Advanced strategies for intensive care management of acute liver failure.

Acute liver failure (ALF) is defined as the loss of hepatic function in conjunction with hepatic encephalopathy and coagulopathy. There is histological evidence of profound hepatocyte damage. If it is not aggressively managed, ALF can be fatal within a few days.

Efficacy and Safety of Sodium Zirconium Cyclosilicate in the Management of Hyperkalemia in Patients with Heart Failure with Reduced and Mildly Reduced Ejection Fraction and Chronic Kidney Disease Treated with Spironolactone: rational for and design of the REGISTA-K trial.

Background: To evaluate whether sodium zirconium cyclosilicate (SZC) enables the uptitration of spironolactone without increasing the risk of hyper- and hypokalemia in patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF and HFmrEF) and moderate/severe chronic kidney disease (CKD) who developed hyperkalemia during treatment with suboptimal spironolactone dose.

Methods: The REGISTA-K is a randomized, double-blind, placebo-controlled, multicenter trial that examined the efficacy and safety of SZC in uptitrating spironolactone without the occurrence of hyperkalemia or hypokalemia. A total of 266 patients with HFrEF and HFmrEF and hyperkalemia will be randomized in a 1:1 ratio to receive either SZC or placebo after treating hyperkalemia with SZC at 25 sites in Japan.

Intraoperative Cardiac Arrests in Asian Recipients of Liver Transplantation-Second Report After Learning Curve.

Background: Although surgical competency and anesthesia for liver transplantation (LT) have evolved significantly in the past decades, intraoperative cardiac arrest (ICA) is still an event that brings a poor prognosis to the recipient. We report a second-decade experience of ICA as a follow-up study of our first report at our institution.

Methods: This is a retrospective observational study of the medical records and the Liver Transplant Program database of our institution.

Citrate-Coated Iron Oxide Nanoparticles Facilitate Endothelialization of Left Ventricular Assist Device Impeller for Improved Antithrombogenicity.

Although left ventricular assist devices (LVADs) are an alternative to heart transplantation, their artificial surfaces often lead to serious thrombotic complications requiring high-risk device replacement. Coating blood-contacting surfaces with antithrombogenic endothelial cells is considered an effective strategy for preventing thrombus formation. However, this concept has not yet been successfully implemented in LVADs, as severe cell loss is to be expected, especially on the impeller surface with high prothrombogenic supraphysiological shear stress.

Cardiac Implantable Electronic Devices in Cardiac Transplant Patients: A Comprehensive Review.

A fraction of patients (approximately 10%) undergoing heart transplantation require permanent pacemaker (PPM) implantation due to sinus node dysfunction or atrioventricular block, occurring either shortly after surgery or later. The incidence of PPM implantation has declined to less than 5% with the introduction of bicaval anastomosis transplantation surgery. Pacing dependency during follow-up varies among recipients.

Single-cell analysis reveals the loss of FABP4-positive proliferating valvular endothelial cells relates to functional mitral regurgitation.

Background: Functional mitral regurgitation (MR) is a common form of mitral valve dysfunction that often persists even after surgical intervention, requiring reoperation in some cases. To advance our understanding of the pathogenesis of functional MR, it is crucial to characterize the cellular composition of the mitral valve leaflet and identify molecular changes in each cell subtype within the mitral valves of MR patients. Therefore, we aimed to comprehensively examine the cellular and molecular components of mitral valves in patients with MR.

Pathophysiology and Management of Postural Orthostatic Tachycardia Syndrome (POTS): A Literature Review.

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of cardiovascular autonomic disorders characterized by orthostatic intolerance and a symptomatic increase in heart rate upon standing, which can significantly impair patients' quality of life. Its pathophysiology is complex, multifactorial; thus, a variety of treatment approaches have been investigated. Recent studies have identified three primary POTS phenotypes-hyperadrenergic, neuropathic, and hypovolemic-each requiring tailored management strategies.

Cardiac Replacement Therapy: critical issues and future perspectives of Heart Transplantation and Artificial Heart.

