. Micro-TENN sensory neurons survive and extend axons into the host spinal cord following a minimally invasive SCI in rats. This work serves as the foundation for future studies investigating the use of micro-TENNs as a living bridge to promote recovery following SCI. Impact statement As spinal cord injury pathology develops, the establishment of a glial scar puts an end to the hope of regeneration and recovery from the consequent neurological deficits. Therefore, growing attention is given to bioengineered scaffolds that can bridge the lesions bordered by this scar tissue. The utilization of longitudinally aligned preformed neural networks-referred to as micro-tissue engineered neural networks (TENNs)-presents a promising opportunity to provide a multipurpose bridging strategy that may take advantage of several potential mechanisms of host regeneration. In addition to providing physical support for regenerating spinal cord axons, micro-TENNs may serve as a functional "cable" that restores lost connections within the spinal cord.
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Affiliation(s)
- Patricia Zadnik Sullivan
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahmed AlBayar
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin C Burrell
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Kevin D Browne
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria Johnson
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas H Smith
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D Kacy Cullen
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Center for Brain Injury & Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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32
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Fries B, Johnson V, Rutsatz W, Schmitt J, Bogossian H. [Localization of ventricular premature contractions by 12-lead ECG]. Herzschrittmacherther Elektrophysiol 2021; 32:21-26. [PMID: 33533995 DOI: 10.1007/s00399-021-00746-7] [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: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 12/01/2022]
Abstract
The advances in imaging and 3D mapping systems in the last decade allowed a better correlation of ventricular premature contractions (PVCs) with anatomical structures. With regard to PVCs, interpretation of the 12-lead ECG is still crucial for the management of patients and the planning of therapies. Although there is an armamentarium of indices and algorithms to exactly pinpoint the origin of a PVC in advance, a thorough understanding of cardiac anatomy and impulse propagation, together with an awareness of the surface ECGs limitations, provides a sufficiently close approximation. PVCs from the diaphragmatic part of the ventricular cavae exhibit a superiorly directed axis, whereas PVCs from superior parts of the heart show an inferior axis. A right bundle branch block morphology or positive concordance of the precordial leads yields a high probability of left ventricular origin of a PVC. A left bundle branch block morphology is indicative of a right ventricular or septal origin of a PVC. Using the transition zone, one can estimate the origin of a PVC with regard to anterior or posterior regions of the heart: A late precordial transition is indicative of a right ventricular origin, an early precordial transition suggests a left ventricular focus. An absent transition in the sense of negative concordance is indicative for an apical origin. The intertwined course of the ventricular outflow tracts makes PVC localization more difficult. Here, shape and height of the R‑wave in V1-V3 help to narrow the origin down. PVCs from structures like the papillary muscles, the moderator band or infundibular bands are challenging to interpret and evidence of the limitations of the surface ECG. Based on the information gained by the aforementioned approach, a prediction of prognosis and possible treatment success is possible.
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Affiliation(s)
- Bastian Fries
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Victoria Johnson
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Wiebke Rutsatz
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Jörn Schmitt
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Harilaos Bogossian
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland. .,Universität Witten-Herdecke, Witten, Deutschland.
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33
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Johnson V, Duncker D. [Starting cardiac electrophysiology-practical guidance]. Herzschrittmacherther Elektrophysiol 2021; 31:325-327. [PMID: 33226479 DOI: 10.1007/s00399-020-00730-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Victoria Johnson
- Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, UKGM Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Mathew S, Fraebel C, Johnson V, Abdelgwad S, Schneider N, Müller P, Chasan R, Hamm C, Schmitt J. Cardiac arrhythmias in patients with SARS-CoV‑2 infection and effects of the lockdown on invasive rhythmological therapy. Herzschrittmacherther Elektrophysiol 2020; 32:108-113. [PMID: 33355696 PMCID: PMC7757077 DOI: 10.1007/s00399-020-00734-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022]
Abstract
Background Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, various strategies have been taken worldwide to reduce the risk of infection. As part of the amendment to the Infection Protection Act, elective medical interventions were restricted, leading to a change in patient care. However, the consequences of the lockdown on the treatment of rhythmological patients in Germany remains unclear. Objectives The aim of this study was to analyze the reduction in rhythmological interventions and the patient care situation using a nationwide survey during the first lockdown period. Methods A survey was sent to all electrophysiological centers certified by the German Society of Cardiology. Here, the treatment volume of tachycardia and bradycardia and their invasive therapy were surveyed before and during the lockdown period. Furthermore, the number of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treated at these centers and the incidence of cardiac arrhythmias was also recorded. Results Participating centers performed a total of 24,648 ablation procedures/year and represent approximately 34% (24,648/72,548) of the estimated German ablation treatments. The majority of these centers (33/40; 82.5%) were so-called primary COVID-19 hospitals (level-1). Overall, the number of ablations and pacemaker implantations were reduced by 41% and 18% respectively. Due to postponed ablation procedures and pacemaker implantations, 22/40 (55%) centers reported a worsening of clinical symptoms or early re-hospitalization of their patients. Conclusion These results demonstrate a significant decline in elective rhythmological procedures during the lockdown, as required by the German Federal Government. At the same time, however, more than half of the participating centers reported an increase in patient re-hospitalizations due to postponed procedures.
