Procalcitonin Dynamics After Long-Term Ventricular Assist Device Implantation.

BACKGROUND: Infectious complications (IC) are one of the main causes of worsening prognosis after long-term ventricular assist device (LVAD) implantation. Procalcitonin (PCT) is widely used for diagnosis of a bacterial infection. The objective of this study was to assess PCT dynamics after LVAD surgery and their relationship to the infectious complications. METHODS: A total of 25 consecutive patients indicated for LVAD implantation as a bridge to heart transplant were included. Procalcitonin levels were prospectively assessed before surgery and during the postoperative period (day 1, 2, 14 and 30). Values were compared according to the presence of IC. RESULTS: Procalcitonin levels were low before surgery, raised significantly within 1st and 2nd day after operation and decreased in the 14th and 30th days back to the baseline. There was no significant difference in PCT values between patients with or without IC as well as with or without right ventricle assist device (RVAD). Acute renal failure (ARF) increased PCT significantly only 14 days after LVAD implantation. In patients with ARF and/or RVAD we observed significantly higher PCT values in the 2nd, 14th and 30th day after operation. In subjects with IC and/or ARF and/or RVAD we also observed significantly elevated PCT concentrations 2 and 14 days after surgery. CONCLUSIONS: Our data show that the ability of PCT to detect IC in patients after LVAD implantation is limited and its concentrations more likely correlate with postoperative complications in general.

Sonochemical synthesis of Gd3+ doped CoFe2O4 spinel ferrite nanoparticles and its physical properties.

In this work, a facile and green method for gadolinium doped cobalt ferrite (CoFe2-xGdxO4; x=0.00, 0.05, 0.10, 0.15, 0.20) nanoparticles by using ultrasonic irradiation was reported. The impact of Gd3+ substitution on the structural, magnetic, dielectric and electrical properties of cobalt ferrite nanoparticles was evaluated. The sonochemically synthesized spinel ferrite nanoparticles were characterized by X-ray Diffraction (XRD), scanning electron microscopy (SEM), Raman spectroscopy, Fourier transform infrared (FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS), vibrating sample magnetometer (VSM). X-ray diffraction (XRD) study confirmed the formation of single phase spinel ferrite of CoFe2-xGdxO4 nanoparticles. XRD results also revealed that ultrasonic irradiation seems to be favourable to achieve highly crystalline single crystal phase gadolinium doped cobalt ferrite nanoparticles without any post annealing process. Fourier Transform Infrared and Raman Spectra confirmed the formation of spinel ferrite crystal structure. X-ray photoelectron spectroscopy revealed the impact of Gd3+ substitution in CoFe2O4 nanoparticles on cation distribution at the tetrahedral and octahedral site in spinel ferrite crystal system. The electrical properties showed that the Gd3+ doped cobalt ferrite (CoFe2-xGdxO4; x=0.20) exhibit enhanced dielectric constant (277 at 100Hz) and ac conductivity (20.2×10-9S/cm at 100Hz). The modulus spectroscopy demonstrated the impact of Gd3+ substitution in cobalt ferrite nanoparticles on grain boundary relaxation time, capacitance and resistance. Magnetic property measurement revealed that the coercivity decreases with Gd3+ substitution from 234.32Oe (x=0.00) to 12.60Oe (x=0.05) and further increases from 12.60Oe (x=0.05) to 68.62Oe (x=0.20). Moreover, saturation magnetization decreases with Gd3+ substitution from 40.19emu/g (x=0.00) to 21.58emu/g (x=0.20). This work demonstrates that the grain size and cation distribution in Gd3+ doped cobalt ferrite nanoparticles synthesized by sonochemical method, is effective in controlling the structural, magnetic, and electrical properties, and can be find very promising applications.

Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction.

Clinical data on optimal management of mechanical complications of myocardial infarction are lacking. We retrospectively evaluated the effect of intra-aortic balloon pump (IABP) on 30-day survival in patients with postinfarction ventricular septal rupture (VSR, n = 55) or acute mitral regurgitation (MR, n = 26) who developed either cardiogenic shock (n = 46) or severe hemodynamic instability that did not fulfill the criteria of shock (n = 35). IABP was inserted in 83% of the patients with shock and 57% of those without shock. Thirty-five (76%) patients with shock and all unstable patients survived until surgical repair, which was performed within a median (interquartile range) of 1 (1 to 2) and 9 (2 to 18) days from the onset of the complication (p <0.001). All patients who did not undergo the operation died within 3 days. Although MR presented more acutely, the patients' outcomes were similar to those with VSR. IABP support reduced 30-day mortality in the patients with shock (61% vs 100%, p = 0.04) but not in the patients without shock (20% vs 27%, p = 0.7). The benefit of IABP support in the shock cohort was driven mainly by reduction of preoperative mortality (11% vs 88%, p <0.001). Early progression of cardiogenic shock and unperformed surgery were the only independent predictors of 30-day mortality (hazard ratio 3.4, 95% confidence interval 1.5 to 8 and hazard ratio 5.1, 95% confidence interval 2.2 to 11, respectively; p = 0.004 and p <0.001, respectively). In conclusion, we suggest that all patients with postinfarction VSR or acute MR with signs of cardiogenic shock should immediately receive IABP as a bridge to emergent surgical repair. In contrast, hemodynamically unstable patients without shock may be first stabilized by medical therapy, without additional benefit of IABP, before they undergo cardiac surgery.