pmid int64 152 38.9M | mesh_terms stringlengths 14 1.3k | mesh_terms_ui_list listlengths 1 47 ⌀ | title stringlengths 0 1.06k | abstract stringlengths 1 94.7k | index float64 37 15.3M ⌀ | in_total_pubmed bool 2 classes | text stringlengths 2 94.8k |
|---|---|---|---|---|---|---|---|
34,137,837 | D003430:Cross-Sectional Studies; D000077321:Deep Learning; D005451:Fluorescein Angiography; D006801:Humans; D007511:Ischemia; D012170:Retinal Vein Occlusion; D012171:Retinal Vessels; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity | [
"D003430",
"D000077321",
"D005451",
"D006801",
"D007511",
"D012170",
"D012171",
"D012189",
"D041623",
"D014792"
] | Macular Ischemia Quantification Using Deep-Learning Denoised Optical Coherence Tomography Angiography in Branch Retinal Vein Occlusion. | To examine whether deep-learning denoised optical coherence tomography angiography (OCTA) images could enhance automated macular ischemia quantification in branch retinal vein occlusion (BRVO).
This retrospective, single-center, cross-sectional study enrolled 74 patients with BRVO and 46 age-matched healthy subjects. The severity of macular ischemia was graded as mild, moderate, or severe. Denoised OCTA images were produced using a neural network model. Quantitative parameters derived from denoised images, including vessel density and nonperfusion area, were compared with those derived from the OCTA machine. The main outcome measures were correlations between quantitative parameters, and areas under receiver operating characteristic curves (AUCs) in classifying the severity of the macular ischemia.
The vessel density and nonperfusion area from denoised images were correlated strongly with the corresponding parameters from machine-derived images in control eyes and BRVO eyes with mild or moderate macular ischemia (all P < 0.001). However, no such correlation was found in eyes with severe macular ischemia. The vessel density and nonperfusion area from denoised images had significantly larger area under receiver operating characteristic curve than those derived from the original images in classifying moderate versus severe macular ischemia (0.927 vs 0.802 [P = 0.042] and 0.946 vs 0.797, [P = 0.022], respectively). There were no significant differences in the areas under receiver operating characteristic curve between the denoised images and the machine-derived parameters in classifying control versus BRVO, and mild versus moderate macular ischemia.
A neural network model is useful for removing speckle noise on OCTA images and facilitating the automated grading of macular ischemia in eyes with BRVO.
Deep-learning denoised optical coherence tomography angiography images could enhance automated macular ischemia quantification. | null | false | Macular Ischemia Quantification Using Deep-Learning Denoised Optical Coherence Tomography Angiography in Branch Retinal Vein Occlusion. To examine whether deep-learning denoised optical coherence tomography angiography (OCTA) images could enhance automated macular ischemia quantification in branch retinal vein occlusion (BRVO).
This retrospective, single-center, cross-sectional study enrolled 74 patients with BRVO and 46 age-matched healthy subjects. The severity of macular ischemia was graded as mild, moderate, or severe. Denoised OCTA images were produced using a neural network model. Quantitative parameters derived from denoised images, including vessel density and nonperfusion area, were compared with those derived from the OCTA machine. The main outcome measures were correlations between quantitative parameters, and areas under receiver operating characteristic curves (AUCs) in classifying the severity of the macular ischemia.
The vessel density and nonperfusion area from denoised images were correlated strongly with the corresponding parameters from machine-derived images in control eyes and BRVO eyes with mild or moderate macular ischemia (all P < 0.001). However, no such correlation was found in eyes with severe macular ischemia. The vessel density and nonperfusion area from denoised images had significantly larger area under receiver operating characteristic curve than those derived from the original images in classifying moderate versus severe macular ischemia (0.927 vs 0.802 [P = 0.042] and 0.946 vs 0.797, [P = 0.022], respectively). There were no significant differences in the areas under receiver operating characteristic curve between the denoised images and the machine-derived parameters in classifying control versus BRVO, and mild versus moderate macular ischemia.
A neural network model is useful for removing speckle noise on OCTA images and facilitating the automated grading of macular ischemia in eyes with BRVO.
Deep-learning denoised optical coherence tomography angiography images could enhance automated macular ischemia quantification. |
31,582,795 | D013700:Giant Cell Arteritis; D005938:Glucocorticoids; D006801:Humans | [
"D013700",
"D005938",
"D006801"
] | A new era for giant cell arteritis. | The landscape of the investigation and management of giant cell arteritis (GCA) is advancing. In this review we will outline the recent advances by searching the current English literature for relevant articles using key words of giant cell arteritis, temporal arteritis, Horton's disease, investigation, and treatment. Delay in diagnosis, diagnostic uncertainty and glucocorticoid (GC) morbidity are among the highest concerns of clinicians and patients in this disease area. The positive news is that fast track pathways, imaging techniques and new therapies are emerging for routine management of GCA. Future directions for intervention in the treatment paradigm will be discussed. | 9,696,821 | true | A new era for giant cell arteritis. The landscape of the investigation and management of giant cell arteritis (GCA) is advancing. In this review we will outline the recent advances by searching the current English literature for relevant articles using key words of giant cell arteritis, temporal arteritis, Horton's disease, investigation, and treatment. Delay in diagnosis, diagnostic uncertainty and glucocorticoid (GC) morbidity are among the highest concerns of clinicians and patients in this disease area. The positive news is that fast track pathways, imaging techniques and new therapies are emerging for routine management of GCA. Future directions for intervention in the treatment paradigm will be discussed. |
20,943,607 | D000971:Antineoplastic Combined Chemotherapy Protocols; D003131:Combined Modality Therapy; D042822:Genomic Instability; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009101:Multiple Myeloma; D013792:Thalidomide; D014182:Transplantation, Autologous | [
"D000971",
"D003131",
"D042822",
"D018380",
"D006801",
"D009101",
"D013792",
"D014182"
] | Multiple myeloma. | Multiple myeloma (MM) is the second most common hematological malignancy, with an incidence of 6/100,000 in Europe. Interactions between myeloma cells and the microenvironment are essential for MM cell survival. Better knowledge of disease biology has led to the introduction of novel agents for the management of myeloma patients. Patients with asymptomatic MM may remain stable for a long time without any therapy, and treatment is needed only in symptomatic disease. Patients who are eligible for high-dose therapy and autologous stem cell transplantation (ASCT) are usually treated with bortezomib- or immunomodulatory drug (IMiD)-based regimens as induction therapy pre-ASCT. In elderly patients, the combination of melphalan and prednisone with either thalidomide (MPT) or bortezomib (MPV) is considered as the standard of care in this setting. Novel agent-based therapies are used for the management of relapsed/refractory disease. However, previous therapies, age, comorbidities and drug safety have to be taken into consideration before deciding the appropriate therapy for patients with relapsed/refractory myeloma. Patients with renal impairment or with extended bone disease may be treated with bortezomib-based regimens, while patients with pre-existing peripheral neuropathy may be treated with lenalidomide-based combinations. Maintenance therapy with thalidomide can be administered post-ASCT; however, caution is needed due to thalidomide toxicity. | 5,167,657 | true | Multiple myeloma. Multiple myeloma (MM) is the second most common hematological malignancy, with an incidence of 6/100,000 in Europe. Interactions between myeloma cells and the microenvironment are essential for MM cell survival. Better knowledge of disease biology has led to the introduction of novel agents for the management of myeloma patients. Patients with asymptomatic MM may remain stable for a long time without any therapy, and treatment is needed only in symptomatic disease. Patients who are eligible for high-dose therapy and autologous stem cell transplantation (ASCT) are usually treated with bortezomib- or immunomodulatory drug (IMiD)-based regimens as induction therapy pre-ASCT. In elderly patients, the combination of melphalan and prednisone with either thalidomide (MPT) or bortezomib (MPV) is considered as the standard of care in this setting. Novel agent-based therapies are used for the management of relapsed/refractory disease. However, previous therapies, age, comorbidities and drug safety have to be taken into consideration before deciding the appropriate therapy for patients with relapsed/refractory myeloma. Patients with renal impairment or with extended bone disease may be treated with bortezomib-based regimens, while patients with pre-existing peripheral neuropathy may be treated with lenalidomide-based combinations. Maintenance therapy with thalidomide can be administered post-ASCT; however, caution is needed due to thalidomide toxicity. |
30,520,514 | D015140:Dementia, Vascular; D004365:Drugs, Chinese Herbal; D006801:Humans; D008516:Medicine, Chinese Traditional; D016032:Randomized Controlled Trials as Topic | [
"D015140",
"D004365",
"D006801",
"D008516",
"D016032"
] | Traditional Chinese herbal medicine for vascular dementia. | BACKGROUND
Traditional Chinese herbal medicine (TCHM) is widely used for treating vascular dementia (VaD) in China. Recent studies of a number of TCHMs have demonstrated in vitro biological activity and therapeutic effects in animals, but the published clinical evidence has not been systematically appraised.
OBJECTIVE
To evaluate the efficacy and safety of TCHMs listed in either the Chinese Pharmacopoeia (CP) or the Chinese National Essential Drug List (NEDL) that are used to treat VaD. A secondary aim was to identify promising TCHMs for further clinical research.
METHODS
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialised Register (on 14 March 2018) and also several Chinese biomedical databases: the Chinese Biological Medicine Database (January 1979 to May 2015), Wanfang database (January 1998 to May 2015), Chongqing VIP Information Co. Ltd or Weipu (January 1998 to May 2015) and the Chinese National Knowledge Infrastructure (January 1979 to May 2015).
METHODS
We included randomised controlled trials (RCTs) of TCHMs compared to placebo, to Western medicine (WM) or to routine therapy for VaD risk factors. Eligible participants were men and women aged 18 years and above, diagnosed with VaD by any of the following four criteria: (1) Diagnostic and Statistical Manual of Mental Disorders (DSM) versions III, III-R, IV, IV-TR; (2) National Institute of Neurological Disorders and Stroke (NINDS-AIREN); (3) International Classification of Diseases 9 or 10; (4) the Hachinski or the Modified Hachinski Ischaemic Score. We required the use of an imaging technique to differentiate VaD from other dementias. We excluded (1) trials with participants diagnosed with mixed dementia or those that did not use an imaging technique to ascertain VaD; (2) trials of NEDL-listed Gingko biloba or Huperzine A as experimental interventions, to avoid duplication of existing Cochrane Reviews; (3) trials using acupuncture alone as the experimental intervention; (4) trials using another CP- or NEDL-listed TCHM (except for Huperzine A and Gingko which are popular in Western practice) as the control intervention; and (5) trials using purely non-pharmacological interventions as the control intervention unless explicitly described as 'routine therapy for VaD risk factors'.
METHODS
We assessed the risks of bias using the Cochrane 'Risk of bias' tool and adapted the Outcome Reporting Bias in Trials (ORBIT) classification system for outcome reporting bias. We assessed TCHM effects on five clinically important outcomes: cognition, global performance, safety, activities of daily living and behaviour and summarised the effects using mean differences for continuous outcomes and risk ratios or risk differences for binary outcomes. We stratified the studies into those that estimated the TCHM versus 'no treatment' effect and those that estimated the TCHM versus the WM effect, with further stratification by the specific TCHM tested or by one of the four modes of action. We pooled using a random-effects model. Due to substantial clinical and design heterogeneity, we did not estimate an 'overall TCHM effect'.
RESULTS
We only found studies (47 studies, 3581 participants) for 18 of the 29 eligible TCHMs as defined by our inclusion criteria. All were superiority trials conducted in China between 1997 and 2013, with most employing a two-arm parallel design with sample sizes ranging from 26 to 240 and a median treatment duration of 12 weeks (range: 2 to 24 weeks).We found that reporting and trial methodology were generally poor; in particular, there was a lack of information on randomisation, an absence of blinding of participants and outcome assessors and incomplete reporting of adverse events (AEs). None of the 30 trials published from 2007 onwards adopted the CONSORT recommendations for reporting RCTs of herbal interventions.We found seven TCHMs which each had potentially large benefits in studies estimating the TCHM versus 'no treatment' effect and in studies estimating the TCHM versus the WM effect. Two TCHMs (NaoXinTong and TongXinLuo) were common to both groups. Three of these TCHMs - Nao XinTong, NaoMaiTai and TongXinLuo - had the strongest evidence to justify further research. Two TCHMs (NaoMaiTai and TongXinLuo) had a 5% or more increased risk of AEs compared to the 'no Treatment' control, but the quality of this evidence was poor.
CONCLUSIONS
We found moderate- to very low-quality evidence of benefit and harm of TCHMs for VaD. Methodological inadequacies need to be addressed by better conducted and reported trials. We identified NaoMaiTai, NaoXinTong and TongXinLuo as warranting special research priority. | null | false | Traditional Chinese herbal medicine for vascular dementia. BACKGROUND
Traditional Chinese herbal medicine (TCHM) is widely used for treating vascular dementia (VaD) in China. Recent studies of a number of TCHMs have demonstrated in vitro biological activity and therapeutic effects in animals, but the published clinical evidence has not been systematically appraised.
OBJECTIVE
To evaluate the efficacy and safety of TCHMs listed in either the Chinese Pharmacopoeia (CP) or the Chinese National Essential Drug List (NEDL) that are used to treat VaD. A secondary aim was to identify promising TCHMs for further clinical research.
METHODS
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialised Register (on 14 March 2018) and also several Chinese biomedical databases: the Chinese Biological Medicine Database (January 1979 to May 2015), Wanfang database (January 1998 to May 2015), Chongqing VIP Information Co. Ltd or Weipu (January 1998 to May 2015) and the Chinese National Knowledge Infrastructure (January 1979 to May 2015).
METHODS
We included randomised controlled trials (RCTs) of TCHMs compared to placebo, to Western medicine (WM) or to routine therapy for VaD risk factors. Eligible participants were men and women aged 18 years and above, diagnosed with VaD by any of the following four criteria: (1) Diagnostic and Statistical Manual of Mental Disorders (DSM) versions III, III-R, IV, IV-TR; (2) National Institute of Neurological Disorders and Stroke (NINDS-AIREN); (3) International Classification of Diseases 9 or 10; (4) the Hachinski or the Modified Hachinski Ischaemic Score. We required the use of an imaging technique to differentiate VaD from other dementias. We excluded (1) trials with participants diagnosed with mixed dementia or those that did not use an imaging technique to ascertain VaD; (2) trials of NEDL-listed Gingko biloba or Huperzine A as experimental interventions, to avoid duplication of existing Cochrane Reviews; (3) trials using acupuncture alone as the experimental intervention; (4) trials using another CP- or NEDL-listed TCHM (except for Huperzine A and Gingko which are popular in Western practice) as the control intervention; and (5) trials using purely non-pharmacological interventions as the control intervention unless explicitly described as 'routine therapy for VaD risk factors'.
METHODS
We assessed the risks of bias using the Cochrane 'Risk of bias' tool and adapted the Outcome Reporting Bias in Trials (ORBIT) classification system for outcome reporting bias. We assessed TCHM effects on five clinically important outcomes: cognition, global performance, safety, activities of daily living and behaviour and summarised the effects using mean differences for continuous outcomes and risk ratios or risk differences for binary outcomes. We stratified the studies into those that estimated the TCHM versus 'no treatment' effect and those that estimated the TCHM versus the WM effect, with further stratification by the specific TCHM tested or by one of the four modes of action. We pooled using a random-effects model. Due to substantial clinical and design heterogeneity, we did not estimate an 'overall TCHM effect'.
RESULTS
We only found studies (47 studies, 3581 participants) for 18 of the 29 eligible TCHMs as defined by our inclusion criteria. All were superiority trials conducted in China between 1997 and 2013, with most employing a two-arm parallel design with sample sizes ranging from 26 to 240 and a median treatment duration of 12 weeks (range: 2 to 24 weeks).We found that reporting and trial methodology were generally poor; in particular, there was a lack of information on randomisation, an absence of blinding of participants and outcome assessors and incomplete reporting of adverse events (AEs). None of the 30 trials published from 2007 onwards adopted the CONSORT recommendations for reporting RCTs of herbal interventions.We found seven TCHMs which each had potentially large benefits in studies estimating the TCHM versus 'no treatment' effect and in studies estimating the TCHM versus the WM effect. Two TCHMs (NaoXinTong and TongXinLuo) were common to both groups. Three of these TCHMs - Nao XinTong, NaoMaiTai and TongXinLuo - had the strongest evidence to justify further research. Two TCHMs (NaoMaiTai and TongXinLuo) had a 5% or more increased risk of AEs compared to the 'no Treatment' control, but the quality of this evidence was poor.
CONCLUSIONS
We found moderate- to very low-quality evidence of benefit and harm of TCHMs for VaD. Methodological inadequacies need to be addressed by better conducted and reported trials. We identified NaoMaiTai, NaoXinTong and TongXinLuo as warranting special research priority. |
16,675,238 | D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007022:Hypotension; D007430:Intraoperative Care; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D020105:Milrinone; D009638:Norepinephrine; D010726:Phosphodiesterase Inhibitors; D011446:Prospective Studies; D014655:Vascular Resistance; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D014667:Vasopressins | [
"D000368",
"D047549",
"D004311",
"D005260",
"D006801",
"D007022",
"D007430",
"D007431",
"D008297",
"D008875",
"D020105",
"D009638",
"D010726",
"D011446",
"D014655",
"D014662",
"D014665",
"D014667"
] | Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. | OBJECTIVE
Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine.