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Affiliation(s)
- Shibu Mathew
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany.
| | - Christian Fraebel
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Victoria Johnson
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Saboukh Abdelgwad
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Nikita Schneider
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Patrick Müller
- Department of cardiology, University Hospital Muenster, Muenster, Germany
| | - Ritvan Chasan
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Christian Hamm
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Joern Schmitt
- Med. Klinik I-Department of cardiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
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35
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Johnson V, Ernst S, Kirchhof P, Lugenbiel P, Luik A, Schmidt B, Duncker D. [Careers in cardiac electrophysiology]. Herzschrittmacherther Elektrophysiol 2020; 31:334-340. [PMID: 32965520 DOI: 10.1007/s00399-020-00719-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Cardiac electrophysiology has developed into a broad, exciting, and challenging subdiscipline of modern cardiology. The professional opportunities available to electrophysiologists are diverse and offer a wide variety of career goals. The aim of this article is to show young cardiologists what different career paths can look like if they opt for electrophysiology today. Personal testimonials from five experienced electrophysiologists on their own career paths show decisions, support, obstacles, and destinations of these paths to practice or university professorship. This article aims to support young cardiologists who are considering specialization in electrophysiology during their career planning.
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Affiliation(s)
- Victoria Johnson
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, UKGM Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, London, Großbritannien
- National Heart and Lung Institute, Imperial College London, London, Großbritannien
| | - Paulus Kirchhof
- Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum, UKE Hamburg, Hamburg, Deutschland
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, Großbritannien
- Standort Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), Hamburg, Deutschland
| | - Patrick Lugenbiel
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberger Zentrum für Herzrhythmusstörungen (HCR), Heidelberg, Deutschland
| | - Armin Luik
- Medizinische Klinik V, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus-Krankenhaus, Frankfurt am Main, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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36
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Duncker D, Dahme T, Deisenhofer I, Hillmann HAK, Kantenwein V, Müller-Leisse J, Palacios D, Pott A, Reents T, Schmitt J, Veltmann C, Zormpas C, Johnson V. [It's all over! : Complications in the EP lab and their solutions]. Herzschrittmacherther Elektrophysiol 2020; 31:401-413. [PMID: 32880705 DOI: 10.1007/s00399-020-00716-5] [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] [Indexed: 01/16/2023]
Abstract
In cardiac electrophysiology, invasive procedures like catheter ablations or device implantations are getting increasingly complex. This poses challenges especially for electrophysiologists in training, not only to learn how to perform the procedure, but also how to manage possible complications. The present article uses exemplary case studies to present how to control complications and how to avoid them. The presented cases deal with complications such as air embolism in left atrial procedures, iatrogenic vascular injuries such as aortic dissection or dissection of the coronary sinus, complications and challenges with lead revisions, and pericardial tamponade. In each case, measures for avoidance as well as practical guidance for management are shown when the respective complication occurs.
