Heart Complications Research Articles

Surgical Management of Heart Failure.

Optimal management of heart failure is collaborative, with the involvement of specialist heart failure physicians, nurses, interventionalists, and surgeons. In addition to medical optimisation and cardiac resynchronisation therapy, surgery plays a valuable role in many patients. We herein study the evidence and the role of surgical intervention in functional mitral regurgitation, coronary revascularisation in ischaemic cardiomyopathy, and surgical ventricular reconstruction. Additionally, we describe techniques of temporary and durable mechanical circulatory support, with their relative advantages and disadvantages, and applications. Finally, we describe the history and nomenclature around heart transplants, their indications, techniques, present-day outcomes, complications, and new developments in the field.

Data Mining Pengelompokan Pasien Rawat Inap Peserta BPJS Menggunakan Metode Clustering (Studi Kasus : RSU.Bangkatan)


 
 
 
 The system currently used by the hospital is still manual in managing patient data and information, therefore it is necessary to have a Bangkat Binjai Hospital Service system to provide complete and detailed information to hospital patients using BPJS. So in this case the author will design and build a system that will be used in grouping inpatients based on the BPJS Class and the variables determined using the clustering method, so that later it can make it easier for administrators to process data and information on inpatients using BPJS. From the tests carried out using the clustering method with the k-means algorithm, it can be seen that cluster 3 of the criteria for disease type, diagnosis result, and age, the group that has the highest set / value of BPJS Class patient data, namely in Cluster 1 totaling 435 patient data Inpatients using BPJS at the age of 20-39 years and the type of disease are benign tumors, then the BPJS class used is the Level 2 BPJS. Inpatients who use BPJS at the age of 20-39 years and the type of disease is heart complications, then the BPJS class used is BPJS Level 1. And the group that has the highest set / value of BPJS Class patient data, namely Cluster 3 totaling 270 inpatient data. who used BPJS at the age of 20-39 years and the type of disease was uric acid, then the BPJS class was used is BPJS Level 1.
 
 
 

English

BACKGROUND Inguinal hernia is a frequently encountered surgical problem. General anaesthesia carries the risk of possible airway complications. Regional blocks improve acute post-operative pain, decrease post-operative visual analogue scale (VAS) score and patient can mobilise early. The purpose of this study was to compare the effectiveness of transversus abdominis plane (TAP) block vs. paravertebral (PVB) block for post-operative analgeia in inguinal hernia surgeries. METHODS We conducted a research on 64 patients of age > 18 years with American society of Anaesthesiologists (ASA I – III) to undergo unilateral inguinal herniorrhaphy. Patients were randomized into two groups. Group T received TAP block in which 20 ml of 0.25 % bupivacaine was injected and Group P underwent PVB in which 5 ml of bupivacaine (0.25 %) at each segment from T10-L1 was injected slowly (total dose of 20 ml). Post-operative VAS score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any was noted. RESULTS The demographic data of both the groups were comparable. Also, pre and postoperative heart rate, blood pressure, IV fluids, ephedrine use, operative time and complications were statistically insignificant. As compared to group T, group P had lower VAS score from 2nd – 12th hour which was statistically significant (P < 0.05). Although more time is required to perform paravertebral block but the time for request of first rescue analgesia was quite prolonged in paravertebral block. Time of ambulation in group P was significantly lower than group T. CONCLUSIONS PVB requires more time to perform due to multiple site of injection, the comparison of both techniques in the present study revealed that PVB showed relatively higher efficacy in the management of post-operative pain, early ambulation and had significant reduction in dose requirement of additional analgesia (diclofenac) and antiemetics (ondansetron) over tap block. KEYWORDS Paravertebral Block, Transversus Abdominis Block, Inguinal Hernia

