Donor Age More Than 20 Years Greater Than Recipient Age Is Associated With Worse 5 Year Survival in Young Adult Heart Transplantation.

Prior studies indicate donor age-recipient age (DA-RA) difference may be of prognostic value in adolescents, although not adults. We aim to analyze the relationship between DA-RA difference and long-term survival of young adult heart transplantation (HTx) recipients. First-time, single-organ HTx recipients aged 18-30 who underwent HTx between 2010 and 2020 were analyzed from the United Network for Organ Sharing (UNOS) registry. Four cohorts were created based on DA-RA difference. The primary outcome was 5 year post-HTx survival. Secondary outcome was post-HTx complications. One thousand eight hundred three donor-recipient pairs were divided into four groups: DA-RA < 0, 0 ≤ DA-RA < 10, 10 ≤ DA-RA < 20, and DA-RA ≥ 20 with 682 (37.8%), 651 (36.1%), 356 (19.7%), 114 (6.3%) pairs in each cohort, respectively. The estimated 5 year survival of the DA-RA ≥ 20 cohort was 66.5% compared to the other three groups at ~75%. After adjustment, DA-RA ≥ 20 was independently associated with worse survival compared to DA-RA < 0 (adjusted hazard ratio [HR] = 1.55; 95% confidence interval [CI] = 1.06-2.27; log-rank p = 0.008). There was no significant difference in complication incidence across cohorts. Among young adults, accepting a donor heart more than 20 years older than the recipient was associated with worse 5 year survival. We did not detect a significant difference up to 20 years. This information may help guide appropriate donor selection in the young adult population.

Fire intensity impacts on physiological performance and mortality in Pinus monticola and Pseudotsuga menziesii saplings: a dose-response analysis.

Fire is a major cause of tree injury and mortality worldwide, yet our current understanding of fire effects is largely based on ocular estimates of stem charring and foliage discoloration, which are error prone and provide little information on underlying tree function. Accurate quantification of physiological performance is a research and forest management need, given that declining performance could help identify mechanisms of-and serve as an early warning sign for-mortality. Many previous efforts have been hampered by the inability to quantify the heat flux that a tree experiences during a fire, given its highly variable nature in space and time. In this study, we used a dose-response approach to elucidate fire impacts by subjecting Pinus monticola var. minima Lemmon and Pseudotsuga menziesii (Mirb.) Franco var. glauca (Beissn.) Franco saplings to surface fires of varying intensity doses and measuring short-term post-fire physiological performance in photosynthetic rate and chlorophyll fluorescence. We also evaluated the ability of spectral reflectance indices to quantify change in physiological performance at the individual tree crown and stand scales. Although physiological performance in both P. monticola and P. menziesii declined with increasing fire intensity, P. monticola maintained a greater photosynthetic rate and higher chlorophyll fluorescence at higher doses, for longer after the fire. Pinus monticola also had complete survival at lower fire intensity doses, whereas P. menziesii had some mortality at all doses, implying higher fire resistance for P. monticola at this life stage. Generally, individual-scale spectral indices were more accurate at quantifying physiological performance than those acquired at the stand-scale. The Photochemical Reflectance Index outperformed other indices at quantifying photosynthesis and chlorophyll fluorescence, highlighting its potential use to quantify crown scale physiological performance. Spectral indices that incorporated near-infrared and shortwave infrared reflectance, such as the Normalized Burn Ratio, were accurate at characterizing stand-scale mortality. The results from this study were included in a conifer cross-comparison using physiology and mortality data from other dose-response studies. The comparison highlights the close evolutionary relationship between fire and species within the Pinus genus, assessed to date, given the high survivorship of Pinus species at lower fire intensities versus other conifers.

Use of Mechanical Circulatory Support to Demonstrate Pulmonary Hypertension Reversibility in Mitral Stenosis.

A 56 year old female with a history of rheumatic mitral stenosis (MS) presented with severe pulmonary edema. Transthoracic echocardiogram demonstrated severe MS (mean valve area 0.5 cm 2 , mean gradient of 16 mm Hg) with preserved left ventricular ejection fraction. Right heart catheterization demonstrated elevated pulmonary artery (PA) pressures of 110/80 mm Hg and a wedge pressure of 40 mm Hg. Mechanical circulatory support (MCS) was initiated with extracorporeal left atrial to femoral artery bypass. MCS allowed preoperative unloading of the left atrium. The volume status and lung congestion were optimized before surgery. In addition, pulmonary hypertension reversibility was demonstrated with significantly lower PA pressures after initiation of MCS. Intraoperatively, the MCS left atrial inflow cannula was pulled back into the right heart and used as a venous cannula for cardiopulmonary bypass. Successful mitral valve replacement was performed. Postoperatively, the mitral valve mean gradient was 3 mm Hg.

Sleep restriction impairs maximal jump performance and joint coordination in elite athletes.

The study objective was to examine the effects of three days of sleep restriction on maximal jump performance and joint coordination. Eleven elite cyclists obtained a one-week baseline of habitual sleep then restricted sleep to 4 h/night (SR) for three nights assessed through self-report and actigraphy. Pre and post-intervention measures were a box drop maximal vertical jump with 3D motion capture to assess physical performance and biomechanical changes, and Psychomotor Vigilance Task (PVT) assessed changes in response time. Associations between biomechanical, physical, and cognitive performance measures were assessed. Participants restricted reported sleep from 7.4 ± 0.5 h/night at baseline to 4.0 ± 0.2 h/night and actigraphy indicated 6.7 ± 0.7 to 3.7 ± 0.2 h/night. Following SR, jump height decreased (0.44 ± 0.09 vs. 0.42 ± 0.10 m, p = 0.02, g = 0.21). Hip sagittal/knee frontal (Δ15.5°, p = 0.04, g = 0.40) and hip frontal/knee frontal (Δ11.0°, p < 0.01, g = 0.44) plane coordination variability increased after SR. Hip sagittal/knee frontal plane coordination variability after SR was associated with increasingly slower PVT response time (r = 0.63, p = 0.03). These findings suggest SR for three days decreased maximal jump performance. SR increased joint coordination variability and was associated with greater impairment in response time. SR leads to deviations from preferred movement patterns, which may have implications for decrements in athlete performance and increased injury risk.