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The author reflects on the opportunities and challenges for pulmonary hypertension in congenital heart disease. The author discusses significant improvements in the treatment of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). It also mentions that the impact of disease targeting therapies in patients with CHD-PAH is recognizable.

In this article the author comments on the ethical nature of keeping a dead body in an intensive care unit (ICU) and denying a living patient access to the ICU. Setting aside cultural differences, he believes that the dead body no longer gets medical benefits from the ICU, while a living patient has every right to receive an ICU-level care. Also investigated is the possibility for hospitals to review their policies when it comes to caring for patients with diverse cultural backgrounds.

Background: Brain injury leading to a persistent vegetative state during pregnancy involves difficult medical and ethical decisions.Case: A 21-year-old multigravid woman entered a persistent vegetative state at 20 1/7 weeks of gestation after cardiac arrest with postanoxic brain injury from a suspected drug overdose. The clinical disciplines responsible for her case formed a collaborative care plan involving ventilator, nutrition, and medication support of the mother and regular fetal monitoring and ultrasound testing. A planned delivery by cesarean at term resulted in a good neonatal outcome.Conclusion: There is no standardized management plan for obstetric care in a persistent vegetative state. This case illustrates a successful multidisciplinary approach that may be useful as a template in similar situations. [ABSTRACT FROM AUTHOR]

Background: Supportive care interventions used to manage chemotherapy‐induced myelosuppression (CIM), including granulocyte colony‐stimulating factors (G‐CSFs), erythropoiesis‐stimulating agents (ESAs), and red blood cell (RBC) transfusions, are burdensome to patients and associated with greater costs to health care systems. We evaluated the utilization of supportive care interventions and their relationship with the myeloprotective agent, trilaciclib. Methods: Data were pooled from three independent randomized phase 2 clinical trials of trilaciclib or placebo administered prior to chemotherapy in patients with extensive‐stage small cell lung cancer (ES‐SCLC). The impact of supportive care on the duration of severe neutropenia (DSN), occurrence of severe neutropenia (SN), and occurrence of RBC transfusions on/after week 5 was analyzed across cycles 1–4. Concordance and association between grade 3/4 anemia, RBC transfusions on/after week 5, and ESA administration was also evaluated. Results: The use of G‐CSFs, ESAs, or RBC transfusions on/after week 5 was significantly lower among patients receiving trilaciclib versus placebo (28.5% vs. 56.3%, p < 0.0001; 3.3% vs. 11.8%, p = 0.0254; and 14.6% vs. 26.1%, p = 0.0252, respectively). Compared with placebo, trilaciclib significantly reduced DSN and SN, irrespective of G‐CSF administration. RBC transfusions and ESAs were most often administered in patients with grade 3/4 anemia; however, patients typically received RBC transfusions over ESA administration. Conclusions: By improving CIM and reducing the need for associated supportive care, trilaciclib has the potential to reduce the burden of myelosuppression on patients receiving myelosuppressive chemotherapy for the treatment of ES‐SCLC. Trial registration: ClinicalTrials.gov (NCT02499770; NCT03041311; NCT02514447). [ABSTRACT FROM AUTHOR]

Abstract In the summer of 2016, delegates from the German Society of Cardiology (DGK), the German Respiratory Society (DGP), and the German Society of Pediatric Cardiology (DGPK) met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary hypertension (PH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines, aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. To this end, a number of working groups was initiated, one of which was specifically dedicated to the definition, clinical classification and initial diagnosis of PH. While the European guidelines provide a detailed clinical classification and a structured approach for diagnostic testing, their application in routine care may be challenging, particularly given the changing phenotype of PH patients who are nowadays often elderly and may present with multiple potential causes of PH, as well as comorbid conditions. Specifically, the working group addresses the thoroughness of diagnostic testing, and the roles of echocardiography, exercise testing, and genetic testing in diagnosing PH. Furthermore, challenges in the diagnostic work-up of patients with various causes of PH including "PAH with comorbidities", CTEPH and coexisting conditions are highlighted, and a modified diagnostic algorithm is provided. The detailed results and recommendations of the working group on definition, clinical classification and initial diagnosis of PH, which were last updated in the spring of 2018, are summarized in this article. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the relationship between socioeconomic status (SES), access to physical activity resources, urban–rural dwelling, levels of pollution and exercise capacity in adult congenital heart disease (ACHD) patients. Background: Exercise intolerance is prevalent in ACHD and the contributing factors are poorly understood. Methods: A total of 1268 ACHD patients living in England who underwent cardiopulmonary exercise testing at our center were included. Neighborhood deprivation (English Indices of Deprivation), urban–rural dwelling, availability of green space, distance to the closest gym/fitness center and levels of pollution were estimated based on administrative data. Results: Urban–rural dwelling, availability of green space and levels of pollution were unrelated to exercise capacity. Lower SES was associated with a significantly lower peak oxygen consumption (P <0.002) and heart rate reserve (P <0.004). This association was non-linear and most pronounced in ACHD patients with cardiac defects of medium complexity living in the most socioeconomically disadvantaged communities. Low SES was associated with higher prevalence of diabetes (P =0.015) and smoking (P =0.01). Coronary artery disease was rare in this young population and low SES was found to be related to exercise capacity independently of the presence of coronary artery disease. Conclusions: Living in poorer areas is associated with exercise intolerance in contemporary ACHD patients. Although low SES is linked to traditional cardiovascular risk factors, the deleterious effects of SES on exercise capacity seem to be only partially mediated via coronary artery disease. Reducing social inequalities in ACHD patients may have a positive effect on quality of life and long-term prognostic implications. [Copyright &y& Elsevier]