AN OVERVIEW OF LESS KNOWN JACOBSEN SYNDROMEAN OVERVIEW OF LESS KNOWN JACOBSEN SYNDROME

Jacobsen syndrome is catastrophic in 1 out of every 5 cases, with children usually dying within the first 2 years of life due to heart complications. Jacobsen syndrome is a contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. The prevalence has been estimated at 1/100,000 births, with a female/male ratio 2:1. The most common clinical features include pre- and postnatal physical growth retardation, psychomotor retardation, and characteristic facial dysmorphism (skull deformities, hypertelorism, ptosis, coloboma, downslanting palpebral fissures, epicanthal folds, broad nasal bridge, short nose, v-shaped mouth, small ears, low set posteriorly rotated ears). Abnormal platelet function, thrombocytopenia or pancytopenia are usually present at birth. Patients commonly have malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Ocular, hearing, immunological and hormonal problems may be also present. The deletion size ranges from 07 to 20 Mb, with the proximal breakpoint within or telomeric to subband 11q 23.3 and the deletion extending usually to the telomere. The deletion is de novo in 85% of reported cases, and in 15% of cases it results from an unbalanced segregation of a familial balanced translocation or from other chromosome rearrangements. Diagnosis is based on clinical findings (intellectual deficit, facial dysmorphic features and thrombocytopenia) and confirmed by cytogenetics analysis.

Notoginsenoside R1 protects hypoxia-reoxygenation deprivation-induced injury by upregulation of miR-132 in H9c2 cells.

Myocardial ischemia/reperfusion injury (IRI) is a common perioperative complication of heart and great vessels surgery, aggravating the original myocardial damage and seriously affecting the postoperative recovery of cardiac function. The aim of this study was to reveal the functional effects and potential mechanisms of notoginsenoside R1 (NG-R1) in myocardial cells injured by hypoxia-reoxygenation (H/R). The rat cardiomyocyte line H9c2 was subjected to H/R with or without NG-R1 treatment. The levels of miR-132 and HBEGF in the cell were altered by microRNA or short-hairpin RNA transfection. Cell viability, apoptosis, lactate dehydrogenase (LDH) and malondialdehyde (MDA) were monitored. Dual luciferin was used to detect the relationship between miR-132 and HBEGF. NG-R1 (20 μM) had no impact on H9c2 cells, but cell viability was significantly reduced at 80 μM. NG-R1 (20 μM) protected H9c2 cells against H/R-induced cell damage, accompanied by increased cell viability, reduced cell apoptosis, and downregulation of LDH and MDA. Furthermore, the level of miR-132 was decreased in response to H/R exposure but then increased after NG-R1 treatment. When miR-132 was overexpressed, H/R-induced cell damage could be recovered. Downregulation of miR-132 limited the protective effect of NG-R1 on H/R damage. We also found that HBEGF was a direct target of miR-132. The expression of HBEGF was increased upon H/R damage, and this increase was reversed after NG-R1 treatment. This study demonstrated that NG-R1 markedly protected H9c2 cells against H/R-induced damage via upregulation of miR-132 and downregulation of its target protein HBEGF.

Nanomedicine in Oncocardiology: Contribution and Perspectives of Preclinical Studies.

Cancer and cardiovascular diseases are the leading causes of death and morbidity worldwide. Strikingly, cardiovascular disorders are more common and more severe in cancer patients than in the general population, increasing incidence rates. In this context, it is vital to consider the anticancer efficacy of a treatment and the devastating heart complications it could potentially cause. Oncocardiology has emerged as a promising medical and scientific field addressing these aspects from different angles. Interestingly, nanomedicine appears to have great promise in reducing the cardiotoxicity of anticancer drugs, maintaining or even enhancing their efficacy. Several studies have shown the benefits of nanocarriers, although with some flaws when considering the concept of oncocardiology. Herein, we discuss how preclinical studies should be designed as closely as possible to clinical protocols, considering various parameters intrinsic to the animal models used and the experimental protocols. The sex and age of the animals, the size and location of the tumors, the doses of the nanoformulations administered, and the acute vs. the long-term effects of treatments are essential aspects. We also discuss the perspectives offered by non-invasive imaging techniques to simultaneously assess both the anticancer effects of treatment and its potential impact on the heart. The overall objective is to accelerate the development and validation of nanoformulations through high-quality preclinical studies reproducing the clinical conditions.

