bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world Endoscopic and Histological Outcomes Are Correlated with Ustekinumab Exposure in Patients with Ulcerative Colitis
Authors: Alsoud Dahham , De Hertogh Gert , Compernolle Griet , Tops Sophie , Sabino João , Ferrante Marc , Thomas Debby , Vermeire Séverine , Verstockt Bram 
Published: May 2022

Abstract

Background
Histo-endoscopic outcomes are being proposed as new treatment targets in ulcerative colitis [UC]. Little is known about the pharmacokinetic-pharmacodynnamic [PK-PD] relationship of ustekinumab [UST] in UC patients or whether serum UST concentrations reflect tissue drug exposure. We aimed to study UST serum concentrations and their relation to tissue exposure and drug effectiveness in a real-world setting.

Methods
A total of 42 UC patients starting UST were prospectively followed by clinical, endoscopic and histological assessments at Week 16. Histological remission was defined as Nancy Histology Index of 0. Analogous to the UNIFI programme, histo-endoscopic mucosal improvement was defined as a combination of histological improvement [Geboes ≤3.1] and endoscopic improvement [MES ≤1]. Paired trough serum samples and colonic mucosal biopsies were collected for UST levels measurement.

Results
After 16 weeks [IQR 15.8–16.4] of therapy, histological remission and histo-endoscopic mucosal improvement were observed in 19 [45%] and 18 [43%] patients, respectively. Patients who achieved these outcomes had higher serum UST levels than those who did not. Patients with shorter disease duration and clinical response at Week 8 had higher odds to achieve histological remission. UST concentrations from paired serum and biopsy samples revealed a strong positive correlation [r = 0.88, p &lt; 0.001], in both inflamed and uninflamed tissue.

Conclusions
In this real-world cohort of refractory UC patients initiating UST, more than a third of the patients achieved histological remission. A drug exposure-response relationship was observed for histo-endoscopic outcomes, with no added value of measuring tissue exposure given the strong correlation with serum exposure.
Time is kidney: relation between pain-to-balloon time and acute kidney injury among ST segment elevation myocardial infarction patients undergoing primary percutaneous intervention
Authors: Zahler D , Rozenfeld KL , Itach T , Lupu L , Banai S , Shacham Y 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Among ST segment elevation myocardial infarction (STEMI) early hemodynamic changes may result in acute kidney injury (AKI) even prior to primary percutaneous coronary intervention (PCI), however, no information to date is present regarding the association between pain to balloon (PBT) and AKI.

Purpose
We evaluated whether PBT predicts the risk of AKI among STEMI patients undergoing primary PCI.

Methods
Medical records of 2343 STEMI patients undergoing primary PCI were reviewed. Patients were stratified by PBT into 3 groups: ≤120, 121-360 and &gt; 360 minutes. Patients' records were assessed for the occurrence of AKI (defined by the KDIGO criteria as serum creatinine elevation ≥ 0.3 mg/dl within 72 hours after admission).

Results
Mean age was 61 ± 13 years and 1919 (82%) were male. Patients having longer PBT had more AKI complicating the course of STEMI (7 % vs. 8 % vs. 13 %, p&lt;0.001) and had significantly higher serum creatinine changes throughout hospitalization (0.08 mg/dl vs. 0.11 mg/dl vs.0.17 mg/dl p&lt;0.001). In a multivariable logistic regression model each 1-hour increase in PBT was independently associated with a 2.2% increase in risk for AKI (OR 1.022, 95% CI 1.01-1.04, p=0.02). In a second model, PBT &gt;360 minutes turned out to be a strong an independent predictor for AKI occurrence (OR 1.6 ,95% CI 1.1-2.2, p=0.006, model 2). Other factors independently associated with AKI included age &gt; 60 years, CKD, hypertension and left ventricular ejection fraction ≤ 45%.

Conclusion
Longer PBT may be an independent marker for the development of AKI in STEMI patients undergoing primary.
Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community acquired pneumonia; an Egyptian multicenter prospective study
Authors: Laimoud M , Abdel-Moaty M , Elshobary M , Mohamed T , Ahmed W 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Non-invasive ventilation (NIV) might be successful if properly selected in adult patients with cardiac dysfunction presenting with community acquired pneumonia. The main objective was to identify contributing factors to NIV failure.

