Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock.

INTRODUCTION: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. METHODS: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. RESULTS: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. CONCLUSIONS: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.

Salivary aldosterone and cortisone respond differently to high- and low-psychologically stressful soccer competitions.

Aldosterone and cortisone are released in response to physical and psychological stress. However, aldosterone and cortisone responses in children engaged in physical competition have not been described. We examined salivary aldosterone and salivary cortisone responses among Hong Kongese boys, aged 8-11 years, during (1) a soccer match against unknown competitors (N = 84, high psychological stress condition) and (2) an intrasquad soccer scrimmage against teammates (N = 81, low psychological stress condition). Aldosterone levels increased during the soccer match and intrasquad soccer scrimmage conditions, consistent with the view that aldosterone responds to physical stress. During the soccer match, winning competitors experienced larger increases in aldosterone compared to losing competitors, indicating that the degree of aldosterone increase was attenuated by match outcome. Cortisone increased during the soccer match and decreased during the intrasquad soccer scrimmage. Competitors on teams that resulted in a tie had larger cortisone increases compared to winners or losers. These findings highlight that the degree of cortisone change is related to boy's cognitive appraisal of the competitor type (i.e., teammates vs. unknown competitors) and the competitive nature of the game (e.g., tie). These results shed new light on adrenal hormone mediators of stress and competition during middle childhood.

Salivary steroid hormone responses to dyadic table tennis competitions among Hong Kongese juvenile boys.

OBJECTIVES: Little is known about salivary steroid hormone responses to dyadic competition among prepubescent boys. The current study explored pre-match and post-match testosterone, dehydroepiandrosterone (DHEA), androstenedione, and cortisol among 22 ethnically Chinese, Hong Kongese table tennis athletes, aged 8-11 years, during dyadic competition against peers. These data provide novel comparative insight into boys' hormone responses when participating in similar forms of competition to that of adults. METHODS: Measures of salivary steroid hormones, age, outcome, and participant's self-reported perceived performance were obtained. Pre-match salivary steroid hormones and competition-induced steroid hormone changes were explored to further assess overall hypothalamic-pituitary-adrenal axis activity. RESULTS: Cortisol decreased for most participants, whereas testosterone measures were below the sensitivity of the assay. DHEA and androstenedione did not significantly change during the table tennis exhibitions and were unrelated to independent performance variables. Correlational analyses indicated that competition-induced androstenedione and cortisol change were positively related. CONCLUSIONS: Findings show that juvenile boys' steroid hormone responses during dyadic athletic competition differ in comparison to adult males, in whom cortisol and testosterone tend to rise. Lack of significant DHEA and androstenedione change during the table tennis competition differs from our previous work that showed DHEA and androstenedione were sensitive to more physically taxing forms of athletic competition (eg, soccer). These results are discussed in light of potential factors that may have contributed to these differences.

A Mori-Zwanzig Dissipative Particle Dynamics Approach for Anisotropic Coarse Grained Molecular Dynamics.

Coarse grained (CG) molecular dynamics simulations are widely used to accelerate atomistic simulations but generally lack a formalism to preserve the dynamics of the system. For spherical particles, the Mori-Zwanzig approach, while computationally complex, has ameliorated this problem. Here we present an anisotropic dissipative particle dynamics (ADPD) model as an extension of this approach, which accounts for the anisotropy for both conservative and nonconservative interactions. For a simple anisotropic system we parametrize the coarse grained force field representing ellipsoidal CG particles from the full-atomistic simulation. To represent the anisotropy of the system, both the conservative and dissipative terms are approximated using the Gay-Berne (GB) functional forms via a force-matching approach. We compare our model with other CG models and demonstrate that it yields better results in both static and dynamical properties. The inclusion of the anisotropic nonconservative force preserves the microscopic dynamical details, and hence the dynamical properties, such as diffusivity, can be better reproduced by the aspherical model. By generalizing the isotropic DPD model, this framework is effective and promising for the development of the CG model for polymers, macromolecules, and biological systems.