Diagnostic and therapeutic advances in the cardiovascular field have caused a progressive reduction in mortality from acute causes, with an ever-increasing chronicity of cardiovascular pathologies. In recent years, mechanical supports have played a fundamental role, allowing the patient to be stabilized in the most critical phase of acute heart failure (AHF) and acting as a "bridge" for definitive therapies. Heart transplantation (HTx) is the gold-standard treatment for end-stage HF, but it is burdened by a series of critical issues that limit its use, first of all the shortage of grafts.

Enhancing lung transplantation with ECMO: a comprehensive review of mechanisms, outcomes, and future considerations.

Background: Lung transplantation (LTx) is a critical intervention for patients with end-stage lung disease. However, challenges such as donor organ scarcity and post-transplant complications significantly affect its success. Recent advancements in Extracorporeal Membrane Oxygenation (ECMO) have shown promise in improving the outcomes and expanding eligibility for LTx.

Right ventricle free wall longitudinal strain screening of lung transplant candidates.

Background: Lung transplant (LUTX) candidates have subclinical right ventricular (RV) dysfunction, which has not yet been assessed by speckle-tracking echocardiography (STE)-derived RV free-wall longitudinal strain (RVFWLS). To evaluate the prevalence of RV dysfunction by RVFWLS and its relationship with conventional RV echocardiographic indexes in LUTX candidates.

Methods: In a single-center prospective observational cohort study, from January 2021 to March 2023 consecutive LUTX candidates underwent cardiac catheterization, radionuclide ventriculography, standard and STE.

Disparities in kidney care in vulnerable populations: A multinational study from the ISN-GKHA.

Vulnerable populations, such as the elderly, children, displaced people, and refugees, often encounter challenges in accessing healthcare. In this study, we used data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to describe kidney care access and delivery to vulnerable populations across countries and regions. Using data from an international survey of clinicians, policymakers, and patient advocates, we assessed the funding and coverage of vulnerable populations on all aspects of kidney replacement therapies (KRT).

The Ross procedure for recurrently failed aortic valve procedures.

The Ross procedure provides young patients with unrepairable aortic valve disease with a living pulmonary autograft that confers significant survival benefit and improved quality of life. However, the procedure is complicated, and surgeons can be reluctant to offer it as a solution, especially in complex re-operative scenarios. We present a young patient with symptomatic, severe aortic insufficiency who had undergone two failed aortic valve procedures for congenital bicuspid aortic valve disease within the prior year.

Parasympathetic Dysfunction Prevails in GBA1-Associated Parkinson's Disease.

Background: The role played by sympathetic and parasympathetic autonomic branches in patients with Parkinson's disease carrying variants in the GBA1 gene (GBA-PD) is still elusive.

Objectives: To characterize cardiovascular autonomic function in GBA-PD and I-PD patients with early and mid-stage disease.

Methods: These assessments were performed: cardiovascular autonomic tests, analysis of heart rate and blood pressure variability, cardiac noradrenergic imaging.

Molecular Characteristics of Sweet Syndrome: A Systematic Review.

Sweet syndrome (SS), originally described as acute febrile neutrophilic dermatosis, is a rare inflammatory skin condition, considered the prototype of neutrophilic dermatoses. It is characterised by the sudden onset of well-defined tender papules, plaques and nodules often accompanied by fever, neutrophilia and elevated markers of inflammation. Several variants have been described both clinically and histopathologically.

Two Coupled Continuous-Flow Ventricular Assist Devices as a Novel BIVAD With One Driveline-Acute Animal Study Results.

Background: The study assesses the feasibility of the DuoCor BiVAS, a novel biventricular assist system integrating magnetic levitation technology.

Methods: In an acute large animal model involving five sheep, each received the DuoCor BiVAS without cardiopulmonary bypass. Hemodynamic and device parameters were monitored continuously for 1-h post-implantation.

Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States.

Background: Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.

Methods: We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and "other"-kidney, simultaneous "other" kidney (n = 73).

Novel Therapeutic Agents for Cardiometabolic Risk Mitigation in Heart Transplant Recipients.

Heart transplant (HT) recipients experience high rates of cardiometabolic disease. Novel therapies targeting hyperlipidemia, diabetes, and obesity, including proprotein convertase subtilisin/kexin inhibitors (PCSK9i), sodium-glucose cotransporter-2 (SGLT2) inhibitors, and glucagon-like peptide-1 (GLP-1) agonists are increasingly used for cardiometabolic risk mitigation in the general population. However, limited data exist to support the use of these agents in patients who have undergone heart transplantation.

