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36,475,546 | D000369:Aged, 80 and over; D006801:Humans; D005260:Female; D008297:Male; D000072657:ST Elevation Myocardial Infarction; D000088642:Nonagenarians; D012189:Retrospective Studies; D017052:Hospital Mortality; D062645:Percutaneous Coronary Intervention; D006761:Hospitals | [
"D000369",
"D006801",
"D005260",
"D008297",
"D000072657",
"D000088642",
"D012189",
"D017052",
"D062645",
"D006761"
] | In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. | BACKGROUND
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
METHODS
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
RESULTS
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
CONCLUSIONS
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge. | null | false | In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. BACKGROUND
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
METHODS
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
RESULTS
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
CONCLUSIONS
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge. |
727,717 | D001157:Arterial Occlusive Diseases; D001158:Arteries; D001160:Arterioles; D001921:Brain; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin; D013116:Spinal Cord; D013577:Syndrome | [
"D001157",
"D001158",
"D001160",
"D001921",
"D006801",
"D008297",
"D008875",
"D012867",
"D013116",
"D013577"
] | Papulosis atrophicans maligna (Köhlmeier-Degos disease): a disseminated occlusive vasculopathy. | Malignant atrophic papulosis usually presents as pathognomonic skin lesions followed by acute abdominal pain, bowel perforation, peritonitis, and death. Rare patients who may lack gastrointestinal symptoms present with central nervous system manifestations, including headache, paresthesias, weakness, and rapid deterioration to death. The patient reported here was a 47-year-old man whose neurological symptoms apparently preceded his cutaneous lesions. His course consisted of a disseminated neurological disease and exacerbated following a herpes zoster infection. His condition rapidly deteriorated despite corticotropin, glucocorticoids, and low-molecular-weight dextran. Necropsy revealed a disseminated occlusive vasculopathy and diffuse encephalomyelomalacia of the brain and spinal cord. A review of autopsied patients with central nervous system involvement is provided. | 10,075,269 | true | Papulosis atrophicans maligna (Köhlmeier-Degos disease): a disseminated occlusive vasculopathy. Malignant atrophic papulosis usually presents as pathognomonic skin lesions followed by acute abdominal pain, bowel perforation, peritonitis, and death. Rare patients who may lack gastrointestinal symptoms present with central nervous system manifestations, including headache, paresthesias, weakness, and rapid deterioration to death. The patient reported here was a 47-year-old man whose neurological symptoms apparently preceded his cutaneous lesions. His course consisted of a disseminated neurological disease and exacerbated following a herpes zoster infection. His condition rapidly deteriorated despite corticotropin, glucocorticoids, and low-molecular-weight dextran. Necropsy revealed a disseminated occlusive vasculopathy and diffuse encephalomyelomalacia of the brain and spinal cord. A review of autopsied patients with central nervous system involvement is provided. |
33,835,396 | D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D015897:Comorbidity; D006333:Heart Failure; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists; D013318:Stroke Volume | [
"D000319",
"D057911",
"D015897",
"D006333",
"D006801",
"D000451",
"D013318"
] | Update on the Impact of Comorbidities on the Efficacy and Safety of Heart Failure Medications. | Multiple newer medications benefit patients with heart failure with reduced ejection fraction (HFrEF). While these therapies benefit the broad population with HFrEF, the efficacy and safety of these therapies have been less well characterized in patients with significant comorbidities.
Common comorbidities of high interest in heart failure (HF) include diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation, and obesity, and each has potential implications for clinical management. As the burden of comorbidities increases in HF populations, risk-benefit assessments of HF therapies in the context of different comorbidities are increasingly relevant for clinical practice. This review summarizes data regarding the core HFrEF therapies in the context of comorbidities, with specific attention to sodium-glucose cotransporter 2 inhibitors, sacubitril/valsartan, mineralocorticoid receptor antagonists (MRAs), and beta-blockers. In general, studies support consistent treatment effects with regard to clinical outcome benefits in the presence of comorbidities. Likewise, safety profiles are relatively consistent irrespective of comorbidities, with the exception of heightened risk of hyperkalemia with MRA therapy in patients with severe CKD. In conclusion, while HF management is complex in the context of multiple comorbidities, the totality of evidence strongly supports guideline-directed medical therapies as foundational for improving outcomes in these high-risk patients. | null | false | Update on the Impact of Comorbidities on the Efficacy and Safety of Heart Failure Medications. Multiple newer medications benefit patients with heart failure with reduced ejection fraction (HFrEF). While these therapies benefit the broad population with HFrEF, the efficacy and safety of these therapies have been less well characterized in patients with significant comorbidities.
Common comorbidities of high interest in heart failure (HF) include diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation, and obesity, and each has potential implications for clinical management. As the burden of comorbidities increases in HF populations, risk-benefit assessments of HF therapies in the context of different comorbidities are increasingly relevant for clinical practice. This review summarizes data regarding the core HFrEF therapies in the context of comorbidities, with specific attention to sodium-glucose cotransporter 2 inhibitors, sacubitril/valsartan, mineralocorticoid receptor antagonists (MRAs), and beta-blockers. In general, studies support consistent treatment effects with regard to clinical outcome benefits in the presence of comorbidities. Likewise, safety profiles are relatively consistent irrespective of comorbidities, with the exception of heightened risk of hyperkalemia with MRA therapy in patients with severe CKD. In conclusion, while HF management is complex in the context of multiple comorbidities, the totality of evidence strongly supports guideline-directed medical therapies as foundational for improving outcomes in these high-risk patients. |
3,425,367 | D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D004243:Divorce; D005260:Female; D006801:Humans; D006814:Hungary; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D009497:Neurotic Disorders; D012307:Risk Factors; D013405:Suicide; D013406:Suicide, Attempted | [
"D000328",
"D000368",
"D000428",
"D004243",
"D005260",
"D006801",
"D006814",
"D006973",
"D008297",
"D008875",
"D009497",
"D012307",
"D013405",
"D013406"
] | Neurotics at risk and suicidal behaviour in the Hungarian population. | On the basis of a study of 5,871 persons representative of the Hungarian population over the age of 20 by age, sex, place of residence and occupation, an analysis was made of the relationships between neurosis risk, suicidal behaviour, drinking habits and social and lifestyle characteristics. Measured by the Juhász Neurosis Rating Scale, the proportion of those at neurosis risk in the population was 23.6%, but considerable regional differences were found. Suicide attempts and the suicide rate by county proved relatively independent of each other. In the counties with higher suicides rates (South-East Hungary) and in the counties around the capital which have high rates of suicide attempts the proportion of those at neurosis risk was very high. The closest correlation with suicide attempts was found in the case of suicide in the family. Where there had been a suicide in the family, 26% of the subjects attempted suicide in the course of their life and where there had been no suicide, the proportion of persons making attempts was only 1%. | 3,817,374 | true | Neurotics at risk and suicidal behaviour in the Hungarian population. On the basis of a study of 5,871 persons representative of the Hungarian population over the age of 20 by age, sex, place of residence and occupation, an analysis was made of the relationships between neurosis risk, suicidal behaviour, drinking habits and social and lifestyle characteristics. Measured by the Juhász Neurosis Rating Scale, the proportion of those at neurosis risk in the population was 23.6%, but considerable regional differences were found. Suicide attempts and the suicide rate by county proved relatively independent of each other. In the counties with higher suicides rates (South-East Hungary) and in the counties around the capital which have high rates of suicide attempts the proportion of those at neurosis risk was very high. The closest correlation with suicide attempts was found in the case of suicide in the family. Where there had been a suicide in the family, 26% of the subjects attempted suicide in the course of their life and where there had been no suicide, the proportion of persons making attempts was only 1%. |
29,897,569 | D015502:Absorptiometry, Photon; D001012:Aorta, Abdominal; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke; D066027:Transplant Recipients; D061205:Vascular Calcification | [
"D015502",
"D001012",
"D005260",
"D006801",
"D016030",
"D008297",
"D008875",
"D009203",
"D009426",
"D016016",
"D012189",
"D012307",
"D020521",
"D066027",
"D061205"
] | A high abdominal aortic calcification score by dual X-ray absorptiometry is associated with cardiovascular events after kidney transplantation. | Aortic calcification is associated with an increased risk for cardiovascular events in renal transplant recipients. This study focused on the association of abdominal aortic calcification (AAC) and cardiovascular events assessed using a dual-energy X-ray absorptiometry (DXA) scoring methodology for AAC.
From 2008 to 2014, renal transplant recipients referred for a DXA procedure within 6 months after transplantation were included in a retrospective, single-centre study. The primary endpoint was the occurrence of cardiovascular events, defined as myocardial infarction, cerebrovascular accident or transient ischaemic attack, after transplantation. AAC was quantified using an 8-point scoring system and patients were divided into three groups; a control group (AAC = 0), a low AAC group (AAC = 1-3) and a high AAC group (AAC = 4-8).
We evaluated 701 patients, 267 (38.1%) had detectable calcifications (low AAC 190 patients, high AAC 77 patients) and 434 (61.9%) had no calcifications. Cardiovascular events were seen in 37 (8.5%) patients in the control group, in 18 (9.5%) in the low AAC group and in 20 (26.0%) in the high AAC group. Univariate Cox proportional hazards analysis of the high AAC score showed a hazard ratio (HR) of 4.23 [95% confidence interval (CI) 2.44-7.33; P < 0.01] for cardiovascular events, while results were not significant for the low AAC score. Multivariate analysis showed an independent significant association between a high AAC score and cardiovascular events [HR 2.78 (95% CI 1.05-7.64); P = 0.04]. Assessment of the continuous net reclassification index (NRI), comparing the combined clinical variables with a model of both AAC scoring and clinical variables, showed an NRI of 0.76 (95% CI 0.65-0.86; P < 0.01).
An independent association between a high AAC score, assessed by DXA, and cardiovascular events was identified and provides an opportunity for early cardiovascular risk stratification in renal transplant recipients. | null | false | A high abdominal aortic calcification score by dual X-ray absorptiometry is associated with cardiovascular events after kidney transplantation. Aortic calcification is associated with an increased risk for cardiovascular events in renal transplant recipients. This study focused on the association of abdominal aortic calcification (AAC) and cardiovascular events assessed using a dual-energy X-ray absorptiometry (DXA) scoring methodology for AAC.
From 2008 to 2014, renal transplant recipients referred for a DXA procedure within 6 months after transplantation were included in a retrospective, single-centre study. The primary endpoint was the occurrence of cardiovascular events, defined as myocardial infarction, cerebrovascular accident or transient ischaemic attack, after transplantation. AAC was quantified using an 8-point scoring system and patients were divided into three groups; a control group (AAC = 0), a low AAC group (AAC = 1-3) and a high AAC group (AAC = 4-8).
We evaluated 701 patients, 267 (38.1%) had detectable calcifications (low AAC 190 patients, high AAC 77 patients) and 434 (61.9%) had no calcifications. Cardiovascular events were seen in 37 (8.5%) patients in the control group, in 18 (9.5%) in the low AAC group and in 20 (26.0%) in the high AAC group. Univariate Cox proportional hazards analysis of the high AAC score showed a hazard ratio (HR) of 4.23 [95% confidence interval (CI) 2.44-7.33; P < 0.01] for cardiovascular events, while results were not significant for the low AAC score. Multivariate analysis showed an independent significant association between a high AAC score and cardiovascular events [HR 2.78 (95% CI 1.05-7.64); P = 0.04]. Assessment of the continuous net reclassification index (NRI), comparing the combined clinical variables with a model of both AAC scoring and clinical variables, showed an NRI of 0.76 (95% CI 0.65-0.86; P < 0.01).
An independent association between a high AAC score, assessed by DXA, and cardiovascular events was identified and provides an opportunity for early cardiovascular risk stratification in renal transplant recipients. |
7,354,369 | D000377:Agnosia; D001933:Brain Stem; D002544:Cerebral Infarction; D006225:Hand; D006801:Humans; D008526:Medulla Oblongata; D009133:Muscular Atrophy; D011149:Pons; D013577:Syndrome; D014110:Touch; D014715:Vertebrobasilar Insufficiency | [
"D000377",
"D001933",
"D002544",
"D006225",
"D006801",
"D008526",
"D009133",
"D011149",
"D013577",
"D014110",
"D014715"
] | Studies on asterognosis and amyotrophy of the hand in brainstem syndromes. Relation to the symptomatology of tumours at the spinocranial junction. | Fifteen patients with symptoms of an ischaemic lesion in the vertebrobasilar territory were investigated with respect to the presence of asterognosis and amyotrophy of the hand muscles. Stereognostic disturbances were noted in 4 patients with a medullary lesion and in two patients with brainstem syndromes of less defined level. The findings in these cases suggested a lesion of the medial lemniscus. Amyotrophy of the hand muscles was not seen in these patients. The absence of association of astereognosis and amyotrophy of the hand muscles in syndromes due to lower brainstem lesions supports the view that these symptoms, when occurring conjointly in foramen magnum tumours, originate from two different lesions and are caused by different mechanisms. | 10,317,108 | true | Studies on asterognosis and amyotrophy of the hand in brainstem syndromes. Relation to the symptomatology of tumours at the spinocranial junction. Fifteen patients with symptoms of an ischaemic lesion in the vertebrobasilar territory were investigated with respect to the presence of asterognosis and amyotrophy of the hand muscles. Stereognostic disturbances were noted in 4 patients with a medullary lesion and in two patients with brainstem syndromes of less defined level. The findings in these cases suggested a lesion of the medial lemniscus. Amyotrophy of the hand muscles was not seen in these patients. The absence of association of astereognosis and amyotrophy of the hand muscles in syndromes due to lower brainstem lesions supports the view that these symptoms, when occurring conjointly in foramen magnum tumours, originate from two different lesions and are caused by different mechanisms. |
30,516,639 | D001921:Brain; D019468:Disease Management; D006801:Humans; D033162:Incidental Findings; D002532:Intracranial Aneurysm; D008279:Magnetic Resonance Imaging; D011788:Quality of Life; D012307:Risk Factors | [
"D001921",
"D019468",
"D006801",
"D033162",
"D002532",
"D008279",
"D011788",
"D012307"
] | Management of patients with unruptured intracranial aneurysms. | Intracranial aneurysms are frequent incidental findings on cranial imaging. The decision for preventive treatment depends on the presumed risk of rupture, the efficacy and risk of complications of preventive treatment, and the quality of life having to live with an unruptured aneurysms. Data on all these factors are still incomplete, and additional data are needed.
The current review describes advances of the last 2 years in assessment of risk of rupture, on risks of preventive aneurysms occlusion, on follow-up imaging and on medical management of patients with unruptured intracranial aneurysms.
In addition to risk factors used to predict absolute risks of rupture, also aneurysm irregularity and aneurysm growth during follow-up are potential risk factors for rupture. To what extent these factors improve risk prediction in absolute terms is yet uncertain. Uncertainty also continues on whether endovascular or surgical occlusion is the preferred method, but a trial comparing these two strategies is ongoing. Aneurysm growth can now be predicted in absolute risks. Enhancement of the aneurysm wall on MRI probably is also related to aneurysm instability and reflects inflammation. A trial assessing the effects of anti-inflammatory treatment and blood pressure lowering on aneurysm growth and rupture is currently ongoing. | null | false | Management of patients with unruptured intracranial aneurysms. Intracranial aneurysms are frequent incidental findings on cranial imaging. The decision for preventive treatment depends on the presumed risk of rupture, the efficacy and risk of complications of preventive treatment, and the quality of life having to live with an unruptured aneurysms. Data on all these factors are still incomplete, and additional data are needed.
The current review describes advances of the last 2 years in assessment of risk of rupture, on risks of preventive aneurysms occlusion, on follow-up imaging and on medical management of patients with unruptured intracranial aneurysms.
In addition to risk factors used to predict absolute risks of rupture, also aneurysm irregularity and aneurysm growth during follow-up are potential risk factors for rupture. To what extent these factors improve risk prediction in absolute terms is yet uncertain. Uncertainty also continues on whether endovascular or surgical occlusion is the preferred method, but a trial comparing these two strategies is ongoing. Aneurysm growth can now be predicted in absolute risks. Enhancement of the aneurysm wall on MRI probably is also related to aneurysm instability and reflects inflammation. A trial assessing the effects of anti-inflammatory treatment and blood pressure lowering on aneurysm growth and rupture is currently ongoing. |
28,411,357 | D000328:Adult; D000783:Aneurysm; D001926:Brain Death; D003928:Diabetic Nephropathies; D046148:Donor Selection; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012077:Renal Artery; D014019:Tissue Donors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures | [
"D000328",
"D000783",
"D001926",
"D003928",
"D046148",
"D005260",
"D006801",
"D016030",
"D008297",
"D008875",
"D009392",
"D012077",
"D014019",
"D016896",
"D014656"
] | Kidney Transplant From a Deceased Donor With Renal Artery Aneurysm: A Case Report. | The use of marginal kidneys or kidneys with pathologic problems (such as renal artery aneurysms in a living or deceased donor) is on the rise due to organ shortages and improvements in surgical techniques. When renal vascular abnormalities are detected during a transplant, it puts the surgeon in a difficult position to decide what to do with the organ. In this study, we report a case of a kidney from a deceased donor who had 2 renal artery saccular aneurysms, which we were able to use for transplant. The recipient was a 61-year-old male patient with diabetic nephropathy and significant comorbidities. Kidney transplant was performed successfully with a good outcome. Recent advancements in surgical techniques have allowed the use of kidneys with renal artery aneurysms for kidney transplant, thus helping to overcome shortages of transplantable organs. | 1,414,558 | true | Kidney Transplant From a Deceased Donor With Renal Artery Aneurysm: A Case Report. The use of marginal kidneys or kidneys with pathologic problems (such as renal artery aneurysms in a living or deceased donor) is on the rise due to organ shortages and improvements in surgical techniques. When renal vascular abnormalities are detected during a transplant, it puts the surgeon in a difficult position to decide what to do with the organ. In this study, we report a case of a kidney from a deceased donor who had 2 renal artery saccular aneurysms, which we were able to use for transplant. The recipient was a 61-year-old male patient with diabetic nephropathy and significant comorbidities. Kidney transplant was performed successfully with a good outcome. Recent advancements in surgical techniques have allowed the use of kidneys with renal artery aneurysms for kidney transplant, thus helping to overcome shortages of transplantable organs. |
27,852,274 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004522:Educational Status; D005260:Female; D005783:Gender Identity; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D000369",
"D001938",
"D004522",
"D005260",
"D005783",
"D054624",
"D006801",
"D006973",
"D016015",
"D008297",
"D008875",
"D044469",
"D012737",
"D012959",
"D055815"
] | Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil. | Hypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race.
We analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education.
Age-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men.
In this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race - a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective. | null | false | Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil. Hypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race.
We analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education.
Age-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men.
In this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race - a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective. |
9,431,629 | D000368:Aged; D006801:Humans; D007383:Intermittent Claudication; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013117:Spinal Cord Compression; D013130:Spinal Stenosis | [
"D000368",
"D006801",
"D007383",
"D016015",
"D008159",
"D008875",
"D011446",
"D011859",
"D013117",
"D013130"
] | A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings. | METHODS
A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis.
OBJECTIVE
To evaluate symptoms and signs in patients undergoing surgery for central spinal stenosis and to correlate the findings to age, preoperative duration of symptoms, and radiographically detected constriction.
BACKGROUND
The degree of constriction of the spinal canal considered to be symptomatic of lumbar canal stenosis is not clear, nor is the relation between the clinical appearance of the disease and the degree of radiographically verified constriction.
METHODS
One hundred five consecutive patients scheduled for decompression surgery were included in a prospective study. The day before surgery, all patients were interviewed and examined, using a defined protocol that included data on age, gender, preoperative duration of symptoms, walking ability, and occurrence of pain at rest and at night. Included were data recording straight leg raising test results, reflex disturbance, and extensor hallucis longus muscle weakness. All radiographs were examined by a neuroradiologist. The anteroposterior diameters at each site from L1-L2 to L5-S1 were recorded. For the computer analysis, the site of and width at the narrowest site was registered, as well as the number of sites with an anteroposterior diameter of less than 10 mm. A statistical analysis was performed using chi-square analysis, nonparametric tests, analysis of variance, and logistic regression.
RESULTS
Pain at rest and at night was reported by 68 and 60 patients, respectively, and was more common in younger patients (P = 0.065 and 0.015, respectively). A severe reduction of walking ability (< 0.5 km) was reported by 70 patients. The straight leg raising test results were negative in 70 patients, positive > 60 degrees in 16, positive 30-60 degrees in 14, and positive < 30 degrees in 5. Younger patients had a positive straight leg raising result (P = 0.028, analysis of variance) more often. Reflex disturbances correlated to patient age: Older patients had reflex disturbances more often. There was no correlation between preoperative duration and pain or neurologic disturbances: Patients with longer preoperative duration of symptoms did not demonstrate more severe symptoms. There was a total myelographic block of the spinal canal in 13 patients. The mean value of the antero-posterior diameter in the other patients was 6.8 mm (range, 4-11 mm). In patients younger than 70 years L4-L5 was the site for the most pronounced constriction, whereas L3-L4 was the narrowest site in the older patients. Degenerative spondylolisthesis was found in 32 patients, and they had a more pronounced constriction of the spinal canal (5.6 mm compared with 6.7 mm in those without displacement, P = 0.02). There was a (nonsignificant) tendency toward more walking disturbances in patients with a more pronounced constriction of the spine. There was no correlation between reflex disturbances or extensor hallucis longus weakness and radiographically detected constriction.
CONCLUSIONS
Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction. | null | false | A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings. METHODS
A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis.
OBJECTIVE
To evaluate symptoms and signs in patients undergoing surgery for central spinal stenosis and to correlate the findings to age, preoperative duration of symptoms, and radiographically detected constriction.
BACKGROUND
The degree of constriction of the spinal canal considered to be symptomatic of lumbar canal stenosis is not clear, nor is the relation between the clinical appearance of the disease and the degree of radiographically verified constriction.
METHODS
One hundred five consecutive patients scheduled for decompression surgery were included in a prospective study. The day before surgery, all patients were interviewed and examined, using a defined protocol that included data on age, gender, preoperative duration of symptoms, walking ability, and occurrence of pain at rest and at night. Included were data recording straight leg raising test results, reflex disturbance, and extensor hallucis longus muscle weakness. All radiographs were examined by a neuroradiologist. The anteroposterior diameters at each site from L1-L2 to L5-S1 were recorded. For the computer analysis, the site of and width at the narrowest site was registered, as well as the number of sites with an anteroposterior diameter of less than 10 mm. A statistical analysis was performed using chi-square analysis, nonparametric tests, analysis of variance, and logistic regression.
RESULTS
Pain at rest and at night was reported by 68 and 60 patients, respectively, and was more common in younger patients (P = 0.065 and 0.015, respectively). A severe reduction of walking ability (< 0.5 km) was reported by 70 patients. The straight leg raising test results were negative in 70 patients, positive > 60 degrees in 16, positive 30-60 degrees in 14, and positive < 30 degrees in 5. Younger patients had a positive straight leg raising result (P = 0.028, analysis of variance) more often. Reflex disturbances correlated to patient age: Older patients had reflex disturbances more often. There was no correlation between preoperative duration and pain or neurologic disturbances: Patients with longer preoperative duration of symptoms did not demonstrate more severe symptoms. There was a total myelographic block of the spinal canal in 13 patients. The mean value of the antero-posterior diameter in the other patients was 6.8 mm (range, 4-11 mm). In patients younger than 70 years L4-L5 was the site for the most pronounced constriction, whereas L3-L4 was the narrowest site in the older patients. Degenerative spondylolisthesis was found in 32 patients, and they had a more pronounced constriction of the spinal canal (5.6 mm compared with 6.7 mm in those without displacement, P = 0.02). There was a (nonsignificant) tendency toward more walking disturbances in patients with a more pronounced constriction of the spine. There was no correlation between reflex disturbances or extensor hallucis longus weakness and radiographically detected constriction.
CONCLUSIONS
Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction. |
552,727 | D000818:Animals; D002417:Cattle; D002418:Cattle Diseases; D004322:Drainage; D005260:Female; D010493:Pericarditis; D010496:Pericardium; D013492:Suppuration | [
"D000818",
"D002417",
"D002418",
"D004322",
"D005260",
"D010493",
"D010496",
"D013492"
] | Suppurative pericarditis treated by pericardiotomy in a cow. | The successful treatment of a single case of traumatic reticulopericarditis is described. Under general anaesthesia the pericardial sac was approached by resection of the distal part of the fifth rib and allowed to drain directly to the exterior. The discussion reviews the surgical technique. | 8,748,395 | true | Suppurative pericarditis treated by pericardiotomy in a cow. The successful treatment of a single case of traumatic reticulopericarditis is described. Under general anaesthesia the pericardial sac was approached by resection of the distal part of the fifth rib and allowed to drain directly to the exterior. The discussion reviews the surgical technique. |
18,507,271 | D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension; D007407:Interviews as Topic; D008297:Male; D008568:Memory; D008875:Middle Aged; D009657:North Carolina; D011581:Psychological Tests; D012044:Regression Analysis | [
"D000328",
"D001741",
"D000368",
"D000369",
"D001794",
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"D003430",
"D005260",
"D006801",
"D006973",
"D007407",
"D008297",
"D008568",
"D008875",
"D009657",
"D011581",
"D012044"
] | Blood pressure and memory in older African Americans. | The rates of high blood pressure among African Americans, as a group, are the highest in the world. The implications for higher average blood pressure include complications for many major chronic conditions, such as cardiovascular disease and diabetes. Less well studied is the effect of blood pressure on the cognitive functioning of African Americans. The purpose of this study was to examine the effect of blood pressure on memory measures in a sample of adult African Americans. Analyses were conducted on a sample of 361 African American adults (mean age 61.50 years, standard deviation 9.39 years). We found significant correlations between systolic blood pressure and most cognitive measures but only for one of the measures and diastolic blood pressure. Regressions revealed significant effects for systolic blood pressure on Digit Symbol, Telephone Interview of Cognitive Status, and Immediate Recall on the Wechsler Logical Memory test. These findings suggest that blood pressure is a source of individual variability in cognitive aging among African Americans. | 96,763 | true | Blood pressure and memory in older African Americans. The rates of high blood pressure among African Americans, as a group, are the highest in the world. The implications for higher average blood pressure include complications for many major chronic conditions, such as cardiovascular disease and diabetes. Less well studied is the effect of blood pressure on the cognitive functioning of African Americans. The purpose of this study was to examine the effect of blood pressure on memory measures in a sample of adult African Americans. Analyses were conducted on a sample of 361 African American adults (mean age 61.50 years, standard deviation 9.39 years). We found significant correlations between systolic blood pressure and most cognitive measures but only for one of the measures and diastolic blood pressure. Regressions revealed significant effects for systolic blood pressure on Digit Symbol, Telephone Interview of Cognitive Status, and Immediate Recall on the Wechsler Logical Memory test. These findings suggest that blood pressure is a source of individual variability in cognitive aging among African Americans. |
9,362,266 | D000818:Animals; D066298:In Vitro Techniques; D008297:Male; D009203:Myocardial Infarction; D017202:Myocardial Ischemia; D009206:Myocardium; D051381:Rats; D017208:Rats, Wistar; D013654:Taurine; D015091:beta-Alanine | [
"D000818",
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"D008297",
"D009203",
"D017202",
"D009206",
"D051381",
"D017208",
"D013654",
"D015091"
] | Taurine depletion, a novel mechanism for cardioprotection from regional ischemia. | Three processes that have been implicated in ischemic injury are impaired Ca2+ movement, altered osmoregulation, and membrane remodeling. Because the amino acid, taurine, affects all three processes, it seemed logical that changes in the myocardial content of taurine might affect ischemic injury. To test this hypothesis, infarct size and areas at risk were compared in isolated hearts from control and taurine-depleted rats after a 45-min ligation of the left anterior descending coronary artery and 2 h of reperfusion. Hearts of rats treated for 4 wk with the taurine inhibitor, beta-alanine, exhibited a 57% reduction in the infarct size-to-risk area ratio. The degree of cardioprotection was found to correlate (r = 0.85) with the extent of taurine depletion, the latter dependent on the length of beta-alanine feeding. When the taurine-depleted rats were fed taurine, myocardial taurine levels were restored and the cardioprotection was lost. However, addition of neither beta-alanine (3%) nor taurine (20 mM) to the perfusion medium altered infarct size. We conclude that taurine depletion renders the heart resistant to injury caused by regional ischemia. | 8,058,468 | true | Taurine depletion, a novel mechanism for cardioprotection from regional ischemia. Three processes that have been implicated in ischemic injury are impaired Ca2+ movement, altered osmoregulation, and membrane remodeling. Because the amino acid, taurine, affects all three processes, it seemed logical that changes in the myocardial content of taurine might affect ischemic injury. To test this hypothesis, infarct size and areas at risk were compared in isolated hearts from control and taurine-depleted rats after a 45-min ligation of the left anterior descending coronary artery and 2 h of reperfusion. Hearts of rats treated for 4 wk with the taurine inhibitor, beta-alanine, exhibited a 57% reduction in the infarct size-to-risk area ratio. The degree of cardioprotection was found to correlate (r = 0.85) with the extent of taurine depletion, the latter dependent on the length of beta-alanine feeding. When the taurine-depleted rats were fed taurine, myocardial taurine levels were restored and the cardioprotection was lost. However, addition of neither beta-alanine (3%) nor taurine (20 mM) to the perfusion medium altered infarct size. We conclude that taurine depletion renders the heart resistant to injury caused by regional ischemia. |
10,203,398 | D001049:Apnea; D001530:Belgium; D016009:Chi-Square Distribution; D003142:Communication; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006323:Heart Arrest; D006801:Humans; D008020:Life Support Care; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors | [
"D001049",
"D001530",
"D016009",
"D003142",
"D004632",
"D004634",
"D006323",
"D006801",
"D008020",
"D011446",
"D015996",
"D013997"
] | Do victims of an out-of-hospital cardiac arrest benefit from a training program for emergency medical dispatchers? | In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects. | 10,901,718 | true | Do victims of an out-of-hospital cardiac arrest benefit from a training program for emergency medical dispatchers? In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects. |
26,976,877 | D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D000077144:Clopidogrel; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction; D009204:Myocardial Revascularization; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors; D013988:Ticlopidine; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States | [
"D000367",
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"D000369",
"D006328",
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"D003324",
"D005260",
"D006801",
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"D006278",
"D009203",
"D009204",
"D010351",
"D010975",
"D058921",
"D012017",
"D012042",
"D012307",
"D013988",
"D013997",
"D016896",
"D014481"
] | Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital Revascularization. | BACKGROUND
While use of P2Y12 receptor inhibitor is recommended by guidelines, few studies have examined its effectiveness among older non-ST-segment elevation myocardial infarction patients who did not undergo coronary revascularization.
RESULTS
We included unrevascularized non-ST-segment elevation myocardial infarction patients ≥65 years discharged home from 463 ACTION Registry-GWTG hospitals from 2007 to 2010. Rates of discharge clopidogrel use were described for patients with no angiography, angiography without obstructive coronary artery disease (CAD; ≥50% stenosis in ≥1 vessel), and angiography with obstructive CAD. Two-year outcomes were ascertained from linked Medicare data and included composite major adverse cardiac events (defined as all-cause death, myocardial infarction readmission, or revascularization), and individual components. Outcomes associated with clopidogrel use were adjusted using inverse probability-weighted propensity modeling. Of 14 154 unrevascularized patients, 54.7% (n=7745) did not undergo angiography, 10.6% (n=1494) had angiography without CAD, and 34.7% (n=4915) had angiography with CAD. Discharge clopidogrel was prescribed for 42.2% of all unrevascularized patients: 37.8% without angiography, 34.1% without obstructive CAD at angiography, and 51.6% with obstructive CAD at angiography. Discharge clopidogrel use was not associated with major adverse cardiac events in any group: without angiography (adjusted hazard ratio [95% CI]: 0.99 [0.93-1.06]), angiography without CAD (1.04 [0.74-1.47]), and angiography with CAD (1.12 [1.00-1.25], Pinteraction=0.20).
CONCLUSIONS
We found no association between discharge clopidogrel use and long-term risk of major adverse cardiac events among older, unrevascularized non-ST-segment elevation myocardial infarction patients. Clopidogrel use in this population requires further prospective evaluation. | null | false | Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital Revascularization. BACKGROUND
While use of P2Y12 receptor inhibitor is recommended by guidelines, few studies have examined its effectiveness among older non-ST-segment elevation myocardial infarction patients who did not undergo coronary revascularization.
RESULTS
We included unrevascularized non-ST-segment elevation myocardial infarction patients ≥65 years discharged home from 463 ACTION Registry-GWTG hospitals from 2007 to 2010. Rates of discharge clopidogrel use were described for patients with no angiography, angiography without obstructive coronary artery disease (CAD; ≥50% stenosis in ≥1 vessel), and angiography with obstructive CAD. Two-year outcomes were ascertained from linked Medicare data and included composite major adverse cardiac events (defined as all-cause death, myocardial infarction readmission, or revascularization), and individual components. Outcomes associated with clopidogrel use were adjusted using inverse probability-weighted propensity modeling. Of 14 154 unrevascularized patients, 54.7% (n=7745) did not undergo angiography, 10.6% (n=1494) had angiography without CAD, and 34.7% (n=4915) had angiography with CAD. Discharge clopidogrel was prescribed for 42.2% of all unrevascularized patients: 37.8% without angiography, 34.1% without obstructive CAD at angiography, and 51.6% with obstructive CAD at angiography. Discharge clopidogrel use was not associated with major adverse cardiac events in any group: without angiography (adjusted hazard ratio [95% CI]: 0.99 [0.93-1.06]), angiography without CAD (1.04 [0.74-1.47]), and angiography with CAD (1.12 [1.00-1.25], Pinteraction=0.20).