METHODS
Fifty patients, undergoing coronary artery bypass graft (CABG) surgery, were assigned randomly in a double-blind manner to receive either vasopressin or norepinephrine. After baseline hemodynamic measurements, a loading dose of milrinone 50 microg/kg was infused slowly for 20 min followed by continuous infusion of 0.5 microg/(kg min). Immediately after the loading dose of milrinone, hemodynamic variables were measured, and vasopressin (VP group) or norepinephrine (NE groups) was infused. After being titrated until the mean arterial pressure was increased by 20%, hemodynamic variables were measured again.
RESULTS
Milrinone infusion reduced both systemic vascular resistance (SVR, 1218+/-299 dynes/cm5 vs 838+/-209 dynes/cm5, 1345+/-299 dynes/cm5 vs 1011+/-195 dynes/cm5) and PVR (95+/-34 dynes/cm5 vs 72+/-30 dynes/cm5, 119+/-85 dynes/cm5 vs 87+/-33 dynes/cm5) in the VP and NE groups, respectively. Vasopressin and norepinephrine infusion increased both SVR (838+/-209 dynes/cm5 vs 1100+/-244 dynes/cm5, 1011+/-195 dynes/cm5 vs 1446+/-681 dynes/cm5, respectively) and PVR (72+/-30 dynes/cm5 vs 84+/-18 dynes/cm5, 87+/-33 dynes/cm5 vs 139+/-97 dynes/cm5, respectively). The PRV/SVR ratio was decreased after vasopressin infusion (0.10+/-0.03 vs 0.08+/-0.03), while no changes were found after norepinephrine infusion (0.09+/-0.02 vs 0.09+/-0.02).
CONCLUSIONS
In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure. | null | false | Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. OBJECTIVE
Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine.
METHODS
Fifty patients, undergoing coronary artery bypass graft (CABG) surgery, were assigned randomly in a double-blind manner to receive either vasopressin or norepinephrine. After baseline hemodynamic measurements, a loading dose of milrinone 50 microg/kg was infused slowly for 20 min followed by continuous infusion of 0.5 microg/(kg min). Immediately after the loading dose of milrinone, hemodynamic variables were measured, and vasopressin (VP group) or norepinephrine (NE groups) was infused. After being titrated until the mean arterial pressure was increased by 20%, hemodynamic variables were measured again.
RESULTS
Milrinone infusion reduced both systemic vascular resistance (SVR, 1218+/-299 dynes/cm5 vs 838+/-209 dynes/cm5, 1345+/-299 dynes/cm5 vs 1011+/-195 dynes/cm5) and PVR (95+/-34 dynes/cm5 vs 72+/-30 dynes/cm5, 119+/-85 dynes/cm5 vs 87+/-33 dynes/cm5) in the VP and NE groups, respectively. Vasopressin and norepinephrine infusion increased both SVR (838+/-209 dynes/cm5 vs 1100+/-244 dynes/cm5, 1011+/-195 dynes/cm5 vs 1446+/-681 dynes/cm5, respectively) and PVR (72+/-30 dynes/cm5 vs 84+/-18 dynes/cm5, 87+/-33 dynes/cm5 vs 139+/-97 dynes/cm5, respectively). The PRV/SVR ratio was decreased after vasopressin infusion (0.10+/-0.03 vs 0.08+/-0.03), while no changes were found after norepinephrine infusion (0.09+/-0.02 vs 0.09+/-0.02).
CONCLUSIONS
In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure. |
18,261,501 | D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002309:Cardiology; D002983:Clinical Competence; D018450:Disease Progression; D004522:Educational Status; D005194:Family Practice; D005853:Geriatrics; D019538:Health Care Surveys; D006333:Heart Failure; D006801:Humans; D007388:Internal Medicine; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D013727:Terminal Care; D014481:United States | [
"D001291",
"D001293",
"D002309",
"D002983",
"D018450",
"D004522",
"D005194",
"D005853",
"D019538",
"D006333",
"D006801",
"D007388",
"D015999",
"D010818",
"D011379",
"D013727",
"D014481"
] | Physician attitudes toward end-stage heart failure: a national survey. | BACKGROUND
Despite recent improvements in medical therapies, heart failure remains a prevalent condition that places significant burdens on providers, patients, and families. However, there is a paucity of data published describing physician beliefs about heart failure management, especially in its advanced stages.
METHODS
In order to better understand physician decision-making in end-stage heart failure, we used a stratified random sampling of physicians obtained from the Master File of the American Medical Association to survey cardiologists (n=600), geriatricians (n=250), and internists/family practitioners (n=600).
RESULTS
Response rate was 59.6% (highest among geriatricians). The vast majority (>90%) of respondents cited similarities between the clinical trajectory of end-stage heart failure and lung cancer or chronic obstructive pulmonary disease; however, only 15.7% stated that they could predict death at 6 months "most of the time" or "always." Inpatient volume was a predictor of confidence in predicting mortality (odds ratio=1.38, 95% confidence interval, 1.36-1.40). Less than one quarter of respondents formally measure quality of life. The experience with deactivation of implantable cardioverter defibrillators was limited: 59.8% of cardiologists, 88.0% of geriatricians, and 95.1% of internal medicine/family practice physicians have had 2 or fewer conversations with patients and families about this option.
CONCLUSIONS
Significant gaps in knowledge about and experience with end-stage heart failure exist among a large proportion of physicians. The growing prevalence and highly symptomatic nature of heart failure highlight the need to further evaluate and improve the way in which care is delivered to patients dying from the disease. | null | false | Physician attitudes toward end-stage heart failure: a national survey. BACKGROUND
Despite recent improvements in medical therapies, heart failure remains a prevalent condition that places significant burdens on providers, patients, and families. However, there is a paucity of data published describing physician beliefs about heart failure management, especially in its advanced stages.
METHODS
In order to better understand physician decision-making in end-stage heart failure, we used a stratified random sampling of physicians obtained from the Master File of the American Medical Association to survey cardiologists (n=600), geriatricians (n=250), and internists/family practitioners (n=600).
RESULTS
Response rate was 59.6% (highest among geriatricians). The vast majority (>90%) of respondents cited similarities between the clinical trajectory of end-stage heart failure and lung cancer or chronic obstructive pulmonary disease; however, only 15.7% stated that they could predict death at 6 months "most of the time" or "always." Inpatient volume was a predictor of confidence in predicting mortality (odds ratio=1.38, 95% confidence interval, 1.36-1.40). Less than one quarter of respondents formally measure quality of life. The experience with deactivation of implantable cardioverter defibrillators was limited: 59.8% of cardiologists, 88.0% of geriatricians, and 95.1% of internal medicine/family practice physicians have had 2 or fewer conversations with patients and families about this option.
CONCLUSIONS
Significant gaps in knowledge about and experience with end-stage heart failure exist among a large proportion of physicians. The growing prevalence and highly symptomatic nature of heart failure highlight the need to further evaluate and improve the way in which care is delivered to patients dying from the disease. |
15,708,697 | D015906:Angioplasty, Balloon, Coronary; D003325:Coronary Care Units; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors | [
"D015906",
"D003325",
"D003365",
"D004632",
"D005260",
"D006801",
"D008297",
"D008875",
"D009203",
"D011446",
"D015912",
"D013997"
] | Primary angioplasty is cost-minimizing compared with pre-hospital thrombolysis for patients within 60 min of a percutaneous coronary intervention center: the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) cost-efficacy sub-study. | OBJECTIVE
This ancillary study of the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) trial sought to assess the cost-efficacy ratio of primary coronary angioplasty (PCA) and pre-hospital thrombolysis (PHT) in patients suffering from an acute myocardial infarction (AMI) (<6 h) close to (<60 min journey) a percutaneous coronary intervention (PCI) center.
BACKGROUND
In the CAPTIM study, at 30 days follow-up PCA was as equally effective as PHT with rescue angioplasty if needed. The cost efficacy of these two strategies has not yet been compared.
METHODS
Data were prospectively collected for 299 patients in three centers. The efficacy analysis was extended at one-year follow-up for those patients. Direct fixed and variable actual costs were assessed with a piggyback data collection.
RESULTS
The one-year primary end point event-rate (death, non-fatal myocardial infarction, and stroke) was not different after PCA or PHT (14% vs. 16. 4%, p = NS). Costs were lower in the PCA group either during the in-hospital period (8,287 vs. 9,170 $, p = 0.0001) and after one-year follow-up, in relation to a higher rate of subsequent revascularizations in the PHT group (49% vs. 23%, p < 0. 01), leading to a longer hospital stay (10 vs. 9.1 days, p = 0. 03).
CONCLUSIONS
After AMI in patients less than 1 h from a PCI center, PCA is as effective and less costly than a combined strategy of PHT followed by rescue angioplasty. | null | false | Primary angioplasty is cost-minimizing compared with pre-hospital thrombolysis for patients within 60 min of a percutaneous coronary intervention center: the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) cost-efficacy sub-study. OBJECTIVE
This ancillary study of the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) trial sought to assess the cost-efficacy ratio of primary coronary angioplasty (PCA) and pre-hospital thrombolysis (PHT) in patients suffering from an acute myocardial infarction (AMI) (<6 h) close to (<60 min journey) a percutaneous coronary intervention (PCI) center.
BACKGROUND
In the CAPTIM study, at 30 days follow-up PCA was as equally effective as PHT with rescue angioplasty if needed. The cost efficacy of these two strategies has not yet been compared.
METHODS
Data were prospectively collected for 299 patients in three centers. The efficacy analysis was extended at one-year follow-up for those patients. Direct fixed and variable actual costs were assessed with a piggyback data collection.
RESULTS
The one-year primary end point event-rate (death, non-fatal myocardial infarction, and stroke) was not different after PCA or PHT (14% vs. 16. 4%, p = NS). Costs were lower in the PCA group either during the in-hospital period (8,287 vs. 9,170 $, p = 0.0001) and after one-year follow-up, in relation to a higher rate of subsequent revascularizations in the PHT group (49% vs. 23%, p < 0. 01), leading to a longer hospital stay (10 vs. 9.1 days, p = 0. 03).
CONCLUSIONS
After AMI in patients less than 1 h from a PCI center, PCA is as effective and less costly than a combined strategy of PHT followed by rescue angioplasty. |
22,152,969 | D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose; D003718:Denmark; D003920:Diabetes Mellitus; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome | [
"D000368",
"D015906",
"D001786",
"D003718",
"D003920",
"D004562",
"D005260",
"D005500",
"D006801",
"D015994",
"D008297",
"D008875",
"D009203",
"D011379",
"D012042",
"D012189",
"D015607",
"D015996",
"D013997",
"D016896"
] | Influence of diabetes mellitus on clinical outcomes following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. | Patients with diabetes mellitus (DM) have a worse outcome after percutaneous coronary intervention (PCI) than nondiabetic patients. The purpose of this study was to compare rates of stent thrombosis, myocardial infarction (MI), target lesion revascularization (TLR), and death in diabetic and nondiabetic patients treated with primary PCI for ST-segment elevation MI (STEMI) in Western Denmark. From January 2002 through June 2005, 3,655 consecutive patients with STEMI treated with primary PCI and stent implantation (316 patients with DM, 8.6%; 3,339 patients without DM, 91.4%) were recorded in the Western Denmark Heart Registry. All patients were followed for 3 years. Cox regression analysis was used to compute hazard ratios (HRs), controlling for potential confounding. Three-year rates of definite stent thrombosis were 1.6% in the DM group and 1.5% in the non-DM group (adjusted HR 1.15, 95% confidence interval [CI] 0.50 to 2.67). The rate of MI was 12.3% in the DM group versus 5.6% in the non-DM group (adjusted HR 2.56, 95% CI 1.81 to 3.61). Rates of TLR were 12.1% in the DM group and 8.7% in the non-DM group (adjusted HR 1.55, 95% CI 1.14 to 2.11). All-cause mortality was 23.7% in patients with DM versus 12.7% in patients without DM (adjusted HR 2.03, 95% CI 1.59 to 2.59). In conclusion, stent thrombosis rate was similar in patients with and without DM and STEMI treated with primary PCI, whereas the presence of DM increased the risk of MI, TLR, and death. | 13,855,499 | true | Influence of diabetes mellitus on clinical outcomes following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Patients with diabetes mellitus (DM) have a worse outcome after percutaneous coronary intervention (PCI) than nondiabetic patients. The purpose of this study was to compare rates of stent thrombosis, myocardial infarction (MI), target lesion revascularization (TLR), and death in diabetic and nondiabetic patients treated with primary PCI for ST-segment elevation MI (STEMI) in Western Denmark. From January 2002 through June 2005, 3,655 consecutive patients with STEMI treated with primary PCI and stent implantation (316 patients with DM, 8.6%; 3,339 patients without DM, 91.4%) were recorded in the Western Denmark Heart Registry. All patients were followed for 3 years. Cox regression analysis was used to compute hazard ratios (HRs), controlling for potential confounding. Three-year rates of definite stent thrombosis were 1.6% in the DM group and 1.5% in the non-DM group (adjusted HR 1.15, 95% confidence interval [CI] 0.50 to 2.67). The rate of MI was 12.3% in the DM group versus 5.6% in the non-DM group (adjusted HR 2.56, 95% CI 1.81 to 3.61). Rates of TLR were 12.1% in the DM group and 8.7% in the non-DM group (adjusted HR 1.55, 95% CI 1.14 to 2.11). All-cause mortality was 23.7% in patients with DM versus 12.7% in patients without DM (adjusted HR 2.03, 95% CI 1.59 to 2.59). In conclusion, stent thrombosis rate was similar in patients with and without DM and STEMI treated with primary PCI, whereas the presence of DM increased the risk of MI, TLR, and death. |
20,513,700 | D016022:Case-Control Studies; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017565:Sarcoidosis, Pulmonary; D018709:Statistics, Nonparametric; D013599:Systole; D018487:Ventricular Dysfunction, Left | [
"D016022",
"D003971",
"D018619",
"D005260",
"D006801",
"D008297",
"D008875",
"D017565",
"D018709",
"D013599",
"D018487"
] | Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis. | OBJECTIVE
Cardiac sarcoidosis is symptomatic in only 5% of patients, and it is an independent predictor of mortality and carries a very poor prognosis. In our study, we aimed to assess left ventricle (LV) systolic and diastolic functions with tissue Doppler imaging (TDI) in patients with early grade pulmonary sarcoidosis.
RESULTS
The study population included 55 patients with Grade I-II sarcoidosis (41 females, 14 males, mean age: 47.9 ± 10.1) and 22 healthy subjects. LV lateral and septal wall early myocardial peak velocity (E(m)), late myocardial peak velocity (A(m)), E(m) to A(m) ratio, myocardial relaxation time (RT(m)), myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCT(m)), contraction time (CT(m)), and the PCT(m) to CT(m) ratio were measured. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, or heart rate. LV systolic parameters, LV septal, and lateral wall IVA, were significantly lower, and the PCT(m) to CT(m) ratio (P = 0.026) was higher at the septal annulus as compared with control group. E(m), a LV diastolic parameter, was significantly lower at the septal annulus.
CONCLUSIONS
Cardiac sarcoid involvement is not rare and is treatable. It should be identified at an early stage. TDI, especially IVA, may be a suitable tool for the early detection of subclinical LV sarcoid involvement. | null | false | Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis. OBJECTIVE
Cardiac sarcoidosis is symptomatic in only 5% of patients, and it is an independent predictor of mortality and carries a very poor prognosis. In our study, we aimed to assess left ventricle (LV) systolic and diastolic functions with tissue Doppler imaging (TDI) in patients with early grade pulmonary sarcoidosis.
RESULTS
The study population included 55 patients with Grade I-II sarcoidosis (41 females, 14 males, mean age: 47.9 ± 10.1) and 22 healthy subjects. LV lateral and septal wall early myocardial peak velocity (E(m)), late myocardial peak velocity (A(m)), E(m) to A(m) ratio, myocardial relaxation time (RT(m)), myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCT(m)), contraction time (CT(m)), and the PCT(m) to CT(m) ratio were measured. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, or heart rate. LV systolic parameters, LV septal, and lateral wall IVA, were significantly lower, and the PCT(m) to CT(m) ratio (P = 0.026) was higher at the septal annulus as compared with control group. E(m), a LV diastolic parameter, was significantly lower at the septal annulus.
