Background Cardiac transplantation remains the most effective treatment for patients with end-stage heart failure, but its use is limited by donor organ shortage. Expanding donor acceptance criteria may increase the availability of transplantable hearts. Left ventricular dysfunction due to neurogenic stunned myocardium is common among organ donors and is characterised by rapid functional and structural recovery. The IMPROVED Heart (IMPact of donor heart function on Recipient Outcomes: a prospectiVE observational study to increase the utilisation of Donor Hearts) study aims to increase the number of heart transplantations by systematically evaluating and using donor hearts with temporarily impaired function.Methods and analysis IMPROVED Heart is a prospective, multicentre observational study. The primary objective is to determine whether recipients of donor hearts with regional wall motion abnormalities and/or mild to moderate global left ventricular dysfunction have outcomes comparable to recipients of hearts with normal function. Cardiac function in potential heart donors is assessed systematically using repeated echocardiography in addition to cardiac biomarkers and clinical data. Heart transplant recipients are managed according to routine clinical practice. Based on a non-inferiority power calculation, 445 transplanted hearts—including at least 89 with impaired function—are required. The study started enrolling in 2022.Ethics and dissemination The study was approved by the Swedish Ethical Review Authority in March 2020 (Dnr 2019-06229). Study findings will be presented at scientific meetings and published in international peer-reviewed journals.Trial registration number NCT04393181

BACKGROUND:Right atrial pressure (RAP) is a key determinant of venous return and reflects right-sided filling pressures in critically ill patients. Central venous pressure (CVP) is commonly used as a surrogate, but its accuracy depends on appropriate transducer levelling. While reference points have been evaluated in supine positions, evidence is lacking for the lateral position, despite its frequent use in intensive care. Furthermore, it remains unclear whether lateral positioning alters RAP itself. METHODS:In this prospective observational study, 16 sedated, mechanically ventilated ICU patients with central venous catheters were included. RAP was measured using a solid-state catheter positioned in the mid-right atrium, confirmed by waveform analysis and echocardiography. Simultaneous CVP was recorded with the transducer levelled 5 cm below the mid-sternum. Measurements were obtained at end-expiration in supine, 45° left lateral, and 45° right lateral positions. Agreement between RAP and CVP was assessed using Bland-Altman analysis, intraclass correlation coefficients, and predefined clinical thresholds. Stepwise hydrostatic adjustments were applied to identify optimal reference levels. RESULTS:In the right lateral position, CVP referenced 5 cm below the sternum closely approximated RAP (bias -0.4 mmHg; limits of agreement -3.2 to +2.4; ICC 0.85). In the left lateral position, the same reference point systematically overestimated RAP (bias -2.2 mmHg; limits of agreement -5.0 to +0.7; ICC 0.58). Adjustment to approximately 2 cm below the sternum minimised bias (-0.1 mmHg) and improved agreement (ICC 0.82). RAP increased in the right lateral position compared with both supine (Δ +2.9 mmHg, p < 0.001) and left lateral (Δ +2.8 mmHg, p < 0.001) positions, while no difference was observed between supine and left lateral positions (p = 0.78). CONCLUSION:In mechanically ventilated ICU patients, central venous pressure accuracy was position-dependent, and optimal external reference levels differed between lateral positions. Right atrial pressure increased in the right lateral position, suggesting that lateral positioning influences cardiopulmonary physiology beyond hydrostatic measurement effects alone. TRIAL REGISTRATION:https://clinicaltrials.gov/study/NCT06705374, registration date 30 April 2024 EDITORIAL COMMENT: The study showed that central venous pressure systematically overestimated right atrial pressure in mechanically ventilated patients placed in the left lateral position. This means that preload and venostasis can be misinterpreted in this position. The influence of increased right atrium pressure on venous return and cardiac output during left lateral positioning in mechanically ventilated patients requires further studies before the clinical relevance can be assessed.

Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after heart transplantation (HTx). We retrospectively analyzed 830 consecutive HTx performed between 1984 and 2021. After excluding patients <18 years and those with missing data, 667 adult recipients remained. ISHLT PGD criteria were applied and perioperative variables and outcomes were reviewed. PGD occurred in 70 patients (10.5%), including 41 (6.1%) with left ventricular PGD and 29 (4.3%) with right ventricular PGD. Most LV-PGD cases were severe (88%). Patients with PGD were younger and more frequently had pretransplant dialysis, ventricular assist device support, or prior cardiac surgery. No donor-related factors were associated with PGD. Recipient-related factors and longer cardiopulmonary bypass time were associated with increased risk. PGD was associated with prolonged mechanical ventilation and ICU stay, and increased need for mechanical circulatory support, dialysis, reoperation, and treatment for sepsis. Mortality or re-transplantation was significantly higher in PGD patients at 30 days (45% vs. 3%) and 1 year (51% vs. 8%; HR 6.89, 95% CI 4.01–11.83, p < 0.0001).

INTRODUCTION:Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences. METHODS:We conducted an international online survey of ICU doctors and nurses. The 16-question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession. RESULTS:We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10 mmol/L. Long-acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM-treatment protocol. CONCLUSIONS:Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long-acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol. EDITORIAL COMMENT:This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as-needed and long-acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point-of-care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.

OBJECTIVES:Since the onset of the COVID-19-pandemic, emerging virus variants, increasing population immunity, and evolving treatment strategies have substantially altered disease severity. This study aimed to identify predictors of critical illness due to COVID-19 over time and compare them with those of seasonal influenza in Sweden. DESIGN, SETTING, PATIENTS, AND MEASUREMENTS:We conducted a retrospective, population-based cohort study using nationwide registry data. All individuals hospitalized for COVID-19 between 2020 and 2022 were categorized into five groups, based on pandemic waves and dominating virus variants. A sixth group included all patients hospitalized for influenza between 2018 and 2022. Patients were followed from hospitalization until ICU admission, in-hospital death, discharge, or end of study. Incidence rates were calculated and Cox regression identified predictors of ICU admission and in-hospital mortality, adjusting for age, sex, socioeconomic factors, comorbidities, and severe acute respiratory syndrome corona virus 2-vaccination. Data on influenza vaccinations were not available from the registers. MAIN RESULTS:We included 92,428 COVID-19 hospitalizations and 21,355 influenza hospitalizations. Hospitalization rates were lowest during the delta-dominant period, while ICU admission rates were lowest during the Omicron-dominant period. The Omicron period most closely resembled influenza inpatient demographics, hospital stay duration, ICU admissions, and in-hospital mortality. Age distributions varied across pandemic periods, with the Omicron period showing an age profile similar to influenza (≈ 50% ≥ 75 yr). Adjusted hazard ratios for ICU-admission were strongest in unvaccinated patients, males, and individuals of 45-74 years for COVID-19, and in individuals of 45-64 years or with chronic lung diseases for influenza. Common predictors of in-hospital mortality included age older than 45 years (with a sharp increase after 74), male sex, and chronic comorbidities, and for COVID-19 also unvaccinated status. CONCLUSIONS:Although COVID-19 consistently resulted in higher hospitalization rates than influenza, demographic and clinical patterns converged during the later pandemic stages. Advanced age was the strongest predictor of severe illness in both infections, with lack of vaccination additionally associated with severe COVID-19.

In the intensive care unit (ICU), conventional assessment of left ventricular systolic function relies on left ventricular ejection fraction (LVEF), but LVEF often has limited prognostic ability. Measures of longitudinal LV performance [global longitudinal strain (GLS), mitral annular plane systolic excursion (MAPSE), and tissue Doppler–derived systolic velocity (S’)] are increasingly used in critical care echocardiography and may capture clinically relevant dysfunction better than LVEF. To date, the prognostic implications of GLS, MAPSE, and S’ have been studied mainly in septic cohorts, while their feasibility and prognostic value in mixed ICU populations remain uncertain. We therefore aimed to evaluate the feasibility and prognostic value of these parameters in a mixed ICU cohort. In this exploratory secondary analysis of a prospective observational ICU cohort, transthoracic echocardiography was performed within 24 hours of ICU admission. LVEF by Simpson biplane, GLS, MAPSE, and S’ were analysed offline. Feasibility was quantified as the proportion of patients with analysable measurements. Associations between echocardiographic parameters were assessed using simple linear regression and are reported as coefficients of determination (R2). Associations with 90-day mortality were assessed using logistic regression, with adjustment for age, Simplified Acute Physiology Score 3, and cardiac index. Of 411 enrolled patients, 377 had at least one parameter available and were included. Feasibility was 71