Lipid levels increase to the normal range after nonmyeloablative hematopoietic cell transplantation for sickle cell disease.

Background: Individuals with sickle cell disease (SCD) have a unique type of dyslipidemia characterized by low total cholesterol (TC), low low-density lipoprotein cholesterol (LDL-c), low high-density lipoprotein cholesterol (HDL-c), and normal triglycerides (TG). This lipid state is theorized to be cardioprotective against atherosclerosis. In SCD, hematopoietic cell transplant (HCT) offers a potentially curative therapy.

Subnormothermic Machine Perfusion of Neonatal and Small-Sized Pediatric Donor Hearts.

Donor heart machine perfusion enables avoidance of prolonged cold ischemia, however the optimal temperature is yet to be elucidated. Given that maintenance of temperature beyond ambient levels demands significant energy, we sought to determine the suitability of room-temperature perfusion preservation of neonatal/pediatric-sized (5-20 kg) piglet donor hearts. A custom device was fabricated suitable for this purpose, with continuous readout of perfusion pressure, flow rate, temperature, and oxygen saturation.

Projecting the Population Level Burden of CKD Progression According to Urine Albumin-to-Creatinine Ratio Categories.

Introduction: Urinary albumin-to-creatinine ratio (uACR) is an independent predictor of chronic kidney disease (CKD) progression. However there is limited evidence on the burden of CKD according to uACR categories at the population level. This study estimates future clinical and financial burden of CKD according to uACR categories using the Inside CKD microsimulation.

What Genetic Modifications of Source Pigs Are Essential and Sufficient for Cell, Tissue, and Organ Xenotransplantation?

Xenotransplantation of porcine organs has made remarkable progress towards clinical application. A key factor has been the generation of genetically multi-modified source pigs for xenotransplants, protected against immune rejection and coagulation dysregulation. While efficient gene editing tools and multi-cistronic expression cassettes facilitate sophisticated and complex genetic modifications with multiple gene knockouts and protective transgenes, an increasing number of independently segregating genetic units complicates the breeding of the source pigs.

Dissociated rhythms between donor and recipient hearts after heart transplantation using the modified bicaval technique.

Unlabelled: The modified bicaval anastomosis technique is an orthotopic heart transplantation technique that preserves the posterior wall of the right atrium as a bridging tissue, creating a dual structure of the recipient and donor hearts between the superior and inferior venae cavae. In this report, we present a case with unique electrophysiological findings following heart transplantation using this technique. The patient, who had persistent atrial fibrillation before the procedure, achieved a maintained sinus rhythm afterward.

SARS-CoV-2 infection-induced immune thrombocytopenia in a patient with orthotopic heart transplantation: A case report and literature review.

Unlabelled: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by low platelet counts with increased risk of bleeding. In particular, ITP induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been increasingly reported. Since immunosuppressive regimens in organ transplantation are often the primary cause of increased risk of infection, ITP following solid organ transplantation has occasionally been observed.

Cardiac evaluation of renal transplant candidates with heart failure.

Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney transplantation. The American Heart Association and American College of Cardiology joint statement provides guidance on risk stratification for the major cause of heart failure for these patients in its recommendations for coronary heart disease. Herein we provide an overview of the available literature on risk stratification for nonischemic heart failure and functional heart disease states such as pulmonary hypertension.

N-terminal pro-brain natriuretic peptide and cardiorenal outcome in patients with anaemia in chronic kidney disease.

Aims: Blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) may be modified by low renal clearance and anaemia. The aim of this study was to investigate the impact of the blood NT-proBNP level on cardiovascular and renal outcomes in patients with these two manifestations.

Methods: This post hoc analysis stemmed from the oBservational clinical Research In chronic kidney disease patients with renal anemia: renal proGnosis in patients with Hyporesponsive anemia To Erythropoiesis-stimulating agents, darbepoetiN alfa (BRIGHTEN) trial, a large prospective study involving patients with non-dialysis kidney disease experiencing anaemia.