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Schroeder L, Pommer K, Geipel A, Strizek B, Heydweiller A, Kipfmueller F, Mueller A. A comparative analysis of the Vasoactive-Inotropic Score, the Vasoactive-Ventilation-Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia. Pediatr Pulmonol 2024; 59:574-583. [PMID: 38014597 DOI: 10.1002/ppul.26785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To date, different severity scores and indices are available to predict outcome in infants with a congenital diaphragmatic hernia (CDH). The Oxygenation Index (OI) and the Vasoactive-Inotropic Score (VIS) has already been evaluated in the CDH population. The Vasoactive-Ventilation-Renal (VVR) Score was recently evaluated as new severity score in several studies on infants with need for cardiac surgery. The score was shown to outperform the VIS and OI as outcome predictors in these infants, but no data are available regarding the evaluation of the VVR Score in CDH infants. PATIENTS AND METHODS This was a retrospective single-center analysis at the University Children's Hospital, Bonn, Germany, during the study period from January 2019 until December 2022. Of 108 CDH infants treated at our institution, a final cohort of 100 neonates met the inclusion criteria. INCLUSION CRITERIA diagnosis of CDH (right-sided, left-sided, or bilateral). EXCLUSION CRITERIA early mortality (before surgical correction of the diaphragm), palliative care after birth, no available data for OI, VIS, and VVR Score calculation. The OI, the VIS, and the VVR Score were calculated at three selected timepoints: at 48-72 h after birth (T1), before surgery (T2), and after surgery (T3). MAIN RESULTS The primary clinical endpoint (in-hospital mortality) was reached in 21% of the infants. Infants surviving to discharge were allocated to group A, infants with fatal outcome to group B. In the univariate analysis, the OI was significantly higher in infants allocated to group B at T2 (p < .001), and T3 (p < .001). The VIS was significantly higher only at T1 in infants allocated to group B (p = .001). The VVR Score was significantly higher at T1 (p = .017), and at T3 (p = .002) in infants not surviving to discharge. In the multivariate analysis, the OI at T2 + T3 (p < .001), the VIS at T1 (p = .048), and the VVR Score at T1 + T3 (p = .023, and p = .048, respectively) remained significantly associated with in-hospital mortality. The OI presented the highest area under the curve (AUC) at T2 and T3 (T2:0.867, p = .001; T3:0.833, p = .000) regarding the primary endpoint in the overall cohort. In the subgroup of infants without need for extracorporeal membrane oxygenation (ECMO) therapy (n = 60) the VVR Sore presented the best performance with an AUC of 0.942 (p = .000) at T3. CONCLUSION The severity scores OI, VIS, and VVR-Score are independent predictors of in-hospital mortality in CDH infants. The OI seems to outperform the VIS and VVR-Score as outcome predictor immediately before and after CDH surgery, whereas the VVR Score presented the best performance in the subgroup of CDH infants without need for ECMO and mild-to-moderate CDH defects.
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Affiliation(s)
- Lukas Schroeder
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany
| | - Katrin Pommer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Heydweiller
- Department for Pediatric Surgery, Clinic and Polyclinic for General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany
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Garcia Filho SG, de Andrade FSRM, Dos Santos RST, Gonçalves LA, Pereira MAA, de Souza AF, Ambrósio AM, Fantoni DT. Comparison of Hemodynamic Effects of Dobutamine and Ephedrine Infusions in Isoflurane-Anesthetized Horses. Vet Sci 2023; 10:vetsci10040278. [PMID: 37104433 PMCID: PMC10146723 DOI: 10.3390/vetsci10040278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
The objective of this study was to compare the hemodynamic effects of dobutamine and ephedrine during the management of anesthesia-related hypotension in healthy horses. Thirteen horses underwent general anesthesia with isoflurane and were randomly divided into two different groups, one of which received a dobutamine constant rate infusion (CRI) (1 µg/kg bwt/min) and the other received an ephedrine CRI (20 µg/kg bwt/min) when hypotension (<60 mmHg) was identified, following up to 15 min after the blood pressure reached 70 mmHg. All horses were equipped with a pulmonary artery catheter and a peripheral artery catheter, and multiparameter monitoring commenced as soon as they were under mechanical ventilation. Hemodynamic parameters were recorded, while tissue perfusion markers (peripheral oxygen saturation, arterial oxygen partial pressure, arterial carbon dioxide partial pressure, arterial pH, arterial plasma bicarbonate concentration, arterial oxygen saturation, mixed venous oxygen saturation, mixed venous oxygen content, arterial oxygen content, arteriovenous oxygen difference, oxygen delivery index, oxygen consumption index, and oxygen extraction ratio), serum lactate