External validation of the REMEMBER score

Background

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is associated with high in-hospital mortality rates. The pRedicting mortality in patients undergoing venoarterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score has been created to predict in-hospital mortality in this subgroup of patients. The aim of this study is to externally validate the REMEMBER score.

Methods

All CABG patients who received VA-ECMO during or after the operation at our center between 01/2012 and 12/2021 were included in the analysis. Discrimination was assessed using concordance statistics, visualized by ROC curve analysis. Calibration-in-the-large and Calibration slope were tested separately.

Results

A total of 107 patients (male: n = 78, 72.9%) were included in this study. The in-hospital mortality rate in our cohort was 45.8% compared with 55% in the original study. The REMEMBER score median predicted mortality rate was 52% (76.9-36%). However, the REMEMBER score showed low discriminative ability [AUC: 0.623 (p = 0.0244; 95% CI = 0.524-0.715)] and inaccurate calibration (intercept = 0.25074; p = 0.0195; slope = 0.39504; p = 0.0303), indicating poor performance.

Conclusions

The REMEMBER score did not predict in-hospital mortality and was therefore not applicable in our cohort of patients. Additional external validation studies in a multicenter setting are therefore advisable.

Digital Communication Technology: Does Offering a Choice of Modality Improve Medication Adherence and Outcomes in a Persistent Asthma Population?

BACKGROUND

Use of digital communication technology has shown potential to improve asthma adherence and outcomes. Few studies have looked at patient preference around mode of medication reminders used to improve and maintain asthma medication adherence.

OBJECTIVE

To determine if, in a population already receiving automated medication reminders, offering a choice for preferred mode of reminder (text, email, phone) would improve their adherence and asthma outcomes over a 1-year period.

METHODS

This was a pragmatic, randomized controlled trial conducted at Kaiser Permanente Colorado involving 7522 adult patients with persistent asthma. Study patients were randomized to receive usual care or their choice of medication reminder. Differences between the 2 groups in both medication adherence and asthma outcomes were then assessed over the following year.

RESULTS

Only 30% of those offered a choice of medication reminder modality responded by making a choice, with 52% preferring text messaging. There was less of a decrease in adherence rate over the 1-year period in those who made a choice regarding the mode of medication refill reminder. There was no difference in asthma outcomes between those who did make a choice compared with those who did not make a choice regarding the mode of medication refill reminder.

CONCLUSION

In a patient population already receiving medication reminders, offering a choice about what type of technology-enabled asthma medication reminder patients wanted did not improve outcomes but did enable a subgroup to better maintain their medication adherence.

Melusin protects from cardiac rupture and improves functional remodelling after myocardial infarction

Aims

Melusin is a muscle-specific chaperone protein whose expression is required for a compensatory hypertrophy response to pressure overload. Here, we evaluated the consequences of melusin overexpression in the setting of myocardial infarction (MI) using a comprehensive multicentre approach.

Methods and results

Mice overexpressing melusin in the heart (TG) and wild-type controls (WT) were subjected to permanent LAD ligation and both the acute response (Day 3) and subsequent remodelling (2 weeks) were examined. Mortality in wild-type mice was significant between Days 3 and 7, primarily due to cardiac rupture, but melusin's overexpression strongly reduced mortality (43.2% in wild-type vs. 27.3% in melusin-TG, P = 0.005). At Day 3 after MI, a time point preceding the mortality peak, TG hearts had increased heat shock protein 70 expression, increased ERK1/2 signalling, reduced cardiomyocyte hyper-contractility and inflammatory cell infiltrates, and increased matricellular protein expression in the infarcted area.

At 2 weeks after MI, melusin overexpression conferred a favourable adaptive remodelling characterized by reduced left ventricle dilatation and better preserved contractility in the presence of a comparable degree of hypertrophy. Adaptive remodelling in melusin TG mice was characterized by reduced apoptosis and fibrosis as well as increased cardiomyocyte contractility.

Conclusions

Consistent with its function as a chaperone protein, melusin overexpression exerts a dual protective action following MI reducing an array of maladaptive processes. In the early phase after MI, reduced inflammation and myocyte remodelling protect against cardiac rupture. Chronically, reduced myocyte loss and matrix remodelling, with preserved myocyte contractility, confer adaptive LV remodelling.

Effects of typeface characteristics on visual field asymmetries for letter identification in children and adults

The current study compared the effects of three typeface characteristics (script-likeness, or resemblance to cursive writing; confusability, or likelihood of confusing one letter with another; and difficulty, as indexed by naming latency) on letter identification in a divided visual fields test. It also asked whether and how these effects change with subject age. Subjects were 48 right-handed 9- and 14-year-old boys and undergraduate men--16 in each age group. They orally identified single letters in eight different typefaces presented tachistoscopically to the left or right visual hemifield. The difference between hemifields in threshold presentation time was the dependent measure. For all ages, the direction and degree of the visual field advantage changed with typeface complexity (a composite index of the three characteristics), with the simplest typeface yielding a right visual field/left hemisphere advantage, and with two of the most complex typefaces yielding a left visual field/right hemisphere advantage. There were age differences, though, in the relative contribution of the individual characteristics to this effect. For undergraduates, the strongest predictor of right hemisphere participation was script-likeness, whereas for 9- and 14-year-olds it was typeface difficulty.

Social preference of the squirrel monkey (Saimiri sciureus)

Adult squirrel monkeys that had lived as a colony for 4 years were presented both during the fatted breeding season and during the nonfatted season with the choice of approaching one of two members of the group or remaining alone. Season affects the magnitude but not the direction of social preference. All animals show a strong preference for the high ranking male. Females have a greater preference for males than males for females. The higher the male’s position on the dominance rank, the greater is his preference to remain alone and to avoid females. The high ranking male is preferred by both males and females, although he rarely selects females.