Stable Function Research Articles

Functional performance of octagonal plan mosques-analysis of octagonal plan mosques in Mosul

The identity of Islamic cities is distinctly manifested through their congregational mosques, primarily characterized by their continuous and stable function, epitomized by the five daily congregational prayers. The performance of a mosque is intricately linked to a set of religious, organizational, structural, and economic determinants. and it is closely tied to the functional and architectural attributes of its elements and spaces. The historic congregational mosques in the Islamic world have predominantly adhered to the architectural model of the Prophet's Mosque, characterized by its rectangular form. In modern mosques, various factors such as technological advancements, and cultural and scientific influences have led to architectural trends and stylistic innovations. These innovations have aimed to enhance the efficiency and performance of congregational mosques, one of which is the octagonal form. The research problem centred on the utilization of the octagonal shape and its adaptability in the context of the congregational mosques in the city of Mosul and its suitability for optimal mosque functioning. The research sought to elucidate the appropriateness of employing the octagonal form in congregational mosques by analysing samples with octagonal layouts in Mosul to investigate the extent to which this form influenced the characteristics of the mosque. The research concluded that all octagonal layouts had undergone modifications and expansions to rectify the unsuitable layout, indicating that the octagonal form is foreign to the traditional mosque typology. Furthermore, it is subject to additional alterations to accommodate the functional and architectural requirements of the congregational mosque.

Spatiotemporal evolution and Sustainably comprehensive zoning optimization of production–living–ecological functions in the Mountain–Flatland areas

Examining the spatiotemporal changes of territorial space is crucial for addressing the conflict between economic-social development and the natural environment and achieving optimal territorial space utilization. However, there is a research gap regarding the spatial characteristics and optimization in the mountain–flatland area. To address this gap, this paper focuses on the urban agglomeration in Central Yunnan (UACY) as a representative mountain-flatland area. A mountain–flatland classification model was established. Based on the evaluation of production– living– ecological functions, the economic models were introduced to measure the balance degree, and further researched the spatiotemporal evolution and coupling coordination characteristics by spatial analysis from 2010 to 2020. The findings indicate the following: (1) The study area exhibited distinct mountain-flatland differentiation, with "western mountainous counties (MCs)/semi-mountainous and semi-flatland counties (SMSFCs), central flatland counties (FCs), and eastern SMSFCs". production function (PF) primarily formed a cluster in the central-northeastern areas of FCs and of SMSFCs, living function (LF) was highly clustered in the central areas of FCs, remained stable, and ecological function (EF) was significantly clustered in the northwestern regions of MCs and of SMSFCs, significantly enhanced in the northeast. (2) The imbalance degree followed the order LF > PF > EF, showing a decreasing trend primarily driven by intra-group imbalances within FCs, SMSFCs, and MCs. The coordinate areas were mainly concentrated in central FCs, and the dysfunctional areas was largely located in MCs and SMSFCs, the degree was improved, especially in northwestern and southeastern MCs and SMSFCs. (3) The study area fell into 18 functional areas, optimized into 13 areas, with recommendations for differentiated development control paths to achieve an optimization of PLEFs. These results provide theoretical references for promoting sustainable utilization of territorial resources and facilitating high-quality regional development in UACY and other parts of the country.

Inducing in situ M2 macrophage polarization to promote the repair of bone defects via scaffold-mediated sustained delivery of luteolin

Immunoregulation mediated bone tissue engineering (BTE) has demonstrated huge potential in promoting repair of critical-size bone defects (CSBDs). The trade-off between stable immunoregulation function and extended immunoregulation period has posed a great challenge to this strategy. Here, we reported a 3D porous biodegradable Poly(HEMA-co-3APBA)/LUT scaffold, in which reversible boronic acid ester bond was formed between the 3APBA moiety and the catechol moiety of luteolin (LUT). The boronic acid ester bond not only protected the bioactivity of LUT but also extended the release period of LUT. The rationale behind the phenomenon of sustained LUT release was explained using a classical transition state theory. In vitro/in vivo assays proved the immunoregulation function of the scaffold in inducing M2 polarization of both M0 and M1 Mφ. The crosstalk between the scaffold treated Raw 264.7 and BMSCs were also investigated through the in vitro co-culture assay. The results demonstrated that the scaffold could induce immunoregulation mediated osteogenic differentiation of BMSCs. In addition, CSBDs model of SD rats was also applied, and the corresponding data proved that the scaffold could accelerate new bone formation, therefore promoting repair of CSBDs. The as-prepared scaffold might be a promising candidate for repair of CSBDs in the future.

Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies

Spirometric obstruction and restriction are two patterns of impaired lung function which are predictive of poor health. We investigated the development of these phenotypes and their transitions through childhood to early adulthood. In this study, we analysed pooled data from three UK population-based birth cohorts established between 1989 and 1995. We applied descriptive statistics, regression modelling and data-driven modelling to data from three population-based birth cohorts with at least three spirometry measures from childhood to adulthood (mid-school: 8-10 years, n=8404; adolescence: 15-18, n=5764; and early adulthood: 20-26, n=4680). Participants were assigned to normal, restrictive, and obstructive spirometry based on adjusted regression residuals. We considered two transitions: from 8-10 to 15-18 and from 15-18 to 20-26 years. Obstructive phenotype was observed in ∼10%, and restrictive in ∼9%. A substantial proportion of children with impaired lung function in school age (between one third in obstructive and a half in restricted phenotype) improved and achieved normal and stable lung function to early adulthood. Of those with normal lung function in school-age, <5% declined to adulthood. Underweight restrictive and obese obstructive participants were less likely to transit to normal. Maternal smoking during pregnancy and current asthma diagnosis increased the risk of persistent obstruction and worsening. Significant associate of worsening in restrictive phenotypes was lower BMI at the first lung function assessment. Data-driven methodologies identified similar risk factors for obstructive and restrictive clusters. The worsening and improvement in obstructive and restrictive spirometry were observed at all ages. Maintaining optimal weight during childhood and reducing maternal smoking during pregnancy may reduce spirometry obstruction and restriction and improve lung function. MRC Grant MR/S025340/1.

Changes in Cardiac Structure and Function Following Fistula Ligation in Kidney Transplant Recipients (Cohort Study)

Purpose: International guidelines recommend that haemodialysis access is provided by an arteriovenous fistula (AVF), which enables frequent, reliable access to the circulation, but there are no guidelines to suggest whether these AVFs need to be ligated after kidney transplantation. Cardiovascular morbidity and mortality remain high in recipients of a kidney transplant, the persistence of a patent arteriovenous fistula (AVF) after transplantation may contribute to ongoing maladaptive cardiovascular remodelling. The ability to reverse this maladaptive remodelling by ligation of this AVF is unknown. We conducted this trial to evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients. Also we studied the ability of preoperative echocardiographic and non-invasive hemodynamic measurements, including the effects of acute temporary occlusion of the fistula, to predict postoperative left ventricular diameter and mass reduction, by the closure of the fistula.&#x0D; Materials and Methods: Nonrandomized controlled trial. kidney transplant recipients (&gt;12 months after transplantation with stable graft function) were divided into 2 groups. The first referred for surgical arteriovenous fistula closure. The second group didn’t receive Fistula closure (control). Standard echocardiographic parameters, heart rate, and blood pressure were assessed preoperatively (fistula closure) at baseline. These measurements were repeated 6 months after surgical closure.&#x0D; Findings: Seventeen kidney transplant patients were prospectively studied with 11 case and 6 controls with no fistula closure. Surgical fistula closure decreased left ventricular end-diastolic diameter and mass indexes (29.9_2.4to 27.4_2.1 mm/m2, P&lt;0.001, and 141_37 to 132_39 g/m2, P&lt;0.05, respectively), whereas no changes were seen in controls after a similar delay. Postoperative left ventricular end-diastolic diameter and mass reductions correlated best with the increases in total peripheral resistance (r_0.85, P&lt;0.0001) and mean arterial blood pressure (r_0.64, P_0.006), respectively.&#x0D; Conclusions. Surgical closure of arteriovenous fistula reduces left ventricular diameter and mass in kidney transplant recipients. The best predictors of those morphological changes are the rise in blood pressure and total peripheral resistance induced by temporary occlusion of the fistula.&#x0D; Implications to Theory, Practice and Policy: Surgical closure of persistent AV fistula after renal transplantation to correct LV geometry and improve symptoms in terms of exertional dyspnea and palpitations.