concentration, and troponin I concentrations were analyzed before the start of infusions (T0), when the blood pressure reached 70 mmHg (T1), and 15 min after T1 (T2). The time to restore the arterial pressure was similar in both groups (p > 0.05); however, the heart rate was higher in the ephedrine group (p = 0.0098), and sinus bradyarrhythmia occurred in the dobutamine group. Furthermore, both experimental protocols increased cardiac output (p = 0.0012), cardiac index (p = 0.0013), systemic vascular resistance (p = 0.008), systemic vascular resistance index (p < 0.001), and ameliorated perfusion markers. In the dobutamine group, the pulmonary artery wedge pressure (p < 0.001) and systolic index (p = 0.003) were elevated, while the arteriovenous oxygen difference was reduced in the ephedrine group (p = 0.02). Troponin I was used as a myocardial injury indicator, and did not differ between moments or between groups (p > 0.05). We concluded that both drugs were effective and safe to treat anesthetic hypotension under the conditions of this study.
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Affiliation(s)
- Sergio Grandisoli Garcia Filho
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Felipe Silveira Rego Monteiro de Andrade
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Rosana Souza Thurler Dos Santos
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Lucas Alaião Gonçalves
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Marco Aurélio Amador Pereira
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Anderson Fernando de Souza
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Aline Magalhães Ambrósio
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
| | - Denise Tabacchi Fantoni
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, 87 Professor Orlando Marques Paiva Ave., São Paulo 05508-270, SP, Brazil
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Michelle L, Bitner BF, Pang JC, Berger MH, Haidar YM, Rajan GR, Tjoa T. Outcomes of perioperative vasopressor use for hemodynamic management of patients undergoing free flap surgery: A systematic review and meta-analysis. Head Neck 2023; 45:721-732. [PMID: 36618003 DOI: 10.1002/hed.27289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 12/15/2022] [Indexed: 01/10/2023] Open
Abstract
This systematic review and meta-analysis investigates the objective evidence regarding outcomes in head and neck free flap surgeries using vasoactive agents in the perioperative period. A search was performed in PubMed, Cochrane, Web of Science, and Scopus databases. Inclusion criteria were clinical studies in which vasopressors were used in head and neck free flap surgery during the intraoperative and perioperative period. Eighteen studies (n = 5397) were included in the qualitative analysis and nine (n = 4381) in the meta-analysis. There was no difference in flap failure outcomes with perioperative vasopressor use in head and neck free flap surgery (n = 4015, OR = 0.93, 95% CI [0.60, 1.44]). When patients received vasopressors perioperatively, there was an associated decrease in flap-specific complications (n = 3881, OR = 0.69, 95% CI [0.55, 0.87]). Intraoperative vasopressor use does not negatively impact free tissue transfer outcomes in head and neck surgery and may reduce overall free flap complications.
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Affiliation(s)
- Lauren Michelle
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Benjamin F Bitner
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Jonathan C Pang
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Govind R Rajan
- Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Orange, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA
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Baekgaard ES, Møller MH, Vester-Andersen M, Krag M. Use of vasoactive agents in non-cardiac surgery: Protocol for a scoping review. Acta Anaesthesiol Scand 2023; 67:120-122. [PMID: 36181393 PMCID: PMC10092778 DOI: 10.1111/aas.14153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND An increasing number of patients undergo surgical procedures worldwide each year, and despite advances in quality and care, morbidity and mortality rates remain high. Perioperative hypotension is a well-described condition, and is associated with adverse outcomes. Both fluids and vasoactive agents are commonly used to treat hypotension, however, whether one vasoactive agent is preferable over another has yet to be explored. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement, we plan to conduct a scoping review of studies assessing the use of vasoactive agents in patients undergoing non-cardiac surgery. We will provide an overview of indications, agents used and outcomes assessed. We will assess and report the certainty of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We will provide descriptive analyses of the included studies accompanied by tabulated results. CONCLUSION The outlined scoping review will provide a summary of the body of evidence on the use of vasoactive agents in the non-cardiac surgical population.