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Affiliation(s)
- David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Tilman Dahme
- Klinik für Innere Medizin II, Kardiologie, Angiologie, Pneumologie, internistische Intensivmedizin, Rehabilitations- und Sportmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Isabel Deisenhofer
- Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland
| | - Henrike A K Hillmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Verena Kantenwein
- Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland
| | - Johanna Müller-Leisse
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Daniel Palacios
- Klinikfür Herz‑, Kinderherz- und Gefäßchirurgie, Abteilung Gefäßchirurgie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Alexander Pott
- Klinik für Innere Medizin II, Kardiologie, Angiologie, Pneumologie, internistische Intensivmedizin, Rehabilitations- und Sportmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Tilko Reents
- Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland
| | - Jörn Schmitt
- Medizinische Klinik I, Abteilung Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Christian Veltmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christos Zormpas
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Victoria Johnson
- Medizinische Klinik I, Abteilung Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
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Johnson V, Maack C. Neue Antidiabetika. Aktuelle Kardiologie 2020. [DOI: 10.1055/a-1223-1699] [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: 10/23/2022]
Abstract
ZusammenfassungDiabetes steigert das Risiko für Herz-Kreislauf-Erkrankungen und hat eine zunehmende Prävalenz. Die Therapie des Diabetes stellte bisher ein Dilemma dar, da viele Therapien zwar den Blutzucker, aber nicht kardiovaskuläre Ereignisse reduzierten. Erst Glukagon-like Peptid-1-Rezeptor-Agonisten (GLP1) und Natrium/Glukose-Cotransporter-2(SGLT2)-Inhibitoren senkten deutlich kardiovaskuläre Endpunkte, und SGLT2-Inhibitoren beugten darüber hinaus der Entwicklung einer Herzinsuffizienz vor. Die Glukosesenkung an sich ist daher nicht entscheidend für den Schutz vor Herz-Kreislauf-Erkrankungen. Die neuen Leitlinien der Europäischen Gesellschaft für Kardiologie stellen daher bei Patienten mit Diabetes und hohem kardiovaskulären Risiko die Verwendung von GLP1-Rezeptor-Agonisten und SGLT2-Inhibitoren der Behandlung mit Metformin voran. Die neuen Studiendaten eröffnen zudem neue metabolische Ansatzpunkte für die Behandlung von Herz-Kreislauf-Erkrankungen auch unabhängig vom Vorliegen
eines Diabetes.
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Affiliation(s)
- Victoria Johnson
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Gießen
| | - Christoph Maack
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg
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Busch S, Johnson V. [Women in electrophysiology: taking the right course of action]. Herzschrittmacherther Elektrophysiol 2020; 31:375-380. [PMID: 32696121 DOI: 10.1007/s00399-020-00701-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
Electrophysiology is a demanding and fascinating cardiac subspecialty, in which few women are working although women indicate an interest in specializing in this field during their cardiology training. Female role models are particularly important to motivate and to encourage young female physicians to become electrophysiological specialists. In order to attract more women to management positions, it is important to take measures to reconcile work and family and to clearly specify selection criteria for management positions.
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Affiliation(s)
- Sonia Busch
- II. Med. Klinik, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.
| | - Victoria Johnson
- Med. Klinik I, Abteilung für Kardiologie/Angiologie, Uniklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
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Johnson V, Troughton J, Varela Mato V, Clemes S, Davies M. A structured health intervention for truckers (SHIFT). Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.101] [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] [Indexed: 11/15/2022]
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Grovola MR, Paleologos N, Wofford KL, Harris JP, Browne KD, Johnson V, Duda JE, Wolf JA, Cullen DK. Mossy cell hypertrophy and synaptic changes in the hilus following mild diffuse traumatic brain injury in pigs. J Neuroinflammation 2020; 17:44. [PMID: 32005260 PMCID: PMC6993507 DOI: 10.1186/s12974-020-1720-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 01/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Each year in the USA, over 2.4 million people experience mild traumatic brain injury (TBI), which can induce long-term neurological deficits. The dentate gyrus of the hippocampus is notably susceptible to damage following TBI, as hilar mossy cell changes in particular may contribute to post-TBI dysfunction. Moreover, microglial activation after TBI may play a role in hippocampal circuit and/or synaptic remodeling; however, the potential effects of chronic microglial changes are currently unknown. The objective of the current study was to assess neuropathological and neuroinflammatory changes in subregions