Percutaneous transluminal angioplasty procedure for central venous stenosis inpatient undergoing hemodialysis in Pelni Hospital: case series

Introduction: Many causes leads to kidney impairment. This does not rule out the increasing number of patients undergoing hemodialysis. The common vascular access used during hemodialysis is an arteriovenous fistula (AVF). The arteriovenous fistula was preferred because it lasts longer and has a lower risk of infection for vascular access, meanwhile central venous stenosis or occlusion in the vein that carries the blood from the extremities to the heart often occur. If vascular access is still used during hemodialysis in which central venous stenosis is formed, it needs to make a new vascular access option. Percutaneous transluminal angiography (PTA) main objectives are to dilate the venous lesion that has occlusion more than 50% and extending the lifespan of arteriovenous fistula. In this case, we report six patients hemodialysis with central venous stenosis treated with percutaneous transluminal angiography. This procedure has benefits that are arteriovenous fistula can be used again to reach hemodialysis adequacy optimally and reduce pain and swelling in the arms. Case description: There six cases who were 45,48,57.58,63 and 66 years old who underwent percutaneous transluminal angioplasty procedures for central venous stenosis. Several past illnesses of the patients underlying the kidney impairment such chronic hypertension, chronic coronary heart complications, and/or diabetes. Several patients felt AVF swollen and/or painful. Minimal residual stenosis after balloon angioplasty was performed. Conclusion: According to our cases, patients that underwent the hemodialysis felt swollen or/and pain due to stenosis ballooning angioplasty help minimize the residual stenosis.

Correlation Between Skin and Affected Organs in 52 Sclerodermic Patients Followed in a Diseases Management Team: Development of a Risk Prediction Model of Organ-Specific Complications.

ObjectiveTo identify the existence of a correlation among the various organs affected, focusing primarily on immuno-dermatological aspects, and to create a risk prediction model of organ-specific complications.Material and MethodsFifty-two patients with stable scleroderma, followed between 2015 and 2019, were investigated through an extensive multidisciplinary evaluation in the last year.ResultsPatients with lung involvement presented a worse degree of skin fibrosis than patients without it (p <0.001). No relationship was observed for the heart, kidney, and esophagus. Patients with pulmonary involvement had a lower pressure of the low esophagus sphincter and a higher Warrick score than patients without it (p <0.05). Age was significantly higher in patients with kidney involvement. Diffuse scleroderma patients had a worse pulmonary impairment than limited scleroderma patients (p <0.05). The manometric “sclerodermic” pattern was observed to be the most frequent (55.6%, p <0.05) in dcSSc patients while the sclerodermic and normal pattern were equally represented (41.2 and 32.4% respectively, p <0.05) in lcSSc patients. When compared to the negative serological groups, anti-Scl-70 positive patients presented a worse lung involvement while anti-centromere patients presented a better lung outcome (p <0.05). PM-Scl 100/75 positive patients presented mostly a pulmonary fibrotic pattern (p <0.05) and, also, heart complications were more likely associated with anti PM-Scl 100/75 positivity (p <0.05). The risk prediction model for organ-specific complications had an accuracy of 84.4% (95%CI 78, 89) in complication-site prediction, AUC of 0.871, 86% of sensitivity, and 83% of specificity, Cohen’s Kappa (k) of 0.68.ConclusionsOut of all the organs studied, the skin is the one that correlates with the lung. Patients with a diffuse form of disease presented more frequently the anti Scl-70 antibody and had a worse lung and esophageal involvement (scleroderma pattern) than the negative group. Conversely, patients with limited disease presented all positive for the anti-centromere antibody with a better lung involvement than the negative group, without any difference among the esophageal manometric pattern. Anti PM-Scl 100/75 antibody patients were associated with pulmonary fibrosis and presented cardiac involvement. The model created has demonstrated excellent values of sensitivity, specificity, and accuracy, but further studies are needed for validation.

Are ECG changes in heart-healthy individuals of various ages related to cardiac disease 20 years later?

