Lung proliferation is dependent on the duration not the timepoint of tracheal occlusion in nitrofen rats with diaphragmatic hernia.

OBJECTIVE: Prenatal tracheal occlusion (TO) promotes lung growth and is applied clinically in fetuses with congenital diaphragmatic hernia (CDH). Limited data are available regarding the effect of duration versus timepoint of TO. Our objective was to document the impact of TO on lung development in the near-term period in rats with nitrofen-induced CDH. METHOD: Nitrofen was administered on embryonic day (ED)9 and fetal TO was performed on ED18.5, 19, or 20 (term = ED22). Sham-operated and untouched littermates served as controls. Lungs were harvested in 0.5-day steps and only fetuses with a left-sided CDH were included in further analyses. Healthy fetuses provided a reference for normal near-term lung development. RESULTS: Duration of TO in the nitrofen rat model for CDH predicts lung growth in terms of lung-body-weight ratio as well as an increased mRNA level of the proliferation marker Ki67. Longer TO also induced a more complex airway architecture. The timepoint of TO was not predictive of lung growth. CONCLUSION: In the nitrofen rat model of CDH, a longer period of TO leads to enhanced lung growth and more refined airway architecture.

Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience.

AIMS: Owing to the increasing use of cardiac implantable electronic devices, there is a growing need for safe and effective techniques to manage device-related complications and lead dysfunction. Lead extraction remains a challenging procedure with inherent risks. We present the 30-day and long-term outcomes of lead extractions in the University Hospitals Leuven. METHODS AND RESULTS: We report a retrospective cohort study of 176 patients admitted to the University Hospitals Leuven between January 2005 and December 2011, for the transvenous extraction of 295 leads. Indications for extraction were lead dysfunction and device upgrade in 84 (47.7%), pocket infection in 61 (34.7%), and systemic infection in 31 patients (17.6%). Extraction was successful in 95.5% of patients with complete removal of the leads or only a minor fragment remaining. One fatal peri-procedural complication occurred. Thirty-day mortality was 3.4% (n = 6). Systemic infection was the only significant predictor of 30-day mortality [odds ratio (OR) 29.706; P = 0.029]. A lower level of haemoglobin prior to extraction also tended to be related with a higher mortality, but this was not significant (OR 2.024; P = 0.082). One-year mortality was 8.5% (n = 15). Systemic infection (OR 9.727; P = 0.009), a lower level of haemoglobin (OR 1.597; P = 0.05), and a higher level of ureum (OR 1.021; P = 0.017) prior to extraction were significant predictors of 1-year mortality. Systemic infection was associated with significantly higher 30-day (19%), 1-year (32%), and long-term (39%) mortality rates. CONCLUSION: Lead extraction can be safely and successfully performed in the majority of patients, with limited life-threatening complications. However, lead extraction because of systemic infection is associated with a significantly higher risk of short- and long-term mortality.

A longer tracheal occlusion period results in increased lung growth in the nitrofen rat model.

OBJECTIVE: Prenatal tracheal occlusion (TO) promotes lung growth and is applied clinically in fetuses with severe congenital diaphragmatic hernia. Limited data are available regarding the effect of duration of TO on lung development. Our objective was to evaluate the effects of long (2 and 2.5 days) versus short (1 day) TO on lung development in rats with nitrofen-induced diaphragmatic hernia. METHOD: Nitrofen was administered on embryonic day (ED) 9 and fetal TO performed either on ED18.5, 19 or 20 (term = 22 days). Sham-operated and untouched littermates served as controls. On ED21, lungs were harvested and only fetuses with a left-sided diaphragmatic defect were included in further analyses. RESULTS: Lung-body-weight ratio incrementally increased with the duration of TO. Increased proliferation following long TO was confirmed by immunohistochemistry and qRT-PCR for the proliferation marker Ki-67. Irrespective of duration, TO induced more complex airway architecture. Medial wall thickness of pulmonary arteries was thinner after long rather than short TO. CONCLUSION: In the nitrofen rat model of congenital diaphragmatic hernia, a longer period of TO leads to enhanced lung growth and less muscularized pulmonary arteries.