CONCLUSIONS
We found no association between discharge clopidogrel use and long-term risk of major adverse cardiac events among older, unrevascularized non-ST-segment elevation myocardial infarction patients. Clopidogrel use in this population requires further prospective evaluation. |
21,558,772 | D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine; D003428:Cross Infection; D004311:Double-Blind Method; D005260:Female; D006330:Heart Defects, Congenital; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009067:Mouthwashes; D009910:Oral Hygiene; D018410:Pneumonia, Bacterial; D053717:Pneumonia, Ventilator-Associated; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D013997:Time Factors | [
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"D002710",
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"D008297",
"D009067",
"D009910",
"D018410",
"D053717",
"D012121",
"D018709",
"D013997"
] | Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. | OBJECTIVE
To evaluate the effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.
METHODS
Prospective, randomized, double-blind, placebo-controlled trial.
METHODS
Pediatric intensive care unit (PICU) at a tertiary care hospital.
METHODS
One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: chlorhexidine (n = 87) and control (n = 73).
METHODS
Oral hygiene with 0.12% chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.
RESULTS
Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months; P = .72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups; P = .17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (P = .46) and the incidence of VAP was 18.3% versus 15% (P = .57) in the chlorhexidine and the control group, respectively. There was no difference in intubation time (P = .34), need for reintubation (P = .37), time interval between hospitalization and nosocomial pneumonia diagnosis (P = .63), time interval between surgery and nosocomial pneumonia diagnosis (P = .10), and time on antibiotics (P = .77) and vasoactive drugs (P = .16) between groups. Median length of PICU stay (3 vs 4 days; P = .53), median length of hospital stay (12 vs 11 days; P = .67), and 28-day mortality (5.7% vs 6.8%; P = .77) were also similar in the chlorhexidine and the control group.
CONCLUSIONS
Oral hygiene with 0.12% chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.
BACKGROUND
ClinicalTrials.gov identifier: NCT00829842 . | null | false | Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. OBJECTIVE
To evaluate the effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.
METHODS
Prospective, randomized, double-blind, placebo-controlled trial.
METHODS
Pediatric intensive care unit (PICU) at a tertiary care hospital.
METHODS
One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: chlorhexidine (n = 87) and control (n = 73).
METHODS
Oral hygiene with 0.12% chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.
RESULTS
Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months; P = .72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups; P = .17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (P = .46) and the incidence of VAP was 18.3% versus 15% (P = .57) in the chlorhexidine and the control group, respectively. There was no difference in intubation time (P = .34), need for reintubation (P = .37), time interval between hospitalization and nosocomial pneumonia diagnosis (P = .63), time interval between surgery and nosocomial pneumonia diagnosis (P = .10), and time on antibiotics (P = .77) and vasoactive drugs (P = .16) between groups. Median length of PICU stay (3 vs 4 days; P = .53), median length of hospital stay (12 vs 11 days; P = .67), and 28-day mortality (5.7% vs 6.8%; P = .77) were also similar in the chlorhexidine and the control group.
CONCLUSIONS
Oral hygiene with 0.12% chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.
BACKGROUND
ClinicalTrials.gov identifier: NCT00829842 . |
15,256,222 | D000818:Animals; D000975:Antioxidants; D001204:Ascorbate Oxidase; D001205:Ascorbic Acid; D001921:Brain; D002851:Chromatography, High Pressure Liquid; D003683:Dehydroascorbic Acid; D005609:Free Radicals; D005978:Glutathione; D006605:Hibernation; D010084:Oxidation-Reduction; D010100:Oxygen; D015427:Reperfusion Injury; D012589:Sciuridae; D013696:Temperature; D013997:Time Factors; D014018:Tissue Distribution; D014527:Uric Acid | [
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"D003683",
"D005609",
"D005978",
"D006605",
"D010084",
"D010100",
"D015427",
"D012589",
"D013696",
"D013997",
"D014018",
"D014527"
] | Ascorbate distribution during hibernation is independent of ascorbate redox state. | Distribution of ascorbate into tissues is an essential process in ascorbate antioxidant defense. Hibernating animals are studied as a model of tolerance to ischemia-reperfusion because of their tolerance to fluctuations in blood flow associated with prolonged torpor and periodic arousal episodes. Throughout hibernation, plasma ascorbate concentration ([Asc](p)) repetitively increases during torpor, then falls during periodic arousal bouts. We previously proposed that high [Asc](p) provides a ready source of antioxidant protection for distribution to the central nervous system and peripheral tissues during arousal. Here we tested whether deliberate oxidation of plasma ascorbate by intravenous administration of ascorbate oxidase (AO), prior to arousal, compromised tissue levels of ascorbate or the other water-soluble antioxidants, glutathione (GSH) and urate. Although AO decreased [Asc](p) to below the level of detection during torpor and after arousal, ascorbate oxidation did not decrease post-arousal tissue levels of reduced ascorbate, glutathione, or urate in any tissue examined, except liver. The data imply that ascorbate is taken up equally well into brain and other tissues as either ascorbate or its oxidized product dehydroascorbate, with subsequent intracellular reduction of dehydroascorbate. Lack of effect of ascorbate oxidation on tissue levels of GSH or urate indicates that dehydroascorbate uptake and reduction do not compromise tissue concentrations of these other water-soluble antioxidants. Thus, we show equal availability of reduced and oxidized plasma ascorbate during metabolically demanding thermogenesis and reperfusion associated with arousal from hibernation. | 6,155,104 | true | Ascorbate distribution during hibernation is independent of ascorbate redox state. Distribution of ascorbate into tissues is an essential process in ascorbate antioxidant defense. Hibernating animals are studied as a model of tolerance to ischemia-reperfusion because of their tolerance to fluctuations in blood flow associated with prolonged torpor and periodic arousal episodes. Throughout hibernation, plasma ascorbate concentration ([Asc](p)) repetitively increases during torpor, then falls during periodic arousal bouts. We previously proposed that high [Asc](p) provides a ready source of antioxidant protection for distribution to the central nervous system and peripheral tissues during arousal. Here we tested whether deliberate oxidation of plasma ascorbate by intravenous administration of ascorbate oxidase (AO), prior to arousal, compromised tissue levels of ascorbate or the other water-soluble antioxidants, glutathione (GSH) and urate. Although AO decreased [Asc](p) to below the level of detection during torpor and after arousal, ascorbate oxidation did not decrease post-arousal tissue levels of reduced ascorbate, glutathione, or urate in any tissue examined, except liver. The data imply that ascorbate is taken up equally well into brain and other tissues as either ascorbate or its oxidized product dehydroascorbate, with subsequent intracellular reduction of dehydroascorbate. Lack of effect of ascorbate oxidation on tissue levels of GSH or urate indicates that dehydroascorbate uptake and reduction do not compromise tissue concentrations of these other water-soluble antioxidants. Thus, we show equal availability of reduced and oxidized plasma ascorbate during metabolically demanding thermogenesis and reperfusion associated with arousal from hibernation. |
25,306,428 | D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D055815:Young Adult | [
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"D014481",
"D055815"
] | Prognostic value of automatically detected early repolarization. | Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. We therefore assessed the prevalence and prognostic significance of AER in 211,920 patients aged 18 to 75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded electrocardiogram of each individual from 2000 to 2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated electrocardiographic interpretations were reviewed for accuracy by a board-certified cardiologist. The primary end point was death during a median follow-up of 8.0 ± 2.6 years. AER was present in 3,450 subjects (1.6%). The prevalence varied significantly with race (African-Americans 2.2%, Hispanics 1.5%, and non-Hispanic whites 0.9%, p <0.01) and gender (male 2.4% vs female 0.6%, p <0.001). In a Cox proportional hazards model controlling for age, smoking status, heart rate, QTc, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, and coronary artery disease, there was no significant difference in mortality regardless of race or gender (relative risk 0.98, 95% confidence interval 0.89 to 1.07). This was true even if J waves were present. In conclusion, AER was not associated with an increased risk of death, regardless of race or gender, and should not trigger additional diagnostic testing. | 13,353,812 | true | Prognostic value of automatically detected early repolarization. Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. We therefore assessed the prevalence and prognostic significance of AER in 211,920 patients aged 18 to 75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded electrocardiogram of each individual from 2000 to 2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated electrocardiographic interpretations were reviewed for accuracy by a board-certified cardiologist. The primary end point was death during a median follow-up of 8.0 ± 2.6 years. AER was present in 3,450 subjects (1.6%). The prevalence varied significantly with race (African-Americans 2.2%, Hispanics 1.5%, and non-Hispanic whites 0.9%, p <0.01) and gender (male 2.4% vs female 0.6%, p <0.001). In a Cox proportional hazards model controlling for age, smoking status, heart rate, QTc, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, and coronary artery disease, there was no significant difference in mortality regardless of race or gender (relative risk 0.98, 95% confidence interval 0.89 to 1.07). This was true even if J waves were present. In conclusion, AER was not associated with an increased risk of death, regardless of race or gender, and should not trigger additional diagnostic testing. |
12,670,851 | D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009203:Myocardial Infarction; D016584:Panic Disorder; D010346:Patient Care Management; D010360:Patient Transfer; D011787:Quality of Health Care; D012017:Referral and Consultation; D012449:Safety | [
"D003951",
"D004636",
"D006801",
"D008297",
"D008505",
"D008875",
"D009203",
"D016584",
"D010346",
"D010360",
"D011787",
"D012017",
"D012449"
] | Profiles in patient safety: emergency care transitions. | A 59-year-old man presented to the emergency department (ED) with the chief complaint of "panic attacks." In total, he was evaluated by 14 faculty physicians, 2 fellows, and 16 residents from emergency medicine, cardiology, neurology, psychiatry, and internal medicine. These multiple transitions were responsible, in part, for the perpetuation of a failure to accurately diagnose the patient's underlying medical illness. The case illustrates the discontinuity of care that occurs at transitions, which may threaten the safety and quality of patient care. Considerable effort must be directed at making transitions effective and safe. Recommendations to improve transitions include a heightened awareness of cognitive biases operating at these vulnerable times, improving team situational awareness and communication, and exploring systems to facilitate effective transfer of relevant data. | 9,367,473 | true | Profiles in patient safety: emergency care transitions. A 59-year-old man presented to the emergency department (ED) with the chief complaint of "panic attacks." In total, he was evaluated by 14 faculty physicians, 2 fellows, and 16 residents from emergency medicine, cardiology, neurology, psychiatry, and internal medicine. These multiple transitions were responsible, in part, for the perpetuation of a failure to accurately diagnose the patient's underlying medical illness. The case illustrates the discontinuity of care that occurs at transitions, which may threaten the safety and quality of patient care. Considerable effort must be directed at making transitions effective and safe. Recommendations to improve transitions include a heightened awareness of cognitive biases operating at these vulnerable times, improving team situational awareness and communication, and exploring systems to facilitate effective transfer of relevant data. |
15,559,220 | D000367:Age Factors; D000368:Aged; D000596:Amino Acids; D002545:Brain Ischemia; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018697:Nootropic Agents; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D013349:Subclavian Steal Syndrome; D016896:Treatment Outcome | [
"D000367",
"D000368",
"D000596",
"D002545",
"D004305",
"D005500",
"D006801",
"D008875",
"D018697",
"D017410",
"D011379",
"D012307",
"D013349",
"D016896"
] | [Clinical and pathogenetical peculiarities and treatment policy in ischemic stroke of elderly and old age]. | The data on randomized study of 2 groups of patients with ischemic brain hemisphere stroke of elderly and old (over 70 years) as well as middle (under 60 years) age are presented. In elderly and old age, stroke develops on the basis of common affection of major vessels, with a great role of the "steal syndrome" in its pathogenesis. In authors' opinion, in treatment of ischemic stroke of elderly and old age attention should be paid to metabolic therapy, in particular to using high dosages of Cerebrolysin. Basing on clinical and paraclinical study, efficacy of this medication is revealed. | null | false | [Clinical and pathogenetical peculiarities and treatment policy in ischemic stroke of elderly and old age]. The data on randomized study of 2 groups of patients with ischemic brain hemisphere stroke of elderly and old (over 70 years) as well as middle (under 60 years) age are presented. In elderly and old age, stroke develops on the basis of common affection of major vessels, with a great role of the "steal syndrome" in its pathogenesis. In authors' opinion, in treatment of ischemic stroke of elderly and old age attention should be paid to metabolic therapy, in particular to using high dosages of Cerebrolysin. Basing on clinical and paraclinical study, efficacy of this medication is revealed. |
30,464,137 | D000368:Aged; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D014655:Vascular Resistance; D016278:Ventricular Function, Right | [
"D000368",
"D001783",
"D006328",
"D004452",
"D015150",
"D005260",
"D006352",
"D006439",
"D006801",
"D006976",
"D008297",
"D008875",
"D020097",
"D014655",
"D016278"
] | Analysis of Biphasic Right Ventricular Outflow Doppler Waveform in Patients with Pulmonary Hypertension. | Pulmonary hypertension (PH) with pulmonary vascular disease (PVD) is a progressive and debilitating disease associated with increased pulmonary vascular resistance (PVR). Biphasic right ventricular outflow tract (RVOT) Doppler flow is frequently seen in severe PH patients with PVD. In association with hemodynamics, the precise analysis of biphasic RVOT Doppler flow (RVDF) has not been fully elucidated. Therefore, the purpose of the present study is to analyze the relation between the hemodynamics and indices of biphasic RVDF in PH patients with PVD.Seventy PH patients with biphasic RVDF were analyzed. All patients underwent transthoracic echocardiography and right heart catheterization. For the analysis of biphasic RVDF, the early waveform was determined as P1 while the late waveform was determined as P2. For each P1 and P2, the duration (D, seconds) and peak flow velocity (PFV, in m/second) were measured.P1D and P2PFV were significantly correlated with PVR (P1D: r = -0.542, P < 0.0001, P2PFV: r = -0.513, P < 0.0001). Therefore, we propose a novel RVDF formula for estimation of PVR, as follows. PVR = 26 - 77 × P1D - 14 × P2PFV. The PVR could be estimated by this proposed formula (r = 0.649, P < 0.0001), which is derived from one Doppler image only unlike previously used PVR prediction formula.P1D and P2PFV were associated with PVR. Moreover, this simple RVDF formula proposed herein can estimate PVR in PH patients with PVD. | null | false | Analysis of Biphasic Right Ventricular Outflow Doppler Waveform in Patients with Pulmonary Hypertension. Pulmonary hypertension (PH) with pulmonary vascular disease (PVD) is a progressive and debilitating disease associated with increased pulmonary vascular resistance (PVR). Biphasic right ventricular outflow tract (RVOT) Doppler flow is frequently seen in severe PH patients with PVD. In association with hemodynamics, the precise analysis of biphasic RVOT Doppler flow (RVDF) has not been fully elucidated. Therefore, the purpose of the present study is to analyze the relation between the hemodynamics and indices of biphasic RVDF in PH patients with PVD.Seventy PH patients with biphasic RVDF were analyzed. All patients underwent transthoracic echocardiography and right heart catheterization. For the analysis of biphasic RVDF, the early waveform was determined as P1 while the late waveform was determined as P2. For each P1 and P2, the duration (D, seconds) and peak flow velocity (PFV, in m/second) were measured.P1D and P2PFV were significantly correlated with PVR (P1D: r = -0.542, P < 0.0001, P2PFV: r = -0.513, P < 0.0001). Therefore, we propose a novel RVDF formula for estimation of PVR, as follows. PVR = 26 - 77 × P1D - 14 × P2PFV. The PVR could be estimated by this proposed formula (r = 0.649, P < 0.0001), which is derived from one Doppler image only unlike previously used PVR prediction formula.P1D and P2PFV were associated with PVR. Moreover, this simple RVDF formula proposed herein can estimate PVR in PH patients with PVD. |
16,275,434 | D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D015607:Stents | [
"D000368",
"D000369",
"D019917",
"D002343",
"D016893",
"D002560",
"D005260",
"D005500",
"D006801",
"D015994",
"D020766",
"D008279",
"D008297",
"D008875",
"D011183",
"D011446",
"D011474",
"D011475",
"D012307",
"D015607"
] | Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study. | BACKGROUND
This was a prospective single-center study to assess and analyze cerebral embolization resulting from carotid artery stenting with neuroprotective filter devices in patients considered as poor surgical candidates for surgical carotid endarterectomy.
METHODS
Fifty-three consecutive patients with an internal carotid artery stenosis were treated by placement of carotid Wallstents with two different types of temporary distal filter protection devices: the Spider filter and the FilterWire. Diffusion-weighted magnetic resonance imaging (DWI) of the brain was obtained 24 hours before the procedure and within 5 to 30 hours after the procedure to detect ischemic brain lesions resulting from the procedure. Inclusion criteria were symptomatic (> or =70%) or asymptomatic (> or =80%) stenoses in surgical high-risk patients.
RESULTS
Two (4%) regressive minor strokes occurred. Postprocedural DWI detected new focal ischemic lesions in 21 patients (40%). The average number of lesions was 5.9 per patient, and the mean lesion volume was 1 mL or less in 19 patients (90%). Small differences were found in the lesion distribution: homolateral anterior circulation in eight cases (15.1%), other vascular territories in seven cases (13.2%), and homolateral anterior circulation plus other vascular territories in six cases (11.3%). The microembolization risk seemed nonpredictable on the basis of clinical parameters and internal carotid artery lesion characteristics. An increased risk in the rate of ipsilateral hemispheric embolization has been observed in difficult carotid arch implantations (P = .04).
CONCLUSIONS
The incidence of new focal ischemic lesions detected by DWI is higher than expected on the basis of previous reports. Embolization from the aortic arch or common carotid arteries could account for most of those events in patients considered as surgical high-risk patients. Although 90% of the events were clinically silent, this high rate of microembolization raises questions about the possible consequences on cerebral cognitive functions. | null | false | Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study. BACKGROUND
This was a prospective single-center study to assess and analyze cerebral embolization resulting from carotid artery stenting with neuroprotective filter devices in patients considered as poor surgical candidates for surgical carotid endarterectomy.
METHODS
Fifty-three consecutive patients with an internal carotid artery stenosis were treated by placement of carotid Wallstents with two different types of temporary distal filter protection devices: the Spider filter and the FilterWire. Diffusion-weighted magnetic resonance imaging (DWI) of the brain was obtained 24 hours before the procedure and within 5 to 30 hours after the procedure to detect ischemic brain lesions resulting from the procedure. Inclusion criteria were symptomatic (> or =70%) or asymptomatic (> or =80%) stenoses in surgical high-risk patients.
RESULTS
Two (4%) regressive minor strokes occurred. Postprocedural DWI detected new focal ischemic lesions in 21 patients (40%). The average number of lesions was 5.9 per patient, and the mean lesion volume was 1 mL or less in 19 patients (90%). Small differences were found in the lesion distribution: homolateral anterior circulation in eight cases (15.1%), other vascular territories in seven cases (13.2%), and homolateral anterior circulation plus other vascular territories in six cases (11.3%). The microembolization risk seemed nonpredictable on the basis of clinical parameters and internal carotid artery lesion characteristics. An increased risk in the rate of ipsilateral hemispheric embolization has been observed in difficult carotid arch implantations (P = .04).
CONCLUSIONS
The incidence of new focal ischemic lesions detected by DWI is higher than expected on the basis of previous reports. Embolization from the aortic arch or common carotid arteries could account for most of those events in patients considered as surgical high-risk patients. Although 90% of the events were clinically silent, this high rate of microembolization raises questions about the possible consequences on cerebral cognitive functions. |
20,846,597 | D015415:Biomarkers; D001706:Biopsy; D009202:Cardiomyopathies; D019091:Critical Pathways; D004452:Echocardiography; D006801:Humans; D007501:Iron; D019190:Iron Overload; D008279:Magnetic Resonance Imaging; D009206:Myocardium; D014057:Tomography, X-Ray Computed | [
"D015415",
"D001706",
"D009202",
"D019091",
"D004452",
"D006801",
"D007501",
"D019190",
"D008279",
"D009206",
"D014057"
] | Iron overload cardiomyopathy: better understanding of an increasing disorder. | The prevalence of iron overload cardiomyopathy (IOC) is increasing. The spectrum of symptoms of IOC is varied. Early in the disease process, patients may be asymptomatic, whereas severely overloaded patients can have terminal heart failure complaints that are refractory to treatment. It has been shown that early recognition and intervention may alter outcomes. Biochemical markers and tissue biopsy, which have traditionally been used to diagnose and guide therapy, are not sensitive enough to detect early cardiac iron deposition. Newer diagnostic modalities such as magnetic resonance imaging are noninvasive and can assess quantitative cardiac iron load. Phlebotomy and chelating drugs are suboptimal means of treating IOC; hence, the roles of gene therapy, hepcidin, and calcium channel blockers are being actively investigated. There is a need for the development of clinical guidelines in order to improve the management of this emerging complex disease. | 11,653,542 | true | Iron overload cardiomyopathy: better understanding of an increasing disorder. The prevalence of iron overload cardiomyopathy (IOC) is increasing. The spectrum of symptoms of IOC is varied. Early in the disease process, patients may be asymptomatic, whereas severely overloaded patients can have terminal heart failure complaints that are refractory to treatment. It has been shown that early recognition and intervention may alter outcomes. Biochemical markers and tissue biopsy, which have traditionally been used to diagnose and guide therapy, are not sensitive enough to detect early cardiac iron deposition. Newer diagnostic modalities such as magnetic resonance imaging are noninvasive and can assess quantitative cardiac iron load. Phlebotomy and chelating drugs are suboptimal means of treating IOC; hence, the roles of gene therapy, hepcidin, and calcium channel blockers are being actively investigated. There is a need for the development of clinical guidelines in order to improve the management of this emerging complex disease. |
27,697,440 | D000991:Antithrombins; D000066491:Clinical Decision-Making; D000069604:Dabigatran; D065427:Factor Xa Inhibitors; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D020300:Intracranial Hemorrhages; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013923:Thromboembolism | [
"D000991",
"D000066491",
"D000069604",
"D065427",
"D006471",
"D006801",
"D020300",
"D017410",
"D018570",
"D013923"
] | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. | Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. | 8,080,679 | true | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. |
27,697,440 | D000991:Antithrombins; D000066491:Clinical Decision-Making; D000069604:Dabigatran; D065427:Factor Xa Inhibitors; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D020300:Intracranial Hemorrhages; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013923:Thromboembolism | [
"D000991",
"D000066491",
"D000069604",
"D065427",
"D006471",
"D006801",
"D020300",
"D017410",
"D018570",
"D013923"
] | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. | Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. | 10,141,236 | true | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. |
160,516 | D000368:Aged; D006332:Cardiomegaly; D004935:Esophageal Diseases; D005260:Female; D006325:Heart Atria; D006801:Humans; D011189:Potassium Chloride; D014456:Ulcer | [
"D000368",
"D006332",
"D004935",
"D005260",
"D006325",
"D006801",
"D011189",
"D014456"
] | Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement. | Ulceration of the oesophagus was suspected clinically and confirmed radiologically in a patient with an enlarged left atrium while on treatment with slow release potassium chloride. Its discontinuation resulted in resolution of symptoms. This potentially serious complication of treatment should be considered in patients with enlargement of the left atrium who develop dysphagia. It is avoided by using soluble forms of potassium chloride replacement. | 1,081,703 | true | Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement. Ulceration of the oesophagus was suspected clinically and confirmed radiologically in a patient with an enlarged left atrium while on treatment with slow release potassium chloride. Its discontinuation resulted in resolution of symptoms. This potentially serious complication of treatment should be considered in patients with enlargement of the left atrium who develop dysphagia. It is avoided by using soluble forms of potassium chloride replacement. |
33,805,763 | D064987:Cell- and Tissue-Based Therapy; D006333:Heart Failure; D006801:Humans; D009206:Myocardium; D032383:Myocytes, Cardiac; D023822:Tissue Engineering | [
"D064987",
"D006333",
"D006801",
"D009206",
"D032383",
"D023822"
] | Cardiac Cell Therapy for Heart Repair: Should the Cells Be Left Out? | Cardiovascular disease (CVD) is still the leading cause of death worldwide. Coronary artery occlusion, or myocardial infarction (MI) causes massive loss of cardiomyocytes. The ischemia area is eventually replaced by a fibrotic scar. From the mechanical dysfunctions of the scar in electronic transduction, contraction and compliance, pathological cardiac dilation and heart failure develops. Once end-stage heart failure occurs, the only option is to perform heart transplantation. The sequential changes are termed cardiac remodeling, and are due to the lack of endogenous regenerative actions in the adult human heart. Regenerative medicine and biomedical engineering strategies have been pursued to repair the damaged heart and to restore normal cardiac function. Such strategies include both cellular and acellular products, in combination with biomaterials. In addition, substantial progress has been made to elucidate the molecular and cellular mechanisms underlying heart repair and regeneration. In this review, we summarize and discuss current therapeutic approaches for cardiac repair and provide a perspective on novel strategies that holding potential opportunities for future research and clinical translation. | 4,444,606 | true | Cardiac Cell Therapy for Heart Repair: Should the Cells Be Left Out? Cardiovascular disease (CVD) is still the leading cause of death worldwide. Coronary artery occlusion, or myocardial infarction (MI) causes massive loss of cardiomyocytes. The ischemia area is eventually replaced by a fibrotic scar. From the mechanical dysfunctions of the scar in electronic transduction, contraction and compliance, pathological cardiac dilation and heart failure develops. Once end-stage heart failure occurs, the only option is to perform heart transplantation. The sequential changes are termed cardiac remodeling, and are due to the lack of endogenous regenerative actions in the adult human heart. Regenerative medicine and biomedical engineering strategies have been pursued to repair the damaged heart and to restore normal cardiac function. Such strategies include both cellular and acellular products, in combination with biomaterials. In addition, substantial progress has been made to elucidate the molecular and cellular mechanisms underlying heart repair and regeneration. In this review, we summarize and discuss current therapeutic approaches for cardiac repair and provide a perspective on novel strategies that holding potential opportunities for future research and clinical translation. |
24,951,664 | D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001786:Blood Glucose; D002880:Chromosomes, Human, Pair 11; D015331:Cohort Studies; D053418:Death Domain Receptor Signaling Adaptor Proteins; D003924:Diabetes Mellitus, Type 2; D005215:Fasting; D005260:Female; D005787:Gene Frequency; D014644:Genetic Variation; D055106:Genome-Wide Association Study; D023281:Genomics; D020662:Guanine Nucleotide Exchange Factors; D006331:Heart Diseases; D006801:Humans; D007328:Insulin; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D017422:Sequence Analysis, DNA | [
"D000368",
"D000369",
"D000375",
"D001786",
"D002880",
"D015331",
"D053418",
"D003924",
"D005215",
"D005260",
"D005787",
"D014644",
"D055106",
"D023281",
"D020662",
"D006331",
"D006801",
"D007328",
"D008297",
"D008875",
"D020641",
"D017422"
] | Association of levels of fasting glucose and insulin with rare variants at the chromosome 11p11.2-MADD locus: Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium Targeted Sequencing Study. | BACKGROUND
Common variation at the 11p11.2 locus, encompassing MADD, ACP2, NR1H3, MYBPC3, and SPI1, has been associated in genome-wide association studies with fasting glucose and insulin (FI). In the Cohorts for Heart and Aging Research in Genomic Epidemiology Targeted Sequencing Study, we sequenced 5 gene regions at 11p11.2 to identify rare, potentially functional variants influencing fasting glucose or FI levels.
RESULTS
Sequencing (mean depth, 38×) across 16.1 kb in 3566 individuals without diabetes mellitus identified 653 variants, 79.9% of which were rare (minor allele frequency <1%) and novel. We analyzed rare variants in 5 gene regions with FI or fasting glucose using the sequence kernel association test. At NR1H3, 53 rare variants were jointly associated with FI (P=2.73×10(-3)); of these, 7 were predicted to have regulatory function and showed association with FI (P=1.28×10(-3)). Conditioning on 2 previously associated variants at MADD (rs7944584, rs10838687) did not attenuate this association, suggesting that there are >2 independent signals at 11p11.2. One predicted regulatory variant, chr11:47227430 (hg18; minor allele frequency=0.00068), contributed 20.6% to the overall sequence kernel association test score at NR1H3, lies in intron 2 of NR1H3, and is a predicted binding site for forkhead box A1 (FOXA1), a transcription factor associated with insulin regulation. In human HepG2 hepatoma cells, the rare chr11:47227430 A allele disrupted FOXA1 binding and reduced FOXA1-dependent transcriptional activity.
CONCLUSIONS
Sequencing at 11p11.2-NR1H3 identified rare variation associated with FI. One variant, chr11:47227430, seems to be functional, with the rare A allele reducing transcription factor FOXA1 binding and FOXA1-dependent transcriptional activity. | null | false | Association of levels of fasting glucose and insulin with rare variants at the chromosome 11p11.2-MADD locus: Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium Targeted Sequencing Study. BACKGROUND
Common variation at the 11p11.2 locus, encompassing MADD, ACP2, NR1H3, MYBPC3, and SPI1, has been associated in genome-wide association studies with fasting glucose and insulin (FI). In the Cohorts for Heart and Aging Research in Genomic Epidemiology Targeted Sequencing Study, we sequenced 5 gene regions at 11p11.2 to identify rare, potentially functional variants influencing fasting glucose or FI levels.
RESULTS
Sequencing (mean depth, 38×) across 16.1 kb in 3566 individuals without diabetes mellitus identified 653 variants, 79.9% of which were rare (minor allele frequency <1%) and novel. We analyzed rare variants in 5 gene regions with FI or fasting glucose using the sequence kernel association test. At NR1H3, 53 rare variants were jointly associated with FI (P=2.73×10(-3)); of these, 7 were predicted to have regulatory function and showed association with FI (P=1.28×10(-3)). Conditioning on 2 previously associated variants at MADD (rs7944584, rs10838687) did not attenuate this association, suggesting that there are >2 independent signals at 11p11.2. One predicted regulatory variant, chr11:47227430 (hg18; minor allele frequency=0.00068), contributed 20.6% to the overall sequence kernel association test score at NR1H3, lies in intron 2 of NR1H3, and is a predicted binding site for forkhead box A1 (FOXA1), a transcription factor associated with insulin regulation. In human HepG2 hepatoma cells, the rare chr11:47227430 A allele disrupted FOXA1 binding and reduced FOXA1-dependent transcriptional activity.
CONCLUSIONS
Sequencing at 11p11.2-NR1H3 identified rare variation associated with FI. One variant, chr11:47227430, seems to be functional, with the rare A allele reducing transcription factor FOXA1 binding and FOXA1-dependent transcriptional activity. |
23,336,931 | D017311:Amlodipine; D000818:Animals; D000959:Antihypertensive Agents; D000069059:Atorvastatin; D002340:Carotid Artery Diseases; D017536:Carotid Artery, Common; D018932:Chemokine CCL2; D050759:Cyclin-Dependent Kinase Inhibitor p21; D004359:Drug Therapy, Combination; D042783:Endothelial Cells; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008297:Male; D011758:Pyrroles; D051381:Rats; D056564:Sirtuin 1; D016159:Tumor Suppressor Protein p53 | [
"D017311",
"D000818",
"D000959",
"D000069059",
"D002340",
"D017536",
"D018932",
"D050759",
"D004359",
"D042783",
"D006538",
"D019161",
"D008297",
"D011758",
"D051381",
"D056564",
"D016159"
] | Combination benefit of amlodipine plus atorvastatin treatment on carotid atherosclerosis in Zucker metabolic rats. | OBJECTIVE
Obesity is the major risk factor for metabolic syndrome and atherosclerotic cardiocerebrovascular diseases.
METHODS
We studied effects of amlodipine, atorvastatin, and their combination on carotid arteriosclerotic processes in a metabolic syndrome model of Zucker fatty rats. Zucker fatty rats were treated with vehicle, amlodipine, atorvastatin, or combination amlodipine plus atorvastatin for 28 days.
RESULTS
Compared with the single treatment with amlodipine or atorvastatin, the combination of amlodipine plus atorvastatin treatment prevented arteriosclerotic processes, and induced a strong recovery of Sirtuin1 (Sirt1) expression and a marked reduction in p53, p21, and monocyte chemoattractant protein-1 (MCP-1).
CONCLUSIONS
As Sirt1 is a longevity gene that prevents endothelial atherosclerotic processes, and p53, p21, and MCP-1 play pivotal roles in the initiation and development of atherosclerosis, these data suggest a strong synergistic benefit of combination therapy with amlodipine and atorvastatin for preventing atherosclerotic processes, and potentially reducing the clinical risk of cerebrovascular events in metabolic obesity patients. | null | false | Combination benefit of amlodipine plus atorvastatin treatment on carotid atherosclerosis in Zucker metabolic rats. OBJECTIVE
Obesity is the major risk factor for metabolic syndrome and atherosclerotic cardiocerebrovascular diseases.
METHODS
We studied effects of amlodipine, atorvastatin, and their combination on carotid arteriosclerotic processes in a metabolic syndrome model of Zucker fatty rats. Zucker fatty rats were treated with vehicle, amlodipine, atorvastatin, or combination amlodipine plus atorvastatin for 28 days.
RESULTS
Compared with the single treatment with amlodipine or atorvastatin, the combination of amlodipine plus atorvastatin treatment prevented arteriosclerotic processes, and induced a strong recovery of Sirtuin1 (Sirt1) expression and a marked reduction in p53, p21, and monocyte chemoattractant protein-1 (MCP-1).