of the dentate gyrus at acute to chronic time points following mild TBI using an established model of closed-head rotational acceleration induced TBI in pigs. METHODS This study utilized archival tissue of pigs which were subjected to sham conditions or rapid head rotation in the coronal plane to generate mild TBI. A quantitative assessment of neuropathological changes in the hippocampus was performed via immunohistochemical labeling of whole coronal tissue sections at 3 days post-injury (DPI), 7 DPI, 30 DPI, and 1 year post-injury (YPI), with a focus on mossy cell atrophy and synaptic reorganization, in context with microglial alterations (e.g., density, proximity to mossy cells) in the dentate gyrus. RESULTS There were no changes in mossy cell density between sham and injured animals, indicating no frank loss of mossy cells at the mild injury level evaluated. However, we found significant mossy cell hypertrophy at 7 DPI and 30 DPI in anterior (> 16% increase in mean cell area at each time; p = < 0.001 each) and 30 DPI in posterior (8.3% increase; p = < 0.0001) hippocampus. We also found dramatic increases in synapsin staining around mossy cells at 7 DPI in both anterior (74.7% increase in synapsin labeling; p = < 0.0001) and posterior (82.7% increase; p = < 0.0001) hippocampus. Interestingly, these morphological and synaptic alterations correlated with a significant change in microglia in proximity to mossy cells at 7 DPI in anterior and at 30 DPI in the posterior hippocampus. For broader context, while we found that there were significant increases in microglia density in the granule cell layer at 30 DPI (anterior and posterior) and 1 YPI (posterior only) and in the molecular layer at 1 YPI (anterior only), we found no significant changes in overall microglial density in the hilus at any of the time points evaluated post-injury. CONCLUSIONS The alterations of mossy cell size and synaptic inputs paired with changes in microglia density around the cells demonstrate the susceptibility of hilar mossy cells after even mild TBI. This subtle hilar mossy cell pathology may play a role in aberrant hippocampal function post-TBI, although additional studies are needed to characterize potential physiological and cognitive alterations.
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Affiliation(s)
- Michael R Grovola
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
| | - Nicholas Paleologos
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
| | - Kathryn L Wofford
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - James P Harris
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
| | - Kevin D Browne
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
| | - Victoria Johnson
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
| | - John E Duda
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Wolf
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA
| | - D Kacy Cullen
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA.
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, 105E Hayden Hall/3320 Smith Walk, Philadelphia, PA, 19104, USA.
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Affiliation(s)
- Sage Davis
- At Covenant Community Care in Royal Oak, Mich., Sage Davis is a family nurse practitioner; Victoria Johnson is a nurse manager; Michelle McClory is a former behavioral health counselor; and Jennifer Warneck is a community health worker
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Johnson V, Hamm CW, Schmitt J. [Device-device interaction]. Herzschrittmacherther Elektrophysiol 2019; 30:183-190. [PMID: 30989336 DOI: 10.1007/s00399-019-0617-z] [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: 03/16/2019] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
With a continuous increase in the approval of cardiac implantable electronic devices (CIED), not only pacemakers (PM) and implantable cardioverter defibrillators (ICD) but especially devices for treating chronic heart failure, more and more possibilities of device-device interactions arise, which in isolated cases can lead to death of the patient. Because of the still low numbers of patients overall, there are very few scientific studies and only isolated case reports on this topic. Devices which are at risk of interaction with a previously implanted PM are wearable cardioverter defibrillators (WCD) and subcutaneous ICDs (S-ICD). These two devices both use the surface electrocardiogram (ECG) in their algorithm for detecting ventricular arrhythmia. These surface ECGs seem to be prone to unipolar pacemaker stimulation artefacts. By correct programming of implanted pacemakers in the bipolar stimulation mode it is possible to avoid ECG artefacts and inadequate treatment. In baroreceptor activation therapy (BAT) there seem to be no device interactions so far, even though this device shows substantial highly frequent artefacts in the ECG. The cardiac contractility modulation (CCM) system has also until now not shown interactions with transvenous or subcutaneous ICD devices, even though randomized trials are missing.
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Affiliation(s)
- Victoria Johnson
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland.
- Deutsches Zentrum für Herzinsuffizienz, Translationale Forschung, Uniklinikum Würzburg, Würzburg, Deutschland.