Arteriolar hyalinization at 0-hour biopsy predicts long-term graft function in deceased kidney transplantation.

Regarding the relationship between donor kidney quality and renal graft function after deceased kidney transplantation (KTx) following donation after cardiac death (DCD), the evaluation timing varies depending on the study. Evaluation of histology and changes in long-term renal graft function is limited. A retrospective single-center study included 71 recipients who underwent 0-hour biopsy for KTx from DCD. The recipients were divided into two groups to evaluate factors related to renal graft function (study1). The two groups were categorized as stable graft function and poor graft function with the change of estimated glomerular filtration rate (eGFR) after KTx. The recipients were then divided into four groups to assess whether the factors identified in study1 were related to the change in long-term renal graft function (study2). They were categorized as follows: Improved, Stable, Deteriorated, and Primary non-function with the change of eGFR after KTx. In study1, donor age ≥ 50 years (29.5% vs. 65.2%; p = 0.09), banff arteriolar hyalinosis (ah) score (0.66 ± 0.78 vs. 1.2 ± 1.0; p = 0.018), and presence of glomerulosclerosis (43.2% vs. 76.2%; p = 0.017) were significant risk factors for poor long-term graft function. When the recipients were divided into four groups, the severity of ah correlated well with changes in long-term renal function. We can predict the shift in long-term renal graft function after KTx from DCD according to the severity of ah by 0-hour biopsy.

Renomegaly and acute kidney injury as primary manifestations of non-Hodgkin’s lymphoma: a report of three cases

BackgroundIn adults with non-Hodgkin's lymphoma, renal enlargement and acute kidney injury occur infrequently at first presentation, especially in T lymphocytic lymphomas.Case presentationWe report three cases of non-Hodgkin’s lymphoma with acute renal injury and bilateral renal enlargement. At diagnosis, one patient presented with an adrenal mass, one patient's lymph node biopsy was consistent with a renal biopsy, and one patient had primary renal lymphoma with no extrarenal disease. Assessment of renal pathology in Case 2 and Case 3 showed interstitial lymphocyte infiltration; the pathological types were non-Hodgkin's diffuse large B lymphoma originating from activated B cells outside germinal centers and non-Hodgkin's T-lymphoblastic lymphoma/leukemia, respectively. Case 1 did not receive anti-lymphoma therapy and died from infection and multiple organ failure within 1 month of hospitalization. Case 2 received eight courses of R-CHOP; her lymphoma recurred 2 years after diagnosis and she died from severe pulmonary infection 3 years after diagnosis. Case 3 received hyper-CVAD regularly and achieved stable renal function; this patient remains under follow-up.ConclusionsRenal lymphoma may have diverse manifestations, especially primary renal lymphoma without extrarenal involvement. Nephrologists should pay careful attention to these manifestations to ensure accurate diagnosis.