BackgroundThis research study aimed at assessing the electrocardiographic (ECG) changes caused by ageing in a cohort of healthy subjects with normal echocardiographic examinations.MethodsA total of 219 healthy individuals (119 males and 100 females) were evaluated for possible arrhythmias with a standard 12-lead resting ECG and 24-h Holter ECG. As the recordings were performed between 1998 and 2000, a 20-year follow-up study was carried out by assessing the local medical records to investigate whether the subjects had experienced any cardiovascular health complications or disease since the baseline assessment.ResultsEighty-three subjects (45 males and 38 females) presented with pathological ECG findings at baseline. The most common finding on analysis of Holter ECG recordings was premature atrial contractions, and the most severe pathological finding was episodes of ventricular tachycardia (eight subjects). Regarding the analysis of the standard 12-lead ECG, the most common finding was left ventricular hypertrophy, and the most severe pathological findings were ST-T changes and prolongation of the QT interval. Despite other cardiac examinations performed on these patients showing normal results, in combination with a strict inclusion criterion, this study showed that 28% of all subjects had pathological resting 12-lead ECGs at rest and 35% had pathological heart rhythms when assessed by 24-h Holter ECG. At follow-up, 21% of females and 43% of males had presented with ECG abnormalities, and 30% of females and 36% of males had cardiovascular disease. There was hypertension in 45% of females and in 58% of males. However, no association was found between the follow-up findings and ECG changes seen at baseline.ConclusionAlthough most ECG changes found at baseline could be considered as a normal variation, they may progress to more severe heart complications as the subject ages. The results of this study also validate ECG findings of previous studies and underline that diagnostic criteria should be based on gender and age.

Development of Capsule containing Immediate Release Tablet and Extended Release Floating Tablet for Monitoring Release of Atenolol

Atenolol is beta blocker absorbed through GIT use for heart diseases. Single tablets, floating tablets and sustained released formulations studied are insufficient to produce effective dose to enhance bioavailability and effectiveness. Our study is focused on development of capsule dosage form containing immediate release (IR) and floating extended release (ER) tablets for monitoring release of atenolol in single dosage form. Two different tablets for IR and ER were prepared in three different combinations (Batch). Pre-formulation and post formulation parameters found to be within acceptable limits of formulation. Release behavior of individual tablets and capsule containing two tablets were studied. Among the batches, capsules containing smaller amount of atenolol in IR and large amount of Atenolol in ER (batch II) showed impressive drug release pattern. This formulation was stable even after a month and achieved optimum release behavior of immediate release and sustained release. This study could be used for effective treatment for different heart complications and reduce toxicity due to high plasma concentration in increased dose frequency.

Data Mining Techniques Based Diabetes Prediction

Data mining plays an important part in the healthcare sector disease prediction. Techniques of data mining are commonly used in early disease detection. Diabetes is one of the world’s greatest health challenges. A widespread chronic condition is a diabetes. Diabetes prediction is a science that is increasingly growing. Diabetes prediction at an early stage will lead to better therapy. It is necessary to avoid, monitor and increase diabetes consciousness because it causes other health issues. Diabetes of type 1 or type 2 can lead to heart disorders, kidney diseases or complications with the eye. This survey paper reflects on numerous approaches and data mining strategies used to forecast multiple diabetes disorders at an early stage. Become a chronic disease because of diabetes. The patient lives will be spared by an early prediction of this disease. By the use of data mining tools and processes, diabetes is avoided and treatment rates are reduced. The association rule mining, classification, clustering, Random Forest, Prediction as well as the Artificial Neural Network (ANN) are among the most common and important data mining technology. Different data mining methods are available to avoid diseases such as cardiac disease, cancer including kidney etc. This study examines the use of data mining methods to predict multiple disease types.

Data Mining Techniques Based Diabetes Prediction

Data mining plays an important part in the healthcare sector disease prediction. Techniques of data mining are commonly used in early disease detection. Diabetes is one of the world's greatest health challenges. A widespread chronic condition is a diabetes. Diabetes prediction is a science that is increasingly growing. Diabetes prediction at an early stage will lead to better therapy. It is necessary to avoid, monitor and increase diabetes consciousness because it causes other health issues. Diabetes of type 1 or type 2 can lead to heart disorders, kidney diseases or complications with the eye. This survey paper reflects on numerous approaches and data mining strategies used to forecast multiple diabetes disorders at an early stage. Become a chronic disease because of diabetes. The patient lives will be spared by an early prediction of this disease. By the use of data mining tools and processes, diabetes is avoided and treatment rates are reduced. The association rule mining, classification, clustering, Random Forest, Prediction as well as the Artificial Neural Network (ANN) are among the most common and important data mining technology. Different data mining methods are available to avoid diseases such as cardiac disease, cancer including kidney etc. This study examines the use of data mining methods to predict multiple disease types.