CONCLUSIONS
As Sirt1 is a longevity gene that prevents endothelial atherosclerotic processes, and p53, p21, and MCP-1 play pivotal roles in the initiation and development of atherosclerosis, these data suggest a strong synergistic benefit of combination therapy with amlodipine and atorvastatin for preventing atherosclerotic processes, and potentially reducing the clinical risk of cerebrovascular events in metabolic obesity patients. |
8,060,581 | D000328:Adult; D001786:Blood Glucose; D004039:Diet, Sodium-Restricted; D005260:Female; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension; D007328:Insulin; D008297:Male; D008875:Middle Aged | [
"D000328",
"D001786",
"D004039",
"D005260",
"D018149",
"D005951",
"D006801",
"D006973",
"D007328",
"D008297",
"D008875"
] | Dietary NaCl restriction deteriorates oral glucose tolerance in hypertensive patients with impairment of glucose tolerance. | This study investigated whether the change of glycemic response to oral glucose loading with an increase of dietary NaCl intake is different between salt-sensitive and salt-resistant groups, or whether it is related to glucose tolerance on a low NaCl diet independent of salt sensitivity. The plasma glucose and insulin response to 75 g oral glucose intake was assessed on low (34 mmol/day) and high (342 mmol/day) NaCl diets in 31 patients with essential hypertension, and the area under the curve for both variables (AUCglu and AUCins) was calculated. The data on the high NaCl diet were corrected for change in hematocrit. The percentage change in systolic, diastolic, and mean blood pressure between the two diets was defined as the salt sensitivity index (SSI) for systolic blood pressure (SSISBP), diastolic blood pressure (SSIDBP), and mean blood pressure (SSIMBP), respectively. The mean values of both AUCglu and AUCins decreased significantly with increase of NaCl intake; however, there was no significant correlation between SSI (SSISBP, SSIDBP, or SSIMBP) and the percentage changes in AUCglu and AUCins. Meanwhile, the percentage changes in AUCglu and AUCins significantly correlated with the respective values of AUCglu and AUCins on the low NaCl diet. These results suggest that extreme NaCl restriction may deteriorate glucose metabolism in hypertensive patients, especially in those with diabetes mellitus or impaired glucose tolerance. | 7,575,587 | true | Dietary NaCl restriction deteriorates oral glucose tolerance in hypertensive patients with impairment of glucose tolerance. This study investigated whether the change of glycemic response to oral glucose loading with an increase of dietary NaCl intake is different between salt-sensitive and salt-resistant groups, or whether it is related to glucose tolerance on a low NaCl diet independent of salt sensitivity. The plasma glucose and insulin response to 75 g oral glucose intake was assessed on low (34 mmol/day) and high (342 mmol/day) NaCl diets in 31 patients with essential hypertension, and the area under the curve for both variables (AUCglu and AUCins) was calculated. The data on the high NaCl diet were corrected for change in hematocrit. The percentage change in systolic, diastolic, and mean blood pressure between the two diets was defined as the salt sensitivity index (SSI) for systolic blood pressure (SSISBP), diastolic blood pressure (SSIDBP), and mean blood pressure (SSIMBP), respectively. The mean values of both AUCglu and AUCins decreased significantly with increase of NaCl intake; however, there was no significant correlation between SSI (SSISBP, SSIDBP, or SSIMBP) and the percentage changes in AUCglu and AUCins. Meanwhile, the percentage changes in AUCglu and AUCins significantly correlated with the respective values of AUCglu and AUCins on the low NaCl diet. These results suggest that extreme NaCl restriction may deteriorate glucose metabolism in hypertensive patients, especially in those with diabetes mellitus or impaired glucose tolerance. |
2,310,255 | D000293:Adolescent; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria; D006327:Heart Block; D006346:Heart Septum; D006801:Humans; D013617:Tachycardia, Supraventricular | [
"D000293",
"D004562",
"D015716",
"D005260",
"D006325",
"D006327",
"D006346",
"D006801",
"D013617"
] | Surgical cure of automatic atrial tachycardia by partial left atrial isolation. | Partial left atrial isolation was performed in a 16-year-old girl with persistent atrial tachycardia refractory to antiarrhythmic agents for 3 years. Intraoperative atrial epicardial and endocardial mapping showed that the earliest atrial activation occurred in an area lateral to the junction of the right superior pulmonary vein and the left atrium. An incision isolating the right half of the left atrial body containing the area of the earliest atrial activation and both right pulmonary veins from the remainder of the left atrium was made. The incision was then reapproximated. An excision encircling the interatrial septum containing the upper anterior portion of the septum with early activation was also made, and the atrial septal defect was repaired with a pericardial patch. The patient has been in sinus rhythm and free of arrhythmia for a follow-up period of 12 months. | 7,445,756 | true | Surgical cure of automatic atrial tachycardia by partial left atrial isolation. Partial left atrial isolation was performed in a 16-year-old girl with persistent atrial tachycardia refractory to antiarrhythmic agents for 3 years. Intraoperative atrial epicardial and endocardial mapping showed that the earliest atrial activation occurred in an area lateral to the junction of the right superior pulmonary vein and the left atrium. An incision isolating the right half of the left atrial body containing the area of the earliest atrial activation and both right pulmonary veins from the remainder of the left atrium was made. The incision was then reapproximated. An excision encircling the interatrial septum containing the upper anterior portion of the septum with early activation was also made, and the atrial septal defect was repaired with a pericardial patch. The patient has been in sinus rhythm and free of arrhythmia for a follow-up period of 12 months. |
22,721,898 | D000293:Adolescent; D000328:Adult; D000368:Aged; D005165:Factor V; D005260:Female; D005838:Genotype; D006801:Humans; D020767:Intracranial Thrombosis; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D008875:Middle Aged; D011110:Polymorphism, Genetic; D020641:Polymorphism, Single Nucleotide; D011516:Prothrombin; D012307:Risk Factors; D014416:Tunisia; D020246:Venous Thrombosis; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D005165",
"D005260",
"D005838",
"D006801",
"D020767",
"D008297",
"D042965",
"D008875",
"D011110",
"D020641",
"D011516",
"D012307",
"D014416",
"D020246",
"D055815"
] | Thrombophilic polymorphisms - factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T - in Tunisian patients with cerebral venous thrombosis. | Cerebral venous thrombosis (CVT) has been associated with thrombophilic defects. We performed a study to evaluate the role of three single nucleotide polymorphisms (SNP), factor V Leiden G1691A (FVL), prothrombin gene mutation G20210A (FII-G20210A) and methylenotetrahydrofolate reductase variant C677T (MTHFR-C677T), as risk factors for CVT in Tunisian patients. A single center case-control study (26 patients with CVT and 197 controls) was performed. Genomic DNA was tested for the three SNP. The principle finding was the association between FVL and CVT (p<0.001, Odds ratio=6.1, 95% confidence interval=2.3-16.5). However, neither the FII-G20210 (p=0.536) nor the homozygous MTHFR-C677T genotype (p=0.325) variant contributed to the risk of CVT in these Tunisian patients. | 13,980,158 | true | Thrombophilic polymorphisms - factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T - in Tunisian patients with cerebral venous thrombosis. Cerebral venous thrombosis (CVT) has been associated with thrombophilic defects. We performed a study to evaluate the role of three single nucleotide polymorphisms (SNP), factor V Leiden G1691A (FVL), prothrombin gene mutation G20210A (FII-G20210A) and methylenotetrahydrofolate reductase variant C677T (MTHFR-C677T), as risk factors for CVT in Tunisian patients. A single center case-control study (26 patients with CVT and 197 controls) was performed. Genomic DNA was tested for the three SNP. The principle finding was the association between FVL and CVT (p<0.001, Odds ratio=6.1, 95% confidence interval=2.3-16.5). However, neither the FII-G20210 (p=0.536) nor the homozygous MTHFR-C677T genotype (p=0.325) variant contributed to the risk of CVT in these Tunisian patients. |
37,166,820 | D006801:Humans; D000068258:Bevacizumab; D012170:Retinal Vein Occlusion; D008269:Macular Edema; D020533:Angiogenesis Inhibitors; D040262:Receptors, Vascular Endothelial Growth Factor; D011993:Recombinant Fusion Proteins; D058449:Intravitreal Injections | [
"D006801",
"D000068258",
"D012170",
"D008269",
"D020533",
"D040262",
"D011993",
"D058449"
] | Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial. | Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.
To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.
This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.
Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).
Incremental cost-utility ratio.
The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.
While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition. | null | false | Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial. Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.
To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.
This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.
Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).
Incremental cost-utility ratio.
The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.
While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition. |
32,028,046 | D000328:Adult; D016757:Death, Sudden, Cardiac; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult | [
"D000328",
"D016757",
"D005260",
"D006801",
"D015994",
"D008297",
"D008875",
"D011159",
"D056910",
"D012189",
"D018570",
"D012307",
"D055815"
] | Short stature is associated with incident sudden cardiac death in a large Asian cohort. | Few data on the association between height and the risk of sudden cardiac death (SCD) in Asian populations are available.
The purpose of this study was to assess the risk of SCD as related to height both in a representative Korean population and in specific subgroups.
This is a retrospective cohort study of 410,119 Koreans age ≥20 years from the Korean National Health Insurance Service-National Sample Cohort, who underwent a national health examination. SCD cases were adjudicated based on information within the claims database. Cox proportional hazard models were applied to estimate hazard ratios and 95% confidence intervals for the association between height and SCD. Potential mediators included demographic factors, health-related habits, and specific cardiovascular comorbidities.
During an 8.45-year follow-up period, a total of 1341 SCDs occurred. Various factors, including short stature, were identified as risk factors for SCD. Multivariable regression analysis revealed that a 10-cm increase in height was associated with a 14% decreased risk for SCD. This relationship remained significant among the elderly, postmenopausal women, and individuals without cardiovascular disease.
Our results indicate that short stature is a significant risk factor for SCD in a Korean population, thus supporting previously published findings correlating height to SCD risk in non-Asian populations. | null | false | Short stature is associated with incident sudden cardiac death in a large Asian cohort. Few data on the association between height and the risk of sudden cardiac death (SCD) in Asian populations are available.
The purpose of this study was to assess the risk of SCD as related to height both in a representative Korean population and in specific subgroups.
This is a retrospective cohort study of 410,119 Koreans age ≥20 years from the Korean National Health Insurance Service-National Sample Cohort, who underwent a national health examination. SCD cases were adjudicated based on information within the claims database. Cox proportional hazard models were applied to estimate hazard ratios and 95% confidence intervals for the association between height and SCD. Potential mediators included demographic factors, health-related habits, and specific cardiovascular comorbidities.
During an 8.45-year follow-up period, a total of 1341 SCDs occurred. Various factors, including short stature, were identified as risk factors for SCD. Multivariable regression analysis revealed that a 10-cm increase in height was associated with a 14% decreased risk for SCD. This relationship remained significant among the elderly, postmenopausal women, and individuals without cardiovascular disease.
Our results indicate that short stature is a significant risk factor for SCD in a Korean population, thus supporting previously published findings correlating height to SCD risk in non-Asian populations. |
18,413,598 | D017667:Adipocytes; D050156:Adipogenesis; D000273:Adipose Tissue; D000818:Animals; D002135:Calcium-Binding Proteins; D009202:Cardiomyopathies; D003924:Diabetes Mellitus, Type 2; D020022:Genetic Predisposition to Disease; D005934:Glucagon; D007328:Insulin; D036341:Intercellular Signaling Peptides and Proteins; D024821:Metabolic Syndrome; D051379:Mice; D008822:Mice, Transgenic; D009765:Obesity; D010179:Pancreas; D011401:Promoter Regions, Genetic; D012333:RNA, Messenger; D054411:Receptors, Leptin; D051780:Sterol Regulatory Element Binding Protein 1; D019076:Transgenes | [
"D017667",
"D050156",
"D000273",
"D000818",
"D002135",
"D009202",
"D003924",
"D020022",
"D005934",
"D007328",
"D036341",
"D024821",
"D051379",
"D008822",
"D009765",
"D010179",
"D011401",
"D012333",
"D054411",
"D051780",
"D019076"
] | Adipogenic capacity and the susceptibility to type 2 diabetes and metabolic syndrome. | To determine whether adipocyte storage capacity influences the onset and severity of type 2 diabetes and other components of the metabolic syndrome, we made normal and db/db mice resistant to obesity by overexpressing leptin receptor-b on the aP2-Lepr-b promoter. On a 4% diet, these mice have no phenotype, but on a 60% fat diet, they resist diet-induced obesity because constitutive adipocyte-specific overexpression of Lepr-b prevents obesity via the antilipogenic autocrine/paracrine action of leptin on adipocytes. After 8 months on the same 60% fat diet, body fat of transgenic mice was 70% below WT controls. Cardiac and liver fat was elevated in the transgenics, and their hyperinsulinemia was more marked, suggesting greater insulin resistance. The aP2-Lepr-b transgene also prevented obesity in db/db mice; at 10 weeks of age their body fat was half that of the db/db mice. This lack of obesity was attributable to reduced expression of sterol regulatory element binding protein-1c and its target lipogenic enzymes in adipose tissue and a 6-fold increase in Pref-1 mRNA. Severe diabetes was present in transgenics at 4 weeks of age, 10 weeks before db/db controls. Echocardiographic evidence of cardiomyopathy appeared at 10 weeks, weeks before the db/db mice. Histologically, loss of beta cells and myocardial fibrosis was present in the transgenic group at least 6 weeks before the db/db mice. These results suggest that the expression level of genes that regulate the adipogenic response to overnutrition profoundly influences the age of onset and severity of diet-induced type 2 diabetes and co-morbidities. | 2,852,628 | true | Adipogenic capacity and the susceptibility to type 2 diabetes and metabolic syndrome. To determine whether adipocyte storage capacity influences the onset and severity of type 2 diabetes and other components of the metabolic syndrome, we made normal and db/db mice resistant to obesity by overexpressing leptin receptor-b on the aP2-Lepr-b promoter. On a 4% diet, these mice have no phenotype, but on a 60% fat diet, they resist diet-induced obesity because constitutive adipocyte-specific overexpression of Lepr-b prevents obesity via the antilipogenic autocrine/paracrine action of leptin on adipocytes. After 8 months on the same 60% fat diet, body fat of transgenic mice was 70% below WT controls. Cardiac and liver fat was elevated in the transgenics, and their hyperinsulinemia was more marked, suggesting greater insulin resistance. The aP2-Lepr-b transgene also prevented obesity in db/db mice; at 10 weeks of age their body fat was half that of the db/db mice. This lack of obesity was attributable to reduced expression of sterol regulatory element binding protein-1c and its target lipogenic enzymes in adipose tissue and a 6-fold increase in Pref-1 mRNA. Severe diabetes was present in transgenics at 4 weeks of age, 10 weeks before db/db controls. Echocardiographic evidence of cardiomyopathy appeared at 10 weeks, weeks before the db/db mice. Histologically, loss of beta cells and myocardial fibrosis was present in the transgenic group at least 6 weeks before the db/db mice. These results suggest that the expression level of genes that regulate the adipogenic response to overnutrition profoundly influences the age of onset and severity of diet-induced type 2 diabetes and co-morbidities. |
37,043,326 | D006801:Humans; D000818:Animals; D051379:Mice; D004195:Disease Models, Animal; D061088:Photoacoustic Techniques; D012151:Resuscitation; D006323:Heart Arrest; D000860:Hypoxia | [
"D006801",
"D000818",
"D051379",
"D004195",
"D061088",
"D012151",
"D006323",
"D000860"
] | Neurovascular Hypoxia Trajectories Assessed by Photoacoustic Imaging in a Murine Model of Cardiac Arrest and Resuscitation. | Cardiac arrest is a common cause of death annually mainly due to postcardiac arrest syndrome that leads to multiple organ global hypoxia and dysfunction after resuscitation. The ability to quantify vasculature changes and tissue oxygenation is crucial to adapt patient treatment in order to minimize major outcomes after resuscitation. For the first time, we applied high-resolution ultrasound associated with photoacoustic imaging (PAI) to track neurovascular oxygenation and cardiac function trajectories in a murine model of cardiac arrest and resuscitation. We report the preservation of brain oxygenation is greater compared to that in peripheral tissues during the arrest. Furthermore, distinct patterns of cerebral oxygen decay may relate to the support of vital brain functions. In addition, we followed trajectories of cerebral perfusion and cardiac function longitudinally after induced cardiac arrest and resuscitation. Volumetric cerebral oxygen saturation (sO2) decreased 24 h postarrest, but these levels rebounded at one week. However, systolic and diastolic cardiac dysfunction persisted throughout and correlated with cerebral hypoxia. Pathophysiologic biomarker trends, identified via cerebral PAI in preclinical models, could provide new insights into understanding the pathophysiology of cardiac arrest and resuscitation. | null | false | Neurovascular Hypoxia Trajectories Assessed by Photoacoustic Imaging in a Murine Model of Cardiac Arrest and Resuscitation. Cardiac arrest is a common cause of death annually mainly due to postcardiac arrest syndrome that leads to multiple organ global hypoxia and dysfunction after resuscitation. The ability to quantify vasculature changes and tissue oxygenation is crucial to adapt patient treatment in order to minimize major outcomes after resuscitation. For the first time, we applied high-resolution ultrasound associated with photoacoustic imaging (PAI) to track neurovascular oxygenation and cardiac function trajectories in a murine model of cardiac arrest and resuscitation. We report the preservation of brain oxygenation is greater compared to that in peripheral tissues during the arrest. Furthermore, distinct patterns of cerebral oxygen decay may relate to the support of vital brain functions. In addition, we followed trajectories of cerebral perfusion and cardiac function longitudinally after induced cardiac arrest and resuscitation. Volumetric cerebral oxygen saturation (sO2) decreased 24 h postarrest, but these levels rebounded at one week. However, systolic and diastolic cardiac dysfunction persisted throughout and correlated with cerebral hypoxia. Pathophysiologic biomarker trends, identified via cerebral PAI in preclinical models, could provide new insights into understanding the pathophysiology of cardiac arrest and resuscitation. |
37,558,295 | D006801:Humans; D006331:Heart Diseases; D005820:Genetic Testing; D009202:Cardiomyopathies; D001145:Arrhythmias, Cardiac; D005817:Genetic Counseling | [
"D006801",
"D006331",
"D005820",
"D009202",
"D001145",
"D005817"
] | A Practical Guide to Genetic Testing in Inherited Heart Disease. | Genetic testing has increasingly been shown to provide critical information regarding the treatment and management of patients with hereditary cardiomyopathies and arrhythmias and is available for a wide variety of conditions. It can provide information regarding arrhythmia risk, lifestyle recommendations, such as exercise avoidance, pharmaceutical therapies, and prognosis. Beyond the proband, genetic testing can be a valuable tool for cascade screening in the family. Genetic testing should be accompanied with genetic counseling, as genetic tests should be accompanied by expert interpretation, support in cascade family evaluation, and psychosocial considerations. Overall, it should be routinely implemented in arrhythmia and cardiomyopathy clinics. | null | false | A Practical Guide to Genetic Testing in Inherited Heart Disease. Genetic testing has increasingly been shown to provide critical information regarding the treatment and management of patients with hereditary cardiomyopathies and arrhythmias and is available for a wide variety of conditions. It can provide information regarding arrhythmia risk, lifestyle recommendations, such as exercise avoidance, pharmaceutical therapies, and prognosis. Beyond the proband, genetic testing can be a valuable tool for cascade screening in the family. Genetic testing should be accompanied with genetic counseling, as genetic tests should be accompanied by expert interpretation, support in cascade family evaluation, and psychosocial considerations. Overall, it should be routinely implemented in arrhythmia and cardiomyopathy clinics. |
8,538,901 | D017545:Aortic Aneurysm, Thoracic; D002102:Cadaver; D006801:Humans; D006965:Hyperplasia; D011093:Polyethylene Terephthalates; D019736:Prostheses and Implants; D017539:Tunica Intima | [
"D017545",
"D002102",
"D006801",
"D006965",
"D011093",
"D019736",
"D017539"
] | Pathological study of implanted dacron grafts in surgery of thoracic aortic aneurysms. | We studied woven dacron grafts that had been implanted in 5 patients of thoracic aortic aneurysms. In addition to usual stains, immunocytochemical analysis was performed using monoclonal antibodies to the muscle actin (HHF35) and to the macrophage (HAM56). In the graft of 5 and 24 days implantation, thin thrombi containing red cells and fibrin covered the luminal surface in some places, and macrophages came into the thrombi. In the grafts of 12 and 38 months implantation, intimal hyperplasia of 0.2-1.0 mm thickness was seen at the anastomotic segments with the accumulation of smooth muscle cells. Except for the anastomotic segments, connective tissue matrix with collagen fibers covered the luminal surface, and in some hollows of the graft crimps, old and fresh thombi were seen in layers. Organizing thrombi of 1.0 mm thickness attached where the branched graft was anastomosed to the main graft. Anastomotic intimal hyperplasia in the graft of 148 month implantation was 0.4-1.0 mm in thickness and 5-10 mm in length, and aside from the intimal hyperplasia, an endothelial lining did not cover the luminal surface of the graft. In the thoracic aorta, woven dacron graft implantation did not cause a critical stenosis with the intimal hyperplasia. The mural thrombi formed at the branched graft, however, threatened to result in graft occlusion or embolization. | 14,348,338 | true | Pathological study of implanted dacron grafts in surgery of thoracic aortic aneurysms. We studied woven dacron grafts that had been implanted in 5 patients of thoracic aortic aneurysms. In addition to usual stains, immunocytochemical analysis was performed using monoclonal antibodies to the muscle actin (HHF35) and to the macrophage (HAM56). In the graft of 5 and 24 days implantation, thin thrombi containing red cells and fibrin covered the luminal surface in some places, and macrophages came into the thrombi. In the grafts of 12 and 38 months implantation, intimal hyperplasia of 0.2-1.0 mm thickness was seen at the anastomotic segments with the accumulation of smooth muscle cells. Except for the anastomotic segments, connective tissue matrix with collagen fibers covered the luminal surface, and in some hollows of the graft crimps, old and fresh thombi were seen in layers. Organizing thrombi of 1.0 mm thickness attached where the branched graft was anastomosed to the main graft. Anastomotic intimal hyperplasia in the graft of 148 month implantation was 0.4-1.0 mm in thickness and 5-10 mm in length, and aside from the intimal hyperplasia, an endothelial lining did not cover the luminal surface of the graft. In the thoracic aorta, woven dacron graft implantation did not cause a critical stenosis with the intimal hyperplasia. The mural thrombi formed at the branched graft, however, threatened to result in graft occlusion or embolization. |
16,583,933 | D001024:Aortic Valve Stenosis; D002404:Catheterization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome; D014463:Ultrasonography | [
"D001024",
"D002404",
"D006801",
"D007223",
"D007231",
"D008297",
"D016896",
"D014463"
] | [Transluminal balloon valvuloplasty in neonates and infants with critical aortic stenosis]. | The purpose of this study was to evaluate children who underwent balloon valvuloplasty due to critical aortic stenosis following clinical (low cardiac output, cardiogenic shock, congestive heart failure) and echocardiographic criteria (morphological evidence of left ventricular hypertrophy, with depression of left ventricular function, irrespective of transvalvular gradient). We assessed the effectiveness of balloon valvuloplasty in 5 children (all male) who were submitted to aortic valve balloon dilatation over 3.5 years (10.1998-05.2003). The age at dilatation was 29+/-24 days, BW 3.92+/-0.82 kg and BSA 0.24+/-0.03 m2. In all children the balloon valvuloplasty was performed with manual inflation of balloon at 4-6 bars through the femoral artery. The mean systolic pressure gradient across the aortic valve decreased from 68+/-20.5 mmHg to 9+/-10.95 mmHg, i.e. by 85%, (p<0.01). Aortic valve ring diameter was 9.2+0.84 mm, and balloon/aortic ring ratio 0.8-0.04. The degree of aortic insufficiency immediately after the dilatation did not significantly increase. Dilatation was performed without complications. Long term results were evaluated in all patients 3.2 - 54 months after valvuloplasty and revealed the continuously increasing residual aortic valve gradient (Doppler measurement) 33+/-10.95 mmHg to be significantly lower (p<0.01) than before valvuloplasty. None of the children was showing clinical symptoms of the disease. According to echocardiographic analysis two of them developed aortic valvar insufficiency grade II, two had trivial insufficiency, one was without insufficiency. One child is an candidate for the Ross procedure in future (gradient 50 mmHg, insufficiency grade II, age 4.5 years.). Balloon valvuloplasty provides effective interventional method in the treatment of the neonates and infants with critical aortic stenosis. | null | false | [Transluminal balloon valvuloplasty in neonates and infants with critical aortic stenosis]. The purpose of this study was to evaluate children who underwent balloon valvuloplasty due to critical aortic stenosis following clinical (low cardiac output, cardiogenic shock, congestive heart failure) and echocardiographic criteria (morphological evidence of left ventricular hypertrophy, with depression of left ventricular function, irrespective of transvalvular gradient). We assessed the effectiveness of balloon valvuloplasty in 5 children (all male) who were submitted to aortic valve balloon dilatation over 3.5 years (10.1998-05.2003). The age at dilatation was 29+/-24 days, BW 3.92+/-0.82 kg and BSA 0.24+/-0.03 m2. In all children the balloon valvuloplasty was performed with manual inflation of balloon at 4-6 bars through the femoral artery. The mean systolic pressure gradient across the aortic valve decreased from 68+/-20.5 mmHg to 9+/-10.95 mmHg, i.e. by 85%, (p<0.01). Aortic valve ring diameter was 9.2+0.84 mm, and balloon/aortic ring ratio 0.8-0.04. The degree of aortic insufficiency immediately after the dilatation did not significantly increase. Dilatation was performed without complications. Long term results were evaluated in all patients 3.2 - 54 months after valvuloplasty and revealed the continuously increasing residual aortic valve gradient (Doppler measurement) 33+/-10.95 mmHg to be significantly lower (p<0.01) than before valvuloplasty. None of the children was showing clinical symptoms of the disease. According to echocardiographic analysis two of them developed aortic valvar insufficiency grade II, two had trivial insufficiency, one was without insufficiency. One child is an candidate for the Ross procedure in future (gradient 50 mmHg, insufficiency grade II, age 4.5 years.). Balloon valvuloplasty provides effective interventional method in the treatment of the neonates and infants with critical aortic stenosis. |
30,870,037 | D000287:Administration, Topical; D017719:Diabetic Foot; D016503:Drug Delivery Systems; D000076722:Drug Development; D055808:Drug Discovery; D006801:Humans; D004364:Pharmaceutical Preparations; D014945:Wound Healing; D014947:Wounds and Injuries | [
"D000287",
"D017719",
"D016503",
"D000076722",
"D055808",
"D006801",
"D004364",
"D014945",
"D014947"
] | The discovery and development of topical medicines for wound healing. | Chronic, nonhealing skin wounds claim >3% of the health-care budget in industrialized countries, and the incidence is rising. Currently, two parallel trends influence innovations within the field of wound healing: the need to reduce spread of antibiotic resistance and the emerging use of health economy and value-based models. Areas covered: This review focuses on the discovery of drug candidates and development of treatments aiming to enhance wound healing in the heterogeneous group of patients with nonhealing wounds. Expert opinion: Nonhealing wounds are multifaceted and recognized as difficult indications. The majority of products currently in use are medical device dressings, or concepts of negative pressure or hyperbaric oxygen treatment. Global best practice guidelines for the treatment of diabetic foot ulcers recommend debridement, redressing, as well as infection control, and are critical to the lack of coherent clinical evidence for many approved products in active wound care. To accelerate wound healing, there is an emerging trend toward biologics, gene therapy, and novel concepts for drug delivery in research and in the pipeline for clinical trials. Scientific delineation of the therapeutic mechanism of action is, in our opinion, vital for clinical trial success and for an increased fraction of medical products in the pharmaceutical pipeline. | null | false | The discovery and development of topical medicines for wound healing. Chronic, nonhealing skin wounds claim >3% of the health-care budget in industrialized countries, and the incidence is rising. Currently, two parallel trends influence innovations within the field of wound healing: the need to reduce spread of antibiotic resistance and the emerging use of health economy and value-based models. Areas covered: This review focuses on the discovery of drug candidates and development of treatments aiming to enhance wound healing in the heterogeneous group of patients with nonhealing wounds. Expert opinion: Nonhealing wounds are multifaceted and recognized as difficult indications. The majority of products currently in use are medical device dressings, or concepts of negative pressure or hyperbaric oxygen treatment. Global best practice guidelines for the treatment of diabetic foot ulcers recommend debridement, redressing, as well as infection control, and are critical to the lack of coherent clinical evidence for many approved products in active wound care. To accelerate wound healing, there is an emerging trend toward biologics, gene therapy, and novel concepts for drug delivery in research and in the pipeline for clinical trials. Scientific delineation of the therapeutic mechanism of action is, in our opinion, vital for clinical trial success and for an increased fraction of medical products in the pharmaceutical pipeline. |
2,234,326 | D000818:Animals; D001769:Blood; D004195:Disease Models, Animal; D004912:Erythrocytes; D005263:Femoral Artery; D006801:Humans; D002546:Ischemic Attack, Transient; D007962:Leukocytes; D008297:Male; D010949:Plasma; D051381:Rats; D011919:Rats, Inbred Strains | [
"D000818",
"D001769",
"D004195",
"D004912",
"D005263",
"D006801",
"D002546",
"D007962",
"D008297",
"D010949",
"D051381",
"D011919"
] | A rat femoral artery model for vasospasm. | A new animal model for vasospasm using rat femoral artery has been developed. Whole blood, washed erythrocytes, or leukocytes in platelet-rich plasma were selectively applied to the adventitial surface of the femoral artery for 7 days in 15 rats, after which the vessels were perfusion-fixed and examined by light and transmission electron microscopy and immunohistochemistry. As compared with matched control arteries, there was a prominent reduction in luminal cross-sectional area after 7 days in vessels exposed to whole blood or washed erythrocytes, but not in those exposed to leukocytes in platelet-rich plasma. In arteries with luminal narrowing, light and transmission electron microscopy demonstrated marked morphological changes throughout the vessel wall similar to those seen in cerebral vasospasm after subarachnoid hemorrhage. Immunohistochemistry disclosed a prominent loss of immunoreactive actin in smooth muscle cells of arteries exposed to whole blood or erythrocytes. To assess the time course of arterial narrowing in this model, whole blood was selectively applied to the adventitial surface of femoral arteries in 23 rats for periods from 2 to 20 days. As compared with control arteries, arterial narrowing was variably present at 2 days, progressively increased by 5 days, was maximal at 7 to 10 days, and returned to near control levels by 20 days. The presence and severity of ultrastructural changes in vessel wall corresponded to the degree of arterial narrowing over time. These results suggest that chronic narrowing in rat femoral artery exposed to periadventitial blood is analogous to that observed in cerebral arterial vasospasm after subarachnoid hemorrhage. This new model represents a simple and reliable means to investigate pathogenic mechanisms and potential therapies for vasospasm. | 14,509,119 | true | A rat femoral artery model for vasospasm. A new animal model for vasospasm using rat femoral artery has been developed. Whole blood, washed erythrocytes, or leukocytes in platelet-rich plasma were selectively applied to the adventitial surface of the femoral artery for 7 days in 15 rats, after which the vessels were perfusion-fixed and examined by light and transmission electron microscopy and immunohistochemistry. As compared with matched control arteries, there was a prominent reduction in luminal cross-sectional area after 7 days in vessels exposed to whole blood or washed erythrocytes, but not in those exposed to leukocytes in platelet-rich plasma. In arteries with luminal narrowing, light and transmission electron microscopy demonstrated marked morphological changes throughout the vessel wall similar to those seen in cerebral vasospasm after subarachnoid hemorrhage. Immunohistochemistry disclosed a prominent loss of immunoreactive actin in smooth muscle cells of arteries exposed to whole blood or erythrocytes. To assess the time course of arterial narrowing in this model, whole blood was selectively applied to the adventitial surface of femoral arteries in 23 rats for periods from 2 to 20 days. As compared with control arteries, arterial narrowing was variably present at 2 days, progressively increased by 5 days, was maximal at 7 to 10 days, and returned to near control levels by 20 days. The presence and severity of ultrastructural changes in vessel wall corresponded to the degree of arterial narrowing over time. These results suggest that chronic narrowing in rat femoral artery exposed to periadventitial blood is analogous to that observed in cerebral arterial vasospasm after subarachnoid hemorrhage. This new model represents a simple and reliable means to investigate pathogenic mechanisms and potential therapies for vasospasm. |
2,755,121 | D000818:Animals; D001145:Arrhythmias, Cardiac; D003243:Consciousness; D003327:Coronary Disease; D004110:Diltiazem; D004562:Electrocardiography; D006339:Heart Rate; D008297:Male; D015428:Myocardial Reperfusion Injury; D009543:Nifedipine; D051381:Rats; D011919:Rats, Inbred Strains; D013610:Tachycardia; D014693:Ventricular Fibrillation; D014700:Verapamil | [
"D000818",
"D001145",
"D003243",
"D003327",
"D004110",
"D004562",
"D006339",
"D008297",
"D015428",
"D009543",
"D051381",
"D011919",
"D013610",
"D014693",
"D014700"
] | Reperfusion-induced arrhythmias in the conscious rat: a comparative study with three calcium antagonists. | The effects of three calcium antagonists (diltiazem, verapamil, and nifedipine) on reperfusion-induced arrhythmias were compared in a conscious rat preparation with coronary artery occlusion and implanted electrocardiogram limb electrodes. Upon reperfusion after a 5-min period of occlusion, all (15/15) untreated control rats exhibited immediate ventricular tachycardia, which rapidly deteriorated to ventricular fibrillation; 87% (13/15) of the rats died as a consequence of these rhythm disturbances. In the groups treated with calcium antagonists, each drug (diltiazem, verapamil, or nifedipine) was given as an intravenous bolus 10 min prior to coronary occlusion (n = 12 in each group). The incidence of ventricular fibrillation was significantly reduced by all three calcium antagonists and this antifibrillatory effect resulted in a significantly lower mortality in all drug-treated groups. With diltiazem (0.5 and 2.0 mg/kg) mortality fell from 87 to 42% (P less than 0.05) and 35% (P less than 0.01), respectively; with verapamil (0.5 and 5.0 mg/kg) it fell to 25% (P less than 0.01) and 0% (P less than 0.001); and with nifedipine (5.0 and 50 micrograms/kg), it fell to 25% (P less than 0.01) and 8% (P less than 0.001). At a dose of 5.0 mg/kg, verapamil caused a large reduction in heart rate both prior to and during coronary occlusion and reperfusion; however, with other doses and drugs no significant changes in heart rate were observed. ST segment elevation during the 5-min ischemic period was reduced by pretreatment with all drugs. In conclusion, in the conscious rat, pretreatment with diltiazem, verapamil, or nifedipine affords some protection against reperfusion-induced arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS) | 7,665,470 | true | Reperfusion-induced arrhythmias in the conscious rat: a comparative study with three calcium antagonists. The effects of three calcium antagonists (diltiazem, verapamil, and nifedipine) on reperfusion-induced arrhythmias were compared in a conscious rat preparation with coronary artery occlusion and implanted electrocardiogram limb electrodes. Upon reperfusion after a 5-min period of occlusion, all (15/15) untreated control rats exhibited immediate ventricular tachycardia, which rapidly deteriorated to ventricular fibrillation; 87% (13/15) of the rats died as a consequence of these rhythm disturbances. In the groups treated with calcium antagonists, each drug (diltiazem, verapamil, or nifedipine) was given as an intravenous bolus 10 min prior to coronary occlusion (n = 12 in each group). The incidence of ventricular fibrillation was significantly reduced by all three calcium antagonists and this antifibrillatory effect resulted in a significantly lower mortality in all drug-treated groups. With diltiazem (0.5 and 2.0 mg/kg) mortality fell from 87 to 42% (P less than 0.05) and 35% (P less than 0.01), respectively; with verapamil (0.5 and 5.0 mg/kg) it fell to 25% (P less than 0.01) and 0% (P less than 0.001); and with nifedipine (5.0 and 50 micrograms/kg), it fell to 25% (P less than 0.01) and 8% (P less than 0.001). At a dose of 5.0 mg/kg, verapamil caused a large reduction in heart rate both prior to and during coronary occlusion and reperfusion; however, with other doses and drugs no significant changes in heart rate were observed. ST segment elevation during the 5-min ischemic period was reduced by pretreatment with all drugs. In conclusion, in the conscious rat, pretreatment with diltiazem, verapamil, or nifedipine affords some protection against reperfusion-induced arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS) |
17,532,413 | D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D004724:Endoscopy; D005260:Female; D006338:Heart Neoplasms; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome | [
"D000293",
"D000328",
"D000368",
"D006348",
"D004724",
"D005260",
"D006338",
"D006801",
"D008297",
"D008875",
"D012189",
"D016896"
] | Endoscopic cardiac tumor resection. | BACKGROUND
The purpose of this study is to report our 9 years' experience with endoscopic cardiac tumor resection using the port access approach.
