Sepsis in cardiothoracic surgery.

Sepsis is a life-changing condition that can occur in patients undergoing cardiothoracic surgery. It is characterized by a dysregulated inflammatory response to infection, often leading to higher rates of organ dysfunction and mortality. The importance of early recognition and prompt intervention in managing sepsis-related complications in cardiothoracic surgery is pivotal to adequate surgical practice. Due to the multiple subsections that construct the broad spectrum of cardiothoracic surgery, it is important to address the presence of sepsis in elective cardiothoracic surgery, urgent/emergency cardiothoracic surgery, solid organ transplantation, and both temporary and permanent mechanical circulatory support (ie, left ventricular assist devices, extracorporeal membrane oxygenation, and percutaneous temporary devices [eg, Impella series]). Exploring the incidence, prevalence, and risk factors of said subsections can lead to improvement in postoperative outcomes. The impact of accompanying infections can progress into further operative morbidity and mortality. To this effect, the perioperative management of cardiothoracic surgery transcends surgical techniques and should undergo additional recognition of other occurrences such as wound infections, bloodstream infections, urinary tract infections, and pneumonia. Sepsis remains a concern in cardiothoracic surgery, as it can lead to devastating consequences. Hence, there is an evident need for heightened vigilance, early recognition, and effective management strategies to mitigate the risk of sepsis in this patient population. The purpose of this article is to provide an overview of sepsis in the different cardiothoracic surgery areas.

The dual prevalence of advanced degrees of obesity and heart failure: a study from the National Inpatient Sample database.

BACKGROUND: National prevalence rates for obesity and heart failure (HF) have been steadily increasing, which predisposes patients to higher morbidity and mortality rates. OBJECTIVES: The purpose of this study was to evaluate the prevalence of HF stages in hospitalized patients according to their body mass index (BMI). SETTING: Academic institution. METHODS: National Inpatient Sample data from 2016 to 2018 were examined to identify patients with obesity, HF (presence or absence of advanced HF [AHF]), and cardiogenic shock (CS). The proportion of hospital admissions was determined for each category on the basis of the presence of AHF with/without CS. A comparative analysis was performed between patients with and without AHF, and multivariate logistic regression analysis was performed for the event of AHF. The same analyses were performed for the event of CS. RESULTS: A total of 3,354,970 hospital admissions were identified. The prevalence of hospital admissions with a diagnosis of AHF and class III obesity and a diagnosis of CS and class III obesity was 21% and .5%, respectively. The prevalence of AHF and other classes of BMI and CS and other classes of BMI was 17% and .5%, respectively. The univariate analysis showed that there were significant variations in 10 factors between hospital admissions with/without the diagnosis of both AHF and CS. Statistical analyses indicated the following findings: Hospitalized patients in higher obesity groups are more likely to have AHF, and they are less likely to have CS compared with those with a BMI of ≤29.9. CONCLUSIONS: This study revealed that the prevalence of AHF was significantly higher in hospitalized patients with class III obesity. These findings have implications for clinical management, and it can be inferred that these patients are less likely to receive advanced cardiac replacement therapies and might benefit from innovative approaches to address severe dual morbidity.

Protein dynamics detected by magic-angle spinning relaxation dispersion NMR.

Magic-angle spinning (MAS) nuclear magnetic resonance (NMR) is establishing itself as a powerful method for the characterization of protein dynamics at the atomic scale. We discuss here how R1ρ MAS relaxation dispersion NMR can explore microsecond-to-millisecond motions. Progress in instrumentation, isotope labeling, and pulse sequence design has paved the way for quantitative analyses of even rare structural fluctuations. In addition to isotropic chemical-shift fluctuations exploited in solution-state NMR relaxation dispersion experiments, MAS NMR has a wider arsenal of observables, allowing to see motions even if the exchanging states do not differ in their chemical shifts. We demonstrate the potential of the technique for probing motions in challenging large enzymes, membrane proteins, and protein assemblies.

The pandemic effect: The outlook of lung transplantation.

