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Usefulness of Impella support in different clinical settings in cardiogenic shock

Journal of geriatric Cardiology 2022年第2期19卷 115-124页

作者： María Isabel Barrionuevo-Sánchez Albert Ariza-Solé Daniel Ortiz-Berbel Joségonzález-Costello joan antoni gómez-hospital Victòria Lorente Oriol Alegre Isaac Llaó JoséCarlos Sánchez-Salado Josep gómez-Lara Arnau Blasco-Lucas Josep Comin-Colet Cardiology Department Intensive Cardiac Care UnitBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain Cardiac Surgery Department Heart Disease InstituteBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain

BACKgROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.

关键词： Impella clinical routine

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Determination of functional fitness age in women aged 50 and older

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Journal of Sport and Health Science 2019年第3期8卷 267-272页

作者： Edgar Johani Latorre-Rojas joan antoni Prat-Subirana Xavier Peirau-Terés Sebastià Mas-Alòs José Vicente Beltrán-garrido antoni Planas-Anzano National Institute of Physical Education of Catalonia University of Lleida Physical Fitness Sport and Recreation Department Floridablanca Campus University Santo Tomas Aquino Department of Nursery and Physiotherapy University of Lleida EUSES TE Health and Sport Science School Rovira i Virgili University

Background: The construction of useful and attainable indicators of fitness assessment deserves special attention in clinical practice. We aimed to construct an indicator of the functional fitness age(FFA) of women aged 50 and older by an equation using fitness outcomes and its correlation with chronological age(CA) and to analyze the external validity of our results by comparing our sample to others.Methods: Participants(n=459, age: 70.3 ± 7.9 years, mean ± SD) were evaluated using the Senior Fitness Test battery. We applied a multiple regression and a subsequent Holt's exponential smoothing to analyze the outcomes.Results: We obtained a statistically significant expression of F(6, 452) = 328.384; p ged 50 and over with regards to CA:FFA = 40.146 + 0.350 X CS(stand)-0.714 X AC(rep)-0.110 X ST(step)-0.177 X CSR(cm)-0.101 X BS(cm) + 8.835 X FUg(s) where CS means chair stand test, AC. means arm curl test, ST means 2-min step test, CSR means chair sit-and-reach test, BS means back scratch test, FUg means 8-foot up-and-go test. We compared this index with percentiles distribution from our sample and from other studies.Conclusion: We suggest the use of FFA as a valid indicator of fitness in adult and senior women as well as a useful motivational tool to undertake exercise programs.

关键词： Disability Elderly Exercise Fitness assessment Health outcomes Senior Fitness Test

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Insulin like growth factor-1 increases fatty liver preservation in IgL-1 solution

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World Journal of gastroenterology 2010年第45期16卷 5693-5700页

作者： Mohamed Amine Zaouali Susagna Padrissa-Altés Ismail Ben Mosbah Hassen Ben Abdennebi Olivier Boillot antoni Rimola Dalila Saidane-Mosbahi joan Roselló-Catafau Experimental Hepatic Ischemia-Reperfusion Unit Institut d'Investigacions Biomèdiques de BarcelonaConsejo Superior de Investigaciones Científicas08036 BarcelonaSpain Unitat de Transplantament de Fetgei Viabilitat del' Empelt Institut d'Investigacions Biomèdiques August Pii Sunyer08036 BarcelonaSpain Laboratory of Human Physiology Faculty of PharmacyUniversity of Monastir5000 MonastirTunisia Unit of Hepatic Transplantation Edouard Herriot Hospital69003 LyonFrance Biomedical Research Center Esther Koplowitz CIBER-ehdInstitute of Health Carlos Ⅲ08036 BarcelonaSpain

AIM: To investigate the benefits of insulin like growth factor-1 (IgF-1) supplementation to serum-free institut georges lopez-1 (IgL-1) solution to protect fatty liver against cold ischemia reperfusion injury. METHODS: Steatotic livers were preserved for 24 h in IgL-1  solution supplemented with or without IgF-1 and then perfused "ex vivo " for 2 h at 37℃. We examined the effects of IgF-1 on hepatic damage and function (transaminases, percentage of sulfobromophthalein clearance in bile and vascular resistance). We also studied other factors associated with the poor tolerance of fatty livers to cold ischemia reperfusion injury such as mitochondrial damage, oxidative stress, nitric oxide, tumor necrosis factor-α (TNF-α) and mitogen-activated protein kinases.RESULTS: Steatotic livers preserved in IgL-1 solutionsupplemented with IgF-1 showed lower transaminase levels, increased bile clearance and a reduction in vascular resistance when compared to those preserved in IgL-1solution alone. These benefits are mediated by activation of AKT and constitutive endothelial nitric oxide synthase (eNOS), as well as the inhibition of inflammatory cytokines such as TNF-α. Mitochondrial damage and oxidative stress were also prevented.CONCLUSION: IgL-1  enrichment with IgF-1 increasedfatty liver graft preservation through AKT and eNOS activation, and prevented TNF-α release during normothermic reperfusion.