| | - Christian W Hamm
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland
| | - Jörn Schmitt
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland
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Johnson V, Schmitt J. Pacientes con fibrilación auricular y mal pronóstico en el síndrome coronario agudo: ¿qué fue antes, el huevo o la gallina? Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johnson V, Schreder S, Kreit E, Mullis R, Mant J. The development and feasibility of a structured self-management programme (My Life After Stroke; MLAS) for stroke survivors. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.276] [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] [Indexed: 10/27/2022]
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Grieshaber P, Oster L, Schneider T, Johnson V, Orhan C, Roth P, Niemann B, Böning A. Total arterial revascularization in patients with acute myocardial infarction - feasibility and outcomes. J Cardiothorac Surg 2018; 13:2. [PMID: 29304874 PMCID: PMC5755408 DOI: 10.1186/s13019-017-0691-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/20/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In acute situations such as acute myocardial infarction (AMI) with indication for coronary artery bypass grafting (CABG), total arterial revascularization (TAR) is often rejected in favour of saphenous vein (SV) grafting, which is assumed to allow for quicker vessel harvesting, a simpler anastomosis technique, and thus quicker revascularization and fewer bleeding complications. The aim of this study was to evaluate whether reluctance to apply TAR in AMI is still justified from a technical point of view in the current era and whether superiority of TAR results is also evident in emergency patients with AMI undergoing CABG. METHODS In this retrospective analysis of 434 consecutive patients undergoing CABG for AMI with either TAR or with a combination of one internal mammary artery and SV grafts between 2008 and 2014, procedural data, short-term and mid-term outcome were compared. Propensity score matching of the groups was performed. RESULTS After propensity score matching, 250 patients were included in the analysis (TAR group: n = 98; SV group n = 152). The procedural time (TAR group: 211 min vs. SV group: 200 min, p = 0.46) did not differ between the groups. Erythrocyte transfusion rates were higher in the SV group (76% vs. 57%; p < 0.001). Rates of re-exploration for bleeding did not differ. Thirty-day mortality rates were comparable (TAR group: 3.4% vs. SV group: 4.5%, p = 0.68). Kaplan-Meier analysis until 7 years postoperatively revealed a tendency for improved survival after TAR (75% vs. 62%; log-rank p = 0.12). CONCLUSION TAR neither impairs rapid revascularization nor reduces its safety in patients with AMI. It may result in improved long-term outcome and should be preferred in the clinical setting of AMI.
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Affiliation(s)
- Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Lukas Oster
- Department of Anaesthesiology, Sana Hospital Berlin-Lichtenberg, Berlin, Germany
| | - Tobias Schneider
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Victoria Johnson
- Department of Cardiology and Angiology, University Hospital Giessen, Giessen, Germany
| | - Coskun Orhan
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Peter Roth
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Bernd Niemann
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
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Weipert K, Kostic S, Goekyildirim T, Gemein C, Chasan R, Johnson V, Hamm C, Erkapic D, Schmitt J. P1688Use of the INSIGHT detection algorithm in subcutaneous ICDs in pacemaker patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1688] [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: 11/13/2022] Open
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Johnson V, Schmitt J, Hamm CW. Stroke prevention in atrial fibrillation – latest guideline recommendations and real world data. Med Monatsschr Pharm 2017; 40:167-170. [PMID: 29952167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Atrial fibrillation (AF) occurs with a prevalence of 1 % in the general population, up to 8 % in patients over 80 years of age and can lead to palpitations, tachycardia, hospitalization for heart failure and stroke. In order to prevent strokes, oral anticoagulation is necessary. In the 2016 guidelines for the management of atrial fibrillation, non vitamin K anticoagulants (NOACs) are preferred among vitamin K anticoagulants due to less severe bleeding, especially intracranial haemorrhage. There is also no longer evidence for antiplatelet therapy in AF. Apart from randomized controlled trials it has been shown in real world data that use of NOACs is safe and feasible. NOACs are not indicated in patients with mechanical valve replacement and valvular atrial fibrillation. Since November 2015 the first specific antidote for dabigatran is available in Germany, a factor Xa antidote (apixaban, rivaroxaban, edoxaban) is being tested in a phase III study.