METHODS
From March 1997 to December 2005, 27 patients (mean age, 56.2 +/- 16.9 years; 70% female) underwent endoscopic cardiac tumor resection using endocardiopulmonary bypass and endoaortic-balloon clamp technique. Nineteen (70%) patients presented in New York Heart Association class I, 4 patients presented with embolic stroke, and 4 patients presented with atrial arrhythmias. All patients underwent echocardiography on admission, intraoperatively, at discharge, and at follow-up evaluation. Eight patients additionally required mitral valve replacement (n = 1), tricuspid valve replacement (n = 1), mitral valve repair (n = 2), mini-maze (n = 1), and closure of patent foramen ovale (n = 3). Mean follow-up was 3.4 +/- 2.7 years.
RESULTS
Mean endoaortic-balloon clamp and endocardiopulmonary bypass times were 68.8 +/- 30.8 minutes and 112.2 +/- 41.5 minutes, respectively. There were no conversions to sternotomy. Tumors resected were classified as left atrial myxoma (n = 20), right atrial myxoma (n = 3), lipoma (n = 1), intravenous leiomyoma involving the inferior vena cava and the tricuspid valve (n = 1), plexiform tumor of the sinoatrial node (n = 1), and papillary fibroelastoma of aortic valve noncoronary cusp (n = 1). There were no hospital deaths. Mean intensive care unit and hospital stays were 1.4 +/- 1.1 days and 7.3 +/- 3.4 days, respectively. Postoperative complications were evolving stroke (n = 1), re-exploration for bleeding (n = 1), and myocardial ischemia requiring stenting (n = 1). Follow-up failed to demonstrate residual or recurrent tumor. One patient had a small residual atrial septal defect. Ninety-two percent of patients appreciated the cosmetic result and fast recovery.
CONCLUSIONS
Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy. | null | false | Endoscopic cardiac tumor resection. BACKGROUND
The purpose of this study is to report our 9 years' experience with endoscopic cardiac tumor resection using the port access approach.
METHODS
From March 1997 to December 2005, 27 patients (mean age, 56.2 +/- 16.9 years; 70% female) underwent endoscopic cardiac tumor resection using endocardiopulmonary bypass and endoaortic-balloon clamp technique. Nineteen (70%) patients presented in New York Heart Association class I, 4 patients presented with embolic stroke, and 4 patients presented with atrial arrhythmias. All patients underwent echocardiography on admission, intraoperatively, at discharge, and at follow-up evaluation. Eight patients additionally required mitral valve replacement (n = 1), tricuspid valve replacement (n = 1), mitral valve repair (n = 2), mini-maze (n = 1), and closure of patent foramen ovale (n = 3). Mean follow-up was 3.4 +/- 2.7 years.
RESULTS
Mean endoaortic-balloon clamp and endocardiopulmonary bypass times were 68.8 +/- 30.8 minutes and 112.2 +/- 41.5 minutes, respectively. There were no conversions to sternotomy. Tumors resected were classified as left atrial myxoma (n = 20), right atrial myxoma (n = 3), lipoma (n = 1), intravenous leiomyoma involving the inferior vena cava and the tricuspid valve (n = 1), plexiform tumor of the sinoatrial node (n = 1), and papillary fibroelastoma of aortic valve noncoronary cusp (n = 1). There were no hospital deaths. Mean intensive care unit and hospital stays were 1.4 +/- 1.1 days and 7.3 +/- 3.4 days, respectively. Postoperative complications were evolving stroke (n = 1), re-exploration for bleeding (n = 1), and myocardial ischemia requiring stenting (n = 1). Follow-up failed to demonstrate residual or recurrent tumor. One patient had a small residual atrial septal defect. Ninety-two percent of patients appreciated the cosmetic result and fast recovery.
CONCLUSIONS
Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy. |
17,578,050 | D000368:Aged; D000925:Anticoagulants; D001021:Aortic Valve; D017984:Enoxaparin; D005240:Feasibility Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006470:Hemorrhage; D006801:Humans; D019934:International Normalized Ratio; D008943:Mitral Valve; D019990:Perioperative Care; D011446:Prospective Studies; D012042:Registries; D013923:Thromboembolism | [
"D000368",
"D000925",
"D001021",
"D017984",
"D005240",
"D006350",
"D019918",
"D006470",
"D006801",
"D019934",
"D008943",
"D019990",
"D011446",
"D012042",
"D013923"
] | Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. | OBJECTIVE
The study aim was to determine the safety and feasibility of a standardized bridging regimen in patients with mechanical heart valves at high thromboembolic risk, using low-molecular-weight heparin (LMWH).
METHODS
Since the year 2000, all patients at the authors' institution, with mechanical heart valves and a need for periprocedural interruption of oral anticoagulation (OAC), were prospectively enrolled in this registry. Patients were treated with enoxaparin following a pre-specified, standardized bridging regimen. The main outcome measures were the incidence of hemorrhagic or thromboembolic events. The follow up period was 30 days after hospital discharge.
RESULTS
A total of 116 patients was included (31 with mitral valve replacement, 76 aortic valve replacement, nine double valve replacement). Patients underwent either major surgery (n = 25), minor surgery (n = 36), pacemaker implantation (n = 21), or coronary catheterization (n = 34). Bridging therapy with enoxaparin was administered for a mean of 7.0 +/- 4.6 days. Eighteen patients (15.5%) were treated as outpatients. In 35 patients (34%) with renal impairment (creatinine clearance <50 ml/min), LMWH dosage was halved. No thromboembolic (95% CI 0-3.1%) and only one major bleeding complication occurred (0.86%; 95% CI 0.02-4.7%); minor bleeding occurred in 10 patients (8.6%; 95% CI 4.2-15.3%). The hemorrhages arose after a mean of 5.4 +/- 1.4 days LMWH therapy.
CONCLUSIONS
Bridging therapy following a standardized LMWH-based regimen with enoxaparin was effective and relatively safe in a large cohort of patients with mechanical heart valves. Extended duration of LMWH therapy seems to promote the incidence of hemorrhage. Neither dose reduction in patients with renal impairment nor outpatient treatment affected the safety and efficacy of this bridging regimen. These findings warrant that more extensive studies be conducted to investigate the safety of this approach. | null | false | Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. OBJECTIVE
The study aim was to determine the safety and feasibility of a standardized bridging regimen in patients with mechanical heart valves at high thromboembolic risk, using low-molecular-weight heparin (LMWH).
METHODS
Since the year 2000, all patients at the authors' institution, with mechanical heart valves and a need for periprocedural interruption of oral anticoagulation (OAC), were prospectively enrolled in this registry. Patients were treated with enoxaparin following a pre-specified, standardized bridging regimen. The main outcome measures were the incidence of hemorrhagic or thromboembolic events. The follow up period was 30 days after hospital discharge.
RESULTS
A total of 116 patients was included (31 with mitral valve replacement, 76 aortic valve replacement, nine double valve replacement). Patients underwent either major surgery (n = 25), minor surgery (n = 36), pacemaker implantation (n = 21), or coronary catheterization (n = 34). Bridging therapy with enoxaparin was administered for a mean of 7.0 +/- 4.6 days. Eighteen patients (15.5%) were treated as outpatients. In 35 patients (34%) with renal impairment (creatinine clearance <50 ml/min), LMWH dosage was halved. No thromboembolic (95% CI 0-3.1%) and only one major bleeding complication occurred (0.86%; 95% CI 0.02-4.7%); minor bleeding occurred in 10 patients (8.6%; 95% CI 4.2-15.3%). The hemorrhages arose after a mean of 5.4 +/- 1.4 days LMWH therapy.
CONCLUSIONS
Bridging therapy following a standardized LMWH-based regimen with enoxaparin was effective and relatively safe in a large cohort of patients with mechanical heart valves. Extended duration of LMWH therapy seems to promote the incidence of hemorrhage. Neither dose reduction in patients with renal impairment nor outpatient treatment affected the safety and efficacy of this bridging regimen. These findings warrant that more extensive studies be conducted to investigate the safety of this approach. |
20,881,568 | D017542:Aneurysm, Ruptured; D002543:Cerebral Hemorrhage; D002552:Cerebral Ventricles; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome | [
"D017542",
"D002543",
"D002552",
"D015331",
"D005260",
"D006801",
"D002532",
"D016015",
"D008297",
"D008875",
"D015999",
"D009422",
"D011237",
"D012189",
"D012720",
"D016896"
] | Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. | BACKGROUND
Intraventricular hemorrhage (IVH) predicts worse outcomes following aneurysmal subarachnoid hemorrhage (SAH). One potential mechanism is that IVH predisposes to the development of delayed ischemic neurological deficits (DINDs). No previous studies have evaluated the association between IVH volume (in milliliters) and subsequent development of DINDs or poor outcomes.
OBJECTIVE
To assess the association between the volume of IVH and the subsequent development of DINDs, delayed cerebral infarction, death, and poor neurological outcomes, specifically among patients with concomitant SAH and IVH.
METHODS
We performed a cohort study involving 152 consecutive patients with concomitant SAH and IVH. To determine volume of IVH, we used the IVH Score, shown to correlate well with computerized volumetric assessment. To determine the relative quantity of subarachnoid blood, we applied the SAH Sum Score. Multivariate logistic regression was used to adjust for potential confounders.
RESULTS
There was no significant association between IVH volume and the development of DINDs or delayed infarction. In contrast, patients with poor neurological outcomes had significantly larger baseline IVH volume (mean, 11.8 mL vs 3.8 mL, P = .001). In the multivariate analysis, IVH volume was an independent predictor of poor outcomes (OR per mL: 1.11 [1.04-1.18]). Patients in the highest quartile for IVH volume were far more likely to progress to poor outcome compared with those in the lowest quartile (OR 4.09 [1.32-12.65]). Interobserver agreement in the determination of IVH Score was moderate to good.
CONCLUSIONS
IVH volume is an independent predictor of poor neurological outcomes, even after adjusting for the amount of subarachnoid blood. The pathophysiology of this association does not appear to involve an increased risk of DINDs or delayed infarction. Measures aimed at accelerating IVH clearance, such as intraventricular thrombolysis, merit further evaluation. | null | false | Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. BACKGROUND
Intraventricular hemorrhage (IVH) predicts worse outcomes following aneurysmal subarachnoid hemorrhage (SAH). One potential mechanism is that IVH predisposes to the development of delayed ischemic neurological deficits (DINDs). No previous studies have evaluated the association between IVH volume (in milliliters) and subsequent development of DINDs or poor outcomes.
OBJECTIVE
To assess the association between the volume of IVH and the subsequent development of DINDs, delayed cerebral infarction, death, and poor neurological outcomes, specifically among patients with concomitant SAH and IVH.
METHODS
We performed a cohort study involving 152 consecutive patients with concomitant SAH and IVH. To determine volume of IVH, we used the IVH Score, shown to correlate well with computerized volumetric assessment. To determine the relative quantity of subarachnoid blood, we applied the SAH Sum Score. Multivariate logistic regression was used to adjust for potential confounders.
RESULTS
There was no significant association between IVH volume and the development of DINDs or delayed infarction. In contrast, patients with poor neurological outcomes had significantly larger baseline IVH volume (mean, 11.8 mL vs 3.8 mL, P = .001). In the multivariate analysis, IVH volume was an independent predictor of poor outcomes (OR per mL: 1.11 [1.04-1.18]). Patients in the highest quartile for IVH volume were far more likely to progress to poor outcome compared with those in the lowest quartile (OR 4.09 [1.32-12.65]). Interobserver agreement in the determination of IVH Score was moderate to good.
CONCLUSIONS
IVH volume is an independent predictor of poor neurological outcomes, even after adjusting for the amount of subarachnoid blood. The pathophysiology of this association does not appear to involve an increased risk of DINDs or delayed infarction. Measures aimed at accelerating IVH clearance, such as intraventricular thrombolysis, merit further evaluation. |
12,939,567 | D003327:Coronary Disease; D006801:Humans; D006973:Hypertension; D007333:Insulin Resistance | [
"D003327",
"D006801",
"D006973",
"D007333"
] | Insulin resistance, hypertension, and coronary heart disease. | The goals of this review are two-fold: to examine the evidence in support of a role for insulin resistance and compensatory hyperinsulinemia in the pathogenesis of essential hypertension, and to evaluate the hypothesis that insulin resistance and its manifestations play major roles in the development of coronary heart disease in patients with essential hypertension. In both instances, only experimental results in human beings will be considered. Although it remains a scientific issue of great importance, the scope of this review precludes a discussion of the mechanistic link between insulin resistance/hyperinsulinemia and essential hypertension. | 6,421,089 | true | Insulin resistance, hypertension, and coronary heart disease. The goals of this review are two-fold: to examine the evidence in support of a role for insulin resistance and compensatory hyperinsulinemia in the pathogenesis of essential hypertension, and to evaluate the hypothesis that insulin resistance and its manifestations play major roles in the development of coronary heart disease in patients with essential hypertension. In both instances, only experimental results in human beings will be considered. Although it remains a scientific issue of great importance, the scope of this review precludes a discussion of the mechanistic link between insulin resistance/hyperinsulinemia and essential hypertension. |
9,391,222 | D000368:Aged; D002121:Calcium Channel Blockers; D002561:Cerebrovascular Disorders; D003680:Deglutition Disorders; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009543:Nifedipine; D010865:Pilot Projects | [
"D000368",
"D002121",
"D002561",
"D003680",
"D004311",
"D005260",
"D006801",
"D008297",
"D009543",
"D010865"
] | Pharmacological treatment of dysphagia in stroke. | The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was repeated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressive heart failure. Initial assessment showed impairment in the pharyngeal phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspiration was seen in 4 patients (active 2, placebo 2). Improvement in swallowing was seen in 8 patients (active 5, placebo 3) at the end of 4 weeks. There were significant changes in the pharyngeal transit time (mean -1.34 second; 95% C.I. -2.56, -0.11) and swallow delay (mean -1.91 seconds; 95% C.I. -3.58, -0.24) in the active group suggesting improvement in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change was not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke-related dysphagia and merit further investigation. | 2,903,413 | true | Pharmacological treatment of dysphagia in stroke. The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was repeated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressive heart failure. Initial assessment showed impairment in the pharyngeal phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspiration was seen in 4 patients (active 2, placebo 2). Improvement in swallowing was seen in 8 patients (active 5, placebo 3) at the end of 4 weeks. There were significant changes in the pharyngeal transit time (mean -1.34 second; 95% C.I. -2.56, -0.11) and swallow delay (mean -1.91 seconds; 95% C.I. -3.58, -0.24) in the active group suggesting improvement in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change was not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke-related dysphagia and merit further investigation. |
29,878,125 | D000199:Actins; D000293:Adolescent; D000328:Adult; D000818:Animals; D002311:Cardiomyopathy, Dilated; D016022:Case-Control Studies; D051338:Cofilin 1; D005260:Female; D006321:Heart; D006801:Humans; D034904:Lamin Type A; D008297:Male; D051379:Mice; D008875:Middle Aged; D019950:Mitogen-Activated Protein Kinase 1; D048052:Mitogen-Activated Protein Kinase 3; D009154:Mutation; D010766:Phosphorylation; D015398:Signal Transduction; D055815:Young Adult | [
"D000199",
"D000293",
"D000328",
"D000818",
"D002311",
"D016022",
"D051338",
"D005260",
"D006321",
"D006801",
"D034904",
"D008297",
"D051379",
"D008875",
"D019950",
"D048052",
"D009154",
"D010766",
"D015398",
"D055815"
] | Cofilin-1 phosphorylation catalyzed by ERK1/2 alters cardiac actin dynamics in dilated cardiomyopathy caused by lamin A/C gene mutation. | Hyper-activation of extracellular signal-regulated kinase (ERK) 1/2 contributes to heart dysfunction in cardiomyopathy caused by mutations in the lamin A/C gene (LMNA cardiomyopathy). The mechanism of how this affects cardiac function is unknown. We show that active phosphorylated ERK1/2 directly binds to and catalyzes the phosphorylation of the actin depolymerizing factor cofilin-1 on Thr25. Cofilin-1 becomes active and disassembles actin filaments in a large array of cellular and animal models of LMNA cardiomyopathy. In vivo expression of cofilin-1, phosphorylated on Thr25 by endogenous ERK1/2 signaling, leads to alterations in left ventricular function and cardiac actin. These results demonstrate a novel role for cofilin-1 on actin dynamics in cardiac muscle and provide a rationale on how increased ERK1/2 signaling leads to LMNA cardiomyopathy. | 4,535,839 | true | Cofilin-1 phosphorylation catalyzed by ERK1/2 alters cardiac actin dynamics in dilated cardiomyopathy caused by lamin A/C gene mutation. Hyper-activation of extracellular signal-regulated kinase (ERK) 1/2 contributes to heart dysfunction in cardiomyopathy caused by mutations in the lamin A/C gene (LMNA cardiomyopathy). The mechanism of how this affects cardiac function is unknown. We show that active phosphorylated ERK1/2 directly binds to and catalyzes the phosphorylation of the actin depolymerizing factor cofilin-1 on Thr25. Cofilin-1 becomes active and disassembles actin filaments in a large array of cellular and animal models of LMNA cardiomyopathy. In vivo expression of cofilin-1, phosphorylated on Thr25 by endogenous ERK1/2 signaling, leads to alterations in left ventricular function and cardiac actin. These results demonstrate a novel role for cofilin-1 on actin dynamics in cardiac muscle and provide a rationale on how increased ERK1/2 signaling leads to LMNA cardiomyopathy. |
15,338,141 | D002545:Brain Ischemia; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke; D019851:Thrombophilia | [
"D002545",
"D002986",
"D015897",
"D019317",
"D005260",
"D005343",
"D005858",
"D006801",
"D015994",
"D008297",
"D015995",
"D018570",
"D012307",
"D020521",
"D019851"
] | [Thrombophilias in patients with ischemic stroke. Indication and calculated costs for evidence-based diagnostics and treatment]. | Patients with ischemic stroke are sometimes found to have an underlying inherited (deficiency of protein C, protein S, antithrombin III, activated protein C resistance, prothrombin gene mutation, hyperhomocysteinemia) or acquired thrombophilia (lupus anticoagulant and anticardiolipin antibodies, hyperhomocysteinemia). Patient selection for thrombophilia screening is, therefore, a frequent question in managing patients with ischemic stroke. In this review we discuss patient selection and timing for laboratory tests for thrombophilia screening in stroke patients based on a literature review and we calculated overall costs per year in Germany for testing patients older than 18 years with an ischemic stroke of undetermined cause. As there is a lack of studies comparing anticoagulation with antiplatelet therapy in patients with diagnosed thrombophilia, laboratory screening for thrombophilia even in a selected group of patients with cryptogenic ischemic stroke remains of questionable value at present. An exception appears to be testing for lupus anticoagulant and anticardiolipin antibodies in younger patients with suspected antiphospholipid syndrome (two positive test results necessary), because anticoagulation seems to be superior to aspirin in patients with antiphospholipid syndrome. | null | false | [Thrombophilias in patients with ischemic stroke. Indication and calculated costs for evidence-based diagnostics and treatment]. Patients with ischemic stroke are sometimes found to have an underlying inherited (deficiency of protein C, protein S, antithrombin III, activated protein C resistance, prothrombin gene mutation, hyperhomocysteinemia) or acquired thrombophilia (lupus anticoagulant and anticardiolipin antibodies, hyperhomocysteinemia). Patient selection for thrombophilia screening is, therefore, a frequent question in managing patients with ischemic stroke. In this review we discuss patient selection and timing for laboratory tests for thrombophilia screening in stroke patients based on a literature review and we calculated overall costs per year in Germany for testing patients older than 18 years with an ischemic stroke of undetermined cause. As there is a lack of studies comparing anticoagulation with antiplatelet therapy in patients with diagnosed thrombophilia, laboratory screening for thrombophilia even in a selected group of patients with cryptogenic ischemic stroke remains of questionable value at present. An exception appears to be testing for lupus anticoagulant and anticardiolipin antibodies in younger patients with suspected antiphospholipid syndrome (two positive test results necessary), because anticoagulation seems to be superior to aspirin in patients with antiphospholipid syndrome. |
19,436,803 | D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency; D001024:Aortic Valve Stenosis; D002648:Child; D004697:Endocarditis, Bacterial; D005260:Female; D006330:Heart Defects, Congenital; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography; D055815:Young Adult | [
"D000293",
"D000328",
"D000367",
"D000368",
"D001021",
"D001022",
"D001024",
"D002648",
"D004697",
"D005260",
"D006330",
"D017052",
"D006801",
"D008297",
"D008875",
"D011379",
"D016016",
"D012189",
"D018570",
"D012307",
"D014463",
"D055815"
] | Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. | We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only independent predictor associated with an increased risk of death (hazard ratio, 2.19; 95% confidence interval, 1.1-4.5; P = 0.031).In our study, patients with infective endocarditis in a bicuspid aortic valve were younger and had a higher incidence of periannular complications. Although a worse prognosis has been reported previously, we found that infective endocarditis in a native bicuspid aortic valve is not likely to increase the risk of death in comparison with infective endocarditis in native tricuspid aortic valves. | 2,240,429 | true | Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only independent predictor associated with an increased risk of death (hazard ratio, 2.19; 95% confidence interval, 1.1-4.5; P = 0.031).In our study, patients with infective endocarditis in a bicuspid aortic valve were younger and had a higher incidence of periannular complications. Although a worse prognosis has been reported previously, we found that infective endocarditis in a native bicuspid aortic valve is not likely to increase the risk of death in comparison with infective endocarditis in native tricuspid aortic valves. |
23,443,603 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents; D006083:Graft Occlusion, Vascular; D006470:Hemorrhage; D006493:Heparin; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058729:Peripheral Arterial Disease; D012307:Risk Factors; D013927:Thrombosis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency | [
"D000328",
"D000368",
"D000369",
"D019917",
"D004305",
"D004334",
"D005260",
"D005343",
"D006083",
"D006470",
"D006493",
"D006495",
"D006801",
"D035002",
"D008297",
"D008875",
"D018579",
"D058729",
"D012307",
"D013927",
"D013997",
"D016896",
"D014654"
] | Risk-adjusted strategies in the prevention of early arterial thrombosis following lower extremity arterial reconstruction: a comparison of unfractionated versus low molecular weight heparin. | OBJECTIVE
In vascular surgery postoperative thrombosis prophylaxis must sufficiently prevent arterial thrombosis. This cohort study examines different therapeutic approaches of unfractionated heparin (UFH) or low molecular weight heparin (LMWH) after vascular reconstruction.
METHODS
Four hundred seventy-five patients entered the study between 2005 and 2008. Our clinical routine made a differentiation between low-risk patients (N.=375) and patients with peripheral bypass, which were grouped as high-risk (N.=148). We changed our postoperative anticoagulation management after 24 months in the low-risk and after each 16 months in the high-risk group. The anticoagulation of low-risk patients consisted of either two applications of 7.500 IU UFH subcutaneously (N.=158) or one daily application of 40 mg LMWH each up to discharge (N.=169). High-risk patients received either 25.000 IU UFH i.v. over 24 hours and 4 days (N.=48), 2-times (N.=51) or one-time weight-adjusted LMWH (N.=49) up to discharge (1 mg/kg body weight). Minor complications (bleedings) were differentiated from major early graft occlusion during the postoperative course. Further follow-up was not done for this study.
RESULTS
Low risk: under LMWH, complications could be significantly reduced (P=0.001). Under LMWH significantly fewer occlusion complications occurred (P=0.01) and operation-induced hemorrhages were less frequently observed (P=0.05), this was significant in the complete low-risk group. High-risk: the one-time weight-adjusted LMWH group similarly exhibited many occlusions, like the unfractionated group (NS). The two-time LMWH treatment was significantly superior to the one-time application with respect to occlusion followed by amputations (P=0.03). Minor complications could be minimized overall by administration of LMWH and its dose reduction (NS).
CONCLUSIONS
The differentiation between patients with high and low risk seems reasonable. An improvement could be achieved by differentiated LMWH application. Synthetic specific antifactor Xa substances (fondaparinux) or other medications could lead in future to other changes in the management of vascular surgery patients and should be further evaluated. | null | false | Risk-adjusted strategies in the prevention of early arterial thrombosis following lower extremity arterial reconstruction: a comparison of unfractionated versus low molecular weight heparin. OBJECTIVE
In vascular surgery postoperative thrombosis prophylaxis must sufficiently prevent arterial thrombosis. This cohort study examines different therapeutic approaches of unfractionated heparin (UFH) or low molecular weight heparin (LMWH) after vascular reconstruction.
METHODS
Four hundred seventy-five patients entered the study between 2005 and 2008. Our clinical routine made a differentiation between low-risk patients (N.=375) and patients with peripheral bypass, which were grouped as high-risk (N.=148). We changed our postoperative anticoagulation management after 24 months in the low-risk and after each 16 months in the high-risk group. The anticoagulation of low-risk patients consisted of either two applications of 7.500 IU UFH subcutaneously (N.=158) or one daily application of 40 mg LMWH each up to discharge (N.=169). High-risk patients received either 25.000 IU UFH i.v. over 24 hours and 4 days (N.=48), 2-times (N.=51) or one-time weight-adjusted LMWH (N.=49) up to discharge (1 mg/kg body weight). Minor complications (bleedings) were differentiated from major early graft occlusion during the postoperative course. Further follow-up was not done for this study.
RESULTS
Low risk: under LMWH, complications could be significantly reduced (P=0.001). Under LMWH significantly fewer occlusion complications occurred (P=0.01) and operation-induced hemorrhages were less frequently observed (P=0.05), this was significant in the complete low-risk group. High-risk: the one-time weight-adjusted LMWH group similarly exhibited many occlusions, like the unfractionated group (NS). The two-time LMWH treatment was significantly superior to the one-time application with respect to occlusion followed by amputations (P=0.03). Minor complications could be minimized overall by administration of LMWH and its dose reduction (NS).
CONCLUSIONS
The differentiation between patients with high and low risk seems reasonable. An improvement could be achieved by differentiated LMWH application. Synthetic specific antifactor Xa substances (fondaparinux) or other medications could lead in future to other changes in the management of vascular surgery patients and should be further evaluated. |
20,044,737 | D030541:Databases, Genetic; D005260:Female; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D006973:Hypertension; D008297:Male; D011941:Receptors, Adrenergic | [
"D030541",
"D005260",
"D056726",
"D020022",
"D006801",
"D006973",
"D008297",
"D011941"
] | Synopsis and data synthesis of genetic association studies in hypertension for the adrenergic receptor family genes: the CUMAGAS-HYPERT database. | BACKGROUND
The adrenergic receptor (adrenoceptor) family genes have been extensively studied as candidate genes in hypertension but the results of individual genetic association studies (GAS) are controversial and inconclusive. To clarify these data, a systematic assessment of GAS for adrenoceptor family genes in hypertension was conducted.
METHODS
Data from 163 GAS involving 7 genes and 37 distinct genetic variants were analyzed and cataloged in CUMAGAS-HYPERT (Cumulative Meta-analysis of Genetic Association Studies-HYPERTension; a web-based information system, which allows the retrieval and synthesis of data from GAS in hypertension, available at http://biomath.med.uth.gr). Data from genome-wide association studies involving the adrenoceptor family genes were also systematically searched.
RESULTS
Individual GAS reported inconsistent associations and had limited power to detect modest genetic effects, with only 1.2% having power >80%. Thirteen variants were investigated by three or more studies and their results were subject to meta-analysis. In the main meta-analyses, significant results were shown for five variants (ADRB1 p.Arg389Gly, ADRB1 p.Ser49Gly, ADRB2 g.9368308A>G, ADRB3 p.Trp64Arg, and ADRA1A p.Cys347Arg) under the allelic contrast and/or the dominant model. Subgroup analyses by ethnicity and gender detected significant associations for three variants (ADRB1 p.Arg389Gly in east Asians, ADRB2 p.Gln27Glu in whites, and ADRB3 p.Trp64Arg in whites and in males). Heterogeneity ranged from none to high. No significant associations were recorded from genome-wide studies.
CONCLUSIONS
There is evidence to implicate adrenoceptor genes in hypertension, although future studies designed to investigate epistatic and gene-environment interactions would allow more solid conclusions to be drawn about the role of these genes in hypertension. | null | false | Synopsis and data synthesis of genetic association studies in hypertension for the adrenergic receptor family genes: the CUMAGAS-HYPERT database. BACKGROUND
The adrenergic receptor (adrenoceptor) family genes have been extensively studied as candidate genes in hypertension but the results of individual genetic association studies (GAS) are controversial and inconclusive. To clarify these data, a systematic assessment of GAS for adrenoceptor family genes in hypertension was conducted.
METHODS
Data from 163 GAS involving 7 genes and 37 distinct genetic variants were analyzed and cataloged in CUMAGAS-HYPERT (Cumulative Meta-analysis of Genetic Association Studies-HYPERTension; a web-based information system, which allows the retrieval and synthesis of data from GAS in hypertension, available at http://biomath.med.uth.gr). Data from genome-wide association studies involving the adrenoceptor family genes were also systematically searched.
RESULTS
Individual GAS reported inconsistent associations and had limited power to detect modest genetic effects, with only 1.2% having power >80%. Thirteen variants were investigated by three or more studies and their results were subject to meta-analysis. In the main meta-analyses, significant results were shown for five variants (ADRB1 p.Arg389Gly, ADRB1 p.Ser49Gly, ADRB2 g.9368308A>G, ADRB3 p.Trp64Arg, and ADRA1A p.Cys347Arg) under the allelic contrast and/or the dominant model. Subgroup analyses by ethnicity and gender detected significant associations for three variants (ADRB1 p.Arg389Gly in east Asians, ADRB2 p.Gln27Glu in whites, and ADRB3 p.Trp64Arg in whites and in males). Heterogeneity ranged from none to high. No significant associations were recorded from genome-wide studies.
CONCLUSIONS
There is evidence to implicate adrenoceptor genes in hypertension, although future studies designed to investigate epistatic and gene-environment interactions would allow more solid conclusions to be drawn about the role of these genes in hypertension. |
30,797,031 | D000368:Aged; D000784:Aortic Dissection; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic; D019917:Blood Vessel Prosthesis Implantation; D002140:California; D057510:Endovascular Procedures; D006764:Hospitals, Community; D016304:Hospitals, Private; D006801:Humans; D061214:Patient Safety; D011183:Postoperative Complications; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome | [
"D000368",
"D000784",
"D001013",
"D017545",
"D019917",
"D002140",
"D057510",
"D006764",
"D016304",
"D006801",
"D061214",
"D011183",
"D018570",
"D012307",
"D013997",
"D016896"
] | Hybrid Aortic Arch Debranching and TEVAR Is Safe in a Private, Community Hospital. | BACKGROUND
Hybrid open cervical vessel debranching and thoracic endovascular aortic repair (TEVAR) is a treatment option in the management of aortic arch or proximal descending thoracic aortic aneurysms. However, these patients are often referred to tertiary care academic centers for aneurysm repair. Our study looks to assess the safety and outcomes of open cervical debranching and TEVAR within a private, community hospital setting.
METHODS
A total of 12 patients underwent hybrid open cervical vessel debranch with staged TEVAR from 2015 to 2018 at Riverside Community Hospital (Riverside, California). Three patients underwent open sternotomy with innominate artery bypass; four patients underwent combined carotid-carotid bypass with left carotid-axillary bypass or left subclavian transposition; three patients solely underwent left carotid-axillary bypass or left subclavian transposition. In cases involving multiple cervical bypasses, two surgeons were present. TEVAR was performed in a staged fashion during the same hospitalization.
RESULTS
There were no patient deaths, MI, or stroke within the 30-day postoperative period and at 1-year follow-up. One patient suffered a small subdural bleed after ascending aorta to innominate bypass involving redo sternotomy and hypothermic circulatory arrest. The mean aortic zone stented was zone 1. On follow-up imaging, all bypass grafts were patent, all aneurysms demonstrated thrombosis without endoleak. Average follow-up was 20 months.
CONCLUSIONS
Hybrid cervical debranching with staged TEVAR can be safely performed by experienced vascular surgeons in the community setting. Staged repair appears to confer better operative and patient outcomes. | null | false | Hybrid Aortic Arch Debranching and TEVAR Is Safe in a Private, Community Hospital. BACKGROUND
Hybrid open cervical vessel debranching and thoracic endovascular aortic repair (TEVAR) is a treatment option in the management of aortic arch or proximal descending thoracic aortic aneurysms. However, these patients are often referred to tertiary care academic centers for aneurysm repair. Our study looks to assess the safety and outcomes of open cervical debranching and TEVAR within a private, community hospital setting.