BACKGROUND:Postoperative neurocognitive decline is a frequent complication triggered by unclear signalling mechanisms. This observational case-control study investigated the effects of hip or knee replacement surgery on the composition of circulating extracellular vesicles (EVs), potential periphery-to-brain messengers, and their association with neurocognitive outcomes. METHODS:We mapped the microRNAome and proteome of plasma-derived EVs from 12 patients (six with good and six with poor neurocognitive outcomes at 3 months after surgery) at preoperative and postoperative timepoints (4, 8, 24, and 48 h). Complement C3-EV association was confirmed by flow cytometry in plasma- and cerebrospinal fluid (CSF)-derived EVs, with total plasma and CSF C3 and C3a concentrations determined using enzyme-linked immunosorbent assay. RESULTS:Differential expression analysis found eight dysregulated EV microRNAs (miRNAs) exclusively in the poor neurocognitive outcomes group. Pathway analysis suggested potential downregulation of proliferative pathways and activation of extracellular matrix and inflammatory response pathways in EV target tissues. Proteome analysis revealed a time-dependent increase in immune-related EV proteins, including complement system proteins, notably EV surface-associated C3. Such upward kinetics was detected earlier in the poor neurocognitive outcomes group. Interestingly, CSF-derived EVs from the same group showed a drastic drop of C3 at 48 h with unchanged concentrations in the good neurocognitive outcomes group. Functionally, the complement system was activated in both patient groups in plasma, but only in the poor neurocognitive outcomes group in CSF. CONCLUSIONS:Our findings highlight the impact of surgery on plasma- and CSF-derived EVs, particularly in patients with poor neurocognitive outcomes, indicating a potential role for EVs. The small sample size necessitates verification with a larger patient cohort.

PURPOSE:Ovarian cancer ranks as a gynecological malignancy with poor prognosis, specifically if detected late. Primary treatment includes cytoreductive surgery and adjuvant chemotherapy with curative intent. Local anesthetics (LA) administered in the perioperative period may potentially impact patient outcome by several mechanisms. The beneficial impact of LA has been attributed, among other factors, to the drug's inhibitory effect on cancer cells. The primary aim of the study was to evaluate the effect of clinically relevant concentrations of ropivacaine and lidocaine on ovarian cancer cell lines. METHOD:Three ovarian cancer cell lines (SKOV-3, SW-626 and CA-OV-3) were treated with 1, 10, 100, or 1000 ​μM of the two LAs. Cell function and morphology were assessed in the following ways: cell counting, phase-contrast and holographic microscopy, a conventional MTT assay for dose response testing, wound healing assay for migration, and cancer stem cell (CSC) identification by aldehyde dehydrogenase. RESULTS:Both ropivacaine and lidocaine significantly reduced cell number, altered morphology, suppressed migration, and decreased the population of CSCs in a concentration-dependent manner. CONCLUSION:LAs exert a direct inhibitory effect on ovarian cancer cell lines in vitro, suggesting their potential benefits in perioperative management for patients undergoing surgery. Clinical studies using LA during ovarian cancer surgery are needed.

In septic shock, administration of large fluid volumes is associated with poor outcomes. Recent evidence shows that non-resuscitation fluids are the major modifiable source of fluids for patients with septic shock in intensive care units (ICUs). This clinical trial is designed to test the hypothesis that restrictive administration of non-resuscitation fluids improves outcomes compared to usual care. Adult patients admitted to ICUs with septic shock will be randomly assigned within 12 h of admission to receive protocolized restrictive administration of non-resuscitation fluids or usual care. The primary outcome is all-cause mortality at 90 days. Secondary outcomes are complications during ICU stay up to 90 days (defined as any acute kidney injury or cerebral, coronary, intestinal, or limb ischemia), mechanical ventilation free days within 90 days, and for survivors cognitive function (by the Montreal Cognitive Assessment [MOCA-BLIND]) and Health-Related Quality of Life (by the EQ Visual Analogue Scale [EQ-VAS]), both at 6 months. In addition, the climate impact of the interventions will be assessed. To detect an absolute reduction in mortality of 7.5%, with an alpha of 5% and a power of 90%, we aim to include 1850 patients. The trial is approved by the Swedish Ethical Review Authority. Results of primary and secondary clinical outcomes and the environmental outcome will be submitted for publication in a peer-reviewed journal. Trial Registration: NCT06140147.