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Affiliation(s)
- Emilie S Baekgaard
- Department of Anaesthesia and Intensive Care, Holbaek Hospital, Zealand, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Vester-Andersen
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Anaesthesia and Intensive Care, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Krag
- Department of Anaesthesia and Intensive Care, Holbaek Hospital, Zealand, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Qin X, Xu X, Hou X, Liang R, Chen L, Hao Y, Gao A, Du X, Zhao L, Shi Y, Li Q. The pharmacological properties and corresponding mechanisms of farrerol: a comprehensive review. Pharm Biol 2022; 60:9-16. [PMID: 34846222 PMCID: PMC8635655 DOI: 10.1080/13880209.2021.2006723] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
CONTEXT Farrerol, a typical natural flavanone isolated from the traditional Chinese herb 'Man-shan-hong' [Rhododendron dauricum L. (Ericaceae)] with phlegm-reducing and cough-relieving properties, is widely used in China for treating bronchitis and asthma. OBJECTIVE To present the anti-inflammatory, antioxidant, vasoactive, antitumor, and antimicrobial effects of farrerol and its underlying molecular mechanisms. METHODS The literature was reviewed by searching PubMed, Medline, Web of Knowledge, Scopus, and Google Scholar databases between 2011 and May 2021. The following key words were used: 'farrerol,' 'flavanone,' 'anti-inflammatory,' 'antioxidant,' 'vasoactive,' 'antitumor,' 'antimicrobial,' and 'molecular mechanisms'. RESULTS Farrerol showed anti-inflammatory effects mainly mediated via the inhibition of interleukin (IL)-6/8, IL-1β, tumour necrosis factor(TNF)-α, NF-κB, NO, COX-2, JNK1/2, AKT, PI3K, ERK1/2, p38, Keap-1, and TGF-1β. Farrerol exhibited antioxidant effects by decreasing JNK, MDA, ROS, NOX4, Bax/Bcl-2, caspase-3, p-p38 MAPK, and GSK-3β levels and enhancing Nrf2, GSH, SOD, GSH-Px, HO-1, NQO1, and p-ERK levels. The vasoactive effects of farrerol were also shown by the reduced α-SMA, NAD(P)H, p-ERK, p-Akt, mTOR, Jak2, Stat3, Bcl-2, and p38 levels, but increased OPN, occludin, ZO-1, eNOS, CaM, IP3R, and PLC levels. The antitumor effects of farrerol were evident from the reduced Bcl-2, Slug, Zeb-1, and vimentin levels but increased p27, ERK1/2, p38, caspase-9, Bax, and E-cadherin levels. Farrerol reduced α-toxin levels and increased NO production and NF-κB activity to impart antibacterial activity. CONCLUSIONS This review article provides a theoretical basis for further studies on farrerol, with a view to develop and utilise farrerol for treating of vascular-related diseases in the future.