Alpha-Loop Snaring Technique: Facilitated Snaring Technique for Fully-Deployed and Deformed Coronary Stent Protruding Into the Aorta.

A 59-year-old female was admitted for non-ST-segment elevation myocardial infarction and Killip class 3 heart failure with a left ventricular ejection fraction of 30%. Coronary angiogram showed moderate to severe stenosis over the ostial-proximal left anterior descending artery with minor disease over the left circumflex artery and right coronary artery. We describe a complication encountered where a protruding stent was weakened and elongated during our attempts to remove it, risking possible breakage, stent embolization, and long stent protrusion inside the aorta. We then describe treatment with what we call the alpha-loop snaring technique, which, to our knowledge, is the first report describing this novel approach, which can salvage a failing snaring attempt of a completely deployed and dislodged coronary stent.

An equilibrium desorption model for the strength and extraction yield of full immersion brewed coffee.

The sensory qualities of brewed coffee are known to be strongly correlated with the total dissolved solids (TDS) and extraction yield (E) of the brew. Here, we derive a predictive model for the TDS and E of full immersion brewed coffee using a pseudo-equilibrium desorption approach. Assuming a single, species-averaged equilibrium constant [Formula: see text] yields theoretical predictions indicating that the TDS is approximately inversely proportional to the water/coffee mass brew ratio, while E is independent of the brew ratio. Our experimental results strongly accord with both theoretical predictions, and indicate that E is approximately 21% over a wide range of brew ratios. An analysis of the standard oven-drying method for measuring E indicates that it yields significant underestimates of the true value at equilibrium, due to retained brew within the spent moist grounds. We further demonstrate that [Formula: see text] is insensitive to grind size, roast level, and brew temperature over the range 80-99 °C. Taken together, our results indicate that full immersion brewing offers precise control over the TDS at equilibrium but little control over E, and that practitioners should pay careful attention to their brew ratio as the most important parameter for full-immersion brewing.

Orbital-Tripsy: Novel Combination of Orbital-Atherectomy and Intravascular-Lithotripsy, in Calcified Coronaries After Failed Intravascular-Lithotripsy.

Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Fortunately, more devices are available to tackle coronary calcifications. However, there remain difficult cases whereby a single modality is insufficient. Here we report the feasibility and success of a case, using Novo combination of Shockwave Lithotripsy after Orbital Atherectomy. (Level of Difficulty: Intermediate.).

A Case of Rota-Shock-Pella.

Severe calcified coronary lesions are frequently encountered in today's percutaneous coronary intervention practice and remain a challenging entity in complex and high-risk patients. The present case illustrates the contemporary approach to management of this coronary problem from hemodynamic support, optical coherence tomography assessment, and plaque modification technique. (Level of Difficulty: Advanced.).

Cross-Cultural Adaptation and Validation of the Hong Kong Version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) for Patients with Knee Osteoarthritis.

INTRODUCTION: This study aimed to validate the Hong Kong version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) for patients with knee osteoarthritis. METHODS: Content validity was assessed using the Item and Scale Content Validity Index (I-CVI and S-CVI). Test-retest reliability and internal consistency were assessed by the Intraclass Correlation Coefficient (ICC) and Cronbach's alpha. Dimensionality was assessed by performing exploratory factor analysis (EFA). Convergent and Divergent Validity was performed by examining the correlation between the HK-KOOS and the Chinese version of the Short Form 12 (SF-12) Health Survey, the Chinese Modified Barthel Index (C-MBI), and the Visual Analogue Scale for Pain (VAS-Pain). Ceiling and floor effects were also examined. RESULTS: A total of 125 participants were recruited in this study. In general, all instructions, items, and response options were considered as understandable, indicating a satisfactory cross-cultural adaptation. The I-CVI and S-CVI scores were 0.80-1 and 0.90-1, respectively, indicating excellent content validity in terms of relevance, representativeness, and understandability. The test-retest reliability of all HK-KOOS subscales was satisfactory with ICC exceeding 0.70 for all domains. Cronbach's alpha exceeded 0.80 for all subscales, indicating satisfactory internal consistency. Medium to strong correlations were found between the HK-KOOS and the VAS-Pain, SF-12, and C-MBI. However, factor analysis indicated a seven-factor structure, rather than the original five-factor structure. Items on pain and activities of daily living were loaded in the same factors. A floor effect was present in the sports and recreation subscale. DISCUSSION AND CONCLUSIONS: Future studies should further examine the dimensionality of the KOOS. The HK-KOOS is a culturally adapted, reliable, and valid outcome measure instrument to be used in Hong Kong patients with primary knee osteoarthritis.