关键词： AKT Institut georges lopez-1 solution Insulin like growth factor-1 Ischemia reperfusion injury Nitric oxide Oxidative stress Steatotic graft preservation

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Hypoxia inducible factor-1αaccumulation in steatotic liver preservation:Role of nitric oxide

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World Journal of gastroenterology 2010年第28期16卷 3499-3509页

作者： Mohamed Amine Zaouali Ismail Ben Mosbah Eleonora Boncompagni Hassen Ben Abdennebi Maria Teresa Mitjavila Ramon Bartrons Isabel Freitas antoni Rimola joan Roselló-Catafau Experimental Hepatic Ischemia Reperfusion Unit Institut of Biomedical Research of BarcelonaSpanish National Research Council08036BarcelonaSpain Liver Transplantation and graft Viability Unit August Pi i Sunyer Biomedical Research Institut08036Barcelona Spain Animal Biology Department Pavia University27100PaviaItaly Laboratory of Human Physiology Faculty of PharmacyUniversity of Monastir5000Monastir Tunisia Department of Physiology Faculty of BiologyUniversity of Barcelona08028BarcelonaSpain Physiological Sciences Department Bellvitge CampusInstitut of Biomedical Research of Bellvitge-Barcelona University08907BarcelonaSpain

AIM:To examine the relevance of hypoxia inducible factor(HIF-1)and nitric oxide(NO)on the preservation of fatty liver against cold ischemia-reperfusion injury(IRI). METHODS:We used an isolated perfused rat liver model and we evaluated HIF-1αin steatotic and non-steatotic livers preserved for 24 h at 4℃in University of Wisconsin and IgL-1 solutions,and then subjected to 2 h of normothermic reperfusion.After normoxic reperfusion,liver enzymes,bile production,bromosulfophthalein clearance,as well as HIF-1αand NO[endothelial NO synthase(eNOS)activity and nitrites/nitrates]were also measured.Other factors associated with the higher susceptibility of steatotic livers to IRI,such as mitochondrial damage and vascular resistance were evaluated. RESULTS:A significant increase in HIF-1αwas found in steatotic and non-steatotic livers preserved in IgL-1 after cold storage.Livers preserved in IgL-1 showed a significant attenuation of liver injury and improvement in liver function parameters.These benefits were enhanced by the addition of trimetazidine(an antiischemic drug),which induces NO and eNOS activation, to IgL-1 solution.In normoxic reperfusion,the presence of NO favors HIF-1αaccumulation,promoting also the activation of other cytoprotective genes,such as hemeoxygenase-1. CONCLUSION:We found evidence for the role of the HIF-1α/NO system in fatty liver preservation,especially when IgL-1 solution is used.

关键词： Fatty liver Tissue preservation Hypoxia inducible factor-1α IgL-1 Nitric oxide Trimetazidine

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Hyperlactatemia in patients with non-acetaminophen-related acute liver failure

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World Journal of gastroenterology 2006年第12期12卷 1949-1953页

作者： Pilar Taurá graciela Martinez-Palli Julia Martinez-Ocon joan Beltran gerard Sanchez-Etayo Jaume Balust Teresa Anglada antoni Mas Juan-Carlos garcia-Valdecasas Department of Anesthesiology Hospital ClinicBarcelonaSpain Department of Hepatology Hospital ClinicBarcelonaSpain Department of Surgery Hospital ClinicBarcelonaSpain

瞄准：为了与 non-acetaminophen 在病人描绘 hyperlactatemia，在一次尝试的尖锐的肝失败(ALF ) 含有澄清机制并且角色作为一个预后因素。方法：在肝移植的背景，有 non-acetaminophen 的 63 个连续病人尖锐的肝失败在与织物氧化的关... 详细信息