Methods
All adult patients with LV EF less than 50% admitted to the ICU with community acquired pneumonia and acute respiratory failure were enrolled in our multicenter prospective study after getting informed consents . The study was registered and given a number (ID ISRCTN14641518). Non-invasive ventilation failure was defined as requirement of intubation after institution of NIV intervention.

Results
We prospectively enrolled 177 patients between February 2019 to July 2020. Fifty-three patients (29.9%) were considered failed NIV. The mean age of studied patients was 64.1±12.6 years with a male predominance (73.4%) and a mean left ventricle EF of 36.4±7.8%. There were insignificant differences between the NIV success and NIV failure groups regarding the underlying morbidities nor the inflammatory markers. The patients who failed NIV were significantly older with higher mean SOFA and APACHE II scores compared to the patients with succeeded NIV. Non-invasive Ventilation failure was associated with longer ICU stay (p&lt;0.001), higher SOFA at 48 hours (p&lt;0.001) and higher mortality (p&lt;0.001) compared to the NIV success group. NIV failure was independently predicted with APACHE II (OR:1.420, p 0.01, 95% CI:1.224 – 1.647), SOFA (OR:17.6 , p &lt;0.001, 95% CI: 4.148-74.68), baseline HACOR (OR:2.041, P 0.026, 95% CI:1.225 –3.401), lung ultrasound score (OR:1.209,P 0.017,95% CI:1.014–1.441) and blood lactate (OR:9.702,P &lt;0.001,95%CI:1.357–69.37).Conclusion: High initial APACHE II and SOFA scores , hindered lactate clearance as well as non-decrementing patterns of HACOR and LUS scores were associated with early NIV failure in patients with heart failure presenting with community acquired pneumonia.
Acute coronary syndromes in young patients and thrombophilia : the experience of our hospital
Authors: Stratinaki M , Stavrakis S , Bachlitzanaki E , Pitarokoilis M , Rogdakis E , Korela D , Detoraki M , Stavratis S , Papaoikonomou E , Kafarakis P , Garidas G , Lamprogiannakis E , Sfiridaki A , Foukarakis E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The number of young patients presenting with acute coronary syndromes is increasing. Among them, there is a large number of patients without major cardiovascular risk factors raising concerns about the cause of the acute coronary syndrome. It is known that thrombophilia is an independent risk factor for myocardial infarction.

Purpose
To evaluate the frequency of thrombophilia in young patients presenting with acute coronary syndrome.

Methods
We performed genetic testing for the most frequent gene mutations responsible for thrombophilia (factor V Leiden, PAI I 4G/5G, prothrombin G20210A, MTHFR C677T, MTHFR A1257C, MTHFR A1298C) in all patients presenting with acute coronary syndrome that were aged &lt;40 (men) or &lt;45 (women), for a period of 10 years.

Results
We recorded 127 patients , 114 (89.76%) male and 13 (10.23%) female. Their mean age was 36±1.7years.Regarding the conventional cardiovascular risk factors, 67/127(52.75%) were smokers, diabetes mellitus was present in 26/127(20.47%), arterial hypertension in 12/127(15.24%), positive family history in 92/127(72.44%) and dyslipidemia in 79/127(62.2%).The genetic testing was positive for thrombophilia in 109/127 (85.82%). 25/109 (22.93%) were factor V Leiden homozygotes, 11/109 (10.09%) factor V Leiden heterozygotes, 17/109(15.59%), PAI I 4G/5G homozygotes, 8/109 (7.33%) PAI I 4G/5G heterozygotes, 36/109 (39.24%) G20210A homozygotes and 12/109 (13.08%) G20210A heterozygotes.

Conclusion
Thrombophilia seems to be present in the majority of young patients presenting with acute coronary syndrome and should not be overlooked. More studies are needed t identify whether the presence of thrombophilia affects the prognosis of these patients as well as whether is necessary a different approach in their treatment and management.
Levosimendan in patients undergoing cardiac surgery: does timing matter?
Authors: Carvalho P , Goncalves F , Pinto C , Moreira I 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Levosimendan (LEV) is an inotropic drug that improves myocardial contractility without increasing oxygen requirement and its use in cardiac surgery has been questioned. Early meta-analysis showed that it was associated with reduced mortality, however recent randomized trials failed to show a benefit of this drug in some specific subsets of patients.