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Affiliation(s)
- Xiaojiang Qin
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- CONTACT Xiaojiang Qin School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinrong Xu
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaomin Hou
- Department of Pharmacology, Shanxi Medical University, Shanxi, China
| | - Ruifeng Liang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Liangjing Chen
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuxuan Hao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Anqi Gao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xufeng Du
- Department of Exercise Rehabilitation, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Liangyuan Zhao
- Department of Exercise Rehabilitation, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yiwei Shi
- Department of Respiratory and Critical Care Medicine, Shanxi Medical University Affiliated First Hospital, Taiyuan, Shanxi, China
| | - Qingshan Li
- School of Pharmaceutical Science, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Chronic Inflammatory Targeted Drugs, School of Materia Medica, Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, China
- Qingshan Li School of Pharmaceutical Science, Shanxi Medical University, Taiyuan, Shanxi, China
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Perizes EN, Chong G, Sanchez-Pinto LN. Derivation and Validation of Vasoactive Inotrope Score Trajectory Groups in Critically Ill Children With Shock. Pediatr Crit Care Med 2022; 23:1017-1026. [PMID: 36053068 PMCID: PMC9722555 DOI: 10.1097/pcc.0000000000003070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To determine whether there are clinically relevant and reproducible Vasoactive Inotrope Score (VIS) trajectories in children with shock during the acute phase of critical illness. DESIGN Retrospective, observational cohort study. SETTING Two tertiary, academic PICUs. PATIENTS Children (< 18 yr old) who required vasoactive infusions within 24 hours of admission to the PICU. Those admitted post cardiac surgery were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS An hourly VIS was calculated for the first 72 hours after initiation of vasoactives. Group-based trajectory modeling (GBTM) was applied to a derivation set (75% of encounters) and compared with the trajectories in a validation set (25% of encounters) using the same variables. The primary outcome was in-hospital mortality, and the secondary outcome was multiple organ dysfunction syndrome (MODS) on day 7. A total of 1,828 patients met inclusion criteria, and 309 (16.9%) died. GBTM identified four subgroups that were reproducible in the validation set: "Mild, fast resolving shock" ( n = 853 [47%]; mortality 9%), "Moderate, slow resolving shock" ( n = 422 [23%]; mortality 15%), "Moderate, prolonged shock" ( n = 312 [17%]; mortality 21%), and "Severe, prolonged shock" ( n = 241 [13%]; mortality 40%). There was a significant difference in mortality, MODS on day 7, and suspected infection ( p < 0.001) across groups. The "Mild, fast resolving shock" and "Severe, prolonged shock" groups were identifiable within the first 24 hours. The "Moderate, slow resolving" and "Moderate, prolonged shock" groups were indistinguishable in the first 24 hours after initiation of vasoactives but differed in in-hospital mortality and MODS on day 7. Hydrocortisone administration was independently associated with poor outcomes in the "Mild, fast resolving shock" group. CONCLUSIONS We uncovered four distinct and reproducible VIS trajectory groups that were associated with different risk factors, response to therapy, and outcomes in children with shock. Characterizing VIS trajectory groups in the acute phase of critical illness may enable better prognostication and more targeted management.
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Affiliation(s)
- Elitsa N. Perizes
- Division of Critical Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace Chong
- Division of Critical Care, University of Chicago Medicine Comer Children’s Hospital, Chicago, IL
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - L. Nelson Sanchez-Pinto
- Division of Critical Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine (Health and Biomedical Informatics), Northwestern University Feinberg School of Medicine, Chicago, IL
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Kerr S, Heinke D, Yazdy MM, Mitchell AA, Darling AM, Lin A, Nestoridi E, Werler MM. Use of vasoactive medications in pregnancy and the risk of stillbirth among birth defect cases. Birth Defects Res 2022; 114:277-294. [PMID: 35238183 PMCID: PMC9798591 DOI: 10.1002/bdr2.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many previous studies have identified risk factors for stillbirth, but few examine stillbirth among pregnancies affected with birth defects. Because many hypothesized etiologies of stillbirth work through vascular pathologies of the placenta, we examined maternal use of vasoactive medications in relation to stillbirth among pregnancies affected with birth defects. METHODS Data were analyzed from the National Birth Defects Prevention Study (1997-2011). We examined use of nonsteroidal anti-inflammatory drugs (NSAIDs), decongestants, short- or long-acting beta-agonists (SABA/LABA), and antihypertensive medications in relation to pregnancies affected by birth defects ending in stillbirth compared to live birth. Associations were measured with odds ratios (ORs) for early pregnancy use and hazard ratios (HRs) for time-varying late pregnancy use. RESULTS Among all birth defects (n = 12,394), the risk of stillbirth was associated with use of antihypertensive medications in early (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0, 3.1) and late pregnancy (HR: 2.0; 95% CI: 1.1, 3.6). Other vasoactive medications were not associated with increased risk of stillbirth. Of 27 specific defect groups, increased risks were observed for only one medication/defect pair: early decongestant use was more common among mothers of stillbirth versus live birth cases with spina bifida (OR: 2.4; 95% CI: 0.9, 6.5). CONCLUSION This exploratory analysis of vasoactive medication use suggests that use of NSAIDs, decongestants, and SABA/LABA is not associated with increased risk of stillbirth among pregnancies affected with birth defects. Our finding of increased risks associated with antihypertensive medication use raises questions of confounding by indication, which we were not able to fully address.