METHODS
A total of 12 patients underwent hybrid open cervical vessel debranch with staged TEVAR from 2015 to 2018 at Riverside Community Hospital (Riverside, California). Three patients underwent open sternotomy with innominate artery bypass; four patients underwent combined carotid-carotid bypass with left carotid-axillary bypass or left subclavian transposition; three patients solely underwent left carotid-axillary bypass or left subclavian transposition. In cases involving multiple cervical bypasses, two surgeons were present. TEVAR was performed in a staged fashion during the same hospitalization.
RESULTS
There were no patient deaths, MI, or stroke within the 30-day postoperative period and at 1-year follow-up. One patient suffered a small subdural bleed after ascending aorta to innominate bypass involving redo sternotomy and hypothermic circulatory arrest. The mean aortic zone stented was zone 1. On follow-up imaging, all bypass grafts were patent, all aneurysms demonstrated thrombosis without endoleak. Average follow-up was 20 months.
CONCLUSIONS
Hybrid cervical debranching with staged TEVAR can be safely performed by experienced vascular surgeons in the community setting. Staged repair appears to confer better operative and patient outcomes. |
16,639,688 | D000368:Aged; D001243:Assisted Circulation; D002294:Carcinoma, Squamous Cell; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008175:Lung Neoplasms; D008297:Male; D011013:Pneumonectomy; D019106:Postoperative Hemorrhage; D011651:Pulmonary Artery; D012770:Shock, Cardiogenic; D012771:Shock, Hemorrhagic | [
"D000368",
"D001243",
"D002294",
"D003131",
"D015199",
"D006801",
"D007423",
"D008175",
"D008297",
"D011013",
"D019106",
"D011651",
"D012770",
"D012771"
] | Mechanical circulatory support for profound cardiac circulatory shock status due to postoperative pulmonary artery bleeding. | A 77-year-old patient suffering from life-threatening pulmonary artery bleeding after pulmonary lobectomy was resuscitated but had refractory cardiogenic shock after the bleeding was controlled. We used mechanical circulatory support with extracorporeal membrane oxygenation and intra-aortic balloon pump to overcome the hemorrhagic shock-related cardiac suppression and multi-organ injury in the post-resuscitation critical period. | 11,887,378 | true | Mechanical circulatory support for profound cardiac circulatory shock status due to postoperative pulmonary artery bleeding. A 77-year-old patient suffering from life-threatening pulmonary artery bleeding after pulmonary lobectomy was resuscitated but had refractory cardiogenic shock after the bleeding was controlled. We used mechanical circulatory support with extracorporeal membrane oxygenation and intra-aortic balloon pump to overcome the hemorrhagic shock-related cardiac suppression and multi-organ injury in the post-resuscitation critical period. |
9,501,819 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005268:Femoral Vein; D005544:Forecasting; D006439:Hemodynamics; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D011152:Popliteal Vein; D012307:Risk Factors; D012501:Saphenous Vein; D014648:Varicose Veins; D014689:Venous Insufficiency | [
"D000293",
"D000328",
"D000368",
"D000369",
"D005260",
"D005268",
"D005544",
"D006439",
"D006801",
"D007866",
"D008297",
"D008875",
"D011152",
"D012307",
"D012501",
"D014648",
"D014689"
] | Correlation of the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in primary varicose veins. | OBJECTIVE
The aim of this study was to correlate the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in patients with primary varicose veins.
METHODS
Venous reflux was examined using duplex colour Doppler ultrasonography in 266 legs in 191 patients. The venous refilling and reflux times were also measured.
RESULTS
Of the 266 legs, 82 per cent had reflux in the long saphenous vein (LSV), 26 per cent in the short saphenous vein (SSV), 62 per cent had incompetent perforators (IPs) in the calf and 48 per cent had reflux in the deep veins. LSV reflux combined with SSV reflux and/or IPs was associated significantly with severe venous disease and abnormal venous haemodynamics. Femoropopliteal reflux played a role in the development of venous eczema and ulcers when combined with superficial venous reflux.
CONCLUSIONS
Patients at high risk of developing complications of venous disease may be identified by an accurate non-invasive evaluation of reflux patterns. | null | false | Correlation of the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in primary varicose veins. OBJECTIVE
The aim of this study was to correlate the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in patients with primary varicose veins.
METHODS
Venous reflux was examined using duplex colour Doppler ultrasonography in 266 legs in 191 patients. The venous refilling and reflux times were also measured.
RESULTS
Of the 266 legs, 82 per cent had reflux in the long saphenous vein (LSV), 26 per cent in the short saphenous vein (SSV), 62 per cent had incompetent perforators (IPs) in the calf and 48 per cent had reflux in the deep veins. LSV reflux combined with SSV reflux and/or IPs was associated significantly with severe venous disease and abnormal venous haemodynamics. Femoropopliteal reflux played a role in the development of venous eczema and ulcers when combined with superficial venous reflux.
CONCLUSIONS
Patients at high risk of developing complications of venous disease may be identified by an accurate non-invasive evaluation of reflux patterns. |
32,559,680 | D000368:Aged; D000784:Aortic Dissection; D000971:Antineoplastic Combined Chemotherapy Protocols; D001027:Aortography; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D003561:Cytarabine; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D000069079:Radiation Exposure; D012189:Retrospective Studies; D013866:Thioguanine; D014057:Tomography, X-Ray Computed | [
"D000368",
"D000784",
"D000971",
"D001027",
"D000072226",
"D003287",
"D003561",
"D020000",
"D005260",
"D006801",
"D008297",
"D008875",
"D011829",
"D000069079",
"D012189",
"D013866",
"D014057"
] | Implementation of an aortic dissection CT protocol with clinical decision support aimed at decreasing radiation exposure by reducing routine abdominopelvic imaging. | Patients suspected of having an acute aortic syndrome in the ED typically undergo CT of the chest/abdomen/pelvis. However, the overwhelming majority of these exams are negative. With the help of clinical decision support, we implemented a new radiologist monitored 'aortic dissection screening protocol' that forgoes routine abdominopelvic imaging in order to reduce radiation dose without compromising diagnostic accuracy. The purpose of the present study is to assess the performance of this protocol. A retrospective analysis was performed to study the effect of the dissection screening protocol on the diagnostic yield, radiation and contrast dose on a total of 835 ED patients who underwent CT scans for suspected aortic dissection over a 48-week study period immediately before and after implementation of the protocol. 3.4% (28/835) of examinations were positive for an acute aortic syndrome over the 48-week study period with no difference in positivity before and after implementation of the 'aortic dissection screening' protocol, 3.0% vs. 3.7%, respectively (p = 0.57). There was a 14.6% reduction in median radiation dose and a 16% decrease in contrast volume utilization for the total ED population who underwent CT for aortic dissection using any protocol in the period after implementation of the 'aortic dissection screening' protocol. Aortic dissection CT in the ED is negative in the overwhelming majority of cases. A monitored 'aortic dissection screening' protocol that initially images the chest only significantly reduced contrast and radiation dose without reducing diagnostic accuracy for ED patients who underwent CT for aortic dissection. | 6,479,876 | true | Implementation of an aortic dissection CT protocol with clinical decision support aimed at decreasing radiation exposure by reducing routine abdominopelvic imaging. Patients suspected of having an acute aortic syndrome in the ED typically undergo CT of the chest/abdomen/pelvis. However, the overwhelming majority of these exams are negative. With the help of clinical decision support, we implemented a new radiologist monitored 'aortic dissection screening protocol' that forgoes routine abdominopelvic imaging in order to reduce radiation dose without compromising diagnostic accuracy. The purpose of the present study is to assess the performance of this protocol. A retrospective analysis was performed to study the effect of the dissection screening protocol on the diagnostic yield, radiation and contrast dose on a total of 835 ED patients who underwent CT scans for suspected aortic dissection over a 48-week study period immediately before and after implementation of the protocol. 3.4% (28/835) of examinations were positive for an acute aortic syndrome over the 48-week study period with no difference in positivity before and after implementation of the 'aortic dissection screening' protocol, 3.0% vs. 3.7%, respectively (p = 0.57). There was a 14.6% reduction in median radiation dose and a 16% decrease in contrast volume utilization for the total ED population who underwent CT for aortic dissection using any protocol in the period after implementation of the 'aortic dissection screening' protocol. Aortic dissection CT in the ED is negative in the overwhelming majority of cases. A monitored 'aortic dissection screening' protocol that initially images the chest only significantly reduced contrast and radiation dose without reducing diagnostic accuracy for ED patients who underwent CT for aortic dissection. |
11,723,364 | D004562:Electrocardiography; D006801:Humans; D006973:Hypertension; D017379:Hypertrophy, Left Ventricular; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged | [
"D004562",
"D006801",
"D006973",
"D017379",
"D007089",
"D008297",
"D008875"
] | Hypertension images: electrocardiographic left ventricular hypertrophy. | The electrocardiogram is an inexpensive adjunct for assessing target organ damage in hypertensive patients. The gender-specific Cornell voltage criteria (men: R(aVL) + S(V3) >35 mm; women: R(aVL) + S(V3) >25 mm) have better overall accuracy than the often-used Sokolow-Lyon or Romhilt-Estes criteria. One of the earliest electrocardiographic findings of hypertensive heart disease is a duration of the negative phase of the P wave in chest lead V1 of >0.04 seconds, a manifestation of left atrial enlargement or abnormality. There is no other cardiovascular risk factor more potent than left ventricular hypertrophy with a "strain pattern." Despite limitations in determining hypertensive heart disease, the electrocardiogram provides other information that is useful in the management of patients with hypertension. | 12,820,299 | true | Hypertension images: electrocardiographic left ventricular hypertrophy. The electrocardiogram is an inexpensive adjunct for assessing target organ damage in hypertensive patients. The gender-specific Cornell voltage criteria (men: R(aVL) + S(V3) >35 mm; women: R(aVL) + S(V3) >25 mm) have better overall accuracy than the often-used Sokolow-Lyon or Romhilt-Estes criteria. One of the earliest electrocardiographic findings of hypertensive heart disease is a duration of the negative phase of the P wave in chest lead V1 of >0.04 seconds, a manifestation of left atrial enlargement or abnormality. There is no other cardiovascular risk factor more potent than left ventricular hypertrophy with a "strain pattern." Despite limitations in determining hypertensive heart disease, the electrocardiogram provides other information that is useful in the management of patients with hypertension. |
2,300,981 | D000818:Animals; D001418:Baclofen; D002545:Brain Ischemia; D004305:Dose-Response Relationship, Drug; D008297:Male; D009043:Motor Activity; D051381:Rats; D011919:Rats, Inbred Strains; D012016:Reference Values | [
"D000818",
"D001418",
"D002545",
"D004305",
"D008297",
"D009043",
"D051381",
"D011919",
"D012016"
] | Baclofen does not protect against cerebral ischemia in rats. | Presynaptic release of glutamate into the extracellular compartment and activation of receptor-operated calcium channels may contribute to ischemic neuronal damage. We evaluated the effect of baclofen, a selective inhibitor of presynaptic glutamate release, on mortality, working memory, and light microscopic hippocampal and cortical damage in the four-vessel occlusion model of cerebral ischemia using 64 male Wistar rats. Baclofen (10 mg/kg i.p.) given 1 hour before and 30-60 minutes after 20 minutes of global ischemia did not lessen mortality, prevent ischemic cellular damage, or significantly improve working memory compared with no treatment. We conclude that preischemic and postischemic administration of baclofen does not protect neurons from ischemic injury. | 14,057,442 | true | Baclofen does not protect against cerebral ischemia in rats. Presynaptic release of glutamate into the extracellular compartment and activation of receptor-operated calcium channels may contribute to ischemic neuronal damage. We evaluated the effect of baclofen, a selective inhibitor of presynaptic glutamate release, on mortality, working memory, and light microscopic hippocampal and cortical damage in the four-vessel occlusion model of cerebral ischemia using 64 male Wistar rats. Baclofen (10 mg/kg i.p.) given 1 hour before and 30-60 minutes after 20 minutes of global ischemia did not lessen mortality, prevent ischemic cellular damage, or significantly improve working memory compared with no treatment. We conclude that preischemic and postischemic administration of baclofen does not protect neurons from ischemic injury. |
8,104,241 | D000319:Adrenergic beta-Antagonists; D000818:Animals; D000975:Antioxidants; D002227:Carbazoles; D000077261:Carvedilol; D004285:Dogs; D016166:Free Radical Scavengers; D006321:Heart; D006801:Humans; D015227:Lipid Peroxidation; D008297:Male; D009203:Myocardial Infarction; D011412:Propanolamines; D051381:Rats; D017207:Rats, Sprague-Dawley; D013552:Swine; D013556:Swine, Miniature; D014665:Vasodilator Agents | [
"D000319",
"D000818",
"D000975",
"D002227",
"D000077261",
"D004285",
"D016166",
"D006321",
"D006801",
"D015227",
"D008297",
"D009203",
"D011412",
"D051381",
"D017207",
"D013552",
"D013556",
"D014665"
] | Myocardial protection by the novel vasodilating beta-blocker, carvedilol: potential relevance of anti-oxidant activity. | OBJECTIVE
Carvedilol is a multiple action antihypertensive drug with potential use in angina and congestive heart failure. The pharmacological profile of carvedilol includes both beta-adrenoceptor blockade and vasodilation, the latter primarily a result of alpha 1-adrenoceptor blockade. Since many beta-blockers have cardioprotective properties, the present study was designed to determine whether carvedilol is also cardioprotective. Because oxygen radicals are believed to influence ischemic tissue injuries, a secondary study was designed to determine whether carvedilol has anti-oxidant actions which could contribute to cardioprotective properties of carvedilol.
METHODS
Four different models of acute myocardial infarction in were examined in three animal species, and the effects of carvedilol were compared to those of propranolol. First, in rats subjected to 30 min of cardiac ischemia followed by 24 h of reperfusion, carvedilol was administered both pre- and post-ischemia (1 mg/kg, intravenously). Second, minipigs were subjected to 45 min of cardiac ischemia followed by 4 h of reperfusion, with carvedilol pretreatment (0.3 or 1 mg/kg intravenously). Third, dogs were subjected to 1 h of cardiac ischemia followed by 24 h of reperfusion with carvedilol pretreatment (1 mg/kg, intravenously) or to permanent coronary occlusion (6 h) with carvedilol pretreatment (0.3 or 1 mg/kg, intravenously). Finally, to examine the anti-oxidant activity of carvedilol, pig myocardial membranes were exposed to oxidizing systems that elicit lipid peroxide products assessed as thiobarbituric acid-reactive substances (TBARS).
RESULTS
In the rats, carvedilol reduced the infarct size by 47% (P < 0.01), in contrast to propranolol, which is inactive in this model. In the minipigs the infarct size was reduced by 46 and 89% (P < 0.01) with carvedilol at 0.3 and 1 mg/kg, respectively; at comparable beta-adrenoceptor blocking doses, carvedilol produced a significantly greater reduction in the infarct size than propranolol (89 versus 48%). In dogs, carvedilol reduced the infarct size by 78% (P < 0.05) compared to the 64% reduction produced by propranolol. In dogs with permanent coronary occlusion, carvedilol produced dose-dependent reductions in the infarct size of 46 and 63% for 0.3 and 1 mg/kg, respectively (P < 0.05), compared to propranolol which did not reduce the infarct size in this model. Carvedilol inhibited lipid peroxidation in a dose-dependent manner with a 50% inhibitory concentration (IC50) of 5 mumol/l. Moreover, superoxide generation by activated human neutrophils in vitro was also inhibited by carvedilol with an IC50 of 28 mumol/l. Finally, carvedilol was shown to scavenge oxygen free radicals in a cell-free system with an IC50 of 25 mumol/l.
CONCLUSIONS
Taken together, these data indicate that carvedilol is a potent cardioprotective drug, which presumably acts by multiple mechanisms, possibly including a novel anti-oxidant effect that is not shared by other beta-blockers. | null | false | Myocardial protection by the novel vasodilating beta-blocker, carvedilol: potential relevance of anti-oxidant activity. OBJECTIVE
Carvedilol is a multiple action antihypertensive drug with potential use in angina and congestive heart failure. The pharmacological profile of carvedilol includes both beta-adrenoceptor blockade and vasodilation, the latter primarily a result of alpha 1-adrenoceptor blockade. Since many beta-blockers have cardioprotective properties, the present study was designed to determine whether carvedilol is also cardioprotective. Because oxygen radicals are believed to influence ischemic tissue injuries, a secondary study was designed to determine whether carvedilol has anti-oxidant actions which could contribute to cardioprotective properties of carvedilol.
METHODS
Four different models of acute myocardial infarction in were examined in three animal species, and the effects of carvedilol were compared to those of propranolol. First, in rats subjected to 30 min of cardiac ischemia followed by 24 h of reperfusion, carvedilol was administered both pre- and post-ischemia (1 mg/kg, intravenously). Second, minipigs were subjected to 45 min of cardiac ischemia followed by 4 h of reperfusion, with carvedilol pretreatment (0.3 or 1 mg/kg intravenously). Third, dogs were subjected to 1 h of cardiac ischemia followed by 24 h of reperfusion with carvedilol pretreatment (1 mg/kg, intravenously) or to permanent coronary occlusion (6 h) with carvedilol pretreatment (0.3 or 1 mg/kg, intravenously). Finally, to examine the anti-oxidant activity of carvedilol, pig myocardial membranes were exposed to oxidizing systems that elicit lipid peroxide products assessed as thiobarbituric acid-reactive substances (TBARS).
RESULTS
In the rats, carvedilol reduced the infarct size by 47% (P < 0.01), in contrast to propranolol, which is inactive in this model. In the minipigs the infarct size was reduced by 46 and 89% (P < 0.01) with carvedilol at 0.3 and 1 mg/kg, respectively; at comparable beta-adrenoceptor blocking doses, carvedilol produced a significantly greater reduction in the infarct size than propranolol (89 versus 48%). In dogs, carvedilol reduced the infarct size by 78% (P < 0.05) compared to the 64% reduction produced by propranolol. In dogs with permanent coronary occlusion, carvedilol produced dose-dependent reductions in the infarct size of 46 and 63% for 0.3 and 1 mg/kg, respectively (P < 0.05), compared to propranolol which did not reduce the infarct size in this model. Carvedilol inhibited lipid peroxidation in a dose-dependent manner with a 50% inhibitory concentration (IC50) of 5 mumol/l. Moreover, superoxide generation by activated human neutrophils in vitro was also inhibited by carvedilol with an IC50 of 28 mumol/l. Finally, carvedilol was shown to scavenge oxygen free radicals in a cell-free system with an IC50 of 25 mumol/l.
CONCLUSIONS
Taken together, these data indicate that carvedilol is a potent cardioprotective drug, which presumably acts by multiple mechanisms, possibly including a novel anti-oxidant effect that is not shared by other beta-blockers. |
2,418,290 | D000200:Action Potentials; D000818:Animals; D001145:Arrhythmias, Cardiac; D001794:Blood Pressure; D004285:Dogs; D004558:Electric Stimulation; D006329:Heart Conduction System; D006339:Heart Rate; D066298:In Vitro Techniques; D009203:Myocardial Infarction; D013928:Thromboxane A2 | [
"D000200",
"D000818",
"D001145",
"D001794",
"D004285",
"D004558",
"D006329",
"D006339",
"D066298",
"D009203",
"D013928"
] | Thromboxane A2 does not contribute to arrhythmogenesis during evolving canine myocardial infarction. | During the healing phase of evolving myocardial infarction, inflammatory cells invade the affected region and produce metabolites that may influence electrophysiological parameters and the genesis of malignant arrhythmias. We have recently shown an increased synthetic capacity within an evolving infarct for thromboxane A2 (TXA2), a metabolite that has been implicated in arrhythmias associated with early ischemia. The present study used both in vivo and in vitro procedures to define the electrophysiological and arrhythmogenic effects, if any, of thromboxane during evolving myocardial infarction. Thirty-three dogs divided into three groups were studied 3-7 days after transient left anterior descending coronary artery ligation. One group (n = 24) was examined by programmed electrical stimulation in the conscious state and, of the five dogs in this group with sustained ventricular tachycardia (VT), none demonstrated consistent limitation of inducibility by selective inhibition of thromboxane synthetase using three different agents. In the second group, (n = 5) regional conduction velocity was assessed using detailed three-dimensional activation analysis from 232 simultaneous intramyocardial sites, and no change was induced by the thromboxane synthetase inhibitor OKY-1581 in either normal or infarcted myocardial zones during sinus rhythm or with pacing. In the third group (n = 4), isolated ventricular muscle was studied in vitro using both intracellular transmembrane action potential recordings and surface extracellular maps from 48 simultaneous points. Neither intracellular action potential parameters nor extracellularly recorded activation patterns were altered by superfusion with the stable thromboxane analog STA2, the activity of which was verified by bioassay. Thus, despite increased synthetic capacity for thromboxane generation, the presence of TXA2 does not directly influence either electrophysiological indices or arrhythmogenesis. | 3,914,614 | true | Thromboxane A2 does not contribute to arrhythmogenesis during evolving canine myocardial infarction. During the healing phase of evolving myocardial infarction, inflammatory cells invade the affected region and produce metabolites that may influence electrophysiological parameters and the genesis of malignant arrhythmias. We have recently shown an increased synthetic capacity within an evolving infarct for thromboxane A2 (TXA2), a metabolite that has been implicated in arrhythmias associated with early ischemia. The present study used both in vivo and in vitro procedures to define the electrophysiological and arrhythmogenic effects, if any, of thromboxane during evolving myocardial infarction. Thirty-three dogs divided into three groups were studied 3-7 days after transient left anterior descending coronary artery ligation. One group (n = 24) was examined by programmed electrical stimulation in the conscious state and, of the five dogs in this group with sustained ventricular tachycardia (VT), none demonstrated consistent limitation of inducibility by selective inhibition of thromboxane synthetase using three different agents. In the second group, (n = 5) regional conduction velocity was assessed using detailed three-dimensional activation analysis from 232 simultaneous intramyocardial sites, and no change was induced by the thromboxane synthetase inhibitor OKY-1581 in either normal or infarcted myocardial zones during sinus rhythm or with pacing. In the third group (n = 4), isolated ventricular muscle was studied in vitro using both intracellular transmembrane action potential recordings and surface extracellular maps from 48 simultaneous points. Neither intracellular action potential parameters nor extracellularly recorded activation patterns were altered by superfusion with the stable thromboxane analog STA2, the activity of which was verified by bioassay. Thus, despite increased synthetic capacity for thromboxane generation, the presence of TXA2 does not directly influence either electrophysiological indices or arrhythmogenesis. |
25,754,018 | D000368:Aged; D000465:Algorithms; D002932:Cineangiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results | [
"D000368",
"D000465",
"D002932",
"D017023",
"D003324",
"D003331",
"D005260",
"D006801",
"D008297",
"D008875",
"D011237",
"D011829",
"D000069079",
"D011857",
"D015203"
] | Novel X-ray imaging technology enables significant patient dose reduction in interventional cardiology while maintaining diagnostic image quality. | OBJECTIVE
The purpose of this study was to quantify the reduction in patient radiation dose during coronary angiography (CA) by a new X-ray technology, and to assess its impact on diagnostic image quality.
BACKGROUND
Recently, a novel X-ray imaging technology has become available for interventional cardiology, using advanced image processing and an optimized acquisition chain for radiation dose reduction.
METHODS
70 adult patients were randomly assigned to a reference X-ray system or the novel X-ray system. Patient demographics were registered and exposure parameters were recorded for each radiation event. Clinical image quality was assessed for both patient groups.
RESULTS
With the same angiographic technique and a comparable patient population, the new imaging technology was associated with a 75% reduction in total kerma-area product (KAP) value (decrease from 47 Gycm2 to 12 Gycm2, P<0.001). Clinical image quality showed an equivalent detail and contrast for both imaging systems. On the other hand, the subjective appreciation of noise was more apparent in images of the new image processing system, acquired at lower doses, compared to the reference system. However, the higher noise content did not affect the overall image quality score, which was adequate for diagnosis in both systems.
CONCLUSIONS
For the first time, we present a new X-ray imaging technology, combining advanced noise reduction algorithms and an optimized acquisition chain, which reduces patient radiation dose in CA drastically (75%), while maintaining diagnostic image quality. Use of this technology may further improve the radiation safety of cardiac angiography and interventions. | null | false | Novel X-ray imaging technology enables significant patient dose reduction in interventional cardiology while maintaining diagnostic image quality. OBJECTIVE
The purpose of this study was to quantify the reduction in patient radiation dose during coronary angiography (CA) by a new X-ray technology, and to assess its impact on diagnostic image quality.
BACKGROUND
Recently, a novel X-ray imaging technology has become available for interventional cardiology, using advanced image processing and an optimized acquisition chain for radiation dose reduction.
METHODS
70 adult patients were randomly assigned to a reference X-ray system or the novel X-ray system. Patient demographics were registered and exposure parameters were recorded for each radiation event. Clinical image quality was assessed for both patient groups.
RESULTS
With the same angiographic technique and a comparable patient population, the new imaging technology was associated with a 75% reduction in total kerma-area product (KAP) value (decrease from 47 Gycm2 to 12 Gycm2, P<0.001). Clinical image quality showed an equivalent detail and contrast for both imaging systems. On the other hand, the subjective appreciation of noise was more apparent in images of the new image processing system, acquired at lower doses, compared to the reference system. However, the higher noise content did not affect the overall image quality score, which was adequate for diagnosis in both systems.
CONCLUSIONS
For the first time, we present a new X-ray imaging technology, combining advanced noise reduction algorithms and an optimized acquisition chain, which reduces patient radiation dose in CA drastically (75%), while maintaining diagnostic image quality. Use of this technology may further improve the radiation safety of cardiac angiography and interventions. |
10,199,492 | D000328:Adult; D000799:Angioedema; D003613:Danazol; D017742:Dental Care for Chronically Ill; D004965:Estrogen Antagonists; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D013515:Surgery, Oral; D013997:Time Factors | [
"D000328",
"D000799",
"D003613",
"D017742",
"D004965",
"D005260",
"D005500",
"D006801",
"D008297",
"D008875",
"D011182",
"D011300",
"D013515",
"D013997"
] | The efficacy of short-term danazol prophylaxis in hereditary angioedema patients undergoing maxillofacial and dental procedures. | OBJECTIVE
This study evaluated the efficacy of short-term danazol prophylaxis in hereditary angioedema patients undergoing maxillofacial or dental procedures.
METHODS
Twelve patients with a history of edema after dental procedures were administered danazol (600 mg/d) 4 days preoperatively and 4 days postoperatively. The serum levels of complement components were determined preoperatively and postoperatively as well as at 6, 12 and 24 hours in six patients.
RESULTS
None of the 12 patients developed angioneurotic edema. The serum levels of the complement components were decreased immediately after surgery and returned to normal within 24 hours.
CONCLUSIONS
The short-term prophylactic use of danazol in patients with hereditary angioedema undergoing oral surgery is an effective preventive measure. | null | false | The efficacy of short-term danazol prophylaxis in hereditary angioedema patients undergoing maxillofacial and dental procedures. OBJECTIVE
This study evaluated the efficacy of short-term danazol prophylaxis in hereditary angioedema patients undergoing maxillofacial or dental procedures.
METHODS
Twelve patients with a history of edema after dental procedures were administered danazol (600 mg/d) 4 days preoperatively and 4 days postoperatively. The serum levels of complement components were determined preoperatively and postoperatively as well as at 6, 12 and 24 hours in six patients.
RESULTS
None of the 12 patients developed angioneurotic edema. The serum levels of the complement components were decreased immediately after surgery and returned to normal within 24 hours.
CONCLUSIONS
The short-term prophylactic use of danazol in patients with hereditary angioedema undergoing oral surgery is an effective preventive measure. |
12,013,669 | D000368:Aged; D001932:Brain Neoplasms; D002543:Cerebral Hemorrhage; D004806:Ependymoma; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012008:Recurrence; D014057:Tomography, X-Ray Computed | [
"D000368",
"D001932",
"D002543",
"D004806",
"D005260",
"D006801",
"D008279",
"D012008",
"D014057"
] | Brain surface ependymoma with repeated episodes of intratumoral hemorrhage--case report. | A 70-year-old woman presented with a rare brain surface ependymoma with repeated intratumoral hemorrhage. She was admitted with progressive dementia. Two years earlier, a diagnosis of subcortical hematoma in the right frontal lobe had been made following a fall. On admission, magnetic resonance imaging showed a huge right frontal mass lesion with multiple hemorrhagic cysts. She underwent gross total resection. The tumor was located on the surface of the frontal lobe, and was sharply demarcated from the surrounding brain tissue with no attachment to the ventricular wall. The histological features were consistent with an ependymoma forming perivascular pseudorosettes. Immunohistochemistry showed positive staining for glial fibrillary acidic protein. Electron microscopy showed microvilli and zonula adherens. This case demonstrates the natural course of malignant progression of ectopic ependymomas. Ependymoma should be included in the differential diagnosis of tumors associated with repeated subcortical hematomas, even if located on the brain surface and distant from ventricles. | 13,039,304 | true | Brain surface ependymoma with repeated episodes of intratumoral hemorrhage--case report. A 70-year-old woman presented with a rare brain surface ependymoma with repeated intratumoral hemorrhage. She was admitted with progressive dementia. Two years earlier, a diagnosis of subcortical hematoma in the right frontal lobe had been made following a fall. On admission, magnetic resonance imaging showed a huge right frontal mass lesion with multiple hemorrhagic cysts. She underwent gross total resection. The tumor was located on the surface of the frontal lobe, and was sharply demarcated from the surrounding brain tissue with no attachment to the ventricular wall. The histological features were consistent with an ependymoma forming perivascular pseudorosettes. Immunohistochemistry showed positive staining for glial fibrillary acidic protein. Electron microscopy showed microvilli and zonula adherens. This case demonstrates the natural course of malignant progression of ectopic ependymomas. Ependymoma should be included in the differential diagnosis of tumors associated with repeated subcortical hematomas, even if located on the brain surface and distant from ventricles. |
34,656,119 | D054058:Acute Coronary Syndrome; D000077144:Clopidogrel; D006801:Humans; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors; D011788:Quality of Life; D000077486:Ticagrelor; D016896:Treatment Outcome | [
"D054058",
"D000077144",
"D006801",
"D062645",
"D010975",
"D011788",
"D000077486",
"D016896"
] | Comparison of ticagrelor with clopidogrel on quality of life in patients with acute coronary syndrome. | BACKGROUND
Ticagrelor has a Class I recommendation for use following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). However, ticagrelor needs to be taken twice a day, as compared to clopidogrel. Its adverse effects, such as dyspnea or bleeding, are known to be more common than with clopidogrel. Dyspnea may tend to be uncomfortable and limit activity. Major bleeding often leads to hospitalization or transfusions, and frequent minor bleeding, which might not result in patients seeking medical care, can make ACS patients feel unhealthy. Thus, these characteristics may affect the health-related quality of life (HQOL).
METHODS
In the PLEIO (comParison of ticagreLor and clopidogrEl on mIcrocirculation in patients with acute cOronary syndrome) trial, we randomized 120 participants to receive ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for at least 12 months. We carried out an HQOL assessment with the Short Form 36 Health Survey (SF-36) questionnaire on the day of discharge following PCI, as well as six months later.
RESULTS
At discharge, the HQOL measures were similar in the ticagrelor and clopidogrel groups, both having a physical component summary (PCS) and a mental component summary (MCS) score. A six-month HQOL follow-up assessment showed that there were no differences between the two study groups in either the PCS or the MCS scores. In both groups, the PCS scores significantly increased over six months of treatment (both p < 0.01). However, the MCS score did not differ significantly. A baseline MCS score is an independent predictor of better physical and mental health status at six months.
CONCLUSIONS
Ticagrelor, as compared to clopidogrel, did not significantly reduce the HQOL during the six months following PCI in patients with ACS. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT02618733. | null | false | Comparison of ticagrelor with clopidogrel on quality of life in patients with acute coronary syndrome. BACKGROUND
Ticagrelor has a Class I recommendation for use following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). However, ticagrelor needs to be taken twice a day, as compared to clopidogrel. Its adverse effects, such as dyspnea or bleeding, are known to be more common than with clopidogrel. Dyspnea may tend to be uncomfortable and limit activity. Major bleeding often leads to hospitalization or transfusions, and frequent minor bleeding, which might not result in patients seeking medical care, can make ACS patients feel unhealthy. Thus, these characteristics may affect the health-related quality of life (HQOL).
METHODS
In the PLEIO (comParison of ticagreLor and clopidogrEl on mIcrocirculation in patients with acute cOronary syndrome) trial, we randomized 120 participants to receive ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for at least 12 months. We carried out an HQOL assessment with the Short Form 36 Health Survey (SF-36) questionnaire on the day of discharge following PCI, as well as six months later.
RESULTS
At discharge, the HQOL measures were similar in the ticagrelor and clopidogrel groups, both having a physical component summary (PCS) and a mental component summary (MCS) score. A six-month HQOL follow-up assessment showed that there were no differences between the two study groups in either the PCS or the MCS scores. In both groups, the PCS scores significantly increased over six months of treatment (both p < 0.01). However, the MCS score did not differ significantly. A baseline MCS score is an independent predictor of better physical and mental health status at six months.