A Model to Evaluate Effect of Patient-Pump Mismatch on Thrombosis in a Pediatric Pulsatile Ventricular Assist Device

<h3>Purpose</h3> Thromboembolic events remain a common and significant complication of Berlin Heart (BH) EXCOR devices. Retrospective studies have found larger sized pumps in relation to body surface area (BSA) to be a risk factor, but this has not been demonstrated experimentally. We present a model to study the thrombogenic effects of patient-pump mismatch. <h3>Methods</h3> Two flow loops were constructed consisting of cardiopulmonary bypass tubing connecting graduated reservoirs to 10cc and 50cc BH's respectively, which were in turn connected to an Ikus driver (Figure 1A). Fresh (<24 hours post draw) porcine blood anticoagulated with Anticoagulant Citrate Dextrose Solution A was recalcified, heparinized, and instilled into the flow loops. Heparin dose was calculated by incubating latex tubes immersed in various concentrations of heparinized donor blood for 30 minutes to determine the donor-specific threshold for thrombus deposition. The flow loops were then run for 90 minutes at room temperature with driving pressures and heart rates titrated to goal flow of 1.2 l/min (simulating a cardiac index of 2.4 L/m² for 0.5 kg/m² BSA). Thrombus deposits were extracted via irrigation and then dried and weighed. <h3>Results</h3> Goal flow required pressure settings 160/-20 mmHg at 120 bpm for the 10cc BH vs. 120/-20 at 60bpm for the 50cc BH. Incomplete filling and emptying was noted on the 50cc Berlin. Dry thrombus weight was 36mg in the 10cc BH and 156mg in the 50cc BH. Qualitatively, deposits were noted primarily at the polyurethane valves in the 10cc BH. In contrast, the 50cc BH had deposits primarily in the tubing connectors (Figure 1B,C). <h3>Conclusion</h3> We demonstrate an effective model for detecting thrombogenic effects of patient-pump mismatch. This model paves the way for future studies focused on BSA's that are at the cusp of adjacent BH pump sizes.

Prevalence of Coronavirus Disease 2019 (COVID-19) Among Children Age Groups

In our study prevalence of coronavirus Disease 2019 (COVID-19) among Children age groups, by diagnosis, symptoms, and treatment of COVID-19 in children. The incidence of COVID-19 among children under 18 years was 1.8 % based on the reported studies, where the mortality rate in the same age group was 0.3 %. No death has been reported in children under 10-years old. It has also been reported that the case fatality rates for the age groups of 0-9 years and 10-19 years are zero and 0.2%, respectively. Cai, et al. [1] There are some studies that report children with COVID-19 having rashes, symptoms and signs similar to Kawasaki’s disease. Heart complications were observed in these cases of Kawasaki’s disease. the levels of bilirubin and hepatic enzymes are the best markers for diagnosing the severity of the disease in the affected children. Large number of angiotensin converting enzyme 2 (ACE2) receptors on cell surfaces, effective innate immune system, and high level of blood lymphocyte have been reported to be the potent reasons for lower incidence of severe symptoms of COVID-19 among children. Children with severe COVID-19 clinical symptoms, especially those suffering from upper respiratory tract symptoms and signs and pneumonia, also children with gastrointestinal tract symptoms and signs as vomiting and diarrhea must be hospitalized similar to adults, while quarantine and home isolations are required for those having mild symptoms. Antiviral medication (Remdesivir, darunavir, ribavirin, oseltamivir, tocilizumab, umifenovir and favipiravir,) ACE inhibitors, interferon-α 2b, co-therapy with azithromycin, inhaling iNO, inhaled bronchodilators and oxygen therapy can be used for treatment. The best treatment for affected children without any clinical and infection symptoms, home isolation protocol has been recommended.