CONCLUSIONS
Cardiac sarcoid involvement is not rare and is treatable. It should be identified at an early stage. TDI, especially IVA, may be a suitable tool for the early detection of subclinical LV sarcoid involvement. |
24,755,382 | D020341:Absorbable Implants; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001938:Brazil; D002317:Cardiovascular Agents; D002858:Chromium Alloys; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D023921:Coronary Stenosis; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima; D011446:Prospective Studies; D011474:Prosthesis Design; D016037:Single-Blind Method; D020123:Sirolimus; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional | [
"D020341",
"D000368",
"D015906",
"D001938",
"D002317",
"D002858",
"D017023",
"D003324",
"D023921",
"D054855",
"D005260",
"D006801",
"D008297",
"D008875",
"D058426",
"D011446",
"D011474",
"D016037",
"D020123",
"D013997",
"D016896",
"D018084"
] | First-in-man randomised comparison of a novel sirolimus-eluting stent with abluminal biodegradable polymer and thin-strut cobalt-chromium alloy: INSPIRON-I trial. | OBJECTIVE
The INSPIRON-I trial is a first-in-man evaluation of the safety and efficacy of the Inspiron drug-eluting stent, a sirolimus-eluting stent with abluminal biodegradable polymer coating and thin cobalt-chromium alloy.
RESULTS
This is a randomised, multicentre comparison between Inspiron and a stent with the same metallic structure but without polymer coating or drug elution (Cronus). The primary objective was to evaluate the in-segment late loss (LLL) at six months. Secondary endpoints included percent in-stent obstruction as measured by intravascular ultrasound (IVUS) at six months and major adverse cardiac events (MACE). Fifty-eight patients were enrolled (60 lesions), 39 for Inspiron and 19 for Cronus. Baseline clinical and angiographic characteristics of both groups were similar. At six months, the in-segment LLL was reduced in the Inspiron group compared to the control group (0.19±0.16 mm vs. 0.58±0.4 mm, respectively; p<0.001), as well as the percent neointimal obstruction (7.8±7.1% vs. 26.5±11.4%; p<0.001). At two-year follow-up, incidence of MACE was similar between groups (7.9 vs. 21.1%, respectively; p=0.20), with lower target lesion revascularisation for Inspiron (0 vs. 21.1%, respectively; p=0.01) and no stent thrombosis.
CONCLUSIONS
Sirolimus eluted from an abluminal biodegradable polymer on a cobalt-chromium alloy proved effective in reducing restenosis at six months. | null | false | First-in-man randomised comparison of a novel sirolimus-eluting stent with abluminal biodegradable polymer and thin-strut cobalt-chromium alloy: INSPIRON-I trial. OBJECTIVE
The INSPIRON-I trial is a first-in-man evaluation of the safety and efficacy of the Inspiron drug-eluting stent, a sirolimus-eluting stent with abluminal biodegradable polymer coating and thin cobalt-chromium alloy.
RESULTS
This is a randomised, multicentre comparison between Inspiron and a stent with the same metallic structure but without polymer coating or drug elution (Cronus). The primary objective was to evaluate the in-segment late loss (LLL) at six months. Secondary endpoints included percent in-stent obstruction as measured by intravascular ultrasound (IVUS) at six months and major adverse cardiac events (MACE). Fifty-eight patients were enrolled (60 lesions), 39 for Inspiron and 19 for Cronus. Baseline clinical and angiographic characteristics of both groups were similar. At six months, the in-segment LLL was reduced in the Inspiron group compared to the control group (0.19±0.16 mm vs. 0.58±0.4 mm, respectively; p<0.001), as well as the percent neointimal obstruction (7.8±7.1% vs. 26.5±11.4%; p<0.001). At two-year follow-up, incidence of MACE was similar between groups (7.9 vs. 21.1%, respectively; p=0.20), with lower target lesion revascularisation for Inspiron (0 vs. 21.1%, respectively; p=0.01) and no stent thrombosis.
CONCLUSIONS
Sirolimus eluted from an abluminal biodegradable polymer on a cobalt-chromium alloy proved effective in reducing restenosis at six months. |
12,883,466 | D000741:Anemia, Aplastic; D015897:Comorbidity; D017261:Glycosylphosphatidylinositols; D006457:Hemoglobinuria, Paroxysmal; D006801:Humans; D007938:Leukemia; D008232:Lymphoproliferative Disorders; D008565:Membrane Proteins; D015394:Molecular Structure; D009154:Mutation; D009190:Myelodysplastic Syndromes; D013234:Stem Cells; D013927:Thrombosis | [
"D000741",
"D015897",
"D017261",
"D006457",
"D006801",
"D007938",
"D008232",
"D008565",
"D015394",
"D009154",
"D009190",
"D013234",
"D013927"
] | Recent insights into the pathophysiology of paroxysmal nocturnal hemoglobinuria. | Paroxysmal nocturnal hemoglobinuria (PNH) is a unique clonal stem cell disorder characterized by intravascular hemolysis, thrombotic events and bone marrow failure. There has been accelerated progress in understanding the mechanisms underlying the clinical features of the disease over the last decade. The development of PNH requires not only a somatic mutation of the phospatidylinositol glycan complementation class A (PIG-A) gene, but also a survival advantage of the PNH clone ('dual pathogenesis' theory). There is increasing evidence that negative selection against the non-mutated cells rather than positive selection of the PIG-A gene mutant cells is responsible for the dominance of the PNH clone. In this review, we summarize the important advances in the understanding of PNH, but we also concentrate on the presence of PNH clones in other hematological disorders, including aplastic anemia (AA), myelodysplastic syndromes (MDS), acute leukemias, and myeloproliferative and lymphoproliferative syndromes. The fuller comprehension of the pathophysiology of PNH may have wider implications than for PNH itself, as indicated by the presence of PNH clones in these hematological malignancies, and by the therapeutic implications of this fact, as already described in patients with AA and MDS. | 5,259,705 | true | Recent insights into the pathophysiology of paroxysmal nocturnal hemoglobinuria. Paroxysmal nocturnal hemoglobinuria (PNH) is a unique clonal stem cell disorder characterized by intravascular hemolysis, thrombotic events and bone marrow failure. There has been accelerated progress in understanding the mechanisms underlying the clinical features of the disease over the last decade. The development of PNH requires not only a somatic mutation of the phospatidylinositol glycan complementation class A (PIG-A) gene, but also a survival advantage of the PNH clone ('dual pathogenesis' theory). There is increasing evidence that negative selection against the non-mutated cells rather than positive selection of the PIG-A gene mutant cells is responsible for the dominance of the PNH clone. In this review, we summarize the important advances in the understanding of PNH, but we also concentrate on the presence of PNH clones in other hematological disorders, including aplastic anemia (AA), myelodysplastic syndromes (MDS), acute leukemias, and myeloproliferative and lymphoproliferative syndromes. The fuller comprehension of the pathophysiology of PNH may have wider implications than for PNH itself, as indicated by the presence of PNH clones in these hematological malignancies, and by the therapeutic implications of this fact, as already described in patients with AA and MDS. |
32,302,265 | D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000086382:COVID-19; D018352:Coronavirus Infections; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D011024:Pneumonia, Viral | [
"D000368",
"D057911",
"D000806",
"D000086382",
"D018352",
"D005260",
"D017052",
"D006801",
"D006973",
"D007297",
"D008297",
"D008875",
"D058873",
"D011024"
] | Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19. | Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension.
To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19.
This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55-68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57-69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19-0.92]; P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15-0.89]; P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12-0.70]; P=0.01) in patients with COVID-19 and coexisting hypertension.
Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk. | null | false | Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19. Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in patients with hypertension.
To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19.
This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 [interquartile range, 55-68] years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 [interquartile range 57-69]; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 [95% CI, 0.19-0.92]; P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 [95% CI, 0.15-0.89]; P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 [95% CI, 0.12-0.70]; P=0.01) in patients with COVID-19 and coexisting hypertension.
Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk. |
12,361,189 | D000367:Age Factors; D000368:Aged; D001158:Arteries; D001794:Blood Pressure; D004548:Elasticity; D005602:France; D006115:Greece; D006339:Heart Rate; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011673:Pulsatile Flow; D012307:Risk Factors; D014655:Vascular Resistance | [
"D000367",
"D000368",
"D001158",
"D001794",
"D004548",
"D005602",
"D006115",
"D006339",
"D006801",
"D006973",
"D008297",
"D008875",
"D015999",
"D011673",
"D012307",
"D014655"
] | Determinants of arterial stiffness in Greek and French hypertensive men. | The aim of the present study was to assess the main determinants of arterial stiffness in Greek and French middle-aged, hypertensive men, by using pulse wave velocity (PWV) measurements, which is an established method of quantification of arterial stiffness. The study was performed in 83 consecutive Greek and 79 consecutive French untreated male hypertensive outpatients aged 45-65 years. French subjects were examined in Paris at the "Centre d'Investigations Préventives et Cliniques" (the IPC Center). Greek patients were examined in Athens at the hypertension outpatient clinic in Sotiria Hospital (University of Athens). In both Greek and French hypertensive subjects, aortic stiffness was determined by the same parameters: age, blood pressure and heart rate (HR) explained approximately 40% of the aortic PWV variations, whereas lipids, triglycerides and tobacco smoking were not significant associated with aortic stiffness. After multivariate adjustments, Greek hypertensives had higher aortic stiffness as compared to the French patients by 1.2 m/s (approximately 10%); p < 0.001. Greek hypertensive subjects had also a higher body weight, waist, HR and prevalence of smoking. However, among all these factors only HR had a significant effect on PWV. Also after adjustment for HR, the difference in PWV between the two populations persisted. In conclusion, in two different populations, stiffness seems to be regulated by the same major factors. The higher aortic stiffness found in Greek hypertensives may be explained by the presence of other non-evaluated risk factors and/or patient selection differences. | 12,052,390 | true | Determinants of arterial stiffness in Greek and French hypertensive men. The aim of the present study was to assess the main determinants of arterial stiffness in Greek and French middle-aged, hypertensive men, by using pulse wave velocity (PWV) measurements, which is an established method of quantification of arterial stiffness. The study was performed in 83 consecutive Greek and 79 consecutive French untreated male hypertensive outpatients aged 45-65 years. French subjects were examined in Paris at the "Centre d'Investigations Préventives et Cliniques" (the IPC Center). Greek patients were examined in Athens at the hypertension outpatient clinic in Sotiria Hospital (University of Athens). In both Greek and French hypertensive subjects, aortic stiffness was determined by the same parameters: age, blood pressure and heart rate (HR) explained approximately 40% of the aortic PWV variations, whereas lipids, triglycerides and tobacco smoking were not significant associated with aortic stiffness. After multivariate adjustments, Greek hypertensives had higher aortic stiffness as compared to the French patients by 1.2 m/s (approximately 10%); p < 0.001. Greek hypertensive subjects had also a higher body weight, waist, HR and prevalence of smoking. However, among all these factors only HR had a significant effect on PWV. Also after adjustment for HR, the difference in PWV between the two populations persisted. In conclusion, in two different populations, stiffness seems to be regulated by the same major factors. The higher aortic stiffness found in Greek hypertensives may be explained by the presence of other non-evaluated risk factors and/or patient selection differences. |
12,797,514 | D006349:Heart Valve Diseases; D006350:Heart Valve Prosthesis; D006351:Heart Valves; D006801:Humans; D008279:Magnetic Resonance Imaging | [
"D006349",
"D006350",
"D006351",
"D006801",
"D008279"
] | Assessment of valve disease: qualitative and quantitative. | Evaluation of valve disease has changed significantly with the development of color Doppler echocardiography. Nevertheless, this technique has limitations, particularly in the assessment of valvular regurgitation. MR imaging, with its ability to provide three-dimensional morphologic data, dynamic cine information, and functional evaluation with flow-sensitive techniques, can be envisioned as a complementary noninvasive modality, able to provide the complete information required for planning therapeutic options. With MR imaging, qualitative as well as accurate and reproducible quantitative information such as volume measurements, cardiac function, and flow velocity profiles are unique for the evaluation of the severity of valve disease. This article reviews the different MR imaging techniques used in assessing valvular heart disease and discusses the advantages and limitations of these techniques in current clinical applications in comparison with classical imaging methods. | 3,833,573 | true | Assessment of valve disease: qualitative and quantitative. Evaluation of valve disease has changed significantly with the development of color Doppler echocardiography. Nevertheless, this technique has limitations, particularly in the assessment of valvular regurgitation. MR imaging, with its ability to provide three-dimensional morphologic data, dynamic cine information, and functional evaluation with flow-sensitive techniques, can be envisioned as a complementary noninvasive modality, able to provide the complete information required for planning therapeutic options. With MR imaging, qualitative as well as accurate and reproducible quantitative information such as volume measurements, cardiac function, and flow velocity profiles are unique for the evaluation of the severity of valve disease. This article reviews the different MR imaging techniques used in assessing valvular heart disease and discusses the advantages and limitations of these techniques in current clinical applications in comparison with classical imaging methods. |
10,402,109 | D000328:Adult; D017023:Coronary Angiography; D003327:Coronary Disease; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking | [
"D000328",
"D017023",
"D003327",
"D003331",
"D005260",
"D006801",
"D008297",
"D009203",
"D011446",
"D012307",
"D012907"
] | Clinical and angiographic features in patients under 35 years with a first Q wave acute myocardial infarction. | Sixty patients less than 35 years with a first Q wave acute myocardial infarction were prospectively studied to evaluate their features, risk factors and evidence of any viral infection. Typical chest pain was present in 98.3% with Q waves and ST segment elevation in all. None had hypotension or cardiogenic shock. Smoking was the most common risk factor (81.7%). Mean total cholesterol was 5.74 (+/-1.42) mmol/l. History of a viral illness was present in 28.3%, severe emotional stress in 21.7% and exhausting physical activity in 18.3%. Mean left ventricular diastolic and end systolic volumes were increased (90.11+/-22.5 ml/m2) and (46.62+/-20.46 ml/m2), respectively. The ejection fraction was depressed (49.71+/-1.6%). Triple vessel disease was seen only in 6.8 and 26.7% had insignificant or no coronary artery disease. Left anterior descending artery was most frequently involved (66%). None had left main involvement. Coronary ectasia was present in 11.7%, intracoronary thrombus in 28.3% and 40% had collaterals. Patients with no significant disease had no diabetes, a smaller number had a raised total cholesterol or smoked and had a lower ejection fraction. Patients from the Indian subcontinent who had fewer conventional risk factors, had more severe disease than those from the Arab world suggesting that other etiological factors need investigation. | 13,340,631 | true | Clinical and angiographic features in patients under 35 years with a first Q wave acute myocardial infarction. Sixty patients less than 35 years with a first Q wave acute myocardial infarction were prospectively studied to evaluate their features, risk factors and evidence of any viral infection. Typical chest pain was present in 98.3% with Q waves and ST segment elevation in all. None had hypotension or cardiogenic shock. Smoking was the most common risk factor (81.7%). Mean total cholesterol was 5.74 (+/-1.42) mmol/l. History of a viral illness was present in 28.3%, severe emotional stress in 21.7% and exhausting physical activity in 18.3%. Mean left ventricular diastolic and end systolic volumes were increased (90.11+/-22.5 ml/m2) and (46.62+/-20.46 ml/m2), respectively. The ejection fraction was depressed (49.71+/-1.6%). Triple vessel disease was seen only in 6.8 and 26.7% had insignificant or no coronary artery disease. Left anterior descending artery was most frequently involved (66%). None had left main involvement. Coronary ectasia was present in 11.7%, intracoronary thrombus in 28.3% and 40% had collaterals. Patients with no significant disease had no diabetes, a smaller number had a raised total cholesterol or smoked and had a lower ejection fraction. Patients from the Indian subcontinent who had fewer conventional risk factors, had more severe disease than those from the Arab world suggesting that other etiological factors need investigation. |
28,530,518 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000077144:Clopidogrel; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009203:Myocardial Infarction; D010975:Platelet Aggregation Inhibitors; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke; D013988:Ticlopidine; D014481:United States; D055815:Young Adult | [
"D000293",
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"D000077144",
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"D006801",
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"D006278",
"D008875",
"D009203",
"D010975",
"D012189",
"D012307",
"D055502",
"D020521",
"D013988",
"D014481",
"D055815"
] | Antiplatelet Therapy and Clinical Outcomes Following Myocardial Infarction Among Patients in a U.S. Employer-Based Insurance Database. | BACKGROUND
Estimates of residual cardiovascular risks among patients who have experienced a recent acute myocardial infarction (MI) are predominantly derived from secondary prevention trial populations, patient registries, and population-based cohorts.
OBJECTIVE
To generate real-world evidence of antiplatelet treatment and recurrent events following MI in patients on antiplatelet treatment among commercial, employer-based insured patients in a large administrative database.
METHODS
This was a retrospective cohort claims database study using the Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental databases between 2007-2011. Patients with an acute MI hospitalization with a discharge date between 2008 and 2010 were included. Excluded were those patients with documentation of stroke, transient ischemic attack (TIA), or severe bleeding at or before index hospitalization and with concomitant use of anticoagulant therapy following index hospitalization. Patients treated with clopidogrel following the index MI hospitalization were followed up to 1 year for repeat MI, stroke, and coronary revascularization.
RESULTS
Among 33,943 post-MI continuous clopidogrel users without history of stroke, TIA, or bleeding, 22% had diabetes, whereas angina and renal impairment were less prevalent (5% and 7%, respectively). Over the 1-year follow-up, 2.4% experienced a repeat MI or stroke, and 8.2% underwent coronary revascularization. Angina, diabetes, and renal impairment were associated with elevated 1-year risk of repeat MI or stroke.