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Affiliation(s)
- Stephen Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA
| | - Dominique Heinke
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Mahsa M. Yazdy
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Allen A. Mitchell
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA
| | - Anne Marie Darling
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Angela Lin
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA,Medical Genetics Unit, Mass General Hospital for Children, Harvard Medical School, Boston, Massachusetts, USA
| | - Eirini Nestoridi
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Martha M. Werler
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
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Smith JD, Ellsperman SE, Basura GJ, Else T. Re-evaluating the prevalence and factors characteristic of catecholamine secreting head and neck paragangliomas. Endocrinol Diabetes Metab 2021; 4:e00256. [PMID: 34277980 PMCID: PMC8279627 DOI: 10.1002/edm2.256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 01/12/2023]
Abstract
Introduction We sought to characterize the prevalence and factors characteristic of head and neck paragangliomas (HNPGLs) that secrete catecholamines to inform best practices for diagnosis and management. Methods This was a retrospective cohort study from 2000 to 2020 at a single‐institution tertiary centre. One‐hundred fifty‐two patients (182 tumours) with HNPGLs with at least one measurement of urine or plasma catecholamines and/or catecholamine metabolite levels prior to treatment were included. We differentiated and characterized those patients with increased level(s) of any nature and those with ‘clinically significant’ versus ‘clinically insignificant’ catecholamine production. Results Thirty‐one (20.4%) patients had increased catecholamine and/or catecholamine metabolite levels. In most patients, these levels were ≤5‐fold above the upper limit of the reference range. Four of these 31 patients with increased levels were ultimately found to have an additional catecholamine secreting mediastinal paraganglioma or pheochromocytoma. Fourteen of 31 patients with HNPGL were deemed clinically significant secretors of catecholamines based on hyper‐adrenergic symptoms and/or profound levels of normetanephrines. This cohort was enriched for patients with paragangliomas of the carotid body or cervical sympathetic chain and those with SDHB genetic mutations. Ultimately, the prevalence of clinically significant catecholamine secreting Hangs was determined to be 9.2% and 7.7% based on a per‐patient and per‐tumour basis, respectively. Conclusions The rate of catecholamine excess in the current cohort of patients with HNPGLs was higher than previously reported. Neuroendocrine tumours of any anatomic subsite may secrete catecholamines, although not all increased laboratory level(s) are indicative of clinically significant catecholamine secretion causing symptoms or warranting adrenergic blockade.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head & Neck Surgery University of Michigan Medical School Ann Arbor MI USA
| | - Susan E Ellsperman
- Department of Otolaryngology - Head & Neck Surgery University of Michigan Medical School Ann Arbor MI USA
| | - Gregory J Basura
- Department of Otolaryngology - Head & Neck Surgery University of Michigan Medical School Ann Arbor MI USA
| | - Tobias Else
- Division of Metabolism, Endocrine, and Diabetes Department of Internal Medicine University of Michigan Medical School Ann Arbor MI USA
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Buchborn T, Lyons T, Song C, Feilding A, Knöpfel T. The serotonin 2A receptor agonist 25CN-NBOH increases murine heart rate and neck-arterial blood flow in a temperature-dependent manner. J Psychopharmacol 2020; 34:786-794. [PMID: 32048564 PMCID: PMC7488829 DOI: 10.1177/0269881120903465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Serotonin 2A receptors, the molecular target of psychedelics, are expressed by neuronal and vascular cells, both of which might contribute to brain haemodynamic characteristics for the psychedelic state. AIM Aiming for a systemic understanding of psychedelic vasoactivity, here we investigated the effect of N-(2-hydroxybenzyl)-2,5-dimethoxy-4-cyanophenylethylamine - a new-generation agonist with superior serotonin 2A receptor selectivity - on brain-supplying neck-arterial blood flow. METHODS We recorded core body temperature and employed non-invasive, collar-sensor based pulse oximetry in anesthetised mice to extract parameters of local blood perfusion, oxygen saturation, heart and respiration rate. Hypothesising an overlap between serotonergic pulse- and thermoregulation, recordings were done under physiological and elevated pad temperatures. RESULTS N-(2-hydroxybenzyl)-2,5-dimethoxy-4-cyanophenylethylamine (1.5 mg/kg, subcutaneous) significantly increased the frequency of heart beats accompanied by a slight elevation of neck-arterial blood flow. Increasing the animal-supporting heat-pad temperature from 37°C to 41°C enhanced the drug's effect on blood flow while counteracting tachycardia. Additionally, N-(2-hydroxybenzyl)-2,5-dimethoxy-4-cyanophenylethylamine promoted bradypnea, which, like tachycardia, quickly reversed at the elevated pad