Is Frailty a Mortality Predictor in Subjects with Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease (COPD) has been frequently associated with frailty. The association between frailty and mortality in patients with COPD has not yet been fully elucidated and it remains controversial whether frailty or airflow limitation is more important in predicting mortality. A total of 141 subjects with stable COPD completed pulmonary function tests and the Kihon Checklist at baseline between 2015 and 2022 and were followed for a maximum of 95 months. Using the Kihon Checklist Total score, we classified patients' frailty status as robust (0-3), pre-frail (4-7), and frail (8-25). At baseline, there were 67 (47.5%) in the robust group, 36 (25.5%) pre-frail, and 38 (27.0%) frail. Death was confirmed in 29 (20.5%). Univariate Cox proportional hazards analyses revealed that all predictive relationships of frailty and airflow limitation with mortality were statistically significant, and the C-index was similar, ranging from 0.63 to 0.66. According to the Log rank test and the Cox regression model, there was a significant difference between the frail and robust groups, (p=0.004 and p=0.005, respectively). No significant differences were found in either comparison with the pre-frail group. When stratification of frailty and FEV1 as well as sex were included as explanatory variables, multivariate Cox regression analysis showed a significant difference between the robust and frail groups with respect to mortality when the robust group was used as the reference (p=0.024). The robust and pre-frail groups did not differ significantly (p=0.163). The mortality of frail COPD patients is higher than those classed as robust. Despite frailty being a substantial mortality predictor, it is uncertain whether or not it is a better predictor than FEV1.

An Interplay between Health Equity and Disparity in Cognitive Decline

AbstractBackgroundCognitive decline may be an early indicator of Alzheimer diseases and related dementia (ADRD). To identify the intervention targets that ameliorate disparities in ADRD, it is critical to employ disparity measures that account for health equity. We aimed to investigate disparity estimates in cognitive decline built on three health equity measures.MethodThe study sample (n = 451) was derived from the bi‐ethnic community‐dwelling San Antonio Longitudinal Study of Aging (SALSA). The latent variable mixture model classified cognitive function trajectory strata based on four repeated measures of the Mini Mental Status Examination (MMSE) over 8.5±1.3 years of follow‐up. Three risk adjustments were employed to optimize equity in social determinants of health (SDoH: income, education, social interactions) between Hispanics and non‐Hispanics. 1) Average constrained regression adjustment minimized the impact of SDoH for Hispanics. 2) Covariance constrained adjustment derived estimates with a near independence between the residuals with ethnicity. 3) Net compensation penalized regression imposed a penalty for excess lower MMSE among Hispanics. Inverse propensity score weighting (IPSW) estimates of disparity further adjusted away confounding due to covariates (demographics, disease burdens) between ethnic groups.ResultTable 1 contrasted baseline characteristics of the study sample between Hispanics and non‐Hispanics. Two MMSE trajectory strata were identified: cognitive decline stratum (38%) with mean MMSE decreased from 23.9 to 21.2; and stable cognitive function stratum (62%) with mean MMSE around 28 throughout. Average constrained and covariance constrained risk adjustments attained optimal SDoH equity across three fairness metrics: predictive ratios, fair covariance, and net compensation (Table 2). Ethnic disparity in cognitive decline (Table 3) was strong conditioned on SDoH equity alone (log(aOR) = 4.27, p&lt;0.001). Balancing covariates alone via IPSW without equity in SDoH also fell short for parity (aOR = 1.16, p&lt;0.001). Parity in cognitive decline could be achievable under both SDoH equity and balanced covariates between ethnic groups (aOR = 0.85, p = 0.21).ConclusionOur study suggested that integrating equity metrices in ADRD disparity research could guide the paths to improve equity and reduce disparity. The field would be better served by identifying the causal drivers of disparities through the advancement in equity metrices and mediation analyses that delineate intricate interactions between SDoH and ADRD risk factors.

Efficacy and Safety of Mepolizumab in the Management of Severe Eosinophilic Asthma: A Systematic Review.