CONCLUSIONS
Ticagrelor, as compared to clopidogrel, did not significantly reduce the HQOL during the six months following PCI in patients with ACS. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT02618733. |
15,539,006 | D001850:Bone Diseases, Infectious; D017719:Diabetic Foot; D003929:Diabetic Neuropathies; D003937:Diagnosis, Differential; D020233:Gait Disorders, Neurologic; D006801:Humans; D008279:Magnetic Resonance Imaging; D010003:Osteoarthritis; D010019:Osteomyelitis; D014057:Tomography, X-Ray Computed | [
"D001850",
"D017719",
"D003929",
"D003937",
"D020233",
"D006801",
"D008279",
"D010003",
"D010019",
"D014057"
] | Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot. | Osteomyelitis (bone infection) and neuro-osteoarthropathy (Charcot arthropathy) are limb-threatening complications of diabetic neuropathy with very different therapies. Distinguishing between them may be difficult, but it is important. In Charcot arthropathy, noninfectious soft tissue inflammation accompanies rapidly progressive destruction, first of joints, then of bone. This occurs in a well-vascularized and severely neuropathic, but nonulcerated, foot. In osteomyelitis, chronic soft tissue ulceration precedes infection of bone, which may be physically exposed. Magnetic resonance imaging and bone biopsy are the preferred diagnostic tests, provided adequate technical and interpretive skills are available. | 1,240,841 | true | Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot. Osteomyelitis (bone infection) and neuro-osteoarthropathy (Charcot arthropathy) are limb-threatening complications of diabetic neuropathy with very different therapies. Distinguishing between them may be difficult, but it is important. In Charcot arthropathy, noninfectious soft tissue inflammation accompanies rapidly progressive destruction, first of joints, then of bone. This occurs in a well-vascularized and severely neuropathic, but nonulcerated, foot. In osteomyelitis, chronic soft tissue ulceration precedes infection of bone, which may be physically exposed. Magnetic resonance imaging and bone biopsy are the preferred diagnostic tests, provided adequate technical and interpretive skills are available. |
16,979,066 | D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases; D002544:Cerebral Infarction; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D012680:Sensitivity and Specificity | [
"D000368",
"D000369",
"D002340",
"D002544",
"D005260",
"D006801",
"D007090",
"D008279",
"D008297",
"D008875",
"D011379",
"D015203",
"D018570",
"D012307",
"D055502",
"D012680"
] | Carotid vulnerable lesions are related to accelerated recurrence for cerebral infarction magnetic resonance imaging study. | OBJECTIVE
We sought to test the hypothesis that magnetic resonance imaging (MRI)-defined vulnerable plaques correlate to accelerated reoccurrence of cerebrovascular events and to evaluate the potential use of MRI in secondary prevention of ischemic stroke.
METHODS
Fifty-three symptomatic participants were recruited from patients sustaining their second MRI-confirmed cerebral infarction. Nine participants were women and 44 were men; the mean age was 69.2 years (range, 55-94 years). Patients were imaged within 7 days after the reoccurrence of cerebral infarction. The MRI diagnostic signals defined a classification of lesion type. We compare the interval between two cerebral infarctions with plaque vulnerability defined by the MRI lesion type. We used a Cox proportional hazards model to calculate the relationship between vulnerable lesions and the interval of cerebral infarction, and we followed these patients for 180 days and compared the recurrent rate for the third-time cerebral infarction between patients with and without vulnerable plaque.
RESULTS
The mean infarction recurrence interval for patients with vulnerable lesions was shorter than the mean interval for patients without vulnerable lesion (310.1 versus 1697.2, P< .001). In patients with recurrent cerebral infarction within 1 year, vulnerable lesions were more frequently detected (76% versus 19%, P< .001). The patients with vulnerable lesions had an 8.8-fold higher hazard risk (8.8; P< .001, 95% confidence interval, 3.9-19.7) than those without vulnerable lesions after adjustment for risk factors. For those with vulnerable plaque, the morbidity of third-time cerebral infarction was higher than those without (24% versus 3%, P = .023).
CONCLUSIONS
MRI-defined vulnerable lesions in carotid arteries are related to accelerated recurrent cerebral infarction and high recurrent rate. MRI demonstrates clinical value in the secondary prevention of cerebral infarction. | null | false | Carotid vulnerable lesions are related to accelerated recurrence for cerebral infarction magnetic resonance imaging study. OBJECTIVE
We sought to test the hypothesis that magnetic resonance imaging (MRI)-defined vulnerable plaques correlate to accelerated reoccurrence of cerebrovascular events and to evaluate the potential use of MRI in secondary prevention of ischemic stroke.
METHODS
Fifty-three symptomatic participants were recruited from patients sustaining their second MRI-confirmed cerebral infarction. Nine participants were women and 44 were men; the mean age was 69.2 years (range, 55-94 years). Patients were imaged within 7 days after the reoccurrence of cerebral infarction. The MRI diagnostic signals defined a classification of lesion type. We compare the interval between two cerebral infarctions with plaque vulnerability defined by the MRI lesion type. We used a Cox proportional hazards model to calculate the relationship between vulnerable lesions and the interval of cerebral infarction, and we followed these patients for 180 days and compared the recurrent rate for the third-time cerebral infarction between patients with and without vulnerable plaque.
RESULTS
The mean infarction recurrence interval for patients with vulnerable lesions was shorter than the mean interval for patients without vulnerable lesion (310.1 versus 1697.2, P< .001). In patients with recurrent cerebral infarction within 1 year, vulnerable lesions were more frequently detected (76% versus 19%, P< .001). The patients with vulnerable lesions had an 8.8-fold higher hazard risk (8.8; P< .001, 95% confidence interval, 3.9-19.7) than those without vulnerable lesions after adjustment for risk factors. For those with vulnerable plaque, the morbidity of third-time cerebral infarction was higher than those without (24% versus 3%, P = .023).
CONCLUSIONS
MRI-defined vulnerable lesions in carotid arteries are related to accelerated recurrent cerebral infarction and high recurrent rate. MRI demonstrates clinical value in the secondary prevention of cerebral infarction. |
17,826,639 | D000800:Angioplasty, Balloon; D050197:Atherosclerosis; D016122:Brachiocephalic Trunk; D006801:Humans; D015607:Stents; D013348:Subclavian Artery; D014711:Vertebral Artery; D014715:Vertebrobasilar Insufficiency | [
"D000800",
"D050197",
"D016122",
"D006801",
"D015607",
"D013348",
"D014711",
"D014715"
] | Endovascular treatment of vertebral artery-origin and innominate/subclavian disease: indications and technique. | Approximately 20% to 40% of patients who have cerebral vascular disease have a vertebral artery-origin stenosis. Atherosclerotic lesions of vertebral arety origin are a potential cause of posterior circulation ischemia, which can be disabling or deadly. Endovascular treatment of vertebral artery-origin and innominate/subclavian artery stenosis has changed in the last 15 years. Surgery usually is successful technically; however, it is also associated with high rates of procedural and periprocedural complications. New techniques and technologies that can be used in the treatment of such lesions are being developed. In this article, the authors discuss the indications, technical aspects, and long-term results of angioplasty and stenting of these vessels. | 12,600,087 | true | Endovascular treatment of vertebral artery-origin and innominate/subclavian disease: indications and technique. Approximately 20% to 40% of patients who have cerebral vascular disease have a vertebral artery-origin stenosis. Atherosclerotic lesions of vertebral arety origin are a potential cause of posterior circulation ischemia, which can be disabling or deadly. Endovascular treatment of vertebral artery-origin and innominate/subclavian artery stenosis has changed in the last 15 years. Surgery usually is successful technically; however, it is also associated with high rates of procedural and periprocedural complications. New techniques and technologies that can be used in the treatment of such lesions are being developed. In this article, the authors discuss the indications, technical aspects, and long-term results of angioplasty and stenting of these vessels. |
19,713,619 | D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D020127:Recovery of Function; D012149:Restraint, Physical; D012189:Retrospective Studies; D020521:Stroke; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome | [
"D000203",
"D000328",
"D000368",
"D015331",
"D005081",
"D005260",
"D006801",
"D008297",
"D008875",
"D009043",
"D020127",
"D012149",
"D012189",
"D020521",
"D000071939",
"D016896"
] | Methods to improve constraint-induced movement therapy. | In global terms, cerebrovascular stroke is the leading cause of long-term disability. Despite improved acute phase management of stroke, the majority of survivors are disabled and many require effective rehabilitation. Constraint-induced movement therapy (CIMT) is one of the recently emerging therapies for subjects with stroke. The effects of two-week long CIMT on behavioural, neurophysiologic and neuroimaging measures in subjects with chronic stroke were studied. Furthermore, the effects of combined upper limb exercise and peripheral preprogrammed multichannel electrical stimulation, i.e. functional electrical therapy (FET), were evaluated. Behavioral gains were obtained in hand function and functional MRI activations, and, in addition, TMS responses appeared more laterally and/or bilaterally in the affected hemisphere in the subjects after CIMT. Neurophysiologic and functional imaging results were supportive evidence for the benefits of use-dependent plasticity in subjects with chronic stroke. | 11,400,196 | true | Methods to improve constraint-induced movement therapy. In global terms, cerebrovascular stroke is the leading cause of long-term disability. Despite improved acute phase management of stroke, the majority of survivors are disabled and many require effective rehabilitation. Constraint-induced movement therapy (CIMT) is one of the recently emerging therapies for subjects with stroke. The effects of two-week long CIMT on behavioural, neurophysiologic and neuroimaging measures in subjects with chronic stroke were studied. Furthermore, the effects of combined upper limb exercise and peripheral preprogrammed multichannel electrical stimulation, i.e. functional electrical therapy (FET), were evaluated. Behavioral gains were obtained in hand function and functional MRI activations, and, in addition, TMS responses appeared more laterally and/or bilaterally in the affected hemisphere in the subjects after CIMT. Neurophysiologic and functional imaging results were supportive evidence for the benefits of use-dependent plasticity in subjects with chronic stroke. |
1,742,789 | D000368:Aged; D002423:Cause of Death; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease; D016757:Death, Sudden, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States | [
"D000368",
"D002423",
"D017023",
"D001026",
"D003327",
"D016757",
"D005260",
"D006801",
"D008297",
"D012189",
"D012307",
"D015996",
"D014481"
] | Predictors of early mortality in patients with angiographically documented left main coronary artery disease. | To determine predictors of early death after coronary angiography in patients with significant left main coronary artery disease (greater than or equal to 60% diameter narrowing, LMCAD), we reviewed the clinical records of patients with LMCAD who died after angiography. Of 1,288 patients with LMCAD studied between January 1978 and October 1989, 21 died within 2 days after angiography (group 1). As a control group, 85 patients were randomly sampled from 1,196 patients who survived at least 30 days after angiography (group 2). The predictors of early death after angiography in patients with LMCAD were older age (P less than 0.05), New York Heart Association Class III or IV (P less than 0.005), shorter duration of unstable angina (P less than 0.005), higher left ventricular end-diastolic pressure (P less than 0.006), lower ejection fraction (P less than 0.005), and significant left circumflex artery disease (P less than 0.006). The use of heparin infusion after angiography did not appear to be a significant factor. It is suggested that earlier operation or more aggressive management be undertaken in patients who, at cardiac catheterization, have significant LMCAD associated with the above-listed variables. | 10,108,010 | true | Predictors of early mortality in patients with angiographically documented left main coronary artery disease. To determine predictors of early death after coronary angiography in patients with significant left main coronary artery disease (greater than or equal to 60% diameter narrowing, LMCAD), we reviewed the clinical records of patients with LMCAD who died after angiography. Of 1,288 patients with LMCAD studied between January 1978 and October 1989, 21 died within 2 days after angiography (group 1). As a control group, 85 patients were randomly sampled from 1,196 patients who survived at least 30 days after angiography (group 2). The predictors of early death after angiography in patients with LMCAD were older age (P less than 0.05), New York Heart Association Class III or IV (P less than 0.005), shorter duration of unstable angina (P less than 0.005), higher left ventricular end-diastolic pressure (P less than 0.006), lower ejection fraction (P less than 0.005), and significant left circumflex artery disease (P less than 0.006). The use of heparin infusion after angiography did not appear to be a significant factor. It is suggested that earlier operation or more aggressive management be undertaken in patients who, at cardiac catheterization, have significant LMCAD associated with the above-listed variables. |
12,618,738 | D000208:Acute Disease; D000328:Adult; D001011:Aorta; D001021:Aortic Valve; D001024:Aortic Valve Stenosis; D002404:Catheterization; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D006406:Hematoma; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D013524:Surgical Flaps; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D017539:Tunica Intima | [
"D000208",
"D000328",
"D001011",
"D001021",
"D001024",
"D002404",
"D003937",
"D017548",
"D006406",
"D006801",
"D008297",
"D011183",
"D012086",
"D013524",
"D013577",
"D014057",
"D017539"
] | Acute aortic intimal tear without a mobile flap mimicking an intramural hematoma. | Several variants of aortic pathology must be considered in the differential diagnosis of the patient presenting with an acute aortic syndrome. In addition to aortic dissection, such entities include intramural hematoma, penetrating aortic ulcer, and localized intimal tear without dissection. These lesions, which lack a mobile intimal flap, may be difficult to correctly identify by transesophageal echocardiography or other imaging modalities. We present a case of an acute aortic syndrome with unusual features on transesophageal echocardiography. | 420,635 | true | Acute aortic intimal tear without a mobile flap mimicking an intramural hematoma. Several variants of aortic pathology must be considered in the differential diagnosis of the patient presenting with an acute aortic syndrome. In addition to aortic dissection, such entities include intramural hematoma, penetrating aortic ulcer, and localized intimal tear without dissection. These lesions, which lack a mobile intimal flap, may be difficult to correctly identify by transesophageal echocardiography or other imaging modalities. We present a case of an acute aortic syndrome with unusual features on transesophageal echocardiography. |
35,098,943 | D017023:Coronary Angiography; D003324:Coronary Artery Disease; D003331:Coronary Vessels; D006439:Hemodynamics; D006801:Humans; D058226:Plaque, Atherosclerotic; D041623:Tomography, Optical Coherence | [
"D017023",
"D003324",
"D003331",
"D006439",
"D006801",
"D058226",
"D041623"
] | Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression. | In this paper, we present a complete workflow for the biomechanical analysis of atherosclerotic plaque in the coronary vasculature. With atherosclerosis as one of the leading causes of global death, morbidity and economic burden, novel ways of analyzing and predicting its progression are needed. One such computational method is the use of fluid-structure interaction (FSI) to analyze the interaction between the blood flow and artery/plaque domains. Coupled with in vivo imaging, this approach could be tailored to each patient, assisting in differentiating between stable and unstable plaques. We outline the three-dimensional reconstruction process, making use of intravascular Optical Coherence Tomography (OCT) and invasive coronary angiography (ICA). The extraction of boundary conditions for the simulation, including replicating the three-dimensional motion of the artery, is discussed before the setup and analysis is conducted in a commercial finite element solver. The procedure for describing the highly nonlinear hyperelastic properties of the artery wall and the pulsatile blood velocity/pressure is outlined along with setting up the system coupling between the two domains. We demonstrate the procedure by analyzing a non-culprit, mildly stenotic, lipid-rich plaque in a patient following myocardial infarction. Established and emerging markers related to atherosclerotic plaque progression, such as wall shear stress and local normalized helicity, respectively, are discussed and related to the structural response in the artery wall and plaque. Finally, we translate the results to potential clinical relevance, discuss limitations, and outline areas for further development. The method described in this paper shows promise for aiding in the determination of sites at risk of atherosclerotic progression and, hence, could assist in managing the significant death, morbidity, and economic burden of atherosclerosis. | 14,250,188 | true | Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression. In this paper, we present a complete workflow for the biomechanical analysis of atherosclerotic plaque in the coronary vasculature. With atherosclerosis as one of the leading causes of global death, morbidity and economic burden, novel ways of analyzing and predicting its progression are needed. One such computational method is the use of fluid-structure interaction (FSI) to analyze the interaction between the blood flow and artery/plaque domains. Coupled with in vivo imaging, this approach could be tailored to each patient, assisting in differentiating between stable and unstable plaques. We outline the three-dimensional reconstruction process, making use of intravascular Optical Coherence Tomography (OCT) and invasive coronary angiography (ICA). The extraction of boundary conditions for the simulation, including replicating the three-dimensional motion of the artery, is discussed before the setup and analysis is conducted in a commercial finite element solver. The procedure for describing the highly nonlinear hyperelastic properties of the artery wall and the pulsatile blood velocity/pressure is outlined along with setting up the system coupling between the two domains. We demonstrate the procedure by analyzing a non-culprit, mildly stenotic, lipid-rich plaque in a patient following myocardial infarction. Established and emerging markers related to atherosclerotic plaque progression, such as wall shear stress and local normalized helicity, respectively, are discussed and related to the structural response in the artery wall and plaque. Finally, we translate the results to potential clinical relevance, discuss limitations, and outline areas for further development. The method described in this paper shows promise for aiding in the determination of sites at risk of atherosclerotic progression and, hence, could assist in managing the significant death, morbidity, and economic burden of atherosclerosis. |
31,698,256 | D000367:Age Factors; D000368:Aged; D001826:Body Fluids; D005260:Female; D020200:Hematoma, Subdural, Chronic; D006801:Humans; D002532:Intracranial Aneurysm; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013355:Subdural Space; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed | [
"D000367",
"D000368",
"D001826",
"D005260",
"D020200",
"D006801",
"D002532",
"D008297",
"D008875",
"D019635",
"D011183",
"D012372",
"D012189",
"D012307",
"D013355",
"D007507",
"D014057"
] | Extensive postoperative subdural fluid volume affects the onset of chronic subdural hematoma after unruptured aneurysmal clipping surgery. | OBJECTIVE
To evaluate risk factors associated with chronic subdural hematoma (CSDH) onset after clipping surgery for unruptured intracranial aneurysm, and determine whether intraoperative conventional arachnoid-plasty (ARP) can suppress the CSDH onset by reducing subdural fluid volume.
METHODS
We retrospectively evaluated 217 patients who underwent surgical clipping at our institution from 2012 to 2018. Risk and predictive factors for symptomatic CSDH development including clinical characteristics, postoperative subdural fluid volume, Hounsfield unit (HU) value of subdural fluid density evaluated by CT and the effect of conventional ARP were compared between CSDH and non-CSDH groups.
RESULTS
Of 217 patients who underwent surgical clipping for anterior circulation aneurysm, 209 were included in this study. Among whom, postoperative CSDH, required burr irrigation, occurred in 12 (5.7%). Mean age was significantly higher in the CSDH group (70 ± 8 years) than in the non-CSDH group (64 ± 11 years, p = 0.03). Subdural fluid volumes on postoperative day (POD)1, POD8 and POD30 were significantly larger in the CSDH group than in the non-CSDH group (38.4 ± 33.5 cm3, 54.8 ± 36.3 cm3, 77.2 ± 36.1 cm3 vs 10.0 ± 7.7 cm3, 16.1 ± 12.8 cm3, 14.0 ± 17.5 cm3, p < 0.001, respectively). However, intraoperative conventional ARP did not reduce postoperative subdural fluid volume nor suppress onset of CSDH. Multivariate logistic regression analysis revealed extensive subdural fluid volume as the only risk factor independently associated with CSDH development.
CONCLUSIONS
In this study, postoperative large subdural fluid volume represented an independent risk factor associated with the incidence of CSDH after unruptured aneurysmal clipping. Reducing subdural fluid volume strategy could suppress the onset of CSDH after surgery. | null | false | Extensive postoperative subdural fluid volume affects the onset of chronic subdural hematoma after unruptured aneurysmal clipping surgery. OBJECTIVE
To evaluate risk factors associated with chronic subdural hematoma (CSDH) onset after clipping surgery for unruptured intracranial aneurysm, and determine whether intraoperative conventional arachnoid-plasty (ARP) can suppress the CSDH onset by reducing subdural fluid volume.
METHODS
We retrospectively evaluated 217 patients who underwent surgical clipping at our institution from 2012 to 2018. Risk and predictive factors for symptomatic CSDH development including clinical characteristics, postoperative subdural fluid volume, Hounsfield unit (HU) value of subdural fluid density evaluated by CT and the effect of conventional ARP were compared between CSDH and non-CSDH groups.
RESULTS
Of 217 patients who underwent surgical clipping for anterior circulation aneurysm, 209 were included in this study. Among whom, postoperative CSDH, required burr irrigation, occurred in 12 (5.7%). Mean age was significantly higher in the CSDH group (70 ± 8 years) than in the non-CSDH group (64 ± 11 years, p = 0.03). Subdural fluid volumes on postoperative day (POD)1, POD8 and POD30 were significantly larger in the CSDH group than in the non-CSDH group (38.4 ± 33.5 cm3, 54.8 ± 36.3 cm3, 77.2 ± 36.1 cm3 vs 10.0 ± 7.7 cm3, 16.1 ± 12.8 cm3, 14.0 ± 17.5 cm3, p < 0.001, respectively). However, intraoperative conventional ARP did not reduce postoperative subdural fluid volume nor suppress onset of CSDH. Multivariate logistic regression analysis revealed extensive subdural fluid volume as the only risk factor independently associated with CSDH development.
CONCLUSIONS
In this study, postoperative large subdural fluid volume represented an independent risk factor associated with the incidence of CSDH after unruptured aneurysmal clipping. Reducing subdural fluid volume strategy could suppress the onset of CSDH after surgery. |
9,244,203 | D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D017963:Azithromycin; D015415:Biomarkers; D002690:Chlamydia Infections; D016993:Chlamydophila pneumoniae; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction | [
"D000284",
"D000368",
"D000900",
"D000907",
"D017963",
"D015415",
"D002690",
"D016993",
"D006801",
"D008297",
"D008875",
"D009203"
] | Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. | BACKGROUND
The clinical significance of the association between elevated anti-Chlamydia pneumoniae (Cp) antibody titres and coronary heart disease (CHD) is unclear. We explored the relationship between antibodies against Cp and future cardiovascular events in male survivors of myocardial infarction (MI). The effect of azithromycin antibiotic therapy was assessed in a subgroup of post-MI patients.
RESULTS
We screened 220 consecutive male survivors of MI for anti-Cp antibodies. Of these, 213 patients were stratified into three groups: group Cp-ve (n=59), no detectable Cp antibodies; group Cp-I (n=74), intermediate titres of 1/8 to 1/32 dilution; and group Cp+ve (n=80), seropositive at > or = 1/64 dilution. Patients with persisting seropositivity of > or = 1/64 were randomized to either oral azithromycin (Cp+ve-A, 500 mg/d for 3 days [n=28] or 500 mg/d for 6 days [n=12]) or placebo (Cp+ve-P, n=20). Cp+ve-NR (n=20) represented patients not recruited into the antibiotic trial. The incidence of adverse cardiovascular events (over a mean follow-up period of 18+/-4 months) was recorded and shown to increase with increasing anti-Cp titre: Cp-ve, n=4 (7%); Cp-I, n=11 (15%); Cp+ve-NR, n=6 (30%); and Cp+ve-P, n=5 (25%). Cp+ve-NR and Cp+ve-P groups had a fourfold-increased risk for adverse cardiovascular events compared with the Cp-ve group (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.2 to 15.5; P=.03). In contrast, the OR for cardiovascular events in patients receiving azithromycin (Cp+ve-A, single or double course) was the same as in the Cp-ve group (OR, 0.9; 95% CI, 0.2 to 4.6, P=NS). Patients receiving azithromycin were more likely to experience a decrease in IgG anti-Cp titres than were those in the placebo group (P=.02).
CONCLUSIONS
An increased anti-Cp antibody titre may be a predictor for further adverse cardiovascular events in post-MI patients. Taking a short course of azithromycin may lower this risk, possibly by acting against Cp. | null | false | Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. BACKGROUND
The clinical significance of the association between elevated anti-Chlamydia pneumoniae (Cp) antibody titres and coronary heart disease (CHD) is unclear. We explored the relationship between antibodies against Cp and future cardiovascular events in male survivors of myocardial infarction (MI). The effect of azithromycin antibiotic therapy was assessed in a subgroup of post-MI patients.
RESULTS
We screened 220 consecutive male survivors of MI for anti-Cp antibodies. Of these, 213 patients were stratified into three groups: group Cp-ve (n=59), no detectable Cp antibodies; group Cp-I (n=74), intermediate titres of 1/8 to 1/32 dilution; and group Cp+ve (n=80), seropositive at > or = 1/64 dilution. Patients with persisting seropositivity of > or = 1/64 were randomized to either oral azithromycin (Cp+ve-A, 500 mg/d for 3 days [n=28] or 500 mg/d for 6 days [n=12]) or placebo (Cp+ve-P, n=20). Cp+ve-NR (n=20) represented patients not recruited into the antibiotic trial. The incidence of adverse cardiovascular events (over a mean follow-up period of 18+/-4 months) was recorded and shown to increase with increasing anti-Cp titre: Cp-ve, n=4 (7%); Cp-I, n=11 (15%); Cp+ve-NR, n=6 (30%); and Cp+ve-P, n=5 (25%). Cp+ve-NR and Cp+ve-P groups had a fourfold-increased risk for adverse cardiovascular events compared with the Cp-ve group (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.2 to 15.5; P=.03). In contrast, the OR for cardiovascular events in patients receiving azithromycin (Cp+ve-A, single or double course) was the same as in the Cp-ve group (OR, 0.9; 95% CI, 0.2 to 4.6, P=NS). Patients receiving azithromycin were more likely to experience a decrease in IgG anti-Cp titres than were those in the placebo group (P=.02).
CONCLUSIONS
An increased anti-Cp antibody titre may be a predictor for further adverse cardiovascular events in post-MI patients. Taking a short course of azithromycin may lower this risk, possibly by acting against Cp. |
15,815,910 | D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors | [
"D000368",
"D017023",
"D003324",
"D005260",
"D006801",
"D007091",
"D021621",
"D018810",
"D008297",
"D011446",
"D012680",
"D013997"
] | 3D motion adapted gating (3D MAG): a new navigator technique for accelerated acquisition of free breathing navigator gated 3D coronary MR-angiography. | This study aimed to evaluate the influence of a new navigator technique (3D MAG) on navigator efficiency, total acquisition time, image quality and diagnostic accuracy. Fifty-six patients with suspected coronary artery disease underwent free breathing navigator gated coronary MRA (Intera, Philips Medical Systems, 1.5 T, spatial resolution 0.9x0.9x3 mm3) with and without 3D MAG. Evaluation of both sequences included: 1) navigator scan efficiency, 2) total acquisition time, 3) assessment of image quality and 4) detection of stenoses >50%. Average navigator efficiencies of the LCA and RCA were 43+/-12% and 42+/-12% with and 36+/-16% and 35+/-16% without 3D MAG (P<0.01). Scan time was reduced from 12 min 7 s without to 8 min 55 s with 3D MAG for the LCA and from 12 min 19 s to 9 min 7 s with 3D MAG for the RCA (P<0.01). The average scores of image quality of the coronary MRAs with and without 3D MAG were 3.5+/-0.79 and 3.46+/-0.84 (P>0.05). There was no significant difference in the sensitivity and specificity in the detection of coronary artery stenoses between coronary MRAs with and without 3D MAG (P>0.05). 3D MAG provides accelerated acquisition of navigator gated coronary MRA by about 19% while maintaining image quality and diagnostic accuracy. | 9,438,155 | true | 3D motion adapted gating (3D MAG): a new navigator technique for accelerated acquisition of free breathing navigator gated 3D coronary MR-angiography. This study aimed to evaluate the influence of a new navigator technique (3D MAG) on navigator efficiency, total acquisition time, image quality and diagnostic accuracy. Fifty-six patients with suspected coronary artery disease underwent free breathing navigator gated coronary MRA (Intera, Philips Medical Systems, 1.5 T, spatial resolution 0.9x0.9x3 mm3) with and without 3D MAG. Evaluation of both sequences included: 1) navigator scan efficiency, 2) total acquisition time, 3) assessment of image quality and 4) detection of stenoses >50%. Average navigator efficiencies of the LCA and RCA were 43+/-12% and 42+/-12% with and 36+/-16% and 35+/-16% without 3D MAG (P<0.01). Scan time was reduced from 12 min 7 s without to 8 min 55 s with 3D MAG for the LCA and from 12 min 19 s to 9 min 7 s with 3D MAG for the RCA (P<0.01). The average scores of image quality of the coronary MRAs with and without 3D MAG were 3.5+/-0.79 and 3.46+/-0.84 (P>0.05). There was no significant difference in the sensitivity and specificity in the detection of coronary artery stenoses between coronary MRAs with and without 3D MAG (P>0.05). 3D MAG provides accelerated acquisition of navigator gated coronary MRA by about 19% while maintaining image quality and diagnostic accuracy. |
21,725,749 | D000704:Analysis of Variance; D000818:Animals; D016227:Benzoquinones; D001921:Brain; D001929:Brain Edema; D001930:Brain Injuries; D002543:Cerebral Hemorrhage; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004791:Enzyme Inhibitors; D007839:Functional Laterality; D047029:Lactams, Macrocyclic; D008297:Male; D051379:Mice; D009422:Nervous System Diseases; D013997:Time Factors | [
"D000704",
"D000818",
"D016227",
"D001921",
"D001929",
"D001930",
"D002543",
"D004195",
"D004305",
"D004791",
"D007839",
"D047029",
"D008297",
"D051379",
"D009422",
"D013997"
] | Geldanamycin reduced brain injury in mouse model of intracerebral hemorrhage. | We investigated the effect of the heat shock protein inducer geldanamycin on the development of secondary brain injury after ICH in mice. The effect of the drug at two different concentrations was evaluated at two time points: 24 and 72 h after ICH induction. In the first part of this study, a total of 30 male CD-1 mice were randomly divided into four groups: one sham group and three ICH groups. ICH animals received either an intraperitoneal injection of vehicle or geldanamycin (1 or 10 mg/kg). Neurological deficits and brain water content were evaluated 24 h after ICH. In the second part of this study, the effect of a high concentration of geldanamycin was evaluated 72 h after ICH. Neurological deficits were evaluated by the Garcia neuroscoring, wire hanging and beam balance tests. For estimation of brain water content, the "wet/dry weight" method was used. We demonstrated that administration of geldanamycin (10 mg/kg) ameliorated ICH-induced increase of brain water content significantly in both parts of the study. Geldanamycin improved the neurological outcome according to performance on Garcia and beam balance tests in the 72 h part of this study. Geldanamycin-induced induction of heat shock protein after ICH has a neuroprotective effect and may be a therapeutic target for ICH. | 6,605,244 | true | Geldanamycin reduced brain injury in mouse model of intracerebral hemorrhage. We investigated the effect of the heat shock protein inducer geldanamycin on the development of secondary brain injury after ICH in mice. The effect of the drug at two different concentrations was evaluated at two time points: 24 and 72 h after ICH induction. In the first part of this study, a total of 30 male CD-1 mice were randomly divided into four groups: one sham group and three ICH groups. ICH animals received either an intraperitoneal injection of vehicle or geldanamycin (1 or 10 mg/kg). Neurological deficits and brain water content were evaluated 24 h after ICH. In the second part of this study, the effect of a high concentration of geldanamycin was evaluated 72 h after ICH. Neurological deficits were evaluated by the Garcia neuroscoring, wire hanging and beam balance tests. For estimation of brain water content, the "wet/dry weight" method was used. We demonstrated that administration of geldanamycin (10 mg/kg) ameliorated ICH-induced increase of brain water content significantly in both parts of the study. Geldanamycin improved the neurological outcome according to performance on Garcia and beam balance tests in the 72 h part of this study. Geldanamycin-induced induction of heat shock protein after ICH has a neuroprotective effect and may be a therapeutic target for ICH. |
18,044,341 | D000872:Anthocyanins; D001786:Blood Glucose; D001794:Blood Pressure; D016022:Case-Control Studies; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019332:Endothelin-1; D005260:Female; D006801:Humans; D006946:Hyperinsulinism; D006973:Hypertension; D008055:Lipids; D008074:Lipoproteins; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D046936:Photinia; D010936:Plant Extracts; D014280:Triglycerides; D049629:Waist-Hip Ratio | [
"D000872",
"D001786",
"D001794",
"D016022",
"D008076",
"D008078",
"D019332",
"D005260",
"D006801",
"D006946",
"D006973",
"D008055",
"D008074",
"D008297",
"D024821",
"D008875",
"D046936",
"D010936",
"D014280",
"D049629"
] | [Effect of anthocyanins from Aronia melanocarpa on blood pressure, concentration of endothelin-1 and lipids in patients with metabolic syndrome]. | OBJECTIVE
To estimate the influence of anthocyanins from Aronia melanocarpa on blood pressure, concentration of endothelin-1 (ET-1), serum lipids, fasting glucose, uric acid and membrane cholesterol in erythrocytes of patients (pts) with metabolic syndrome (MS).
METHODS
The study comprised 22 healthy volunteers and 25 pts with MS treated with anthocyanins (3 x 100 mg/d) for 2 months. Waist circumference (> or = 80 cm for women and > or =94 cm for men), triglicerydes (TG) level >150 mg/dl (1.7 mmol/l), cholesterol-HDL (HDL-C) level < 40 mg/dl (1.0 mmol/l) for men and <50 mg/dl (1.3 mmol/l) for women, systolic blood pressure (SBP) >130 mmHg and/or diastolic blood pressure (DBP) >85 mmHg were inclusion criteria for patients with MS. Before and after 2 months of treatment the following parameters were determined: SBP, DBP, serum lipids (total cholesterol--TC, cholesterol LDL--LDL-C, cholesterol HDL--HDL-C, TG--by enzymatic method), membrane cholesterol in erythrocytes (method of IIcy), ET-1 (immunoenzymatic method), fasting glucose level was (colorimetric method), uric acid (enzymatic--colorimetric method).
RESULTS
After two months therapy of anthocyanins from Aronia melanocarpa in comparison with baseline it was observed a significant decrease of: SBP (144.20 +/- 9.97 vs. 131.83 +/- 12.24 mmHg, p < 0.001) and DBP (87.20 +/- 9.9 vs. 82.13 +/- 10.33 mmHg, p < 0.05), TC (242.80 +/- 34.48 vs. 227.96 +/- 33.07 mg/dl, p < 0.001), LDL-C (158.71 +/- 35.78 vs. 146.21 +/- 34.63 mg/dl, p < 0.01), TG (215.92 +/- 63.61 vs. 187.58 +/- 90 mg/dl, p < 0.05), ET-1 (2.44 +/- 0.51 vs. 1.74 +/- 0.42 pg/ml, p < 0.001) and membrane cholesterol (4.85 +/- 0.65 vs. 2.81 +/- 0.54 mmol/Lpc, p < 0.001), uric acid and fasting blood glucose levels did not change significantly after study cessation.