Background:Primary graft dysfunction (PGD) remains a leading cause of early morbidity and mortality in lung transplantation. PGD is characterized by diffuse alveolar damage and the accumulation of extravascular lung water in the transplanted lung. Pre-existing injury and stress during the donation process are further aggravated by ischemia-reperfusion injury occurring during donation and transplantation. This study examines the relationship between adjusted donor lung weight, a surrogate for extravascular lung water, and outcomes following bilateral lung transplantation. Methods:We retrospectively analyzed 194 bilateral lung transplantations performed between January 2014 and May 2021. Donor lung weights were recorded after procurement, adjusted for body surface area, and categorized into quartiles. The primary outcomes assessed were the incidence of PGD (grades II and III) and duration of intensive care unit (ICU) stay. Secondary outcomes included mechanical ventilation duration, pulmonary function at discharge, and one-year mortality. Results:The incidence of PGD was significantly higher in the upper 4th quartile group ("high-weight," 22.9%) compared with the three lower quartile groups ("low-weight," 8.9%) (p = .020). Multivariate regression identified adjusted lung weight as an independent risk factor for PGD. The "low-weight" group showed higher rates of early extubation within 72 hours of lung transplantation (90.9% vs 83.0%, p = 0.048) and shorter ICU stays (median 3 vs 5 days, p = 0.026). No significant differences were found in ventilation duration, spirometry values, or 1-year survival. Conclusion:Adjusted donor lung weight is an independent predictor of PGD, suggesting that higher lung weights contribute to worse early outcomes post-transplant. Incorporating lung weight into donor assessment may improve recipient management and outcomes.

Objectives: Mental fatigue is a common and debilitating symptom following an aneurysmal subarachnoid hemorrhage (aSAH). However, its long-term prevalence and consequences remain unclear. In this longitudinal pilot study, the Mental Fatigue Scale (MFS) was used to evaluate the prevalence, severity, and dynamics of mental fatigue for up to 5 years and to correlate patient demographics and early complications to the development of mental fatigue.Method: Functional outcomes were scored using the Glasgow Outcome Scale-Extended (GOSE) during telephone interviews 1, 3, and 5 years after aSAH. The MFS questionnaires (maximum score 42, >= 10.5 points indicating mental fatigue) were subsequently sent by mail. Patient admission data and events during the acute phase were recorded.Results: Of 64 included patients, 31 could be assessed at all time points. Mental fatigue (MFS score >= 10.5) was present in 58%, 48%, and 52% of the patients at 1, 3, and 5 years, respectively. A significant decrease in the total MFS score was observed between 1 and 5 years (p = 0.025). The proportion of patients experiencing severe mental fatigue halved from 1 to 3 years. The median (range) MFS scores were significantly higher for women (14.5, 0-29.5) than for men (3, 0-17.5) at 1 year (p = 0.043). Compared with patients experiencing loss of consciousness at ictus (LOCi), those without LOCi exhibited a progressive decline in the total MFS score (p = 0.003).Conclusions: Although total MFS scores significantly improved, mental fatigue was a common and persistent symptom affecting half of the patients up to 5 years following aSAH. Mental fatigue was more prevalent in women than men; further, patients who experienced LOCi during the acute phase improved less over time. Our results highlight the importance of evaluating mental fatigue when assessing patient recovery and long-term outcomes.Trial Registration: Clinical Trial NCT06239142