瞄准：为了与 non-acetaminophen 在病人描绘 hyperlactatemia，在一次尝试的尖锐的肝失败(ALF ) 含有澄清机制并且角色作为一个预后因素。方法：在肝移植的背景，有 non-acetaminophen 的 63 个连续病人尖锐的肝失败在与织物氧化的关系被学习，血液动力学、新陈代谢的参数。在移植前后，感染的病人和结果的数字被登记。结果：尖锐 ALF 比稍尖的 ALF 显示出 lactate 的高水平(5.4+/- 1 mmol/L 对 2.2+/- 0.6 mmol/L， P=0.01 ) 。氧化参数在正常范围以内。Lactate 层次与呼吸商显示出好关联(r=0.759， P< 0.005 ) ，吝啬的葡萄糖管理(r=0.664， P=0.01 ) 并且脑病(r=0.698， P=0.02 ) ，然而并非与在 PCO2， pH 和感染(P=0.1 ) 的存在的内脏的动静脉的差别。门静脉 lactate 更高(P< 0.05 ) 比动脉、混合静脉 lactate，在肠和怒气建议它 hyperlactatemia 的生产。感染的存在是幸存的一个独立预言者。结论：Hyperlactatemia 不由于在糖酵解的全面加速的副产品是一个预后因素。

关键词：醋氨酚肝功能障碍病理机制临床表现

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Outcomes of abdominal surgery in patients with liver cirrhosis

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World Journal of gastroenterology 2016年第9期22卷 2657-2667页

作者： Juan C Lopez-Delgado Josep Ballus Francisco Esteve Nelson L Betancur-Zambrano Vicente Corral-Velez Rafael Manez antoni J Betbese joan A Roncal Casimiro Javierre hospital Universitari de Bellvitge Intensive Care Department L'Hospitalet de Llobregat 08907 Barcelona Spain IDIBELL (Institut d'Investigacio Biomedica Bellvitge Biomedical Investigation Institute of Bellvitge) Research Team of Area of Innate Immunity and Pathology of the Critical Patient L'Hospitalet de Llobregat 08908 Barcelona Spain hospital de la Santa Creu i Sant Pau Intensive Care Department 08041 Barcelona Spain Physiological Sciences II Department Universitat de Barcelona Campus Bellvitge 08907 Barcelona Spain

Patients suffering from liver cirrhosis(LC) frequently require non-hepatic abdominal surgery,even before liver transplantation.LC is an important risk factor itself for surgery,due to the higher than average associated morbidity and mortality.This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors,such as coagulopathy,poor nutritional status,adaptive immune dysfunction,cirrhotic cardiomyopathy,and renal and pulmonary dysfunction,which all lead to poor outcomes.Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery.In the emergency setting,with the presence of decompensated LC,alcoholic hepatitis,severe/advanced LC,and significant extrahepatic organ dysfunction conservative management is preferred.A multidisciplinary,individualized,and specialized approach can improve outcomes;preoperative optimization after risk stratification and careful management are mandatory before surgery.Laparoscopic techniques can also improve outcomes.We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before,during,and after surgery.

关键词： Liver cirrhosis Outcomes Coagulopathy Nutritional status Abdominal surgery Adaptive immune dysfuncti

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Polyethylene glycol rinse solution:An effective way to prevent ischemia-reperfusion injury

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World Journal of gastroenterology 2014年第43期20卷 16203-16214页

作者： Mohamed Amine Zaouali Mohamed Bejaoui Maria Calvo Emma Folch-Puy Eirini Pantazi gianfranco Pasut antoni Rimola Hassen Ben Abdennebi René Adam joan Roselló-Catafau Experimental Hepatic Ischemia-Reperfusion Unit IIBB-CSICCSIC-IDIBAPS08036 BarcelonaSpain Molecular Biology and Anthropology Applied to Development and Health (UR12ES11) Faculty of PharmacyUniversity of Monastir5000 MonastirTunisia Serveis Cientifico-Tècnics Universitat de Barcelona08036 BarcelonaSpain Pharmaceutical and Pharmacological Department University of Padova35122 PadovaItaly hospital Clínic Networked Biomedical Research Center of Hepatic and Digestive Diseases (Ciber EHD)08036 BarcelonaSpain AP-HP H?pital Paul Brousse Centre Hepato-BiliaireUniv Paris-Sud Villejuif75008 ParisFrance

AIM:To test whether a new rinse solution containing polyethylene glycol 35(PEg-35)could prevent ischemia-reperfusion injury(IRI)in liver grafts.METHODS:Sprague-Dawley rat livers were stored in University of Wisconsin preservation solution and then washed with different rinse solutions(Ringer’s lactate solution and a new rinse solution enriched with PEg-35 at either 1 or 5 g/L)before ex vivo perfusion with Krebs-Heinseleit buffer solution.We assessed the following:liver injury(transaminase levels),mitochondrial damage(glutamate dehydrogenase activity),liver function(bile output and vascular resistance),oxidative stress(malondialdehyde),nitric oxide,liver autophagy(Beclin-1 and LCB3)and cytoskeleton integrity(filament and globular actin fraction);as well as levels of metalloproteinases(MMP2 and MMP9),adenosine monophosphate-activated protein kinase(AMPK),heat shock protein 70(HSP70)and heme oxygenase 1(HO-1).RESULTS:When we used the PEg-35 rinse solution,reduced hepatic injury and improved liver function were noted after reperfusion.The PEg-35 rinse solution prevented oxidative stress,mitochondrial damage,and liver autophagy.Further,it increased the expression of cytoprotective heat shock proteins such as HO-1 and HSP70,activated AMPK,and contributed to the restoration of cytoskeleton integrity after IRI.CONCLUSION:Using the rinse solution containing PEg-35 was effective for decreasing liver graft vulnerability to IRI.