Purpose
This study sought to evaluate if the timing of the initiation of LEV infusion could have impact in short-term prognosis.

Methods
This was an unicenter retrospective study of patients submitted to a cardiac surgery between December 2009 and December 2018 and who did LEV during hospitalization. Three groups were established upon the beginning of LEV administration: preoperative, intraoperative and postoperative. Statistical comparisons between groups are presented below in this order.

Results
Out of 141 patients, 40,4% belonged to the preoperative group, 31,2% to the intraoperative group and 28,4% to the postoperative group. Demographic data was balanced between the three groups with the exception of past history of peripheral artery disease (3,6% vs 15,9% vs 2,5%, p=0,024) and previous cardiac surgery (19,3% vs 4,5% vs 2,5%, p=0,009). The type of cardiac surgery, whether with or without cardiopulmonary bypass, was similar in all groups. Left ventricular ejection fraction was not significantly different (36,9±12,3% vs 41,2±12,5% vs 42,2±12,2%, p=0,080) and the same happened with the proportion of patients with right ventricle dysfunction (12,3% vs 9,1% vs 10%, p=0,865). Moreover, total dose of LEV and its infusion duration were not different (p=0,117 and p=0,242, respectively).
Compared to the postoperative group, preoperative and intraoperative initiation was not independently associated with a significantly lower risk of in-hospital cardiogenic shock requiring inotropic drugs (adjusted OR 0,84 (95% CI 0,23-3,06) and 1,04 (95% CI 0,30-3,60), respectively) or mechanical circulatory support (adjusted OR 1,29 (95% CI 0,18-9,34) and 0,57 (95% CI 0,06-5,64)), myocardial infarction (adjusted OR 1,25 (95% CI 0,16-9,87) and 1,46 (95% CI 0,20-10,51)) and death (adjusted OR 1,85 (95% CI 0,28-12,18) and 4,41 (95% CI 0,81-24,00)). However, preoperative LEV was associated with less acute kidney injury (adjusted OR 0,36 (95% CI 0,14-0,93)) compared to postoperative initiation. Still, the need for renal replacement therapy didn’t differ significantly between all groups. Overall, subgroup analysis showed identical results independently of biventricular systolic function, type of surgery and need of cardiopulmonary bypass.

Conclusions
In this heterogeneous population submitted to a cardiac surgery, timing of LEV initiation did not have a significant impact on short-term in-hospital major adverse outcomes, independently of biventricular systolic function and type of surgery.
Impella CP implantation during cardiopulmonary resuscitation for cardiac arrest: a multicenter experience
Authors: Panagides V , Vase H , Shah S , Basir MB , Mancini J , Kamran H , Batra S , Laine M , Eiskjaer H , Karami K , Paganelli F , Henriques JP , Bonello L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Abstract: Background
Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown.

Methods
We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival.

Results
Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age &lt; 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively).

Conclusions
In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.
Chest pain post anti-Covid-19 vaccination with mRNA BNT162b2 vaccine : the experience of a secondary hospital
Authors: Stratinaki M , Vassilakis D , Stavrakis S , Bachlitzanaki E , Detoraki M , Korela D , Papaoikonomou E , Pitarokoilis M , Rogdakis E , Kafarakis P , Garidas G , Lamprogiannakis E , Foukarakis E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Vaccination against Covid-19 has been proved an effective protective measure against the pandemic. It has been noticed that a number of patients visited the emergency department (ED) complaining of chest pain following their vaccination.

Purpose
To record the patients that visited the ED of our hospital referring chest pain following their vaccination with BNT162b2 vaccine, the clinical and laboratory parameters as well as their final diagnosis.

Methods
We recorded the patients that visited the ED of our hospital (secondary hospital) referring "chest pain after the vaccine", for a period of 6 months. We included patients that had received the first or the second dose of the vaccine 1-30 days prior their visit. We recorded basic demographic characteristics, ECG findings the laboratory test results as well as the possible diagnosis made in the ED.