Postoperative pulmonary complications, particularly atelectasis, are common after cardiac surgery and may contribute to impaired gas exchange or acute lung injury (ALI). Neurally Adjusted Ventilatory Assist (NAVA) delivers ventilatory support proportional to the patient’s respiratory drive, offering theoretical advantages over Pressure Support Ventilation (PSV), including improved synchrony, enhanced diaphragmatic efficiency, and reduced risk of ventilator-induced lung injury. However, comparative data on gas exchange, dead space, and regional ventilation during weaning after cardiac surgery remain limited. This prospective crossover study evaluated 12 mechanically ventilated patients with mild ALI following cardiac surgery across three ventilation phases: two PSV phases (PSV1 and PSV2) separated by a phase of NAVA. Intrapulmonary shunt fraction was calculated from measurements obtained via a Swan-Ganz catheter. Physiological dead space fraction (VD/VT) was assessed using three methods: the Bohr–Enghoff equation, end-tidal CO₂-derived alveolar dead space fraction (AVDSf-ET), and a novel time-to-volume converted capnographic approach (VCAP-CALC). Regional ventilation was assessed using electrical impedance tomography (EIT), and neuroventilatory efficiency (NVE) was calculated from diaphragmatic electrical activity (EAdi). Data were analyzed using linear mixed-effects models to account for repeated measures and within-subject variability. VD/VT was significantly lower during NAVA compared with PSV1 and PSV2 when assessed by VCAP-CALC (58.5% vs. 63.8% and 61.3%, respectively; p < 0.001). The PaO₂/FiO₂ ratio and NVE were significantly higher during NAVA (p = 0.01 and p = 0.037, respectively). No significant difference in pulmonary shunt fraction was observed. EIT revealed a modest increase in dorsal end-expiratory lung volume during NAVA, without redistribution of tidal volume or Center of Ventilation. The VCAP-CALC method showed strong agreement with established dead space measures (R2 = 0.77–0.82) and demonstrated high repeatability (mean coefficient of variation 3.5%). NAVA is a safe and feasible ventilatory mode following cardiac surgery, associated with reduced dead space fraction, improved oxygenation and enhanced neuroventilatory efficiency. Given that shunt fraction remained unchanged, the observed improvement in ventilation–perfusion (V/Q) matching reflects a reduction in VD/VT. The potential implications for postoperative recovery and long-term outcomes merit evaluation in larger clinical studies. ClinicalTrials.gov: NCT03217305. Initial Release 21/06/2017.

BackgroundUnit-to-unit transfer of critically ill patients infers hazards that may cause adverse events. Circumstantial factors associated with mortality after intensive care include days in the ICU, night-time or weekend discharge and capacity transfer as compared to other reasons for transfer. Distance travelled may also constitute an indirect risk. The aim of this study was to assess potential associations between these circumstantial factors and the risk of death 30 days after transfer.MethodsData from 2015 to 2019 was retrieved from the Swedish Intensive Care Registry. Logistic regression was used for risk analysis.ResultsAmong 4,327 patients, 965 (22%) were deceased 30 days after transfer. 1351 patients undergoing capacity transfer had a higher morbidity than patients transferred for other reasons. Using univariable logistic regression, days spent in the referring ICU before transfer, capacity transfer as compared to clinical transfer and repatriation as well as SAPS3 in the receiving ICU were associated with a higher risk of death at 30 days. However, after multivariable regression with adjustment for ICD-10 diagnosis and Standardised Mortality Rate in the receiving ICU, these associations were lost.ConclusionOur results suggest that inter-hospital transfer is safe to carry out at any time of day and over shorter as well as longer distances.

In critically ill patients, early hemodynamic assessment is essential for guiding shock resuscitation. While cardiac output (CO) is a key indicator of circulatory status, its measurement is often limited by technical and practical constraints. This perspective explores the physiological and clinical relevance of pulse pressure (PP) as a potential surrogate for stroke volume (SV), emphasizing its accessibility at the bedside. The paper discusses how factors such as arterial compliance, vascular tone, and pulse wave amplification influence the PP-SV relationship, often complicating interpretation in acute and complex hemodynamic states. It also examines the effects of vasopressors, vascular decoupling, and catheter site on PP measurements, particularly in septic shock. Despite its limitations, the review highlights how peripheral PP, when carefully interpreted, may aid in identifying low SV and guiding early resuscitation strategies.