CONCLUSIONS
This study suggests that there is residual cardiovascular risk, although relatively low, in an insured, secondary prevention population on antiplatelet treatment following an MI. In patients with MI, identifying angina, diabetes, and renal impairment may aid risk stratification and guide the effective management of these higher-risk patients.
BACKGROUND
Funding for this research was provided by Merck & Co. Although Merck & Co. formally reviewed a penultimate draft, the opinions expressed are those of the authorship and may not necessarily reflect those of the company. Reed Chase, Wu, Mavros, Heithoff, and Hanson are employees of Merck Sharp & Dohme, a subsidiary of Merck & Co., and may own stock and/or hold stock options in the company. Patel was an employee of Merck & Co. during the conduct of this study and preparation of the manuscript. Simpson is a paid consultant for Merck, Pfizer, and Amgen and has received speaker's fees from Merck and Pfizer. Study concept and design were contributed by all authors except Hanson. Heifhoff and Patel collected the data, and data interpretation was performed by Simpson, Mavros, Patel, Wu, and Hanson. The manuscript was written by Hanson, Mavros, and Patel and revised by Heithoff, Wu, Simpson, and Reed Chase. | null | false | Antiplatelet Therapy and Clinical Outcomes Following Myocardial Infarction Among Patients in a U.S. Employer-Based Insurance Database. BACKGROUND
Estimates of residual cardiovascular risks among patients who have experienced a recent acute myocardial infarction (MI) are predominantly derived from secondary prevention trial populations, patient registries, and population-based cohorts.
OBJECTIVE
To generate real-world evidence of antiplatelet treatment and recurrent events following MI in patients on antiplatelet treatment among commercial, employer-based insured patients in a large administrative database.
METHODS
This was a retrospective cohort claims database study using the Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental databases between 2007-2011. Patients with an acute MI hospitalization with a discharge date between 2008 and 2010 were included. Excluded were those patients with documentation of stroke, transient ischemic attack (TIA), or severe bleeding at or before index hospitalization and with concomitant use of anticoagulant therapy following index hospitalization. Patients treated with clopidogrel following the index MI hospitalization were followed up to 1 year for repeat MI, stroke, and coronary revascularization.
RESULTS
Among 33,943 post-MI continuous clopidogrel users without history of stroke, TIA, or bleeding, 22% had diabetes, whereas angina and renal impairment were less prevalent (5% and 7%, respectively). Over the 1-year follow-up, 2.4% experienced a repeat MI or stroke, and 8.2% underwent coronary revascularization. Angina, diabetes, and renal impairment were associated with elevated 1-year risk of repeat MI or stroke.
CONCLUSIONS
This study suggests that there is residual cardiovascular risk, although relatively low, in an insured, secondary prevention population on antiplatelet treatment following an MI. In patients with MI, identifying angina, diabetes, and renal impairment may aid risk stratification and guide the effective management of these higher-risk patients.
BACKGROUND
Funding for this research was provided by Merck & Co. Although Merck & Co. formally reviewed a penultimate draft, the opinions expressed are those of the authorship and may not necessarily reflect those of the company. Reed Chase, Wu, Mavros, Heithoff, and Hanson are employees of Merck Sharp & Dohme, a subsidiary of Merck & Co., and may own stock and/or hold stock options in the company. Patel was an employee of Merck & Co. during the conduct of this study and preparation of the manuscript. Simpson is a paid consultant for Merck, Pfizer, and Amgen and has received speaker's fees from Merck and Pfizer. Study concept and design were contributed by all authors except Hanson. Heifhoff and Patel collected the data, and data interpretation was performed by Simpson, Mavros, Patel, Wu, and Hanson. The manuscript was written by Hanson, Mavros, and Patel and revised by Heithoff, Wu, Simpson, and Reed Chase. |
30,632,137 | D002648:Child; D005006:Ethnicity; D005260:Female; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D008297:Male; D008403:Mass Screening; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma; D012307:Risk Factors; D019851:Thrombophilia; D054556:Venous Thromboembolism | [
"D002648",
"D005006",
"D005260",
"D006495",
"D006801",
"D008297",
"D008403",
"D054198",
"D012307",
"D019851",
"D054556"
] | Thrombophilia screening and thromboprophylaxis may benefit specific ethnic subgroups with paediatric acute lymphoblastic leukaemia. | This study investigated the prevalence of inherited thrombophilia, risk of venous thromboembolism (VTE) and benefit of low molecular weight heparin prophylaxis in 476 Israeli children with acute lymphoblastic leukaemia (ALL) treated between 2004 and 2016. Thrombophilia was found in 15·5%. Arab children had a higher prevalence of F5 R506Q (factor V Leiden) than Jewish children (19·4% vs. 2·9%, P < 0·01). Patients with thrombophilia had higher VTE rates VTE (26·5% vs. 5·6%, P < 0·001). None of the thrombophilic children given prophylaxis had severe VTE. Routine evaluation for inherited thrombophilia followed by thromboprophylaxis when findings are positive may benefit at-risk patients with ALL. | 22,073 | true | Thrombophilia screening and thromboprophylaxis may benefit specific ethnic subgroups with paediatric acute lymphoblastic leukaemia. This study investigated the prevalence of inherited thrombophilia, risk of venous thromboembolism (VTE) and benefit of low molecular weight heparin prophylaxis in 476 Israeli children with acute lymphoblastic leukaemia (ALL) treated between 2004 and 2016. Thrombophilia was found in 15·5%. Arab children had a higher prevalence of F5 R506Q (factor V Leiden) than Jewish children (19·4% vs. 2·9%, P < 0·01). Patients with thrombophilia had higher VTE rates VTE (26·5% vs. 5·6%, P < 0·001). None of the thrombophilic children given prophylaxis had severe VTE. Routine evaluation for inherited thrombophilia followed by thromboprophylaxis when findings are positive may benefit at-risk patients with ALL. |
8,287,301 | D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D006801:Humans; D007022:Hypotension | [
"D000767",
"D000775",
"D006801",
"D007022"
] | [Prevention and treatment of hypotension during spinal anesthesia]. | Spinal and epidural anaesthesias alter self-regulation of arterial pressure as they lead to a sympathetic blockade. The extent and the speed of appearance of this blockade conditions the magnitude of the decrease of arterial pressure. So, epidural or spinal anaesthesias may only be performed on hemodynamically stable patients for a non hemorrhagic surgery. The routine fluid preloading is illogical and poorly efficient. Correcting a deep arterial hypotension demands first of all the use of vasoconstricting agents the choice of which depends on the site of the anaesthesia and on the cardiovascular condition of the patient. The occurrence of bradycardia more often indicates a hypovolaemic state. | null | false | [Prevention and treatment of hypotension during spinal anesthesia]. Spinal and epidural anaesthesias alter self-regulation of arterial pressure as they lead to a sympathetic blockade. The extent and the speed of appearance of this blockade conditions the magnitude of the decrease of arterial pressure. So, epidural or spinal anaesthesias may only be performed on hemodynamically stable patients for a non hemorrhagic surgery. The routine fluid preloading is illogical and poorly efficient. Correcting a deep arterial hypotension demands first of all the use of vasoconstricting agents the choice of which depends on the site of the anaesthesia and on the cardiovascular condition of the patient. The occurrence of bradycardia more often indicates a hypovolaemic state. |
8,879,945 | D000789:Angina, Unstable; D006801:Humans; D009203:Myocardial Infarction; D009204:Myocardial Revascularization; D012307:Risk Factors; D015912:Thrombolytic Therapy; D014665:Vasodilator Agents | [
"D000789",
"D006801",
"D009203",
"D009204",
"D012307",
"D015912",
"D014665"
] | Pathophysiology and initial management of the acute coronary syndromes. | Acute coronary syndromes are responsible for more than half a million hospital admissions each year in the United States alone. Plaque rupture is the precipitating pathophysiologic event. The degree of narrowing of plaques that rupture is not necessarily severe, in the range of 30% to 70% diameter stenosis. Plaques containing large lipid pools with only thin fibrous caps are most at risk. The site of rupture is most often at the shoulder of the plaque, where stress is highest. Clusters of macrophages are often seen at these points. Most plaque ruptures heal without causing symptoms, perhaps leaving a narrowing somewhat more severe than before. Plaque ruptures that expose larger areas of thrombogenic intramural debris to flowing blood in areas of high turbulence are most likely to provoke more extensive thrombosis. Risk factors, particularly smoking and hypercholesterolemia, cause increased thrombin deposition at the site of deep arterial injury. Thrombin deposition causes local coronary vasoconstriction that may contribute to the development of ischemia. Whether plaque rupture with thrombosis causes infarction, unstable angina, or no symptoms at all depends on the site of the lesion, its severity, and whether the jeopardized myocardium is served by collaterals. Aspirin, heparin, and, potentially, the newer agents provide benefit in each of the acute coronary syndromes. | 12,561,002 | true | Pathophysiology and initial management of the acute coronary syndromes. Acute coronary syndromes are responsible for more than half a million hospital admissions each year in the United States alone. Plaque rupture is the precipitating pathophysiologic event. The degree of narrowing of plaques that rupture is not necessarily severe, in the range of 30% to 70% diameter stenosis. Plaques containing large lipid pools with only thin fibrous caps are most at risk. The site of rupture is most often at the shoulder of the plaque, where stress is highest. Clusters of macrophages are often seen at these points. Most plaque ruptures heal without causing symptoms, perhaps leaving a narrowing somewhat more severe than before. Plaque ruptures that expose larger areas of thrombogenic intramural debris to flowing blood in areas of high turbulence are most likely to provoke more extensive thrombosis. Risk factors, particularly smoking and hypercholesterolemia, cause increased thrombin deposition at the site of deep arterial injury. Thrombin deposition causes local coronary vasoconstriction that may contribute to the development of ischemia. Whether plaque rupture with thrombosis causes infarction, unstable angina, or no symptoms at all depends on the site of the lesion, its severity, and whether the jeopardized myocardium is served by collaterals. Aspirin, heparin, and, potentially, the newer agents provide benefit in each of the acute coronary syndromes. |
2,574,133 | D000311:Adrenal Glands; D006801:Humans; D006976:Hypertension, Pulmonary; D007610:Kallikreins; D007705:Kinins; D018377:Neurotransmitter Agents; D010913:Pituitary-Adrenal System; D011655:Pulmonary Embolism; D012084:Renin-Angiotensin System; D013564:Sympathetic Nervous System | [
"D000311",
"D006801",
"D006976",
"D007610",
"D007705",
"D018377",
"D010913",
"D011655",
"D012084",
"D013564"
] | [The humoral regulatory systems in thromboembolism of the pulmonary arteries]. | The work deals with the results of biochemical and angiographic studies in 26 patients with thromboembolism of the pulmonary arteries (TEPA) and pulmonary hypertension of various degree. Acute occlusion of the pulmonary arterial channel calls forth a response of the organism's humoral regulating systems. The degree of hypertension of pulmonary circulation in TEPA, which is determined by the volume of affection of the pulmonary vascular channel, is directly dependent on the functional activity of the adaptation system and the severity of disorders of the intra- and intersystemic connections. | null | false | [The humoral regulatory systems in thromboembolism of the pulmonary arteries]. The work deals with the results of biochemical and angiographic studies in 26 patients with thromboembolism of the pulmonary arteries (TEPA) and pulmonary hypertension of various degree. Acute occlusion of the pulmonary arterial channel calls forth a response of the organism's humoral regulating systems. The degree of hypertension of pulmonary circulation in TEPA, which is determined by the volume of affection of the pulmonary vascular channel, is directly dependent on the functional activity of the adaptation system and the severity of disorders of the intra- and intersystemic connections. |
16,414,389 | D000293:Adolescent; D000328:Adult; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013625:Takayasu Arteritis; D013997:Time Factors | [
"D000293",
"D000328",
"D002648",
"D018450",
"D005260",
"D005500",
"D006801",
"D008297",
"D008875",
"D013625",
"D013997"
] | Takayasu's arteritis: operative results and influence of disease activity. | OBJECTIVE
To determine the short- and long-term outcomes of patients treated operatively for Takayasu's arteritis and the effect of disease activity on results.
METHODS
Forty-two (17%) of the 251 patients enrolled in our Takayasu's arteritis registry between 1975 and 2002 required operation for symptomatic disease. Data were obtained from the registry, patient records, phone correspondence, and written surveys.
RESULTS
There were 38 females and 4 males with a median age of 29 years (range, 12 to 56 years), and 32 (76%) were white. Sixty operations were performed for symptomatic disease. The mean duration of symptoms before operation was 5.6 months (range, 0 to 25 months). Thirteen (31%) patients had active disease and underwent operation for acute presentation or failure of medical management. Thirty-nine patients (93%) had operation for occlusive disease. Twenty-two (52%) patients had involvement of both the great and abdominal aortic branch vessels; 10 (24%) had great vessel disease alone; 9 (21%) had involvement of abdominal arteries; and 1 (2%) had coronary artery disease. There was no operative death, myocardial infarction, major stroke, or renal failure. Three patients had early graft thrombosis, two had a minor stroke, and two developed hyperperfusion syndrome. The median follow-up was 6.7 years (range, 1 month to 19.3 years). Eleven (26%) patients required 15 graft revisions; five of the patients had active disease at the time of initial operation. All early revisions (<1 year) were in patients with active disease. By Kaplan-Meier analysis, freedom from revision at 5 and 10 years was 100% in patients with quiescent disease not requiring steroids (group I, n = 5, 12%), 95% and 81% in patients whose disease was quiescent on steroids (group II, n = 24, 57%), 57% in patients with active disease on steroids (group III, n = 7, 17%), and 33% in patients with active disease and no long-term steroids (group IV, n = 6, 14%) (P < .006). The rate of revision or progression of disease at another site in 5 years was 0% in group 1, 10% in group 2, 57% in group 3, and 67% in group 4 (P < .001) The differences were even more pronounced when an analysis was done on the basis of disease activity alone, irrespective of steroid use. During the follow-up period, 3 of 39 great vessel, 2 of 18 mesenteric/renal, and 1 of 9 aortofemoropopliteal reconstructions occluded. The predicted mortality for patients was 4% at both 5 and 10 years (95% CI) respectively (confidence interval [CI], 0% to 11%) and 10 (CI, 0% to 14%) years, respectively.
CONCLUSIONS
The minority of patients with Takayasu's arteritis require operation. In our predominantly white female patient population, occlusive symptoms were the most common indication for operation. Operation for these selected patients was safe, with no operative mortality, myocardial infarction, major stroke, or renal failure. Patients with active disease requiring operation are more likely to require revision or develop progressive symptomatic disease at another site. Long-term survival is excellent, regardless of disease activity at the time of operation. | null | false | Takayasu's arteritis: operative results and influence of disease activity. OBJECTIVE
To determine the short- and long-term outcomes of patients treated operatively for Takayasu's arteritis and the effect of disease activity on results.
METHODS
Forty-two (17%) of the 251 patients enrolled in our Takayasu's arteritis registry between 1975 and 2002 required operation for symptomatic disease. Data were obtained from the registry, patient records, phone correspondence, and written surveys.
RESULTS
There were 38 females and 4 males with a median age of 29 years (range, 12 to 56 years), and 32 (76%) were white. Sixty operations were performed for symptomatic disease. The mean duration of symptoms before operation was 5.6 months (range, 0 to 25 months). Thirteen (31%) patients had active disease and underwent operation for acute presentation or failure of medical management. Thirty-nine patients (93%) had operation for occlusive disease. Twenty-two (52%) patients had involvement of both the great and abdominal aortic branch vessels; 10 (24%) had great vessel disease alone; 9 (21%) had involvement of abdominal arteries; and 1 (2%) had coronary artery disease. There was no operative death, myocardial infarction, major stroke, or renal failure. Three patients had early graft thrombosis, two had a minor stroke, and two developed hyperperfusion syndrome. The median follow-up was 6.7 years (range, 1 month to 19.3 years). Eleven (26%) patients required 15 graft revisions; five of the patients had active disease at the time of initial operation. All early revisions (<1 year) were in patients with active disease. By Kaplan-Meier analysis, freedom from revision at 5 and 10 years was 100% in patients with quiescent disease not requiring steroids (group I, n = 5, 12%), 95% and 81% in patients whose disease was quiescent on steroids (group II, n = 24, 57%), 57% in patients with active disease on steroids (group III, n = 7, 17%), and 33% in patients with active disease and no long-term steroids (group IV, n = 6, 14%) (P < .006). The rate of revision or progression of disease at another site in 5 years was 0% in group 1, 10% in group 2, 57% in group 3, and 67% in group 4 (P < .001) The differences were even more pronounced when an analysis was done on the basis of disease activity alone, irrespective of steroid use. During the follow-up period, 3 of 39 great vessel, 2 of 18 mesenteric/renal, and 1 of 9 aortofemoropopliteal reconstructions occluded. The predicted mortality for patients was 4% at both 5 and 10 years (95% CI) respectively (confidence interval [CI], 0% to 11%) and 10 (CI, 0% to 14%) years, respectively.
