Selection of percutaneous mechanical circulatory support in cardiogenic shock: patient-specific considerations and insights from contemporary clinical data.

PURPOSE OF REVIEW: Cardiogenic shock remains a complex and variable disease process requiring early recognition and prompt, multidisciplinary treatment. Available data link usage of high-dose and/or multiple vasopressors in cardiogenic shock to increased mortality. This review proposes a structured approach to escalation of percutaneous mechanical circulatory support (pMCS) in cardiogenic shock, based on the hemodynamic and metabolic parameters highlighted in the revised SCAI Shock Classification, and supported by the available clinical data. RECENT FINDINGS: Intra-aortic balloon pumps (IABP) may improve hemodynamics in early cardiogenic shock (stage B) but offer little benefit in stage C-E shock where percutaneous ventricular assist devices (pVAD) improve cardiac power/index and may improve survival in certain subsets. In stage D-E shock, escalation from standalone pVADs to devices in combination is often appropriate. Left ventricular venting, with IABP or Impella, in conjunction with VA ECMO, appears to be beneficial. SUMMARY: Graded escalation of pMCS support should be considered in SCAI stage B shock patients onwards, with the choice of support allowable by local expertise, matched to the degree and anticipated trajectory of hemodynamic and metabolic compromise. Additional clinical data are required before timing, and escalation of pMCS initiation may be integrated into a single treatment algorithm.

Type 1 Gastric Neuroendocrine Tumor Found on Endoscopic Polypectomy.

Gastric neuroendocrine tumors (GNET) are rare gastric neoplasms accounting for <1% of all gastric neoplasms. The World Health Organization (WHO) categorized these neoplasms as types 1-3 to help predict malignant potential and long-term survival and guide management. Improved outcomes have been shown with endoscopic resections, but further studies are needed to confirm the best approach. We present a case of a 56-year-old woman who demonstrated the classic features of type one GNET with mucosal and submucosal involvement in the setting of primary atrophic gastritis, secondary hypergastrinemia, and underlying pernicious anemia. In general, standardizing treatment has been difficult due to a variable presentation.

Application of Parallel Multiparametric Cell-Based FLIPR Detection Assays for the Identification of Modulators of the Muscarinic Acetylcholine Receptor 4 (M4).

Muscarinic acetylcholine receptors (mAChRs) have long been viewed as viable targets for novel therapeutic agents for the treatment of Alzheimer's disease and other disorders involving impaired cognitive function. In an attempt to identify orthosteric and allosteric modulators of the muscarinic acetylcholine receptor M(4) (M(4)), we developed a homogenous, multiparametric, 1536-well assay to measure M(4) receptor agonism, positive allosteric modulation (PAM), and antagonism in a single well. This assay yielded a Z' of 0.85 ± 0.05 in the agonist, 0.72 ± 0.07 in PAM, and 0.80 ± 0.06 in the antagonist mode. Parallel screening of the M(1) and M(5) subtypes using the same multiparametric assay format revealed chemotypes that demonstrate selectivity and/or promiscuity between assays and modalities. This identified 503 M(4) selective primary agonists, 1450 PAMs, and 2389 antagonist hits. Concentration-response analysis identified 25 selective agonists, 4 PAMs, and 41 antagonists. This demonstrates the advantages of this approach to rapidly identify selective receptor modulators while efficiently removing assay artifacts and undesirable compounds.

Evaluation of temporal artery and disposable digital oral thermometers in acutely ill patients.

Accurate measurement of temperature is essential for timely and appropriate patient management. In this study, both the digital, disposable oral and temporal artery thermometers had precision values that exceeded expert recommendations for use of the devices as equivalent to a reference standard device.