Severe eosinophilic asthma (SEA) is characterized by persistent airway inflammation and frequent exacerbations despite standard treatments. Mepolizumab, a monoclonal antibody that reduces eosinophil levels by targeting interleukin-5, has emerged as an add-on therapy for patients with SEA. This systematic review evaluated mepolizumab's efficacy and safety for treating SEA. A comprehensive literature search was conducted across major databases. Thirty-two studies with over 6,000 patients were included, comprising randomized controlled trials, open-label extensions, and real-world observational analyses. Study quality and risk of bias were assessed using standard tools. Meta-analysis was deemed inappropriate due to heterogeneity. Instead, a narrative synthesis was performed. Mepolizumab significantly reduced exacerbation rates by around 50% and improved symptoms and lung function compared to placebo in pivotal trials. Long-term open-label studies showed sustained reductions in exacerbations and stable lung function for up to 4.5 years. Real-world data demonstrated consistent 50%-90% exacerbation decreases across diverse patient populations over 6-24 months. Mepolizumab exhibited an acceptable safety profile, with mild injection site reactions and headaches as most common adverse events. While specific subgroups may show enhanced responses, mepolizumab displayed broad efficacy regardless of patient demographics or phenotypes. The extensive evidence provides robust support for mepolizumab as an efficacious and safe add-on treatment option for patients with severe, refractory eosinophilic asthma. Further high-quality comparative effectiveness research is warranted to optimize patient selection and positioning among emerging biologics.

A New Discriminant Method for the Stability of Fourth-Order Differential Equation

The stability of nonlinear differential equations has been widely studied based on various methods. In this paper, we transform a class of fourth-order differential equations into a perturbation system and study the stability and asymptotic stability of zero solutions. By utilizing Lyapunov’s second method, we give sufficient conditions for zero-solution stability and asymptotic stability and provide the construction method of the zero-solution asymptotically stable Lyapunov function of such fourth-order differential equations. In addition, this paper removes the requirement of negative definite when the general differential equation is zero solution stable and obtains a looser stability condition. This paper provides an alternative approach to the research of stability of differential systems.

IgA nephropathy.

IgA nephropathy (IgAN), the most prevalent primary glomerulonephritis worldwide, carries a considerable lifetime risk of kidney failure. Clinical manifestations of IgAN vary from asymptomatic with microscopic or intermittent macroscopic haematuria and stable kidney function to rapidly progressive glomerulonephritis. IgAN has been proposed to develop through a 'four-hit' process, commencing with overproduction and increased systemic presence of poorly O-glycosylated galactose-deficient IgA1 (Gd-IgA1), followed by recognition of Gd-IgA1 by antiglycan autoantibodies, aggregation of Gd-IgA1 and formation of polymeric IgA1 immune complexes and, lastly, deposition of these immune complexes in the glomerular mesangium, leading to kidney inflammation and scarring. IgAN can only be diagnosed by kidney biopsy. Extensive, optimized supportive care is the mainstay of therapy for patients with IgAN. For those at high risk of disease progression, the 2021 KDIGO Clinical Practice Guideline suggests considering a 6-month course of systemic corticosteroid therapy; however, the efficacy of systemic steroid treatment is under debate and serious adverse effects are common. Advances in understanding the pathophysiology of IgAN have led to clinical trials of novel targeted therapies with acceptable safety profiles, including SGLT2 inhibitors, endothelin receptor blockers, targeted-release budesonide, B cell proliferation and differentiation inhibitors, as well as blockade of complement components.