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Boeder NF, Johnson V, Dörr O, Wiebe J, Elsässer A, Möllmann H, Hamm CW, Nef HM, Bauer T. Bioresorbable scaffold implantation in patients with indication for oral anticoagulation: A propensity matched analysis. Int J Cardiol 2017; 231:73-77. [PMID: 27899203 DOI: 10.1016/j.ijcard.2016.11.280] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To examine ischemic and bleeding outcomes in patients on triple antithrombotic therapy (TAT) compared with dual antiplatelet therapy (DAPT) after the implantation of bioresorbable scaffolds (BRS). BACKGROUND The optimal antithrombotic regimen in patients undergoing percutaneous coronary intervention that have an indication for oral anticoagulation is unclear, in particular among those undergoing BRS implantation. METHODS Consecutive patients of a single-center, all-comers BRS registry were included. Patients were followed up after 30days, 6 and 12months, and thereafter yearly. Outcome parameters were target vessel failure (TVF), major adverse cardiac events (MACE) including target lesion revascularization (TLR), scaffold thrombosis (ST), death, myocardial infarction, and any bleeding as defined by BARC. Patients on TAT were matched to patients on DAPT. RESULTS A total of 607 patients were included. Fifty-five patients receiving TAT were matched with 165 patients treated with DAPT. Acute coronary syndrome was an indication for coronary angiography in 50.9% vs 50.4% groups (p=0.97). Major adverse cardiac events occurred in 16.4% of TAT patients vs. 8.9% DAPT patients (p=0.12), TLR in 5.5% vs. 1.9% (p=0.17), ST in 3.6% vs. 1.9% (p=0.46), and TVF in 3.6 vs. 1.9% (p=0.46). Patients died in 7.3% in the TAT group vs. 5.1% in the DAPT group (p=0.26). No severe bleeding was recorded in either of the groups. CONCLUSION There was no difference in bleeding or ischemic events between the patients on TAT and those on DAPT after BRS implantation. The high rate of scaffold thrombosis in all of these patients, however, is not negligible.
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Affiliation(s)
- Niklas F Boeder
- University of Giessen, Department of Cardiology, Giessen, Germany
| | - Victoria Johnson
- University of Giessen, Department of Cardiology, Giessen, Germany
| | - Oliver Dörr
- University of Giessen, Department of Cardiology, Giessen, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Munich, Germany
| | | | - Helge Möllmann
- St. Johannes-Hospital, Department of Internal Medicine, Dortmund, Germany
| | - Christian W Hamm
- University of Giessen, Department of Cardiology, Giessen, Germany
| | - Holger M Nef
- University of Giessen, Department of Cardiology, Giessen, Germany
| | - Timm Bauer
- University of Giessen, Department of Cardiology, Giessen, Germany.
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Schmitt J, Abaci G, Johnson V, Erkapic D, Gemein C, Chasan R, Weipert K, Hamm CW, Klein HU. Safety of the Wearable Cardioverter Defibrillator (WCD) in Patients with Implanted Pacemakers. Pacing Clin Electrophysiol 2016; 40:271-277. [PMID: 27943296 DOI: 10.1111/pace.12986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/19/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is an important approach for better risk stratification, applied to patients considered to be at high risk of sudden arrhythmic death. Patients with implanted pacemakers may also become candidates for use of the WCD. However, there is a potential risk that pacemaker signals may mislead the WCD detection algorithm and cause inappropriate WCD shock delivery. The aim of the study was to test the impact of different types of pacing, various right ventricular (RV) lead positions, and pacing modes for potential misleading of the WCD detection algorithm. METHODS Sixty patients with implanted pacemakers received the WCD for a short time and each pacing mode (AAI, VVI, and DDD) was tested for at least 30 seconds in unipolar and bipolar pacing configuration. In case of triggering the WCD detection algorithm and starting the sequence of arrhythmia alarms, shock delivery was prevented by pushing of the response buttons. RESULTS In six of 60 patients (10%), continuous unipolar pacing in DDD mode triggered the WCD detection algorithm. In no patient, triggering occurred with bipolar DDD pacing, unipolar and bipolar AAI, and VVI pacing. Triggering was independent of pacing amplitude, RV pacing lead position, and pulse generator implantation site. CONCLUSION Unipolar DDD pacing bears a high risk of false triggering of the WCD detection algorithm. Other types of unipolar pacing and all bipolar pacing modes do not seem to mislead the WCD detection algorithm. Therefore, patients with no reprogrammable unipolar DDD pacing should not become candidates for the WCD.
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Affiliation(s)
- Joern Schmitt
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Guezine Abaci
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Victoria Johnson
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Damir Erkapic
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Christopher Gemein
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Ritvan Chasan
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Kay Weipert
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Christian W Hamm
- Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany.,Abteilung für Kardiologie, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Helmut U Klein
- Heart Research Follow Up Program, University Hospital of Rochester Medical Center, Rochester, New York
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Srikanthan K, Drouot C, Sukumaran B, Johnson V, Walshaw M, Mohan K. P16 Radial ebus biopsy with guide sheath for peripheral pulmonary lesions. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.159] [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] [Indexed: 11/03/2022]
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