CONCLUSIONS
The results of our study show that anthocyanins from Aronia melanocarpa may be of benefit to patients with MS as for as atherosclerosis prevention is concerned. It seems to result from anthocyanins influence on blood pressure, serum lipid and endothelin-1 level. | null | false | [Effect of anthocyanins from Aronia melanocarpa on blood pressure, concentration of endothelin-1 and lipids in patients with metabolic syndrome]. OBJECTIVE
To estimate the influence of anthocyanins from Aronia melanocarpa on blood pressure, concentration of endothelin-1 (ET-1), serum lipids, fasting glucose, uric acid and membrane cholesterol in erythrocytes of patients (pts) with metabolic syndrome (MS).
METHODS
The study comprised 22 healthy volunteers and 25 pts with MS treated with anthocyanins (3 x 100 mg/d) for 2 months. Waist circumference (> or = 80 cm for women and > or =94 cm for men), triglicerydes (TG) level >150 mg/dl (1.7 mmol/l), cholesterol-HDL (HDL-C) level < 40 mg/dl (1.0 mmol/l) for men and <50 mg/dl (1.3 mmol/l) for women, systolic blood pressure (SBP) >130 mmHg and/or diastolic blood pressure (DBP) >85 mmHg were inclusion criteria for patients with MS. Before and after 2 months of treatment the following parameters were determined: SBP, DBP, serum lipids (total cholesterol--TC, cholesterol LDL--LDL-C, cholesterol HDL--HDL-C, TG--by enzymatic method), membrane cholesterol in erythrocytes (method of IIcy), ET-1 (immunoenzymatic method), fasting glucose level was (colorimetric method), uric acid (enzymatic--colorimetric method).
RESULTS
After two months therapy of anthocyanins from Aronia melanocarpa in comparison with baseline it was observed a significant decrease of: SBP (144.20 +/- 9.97 vs. 131.83 +/- 12.24 mmHg, p < 0.001) and DBP (87.20 +/- 9.9 vs. 82.13 +/- 10.33 mmHg, p < 0.05), TC (242.80 +/- 34.48 vs. 227.96 +/- 33.07 mg/dl, p < 0.001), LDL-C (158.71 +/- 35.78 vs. 146.21 +/- 34.63 mg/dl, p < 0.01), TG (215.92 +/- 63.61 vs. 187.58 +/- 90 mg/dl, p < 0.05), ET-1 (2.44 +/- 0.51 vs. 1.74 +/- 0.42 pg/ml, p < 0.001) and membrane cholesterol (4.85 +/- 0.65 vs. 2.81 +/- 0.54 mmol/Lpc, p < 0.001), uric acid and fasting blood glucose levels did not change significantly after study cessation.
CONCLUSIONS
The results of our study show that anthocyanins from Aronia melanocarpa may be of benefit to patients with MS as for as atherosclerosis prevention is concerned. It seems to result from anthocyanins influence on blood pressure, serum lipid and endothelin-1 level. |
33,402,052 | D000200:Action Potentials; D000368:Aged; D004576:Electromyography; D005260:Female; D005542:Forearm; D006429:Hemiplegia; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D010525:Peripheral Nerves; D012189:Retrospective Studies; D012782:Shoulder; D020521:Stroke | [
"D000200",
"D000368",
"D004576",
"D005260",
"D005542",
"D006429",
"D006801",
"D008297",
"D008875",
"D009431",
"D010525",
"D012189",
"D012782",
"D020521"
] | Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study. | Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients.Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function.Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05).Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function. | null | false | Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study. Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients.Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function.Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05).Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function. |
7,713,923 | D000818:Animals; D001779:Blood Coagulation Factors; D002135:Calcium-Binding Proteins; D037282:Calreticulin; D002417:Cattle; D003328:Coronary Thrombosis; D004285:Dogs; D004730:Endothelium, Vascular; D008168:Lung; D051379:Mice; D008954:Models, Biological; D009569:Nitric Oxide; D011994:Recombinant Proteins; D012261:Ribonucleoproteins; D014812:Vitamin K | [
"D000818",
"D001779",
"D002135",
"D037282",
"D002417",
"D003328",
"D004285",
"D004730",
"D008168",
"D051379",
"D008954",
"D009569",
"D011994",
"D012261",
"D014812"
] | Calreticulin, an antithrombotic agent which binds to vitamin K-dependent coagulation factors, stimulates endothelial nitric oxide production, and limits thrombosis in canine coronary arteries. | Coagulation Factor IX/IXa has been shown to bind to cellular surfaces, and Factor IXa expresses its procoagulant activity by assembling into the intrinsic Factor X activating complex (Factors IXa/VIIIa/X), which also forms on membrane surfaces. This led us to identify cellular proteins which bind Factor IX/IXa; an approximately 55-kDa polypeptide was purified to homogeneity from bovine lung extracts based on its capacity to bind 125I-Factor IX in a dose-dependent and saturable manner. From protein sequence data of the amino terminus and internal peptides, the approximately 55-kDa polypeptide was identified as calreticulin, a previously identified intracellular calcium-binding protein. Recombinant calreticulin bound vitamin K-dependent coagulation factors, 125I-Factor IX, 125I-Factor X, and 125I-prothrombin (Kd values of approximately 2.7, 3.2, and 8.3 nM, respectively), via interaction with its C-domain, although it did not affect the coagulant properties of these proteins. 125I-Calreticulin also bound to endothelial cells in vitro (Kd approximately 7.4 nM), and mouse infusion studies showed an initial rapid phase of clearance in which calreticulin could be localized on the vascular endothelium. Exposure of endothelial cells to calreticulin led to dose-dependent, immediate, and sustained increase in the production of nitric oxide, as measured using a porphyrinic microsensor. In a canine electrically induced thrombosis model, intracoronary infusion of calreticulin (n = 7) prevented occlusion of the left circumflex coronary artery in a dose-dependent manner compared with vehicle-treated controls (n = 5). These results indicate that calreticulin interacts with the endothelium to stimulate release of nitric oxide and inhibit clot formation. | 12,695,137 | true | Calreticulin, an antithrombotic agent which binds to vitamin K-dependent coagulation factors, stimulates endothelial nitric oxide production, and limits thrombosis in canine coronary arteries. Coagulation Factor IX/IXa has been shown to bind to cellular surfaces, and Factor IXa expresses its procoagulant activity by assembling into the intrinsic Factor X activating complex (Factors IXa/VIIIa/X), which also forms on membrane surfaces. This led us to identify cellular proteins which bind Factor IX/IXa; an approximately 55-kDa polypeptide was purified to homogeneity from bovine lung extracts based on its capacity to bind 125I-Factor IX in a dose-dependent and saturable manner. From protein sequence data of the amino terminus and internal peptides, the approximately 55-kDa polypeptide was identified as calreticulin, a previously identified intracellular calcium-binding protein. Recombinant calreticulin bound vitamin K-dependent coagulation factors, 125I-Factor IX, 125I-Factor X, and 125I-prothrombin (Kd values of approximately 2.7, 3.2, and 8.3 nM, respectively), via interaction with its C-domain, although it did not affect the coagulant properties of these proteins. 125I-Calreticulin also bound to endothelial cells in vitro (Kd approximately 7.4 nM), and mouse infusion studies showed an initial rapid phase of clearance in which calreticulin could be localized on the vascular endothelium. Exposure of endothelial cells to calreticulin led to dose-dependent, immediate, and sustained increase in the production of nitric oxide, as measured using a porphyrinic microsensor. In a canine electrically induced thrombosis model, intracoronary infusion of calreticulin (n = 7) prevented occlusion of the left circumflex coronary artery in a dose-dependent manner compared with vehicle-treated controls (n = 5). These results indicate that calreticulin interacts with the endothelium to stimulate release of nitric oxide and inhibit clot formation. |
2,142,517 | D000368:Aged; D001157:Arterial Occlusive Diseases; D001366:Axillary Artery; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007866:Leg; D008297:Male; D011093:Polyethylene Terephthalates | [
"D000368",
"D001157",
"D001366",
"D001807",
"D005260",
"D005263",
"D006801",
"D007866",
"D008297",
"D011093"
] | [Extra-anatomical bypasses: axillofemoral and femorofemoral. Indications and results]. | Indications for a unilateral or bilateral axillofemoral and femorofemoral bypass, are presented. Our experience in 48 patients with axillofemoral and femorofemoral form the basis of this report. Indications for these extended bypasses included suppurative growing infection and obliterated common and profunda femoris arteries. These procedures were rapidly performed in critically ill patients. One patient died of recurrent artoduodenal hemorrhage three days following successful axillofemoral bypass. The other patients enjoyed patent grafts for variable periods, although some of them successfully underwent a declotting procedure. | null | false | [Extra-anatomical bypasses: axillofemoral and femorofemoral. Indications and results]. Indications for a unilateral or bilateral axillofemoral and femorofemoral bypass, are presented. Our experience in 48 patients with axillofemoral and femorofemoral form the basis of this report. Indications for these extended bypasses included suppurative growing infection and obliterated common and profunda femoris arteries. These procedures were rapidly performed in critically ill patients. One patient died of recurrent artoduodenal hemorrhage three days following successful axillofemoral bypass. The other patients enjoyed patent grafts for variable periods, although some of them successfully underwent a declotting procedure. |
66,844 | D000818:Animals; D002462:Cell Membrane; D003593:Cytoplasm; D004285:Dogs; D006651:Histocytochemistry; D006801:Humans; D051379:Mice; D009203:Myocardial Infarction; D009206:Myocardium; D009336:Necrosis; D011509:Proteoglycans; D013194:Staining and Labeling | [
"D000818",
"D002462",
"D003593",
"D004285",
"D006651",
"D006801",
"D051379",
"D009203",
"D009206",
"D009336",
"D011509",
"D013194"
] | [Ultrastructure of the contact between interstitial cells and myocardial cells in mammalian hearts]. | By combination of light, electron-microscopical and histochemical findings in the myocardium of dog and mice, the hypothesis of an intimate contact between a widely branched interstitial cell type, rich in proteoglycans, and myocardial cells could be strengthened. The branches seem to penetrate the transversal tubular system of the myocardial cells. Functionally, this interstitial (mast cell-like) cell type might influence via proteoglycans - delivered into the transversal tubuli - the excitation phenomena of the myocardial cell membrane. One of the earliest pathomorphological changes in the myocardium, as revealed by the light-microscopie, is the disengagement of these interstitial cells and the myocardial cells. From this point of view the genesis of myocardial cell necrosis has been discussed. | null | false | [Ultrastructure of the contact between interstitial cells and myocardial cells in mammalian hearts]. By combination of light, electron-microscopical and histochemical findings in the myocardium of dog and mice, the hypothesis of an intimate contact between a widely branched interstitial cell type, rich in proteoglycans, and myocardial cells could be strengthened. The branches seem to penetrate the transversal tubular system of the myocardial cells. Functionally, this interstitial (mast cell-like) cell type might influence via proteoglycans - delivered into the transversal tubuli - the excitation phenomena of the myocardial cell membrane. One of the earliest pathomorphological changes in the myocardium, as revealed by the light-microscopie, is the disengagement of these interstitial cells and the myocardial cells. From this point of view the genesis of myocardial cell necrosis has been discussed. |
35,383,106 | D000328:Adult; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies | [
"D000328",
"D015331",
"D005260",
"D006330",
"D006801",
"D007362",
"D007902",
"D008297",
"D012189"
] | Adult patients with congenital heart disease in the intensive care unit. | Current data on intensive care unit (ICU) admissions in patients with adult congenital heart disease (ACHD) are limited and focus on admissions after elective cardiac surgery. This study describes non-elective ICU admissions in patients with ACHD.
A retrospective matched cohort study was performed from January 2000 until December 2015 in a tertiary care centre ICU (there was no cardiac care unit). Primary outcomes were short-term (during hospital stay or <30 days after discharge) and long-term (>30 days after discharge until end of follow-up) mortality. Outcomes were compared with non-ACHD non-elective ICU admissions, matched 1:1 on age, sex and admission diagnosis.
A total of 138 admissions in 104 patients with ACHD (65.9% male, median age 30 years) were included, during 8.6 years of follow-up. The majority had a moderate-to-severe heart defect. Arrhythmia was the most common admission diagnosis (44.2%), followed by haemorrhage (10.9%), heart failure (8.7%) and pulmonary disease (8.7%). Short-term mortality and total mortality were lower in the ACHD admissions than in the non-ACHD admissions (4.8% vs 16.3%, p=0.005 and 17.3% vs 28.9%, p=0.030), whereas long-term (12.5% vs 12.6%, p=0.700) did not differ. Severe CHD (HR 3.1, 95% CI 1.1 to 8.6) at baseline, and mechanical circulatory support device use (8.3, 1.4 to 47.4) and emergency intervention (0.2, 0.1 to 0.7) during the ICU stay were independently associated with mortality in the ACHD group.
Non-elective ICU admissions in patients with ACHD are most often for arrhythmia and in patients with moderate-to-severe CHD. Reassuringly, short-term and total mortality are lower compared with patients without ACHD, however, long-term mortality is higher than expected for patients with ACHD. | null | false | Adult patients with congenital heart disease in the intensive care unit. Current data on intensive care unit (ICU) admissions in patients with adult congenital heart disease (ACHD) are limited and focus on admissions after elective cardiac surgery. This study describes non-elective ICU admissions in patients with ACHD.
A retrospective matched cohort study was performed from January 2000 until December 2015 in a tertiary care centre ICU (there was no cardiac care unit). Primary outcomes were short-term (during hospital stay or <30 days after discharge) and long-term (>30 days after discharge until end of follow-up) mortality. Outcomes were compared with non-ACHD non-elective ICU admissions, matched 1:1 on age, sex and admission diagnosis.
A total of 138 admissions in 104 patients with ACHD (65.9% male, median age 30 years) were included, during 8.6 years of follow-up. The majority had a moderate-to-severe heart defect. Arrhythmia was the most common admission diagnosis (44.2%), followed by haemorrhage (10.9%), heart failure (8.7%) and pulmonary disease (8.7%). Short-term mortality and total mortality were lower in the ACHD admissions than in the non-ACHD admissions (4.8% vs 16.3%, p=0.005 and 17.3% vs 28.9%, p=0.030), whereas long-term (12.5% vs 12.6%, p=0.700) did not differ. Severe CHD (HR 3.1, 95% CI 1.1 to 8.6) at baseline, and mechanical circulatory support device use (8.3, 1.4 to 47.4) and emergency intervention (0.2, 0.1 to 0.7) during the ICU stay were independently associated with mortality in the ACHD group.
Non-elective ICU admissions in patients with ACHD are most often for arrhythmia and in patients with moderate-to-severe CHD. Reassuringly, short-term and total mortality are lower compared with patients without ACHD, however, long-term mortality is higher than expected for patients with ACHD. |
10,589,546 | D000328:Adult; D004272:DNA, Mitochondrial; D042967:Electron Transport Complex I; D003576:Electron Transport Complex IV; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D017241:MELAS Syndrome; D008297:Male; D008931:Mitochondria, Muscle; D018482:Muscle, Skeletal; D009247:NADH, NADPH Oxidoreductases; D015418:Optic Atrophies, Hereditary; D017354:Point Mutation; D016133:Polymerase Chain Reaction | [
"D000328",
"D004272",
"D042967",
"D003576",
"D005260",
"D020022",
"D006801",
"D017241",
"D008297",
"D008931",
"D018482",
"D009247",
"D015418",
"D017354",
"D016133"
] | The mitochondrial DNA G13513A transition in ND5 is associated with a LHON/MELAS overlap syndrome and may be a frequent cause of MELAS. | We report on 4 male patients with clinical, radiological, and muscle biopsy findings typical of the mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) phenotype. Skeletal muscle mitochondrial DNA (mtDNA) analysis showed that all patients harbored a heteroplasmic G13513A mutation in the ND5 subunit gene. One of these cases (Patient 1) presented with symptoms characteristic of Leber's hereditary optic neuropathy (LHON) 2 years before the first stroke-like episode. Quantitative analysis in several postmortem tissue sections showed that the relative proportions of mutant mtDNA were generally lower than those reported with other pathogenic mtDNA mutations. Single-fiber polymerase chain reaction studies demonstrated significantly higher amounts of mutant mtDNA in ragged red fibers (RRFs) compared with non-RRFs. This study indicates that the G13513A transition is likely to be pathogenic, that it can cause an LHON/MELAS overlap syndrome, and that it may be a more frequent cause of MELAS than previously recognized. | 14,240,577 | true | The mitochondrial DNA G13513A transition in ND5 is associated with a LHON/MELAS overlap syndrome and may be a frequent cause of MELAS. We report on 4 male patients with clinical, radiological, and muscle biopsy findings typical of the mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) phenotype. Skeletal muscle mitochondrial DNA (mtDNA) analysis showed that all patients harbored a heteroplasmic G13513A mutation in the ND5 subunit gene. One of these cases (Patient 1) presented with symptoms characteristic of Leber's hereditary optic neuropathy (LHON) 2 years before the first stroke-like episode. Quantitative analysis in several postmortem tissue sections showed that the relative proportions of mutant mtDNA were generally lower than those reported with other pathogenic mtDNA mutations. Single-fiber polymerase chain reaction studies demonstrated significantly higher amounts of mutant mtDNA in ragged red fibers (RRFs) compared with non-RRFs. This study indicates that the G13513A transition is likely to be pathogenic, that it can cause an LHON/MELAS overlap syndrome, and that it may be a more frequent cause of MELAS than previously recognized. |
30,014,299 | D000208:Acute Disease; D000328:Adult; D000368:Aged; D000925:Anticoagulants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D012008:Recurrence; D012307:Risk Factors; D014463:Ultrasonography; D054556:Venous Thromboembolism; D020246:Venous Thrombosis | [
"D000208",
"D000328",
"D000368",
"D000925",
"D005260",
"D006801",
"D008297",
"D008875",
"D009369",
"D012008",
"D012307",
"D014463",
"D054556",
"D020246"
] | Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer. | After acute proximal deep vein thrombosis (DVT) the thrombotic mass decreases, especially during the first months of anticoagulation. The persistence of residual vein obstruction (RVO) may predict future recurrence in patients with cancer-associated DVT. We aimed to evaluate the proportion of patients with RVO after an episode of cancer associated isolated distal DVT (IDDVT), to identify variables associated with RVO, and to provide initial evidence of its association with recurrent VTE. We performed a post-hoc analysis of a multicenter cohort study of patients with isolated cancer-associated acute IDDVT. We included patients who underwent a control ultrasonography at the end of the anticoagulant treatment between day 30 and day 365 after index IDDVT, given that no recurrent VTE had already occurred on anticoagulant treatment. A total of 153 patients had ultrasonographic follow-up after a median of 92 days from index IDDVT: 45.8% had RVO and 54.2% exhibited complete recanalization. Female sex, Body Mass Index > 30 Kg/m2 and involvement of axial calf veins showed the strongest association with RVO. The risk of recurrence was twofold higher in patients with (versus without) RVO. RVO persisted in approximately half of patients with an episode of cancer-associated IDDVT at anticoagulant discontinuation. Patients with RVO appeared to be at a higher risk for recurrent events. | null | false | Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer. After acute proximal deep vein thrombosis (DVT) the thrombotic mass decreases, especially during the first months of anticoagulation. The persistence of residual vein obstruction (RVO) may predict future recurrence in patients with cancer-associated DVT. We aimed to evaluate the proportion of patients with RVO after an episode of cancer associated isolated distal DVT (IDDVT), to identify variables associated with RVO, and to provide initial evidence of its association with recurrent VTE. We performed a post-hoc analysis of a multicenter cohort study of patients with isolated cancer-associated acute IDDVT. We included patients who underwent a control ultrasonography at the end of the anticoagulant treatment between day 30 and day 365 after index IDDVT, given that no recurrent VTE had already occurred on anticoagulant treatment. A total of 153 patients had ultrasonographic follow-up after a median of 92 days from index IDDVT: 45.8% had RVO and 54.2% exhibited complete recanalization. Female sex, Body Mass Index > 30 Kg/m2 and involvement of axial calf veins showed the strongest association with RVO. The risk of recurrence was twofold higher in patients with (versus without) RVO. RVO persisted in approximately half of patients with an episode of cancer-associated IDDVT at anticoagulant discontinuation. Patients with RVO appeared to be at a higher risk for recurrent events. |
26,492,183 | D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D016543:Central Nervous System Neoplasms; D002675:Child, Preschool; D016371:Cranial Irradiation; D042783:Endothelial Cells; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015534:Trans-Activators; D000071230:Transcriptional Regulator ERG; D019043:Vascular Neoplasms | [
"D000328",
"D000368",
"D014408",
"D016543",
"D002675",
"D016371",
"D042783",
"D005260",
"D006801",
"D006965",
"D007150",
"D008279",
"D008297",
"D008875",
"D009381",
"D012307",
"D013997",
"D014057",
"D015534",
"D000071230",
"D019043"
] | CNS Masson Tumors: Frequent Association With Therapeutic Radiation. | Masson tumor (MT, papillary endothelial hyperplasia) is an exaggerated form of thrombus reorganization rarely occurring in the central nervous system (CNS), where it presents as a mass or hemorrhage in parenchyma, meninges, or venous sinuses. MT is subclassified as type 1 arising within a histologically normal vessel, type 2 associated with a ruptured vascular malformation, and extravascular. Limited reports of CNS MT after radiosurgery, or especially external radiation therapy, have emerged. We searched our databases for cases reported from 2008 to present. Nine cases were identified, 6 of which were associated with receipt of therapeutic radiation for known lesions, with intervals of 1 to 25+ years to MT development (4 neoplasms=external beam radiation; 1 neoplasm=external beam radiation+radiosurgery, 1 arteriovenous malformation=radiosurgery). MTs were coassociated with radiation-induced vascular malformations (1 cavernoma-like, 1 massive) only in 2 of 6 irradiated patients, whereas the other 4 had MTs only. The 3 MTs in nonirradiated patients were extravascular, with 1 spontaneously developing in a hemangioblastoma. Seven of 9 MTs were intracerebral, 1 was within the spinal cord, and 1 was subdural. Papillary MT architecture was best appreciated by CD31 or CD34 immunohistochemistry, although ERG verified the endothelial monolayer population. Most CNS MTs at our institution have arisen in patients who have received therapeutic cranial radiation, many of whom received only external beam radiation. Although MTs could conceivably represent early, severe phases in radiation-induced cavernoma development, most were not found coassociated with the latter. This study further extends our knowledge of types of radiation-induced CNS vascular abnormalities. | 7,298,933 | true | CNS Masson Tumors: Frequent Association With Therapeutic Radiation. Masson tumor (MT, papillary endothelial hyperplasia) is an exaggerated form of thrombus reorganization rarely occurring in the central nervous system (CNS), where it presents as a mass or hemorrhage in parenchyma, meninges, or venous sinuses. MT is subclassified as type 1 arising within a histologically normal vessel, type 2 associated with a ruptured vascular malformation, and extravascular. Limited reports of CNS MT after radiosurgery, or especially external radiation therapy, have emerged. We searched our databases for cases reported from 2008 to present. Nine cases were identified, 6 of which were associated with receipt of therapeutic radiation for known lesions, with intervals of 1 to 25+ years to MT development (4 neoplasms=external beam radiation; 1 neoplasm=external beam radiation+radiosurgery, 1 arteriovenous malformation=radiosurgery). MTs were coassociated with radiation-induced vascular malformations (1 cavernoma-like, 1 massive) only in 2 of 6 irradiated patients, whereas the other 4 had MTs only. The 3 MTs in nonirradiated patients were extravascular, with 1 spontaneously developing in a hemangioblastoma. Seven of 9 MTs were intracerebral, 1 was within the spinal cord, and 1 was subdural. Papillary MT architecture was best appreciated by CD31 or CD34 immunohistochemistry, although ERG verified the endothelial monolayer population. Most CNS MTs at our institution have arisen in patients who have received therapeutic cranial radiation, many of whom received only external beam radiation. Although MTs could conceivably represent early, severe phases in radiation-induced cavernoma development, most were not found coassociated with the latter. This study further extends our knowledge of types of radiation-induced CNS vascular abnormalities. |
25,680,403 | D000368:Aged; D003097:Collateral Circulation; D023921:Coronary Stenosis; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012737:Sex Factors | [
"D000368",
"D003097",
"D023921",
"D003920",
"D005260",
"D006801",
"D008297",
"D008875",
"D012720",
"D012737"
] | Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis. | BACKGROUND
Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms—along with angiogenesis—to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery.
METHODS
The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group.
RESULTS
Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p < 0.001). Additionally, female gender and DM were found to be independently associated with poor CVD in patients with CTO (p = 0.005 and p < 0.001, respectively). Monocyte count was found to be independent of CVD neither in patients with ≥95% stenosis nor in patients with CTO.
CONCLUSIONS
Our data show that DM is an independent factor for poor coronary CVD both in patients with severe coronary artery stenosis and in patients with CTO. Female gender or being in post-menopausal period is another negative risk factor for poor CVD in addition to DM in patients with CTO. | null | false | Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis. BACKGROUND
Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms—along with angiogenesis—to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery.
METHODS
The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group.
RESULTS
Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p < 0.001). Additionally, female gender and DM were found to be independently associated with poor CVD in patients with CTO (p = 0.005 and p < 0.001, respectively). Monocyte count was found to be independent of CVD neither in patients with ≥95% stenosis nor in patients with CTO.
CONCLUSIONS
Our data show that DM is an independent factor for poor coronary CVD both in patients with severe coronary artery stenosis and in patients with CTO. Female gender or being in post-menopausal period is another negative risk factor for poor CVD in addition to DM in patients with CTO. |
17,919,623 | D000818:Animals; D001706:Biopsy; D004699:Endocardium; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation; D006352:Heart Ventricles; D007150:Immunohistochemistry; D017202:Myocardial Ischemia; D009206:Myocardium; D010215:Papio; D013552:Swine; D013997:Time Factors; D014183:Transplantation, Heterologous; D016042:Transplantation, Heterotopic | [
"D000818",
"D001706",
"D004699",
"D006084",
"D006085",
"D016027",
"D006352",
"D007150",
"D017202",
"D009206",
"D010215",
"D013552",
"D013997",
"D014183",
"D016042"
] | The utility of right ventricular endomyocardial biopsy for the diagnosis of xenograft rejection after CD46 pig-to-baboon cardiac transplantation. | BACKGROUND
Endomyocardial biopsy is the standard means of establishing cardiac allograft rejection diagnosis. The efficacy of this procedure in xenotransplantation has not been determined. In this study we compare the histology of right ventricular endomyocardial biopsy specimens with the corresponding full cross sections of explanted right ventricle (RV). We also compare RV with the related left ventricle (LV) cross sections.
METHODS
Heterotopic CD46 pig-to-baboon cardiac xenotransplants (n = 64) were studied. RV endomyocardial biopsy specimens were taken at cardiac explant by using a standard bioptome (n = 24) or by sharp dissection (n = 40). Hematoxylin and eosin stained sections of RV and LV cross-section and RV endomyocardial biopsy specimens were compared in a blinded fashion. Characteristics of delayed xenograft rejection and a global assessment of ischemia were scored from 0 to 4 according to the percentage of myocardium involved (0, 0%; 1, 1%-25%; 2, 26%-50%; 3, 51%-75%; and 4, 76%-100%).
RESULTS
Median graft survival was 30 days (range, 3-137 days). Linear regression analysis of histology scores demonstrated that specimens from both bioptome and sharp dissection equally represented the histology of the RV cross section. Global ischemic injury was strongly correlated between RV and RV endomyocardial biopsy (R(2) = 0.84) and between RV and LV cross sections (R(2) = 0.84). Individual characteristics of delayed xenograft rejection showed no significant variation between RV and RV endomyocardial biopsy or between RV and LV (p < 0.05).
CONCLUSIONS
These results indicate that delayed xenograft rejection is a widespread process involving both right and left ventricles similarly. This study shows that histologic assessment of RV endomyocardial biopsy specimens is an effective method for the monitoring of delayed xenograft rejection after cardiac xenotransplantation. | null | false | The utility of right ventricular endomyocardial biopsy for the diagnosis of xenograft rejection after CD46 pig-to-baboon cardiac transplantation. BACKGROUND
Endomyocardial biopsy is the standard means of establishing cardiac allograft rejection diagnosis. The efficacy of this procedure in xenotransplantation has not been determined. In this study we compare the histology of right ventricular endomyocardial biopsy specimens with the corresponding full cross sections of explanted right ventricle (RV). We also compare RV with the related left ventricle (LV) cross sections.
METHODS
Heterotopic CD46 pig-to-baboon cardiac xenotransplants (n = 64) were studied. RV endomyocardial biopsy specimens were taken at cardiac explant by using a standard bioptome (n = 24) or by sharp dissection (n = 40). Hematoxylin and eosin stained sections of RV and LV cross-section and RV endomyocardial biopsy specimens were compared in a blinded fashion. Characteristics of delayed xenograft rejection and a global assessment of ischemia were scored from 0 to 4 according to the percentage of myocardium involved (0, 0%; 1, 1%-25%; 2, 26%-50%; 3, 51%-75%; and 4, 76%-100%).
RESULTS
Median graft survival was 30 days (range, 3-137 days). Linear regression analysis of histology scores demonstrated that specimens from both bioptome and sharp dissection equally represented the histology of the RV cross section. Global ischemic injury was strongly correlated between RV and RV endomyocardial biopsy (R(2) = 0.84) and between RV and LV cross sections (R(2) = 0.84). Individual characteristics of delayed xenograft rejection showed no significant variation between RV and RV endomyocardial biopsy or between RV and LV (p < 0.05).
CONCLUSIONS
These results indicate that delayed xenograft rejection is a widespread process involving both right and left ventricles similarly. This study shows that histologic assessment of RV endomyocardial biopsy specimens is an effective method for the monitoring of delayed xenograft rejection after cardiac xenotransplantation. |
17,186,981 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage; D001281:Atrial Fibrillation; D001344:Autopsy; D016022:Case-Control Studies; D005260:Female; D006325:Heart Atria; D006349:Heart Valve Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D032383:Myocytes, Cardiac; D011237:Predictive Value of Tests; D012008:Recurrence | [
"D000328",
"D000368",
"D000369",
"D020517",
"D001281",
"D001344",
"D016022",
"D005260",
"D006325",
"D006349",
"D006801",
"D008297",
"D008875",
"D032383",
"D011237",
"D012008"
] | Histopathological features of the resected left atrial appendage as predictors of recurrence after surgery for atrial fibrillation in valvular heart disease. | BACKGROUND
A histopathological assessment of left atrial appendages (LAA) resected during surgical treatment for atrial fibrillation (AF) was made, with the aim of improving the prediction of postoperative AF recurrence.
RESULTS
This clinicopathological study involved 57 surgical cases of valvular AF and 34 age- and sex-matched control autopsy cases with a history of sinus rhythm. LAA from the cases with valvular AF showed greater hypertrophy of cardiomyocytes (p<0.0001), greater nuclear enlargement (p<0.0001), more bizarre nuclei (BN; p<0.0001), and more intercellular fibrosis (ICF; p<0.001). Partial disarray of cardiomyocytes and fatty infiltration were recognized in both the AF and control groups. Thirty-seven cases had maintained sinus rhythm after surgery from 7 months to 10 years. AF recurred within a month of surgery in 17 and after a month in 3; there was no significant difference in histopathological features between them. These 20 cases had more cellular hypertrophy (p<0.025), nuclear enlargement (p<0.025), BN (p<0.01), and ICF (p<0.025) than those who maintained sinus rhythm after surgery.
CONCLUSIONS
The histopathological findings for LAA reflected the underlying valvular diseases; however, the most reliable predictors of postoperative AF recurrence were hypertrophy of cardiomyocytes, bizarre shaped nuclei, and extensive ICF. | null | false | Histopathological features of the resected left atrial appendage as predictors of recurrence after surgery for atrial fibrillation in valvular heart disease. BACKGROUND
A histopathological assessment of left atrial appendages (LAA) resected during surgical treatment for atrial fibrillation (AF) was made, with the aim of improving the prediction of postoperative AF recurrence.
RESULTS
This clinicopathological study involved 57 surgical cases of valvular AF and 34 age- and sex-matched control autopsy cases with a history of sinus rhythm. LAA from the cases with valvular AF showed greater hypertrophy of cardiomyocytes (p<0.0001), greater nuclear enlargement (p<0.0001), more bizarre nuclei (BN; p<0.0001), and more intercellular fibrosis (ICF; p<0.001). Partial disarray of cardiomyocytes and fatty infiltration were recognized in both the AF and control groups. Thirty-seven cases had maintained sinus rhythm after surgery from 7 months to 10 years. AF recurred within a month of surgery in 17 and after a month in 3; there was no significant difference in histopathological features between them. These 20 cases had more cellular hypertrophy (p<0.025), nuclear enlargement (p<0.025), BN (p<0.01), and ICF (p<0.025) than those who maintained sinus rhythm after surgery.