BACKGROUND:A prediction model that estimates mortality at admission to the intensive care unit (ICU) is of potential benefit to both patients and society. Logistic regression models like Simplified Acute Physiology Score 3 (SAPS 3) and APACHE are the traditional ICU mortality prediction models. With the emergence of machine learning (machine learning) and artificial intelligence, new possibilities arise to create prediction models that have the potential to sharpen predictive accuracy and reduce the likelihood of misclassification in the prediction of 30-day mortality. METHODS:We used the Swedish Intensive Care Registry (SIR) to identify and include all patients ≥18 years of age admitted to general ICUs in Sweden from 2008 to 2022 with SAPS 3 score registered. Only data collected within 1 h of ICU admission was used. We had 153 candidate predictors including baseline characteristics, previous medical conditions, blood works, physiological parameters, cause of admission, and initial treatment. We stratified the data randomly on the outcome variable 30-day mortality and created a training set (80% of data) and a test set (20% of data). We evaluated several hundred prediction models using multiple ML frameworks including random forest, gradient boosting, neural networks, and logistic regression models. Model performance was evaluated by comparing the receiver operator characteristic area under the curve (AUC-ROC). The best performing model was fine-tuned by optimizing hyperparameters. The model's calibration was evaluated by a calibration belt. Ultimately, we simplified the best performing model with the top 1-20 predictors. RESULTS:We included 296,344 first-time ICU admissions. We found age, Glasgow Coma Scale, creatinine, systolic blood pressure, and pH being the most important predictors. The AUC-ROC was 0.884 in test data using all predictors, specificity 95.2%, sensitivity 47.0%, negative predictive value of 87.9% and positive predictive value of 70.7%. The final model showed excellent calibration. The ICU risk evaluation for 30-day mortality (ICURE) prediction model performed equally well to the SAPS 3 score with only eight variables and improved further with the addition of more variables. CONCLUSION:The ICURE prediction model predicts 30-day mortality rate at first-time ICU admission superiorly compared to the established SAPS 3 score.

Background: Thrombocytopenia affects 12-20% of women with preeclampsia and a low platelet count impairs coagulation. Women with preeclampsia have an increased risk of both cerebral hemorrhage, thromboembolism, and postpartum hemorrhage. Studies of platelet function and coagulation in women with preeclampsia show conflicting results. Therefore, we aimed to study platelet aggregation and coagulation in women with preeclampsia. Method: Women with preeclampsia and women with normotensive pregnancies were included prior to delivery in a prospective observational study as a part of the Gothenburg Preeclampsia Adverse Event (GoPROVE) Biobank and Database. Sampling and analyses were performed shortly before delivery. Platelet count was analyzed and impedance aggregometry was used for examining platelet adhesion and aggregation. Thromboelastometry was used to assess coagulation. Results: Ninety-three women with preeclampsia and 45 normotensive pregnant control patients were included. There was no difference in platelet aggregation (adenosine diphosphate, ADP-test), (arachidonic acid, ASPI-test) or (thrombin receptor-activating peptide, TRAP-test) between women with preeclampsia and women with normotensive pregnancies. Women with preeclampsia had lower platelet counts, shorter clotting (EXTEM-CT and INTEM-CT) and clot formation (EXTEM-CFT and INTEM-CFT) times than women with normotensive pregnancies. Platelet aggregation and coagulation were hyperactivated in women with preeclampsia and normal platelet counts. In women with preeclampsia and thrombocytopenia, platelet aggregation and thromboelastic tests of coagulation were impaired compared with normotensive pregnancies. Conclusion: Platelet aggregation and thromboelastic tests of coagulation are dependent on platelet counts in women with preeclampsia. At normal platelet counts, women with preeclampsia have hyperactivated tests of coagulation. In contrast, women with thrombocytopenia demonstrated lower coagulation test values.