LC/MS-MS quantification of myo-inositol: a novel biomarker for kidney disease

Abstract Creatinine is the primary biomarker used for assessing kidney function in patients with suspected acute and chronic kidney injury. However, creatinine, a product of muscle creatine metabolism, is an imperfect proxy for renal function because it is subject to non-renal interferences including muscle mass, diet, and medications. Creatinine is particularly problematic as a biomarker of acute kidney injury (AKI) due to relatively high renal function reserve, requiring considerable kidney damage and time for a clinically significant change in creatinine to be detected. Given that AKI and chronic kidney injury (CKD) are associated with high mortality, morbidity, and contribute significantly to health care costs, there is an unmet need for highly sensitive and specific biomarkers for assessing renal function in patients. Myo-inositol oxygenase (MIOX) is a novel biomarker limitedly expressed in the proximal renal tubules. MIOX concentrations are elevated in mice with renal injury and in critically ill patients with AKI. Our previously published studies have demonstrated that elevation in MIOX concentrations precedes changes in creatinine concentrations by approximately 54 hours. Importantly, MIOX facilitates the conversion of myo-inositol to glucuronic acid. We developed a robust LC-MS/MS method to quantify myo-inositol in human plasma, hypothesizing that following renal injury (acute and chronic), plasma concentrations of myo-inositol will increase, and will correlate with increases in serum creatinine concentrations. A healthy outpatient cohort was identified from samples obtained from out-patients with normal plasma creatinine, eGFR&amp;gt;60, as well as normal urine protein: creatinine ratio, albumin: creatinine ratio, or urinalysis results that were pan-negative/pan-normal. Remnant samples from out-patients with clinically staged CKD who have not initiated dialyses were selected for the CKD group. In healthy adult out-patients with stable renal function, the central 95th% distribution of plasma myo-inositol concentrations was 16.61 - 44.2 uM (Median 27.7uM, 95% CI: 26.7-28-7). No sex-based differences in plasma myo-inositol were observed. We also observed excellent correlation between plasma myo-inositol and serum creatinine concentrations (r=0.84, 95% CI: 80-88), as well as excellent sensitivity (99%) and specificity (100%) at a myo-inositol concentration of 50.22uM for differentiating patients with stable kidney function from those with CKD. Patients with CKD exhibited higher plasma myo-inositol concentrations (p value &amp;lt;0.0001) with a central 95% percentile of 51.2-309.1 uM (Median 104.1 uM, 95% CI: 92.3- 113.6). These results imply that myo-inositol concentrations increase in accord with renal injury and MIOX buildup in patients with kidney dysfunction, making it a potential biomarker for renal impairment.

Abstract 15754: The Incidence and Effect of Cardiac Function Decline After Lower Extremity Revascularization

Introduction: The impact of cardiac function decline on major adverse limb events (MALE) following lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD) has not been described. Methods: The electronic records of patients undergoing LER for PAD in a single center were reviewed. Two transthoracic echocardiograms were captured, the first within 6 months of LER and the second on later follow-up. Patients were then divided into 2 groups: cardiac function decline (decrease in left ventricular ejection fraction (EF) by ≥10%) or stable cardiac function (reduction in EF&lt;10% or improved EF). Patient characteristics and outcomes were compared, including MALE. Results: Of the 922 patients who underwent LER, 221 (24.0%) experienced a cardiac function decline. Out of the 701 patients with stable cardiac function, 599 (65.0%) had a &lt;10% reduction in EF, and 102 (11.0%) had an EF improvement. Patients with cardiac function decline were more likely to have diabetes mellitus and heart failure. Furthermore, patients with cardiac function decline were more likely to undergo open surgical revascularization. Patients with cardiac function decline demonstrated higher rates of periprocedural bleeding after initial LER. After a 3-year follow-up, patients with cardiac function decline had higher mortality and lower overall frequency of reinterventions. However, Kaplan-Meier analysis revealed no difference in freedom from MALE between the 2 groups. Conclusion: Patients with cardiac function decline after LER for PAD have increased mortality but no significant difference in limb outcomes compared to patients with stable cardiac function.

Abstract 17254: Myocardial Functional Recovery Following Durable Ventricular Assist Device in Children

Introduction: Ventricular Assist Device (VAD) explantation following myocardial functional recovery (MFR) for heart failure (HF) is uncommon and associated with a risk of recurrence of HF. Research Question: What are the patient characteristics and outcomes for VAD explantation in children following MFR? Methods: Retrospective, single centre study of patients who were supported with durable VADs, both intracorporeal continuous flow devices (CFD) and paracorporeal pulsatile flow devices (PFD) between 2004 to 2022. Results: A total of 75 children, of which 43 were female, underwent VAD implantation (PFD = 61 and CFD = 14) at a median (IQR) age of 5.6 (0.8, 13.5) years and with a weight of 16.2 (7.5, 40.7) kg. From this cohort, we identified 8/75 (11%) children who underwent VAD explantation for MFR after a median duration of 56 (22, 115) days. All were supported with durable PFD. Five were listed for transplantation as a part of their HF management strategy following VAD implantation and four patients had dilated cardiomyopathy (DCM). Of those, 7/8 (88%) children with MFR were under 2 years of age and 5/8 (63%) were supported for &gt; 90 days. The pathological findings on the LV core samples were variable in severity and no patient had any evidence of active inflammation (see Table). After explant, 7/8 patients remained in HF remission with no symptoms and stable LV function. One patient had a recurrence of HF following explantation after demonstrating MFR while on VAD support. This patient was 5 years old at implant and was in HF remission for ~9 months following explant before HF recurrence, requiring VAD re-implantation and eventual heart transplantation. Conclusions: MFR resulting in VAD explantation is feasible in children with chronic HF especially for those &lt; 2 years of age. Further work is needed to help better identify the features that promote MFR and maintain it after explant.