CONCLUSIONS
The histopathological findings for LAA reflected the underlying valvular diseases; however, the most reliable predictors of postoperative AF recurrence were hypertrophy of cardiomyocytes, bizarre shaped nuclei, and extensive ICF. |
29,885,463 | D000368:Aged; D050197:Atherosclerosis; D001483:Base Sequence; D016022:Case-Control Studies; D003324:Coronary Artery Disease; D005260:Female; D005787:Gene Frequency; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D012307:Risk Factors; D056564:Sirtuin 1 | [
"D000368",
"D050197",
"D001483",
"D016022",
"D003324",
"D005260",
"D005787",
"D056726",
"D020022",
"D006801",
"D008297",
"D008875",
"D020641",
"D012189",
"D012307",
"D056564"
] | SIRT1 gene polymorphisms associated with decreased risk of atherosclerotic coronary artery disease. | Coronary artery disease (CAD) exhibits the rules of the multifactorial hereditary. Notwithstanding, the role of genetic factors in the prevalence of CAD is estimated very high. SIRT1 plays an athero-protective role and alterations in its expression have some important consequence in the metabolism, cholesterol, and fat deposition. The aim of our study was to investigate the association between rs4746720, rs12413112, and rs1467568 polymorphisms in the SIRT1 gene and CAD in the high-risk cases. In the present retrospective case-control study, 150 healthy individuals and 150 cases diagnosed with atherosclerotic lesions were investigated. ARMS PCR was used to determine the genotypes of rs4746720 polymorphism, while tetra primer-ARMS PCR was used for genotyping of rs12413112 and rs1467568 polymorphisms. Considering rs12413112 polymorphism, the frequency of the AG heterozygote genotype was significantly lower in cases than controls (P < 0.001). Furthermore, the frequency of the A-positive (AA+AG vs. GG) genotype was significantly different between groups (P < 0.001). The frequency of the variant A allele was 0.36% in cases and 0.46% in controls (P = 0.01). Except for a borderline protective effect in the present of rs1467568AG genotype, the allele and genotype distributions of both rs1467568 and rs4746720 polymorphisms did not differ between two groups. The haplotype constructed from rs1467568A, rs12413112A, and rs4746720T alleles showed a significant protective effect on the risk of CAD (OR: 0.53; 95%CI: 0.35-0.78; P = 0.001). In conclusion, the SIRT1 gene may contribute to the pathogenesis of CAD, while further investigations were suggested to confirm our results. | 11,083,974 | true | SIRT1 gene polymorphisms associated with decreased risk of atherosclerotic coronary artery disease. Coronary artery disease (CAD) exhibits the rules of the multifactorial hereditary. Notwithstanding, the role of genetic factors in the prevalence of CAD is estimated very high. SIRT1 plays an athero-protective role and alterations in its expression have some important consequence in the metabolism, cholesterol, and fat deposition. The aim of our study was to investigate the association between rs4746720, rs12413112, and rs1467568 polymorphisms in the SIRT1 gene and CAD in the high-risk cases. In the present retrospective case-control study, 150 healthy individuals and 150 cases diagnosed with atherosclerotic lesions were investigated. ARMS PCR was used to determine the genotypes of rs4746720 polymorphism, while tetra primer-ARMS PCR was used for genotyping of rs12413112 and rs1467568 polymorphisms. Considering rs12413112 polymorphism, the frequency of the AG heterozygote genotype was significantly lower in cases than controls (P < 0.001). Furthermore, the frequency of the A-positive (AA+AG vs. GG) genotype was significantly different between groups (P < 0.001). The frequency of the variant A allele was 0.36% in cases and 0.46% in controls (P = 0.01). Except for a borderline protective effect in the present of rs1467568AG genotype, the allele and genotype distributions of both rs1467568 and rs4746720 polymorphisms did not differ between two groups. The haplotype constructed from rs1467568A, rs12413112A, and rs4746720T alleles showed a significant protective effect on the risk of CAD (OR: 0.53; 95%CI: 0.35-0.78; P = 0.001). In conclusion, the SIRT1 gene may contribute to the pathogenesis of CAD, while further investigations were suggested to confirm our results. |
26,621,978 | D062186:Arterial Pressure; D019985:Benchmarking; D062906:Cardiac Catheters; D002407:Catheterization, Swan-Ganz; D003951:Diagnostic Errors; D004867:Equipment Design; D006801:Humans; D006976:Hypertension, Pulmonary; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D011651:Pulmonary Artery; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D014160:Transducers, Pressure | [
"D062186",
"D019985",
"D062906",
"D002407",
"D003951",
"D004867",
"D006801",
"D006976",
"D017410",
"D011237",
"D011379",
"D011651",
"D011669",
"D015203",
"D014160"
] | Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. | Right heart catheterisation (RHC) plays a central role in identifying pulmonary hypertension (PH) disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH). Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice. | 10,650,360 | true | Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. Right heart catheterisation (RHC) plays a central role in identifying pulmonary hypertension (PH) disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH). Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice. |
8,418,737 | D000818:Animals; D003097:Collateral Circulation; D003327:Coronary Disease; D004285:Dogs; D005260:Female; D006321:Heart; D006439:Hemodynamics; D007275:Injections, Intravenous; D008297:Male; D015742:Propofol | [
"D000818",
"D003097",
"D003327",
"D004285",
"D005260",
"D006321",
"D006439",
"D007275",
"D008297",
"D015742"
] | Effects of propofol on the function of normal, collateral-dependent, and ischemic myocardium. | To examine the effects of propofol on the function of normal, collateral-dependent, and acutely ischemic myocardium, nine mongrel dogs were chronically instrumented with hydraulic occluders and ameroid constrictors were inserted around the left coronary artery, pressure transducers in the left ventricle, and heparin-filled catheters in the descending aorta and the left atrium. Regional function of normal, collateral-dependent, and acutely ischemic myocardium was assessed by sonomicrometry. Propofol (5 mg/kg intravenously) reduced function in normal myocardium (-15% +/- 5%, 1 min and -14% +/- 5%, 3 min after injection) and in collateral-dependent myocardium (-14% +/- 5% and -13% +/- 5%) to similar degrees, whereas ischemic myocardial function deteriorated significantly more (-25% +/- 10% and -23% +/- 10%, P < 0.01). Although left ventricular end-diastolic pressure remained unchanged and left ventricular contractility was reduced (-16% +/- 4%, 1 min and -15% +/- 3%, 3 min after propofol, P < 0.01), significant increases in heart rate (35% +/- 7% and 26% +/- 7%, P < 0.01) and decreases in coronary perfusion pressure (-14% +/- 5%, P < 0.05 and -19% +/- 6%, P < 0.01) occurred, likely affecting the function of ischemic myocardium. Thus, whereas collateral-dependent myocardium tolerated these adverse hemodynamic effects, ischemic myocardium responded with impairment of regional function that was significantly more pronounced than the impairment which occurred in normal or collateral-dependent areas after a 5 mg/kg intravenous bolus of propofol. | 6,549,262 | true | Effects of propofol on the function of normal, collateral-dependent, and ischemic myocardium. To examine the effects of propofol on the function of normal, collateral-dependent, and acutely ischemic myocardium, nine mongrel dogs were chronically instrumented with hydraulic occluders and ameroid constrictors were inserted around the left coronary artery, pressure transducers in the left ventricle, and heparin-filled catheters in the descending aorta and the left atrium. Regional function of normal, collateral-dependent, and acutely ischemic myocardium was assessed by sonomicrometry. Propofol (5 mg/kg intravenously) reduced function in normal myocardium (-15% +/- 5%, 1 min and -14% +/- 5%, 3 min after injection) and in collateral-dependent myocardium (-14% +/- 5% and -13% +/- 5%) to similar degrees, whereas ischemic myocardial function deteriorated significantly more (-25% +/- 10% and -23% +/- 10%, P < 0.01). Although left ventricular end-diastolic pressure remained unchanged and left ventricular contractility was reduced (-16% +/- 4%, 1 min and -15% +/- 3%, 3 min after propofol, P < 0.01), significant increases in heart rate (35% +/- 7% and 26% +/- 7%, P < 0.01) and decreases in coronary perfusion pressure (-14% +/- 5%, P < 0.05 and -19% +/- 6%, P < 0.01) occurred, likely affecting the function of ischemic myocardium. Thus, whereas collateral-dependent myocardium tolerated these adverse hemodynamic effects, ischemic myocardium responded with impairment of regional function that was significantly more pronounced than the impairment which occurred in normal or collateral-dependent areas after a 5 mg/kg intravenous bolus of propofol. |
8,571,038 | D017130:Angioplasty; D000075202:Contraindications; D006801:Humans; D009203:Myocardial Infarction; D015425:Myocardial Reperfusion; D015912:Thrombolytic Therapy; D014654:Vascular Patency | [
"D017130",
"D000075202",
"D006801",
"D009203",
"D015425",
"D015912",
"D014654"
] | [Coronary recanalization in the acute phase of myocardial infarction]. | Early reopening of the infarct-related artery limits infarct size, preserves left ventricular function and reduces short and long term mortality rate. The earlier the reopening, the higher the benefit, the best results being obtained within the first 3 hours, but remaining significant up to 12 hours after onset of symptoms. In addition, complete reperfusion of the infarct-related artery without delay of distal filling enhances the results. Early reopening can be obtained with use of intravenous thrombolysis. The indication of rescue angioplasty in case of failed thrombolysis or of immediate, deferred or elective adjunctive angioplasty after successful thrombolysis remain debated. Contraindications to thrombolysis exist in about 13% of patients, in whom the only solution is direct angioplasty without thrombolysis. | null | false | [Coronary recanalization in the acute phase of myocardial infarction]. Early reopening of the infarct-related artery limits infarct size, preserves left ventricular function and reduces short and long term mortality rate. The earlier the reopening, the higher the benefit, the best results being obtained within the first 3 hours, but remaining significant up to 12 hours after onset of symptoms. In addition, complete reperfusion of the infarct-related artery without delay of distal filling enhances the results. Early reopening can be obtained with use of intravenous thrombolysis. The indication of rescue angioplasty in case of failed thrombolysis or of immediate, deferred or elective adjunctive angioplasty after successful thrombolysis remain debated. Contraindications to thrombolysis exist in about 13% of patients, in whom the only solution is direct angioplasty without thrombolysis. |
24,559,419 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries | [
"D000328",
"D000368",
"D000369",
"D001145",
"D004562",
"D005260",
"D006801",
"D008297",
"D008875",
"D011446",
"D013119"
] | Cardiac arrhythmias the first month after acute traumatic spinal cord injury. | OBJECTIVE
Cardiovascular complications including cardiac arrest and arrhythmias remain a clinical challenge in the management of acute traumatic spinal cord injury (SCI). Still, there is a lack of knowledge regarding the characteristics of arrhythmias in patients with acute traumatic SCI. The aim of this prospective observational study was to investigate the occurrence of cardiac arrhythmias and cardiac arrests in patients with acute traumatic SCI.
METHODS
As early as possible after SCI 24-hour Holter monitoring was performed. Additional Holter recordings were performed 1, 2, 3, and 4 weeks after SCI. Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks.
RESULTS
Thirty patients were included. Bradycardia (heart rate (HR) <50 b.p.m.) was present in 17-35% of the patients with cervical (C1-C8) SCI (n = 24) within the first 14 days. In the following 14 days, the occurrence was 22-32%. Bradycardia in the thoracic (Th1-Th12) SCI group (n = 6) was present in 17-33% during the observation period. The differences between the two groups were not statistically significant. The mean minimum HR was significantly lower in the cervical group compared with the thoracic group both on 12-lead ECGs obtained shortly after SCI (P = 0.030) and at 4 weeks (P = 0.041).
CONCLUSIONS
Many patients with cervical SCI experience arrhythmias such as bradycardia, sinus node arrest, supraventricular tachycardia, and more rarely cardiac arrest the first month after SCI. Apart from sinus node arrests and limited bradycardia, no arrhythmias were seen in patients with thoracic SCI. Standard 12-lead ECGs will often miss the high prevalence these arrhythmias have. | null | false | Cardiac arrhythmias the first month after acute traumatic spinal cord injury. OBJECTIVE
Cardiovascular complications including cardiac arrest and arrhythmias remain a clinical challenge in the management of acute traumatic spinal cord injury (SCI). Still, there is a lack of knowledge regarding the characteristics of arrhythmias in patients with acute traumatic SCI. The aim of this prospective observational study was to investigate the occurrence of cardiac arrhythmias and cardiac arrests in patients with acute traumatic SCI.
METHODS
As early as possible after SCI 24-hour Holter monitoring was performed. Additional Holter recordings were performed 1, 2, 3, and 4 weeks after SCI. Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks.
RESULTS
Thirty patients were included. Bradycardia (heart rate (HR) <50 b.p.m.) was present in 17-35% of the patients with cervical (C1-C8) SCI (n = 24) within the first 14 days. In the following 14 days, the occurrence was 22-32%. Bradycardia in the thoracic (Th1-Th12) SCI group (n = 6) was present in 17-33% during the observation period. The differences between the two groups were not statistically significant. The mean minimum HR was significantly lower in the cervical group compared with the thoracic group both on 12-lead ECGs obtained shortly after SCI (P = 0.030) and at 4 weeks (P = 0.041).
CONCLUSIONS
Many patients with cervical SCI experience arrhythmias such as bradycardia, sinus node arrest, supraventricular tachycardia, and more rarely cardiac arrest the first month after SCI. Apart from sinus node arrests and limited bradycardia, no arrhythmias were seen in patients with thoracic SCI. Standard 12-lead ECGs will often miss the high prevalence these arrhythmias have. |
25,234,602 | D000464:Alginates; D000704:Analysis of Variance; D000818:Animals; D018929:Cell Culture Techniques; D002478:Cells, Cultured; D004195:Disease Models, Animal; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D020723:Glucuronic Acid; D006329:Heart Conduction System; D006603:Hexuronic Acids; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D045164:Mesenchymal Stem Cell Transplantation; D018613:Microscopy, Confocal; D009203:Myocardial Infarction; D011897:Random Allocation; D012016:Reference Values; D013552:Swine; D016896:Treatment Outcome | [
"D000464",
"D000704",
"D000818",
"D018929",
"D002478",
"D004195",
"D015150",
"D004562",
"D022062",
"D020723",
"D006329",
"D006603",
"D020136",
"D045164",
"D018613",
"D009203",
"D011897",
"D012016",
"D013552",
"D016896"
] | Improved conduction and increased cell retention in healed MI using mesenchymal stem cells suspended in alginate hydrogel. | BACKGROUND
Mesenchymal stem cells (MSCs) have been associated with reduced arrhythmias; however, the mechanism of this action is unknown. In addition, limited retention and survival of MSCs can significantly reduce efficacy. We hypothesized that MSCs can improve impulse conduction and that alginate hydrogel will enhance retention of MSCs in a model of healed myocardial infarction (MI).
RESULTS
Four weeks after temporary occlusion of the left anterior descending artery (LAD), pigs (n = 13) underwent a sternotomy to access the infarct and then were divided into two studies. In study 1, designed to investigate impulse conduction, animals were administered, by border zone injection, 9-15 million MSCs (n = 7) or phosphate-buffered saline (PBS) (control MI, n = 5). Electrogram width measured in the border zone 2 weeks after injections was significantly decreased with MSCs (-30 ± 8 ms, p < 0.008) but not in shams (4 ± 10 ms, p = NS). Optical mapping from border zone tissue demonstrated that conduction velocity was higher in regions with MSCs (0.49 ± 0.03 m/s) compared to regions without MSCs (0.39 ± 0.03 m/s, p < 0.03). In study 2, designed to investigate MSC retention, animals were administered an equal number of MSCs suspended in either alginate (2 or 1 % w/v) or PBS (n = 6/group) by border zone injection. Greater MSC retention and survival were observed with 2% alginate compared to PBS or 1% alginate. Confocal immunofluorescence demonstrated that MSCs survive and are associated with expression of connexin-43 (Cx43) for either PBS (control), 1%, or 2% alginate.
CONCLUSIONS
For the first time, we are able to directly associate MSCs with improved impulse conduction and increased retention and survival using an alginate scaffold in a clinically relevant model of healed MI. | null | false | Improved conduction and increased cell retention in healed MI using mesenchymal stem cells suspended in alginate hydrogel. BACKGROUND
Mesenchymal stem cells (MSCs) have been associated with reduced arrhythmias; however, the mechanism of this action is unknown. In addition, limited retention and survival of MSCs can significantly reduce efficacy. We hypothesized that MSCs can improve impulse conduction and that alginate hydrogel will enhance retention of MSCs in a model of healed myocardial infarction (MI).
RESULTS
Four weeks after temporary occlusion of the left anterior descending artery (LAD), pigs (n = 13) underwent a sternotomy to access the infarct and then were divided into two studies. In study 1, designed to investigate impulse conduction, animals were administered, by border zone injection, 9-15 million MSCs (n = 7) or phosphate-buffered saline (PBS) (control MI, n = 5). Electrogram width measured in the border zone 2 weeks after injections was significantly decreased with MSCs (-30 ± 8 ms, p < 0.008) but not in shams (4 ± 10 ms, p = NS). Optical mapping from border zone tissue demonstrated that conduction velocity was higher in regions with MSCs (0.49 ± 0.03 m/s) compared to regions without MSCs (0.39 ± 0.03 m/s, p < 0.03). In study 2, designed to investigate MSC retention, animals were administered an equal number of MSCs suspended in either alginate (2 or 1 % w/v) or PBS (n = 6/group) by border zone injection. Greater MSC retention and survival were observed with 2% alginate compared to PBS or 1% alginate. Confocal immunofluorescence demonstrated that MSCs survive and are associated with expression of connexin-43 (Cx43) for either PBS (control), 1%, or 2% alginate.
CONCLUSIONS
For the first time, we are able to directly associate MSCs with improved impulse conduction and increased retention and survival using an alginate scaffold in a clinically relevant model of healed MI. |
8,619,673 | D000368:Aged; D003323:Coronary Aneurysm; D017023:Coronary Angiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male | [
"D000368",
"D003323",
"D017023",
"D006801",
"D008279",
"D008297"
] | Surgical treatment of multiple coronary aneurysms in an elderly man. | We report an unusual case involving a 70-year-old man with multiple coronary aneurysms, including a 5-cm aneurysm of the right coronary artery. The precise size was determined with magnetic resonance imaging, although the aneurysms were diagnosed initially on angiography. Multiple coronary aneurysms are rare in adults, The cause may have been atherosclerosis, syphilis, or collagen vascular disease, all of which cause weakening of the media. The patient underwent successful operation, including coronary artery bypass grafting. | 9,225,316 | true | Surgical treatment of multiple coronary aneurysms in an elderly man. We report an unusual case involving a 70-year-old man with multiple coronary aneurysms, including a 5-cm aneurysm of the right coronary artery. The precise size was determined with magnetic resonance imaging, although the aneurysms were diagnosed initially on angiography. Multiple coronary aneurysms are rare in adults, The cause may have been atherosclerosis, syphilis, or collagen vascular disease, all of which cause weakening of the media. The patient underwent successful operation, including coronary artery bypass grafting. |
27,354,043 | D003327:Coronary Disease; D054855:Drug-Eluting Stents; D000068338:Everolimus; D006801:Humans; D009543:Nifedipine; D011446:Prospective Studies; D020123:Sirolimus; D016896:Treatment Outcome | [
"D003327",
"D054855",
"D000068338",
"D006801",
"D009543",
"D011446",
"D020123",
"D016896"
] | Beneficial effects of long-acting nifedipine on coronary vasomotion abnormalities after drug-eluting stent implantation: The NOVEL study. | It is widely known that drug-eluting stents (DES) induce coronary vasomotion abnormalities. We have previously demonstrated that chronic treatment with long-acting nifedipine suppresses coronary hyperconstricting responses induced by the first-generation DES (e.g. sirolimus- and pacritaxel-eluting stents) through inhibition of vascular inflammation in pigs. To examine whether this is also the case with the second-generation DES (everolimus-eluting stents, EES) in humans, the most widely used DES in the world, we conducted a prospective, randomized, multicentre trial, termed as the NOVEL Study.
We evaluated 100 patients with stable angina pectoris who underwent scheduled implantation of EES in the left coronary arteries. They were randomly assigned to receive either conventional treatments alone or additionally long-acting nifedipine (10-60 mg/day) (n = 50 each). After 8-10 months, 37 patients in the control and 38 in the nifedipine group were examined for coronary vasoreactivity to intracoronary acetylcholine (ACh) by quantitative coronary angiography after 48-h withdrawal of nifedipine. Coronary vasoconstricting responses to ACh were significantly enhanced at the distal edge of EES compared with non-stented vessel (P = 0.0001) and were significantly suppressed in the nifedipine group compared with the control group (P = 0.0044). Furthermore, the inflammatory profiles were also improved only in the nifedipine group, which evaluated by serum levels of high-sensitivity CRP (P = 0.0001) and adiponectin (P = 0.0039).
These results indicate that DES-induced coronary vasomotion abnormalities still remain an important clinical issue even with the second-generation DES, for which long-acting nifedipine exerts beneficial effects associated with its anti-inflammatory effects.
This study is registered at the UMIN Clinical Trial Registry (UMIN-CTR; ID=UMIN000015147). | null | false | Beneficial effects of long-acting nifedipine on coronary vasomotion abnormalities after drug-eluting stent implantation: The NOVEL study. It is widely known that drug-eluting stents (DES) induce coronary vasomotion abnormalities. We have previously demonstrated that chronic treatment with long-acting nifedipine suppresses coronary hyperconstricting responses induced by the first-generation DES (e.g. sirolimus- and pacritaxel-eluting stents) through inhibition of vascular inflammation in pigs. To examine whether this is also the case with the second-generation DES (everolimus-eluting stents, EES) in humans, the most widely used DES in the world, we conducted a prospective, randomized, multicentre trial, termed as the NOVEL Study.
We evaluated 100 patients with stable angina pectoris who underwent scheduled implantation of EES in the left coronary arteries. They were randomly assigned to receive either conventional treatments alone or additionally long-acting nifedipine (10-60 mg/day) (n = 50 each). After 8-10 months, 37 patients in the control and 38 in the nifedipine group were examined for coronary vasoreactivity to intracoronary acetylcholine (ACh) by quantitative coronary angiography after 48-h withdrawal of nifedipine. Coronary vasoconstricting responses to ACh were significantly enhanced at the distal edge of EES compared with non-stented vessel (P = 0.0001) and were significantly suppressed in the nifedipine group compared with the control group (P = 0.0044). Furthermore, the inflammatory profiles were also improved only in the nifedipine group, which evaluated by serum levels of high-sensitivity CRP (P = 0.0001) and adiponectin (P = 0.0039).
These results indicate that DES-induced coronary vasomotion abnormalities still remain an important clinical issue even with the second-generation DES, for which long-acting nifedipine exerts beneficial effects associated with its anti-inflammatory effects.
This study is registered at the UMIN Clinical Trial Registry (UMIN-CTR; ID=UMIN000015147). |
20,168,272 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy; D005260:Female; D005451:Fluorescein Angiography; D005453:Fluorescence; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation; D054023:Lasers, Semiconductor; D008269:Macular Edema; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields | [
"D000328",
"D000368",
"D000369",
"D003930",
"D005260",
"D005451",
"D005453",
"D005654",
"D006801",
"D017075",
"D054023",
"D008269",
"D008297",
"D008875",
"D011446",
"D012160",
"D041623",
"D016896",
"D014792",
"D058609",
"D014794"
] | Microperimetry and fundus autofluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. | OBJECTIVE
The purpose of this study was to evaluate and compare microperimetry and fundus autofluorescence (FAF) after subthreshold micropulse diode laser versus modified Early Treatment Diabetic Retinopathy Study photocoagulation for clinically significant diabetic macular edema.
METHODS
A prospective randomized clinical trial including 62 eyes (50 patients) with untreated, center-involving, clinically significant diabetic macular edema was performed. All patients underwent best-corrected visual acuity determination (logarithm of the minimum angle of resolution), slit-lamp biomicroscopy, FAF, optical coherence tomography, microperimetry (macular sensitivity), and fluorescein angiography before and after treatment. Best-corrected visual acuity, optical coherence tomography, microperimetry, and FAF were repeated at 1-, 3-, 6-, 9-, and 12-month follow-up examinations. Fluorescein angiography was performed at baseline and at 6 and 12 months.
RESULTS
Before treatment, demographic and macular parameters were not different between the two treatment groups. At 12 months, best-corrected visual acuity remained stable in both groups (P = 0.41 and P = 0.82), mean central retinal thickness decreased in both groups (P = 0.0002 and P < 0.0001), and mean central 4 degrees and 12 degrees retinal sensitivity increased in the micropulse diode laser group (P = 0.02 and P = 0.0075) and decreased in the Early Treatment Diabetic Retinopathy Study group (P = 0.2 and P = 0.0026). There was no significant difference in either best-corrected visual acuity or central retinal thickness between the 2 treatment groups (P = 0.48 and P = 0.29), whereas there was a significant difference in 4 degrees and 12 degrees retinal sensitivity (P = 0.04 and P < 0.0001). Fundus autofluorescence never changed in the micropulse diode laser group even after retreatment. In the Early Treatment Diabetic Retinopathy Study group, FAF increased up to 9 months and decreased in 6 eyes (20%) at 12 months.
CONCLUSIONS
Micropulse diode laser seems to be as effective as modified Early Treatment Diabetic Retinopathy Study laser photocoagulation in the treatment of clinically significant diabetic macular edema. Micropulse diode laser treatment does not determine any change on FAF showing (at least) nonclinically visible damage of the retinal pigment epithelium. Microperimetry data encourage the use of a new, less aggressive laser therapeutic approach in the treatment of clinically significant diabetic macular edema. | null | false | Microperimetry and fundus autofluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. OBJECTIVE
The purpose of this study was to evaluate and compare microperimetry and fundus autofluorescence (FAF) after subthreshold micropulse diode laser versus modified Early Treatment Diabetic Retinopathy Study photocoagulation for clinically significant diabetic macular edema.
METHODS
A prospective randomized clinical trial including 62 eyes (50 patients) with untreated, center-involving, clinically significant diabetic macular edema was performed. All patients underwent best-corrected visual acuity determination (logarithm of the minimum angle of resolution), slit-lamp biomicroscopy, FAF, optical coherence tomography, microperimetry (macular sensitivity), and fluorescein angiography before and after treatment. Best-corrected visual acuity, optical coherence tomography, microperimetry, and FAF were repeated at 1-, 3-, 6-, 9-, and 12-month follow-up examinations. Fluorescein angiography was performed at baseline and at 6 and 12 months.
RESULTS
Before treatment, demographic and macular parameters were not different between the two treatment groups. At 12 months, best-corrected visual acuity remained stable in both groups (P = 0.41 and P = 0.82), mean central retinal thickness decreased in both groups (P = 0.0002 and P < 0.0001), and mean central 4 degrees and 12 degrees retinal sensitivity increased in the micropulse diode laser group (P = 0.02 and P = 0.0075) and decreased in the Early Treatment Diabetic Retinopathy Study group (P = 0.2 and P = 0.0026). There was no significant difference in either best-corrected visual acuity or central retinal thickness between the 2 treatment groups (P = 0.48 and P = 0.29), whereas there was a significant difference in 4 degrees and 12 degrees retinal sensitivity (P = 0.04 and P < 0.0001). Fundus autofluorescence never changed in the micropulse diode laser group even after retreatment. In the Early Treatment Diabetic Retinopathy Study group, FAF increased up to 9 months and decreased in 6 eyes (20%) at 12 months.
CONCLUSIONS
Micropulse diode laser seems to be as effective as modified Early Treatment Diabetic Retinopathy Study laser photocoagulation in the treatment of clinically significant diabetic macular edema. Micropulse diode laser treatment does not determine any change on FAF showing (at least) nonclinically visible damage of the retinal pigment epithelium. Microperimetry data encourage the use of a new, less aggressive laser therapeutic approach in the treatment of clinically significant diabetic macular edema. |
20,739,902 | D000328:Adult; D001024:Aortic Valve Stenosis; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles; D017052:Hospital Mortality; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left | [
"D000328",
"D001024",
"D016009",
"D015150",
"D005260",
"D006350",
"D019918",
"D006352",
"D017052",
"D006801",
"D007194",
"D008297",
"D008875",
"D011474",
"D012189",
"D018570",
"D012307",
"D013997",
"D016896",
"D016277"
] | A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type. | BACKGROUND
The ideal management of aortic stenosis in patients with a small aortic root remains controversial. Reports of adverse effects of patient-prosthesis mismatch (PPM) from a small-sized valve have to be weighed against the increased morbidity and mortality of aortic root enlargement procedures.
METHODS
The present study retrospectively reviewed and compared clinical data of patients with predominant aortic stenosis with small aortic root (n = 209) who underwent isolated aortic valve replacement without (AVR group, n = 162) or with aortic root enlargement (AVR + ARE group, n = 47) using a single prosthesis type between January 2002 and June 2008 to assess their effect on perioperative outcomes.
RESULTS
The in-hospital mortality (4.28% in AVR + ARE vs. 3.08% in AVR group) and other perioperative outcomes were similar in both the groups. Although patients of the AVR + ARE group had a greater degree of left-ventricular (LV) mass regression (-41.3 ± 32.1 vs. -21.5 ± 37.4) in the follow-up period at 12 months, there was no significant difference in functional outcome. Patients with severe postoperative PPM (indexed effective orifice area ≤0.65 cm²/m² body surface area) showed increased perioperative mortality (9.52 vs. 1.85%) and less regression of LV mass (-13.2.8 ± 27.1 vs. -27.6 ± 31.9), higher transvalvular gradient and were more symptomatic at 12-month follow-up (New York Heart Association class 1.44 ± 0.41 vs. 1.22 ± 0.28) compared to those who were having only mild to moderate PPM (indexed effective orifice area > 0.65).
CONCLUSIONS
ARE procedures are invaluable techniques in surgical management of small aortic root patients and can be used without significantly increasing early morbidity and mortality, particularly in those cases in which AVR with a small prosthesis will lead to severe PPM. | null | false | A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type. BACKGROUND
The ideal management of aortic stenosis in patients with a small aortic root remains controversial. Reports of adverse effects of patient-prosthesis mismatch (PPM) from a small-sized valve have to be weighed against the increased morbidity and mortality of aortic root enlargement procedures.
METHODS
The present study retrospectively reviewed and compared clinical data of patients with predominant aortic stenosis with small aortic root (n = 209) who underwent isolated aortic valve replacement without (AVR group, n = 162) or with aortic root enlargement (AVR + ARE group, n = 47) using a single prosthesis type between January 2002 and June 2008 to assess their effect on perioperative outcomes.
RESULTS
The in-hospital mortality (4.28% in AVR + ARE vs. 3.08% in AVR group) and other perioperative outcomes were similar in both the groups. Although patients of the AVR + ARE group had a greater degree of left-ventricular (LV) mass regression (-41.3 ± 32.1 vs. -21.5 ± 37.4) in the follow-up period at 12 months, there was no significant difference in functional outcome. Patients with severe postoperative PPM (indexed effective orifice area ≤0.65 cm²/m² body surface area) showed increased perioperative mortality (9.52 vs. 1.85%) and less regression of LV mass (-13.2.8 ± 27.1 vs. -27.6 ± 31.9), higher transvalvular gradient and were more symptomatic at 12-month follow-up (New York Heart Association class 1.44 ± 0.41 vs. 1.22 ± 0.28) compared to those who were having only mild to moderate PPM (indexed effective orifice area > 0.65).
CONCLUSIONS
ARE procedures are invaluable techniques in surgical management of small aortic root patients and can be used without significantly increasing early morbidity and mortality, particularly in those cases in which AVR with a small prosthesis will lead to severe PPM. |
1,389,854 | D000208:Acute Disease; D000328:Adult; D000707:Anaphylaxis; D005260:Female; D006801:Humans; D007022:Hypotension; D007431:Intraoperative Complications; D008303:Malignant Carcinoid Syndrome; D013390:Succinylcholine | [
"D000208",
"D000328",
"D000707",
"D005260",
"D006801",
"D007022",
"D007431",
"D008303",
"D013390"
] | Anaphylactoid or carcinoid? | A patient with a carcinoid tumour and a history suggestive of carcinoid syndrome, but with no biochemical evidence in support, had a cardiovascular collapse during an anaesthetic with propofol and suxamethonium. Subsequent investigations suggested an anaphylactoid reaction to suxamethonium, but there were features in common with a carcinoid crisis. The necessity for a second anaesthetic soon afterwards posed a dilemma. In the event of a similar reaction during another anaesthetic, a management plan beforehand should include ready availability of appropriate drugs and the use of sympathomimetic drugs that are less likely to exacerbate the situation. | 13,608,746 | true | Anaphylactoid or carcinoid? A patient with a carcinoid tumour and a history suggestive of carcinoid syndrome, but with no biochemical evidence in support, had a cardiovascular collapse during an anaesthetic with propofol and suxamethonium. Subsequent investigations suggested an anaphylactoid reaction to suxamethonium, but there were features in common with a carcinoid crisis. The necessity for a second anaesthetic soon afterwards posed a dilemma. In the event of a similar reaction during another anaesthetic, a management plan beforehand should include ready availability of appropriate drugs and the use of sympathomimetic drugs that are less likely to exacerbate the situation. |
7,142,822 | D000368:Aged; D000783:Aneurysm; D001014:Aortic Aneurysm; D001027:Aortography; D001161:Arteriosclerosis; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery | [
"D000368",
"D000783",
"D001014",
"D001027",
"D001161",
"D005260",
"D005263",
"D006801",
"D007083",
"D008297",
"D008875",
"D011150"
] | [Arteriomegaly. Apropos of 6 cases]. | Six cases of megalodolichoartery (M. D. A.) or arteriomegaly are reported. The arteriographic characteristics of the condition are reviewed: abnormally dilated and tortuous arteries, frequently aneurysmal, sometimes the site of obstruction by obliterative arteriosclerosis or embolism. Although clinically the relation between M. D. A. and arterial atheroma appears close, underlying abnormalities of elastic tissue cannot be excluded from the aetiology of the disease. | null | false | [Arteriomegaly. Apropos of 6 cases]. Six cases of megalodolichoartery (M. D. A.) or arteriomegaly are reported. The arteriographic characteristics of the condition are reviewed: abnormally dilated and tortuous arteries, frequently aneurysmal, sometimes the site of obstruction by obliterative arteriosclerosis or embolism. Although clinically the relation between M. D. A. and arterial atheroma appears close, underlying abnormalities of elastic tissue cannot be excluded from the aetiology of the disease. |
31,864,875 | D054058:Acute Coronary Syndrome; D015415:Biomarkers; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004635:Emergency Medicine; D006331:Heart Diseases; D006801:Humans; D009203:Myocardial Infarction; D011655:Pulmonary Embolism; D018805:Sepsis; D020521:Stroke; D014336:Troponin | [
"D054058",
"D015415",
"D003937",
"D004562",
"D004635",
"D006331",
"D006801",
"D009203",
"D011655",
"D018805",
"D020521",
"D014336"
] | An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. | Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.
This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.
ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality.
Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition. | null | false | An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.
This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.
ACS includes the diagnosis of myocardial infarction (MI), which incorporates assessment for elevated troponin. Troponin I and T are the most common biomarkers used in assessment of myocardial injury and may be released with myocyte injury and necrosis, myocyte apoptosis and cell turnover, and oxygen supply demand mismatch. Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation. These include cardiac and non-cardiac conditions. Cardiac conditions include heart failure, dysrhythmia, and dissection, while non-cardiac causes include pulmonary embolism, sepsis, stroke, and many others. Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of the patient with troponin elevation. In most cases, elevated troponin is a marker for poor outcomes including increased rates of mortality.
Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition. |
Subsets and Splits