CONCLUSIONS
The minority of patients with Takayasu's arteritis require operation. In our predominantly white female patient population, occlusive symptoms were the most common indication for operation. Operation for these selected patients was safe, with no operative mortality, myocardial infarction, major stroke, or renal failure. Patients with active disease requiring operation are more likely to require revision or develop progressive symptomatic disease at another site. Long-term survival is excellent, regardless of disease activity at the time of operation. |
34,984,774 | D002543:Cerebral Hemorrhage; D020345:Enterocolitis, Necrotizing; D005260:Female; D005315:Fetal Diseases; D006801:Humans; D007231:Infant, Newborn; D000089382:Oxygen Saturation; D012189:Retrospective Studies | [
"D002543",
"D020345",
"D005260",
"D005315",
"D006801",
"D007231",
"D000089382",
"D012189"
] | Intraoperative cerebral oxygen saturation and neurological outcomes following surgical management of necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis. | BACKGROUND
The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis.
METHODS
The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics.
RESULTS
The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1 year: Intraventricular hemorrhage (N = 2) and Periventricular leukomalacia (N = 7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1 year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications.
CONCLUSIONS
Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis. | null | false | Intraoperative cerebral oxygen saturation and neurological outcomes following surgical management of necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis. BACKGROUND
The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis.
METHODS
The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics.
RESULTS
The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1 year: Intraventricular hemorrhage (N = 2) and Periventricular leukomalacia (N = 7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1 year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications.
CONCLUSIONS
Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis. |
27,399,236 | D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006331:Heart Diseases; D006801:Humans; D007239:Infections | [
"D003937",
"D003952",
"D006331",
"D006801",
"D007239"
] | Infectious Diseases of the Heart: Pathophysiology, Clinical and Imaging Overview. | Myriad infectious organisms can infect the endocardium, myocardium, and pericardium, including bacteria, fungi, parasites, and viruses. Significant cardiac infections are rare in the general population but are associated with high morbidity and mortality as well as increased risk in certain populations, such as the elderly, those undergoing cardiac instrumentation, and intravenous drug abusers. Diagnostic imaging of cardiac infections plays an important role despite its variable sensitivity and specificity, which are due in part to the nonspecific manifestations of the central inflammatory process of infection and the time of onset with respect to the time of imaging. The primary imaging modality remains echocardiography. However, cardiac computed tomography and magnetic resonance (MR) imaging have emerged as the modalities of choice wherever available, especially for diagnosis of complex infectious complications including abscesses, infected prosthetic material, central lines and instruments, and the cryptic manifestations of viral and parasitic diseases. MR imaging can provide functional, morphologic, and prognostic value in a single examination by allowing characterization of inflammatory changes from the acute to chronic stages, including edema and the patterns and extent of delayed gadolinium enhancement. We review the heterogeneous and diverse group of cardiac infections based on their site of primary cardiac involvement with emphasis on their cross-sectional imaging manifestations. Online supplemental material is available for this article. (©)RSNA, 2016. | 6,301,458 | true | Infectious Diseases of the Heart: Pathophysiology, Clinical and Imaging Overview. Myriad infectious organisms can infect the endocardium, myocardium, and pericardium, including bacteria, fungi, parasites, and viruses. Significant cardiac infections are rare in the general population but are associated with high morbidity and mortality as well as increased risk in certain populations, such as the elderly, those undergoing cardiac instrumentation, and intravenous drug abusers. Diagnostic imaging of cardiac infections plays an important role despite its variable sensitivity and specificity, which are due in part to the nonspecific manifestations of the central inflammatory process of infection and the time of onset with respect to the time of imaging. The primary imaging modality remains echocardiography. However, cardiac computed tomography and magnetic resonance (MR) imaging have emerged as the modalities of choice wherever available, especially for diagnosis of complex infectious complications including abscesses, infected prosthetic material, central lines and instruments, and the cryptic manifestations of viral and parasitic diseases. MR imaging can provide functional, morphologic, and prognostic value in a single examination by allowing characterization of inflammatory changes from the acute to chronic stages, including edema and the patterns and extent of delayed gadolinium enhancement. We review the heterogeneous and diverse group of cardiac infections based on their site of primary cardiac involvement with emphasis on their cross-sectional imaging manifestations. Online supplemental material is available for this article. (©)RSNA, 2016. |
19,932,262 | D000328:Adult; D000818:Animals; D015415:Biomarkers; D015153:Blotting, Western; D015815:Cell Adhesion Molecules; D004195:Disease Models, Animal; D018450:Disease Progression; D004452:Echocardiography; D004719:Endomyocardial Fibrosis; D005109:Extracellular Matrix; D005786:Gene Expression Regulation; D006333:Heart Failure; D006352:Heart Ventricles; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D007150:Immunohistochemistry; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009206:Myocardium; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012313:RNA; D017725:Ventricular Pressure; D020257:Ventricular Remodeling; D055815:Young Adult | [
"D000328",
"D000818",
"D015415",
"D015153",
"D015815",
"D004195",
"D018450",
"D004452",
"D004719",
"D005109",
"D005786",
"D006333",
"D006352",
"D006801",
"D017379",
"D007150",
"D008297",
"D051379",
"D008810",
"D009206",
"D016133",
"D011379",
"D012313",
"D017725",
"D02... | Periostin is a novel factor in cardiac remodeling after experimental and clinical unloading of the failing heart. | BACKGROUND
Maladaptive left ventricular hypertrophy (LVH) remains a prevalent and highly morbid condition associated with end-stage heart disease. Originally evaluated in the context of bone development, periostin is important in endocardial cushion formation and has recently been implicated in heart failure. Because of its potential role in cardiovascular development, we sought to establish the role of periostin after relief of pressure overload in animal and human models.
METHODS
Pressure overload induction of LVH was performed by minimally invasive aortic arch banding of C57Bl6 mice. Bands were removed 1 month later to allow regression. Cardiac tissue was procured in paired samples of patients receiving LV assist devices (LVAD), with subsequent reanalysis at the time of explant for transplantation.
RESULTS
One week after debanding, heart weight/body weight ratios and echocardiography confirmed decreased LV mass relative to hypertrophied animals. Gene and protein expression of periostin was measured by real-time polymerase chain reaction and Western blot, and was similarly decreased compared with LVH mice. Immunohistochemical localization of periostin showed it was exclusively in the extracellular matrix of the myocardium. The decrease in periostin with pressure relief paralleled changes in interstitial fibrosis observed by picrosirius red staining. Corroborating the murine data, periostin expression was significantly reduced after LVAD-afforded pressure relief in patients.
CONCLUSIONS
Periostin is closely associated with pressure overload-induced LVH and LVH regression in both animal and human models. The magnitude of expression changes and the consistent nature of these changes indicate that periostin may be a mediator of cardiac remodeling. | null | false | Periostin is a novel factor in cardiac remodeling after experimental and clinical unloading of the failing heart. BACKGROUND
Maladaptive left ventricular hypertrophy (LVH) remains a prevalent and highly morbid condition associated with end-stage heart disease. Originally evaluated in the context of bone development, periostin is important in endocardial cushion formation and has recently been implicated in heart failure. Because of its potential role in cardiovascular development, we sought to establish the role of periostin after relief of pressure overload in animal and human models.
METHODS
Pressure overload induction of LVH was performed by minimally invasive aortic arch banding of C57Bl6 mice. Bands were removed 1 month later to allow regression. Cardiac tissue was procured in paired samples of patients receiving LV assist devices (LVAD), with subsequent reanalysis at the time of explant for transplantation.
RESULTS
One week after debanding, heart weight/body weight ratios and echocardiography confirmed decreased LV mass relative to hypertrophied animals. Gene and protein expression of periostin was measured by real-time polymerase chain reaction and Western blot, and was similarly decreased compared with LVH mice. Immunohistochemical localization of periostin showed it was exclusively in the extracellular matrix of the myocardium. The decrease in periostin with pressure relief paralleled changes in interstitial fibrosis observed by picrosirius red staining. Corroborating the murine data, periostin expression was significantly reduced after LVAD-afforded pressure relief in patients.
CONCLUSIONS
Periostin is closely associated with pressure overload-induced LVH and LVH regression in both animal and human models. The magnitude of expression changes and the consistent nature of these changes indicate that periostin may be a mediator of cardiac remodeling. |
26,190,746 | D000700:Analgesics; D001783:Blood Flow Velocity; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005045:Etomidate; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008297:Male; D011667:Pulmonary Veins; D013771:Tetralogy of Fallot | [
"D000700",
"D001783",
"D002675",
"D017548",
"D005045",
"D005260",
"D006439",
"D006801",
"D006993",
"D007649",
"D008297",
"D011667",
"D013771"
] | Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot. | BACKGROUND
Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF.
METHODS
Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration).
RESULTS
Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate.
CONCLUSIONS
Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis. | null | false | Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot. BACKGROUND
Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF.
METHODS
Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration).
RESULTS
Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate.
CONCLUSIONS
Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis. |
26,694,693 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D023921:Coronary Stenosis; D003331:Coronary Vessels; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed | [
"D000328",
"D000368",
"D000369",
"D017023",
"D023921",
"D003331",
"D004562",
"D005260",
"D005500",
"D006801",
"D015994",
"D008297",
"D008875",
"D011237",
"D012372",
"D056910",
"D012189",
"D018570",
"D012307",
"D015996",
"D013997",
"D014057"
] | Early repolarization is associated with significant coronary artery stenosis in asymptomatic adults. | The aim of our study was to investigate the relationship between early repolarization (ERP) and coronary heart disease (CHD) by evaluating its association with coronary artery stenosis and plaques. Consecutive asymptomatic adults aged 30 or more without CHD were investigated (n = 3100). Adjusting for major cardiovascular risk factors, ERP was significantly associated with significant coronary stenosis with incremental predictive value (aOR 1.71, 95% CI 1.13-2.60; ROC AUC 0.763 vs. 0.723, P < 0.001; NRI 4.86%, P = 0.042; IDI 0.0030, P = 0.040), specifically in intermediate risk group (aOR 2.33, 95% CI 1.29-4.20; ROC AUC 0.753 vs. 0.708, P = 0.001). ERP was shown to be especially associated with significant coronary stenosis with non-calcified plaque (aOR 2.26, 95% CI 1.28-3.98). Our study is the first to directly show the association of ERP with CHD. Future studies are needed to replicate our results and investigate whether it would be beneficial to include ERP in risk algorithms for CHD screening. | 7,906,299 | true | Early repolarization is associated with significant coronary artery stenosis in asymptomatic adults. The aim of our study was to investigate the relationship between early repolarization (ERP) and coronary heart disease (CHD) by evaluating its association with coronary artery stenosis and plaques. Consecutive asymptomatic adults aged 30 or more without CHD were investigated (n = 3100). Adjusting for major cardiovascular risk factors, ERP was significantly associated with significant coronary stenosis with incremental predictive value (aOR 1.71, 95% CI 1.13-2.60; ROC AUC 0.763 vs. 0.723, P < 0.001; NRI 4.86%, P = 0.042; IDI 0.0030, P = 0.040), specifically in intermediate risk group (aOR 2.33, 95% CI 1.29-4.20; ROC AUC 0.753 vs. 0.708, P = 0.001). ERP was shown to be especially associated with significant coronary stenosis with non-calcified plaque (aOR 2.26, 95% CI 1.28-3.98). Our study is the first to directly show the association of ERP with CHD. Future studies are needed to replicate our results and investigate whether it would be beneficial to include ERP in risk algorithms for CHD screening. |
380,605 | D000208:Acute Disease; D003327:Coronary Disease; D003331:Coronary Vessels; D006801:Humans; D009203:Myocardial Infarction; D010974:Platelet Aggregation; D013035:Spasm; D013315:Stress, Psychological; D014661:Vasoconstriction; D014664:Vasodilation | [
"D000208",
"D003327",
"D003331",
"D006801",
"D009203",
"D010974",
"D013035",
"D013315",
"D014661",
"D014664"
] | Coronary artery vasospasm: the likely immediated cause of acute myocardial infarction. | Features of infarction can be divided into two types--the spasmodic and the mechanical. The former (pre-infarct angina and emotional factors in infarction) seem readily explainable by spasm, and are similar to the findings in angina which prompted Heberden to consider angina as spasmodic. The mechanical features of infarction (association with thrombosis and arteriosclerosis, and severe and unremitting chest pain) seem to be the antithesis of spasm and probably account for the reluctance to consider spasm seriously in infarction. The injury-vasospasm hypothesis of acute myocardial infarction explains both spasmodic and mechanical features. Spasm represents a dominance of vasoconstricting over vasodilating forces. Coronary sclerosis can result in both ischaemia (vasodilating) and ischaemic injury-spasm (vasoconstricting). The fight-flight component of the autonomic nervous system is considered to be vasodilating, and the conservation-withdrawal portion to be vasoconstricting. Once spasm occurs, a new balance of forces obtains which can lead either to vasodilatation and relief of symptoms or to infarction. | 14,889,175 | true | Coronary artery vasospasm: the likely immediated cause of acute myocardial infarction. Features of infarction can be divided into two types--the spasmodic and the mechanical. The former (pre-infarct angina and emotional factors in infarction) seem readily explainable by spasm, and are similar to the findings in angina which prompted Heberden to consider angina as spasmodic. The mechanical features of infarction (association with thrombosis and arteriosclerosis, and severe and unremitting chest pain) seem to be the antithesis of spasm and probably account for the reluctance to consider spasm seriously in infarction. The injury-vasospasm hypothesis of acute myocardial infarction explains both spasmodic and mechanical features. Spasm represents a dominance of vasoconstricting over vasodilating forces. Coronary sclerosis can result in both ischaemia (vasodilating) and ischaemic injury-spasm (vasoconstricting). The fight-flight component of the autonomic nervous system is considered to be vasodilating, and the conservation-withdrawal portion to be vasoconstricting. Once spasm occurs, a new balance of forces obtains which can lead either to vasodilatation and relief of symptoms or to infarction. |
28,273,737 | D054058:Acute Coronary Syndrome; D020099:Coated Materials, Biocompatible; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents; D008297:Male; D008875:Middle Aged; D058426:Neointima; D014025:Titanium; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome | [
"D054058",
"D020099",
"D054855",
"D000068338",
"D005260",
"D005500",
"D006801",
"D007166",
"D008297",
"D008875",
"D058426",
"D014025",
"D041623",
"D016896"
] | Optical coherence tomography follow-up 18 months after titanium-nitride-oxide-coated versus everolimus-eluting stent implantation in patients with acute coronary syndrome. | Background Inadequate neointimal coverage of stent struts is associated with late stent thrombosis. Purpose To demonstrate the extent of neointimal coverage and strut malapposition in titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) by optical coherence tomography (OCT) performed at 18-month follow-up. Material and Methods In the BASE-ACS trial, 827 patients presenting with acute coronary syndrome were randomized to receive either BAS or EES. Forty patients (20 BAS, 20 EES) underwent OCT at 18-month follow-up for evaluation of stent strut coverage, malapposition, and neointimal hyperplasia (NIH). Primary endpoint was binary stent strut coverage (ratio of covered struts to all analyzed struts multiplied by 100). Co-primary endpoint was the percentage of malapposed struts. Results We analyzed 3465 struts in 330 cross-sections of BAS and 3327 struts in 316 cross-sections of EES. Binary stent strut coverage, based on strut-level analysis, was higher with BAS versus EES (99.5% versus 94.2%, respectively; P < 0.001), the strut-level percentage of malapposed struts was lower with BAS (0.6% versus 2.5%, respectively; P < 0.001). Yet, the mean NIH thickness was greater with BAS (237 ± 125 versus 108 ± 62 µm, respectively; P < 0.001). Conclusion In the current post-hoc analysis with OCT performed at 18 months, binary strut coverage, based on strut-level analysis, was higher with BAS versus EES; strut-level malapposed struts were fewer with BAS; yet, BAS induced thicker NIH. | 1,626,424 | true | Optical coherence tomography follow-up 18 months after titanium-nitride-oxide-coated versus everolimus-eluting stent implantation in patients with acute coronary syndrome. Background Inadequate neointimal coverage of stent struts is associated with late stent thrombosis. Purpose To demonstrate the extent of neointimal coverage and strut malapposition in titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) by optical coherence tomography (OCT) performed at 18-month follow-up. Material and Methods In the BASE-ACS trial, 827 patients presenting with acute coronary syndrome were randomized to receive either BAS or EES. Forty patients (20 BAS, 20 EES) underwent OCT at 18-month follow-up for evaluation of stent strut coverage, malapposition, and neointimal hyperplasia (NIH). Primary endpoint was binary stent strut coverage (ratio of covered struts to all analyzed struts multiplied by 100). Co-primary endpoint was the percentage of malapposed struts. Results We analyzed 3465 struts in 330 cross-sections of BAS and 3327 struts in 316 cross-sections of EES. Binary stent strut coverage, based on strut-level analysis, was higher with BAS versus EES (99.5% versus 94.2%, respectively; P < 0.001), the strut-level percentage of malapposed struts was lower with BAS (0.6% versus 2.5%, respectively; P < 0.001). Yet, the mean NIH thickness was greater with BAS (237 ± 125 versus 108 ± 62 µm, respectively; P < 0.001). Conclusion In the current post-hoc analysis with OCT performed at 18 months, binary strut coverage, based on strut-level analysis, was higher with BAS versus EES; strut-level malapposed struts were fewer with BAS; yet, BAS induced thicker NIH. |
10,836,365 | D000208:Acute Disease; D000328:Adult; D004351:Drug Resistance; D005165:Factor V; D005260:Female; D005838:Genotype; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011486:Protein C; D012079:Renal Circulation; D012307:Risk Factors; D013927:Thrombosis; D014652:Vascular Diseases | [
"D000208",
"D000328",
"D004351",
"D005165",
"D005260",
"D005838",
"D006084",
"D006801",
"D016030",
"D008297",
"D008875",
"D015995",
"D011379",
"D011486",
"D012079",
"D012307",
"D013927",
"D014652"
] | Factor V R506Q mutation (activated protein C resistance) is an additional risk factor for early renal graft loss associated with acute vascular rejection. | BACKGROUND
The factor V R506Q mutation (FV R506Q, FV:Q506, or FV Leiden) resulting in activated protein C (APC) resistance is the most common inherited risk factor for venous thrombosis, including in renal transplant recipients. We investigated a possible association between the FV mutation and early renal graft loss, and the prevalence of macro- and microvascular thrombosis, endothelialitis, and fibrinoid vascular necrosis by FV genotype.