Abstract 15484: Heart Transplantation in a Light-Chain Amyloidosis Patient at Mayo Stage IIIa After Anti-Plasma Cell Chemotherapy With Complete Remission

A 42-year-old female patient was admitted for lower limb edema. Laboratory tests showed nephrotic proteinuria (2.76g/24h). Serum-free λ light chains were 84.9 mg/L, with a κ/λ ratio of 0.12. Bone marrow examination detected 6% immature clonal plasma cells. Amyloid deposition was identified in a renal biopsy. Cardiac magnetic resonance (CMR) revealed normal left ventricular ejection fraction (LVEF), left ventricular circumferential late gadolinium enhancement (LGE), and elevated myocardial T1 value (1459ms) and extracellular volume (47.4%). She was diagnosed with AL amyloidosis and classed as IIIa by the Mayo Stage 2004. A hematologic complete response (CR) was achieved and sustained after treatment with sequencing cyclophosphamide, bortezomib, dexamethasone (CyBorD) and daratumumab regimen. The follow-up CMRs were underwent at 6, 12, and 18 months after starting chemotherapy, which monitored cardiac changes in reponse to CR. Unfortunately, there was no alleviation of cardiac involvement. CMR re-examination (at 42 months) revealed severe cardiac function impairment (LVEF 28%), and dramatically increased extracellular volume (66.2%). Then, she underwent heart transplantation (HTx) evaluated by the heart transplantation multidisciplinary team. Three months later, she was doing well, CMR demonstrated stable cardiac allograft function. Repeated endomyocardial biopsies showed no amyloid deposits. This case illustrates that cardiac amyloid deposition might be a dynamic process in AL amyloidosis and highlights the value of CMR in long-term monitoring and identifying the patients reached CR who need HTx.

Kidney Transplant Recipients Show Limited Lung Diffusion Capacity but Similar Hydrogen Peroxide Exhalation as Healthy Matched Volunteers: A Pilot Study.

Patients with end-stage chronic kidney disease show higher systemic oxidative stress and exhale more hydrogen peroxide (H2O2) than healthy controls. Kidney transplantation reduces oxidative stress and H2O2 production by blood polymorphonuclear leukocytes (PMNs). Kidney transplant recipients (KTRs) may be predisposed to an impairment of lung diffusing capacity due to chronic inflammation. Lung function and H2O2 concentration in the exhaled breath condensate (EBC) were compared in 20 KTRs with stable allograft function to 20 healthy matched controls. Serum interleukin eight (IL-8) and C-reactive protein (CRP), blood cell counts, and spirometry parameters did not differ between groups. However, KTRs showed lower total lung diffusing capacity for carbon monoxide, corrected for hemoglobin concentration (TLCOc), in comparison to healthy controls (92.1 ± 11.5% vs. 102.3 ± 11.9% of predicted, p = 0.009), but similar EBC H2O2 concentration (1.63 ± 0.52 vs. 1.77 ± 0.50 µmol/L, p = 0.30). The modality of pre-transplant renal replacement therapy had no effect on TLCOc and EBC H2O2. TLCOc did not correlate with time after transplantation. In this study, TLCOc was less reduced in KTRs in comparison to previous reports. We suggest this fact and the non-elevated H2O2 exhalation exhibited by KTRs, may result perhaps from the evolution of the immunosuppressive therapy.

