Artificial organs
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Comparative Study
Continuous coronary sinus perfusion reverses ongoing myocardial damage in acute ischemia.
Acute cardiogenic shock or cardiac arrest (CS/CA) before cardiopulmonary bypass (CPB) installation are life-threatening events in acute coronary syndromes. We evaluated whether continuous retrograde warm-blood perfusion(CRWBP) before aortic cross-clamping (ACC),with immediate CPB installation may improve hospital results in these dreadful events. Hospital outcome of 18 coronary artery bypass grafting (CABG) (Group A) with CS/CA before CPB, with immediate CPB installation and CRWBP,has been compared with 24 CABG (Group B) with CS/CA undergoing only immediate CPB installation. ⋯ CRWBP improved post operative left ventricular ejection fraction (EF) (P = 0.017)and wall motion score index (P = 0.041), whereas Group B showed a significant worsening of EF (P = 0.0001) and wall motion score index (P = 0.002). Patients in Group A had shorter intubation time (P = 0.0001), intensive therapy unit(ITU) stay (P = 0.001), and hospital stay (P = 0.0001). CRWBP reverses myocardial damage in patients with CS/CA during acute coronary syndromes, adding a straightforward benefit to hospital survival.
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We report a possible new therapeutic strategy, using extracorporeal cardiopulmonary support (ECLS), for severe refractory cardiogenic shock (SRCS) in a patient with Tako-tsubo cardiomyopathy (TC). TC is a syndrome characterized by left ventricular wall motion abnormalities, without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. ⋯ For the first time in a Tako-tsubo patient with refractory cardiogenic shock, we used ECLS treatment in order to rest the heart, sustain circulation and end-organ perfusion, and promote potential ventricular recovery. ECLS might be the selected treatment for SRCS in patients with TC, and seems to be an effective and useful ultimate therapeutic strategy for preventing death.
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Patients with end-stage renal disease have a very high prevalence and extent of arterial calcification. A number of studies suggest that similar pathophysiologic mechanisms are responsible for development and progression of calcification of atherosclerotic plaque and bone formation. Fetuin-A is a potent calcification inhibitor and is expressed in bone, with not-yet well-defined functions. ⋯ Moreover, significant positive correlations were shown between the serum fetuin-A levels, BMD values, and T-scores of proximal radius, neck, and trochanter of the femur, but not with the lumbar spine. The present study demonstrates an association between serum fetuin-A levels, coronary artery calcification, and bone mineral densities--except for the lumbar spine, in maintenance HD patients. However, the results should be interpreted with caution because of the cross-sectional design of the study.
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This article describes a new powering system for implantable medical devices that could significantly increase their lifetime. The idea is based on the substitution of the usual implantable device battery for an electric accumulator (rechargeable battery), which is fed by the electric power generated by a photovoltaic converter inside the implantable device. Light impinges on the photovoltaic device through an optical fiber going from the photovoltaic device to just beneath the patient's epidermis. ⋯ For example, after 13 h/week of laser exposure, the lifetime of the implantable device would increase by 50%. Other combinations resulting in lifetime increases of more than 100% are also possible. So, the proposed system is now ready to take a further step forward: in vivo animal testing.