METHODS
One hundred and nine renal allograft recipients were genotyped for FV mutation. A vascular rejection subgroup of patients (n=29) had experienced at least one episode of vascular rejection, or graft thrombosis. A second group of patients (n=80) had experienced no acute rejection and retained a well-functioning graft.
RESULTS
The prevalence of APC resistance was numerically but not statistically significantly higher in the vascular rejection group (17.2%) compared with the group without rejection episodes (7.5%) (P=0.16). There was a significant association between the presence or absence of FV mutation and graft survival, with a 55.6% 1-year graft survival rate versus a 76.4% rate, respectively (P=0.02). The prevalence of vascular rejection, as evidenced by endothelialitis or fibrinoid vascular necrosis, was significantly associated with APC resistance but macro- or microvascular thrombosis were not.
CONCLUSIONS
Renal transplant recipients who are carriers of the FV:Q506 allele have an increased risk of early graft loss. Vascular rejection changes including endothelialitis and fibrinoid vascular necrosis were more common in this group, and therefore an association between the hypercoagulable state, which entails an up-regulation of the mitogenic and proinflammatory enzyme thrombin, and the immunological challenge to the endothelium may be the cause of inferior prognosis in these patients. | null | false | Factor V R506Q mutation (activated protein C resistance) is an additional risk factor for early renal graft loss associated with acute vascular rejection. BACKGROUND
The factor V R506Q mutation (FV R506Q, FV:Q506, or FV Leiden) resulting in activated protein C (APC) resistance is the most common inherited risk factor for venous thrombosis, including in renal transplant recipients. We investigated a possible association between the FV mutation and early renal graft loss, and the prevalence of macro- and microvascular thrombosis, endothelialitis, and fibrinoid vascular necrosis by FV genotype.
METHODS
One hundred and nine renal allograft recipients were genotyped for FV mutation. A vascular rejection subgroup of patients (n=29) had experienced at least one episode of vascular rejection, or graft thrombosis. A second group of patients (n=80) had experienced no acute rejection and retained a well-functioning graft.
RESULTS
The prevalence of APC resistance was numerically but not statistically significantly higher in the vascular rejection group (17.2%) compared with the group without rejection episodes (7.5%) (P=0.16). There was a significant association between the presence or absence of FV mutation and graft survival, with a 55.6% 1-year graft survival rate versus a 76.4% rate, respectively (P=0.02). The prevalence of vascular rejection, as evidenced by endothelialitis or fibrinoid vascular necrosis, was significantly associated with APC resistance but macro- or microvascular thrombosis were not.
CONCLUSIONS
Renal transplant recipients who are carriers of the FV:Q506 allele have an increased risk of early graft loss. Vascular rejection changes including endothelialitis and fibrinoid vascular necrosis were more common in this group, and therefore an association between the hypercoagulable state, which entails an up-regulation of the mitogenic and proinflammatory enzyme thrombin, and the immunological challenge to the endothelium may be the cause of inferior prognosis in these patients. |
6,204,149 | D000328:Adult; D000368:Aged; D001794:Blood Pressure; D004032:Diet; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D011188:Potassium; D011189:Potassium Chloride; D011897:Random Allocation; D012964:Sodium | [
"D000328",
"D000368",
"D001794",
"D004032",
"D005260",
"D006801",
"D006973",
"D008297",
"D008875",
"D011188",
"D011189",
"D011897",
"D012964"
] | Does increasing potassium intake lower blood pressure in essential hypertension? | Twenty-three unselected patients with mild to moderate essential hypertension whose average supine blood pressure after 2 months of observation on no treatment was 154/99 mm Hg were entered into an 8-week double-blind randomised crossover study of 1 month's treatment with slow release potassium tablets (64 mmol/day) versus placebo without alteration of dietary sodium or potassium intake. By the fourth week mean supine blood pressure had fallen by 4% with potassium supplementation compared with placebo. In a separate metabolic study the effect of 12 slow release potassium tablets (98 mmol/day) was studied in 12 patients with mild essential hypertension who had a fixed sodium and potassium intake. The increase in potassium intake caused immediate natriuresis with an average cumulative sodium loss of 110 mmol per patient. In spite of this loss of sodium there was no rise in plasma renin activity, but there was a significant increase in plasma noradrenaline level. On an average western diet containing approximately 150 mmol of sodium/day, potassium chloride supplementation causes a small but worthwhile fall in blood pressure in many patients with essential hypertension. It is likely that part of the mechanism of this fall in blood pressure is related to the increase in potassium intake causing a loss of sodium with no compensatory rise in renin release. | 9,520,902 | true | Does increasing potassium intake lower blood pressure in essential hypertension? Twenty-three unselected patients with mild to moderate essential hypertension whose average supine blood pressure after 2 months of observation on no treatment was 154/99 mm Hg were entered into an 8-week double-blind randomised crossover study of 1 month's treatment with slow release potassium tablets (64 mmol/day) versus placebo without alteration of dietary sodium or potassium intake. By the fourth week mean supine blood pressure had fallen by 4% with potassium supplementation compared with placebo. In a separate metabolic study the effect of 12 slow release potassium tablets (98 mmol/day) was studied in 12 patients with mild essential hypertension who had a fixed sodium and potassium intake. The increase in potassium intake caused immediate natriuresis with an average cumulative sodium loss of 110 mmol per patient. In spite of this loss of sodium there was no rise in plasma renin activity, but there was a significant increase in plasma noradrenaline level. On an average western diet containing approximately 150 mmol of sodium/day, potassium chloride supplementation causes a small but worthwhile fall in blood pressure in many patients with essential hypertension. It is likely that part of the mechanism of this fall in blood pressure is related to the increase in potassium intake causing a loss of sodium with no compensatory rise in renin release. |
24,185,038 | D055109:Ankle Brachial Index; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease; D058226:Plaque, Atherosclerotic; D014057:Tomography, X-Ray Computed | [
"D055109",
"D017023",
"D003324",
"D005260",
"D006801",
"D035002",
"D008297",
"D008875",
"D058729",
"D058226",
"D014057"
] | Computed tomography characteristics of coronary artery atherosclerosis in subjects with lower extremity peripheral artery disease and no cardiac symptoms. | BACKGROUND
Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower‑extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated.
OBJECTIVE
The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower‑extremity PAD and no cardiac symptoms.
METHODS
Sixty‑five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower‑extremity PAD and no cardiac symptoms underwent CTCA.
RESULTS
CTCA revealed CAD in 56 subjects. Twenty‑two had obstructive CAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty‑six individuals demonstrated abnormal carotid artery intima-media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049).
CONCLUSIONS
CTCA may be effective to detect CAD in subjects with lower‑extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high‑risk coronary artery plaques. | null | false | Computed tomography characteristics of coronary artery atherosclerosis in subjects with lower extremity peripheral artery disease and no cardiac symptoms. BACKGROUND
Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower‑extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated.
OBJECTIVE
The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower‑extremity PAD and no cardiac symptoms.
METHODS
Sixty‑five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower‑extremity PAD and no cardiac symptoms underwent CTCA.
RESULTS
CTCA revealed CAD in 56 subjects. Twenty‑two had obstructive CAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty‑six individuals demonstrated abnormal carotid artery intima-media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049).
CONCLUSIONS
CTCA may be effective to detect CAD in subjects with lower‑extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high‑risk coronary artery plaques. |
19,150,317 | D006502:Budd-Chiari Syndrome; D006801:Humans; D008103:Liver Cirrhosis; D011169:Portal Vein; D012307:Risk Factors; D020246:Venous Thrombosis | [
"D006502",
"D006801",
"D008103",
"D011169",
"D012307",
"D020246"
] | Portal vein thrombosis and budd-Chiari syndrome. | Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management. | 129,450 | true | Portal vein thrombosis and budd-Chiari syndrome. Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management. |
19,150,317 | D006502:Budd-Chiari Syndrome; D006801:Humans; D008103:Liver Cirrhosis; D011169:Portal Vein; D012307:Risk Factors; D020246:Venous Thrombosis | [
"D006502",
"D006801",
"D008103",
"D011169",
"D012307",
"D020246"
] | Portal vein thrombosis and budd-Chiari syndrome. | Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management. | 3,047,663 | true | Portal vein thrombosis and budd-Chiari syndrome. Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management. |
20,023,546 | D000792:Angiography; D000818:Animals; D001488:Basilar Artery; D000242:Cyclic AMP; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D007269:Injections, Intra-Arterial; D008297:Male; D020105:Milrinone; D009119:Muscle Contraction; D009131:Muscle, Smooth, Vascular; D010726:Phosphodiesterase Inhibitors; D013345:Subarachnoid Hemorrhage; D013997:Time Factors; D014664:Vasodilation; D020301:Vasospasm, Intracranial | [
"D000792",
"D000818",
"D001488",
"D000242",
"D004195",
"D004285",
"D005260",
"D007269",
"D008297",
"D020105",
"D009119",
"D009131",
"D010726",
"D013345",
"D013997",
"D014664",
"D020301"
] | Effect of vasodilation by milrinone, a phosphodiesterase III inhibitor, on vasospastic arteries after a subarachnoid hemorrhage in vitro and in vivo: effectiveness of cisternal injection of milrinone. | OBJECTIVE
Cerebral vasospasm remains a major cause of morbidity and mortality. Milrinone, a bipyridine phosphodiesterase III inhibitor, is a potent member of the inodilator class of cardiac agents for vasospasm and is injected intra-arterially or intracisternally. There have been no studies investigating the duration of action (context-sensitive half-life) of milrinone for vasospasm or the most effective route of administration (intra-arterial versus intracisternal). We examined the effects of intracisternal and intra-arterial injection of milrinone on chronic cerebral vasospasm in dogs.
METHODS
A double-hemorrhage canine model was used. In a preliminary isometric tension study of canine vasospastic basilar arteries, the vasodilatory effects of milrinone were examined 7 days after an initial injection of blood. Milrinone was injected intracisternally (0.1 mg, 0.47 mmol/L) or intra-arterially (0.3 mg/kg, 1.2 mmol/L), and angiograms were performed 30, 60, 120, 180, 240, 300, and 360 minutes later on day 7.
RESULTS
Milrinone produced concentration-dependent vasodilation and was effective intracisternally, resulting in significant dilation until 180 minutes after injection and a tendency for dilation until 240 minutes. The effect of intra-arterial injection was not as significant compared with an intracisternal injection, resulting in significant dilation only at 180 minutes after intra-arterial injection.
CONCLUSIONS
Intracisternal injection of milrinone was more effective than intra-arterial injection for chronic cerebral vasospasm in dogs because intracisternal injection produced a higher concentration in vasospastic arteries (0.034-0.068 mmol/L intracisternally versus 0.016 mmol/L intra-arterially). | null | false | Effect of vasodilation by milrinone, a phosphodiesterase III inhibitor, on vasospastic arteries after a subarachnoid hemorrhage in vitro and in vivo: effectiveness of cisternal injection of milrinone. OBJECTIVE
Cerebral vasospasm remains a major cause of morbidity and mortality. Milrinone, a bipyridine phosphodiesterase III inhibitor, is a potent member of the inodilator class of cardiac agents for vasospasm and is injected intra-arterially or intracisternally. There have been no studies investigating the duration of action (context-sensitive half-life) of milrinone for vasospasm or the most effective route of administration (intra-arterial versus intracisternal). We examined the effects of intracisternal and intra-arterial injection of milrinone on chronic cerebral vasospasm in dogs.
METHODS
A double-hemorrhage canine model was used. In a preliminary isometric tension study of canine vasospastic basilar arteries, the vasodilatory effects of milrinone were examined 7 days after an initial injection of blood. Milrinone was injected intracisternally (0.1 mg, 0.47 mmol/L) or intra-arterially (0.3 mg/kg, 1.2 mmol/L), and angiograms were performed 30, 60, 120, 180, 240, 300, and 360 minutes later on day 7.
RESULTS
Milrinone produced concentration-dependent vasodilation and was effective intracisternally, resulting in significant dilation until 180 minutes after injection and a tendency for dilation until 240 minutes. The effect of intra-arterial injection was not as significant compared with an intracisternal injection, resulting in significant dilation only at 180 minutes after intra-arterial injection.