Prevalence of Coronavirus Disease 2019 (COVID-19) Among Children Age Groups

In our study prevalence of coronavirus Disease 2019 (COVID-19) among Children age groups, by diagnosis, symptoms, and treatment of COVID-19 in children. The incidence of COVID-19 among children under 18 years was 1.8 % based on the reported studies, where the mortality rate in the same age group was 0.3 %. No death has been reported in children under 10-years old. It has also been reported that the case fatality rates for the age groups of 0-9 years and 10-19 years are zero and 0.2%, respectively. Cai, et al. [1] There are some studies that report children with COVID-19 having rashes, symptoms and signs similar to Kawasaki’s disease. Heart complications were observed in these cases of Kawasaki’s disease. the levels of bilirubin and hepatic enzymes are the best markers for diagnosing the severity of the disease in the affected children. Large number of angiotensin converting enzyme 2 (ACE2) receptors on cell surfaces, effective innate immune system, and high level of blood lymphocyte have been reported to be the potent reasons for lower incidence of severe symptoms of COVID-19 among children. Children with severe COVID-19 clinical symptoms, especially those suffering from upper respiratory tract symptoms and signs and pneumonia, also children with gastrointestinal tract symptoms and signs as vomiting and diarrhea must be hospitalized similar to adults, while quarantine and home isolations are required for those having mild symptoms. Antiviral medication (Remdesivir, darunavir, ribavirin, oseltamivir, tocilizumab, umifenovir and favipiravir,) ACE inhibitors, interferon-α 2b, co-therapy with azithromycin, inhaling iNO, inhaled bronchodilators and oxygen therapy can be used for treatment. The best treatment for affected children without any clinical and infection symptoms, home isolation protocol has been recommended.

Prevalence of Coronavirus Disease 2019 (COVID-19) Among Children Age Groups

In our study prevalence of coronavirus Disease 2019 (COVID-19) among Children age groups, by diagnosis, symptoms, and treatment of COVID-19 in children. The incidence of COVID-19 among children under 18 years was 1.8 % based on the reported studies, where the mortality rate in the same age group was 0.3 %. No death has been reported in children under 10-years old. It has also been reported that the case fatality rates for the age groups of 0-9 years and 10-19 years are zero and 0.2%, respectively. Cai, et al. [1] There are some studies that report children with COVID-19 having rashes, symptoms and signs similar to Kawasaki’s disease. Heart complications were observed in these cases of Kawasaki’s disease. the levels of bilirubin and hepatic enzymes are the best markers for diagnosing the severity of the disease in the affected children. Large number of angiotensin converting enzyme 2 (ACE2) receptors on cell surfaces, effective innate immune system, and high level of blood lymphocyte have been reported to be the potent reasons for lower incidence of severe symptoms of COVID-19 among children. Children with severe COVID-19 clinical symptoms, especially those suffering from upper respiratory tract symptoms and signs and pneumonia, also children with gastrointestinal tract symptoms and signs as vomiting and diarrhea must be hospitalized similar to adults, while quarantine and home isolations are required for those having mild symptoms. Antiviral medication (Remdesivir, darunavir, ribavirin, oseltamivir, tocilizumab, umifenovir and favipiravir,) ACE inhibitors, interferon-α 2b, co-therapy with azithromycin, inhaling iNO, inhaled bronchodilators and oxygen therapy can be used for treatment. The best treatment for affected children without any clinical and infection symptoms, home isolation protocol has been recommended.

Role of TLR4/MyD88/NF-κB signaling in heart and liver-related complications in a rat model of type 2 diabetes mellitus.

AimsTo analyze expression of members of the Toll-like receptor (TLR)4/myeloid differentiation primary response 88 (MyD88)/nuclear factor (NF)-κB signaling pathway in the heart and liver in a rat model of type 2 diabetes mellitus (T2DM). Our overall goal was to understand the underlying pathophysiological mechanisms.MethodsWe measured fasting blood glucose (FBG) and insulin (FINS) in a rat model of T2DM. Expression of members of the TLR4/MyD88/NF-κB signaling pathway as well as downstream cytokines was investigated. Levels of mRNA and protein were assessed using quantitative real-time polymerase chain reaction and western blotting, respectively. Protein content of tissue homogenates was assessed using enzyme-linked immunosorbent assays.ResultsDiabetic rats had lower body weights, higher FBG, higher FINS, and higher intraperitoneal glucose tolerance than normal rats. In addition, biochemical indicators related to heart and liver function were elevated in diabetic rats compared with normal rats. TLR4 and MyD88 were involved in the occurrence of T2DM as well as T2DM-related heart and liver complications. TLR4 caused T2DM-related heart and liver complications through activation of NF-κB.ConclusionsTLR4/MyD88/NF-κB signaling induces production of tumor necrosis factor-α, interleukin-6, and monocyte chemoattractant protein-1, leading to the heart- and liver-related complications of T2DM.