Background and aimStress cardiomyopathy in donors can potentially affect graft function and longevity. This study aims to investigate the association between echocardiographic left ventricular ejection fraction (LVEF) < 50%, and/or the presence of left ventricular regional wall motion abnormalities (RWMA) in organ donors, and short- and long-term liver and kidney graft survival. Our secondary aim was to link graft survival with donor and recipient characteristics. MethodsAll donors considered for liver and kidney donation with echocardiographic records at Sahlgrenska University Hospital between 2006 and 2016 were matched with their recipients through the Scandiatransplant register. The studied outcomes were graft survival, re-transplantation, and recipient death. Kaplan-Meier curves were used to plot time to event. Multivariate Cox-regression was used to test independence. ResultsThere were 370 liver donors and 312 kidney donors (matched with 458 recipients) with echocardiographic records at Sahlgrenska University Hospital between June 2006 and November 2016. Of patients with LV dysfunction by echocardiography, there were 102 liver- and 72 kidney donors. Univariate survival analyses showed no statistical difference in the short- and long-term graft survival from donors with LV dysfunction compared to donors without. Donor age > 65 years, recipient re-transplantation and recipient liver tumor were predictors of worse outcome in liver transplants (p < .05). Donor age > 65, donor hypertension, recipient re-transplantation, and a recipient diagnosis of diabetes or nephritis/glomerulonephritis had a negative association with graft survival in kidney transplants (p < .05). ConclusionWe found no significant association between donor LV dysfunction and short- and long-term graft survival in liver and kidney transplants, suggesting that livers and kidneys from such donors can be safely transplanted.

Abstract Global ischemia has been shown to induce cardiac regenerative response in animal models. One of the suggested mechanisms behind cardiac regeneration is dedifferentiation of cardiomyocytes. How human adult cardiomyocytes respond to global ischemia is not fully known. In this study, biopsies from the left ventricle (LV) and the atrioventricular junction (AVj), a potential stem cell niche, were collected from multi-organ donors with cardiac arrest (N = 15) or without cardiac arrest (N = 6). Using immunohistochemistry, we investigated the expression of biomarkers associated with stem cells during cardiomyogenesis; MDR1, SSEA4, NKX2.5, and WT1, proliferation markers PCNA and Ki67, and hypoxia responsive factor HIF1α. The myocyte nuclei marker PCM1 and cardiac Troponin T were also included. We found expression of cardiac stem cell markers in a subpopulation of LV cardiomyocytes in the cardiac arrest group. The same cells showed a low expression of Troponin T indicating remodeling of cardiomyocytes. No such expression was found in cardiomyocytes from the control group. Stem cell biomarker expression in AVj was more pronounced in the cardiac arrest group. Furthermore, co-expression of PCNA and Ki67 with PCM1 was only found in the cardiac arrest group in the AVj. Our results indicate that a subpopulation of human cardiomyocytes in the LV undergo partial dedifferentiation upon global ischemia and may be involved in the cardiac regenerative response together with immature cardiomyocytes in the AVj.

BACKGROUND:Patients with an out-of-hospital cardiac arrest (OHCA) often undergo coronary angiography, although a culprit lesion is found in only 30%-40% of patients. The aim of this study was to investigate high-sensitivity troponin T (hsTnT) levels in post cardiac arrest patients with and without coronary culprit lesions; factors affecting hsTnT levels after return of spontaneous circulation (ROSC); and the diagnostic ability of hsTnT in identifying patients with culprit lesions. We hypothesized that peak hsTnT levels were higher during the initial 48 h after cardiac arrest in patients with a coronary culprit lesion. METHODS:This was a retrospective observational study, which included patients admitted to the Intensive Care Unit after an OHCA and who received a coronary angiography. Peak values and dynamic changes in hsTnT were analyzed in relation to the presence of a culprit lesion at coronary angiography. RESULTS:A total of 238 patients were studied, of whom 140 had a culprit lesion. HsTnT levels during the initial 48 h were higher in patients with culprit lesions, longer time to ROSC and an unwitnessed cardiac arrest. At 6 to 12 h after ROSC, a hsTnT cut-off level of 1690 ng/L had a sensitivity of 64% and specificity of 84% to identify a culprit lesion. In patients without ST-elevations, hsTnT measured between 6 and 12 h after ROSC had a specificity above 90%, with a sensitivity of 46%. CONCLUSION:HsTnT levels after cardiac arrest are higher in patients with coronary culprit lesions. Presence of a culprit lesion, witnessed status and the duration of CPR are important factors affecting hsTnT levels. Repeated measurement of hsTnT within the first 12 h after admission improved diagnostic accuracy but the value of hsTnT as a predictor of culprit lesions early after OHCA is limited.