Results
207 patients visited the ED complaining of "chest pain after having the Covid-19 vaccine", 96 male and 111 female, with mean age 47±8.2 years. 7 patients(3.38%) had elevated high sensitivity troponin and were diagnosed with myocarditis ( 2 female patients aged 5 and 62 years and 5 males aged 18-24 years. In 5/7 ST elevations were recorded in the 12-lead ECG, in 4/7 the transthoracic echocardiogram(TTE) revealed mildly impaired left ventricular function. Myocarditis was confirmed via cardiac MRI in all patients. Virology tests were negative for the common viruses.6/7 visited the ED 2-5 days after the second dose, whereas 1/7 10 days after the first dose). 2 patients(0.96%) were diagnosed with pericarditis (Both of them had received the second dose 5-7 days prior their visit, presented with pericardial rub and diffuse ST elevations in the ECG, as well as elevated CRP and moderate pericardial effusion). For the remaining 198 patients (95.65%) we did not record any abnormal findings in the ECG or the chest X ray and the chest pain was regarded non cardiac. Interestingly enough, 107 patients (51.69%) found to have a mild to moderate increase in the D-Dimer levels (mean 1.1±0.6 mg/l).Pulmonary embolism and aortic dissection was excluded to all of them based on our hospital’s protocol.

Conclusion
The vast majority (95.65%) of patients complaining of post Covid-19 vaccine chest pain had normal ECG and laboratory findings, suggesting a non cardiac origin.There were diagnosed some cases with myocarditis or pericarditis, a well described possible side effect of the BNT162b2 vaccine. Moreover, 51.69% of these patients were found to have elevated D-Dimer levels but we did not record any clinical significance.
Renal replacement therapy in acute coronary syndrome: what kind of patient requires it and what is its prognostic impact?
Authors: Martinez Nunez R , Altarejos Salido F , Paez Munoz R , Garcia Gonzalez N , Garcia Rubira JC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The clinical acuity and medical complexity in contemporary tertiary center Cardiology Critical Care Units (CCCU) have heralded an increase in the prevalence of acute and chronic kidney disease. Consequently, renal replacement therapy (RRT) has become a rising technique in these units.

Purpose
Our aim was to analyze the baseline characteristics, complications and prognosis of patients with acute coronary syndrome (ACS) who required RRT during their admission, and to compare them with the characteristics of those patients who did not.

Methods
Retrospective observational analysis of registered ACS patients admitted to the CCCU of a tertiary center between January 2011 and January 2021. A comparative analysis was performed between those patients who required RRT during their admission, either due to chronic kidney disease (CKD) or peri-infarct acute kidney injury, and the remaining patients.

Results
2596 patients were included in the analysis, showing the baseline characteristics listed in the table. A total of 53 (2%) required RRT during their admission. Patients requiring RRT more frequently presented ACS without ST elevation (69.8% vs 37.9%; p &lt;0.001), multivessel disease (41.3% vs 17%; p &lt;0.001) and a III or IV Killip-Kimbal (KK) score (38.5% vs 11%; p &lt;0.001). During admission, they had a higher incidence of atrial fibrillation (AF) (34% vs 13.3%; p &lt;0.001), bleeding (26.4% vs 10.5%; p &lt;0.001), stroke (5.7% vs 1.2%; p 0.004), peri-infarct cardiorespiratory arrest (20.8% vs 10.2%; p 0.013) and in-hospital death (34% vs 5.9%; p &lt;0.001). In the multivariate analysis performed, RRT was not an independent predictor of mortality when corrected for other risk factors (diabetes mellitus, GRACE and CRUSADE scores, STEACS, single vessel disease, or KK score on admission).

Conclusions
Patients admitted with ACS who required RRT had a higher risk profile, with a worse in-hospital prognosis and a higher incidence of complications. However, RRT was not found to be an independent predictor of mortality after adjusting for other variables.
Time course and prognostic impact of venoarterial extracorporeal membrane flow throughout cardiogenic shock
Authors: Montero S , Huang F , Rivas-Lasarte M , Chommeloux J , Brechot N , Hekimian G , Franchineau G , Luyt CE , Garcia-Garcia C , Bayes-Genis A , Lebreton G , Cinca J , Combes A , Alvarez-Garcia J , Schmidt M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In VA-ECMO supported patients because of refractory cardiogenic shock (CS), there is a lack of evidence on what is the "optimal" ECMO flow.