关键词： Liver washout Liver transplantation Rinse solution

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Incidence of cystoid macular edema after Descemet's stripping automated endothelial keratoplasty

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International Journal of Ophthalmology(English edition) 2017年第7期10卷 1081-1087页

作者： Eduard Pedemonte-Sarrias Toni Salvador Playà Irene Sassot Cladera Oscar gris joan Ribas Martínez José garcía-Arumí Núria giménez Ophthalmology Department Hospital Universitari Mútua TerrassaFundació Docència i Recerca Mútua TerrassaUniversitat de Barcelona Ophthalmology Department Hospital Universitari Germans Trias i PujolHealth Sciences Research Institute Germans Trias i Pujol Foundation Surgery Department Universitat Autònoma de Barcelona Instituto de Microcirugía Ocular (IMO) Ophthalmology Department Hospital Sant Antoni Abat Ophthalmology Department Hospital Universitari Vall d’HebronUniversitat Autònoma de Barcelona Research Unit Fundació Docència i Recerca Mútua TerrassaUniversitat de Barcelona Laboratory of Toxicology Universitat Autònoma de Barcelona

AIM： To determine the incidence of cystoid macular edema（CME） after Descemet＇s stripping automated endothelial keratoplasty（DSAEK）.METHODS： This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS： Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone（7%; 3/41） and the other three, DSAEK combined with phacoemulsification（21%; 3/14）. Five out of six patients with CME responded to standard therapy.CONCLUSION： CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber（PC） intraocular lens（IOL） implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.

关键词： Descemet membrane endothelial keratoplasty Descemet stripping automated endothelial keratoplasty combined with phacoemulsification Descemet stripping endothelial keratoplasty macular edema postoperative complications

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Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation

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World Journal of gastroenterology 2014年第42期20卷 15820-15829页

作者： Xabier garcía-Albéniz Rosa gallego Ralf Dieter Hofheinz gloria Fernández-Esparrach Juan Ramón Ayuso-Colella Josep antoni Bombí Carles Conill Miriam Cuatrecasas Salvadora Delgado Angels ginés Rosa Miquel Mario Pagés Estela Pineda Verónica Pereira Aarón Sosa Oscar Reig Iván Victoria Luis Feliz antonio María de Lacy antoni Castells Iris Burkholder Andreas Hochhaus joan Maurel Department of Epidemiology Harvard School of Public Health Department of Medical Oncology Hospital Clínic ICMHO IDIBAPS CIBEREHD University of Barcelona Interdisciplinary Tumor Center Mannheim and Ⅲ Medical Clinic University Hospital Mannheim University of Heidelberg Department of gastroenterology Endoscopy Unit Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Radiology Hospital Clínic CDI IDIBAPS University of Barcelona Department of Pathology Hospital Clínic IDIBAPS University of Barcelona Department of Radiation Oncology Hospital Clínic ICMHO University of Barcelona Department of gastrointestinal Surgery Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of gastroenterology Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Nursing and Health University of Applied Sciences of the Saarland Department for Hematology and Oncology Clinic for Internal Medicine Ⅱ Jena University Hospital

AIM:To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy.METHODS:Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy.Laparoscopic surgery was planned after 5-8 wk.Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol.Patients with ypT1-2N0 or ypT3-4 or N+were offered 5-fluorouracil-based adjuvant treatment on an individual basis.An external cohort was used as a reference for the findings.RESULTS:One hundred and seventy six patients were treated with induction chemoradiotherapy and 170underwent total mesorectal excision.Cancer staging of ypT0N0 was achieved in 26/170(15.3%)patients.After a median follow-up of 58.3 mo,patients withypT0N0 had five-year disease-free and overall survival rates of 96%(95%CI:77-99)and 100%,respectively.We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation.The inherent good prognosis of these patients will have implications for clinical trial design and care of patients.CONCLUSION:Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.

关键词： Exercise Follow-up gastrointestinal dis-eases Irri

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