Abstract 13553: Traumatic Right Atrium Perforation Causing Pneumopericardium and Pneumothorax, Treated Conservatively

Background: Pneumopericardium after pacemaker implantation is an extremely rare complication. Patients can present with symptoms such as chest pain, shortness of breath, or be completely asymptomatic. We present a case of a 68-year-old male who underwent dual chamber pacemaker implantation complicated by a pneumopericardium and contralateral pneumothorax. Case Report: A 68-year-old male with a past medical history of coronary artery disease status post percutaneous coronary intervention to the obtuse marginal artery and left circumflex, hypertension and benign prostatic hyperplasia presented with syncope while driving. Telemetry showed symptomatic long pauses up to 6.2 seconds and a dual chamber pacemaker implantation was recommended via the left subclavian vein approach. It was noted that the patient had multiple attempts to place the right atrium lead. Two days after the procedure, the patient developed severe right-sided chest pain and an electrocardiogram showed diffuse ST segment elevations consistent with pericarditis. A chest computed tomography (CT) showed a large right-sided pneumothorax and pneumopericardium and a chest tube was placed. The pacemaker was interrogated and showed a stable function and the patient was managed conservatively. A repeat CT chest showed significant improvement in both the pneumopericardium and the pneumothorax and the patient did well on follow up. Discussion: Ipsilateral pneumothorax and cardiac perforation are not uncommon following pacemaker implantation; however, contralateral pneumothorax and pneumopericardium are extremely rare. In our patient, it appears that the right atrium lead perforated through the right atrium into the right pleural space creating a fistula between the pericardial and pleural spaces. This was not detected on the initial chest x-ray and was only seen on subsequent CT chest imaging. Treatment of pneumopericardium usually involves lead revision or extraction; however, conservative therapy can be successfully attempted with close monitoring, as in our case.

Impact of percutaneous coronary intervention on renal function in patients with coronary heart disease

The relationship between cardiac and renal function is complicated. The impact of percutaneous coronary intervention (PCI) on renal function in patients with coronary artery disease is still unclear. The current study sought to assess renal function change, including the time course of renal function, after elective PCI in patients with improved renal function and to identify renal function predictors of major adverse cardiovascular events. We examined data from 1572 CHD patients who had coronary angiography (CAG) or PCI in this retrospective cohort study. Patients receiving elective PCI (n=1240) and CAG (n=332) between January 2013 and December 2018 were included. Pre-PCI and procedural variables associated with post-PCI eGFR, change in renal function after post-PCI follow-up, and post-PCI eGFR association with major adverse cardiovascular events were investigated. Following the procedure, 88.7 percent of PCI group patients had unchanged or improved renal function. The treatment of PCI was found to independently correlate with IRF following coronary angiography in an analysis of patients undergoing PCI [OR 4.561 (95% CI:2 .556-8.139); p&lt;0.001]. The area under the receiver operating characteristic (ROC) curve is 0.763 (model with the treatment of PCI). Improved renal function (IRF) and stable renal function were both associated with a lower risk of a major cardiovascular event.

A Validated LC-MS/MS Method for Performing Belatacept Drug Monitoring in Renal Transplantation.

Belatacept, a CTLA4-Ig, was designed to prevent rejection and graft loss in kidney transplant recipients. This immunotherapy showed a long-term clinical benefit mainly on renal function and better glycemic control but was also associated with a higher number of severe infectious diseases, particularly CMV disease, and lymphoproliferative disease. Therapeutic drug monitoring usually guides the benefit-risk assessment of long-term immunosuppression. In this study, an analytical method by LC-MS/MS was developed in 20 microL of plasma for the belatacept quantification. Intra- and inter-assay precision and accuracy were lower than 20% for the limit of quantification, and 15% for higher concentrations. The method was implemented in our lab and provided data about the inter-variability (N = 108) and intra-variability (N = 33) of belatacept concentrations in kidney transplant recipients with a stable renal function, after conversion from a CNI- to a belatacept-based regimen.