temperature. The interrelatedness of N-(2-hydroxybenzyl)-2,5-dimethoxy-4-cyanophenylethylamine's respiro-cardiovascular effects and thermoregulation was further corroborated by the drug selectively increasing the core body temperature at the elevated pad temperature. Arterial oxygen saturation was not affected by N-(2-hydroxybenzyl)-2,5-dimethoxy-4-cyanophenylethylamine at either temperature. CONCLUSIONS Our findings imply that selective serotonin 2A receptor activation modulates systemic cardiovascular functioning in orchestration with thermoregulation and with immediate relevance to brain-imminent neck (most likely carotid) arteries. As carotid branching is a critical last hub to channel cardiovascular output to or away from the brain, our results might have implications for the brain haemodynamics associated with psychedelia.
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Affiliation(s)
- Tobias Buchborn
- Laboratory for Neuronal Circuit Dynamics, Department of Medicine, Imperial College, London, UK,Centre for Psychedelic Research, Department of Medicine, Imperial College, London, UK,Tobias Buchborn, Laboratory for Neuronal Circuit Dynamics, Department of Medicine, Imperial College, Du Cane Road, Burlington Danes, London, W12 0NN, UK.
| | - Taylor Lyons
- Laboratory for Neuronal Circuit Dynamics, Department of Medicine, Imperial College, London, UK,Centre for Psychedelic Research, Department of Medicine, Imperial College, London, UK
| | - Chenchen Song
- Laboratory for Neuronal Circuit Dynamics, Department of Medicine, Imperial College, London, UK
| | | | - Thomas Knöpfel
- Laboratory for Neuronal Circuit Dynamics, Department of Medicine, Imperial College, London, UK,Centre for Neurotechnology, Institute of Biomedical Engineering, Imperial College, London, UK
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10
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Poterucha JT, Vallabhajosyula S, Egbe AC, Krien JS, Aganga DO, Holst K, Golden AW, Dearani JA, Crow SS. Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery. CONGENIT HEART DIS 2018; 14:193-200. [PMID: 30451381 DOI: 10.1111/chd.12717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 10/06/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). METHODS We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity. RESULTS Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty-two patients (25%), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty-eight patients (15%) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95% CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95% CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4-15.5; P < 0.0001). CONCLUSIONS MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.
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Affiliation(s)
- Joseph T Poterucha
- Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Joseph S Krien
- Department of Hospital Medicine, Mayo Clinic Health System, La Crosse, Wisconsin
| | - Devon O Aganga
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kimberly Holst
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Adele W Golden
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Joseph A Dearani
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sheri S Crow
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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11
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Wahlstrøm KL, Novovic S, Ersbøll AK, Hasbak P, Jørgensen LN, Berner Hansen M. Serotonin, calcitonin and calcitonin gene-related peptide in acute pancreatitis. Scand J Gastroenterol 2017; 52:1140-1147. [PMID: 28679347 DOI: 10.1080/00365521.2017.1346703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate plasma levels of serotonin, calcitonin and calcitonin gene-related peptide (CGRP) in the course of acute pancreatitis (AP) taking organ failure, etiology and severity into consideration. MATERIAL AND METHODS Sixty consecutive patients with alcohol- or gallstone-induced AP were included over a 15-month period. Patients were treated according to a standardized algorithm and monitored for organ specific morbidity and mortality. Organ functions and blood samples were assessed on days 0, 1, 2 and 14 after hospital admission. Twenty healthy volunteers, matched for age and gender, comprised the reference group. RESULTS Lower levels of serotonin were observed in patients at admission compared to healthy volunteers (p = .021). Serotonin levels increased from day 2 to 14 (p < .001), but with no relation to severity, etiology or organ failure. No difference in calcitonin levels was found in patients at admission compared to healthy volunteers. However, calcitonin levels decreased over time (p < .001) and higher levels were found in patients with respiratory failure (p = .039). No difference was observed in relation to severity or etiology. CGRP levels in patients at admission did not differ from healthy volunteers, nor did CGRP change over time or show any relationship to severity, etiology or organ failure. CONCLUSION Our data suggest serotonin and calcitonin levels to be associated to time-course of AP, and calcitonin levels to organ dysfunction. We hypothesize that serotonin plays a pathogenic role in the compromised pancreatic microcirculation, and calcitonin a role as a biomarker of severity in AP.