Coalitional Physical Competition : Acute Salivary Steroid Hormone Responses among Juvenile Male Soccer Players in Hong Kong.

A large body of research links testosterone and cortisol to male-male competition. Yet, little work has explored acute steroid hormone responses to coalitional, physical competition during middle childhood. Here, we investigate testosterone, dehydroepiandrosterone (DHEA), androstenedione, and cortisol release among ethnically Chinese boys in Hong Kong (N = 102), aged 8-11 years, during a soccer match (n = 84) and an intrasquad soccer scrimmage (n = 81), with 63 participants competing in both treatments. The soccer match and intrasquad soccer scrimmage represented out-group and in-group treatments, respectively. Results revealed that testosterone showed no measurable change. DHEA increased during both treatments in the majority of participants and the degree of change had no relation to independent variables (e.g., performance, age, treatment, outcome) or covariate measures (Body Mass Index, Pubertal Development Scale). Most boys experienced androstenedione increases during match play, but no significant differences during the intrasquad soccer scrimmage competitions. The magnitude of change differed significantly between treatments and was positively associated with age. These latter findings suggest boys' androstenedione responses may be sensitive to competitor type (i.e., unknown competitors vs. peers). For most subjects, cortisol significantly increased during match play, decreased during the intrasquad soccer scrimmage, and differed significantly between treatments, suggesting each treatment promoted a different psychological state among competitors. Cortisol/DHEA molar ratio decreased during the intrasquad scrimmage, suggestive of a more relaxed mental state. These data shed new light on potential proximate mechanisms associated with coalitional competition among prepubescent boys, with relevance to adrenarche and life history theory.

The Diurnal Variation on Cardiovascular Endurance Performance of Secondary School Athlete Student.

BACKGROUND: The previous investigations in diurnal variation of endurance sports performance did not reach a consensus and have been limited. This study would be a valuable resource for endurance sports trainers and event managers to plan their training and competition in a specific time of day. OBJECTIVES: The aim of this study is to find out the diurnal variation in cardiovascular endurance performance in the young athletes. MATERIALS AND METHODS: Thirty five athlete students (15.17 ± 1.62 years) participated in this study. Maximal oxygen uptake (VO2max), post-exercise percentage of maximal heart rate (MHR% post-ex), post-exercise body temperature (BTemppost-ex), and post exercise blood lactic acid level (LApost-ex) were measured in this study. Three non-consecutive testings: A) Morning (09:00-10:00; AM), B) Noon (12:00-13:00; NN) and C) Afternoon (16:00-17:00; PM) were conducted. Participants were required to follow the meal plan and resting schedule for all testing days. RESULTS: VO2max was significantly higher at NN (F2. 68 = 3.29, P < 0.05, η2 = 0.088) in comparison with PM. The MHR%post-ex, BTemppost-ex, LApost-ex was not significantly different among three times of day. CONCLUSIONS: Diurnal effect on endurance performance was found and the highest exercise VO2max was identified at noon. Secondary school students or young athletes are recommended to have sports training related to VO2max at noon for the purpose of maximizing training effectiveness.