Stem cell-based therapies for cardiac diseases: The critical role of angiogenic exosomes.

Finding effective treatments for cardiac diseases is among the hottest subjects in medicine; cell-based therapies have brought great promises for managing a broad range of life-threatening heart complications such as myocardial infarction. After clarifying the critical role of angiogenesis in tissue repair and regeneration, various stem/progenitor cell were utilized to accelerate the healing of injured cardiac tissue. Embryonic, fetal, adult, and induced pluripotent stem cells have shown the appropriate proangiogenic potential for tissue repair strategies. The capability of stem cells for differentiating into endothelial lineages was initially introduced as the primary mechanism involved in improving angiogenesis and accelerated heart tissue repair. However, recent studies have demonstrated the leading role of paracrine factors secreted by stem cells in advancing neo-vessel formation. Genetically modified stem cells are also being applied for promoting angiogenesis regarding their ability to considerably overexpress and secrete angiogenic bioactive molecules. Yet, conducting further research seems necessary to precisely identify molecular mechanisms behind the proangiogenic potential of stem cells, including the signaling pathways and regulatory molecules such as microRNAs. In conclusion, stem cells' pivotal roles in promoting angiogenesis and consequent improved cardiac healing and remodeling processes should not be ignored, especially in the case of stem cell-derived extracellular vesicles.

County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States

As of November 12, 2020, the mortality to incidence ratio (MIR) of COVID-19 was 5.8% in the US. A longitudinal model-based clustering system on the disease trajectories over time was used to identify “vulnerable” clusters of counties that would benefit from allocating additional resources by federal, state and county policymakers. County-level COVID-19 cases and deaths, together with a set of potential risk factors were collected for 3050 U.S. counties during the 1st wave of COVID-19 (Mar25–Jun3, 2020), followed by similar data for 1344 counties (in the “sunbelt” region of the country) during the 2nd wave (Jun4–Sep2, 2020), and finally for 1055 counties located broadly in the great plains region of the country during the 3rd wave (Sep3–Nov12, 2020). We used growth mixture models to identify clusters of counties exhibiting similar COVID-19 MIR growth trajectories and risk-factors over time. The analysis identifies “more vulnerable” clusters during the 1st, 2nd and 3rd waves of COVID-19. Further, tuberculosis (OR 1.3–2.1–3.2), drug use disorder (OR 1.1), hepatitis (OR 13.1), HIV/AIDS (OR 2.3), cardiomyopathy and myocarditis (OR 1.3), diabetes (OR 1.2), mesothelioma (OR 9.3) were significantly associated with increased odds of being in a more vulnerable cluster. Heart complications and cancer were the main risk factors increasing the COVID-19 MIR (range 0.08–0.52% MIR↑). We identified “more vulnerable” county-clusters exhibiting the highest COVID-19 MIR trajectories, indicating that enhancing the capacity and access to healthcare resources would be key to successfully manage COVID-19 in these clusters. These findings provide insights for public health policymakers on the groups of people and locations they need to pay particular attention while managing the COVID-19 epidemic.

Surgical Techniques, Complications, and Long-Term Health Effects of Cardiac Implantable Electronic Devices.

Cardiovascular implantable electronic device (CIED) has helped with advanced technological improvement in the cardiac field and has been a long-term alternative to medical management. There are different forms of CIEDs such as pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. These devices are efficient in establishing near-normal hemodynamics and circulation that ultimately aid physicians to improve the quality of life for their patients. However, there are risk factors that can result in postoperative complications, including infection, lead and pulse generator complications, heart complications, medication-related complications, and psychosocial complications. To ensure optimal outcome of CIED placement, preprocedural measures need to be in place such as matching the right candidate and using appropriate devices. This review aims to highlight the surgical techniques for CIEDs, the associated postoperative complications, and long-term health effects.