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Affiliation(s)
- Kirsten Lykke Wahlstrøm
- a Digestive Disease Center K , Bispebjerg Hospital , University of Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark
| | - Srdan Novovic
- a Digestive Disease Center K , Bispebjerg Hospital , University of Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,b Department of Gastroenterology and Gastrointestinal Surgery , University of Copenhagen, Hvidovre Hospital , Copenhagen , Denmark
| | - Annette Kjær Ersbøll
- c National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
| | - Philip Hasbak
- d Department of Clinical Physiology Nuclear Medicine and PET , University of Copenhagen, Rigshospitalet , Copenhagen , Denmark.,e Department of Clinical Physiology and Nuclear Medicine , University of Copenhagen, Glostrup Hospital , Glostrup , Denmark
| | - Lars Nannestad Jørgensen
- a Digestive Disease Center K , Bispebjerg Hospital , University of Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark
| | - Mark Berner Hansen
- a Digestive Disease Center K , Bispebjerg Hospital , University of Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,f Department of Research and Development, Zealand Pharma , Glostrup , Denmark
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12
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Butlin M, Lindesay G, Viegas KD, Avolio AP. Pressure dependency of aortic pulse wave velocity in vivo is not affected by vasoactive substances that alter aortic wall tension ex vivo. Am J Physiol Heart Circ Physiol 2015; 308:H1221-8. [PMID: 25770242 DOI: 10.1152/ajpheart.00536.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 03/10/2015] [Indexed: 11/22/2022]
Abstract
Aortic stiffness, a predictive parameter in cardiovascular medicine, is blood pressure dependent and experimentally requires isobaric measurement for meaningful comparison. Vasoactive drug administration to change peripheral resistance and blood pressure allows such isobaric comparison but may alter large conduit artery wall tension, directly changing aortic stiffness. This study quantifies effects of sodium nitroprusside (SNP, vasodilator) and phenylephrine (PE, vasoconstrictor) on aortic stiffness measured by aortic pulse wave velocity (aPWV) assessed by invasive pressure catheterization in anaesthetized Sprague-Dawley rats (n = 7). This was compared with nondrug-dependent alteration of blood pressure through reduced venous return induced by partial vena cava occlusion. In vivo drug concentration was estimated by modeling clearance rates. Ex vivo responses of excised thoracic and abdominal aortic rings to drugs was measured using myography. SNP administration did not alter aPWV compared with venous occlusion (P = 0.21-0.87). There was a 5% difference in aPWV with PE administration compared with venous occlusion (P < 0.05). The estimated in vivo maximum concentration of PE (7.0 ± 1.8 ×10(-7) M) and SNP (4.2 ± 0.6 ×10(-7) M) caused ex vivo equivalent contraction of 52 mmHg (thoracic) and 112 mmHg (abdominal) and relaxation of 96% (both abdominal and thoracic), respectively, despite having a negligible effect on aPWV in vivo. This study demonstrates that vasoactive drugs administered to alter systemic blood pressure have a negligible effect on aPWV and provide a useful tool to study pressure-normalized and pressure-dependent aPWV in large conduit arteries in vivo. However, similar drug concentrations affect aortic ring wall tension ex vivo. Future studies investigating in vivo and ex vivo kinetics will need to elucidate mechanisms for this marked difference.
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Affiliation(s)
- Mark Butlin
- The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - George Lindesay
- The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Kayla D Viegas
- The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Alberto P Avolio
- The Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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