Purpose
To describe the evolution of VA-ECMO flow in a CS population according to the degree of support and analyze the impact of early high-ECMO flows on short-term outcomes.
Methods We performed a retrospective, single-center study including patients in refractory CS supported with peripheral VA-ECMO admitted at an University Hospital. Based on the median flow over the first 48 hours of ECMO run, patients were classified as "high-flow" or "low-flow" when median ECMO flow was ⋝ or &lt; than 3.6 L/min, respectively. All statistical tests were two-sided, with a p value ≤ 0.05 considered significant.

Results
Two hundred and nine patients were included. Median age was 51 (40-59) years, 78% were males, and the median SAPS II was 51 (32 - 66). The most frequent etiology leading to CS was end-stage-dilated cardiomyopathy (57%). "High-flow" and "low-flow" groups each represented 50% of the study population, respectively (Figure 1). Median flows between both groups were continuously lower in "low-flow" patients at any time-point, with the "low-flow" group maintaining VA-ECMO flows around 3.0-3.1 L/min. The "high-flow" group had a higher frequency of ischemic etiology and was significantly sicker at admission. Almost 70% of the study population was managed with LV unloading. More than 40% of patients were managed with an awake strategy, with much higher rates of awake ECMO in the "low-flow" group (52% vs 30%, p&lt;0.001). Patients with "high-flow" had 50% more VAP than "low-flow" patients and median days on mechanical ventilation were significantly less in the "low-flow" group (4 [1.5 - 7.5] vs 6 [3 - 12] days, p=0.009, respectively). No differences were either found in total days in ICU or days of hospitalization. Finally, global in-hospital mortality was 46%, with less but not statistically significant differences in the "low-flow" group (41% vs 51%, p=0.144, respectively). Mortality at 60-days were alike for both groups.

Conclusions
In patients with refractory CS supported with VA-ECMO, sicker patients were managed with higher degree of support from early phases. Patients with high flows presented with higher rates of VAP, but presented similar in-hospital and short-term survival compared to patients with lower flows. Future research is now warranted to address the specific, direct, impact of higher flows in lung injury or length of MV.
Time trends in 30-day mortality in patients with pulmonary embolism
Authors: Vojtickova L , Kleissner M , Kettner J , Kautzner J , Sramko M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is a lack of evidence about recent mortality rates in patients with acute pulmonary embolism (PE).

Purpose
To compare 30-day mortality between the current and historical cohort of patients treated for acute PE.

Methods
We provide a retrospective analysis of clinical and imaging features of 400 consecutive patients who were admitted to our hospital with the diagnosis of acute pulmonary embolism between February 2010 and April 2021. Patients with out-of-hospital cardiac arrest without return of spontaneous circulation (14 patients) were excluded from the study cohort. The 30-day mortality was compared between patients admitted before January 2016 (n =178) and after January 2016 (n = 222). We stratified patients into low-, intermediate-, and high-risk group according to the ‘2019 ESC Guidelines on Acute Pulmonary Embolism’.

Results
The diagnosis of pulmonary embolism was based on results of computed tomography (86%), pulmonary ventilation/perfusion scan (7%), echocardiography (7%) and autopsy (1%).
Most patients were stratified as intermediate-risk (313 patients [78 %]), followed by low-risk (46 [12%]) and high-risk pulmonary embolism (41 [10%]).
The risk-stratification profile did not differ between the current and historical cohort (79% vs. 77% for intermediate-risk, 12% vs. 11% for low-risk, and 9% vs. 12% for high-risk patients, all p&gt; 0.05).
Seventeen patients (4%) died within 30 days of admission to the hospital: ten patients in the high-risk (24%), seven in the intermediate-risk (2%), and none (0%) in the low-risk group (p &lt;0.0001). There was no significant difference in 30-day mortality between the current and historical cohort (9 [4%] vs. 8 [4%], p = 0.83).
In a multivariate regression analysis, only the initial presence of cardiogenic shock was associated with higher 30-day mortality.

Conclusion
In-hospital mortality of patients with intermediate- and low-risk pulmonary embolism is lower than reported in the past and has not changed over the last decade. High-risk pulmonary embolism is associated with 24% 30-day mortality.