CONCLUSIONS
Intracisternal injection of milrinone was more effective than intra-arterial injection for chronic cerebral vasospasm in dogs because intracisternal injection produced a higher concentration in vasospastic arteries (0.034-0.068 mmol/L intracisternally versus 0.016 mmol/L intra-arterially). |
23,258,507 | D001165:Arteriovenous Malformations; D019468:Disease Management; D006801:Humans; D011183:Postoperative Complications; D016634:Radiosurgery | [
"D001165",
"D019468",
"D006801",
"D011183",
"D016634"
] | Targeting and conformality in arteriovenous malformation radiosurgery. | The struggle to achieve a high degree of conformity around targets of complex morphology has been one of the driving forces in the development of ever more sophisticated radiosurgical devices and intricate treatment delivery. Rarely are radiosurgical targets more complex in shape than those associated with arteriovenous malformations (AVMs). In this report we examine theoretical and practical issues of target delineation and creation of conformal AVM treatment plans, and comment on the concepts of gradient and homogeneity. | 10,422,107 | true | Targeting and conformality in arteriovenous malformation radiosurgery. The struggle to achieve a high degree of conformity around targets of complex morphology has been one of the driving forces in the development of ever more sophisticated radiosurgical devices and intricate treatment delivery. Rarely are radiosurgical targets more complex in shape than those associated with arteriovenous malformations (AVMs). In this report we examine theoretical and practical issues of target delineation and creation of conformal AVM treatment plans, and comment on the concepts of gradient and homogeneity. |
31,075,471 | D000328:Adult; D017541:Aneurysm, False; D017544:Aortic Aneurysm, Abdominal; D001019:Aortic Rupture; D001528:Behcet Syndrome; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents; D015607:Stents; D016896:Treatment Outcome | [
"D000328",
"D017541",
"D017544",
"D001019",
"D001528",
"D004621",
"D057510",
"D005260",
"D006801",
"D007166",
"D015607",
"D016896"
] | Multiple Overlapping Stent Implantation Combined with Coil Embolization for a Suprarenal Aortic Pseudoaneurysm with Impending Rupture in a Patient with Behçet's Disease. | Behçet's disease is an autoimmune vasculitis, which mainly manifests as aneurysm when arteries are involved. Treatments including graft interposition or stent-graft implantation are best performed after active inflammation subsides, otherwise there will be complications such as anastomotic pseudoaneurysms and graft occlusion. We report the treatment of a suprarenal abdominal aortic pseudoaneurysm in a patient with Behçet's disease via multiple overlapping stent implantation combined with coil embolization which was performed in a subacute fashion because of impending rupture of the pseudoaneurysm. She was maintained on long-term immunosuppressive therapy and remained symptom free at 2-year follow-up. | 12,412,204 | true | Multiple Overlapping Stent Implantation Combined with Coil Embolization for a Suprarenal Aortic Pseudoaneurysm with Impending Rupture in a Patient with Behçet's Disease. Behçet's disease is an autoimmune vasculitis, which mainly manifests as aneurysm when arteries are involved. Treatments including graft interposition or stent-graft implantation are best performed after active inflammation subsides, otherwise there will be complications such as anastomotic pseudoaneurysms and graft occlusion. We report the treatment of a suprarenal abdominal aortic pseudoaneurysm in a patient with Behçet's disease via multiple overlapping stent implantation combined with coil embolization which was performed in a subacute fashion because of impending rupture of the pseudoaneurysm. She was maintained on long-term immunosuppressive therapy and remained symptom free at 2-year follow-up. |
2,134,030 | D001161:Arteriosclerosis; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D006801:Humans; D066298:In Vitro Techniques; D016491:Peripheral Vascular Diseases; D013525:Surgical Instruments | [
"D001161",
"D004867",
"D005069",
"D006801",
"D066298",
"D016491",
"D013525"
] | Peripheral atherectomy: experimental results with a new device. | The size of present rotational atherectomy devices is limited in part by a tendency to produce vessel torsion. The authors designed and investigated a large-bore rotational atherectomy device for peripheral atherectomy in a single pass without significant torsion. A plaque was retrieved from 36 of 40 cadaveric iliac arteries. The mean plaque size was 8.4 x 3.9 mm, and the average number retrieved per artery was two. Thirty of 34 severely calcified arteries were treated successfully. Effluent study revealed no distal embolization; however, six perforations and four dissections occurred. Preliminary results suggest that a cutting surface with a relatively large diameter can be designed to be effective without producing vessel torsion. Changes in future designs will include added flexibility and expandable cutting surfaces to enhance safety and minimize entry diameter. | 6,079,197 | true | Peripheral atherectomy: experimental results with a new device. The size of present rotational atherectomy devices is limited in part by a tendency to produce vessel torsion. The authors designed and investigated a large-bore rotational atherectomy device for peripheral atherectomy in a single pass without significant torsion. A plaque was retrieved from 36 of 40 cadaveric iliac arteries. The mean plaque size was 8.4 x 3.9 mm, and the average number retrieved per artery was two. Thirty of 34 severely calcified arteries were treated successfully. Effluent study revealed no distal embolization; however, six perforations and four dissections occurred. Preliminary results suggest that a cutting surface with a relatively large diameter can be designed to be effective without producing vessel torsion. Changes in future designs will include added flexibility and expandable cutting surfaces to enhance safety and minimize entry diameter. |
3,876,020 | D000792:Angiography; D001165:Arteriovenous Malformations; D003082:Colectomy; D003106:Colon; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D008875:Middle Aged; D013671:Technetium Tc 99m Sulfur Colloid | [
"D000792",
"D001165",
"D003082",
"D003106",
"D003113",
"D003937",
"D004239",
"D006471",
"D006801",
"D008875",
"D013671"
] | Colonic angiodysplasia and blood loss. | Colonic angiodysplasia is now recognized as a frequent cause of gastrointestinal bleeding in patients over age 55. These microvascular arteriovenous malformations may be as common a cause of colonic bleeding as diverticular disease. The lesions are not evident on barium studies. Even colonoscopy and selective colonic angiography can give false-negative results. Therefore, repeated studies for recurrent episodes of bleeding are often necessary before the diagnosis is made. Methods of treatment include coagulation biopsy, segmental colon resection and right hemicolectomy. | 2,057,957 | true | Colonic angiodysplasia and blood loss. Colonic angiodysplasia is now recognized as a frequent cause of gastrointestinal bleeding in patients over age 55. These microvascular arteriovenous malformations may be as common a cause of colonic bleeding as diverticular disease. The lesions are not evident on barium studies. Even colonoscopy and selective colonic angiography can give false-negative results. Therefore, repeated studies for recurrent episodes of bleeding are often necessary before the diagnosis is made. Methods of treatment include coagulation biopsy, segmental colon resection and right hemicolectomy. |
14,694,786 | D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D019072:Antibiotic Prophylaxis; D016470:Bacteremia; D004535:Ehlers-Danlos Syndrome; D006471:Gastrointestinal Hemorrhage; D005817:Genetic Counseling; D006801:Humans; D027425:Multidrug Resistance-Associated Proteins; D010375:Pedigree; D011561:Pseudoxanthoma Elasticum; D012307:Risk Factors; D012421:Rupture; D013683:Telangiectasia, Hereditary Hemorrhagic | [
"D000293",
"D000328",
"D017668",
"D019072",
"D016470",
"D004535",
"D006471",
"D005817",
"D006801",
"D027425",
"D010375",
"D011561",
"D012307",
"D012421",
"D013683"
] | [Mendelian arterial diseases. Pseudoxanthoma elasticum, Ehlers-Danlos vascular syndrome, Rendu-Osler disease]. | Understanding the features of the various hereditary vascular pathologies allows consideration and confirmation of the diagnosis, and a search for treatable hidden disorders, avoiding harmful investigations, initiating follow up, performing family investigations and providing genetic counselling. Pseudoxanthoma elasticum must be considered in the presence of calcified distal arteriopathy of the lower limbs in a young subject without any other aetiological aspects. Cutaneous or mucosal lesions confirmed on histological examination, angioid streaks at the back of the eye and a family history support the diagnosis, which is confirmed by showing pathogenic mutations of the ABCC6 gene. It is then important to search for a peripheral disorder in other arterial territory, a low grade coronaropathy, hypertension and an endocardial disorder. Prescription of antithrombotics must be made carefully because of the risk of gastro-intestinal haemorrhage. Vascular Ehlers-Danlos syndrome is suspected in a subject less than 30 years old with diffuse aneurysmal disease, spontaneous arterial rupture or dissection, a carotido-cavernous fistula or early onset varices. Demonstrating an ecchymotic tendency or an acrogeric morphology, especially in a familial context, warrants cutaneous biopsy for anatomopathological examination and fibroblast culture for a study of the C0L3A1 gene. When the diagnosis is suggested, it is advisable to prohibit any arterial puncture, cold surgery or gastro-intestinal endoscopy. The search for aneurysmal lesions must be performed by non-invasive imaging. The therapeutic management requires specialised teams. The combination of repeated epistaxis, muco-cutaneous telangectasia and similar characteristics in a family suggests the diagnosis of Osler-Weber-Rendu disease. The search for iron deficiency, gastro-intestinal bleeds and pulmonary, hepatic or cerebral arterio-venous malformations is then necessary. Besides skilled endovascular management when indicated, it is important to advise every patient with a pulmonary arterio-venous malformation to take antibiotic prophylaxis against cerebral abscess in situations at risk of bacteraemia. | null | false | [Mendelian arterial diseases. Pseudoxanthoma elasticum, Ehlers-Danlos vascular syndrome, Rendu-Osler disease]. Understanding the features of the various hereditary vascular pathologies allows consideration and confirmation of the diagnosis, and a search for treatable hidden disorders, avoiding harmful investigations, initiating follow up, performing family investigations and providing genetic counselling. Pseudoxanthoma elasticum must be considered in the presence of calcified distal arteriopathy of the lower limbs in a young subject without any other aetiological aspects. Cutaneous or mucosal lesions confirmed on histological examination, angioid streaks at the back of the eye and a family history support the diagnosis, which is confirmed by showing pathogenic mutations of the ABCC6 gene. It is then important to search for a peripheral disorder in other arterial territory, a low grade coronaropathy, hypertension and an endocardial disorder. Prescription of antithrombotics must be made carefully because of the risk of gastro-intestinal haemorrhage. Vascular Ehlers-Danlos syndrome is suspected in a subject less than 30 years old with diffuse aneurysmal disease, spontaneous arterial rupture or dissection, a carotido-cavernous fistula or early onset varices. Demonstrating an ecchymotic tendency or an acrogeric morphology, especially in a familial context, warrants cutaneous biopsy for anatomopathological examination and fibroblast culture for a study of the C0L3A1 gene. When the diagnosis is suggested, it is advisable to prohibit any arterial puncture, cold surgery or gastro-intestinal endoscopy. The search for aneurysmal lesions must be performed by non-invasive imaging. The therapeutic management requires specialised teams. The combination of repeated epistaxis, muco-cutaneous telangectasia and similar characteristics in a family suggests the diagnosis of Osler-Weber-Rendu disease. The search for iron deficiency, gastro-intestinal bleeds and pulmonary, hepatic or cerebral arterio-venous malformations is then necessary. Besides skilled endovascular management when indicated, it is important to advise every patient with a pulmonary arterio-venous malformation to take antibiotic prophylaxis against cerebral abscess in situations at risk of bacteraemia. |
2,639,939 | D000818:Animals; D003782:Dental Pulp; D004285:Dogs; D004558:Electric Stimulation; D006940:Hyperemia; D007834:Lasers; D008340:Mandibular Nerve; D008833:Microcirculation; D014665:Vasodilator Agents; D014666:Vasomotor System | [
"D000818",
"D003782",
"D004285",
"D004558",
"D006940",
"D007834",
"D008340",
"D008833",
"D014665",
"D014666"
] | Direct pharmacological action of vasoactive substances on pulpal blood flow: an analysis and critique. | An adequate blood supply to the dental pulp is essential to the health of the tooth; therefore, there have been a number of efforts to study pulpal blood flow and the factors which influence it. However, blood flow to the dental pulp is relatively inaccessible and apparently quite low. Consequently, it is difficult to obtain accurate flow measurements, partly owing to methodological difficulties with the small size of the tissue and its enclosure within rigid walls. In this study, the effects of locally applied vasoactive substances and their specific antagonists on pulpal blood flow have been examined by laser Doppler flowmetry. It is the purpose of this article to examine, in-depth, the involvement of endogenous vasoactive substances in the regulatory mechanism of blood flow within the dental pulp and expand our knowledge of pulpal microcirculatory hemodynamics. | 13,411,615 | true | Direct pharmacological action of vasoactive substances on pulpal blood flow: an analysis and critique. An adequate blood supply to the dental pulp is essential to the health of the tooth; therefore, there have been a number of efforts to study pulpal blood flow and the factors which influence it. However, blood flow to the dental pulp is relatively inaccessible and apparently quite low. Consequently, it is difficult to obtain accurate flow measurements, partly owing to methodological difficulties with the small size of the tissue and its enclosure within rigid walls. In this study, the effects of locally applied vasoactive substances and their specific antagonists on pulpal blood flow have been examined by laser Doppler flowmetry. It is the purpose of this article to examine, in-depth, the involvement of endogenous vasoactive substances in the regulatory mechanism of blood flow within the dental pulp and expand our knowledge of pulpal microcirculatory hemodynamics. |
17,016,681 | D001281:Atrial Fibrillation; D017115:Catheter Ablation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D013617:Tachycardia, Supraventricular; D016896:Treatment Outcome | [
"D001281",
"D017115",
"D006801",
"D008297",
"D008875",
"D011667",
"D013617",
"D016896"
] | Dual mechanisms underlying pulmonary vein tachycardias in a patient with paroxysmal atrial fibrillation. | We report a case of a 46-year-old man with paroxysmal atrial fibrillation who underwent pulmonary vein isolation. After a complete isolation of each pulmonary vein was performed, two different types of pulmonary vein tachycardia appeared: a regular tachycardia in the left inferior pulmonary vein with a supposed reentrant mechanism, and an irregular tachycardia in the right superior PV showing a nonreentrant character. | 14,357,812 | true | Dual mechanisms underlying pulmonary vein tachycardias in a patient with paroxysmal atrial fibrillation. We report a case of a 46-year-old man with paroxysmal atrial fibrillation who underwent pulmonary vein isolation. After a complete isolation of each pulmonary vein was performed, two different types of pulmonary vein tachycardia appeared: a regular tachycardia in the left inferior pulmonary vein with a supposed reentrant mechanism, and an irregular tachycardia in the right superior PV showing a nonreentrant character. |
36,852,954 | D000328:Adult; D000818:Animals; D006801:Humans; D000368:Aged; D009223:Myotonic Dystrophy; D002311:Cardiomyopathy, Dilated; D006321:Heart; D035683:MicroRNAs; D004330:Drosophila | [
"D000328",
"D000818",
"D006801",
"D000368",
"D009223",
"D002311",
"D006321",
"D035683",
"D004330"
] | Deregulations of miR-1 and its target Multiplexin promote dilated cardiomyopathy associated with myotonic dystrophy type 1. | Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy in adults. It is caused by the excessive expansion of noncoding CTG repeats, which when transcribed affects the functions of RNA-binding factors with adverse effects on alternative splicing, processing, and stability of a large set of muscular and cardiac transcripts. Among these effects, inefficient processing and down-regulation of muscle- and heart-specific miRNA, miR-1, have been reported in DM1 patients, but the impact of reduced miR-1 on DM1 pathogenesis has been unknown. Here, we use Drosophila DM1 models to explore the role of miR-1 in cardiac dysfunction in DM1. We show that miR-1 down-regulation in the heart leads to dilated cardiomyopathy (DCM), a DM1-associated phenotype. We combined in silico screening for miR-1 targets with transcriptional profiling of DM1 cardiac cells to identify miR-1 target genes with potential roles in DCM. We identify Multiplexin (Mp) as a new cardiac miR-1 target involved in DM1. Mp encodes a collagen protein involved in cardiac tube formation in Drosophila. Mp and its human ortholog Col15A1 are both highly enriched in cardiac cells of DCM-developing DM1 flies and in heart samples from DM1 patients with DCM, respectively. When overexpressed in the heart, Mp induces DCM, whereas its attenuation rescues the DCM phenotype of aged DM1 flies. Reduced levels of miR-1 and consecutive up-regulation of its target Mp/Col15A1 might be critical in DM1-associated DCM. | null | false | Deregulations of miR-1 and its target Multiplexin promote dilated cardiomyopathy associated with myotonic dystrophy type 1. Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy in adults. It is caused by the excessive expansion of noncoding CTG repeats, which when transcribed affects the functions of RNA-binding factors with adverse effects on alternative splicing, processing, and stability of a large set of muscular and cardiac transcripts. Among these effects, inefficient processing and down-regulation of muscle- and heart-specific miRNA, miR-1, have been reported in DM1 patients, but the impact of reduced miR-1 on DM1 pathogenesis has been unknown. Here, we use Drosophila DM1 models to explore the role of miR-1 in cardiac dysfunction in DM1. We show that miR-1 down-regulation in the heart leads to dilated cardiomyopathy (DCM), a DM1-associated phenotype. We combined in silico screening for miR-1 targets with transcriptional profiling of DM1 cardiac cells to identify miR-1 target genes with potential roles in DCM. We identify Multiplexin (Mp) as a new cardiac miR-1 target involved in DM1. Mp encodes a collagen protein involved in cardiac tube formation in Drosophila. Mp and its human ortholog Col15A1 are both highly enriched in cardiac cells of DCM-developing DM1 flies and in heart samples from DM1 patients with DCM, respectively. When overexpressed in the heart, Mp induces DCM, whereas its attenuation rescues the DCM phenotype of aged DM1 flies. Reduced levels of miR-1 and consecutive up-regulation of its target Mp/Col15A1 might be critical in DM1-associated DCM. |
10,879,414 | D002114:Calcinosis; D003327:Coronary Disease; D003362:Cost-Benefit Analysis; D006801:Humans; D018803:Models, Economic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed | [
"D002114",
"D003327",
"D003362",
"D006801",
"D018803",
"D018570",
"D012307",
"D012720",
"D014057"
] | Cost effectiveness of coronary calcification scanning using electron beam tomography in intermediate and high risk asymptomatic individuals. | Pharmaceutical therapy of hyperlipidemia is clearly beneficial. In the patient without established heart disease however, conventional risk assessment is imprecise and determining which patients are at highest versus lowest risk is a common clinical conundrum. It is well established that the most powerful determinant to risk is the overall extent/severity of coronary disease. Electron beam tomography (EBT) and quantification of coronary artery calcium has been shown to provide a valid non-invasive surrogate to atherosclerotic plaque burden. Screening patients who are considered to be at traditional intermediate to high risk by first using EBT can refine the broad-based population risk to a more individual basis. Data that is based upon a model developed for application of EBT are presented, which discuss its potential as a cost effective application to guide statin therapy in intermediate and high-risk sub-groups. | 12,369,295 | true | Cost effectiveness of coronary calcification scanning using electron beam tomography in intermediate and high risk asymptomatic individuals. Pharmaceutical therapy of hyperlipidemia is clearly beneficial. In the patient without established heart disease however, conventional risk assessment is imprecise and determining which patients are at highest versus lowest risk is a common clinical conundrum. It is well established that the most powerful determinant to risk is the overall extent/severity of coronary disease. Electron beam tomography (EBT) and quantification of coronary artery calcium has been shown to provide a valid non-invasive surrogate to atherosclerotic plaque burden. Screening patients who are considered to be at traditional intermediate to high risk by first using EBT can refine the broad-based population risk to a more individual basis. Data that is based upon a model developed for application of EBT are presented, which discuss its potential as a cost effective application to guide statin therapy in intermediate and high-risk sub-groups. |
7,651,767 | D001794:Blood Pressure; D016022:Case-Control Studies; D004374:Ductus Arteriosus, Patent; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D011674:Pulse; D017534:Radial Artery | [
"D001794",
"D016022",
"D004374",
"D005500",
"D006801",
"D007231",
"D011674",
"D017534"
] | Bisferiens peaks in the radial artery pressure wave in newborn infants: a sign of patent ductus arteriosus. | Previously, we found evidence that radial artery pressure wave forms in newborns represent central aortic wave forms, provided that pressure is measured with adequate accuracy. Therefore, we postulated that the neonatal radial artery wave form, like the adult aortic wave form, may contribute to cardiovascular diagnosis. We investigated whether radial artery wave forms in infants suffering from patent ductus arteriosus (PDA) are different from the wave forms as seen without the presence of PDA. We studied 34 newborn infants with a radial artery line and with the possible clinical diagnosis of PDA with left-to-right shunt. On the basis of echocardiographic examination to assess PDA, these infants were divided in two groups: infants with PDA (n = 24) and without PDA (n = 10). In 15 out of 24 infants with PDA, recordings were repeated after ductal closure. Blood pressure measurement was performed with a high fidelity cathetermanometer system using a tip-transducer (natural frequency 95 Hz, damping coefficient 0.15). Contour analysis was performed by describing morphology of the waves during PDA and without PDA. In 23 out of 24 infants with PDA, a pulsus bisferiens was present: two peaks separated by a deep cleft. The average pressure difference between the first pressure peak and the cleft [delta Ppeak1] was 0.35 +/- 0.19 kPa, and the average difference between the cleft and the second pressure peak [delta Ppeak2] was 0.44 +/- 0.23 kPa. the ratio of mean magnitude of delta Ppeak1 and delta Ppeak2 was 0.81 +/- 0.26. None of the 10 infants without PDA showed pulsus bisferiens.(ABSTRACT TRUNCATED AT 250 WORDS) | 11,943,670 | true | Bisferiens peaks in the radial artery pressure wave in newborn infants: a sign of patent ductus arteriosus. Previously, we found evidence that radial artery pressure wave forms in newborns represent central aortic wave forms, provided that pressure is measured with adequate accuracy. Therefore, we postulated that the neonatal radial artery wave form, like the adult aortic wave form, may contribute to cardiovascular diagnosis. We investigated whether radial artery wave forms in infants suffering from patent ductus arteriosus (PDA) are different from the wave forms as seen without the presence of PDA. We studied 34 newborn infants with a radial artery line and with the possible clinical diagnosis of PDA with left-to-right shunt. On the basis of echocardiographic examination to assess PDA, these infants were divided in two groups: infants with PDA (n = 24) and without PDA (n = 10). In 15 out of 24 infants with PDA, recordings were repeated after ductal closure. Blood pressure measurement was performed with a high fidelity cathetermanometer system using a tip-transducer (natural frequency 95 Hz, damping coefficient 0.15). Contour analysis was performed by describing morphology of the waves during PDA and without PDA. In 23 out of 24 infants with PDA, a pulsus bisferiens was present: two peaks separated by a deep cleft. The average pressure difference between the first pressure peak and the cleft [delta Ppeak1] was 0.35 +/- 0.19 kPa, and the average difference between the cleft and the second pressure peak [delta Ppeak2] was 0.44 +/- 0.23 kPa. the ratio of mean magnitude of delta Ppeak1 and delta Ppeak2 was 0.81 +/- 0.26. None of the 10 infants without PDA showed pulsus bisferiens.(ABSTRACT TRUNCATED AT 250 WORDS) |
26,631,136 | D000328:Adult; D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D058456:Retinal Telangiectasis; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A; D014792:Visual Acuity; D055815:Young Adult | [
"D000328",
"D020533",
"D000068258",
"D005260",
"D005451",
"D005500",
"D005654",
"D006801",
"D058449",
"D017075",
"D008297",
"D008875",
"D058456",
"D012189",
"D013997",
"D041623",
"D016896",
"D042461",
"D014792",
"D055815"
] | Intravitreal bevacizumab injections combined with laser photocoagulation for adult-onset Coats' disease. | OBJECTIVE
To evaluate the efficacy of intravitreal bevacizumab injections combined with laser photocoagulation in the treatment of adult-onset Coats' disease.
