Cardiology Care and Loss to Follow-Up Among Adults With Congenital Heart Defects in CH STRONG.

Many of the estimated 1.4 million adults with congenital heart defects (CHDs) in the United States are lost to follow-up (LTF) despite recommendations for ongoing cardiology care. Using 2016 to 2019 CH STRONG (Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG) data, we describe cardiac care among community-based adults with CHD, born in 1980 to 1997, identified through state birth defects registries. Our estimates of LTF were standardized to the CH STRONG eligible population and likely more generalizable to adults with CHD than clinic-based data. Half of our sample were LTF and more than 45% had not received cardiology care in over 5 years. Of those who received care, only 1 in 3 saw an adult CHD physician at their last encounter. Not knowing they needed to see a cardiologist, being told they no longer needed cardiology care, and feeling "well" were the top reasons for LTF, and only half of respondents report doctors discussing the need for cardiac follow-up.

Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance.

OBJECTIVES: The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory. BACKGROUND: CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device. METHODS: Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics. RESULTS: Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p < 0.01), while no difference was found between the 2 mechanical approaches (28% vs. 35%: p = 0.75). Comparing integrated coronary perfusion pressure showed sequential improvement in hemodynamic support with mechanical devices (401 ± 230 vs. 1,337 ± 905 mm Hg/s; p = 0.06). CONCLUSIONS: Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.

Ant aggregations self-heal to compensate for the Ringelmann effect.

Fire ants, Solenopsis invicta, link their bodies together to form structures such as rafts, bivouacs and bridges. Such structures are in danger of being damaged by natural disturbances such as passing water currents. In this combined experimental and theoretical study, we investigate the self-healing of ant assemblages. We press two ant aggregations together and measure the forces to pull them apart. As the group size increases, the contribution of each ant decreases. This phenomenon, known as the Ringelmann effect, or social loafing, has previously been shown for cattle and humans. In this study, we show that it is a challenge for ants as well. We rationalize this effect with an agent-based simulation which exhibits the Ringelmann effect of ants that periodically make and break links with each other, but grip with higher probability if the ants are stretched. Over time, ants compensate for the Ringelmann effect by building more links. We use a mathematical model to show that the rate of new links is proportional to the number of free ants in the cluster. The principles found here may inspire new directions in self-healing and active materials.

A spatially and temporally explicit risk assessment for salmon from a prey base exposed to agricultural insecticides.

This risk assessment applied a framework for determining probable co-occurrence of juvenile spring Chinook salmon (Oncorhynchus tshawytscha) with agricultural pesticides in the Willamette Basin, Oregon (Teply et al. this issue) to characterize risk to the threatened population. The assessment accounted for spatial and temporal distribution of 6 acetylcholinesterase-inhibiting insecticides in salmonid habitat within the basin and their relative contributions to mixture toxicity estimated from chemical monitoring data. The 6 insecticides were chlorpyrifos, diazinon, malathion, carbaryl, carbofuran, and methomyl. Seasonal distributions of the juvenile salmon prey base across the basin were determined and compared to co-occurrence with the insecticide mixture to determine the probability of prey reduction and reduced production of juvenile fish. Probability of effect on freshwater aquatic invertebrates was based on acute toxicity species sensitivity distributions (normalized to the most potent compound, chlorpyrifos) using a novel approach to apply the toxicological concept of concentration addition to species sensitivity distributions with differing slopes. The chlorpyrifos distribution was then used to determine relative sensitivity among various species tested within the important taxa making up the prey base. A prey base index was devised, incorporating diet composition and prey availability, to evaluate the indirect effects of the insecticide mixture on juvenile salmon production occurring as a result of a reduction in the prey base. Our analysis targeted fish use of backwater and off-channel habitat units, because they generally coincide with agricultural lands in lowlands and represent shallow habitat with limited water exchange. The percentage of agricultural land use within 300 m of critical habitat stream reaches was used to scale chemical measurement data from a site with high agricultural land use across the full extent of the basin to provide estimates of chemical exposure in each reach. Seasonal impacts were evaluated from mean monthly concentrations. Stressor impact on 5 key taxa was evaluated at each time step and for each reach, and the outcome was compared to a conservation threshold assigned to the prey base index. Only 13% of juveniles reared in backwater, off-channel habitat within 300 m of agricultural land. Percent reduction of carrying capacity as a consequence of reduced prey was estimated to be 5% over the entire brood year. This can be considered lost capacity that is probably compensated elsewhere via increased occupancy (emigration to other habitat units within the reach), which is not accounted for in the model.

PTH stimulated growth and decreased Col-X deposition are phosphotidylinositol-3,4,5 triphosphate kinase and mitogen activating protein kinase dependent in avian sterna.

Type X collagen (Col-X) deposition is a marker of terminal differentiation during chondrogenesis, in addition to appositional growth and apoptosis. The parathyroid hormone/parathyroid hormone related peptide (PTH/PTHrP) receptor, or PPR, is a G-Protein coupled receptor (GPCR), which activates several downstream pathways, moderating chondrocyte differentiation, including suppression of Col-X deposition. An Avian sterna model was used to analyze the PPR GPCR downstream kinase role in growth rate and extracellular matrix (ECM) including Col-II, IX, and X. Phosphatidylinositol kinase (PI3K), mitogen activating protein kinase (MAPK) and protein kinase A (PKA) were inhibited with specific established inhibitors LY294002, PD98059, and H89, respectively to test the hypothesis that they could reverse/inhibit the PTH/PTHrP pathway. Excised E14 chick sterna were PTH treated with or without an inhibitor and compared to controls. Sternal length was measured every 24 hr. Cultured sterna were immuno-stained using specific antibodies for Col-II, IX, or X and examined via confocal microscopy. Increased growth in PTH-treated sterna was MAPK, PI3K, and PKA dose dependent, suggesting growth was regulated through multiple pathways. Col-X deposition was rescued in PTH-treated sterna in the presence of PI3K or MAPK inhibitors, but not with the PKA inhibitor. All three inhibitors moderately disrupted Col-II and Col-IX deposition. These results suggest that PTH can activate multiple pathways during chondrocyte differentiation.