Lung transplant (LT) is a life-saving treatment for patients with end-stage lung disease. In the setting of COVID-19-associated acute respiratory distress syndrome (ARDS), LT emerged as a therapeutic option for select cases. It is challenging to determine the extent of the knowledge and interest the United States (US) general population has on LT as salvage therapy during and following the COVID-19 pandemic. It is the authors' opinion that patient therapeutic education (PTE) can directly influence established practices by creating an open channel of communication based on needs and expectations for healthcare services. This perspective is a cursory reflection of the nuances between healthcare providers, their services, the interests and expectations of the general population, specifically on LT following COVID-19. The main endpoint of this study is to analyze the US general population's interest in LT as COVID-19 salvage therapy via the Google Trends (GT) web-kit tool.

A distinct mechanism of C-type inactivation in the Kv-like KcsA mutant E71V.

C-type inactivation is of great physiological importance in voltage-activated K+ channels (Kv), but its structural basis remains unresolved. Knowledge about C-type inactivation has been largely deduced from the bacterial K+ channel KcsA, whose selectivity filter constricts under inactivating conditions. However, the filter is highly sensitive to its molecular environment, which is different in Kv channels than in KcsA. In particular, a glutamic acid residue at position 71 along the pore helix in KcsA is substituted by a valine conserved in most Kv channels, suggesting that this side chain is a molecular determinant of function. Here, a combination of X-ray crystallography, solid-state NMR and MD simulations of the E71V KcsA mutant is undertaken to explore inactivation in this Kv-like construct. X-ray and ssNMR data show that the filter of the Kv-like mutant does not constrict under inactivating conditions. Rather, the filter adopts a conformation that is slightly narrowed and rigidified. On the other hand, MD simulations indicate that the constricted conformation can nonetheless be stably established in the mutant channel. Together, these findings suggest that the Kv-like KcsA mutant may be associated with different modes of C-type inactivation, showing that distinct filter environments entail distinct C-type inactivation mechanisms.

Comparison of the characteristics, morbidity and mortality of COVID-19 between first and second/third wave in a hospital setting in Lombardy: a retrospective cohort study.

Coronavirus disease 2019 (COVID-19) represents a major health problem in terms of deaths and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand the determinants of outcome in two different COVID-19 outbreaks. A total of 634 unvaccinated patients admitted from local emergency room to the Internal Medicine ward with a confirmed diagnosis of SARS-CoV-2 infection and a moderate-to-severe COVID-19 were included in the study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 374 consecutive patients during SARS-CoV-2 2nd/3rd wave (from October 2020 to May 2021) were considered. Demographic data were not significantly different between waves, except a lower prevalence of female sex during first wave. Mortality was significantly higher during the 1st wave than in the following periods (24.2% vs. 11%; p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (8 ± 6 vs. 6 ± 4 days; p < 0.001), while in-hospital staying was significantly shorter (10 ± 14 vs. 15 ± 11 days; p < 0.001). Other significant differences were a larger use of corticosteroids and low-molecular weight heparin as well less antibiotic prescription during the second wave. Respiratory, bio-humoral and X-ray scores were significantly poorer at the time of admission in first-wave patients. After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen on admission to the Internal Medicine ward and length of hospital stay and duration of symptoms were the strongest predictors of outcome. Concomitant anti-hypertensive treatment (including ACE-inhibitors and angiotensin-receptor blockers) did not affect the outcome. In conclusion, our data suggest that earlier diagnosis, timely hospital admission and rational use of the therapeutic options reduced the systemic inflammatory response and were associated to a better outcome during the 2nd/3rd wave.

High-Resolution Studies of Proteins in Natural Membranes by Solid-State NMR.

Membrane proteins are vital for cell function and thus represent important drug targets. Solid-state Nuclear Magnetic Resonance (ssNMR) spectroscopy offers a unique access to probe the structure and dynamics of such proteins in biological membranes of increasing complexity. Here, we present modern solid-state NMR spectroscopy as a tool to study structure and dynamics of proteins in natural lipid membranes and at atomic scale. Such spectroscopic studies profit from the use of high-sensitivity ssNMR methods, i.e., proton-(1H)-detected ssNMR and DNP (Dynamic Nuclear Polarization) supported ssNMR. Using bacterial outer membrane beta-barrel protein BamA and the ion channel KcsA, we present methods to prepare isotope-labeled membrane proteins and to derive structural and motional information by ssNMR.