METHODS
Thirteen eyes of 13 patients suffering from adult-onset Coats' disease were retrospectively included and analyzed. All patients were treated at baseline using intravitreal bevacizumab injections combined with laser photocoagulation. Follow-up treatment was performed as necessary.
RESULTS
The mean age of the subjects was 40.3 years, and the mean follow-up period was 24.8 months. The mean number of bevacizumab injections was 2.69, and the mean number of laser treatment sessions was 1.68. The mean baseline best-corrected visual acuity (BCVA) was 0.72 logarithm of the minimum angle of resolution (logMAR; 20/104 Snellen equivalent), while the mean BCVA at the final visit was 0.68 logMAR (20/95; P = 0.548). In three patients (23.0 %), BCVA had improved by more than 3 lines, and seven patients (54.0 %) showed stable BCVA (changes within 2 lines of visual acuity) after treatment. The mean central foveal thickness improved significantly, from 473 μm at baseline to 288 μm at the final visit (P = 0.023). Final BCVA was significantly correlated with a baseline BCVA (P < 0.001; ρ = 0.882). The final BCVA of patients who had subfoveal hard exudates at baseline was significantly worse than that of patients without such exudates (P = 0.005).
CONCLUSIONS
Intravitreal bevacizumab injection combined with laser photocoagulation may be an effective treatment option for adult-onset Coats' disease. Both poor initial BCVA and the occurrence of subfoveal hard exudates at baseline were associated with poor prognosis and poor therapeutic response. | null | false | Intravitreal bevacizumab injections combined with laser photocoagulation for adult-onset Coats' disease. OBJECTIVE
To evaluate the efficacy of intravitreal bevacizumab injections combined with laser photocoagulation in the treatment of adult-onset Coats' disease.
METHODS
Thirteen eyes of 13 patients suffering from adult-onset Coats' disease were retrospectively included and analyzed. All patients were treated at baseline using intravitreal bevacizumab injections combined with laser photocoagulation. Follow-up treatment was performed as necessary.
RESULTS
The mean age of the subjects was 40.3 years, and the mean follow-up period was 24.8 months. The mean number of bevacizumab injections was 2.69, and the mean number of laser treatment sessions was 1.68. The mean baseline best-corrected visual acuity (BCVA) was 0.72 logarithm of the minimum angle of resolution (logMAR; 20/104 Snellen equivalent), while the mean BCVA at the final visit was 0.68 logMAR (20/95; P = 0.548). In three patients (23.0 %), BCVA had improved by more than 3 lines, and seven patients (54.0 %) showed stable BCVA (changes within 2 lines of visual acuity) after treatment. The mean central foveal thickness improved significantly, from 473 μm at baseline to 288 μm at the final visit (P = 0.023). Final BCVA was significantly correlated with a baseline BCVA (P < 0.001; ρ = 0.882). The final BCVA of patients who had subfoveal hard exudates at baseline was significantly worse than that of patients without such exudates (P = 0.005).
CONCLUSIONS
Intravitreal bevacizumab injection combined with laser photocoagulation may be an effective treatment option for adult-onset Coats' disease. Both poor initial BCVA and the occurrence of subfoveal hard exudates at baseline were associated with poor prognosis and poor therapeutic response. |
36,256,501 | D006801:Humans; D007223:Infant; D009080:Mucocutaneous Lymph Node Syndrome; D007564:Japan; D003324:Coronary Artery Disease; D016756:Immunoglobulins, Intravenous; D016896:Treatment Outcome; D012189:Retrospective Studies | [
"D006801",
"D007223",
"D009080",
"D007564",
"D003324",
"D016756",
"D016896",
"D012189"
] | Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan. | BACKGROUND
The treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to the Z-score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD.
METHODS
The 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according to Z-score, treatment by KD treatment stage, and predictors of CAAs.
RESULTS
The response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based on Z-scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second-line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third-line treatment. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year were associated with significantly higher incidences of CAAs.
CONCLUSIONS
Using the Z-score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year are useful predictors of CAAs. | null | false | Status of treatment and outcome in Kawasaki disease in the Kinki area of Japan. BACKGROUND
The treatment guidelines for acute Kawasaki disease (KD) have been revised several times. Moreover, the criterion used to define coronary artery abnormalities (CAAs) has changed from the coronary artery's internal diameter to the Z-score. Treatment for KD and methods for evaluating CAAs vary between hospitals, so we investigated the actual status of acute KD treatment and development of CAAs under the 2012 Japanese treatment guidelines for acute KD.
METHODS
The 24th Japanese Nationwide Survey on Kawasaki Disease yielded 2618 patients who developed KD in the Kinki area in 2016. We sent a secondary questionnaire to each participating hospital and used the resulting data to investigate the frequency of CAAs according to Z-score, treatment by KD treatment stage, and predictors of CAAs.
RESULTS
The response rate was 80.0%. The data for 1426 patients without major data deficiencies were examined. The frequency of CAAs was 3.0% when based on coronary artery internal diameters and 8.8% when based on Z-scores. Intravenous immunoglobulins combined with corticosteroids were administered as an initial treatment in 12.8% of cases and as a second-line treatment in 16.8% of cases. Corticosteroids, cyclosporine A, infliximab, and plasma exchange were used at similar frequencies for third-line treatment. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year were associated with significantly higher incidences of CAAs.
CONCLUSIONS
Using the Z-score resulted in a threefold increase in the number of patients diagnosed with CAAs. A pretreatment maximum coronary artery Z-score of ≥1.9 and age <1 year are useful predictors of CAAs. |
4,825,235 | D000241:Adenosine; D000328:Adult; D000368:Aged; D000787:Angina Pectoris; D000818:Animals; D001161:Arteriosclerosis; D003327:Coronary Disease; D003401:Creatine; D003402:Creatine Kinase; D004285:Dogs; D005260:Female; D006801:Humans; D007042:Hypoxanthines; D007288:Inosine; D007770:L-Lactate Dehydrogenase; D007773:Lactates; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D005082:Physical Exertion; D011188:Potassium; D012964:Sodium | [
"D000241",
"D000328",
"D000368",
"D000787",
"D000818",
"D001161",
"D003327",
"D003401",
"D003402",
"D004285",
"D005260",
"D006801",
"D007042",
"D007288",
"D007770",
"D007773",
"D008297",
"D008875",
"D009206",
"D005082",
"D011188",
"D012964"
] | Release of adenosine from human hearts during angina induced by rapid atrial pacing. | This study was designed to determine whether human hearts release adenosine, a possible regulator of coronary flow, during temporary myocardial ischemia and, if so, to examine the mechanisms involved. Release of adenosine from canine hearts had been reported during reactive hyperemia following brief coronary occlusion, and we initially confirmed this observation in six dogs hearts. Angina was then produced in 15 patients with anginal syndrome and severe coronary atherosclerosis by rapid atrial pacing during diagnostic studies. In 13 of these patients, adenosine appeared in coronary sinus blood, at a mean level of 40 nmol/100 ml blood (SE = +/-9). In 11 of these 13, adenosine was not detectable in control or recovery samples; when measured, there was concomitant production of lactate and minimal leakage of K(+), but no significant release of creatine phosphokinase, lactic acid dehydrogenase, creatine, or Na(+). THERE WAS NO DETECTABLE RELEASE OF ADENOSINE BY HEARTS DURING PACING OR EXERCISE IN THREE CONTROL GROUPS OF PATIENTS: nine with anginal syndrome and severe coronary atherosclerosis who did not develop angina or produce lactate during rapid pacing, five with normal coronaries and no myocardial disease, and three with normal coronaries but with left ventricular failure. The results indicate that human hearts release significant amounts of adenosine during severe regional myocardial ischemia and anaerobic metabolism. Adenosine release might provide a useful supplementary index of the early effects of ischemia on myocardial metabolism, and might influence regional coronary flow during or after angina pectoris. | 4,729,457 | true | Release of adenosine from human hearts during angina induced by rapid atrial pacing. This study was designed to determine whether human hearts release adenosine, a possible regulator of coronary flow, during temporary myocardial ischemia and, if so, to examine the mechanisms involved. Release of adenosine from canine hearts had been reported during reactive hyperemia following brief coronary occlusion, and we initially confirmed this observation in six dogs hearts. Angina was then produced in 15 patients with anginal syndrome and severe coronary atherosclerosis by rapid atrial pacing during diagnostic studies. In 13 of these patients, adenosine appeared in coronary sinus blood, at a mean level of 40 nmol/100 ml blood (SE = +/-9). In 11 of these 13, adenosine was not detectable in control or recovery samples; when measured, there was concomitant production of lactate and minimal leakage of K(+), but no significant release of creatine phosphokinase, lactic acid dehydrogenase, creatine, or Na(+). THERE WAS NO DETECTABLE RELEASE OF ADENOSINE BY HEARTS DURING PACING OR EXERCISE IN THREE CONTROL GROUPS OF PATIENTS: nine with anginal syndrome and severe coronary atherosclerosis who did not develop angina or produce lactate during rapid pacing, five with normal coronaries and no myocardial disease, and three with normal coronaries but with left ventricular failure. The results indicate that human hearts release significant amounts of adenosine during severe regional myocardial ischemia and anaerobic metabolism. Adenosine release might provide a useful supplementary index of the early effects of ischemia on myocardial metabolism, and might influence regional coronary flow during or after angina pectoris. |
21,805,085 | D000328:Adult; D005419:Flavonoids; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010146:Pain; D010147:Pain Measurement; D011446:Prospective Studies; D012611:Scrotum; D055101:Semen Analysis; D013076:Sperm Count; D013081:Sperm Motility; D013737:Testis; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele; D055815:Young Adult | [
"D000328",
"D005419",
"D005500",
"D006801",
"D008297",
"D010146",
"D010147",
"D011446",
"D012611",
"D055101",
"D013076",
"D013081",
"D013737",
"D016896",
"D018615",
"D014646",
"D055815"
] | Effects of micronised purified flavonoid fraction on pain, semen analysis and scrotal color Doppler parameters in patients with painful varicocele; results of a randomized placebo-controlled study. | OBJECTIVE
Aim of this study is to evaluate the effects of micronised purified flavonoid fraction (Daflon(®)) on pain, semen analysis and color Doppler parameters in patients with painful varicocele.
METHODS
Forty varicocele patients whom have normal sperm concentration (>20 million/ml) were involved in the study. The patients were divided into two groups such as Daflon (n = 20) and placebo (n = 20) group. Pain score, semen analyses and Doppler sonography were performed in all patients before and after the treatment.
RESULTS
In the first group, mean pain scores at 1, 3, 6 and 12 months were 1.80 ± 1.32, 1.15 ± 0.93, 1.05 ± 0.95 and 0.95 ± 0.89, respectively, all were significantly lower (P < 0.001 for each) than baseline (5.25 ± 1.07). While semen volume, total sperm count, sperm concentration and morphology were not changed significantly, the motility of sperm increased significantly (P = 0.015) due to decrease in grade 1 sperms at the 6th month in the first group. Reflux time of left spermatic vein during the Valsalva maneuver decreased significantly (P < 0.001).
CONCLUSIONS
Results of this study suggest the safety and efficacy of Daflon in the treatment of varicocele-associated pain. However, these results of the present study must be confirmed by randomized placebo-controlled studies by using different drug doses and durations before making any recommendation for the use of Daflon. | null | false | Effects of micronised purified flavonoid fraction on pain, semen analysis and scrotal color Doppler parameters in patients with painful varicocele; results of a randomized placebo-controlled study. OBJECTIVE
Aim of this study is to evaluate the effects of micronised purified flavonoid fraction (Daflon(®)) on pain, semen analysis and color Doppler parameters in patients with painful varicocele.
METHODS
Forty varicocele patients whom have normal sperm concentration (>20 million/ml) were involved in the study. The patients were divided into two groups such as Daflon (n = 20) and placebo (n = 20) group. Pain score, semen analyses and Doppler sonography were performed in all patients before and after the treatment.
RESULTS
In the first group, mean pain scores at 1, 3, 6 and 12 months were 1.80 ± 1.32, 1.15 ± 0.93, 1.05 ± 0.95 and 0.95 ± 0.89, respectively, all were significantly lower (P < 0.001 for each) than baseline (5.25 ± 1.07). While semen volume, total sperm count, sperm concentration and morphology were not changed significantly, the motility of sperm increased significantly (P = 0.015) due to decrease in grade 1 sperms at the 6th month in the first group. Reflux time of left spermatic vein during the Valsalva maneuver decreased significantly (P < 0.001).
CONCLUSIONS
Results of this study suggest the safety and efficacy of Daflon in the treatment of varicocele-associated pain. However, these results of the present study must be confirmed by randomized placebo-controlled studies by using different drug doses and durations before making any recommendation for the use of Daflon. |
26,024,891 | D000818:Animals; D000893:Anti-Inflammatory Agents; D015687:Cell Hypoxia; D049109:Cell Proliferation; D005260:Female; D005347:Fibroblasts; D006801:Humans; D006976:Hypertension, Pulmonary; D007093:Imidazoles; D015850:Interleukin-6; D008297:Male; D048308:Mitogen-Activated Protein Kinase 14; D011651:Pulmonary Artery; D011725:Pyridines; D017207:Rats, Sprague-Dawley; D066253:Vascular Remodeling | [
"D000818",
"D000893",
"D015687",
"D049109",
"D005260",
"D005347",
"D006801",
"D006976",
"D007093",
"D015850",
"D008297",
"D048308",
"D011651",
"D011725",
"D017207",
"D066253"
] | The reversal of pulmonary vascular remodeling through inhibition of p38 MAPK-alpha: a potential novel anti-inflammatory strategy in pulmonary hypertension. | The p38 mitogen-activated protein kinase (MAPK) system is increasingly recognized as an important inflammatory pathway in systemic vascular disease but its role in pulmonary vascular disease is unclear. Previous in vitro studies suggest p38 MAPKα is critical in the proliferation of pulmonary artery fibroblasts, an important step in the pathogenesis of pulmonary vascular remodeling (PVremod). In this study the role of the p38 MAPK pathway was investigated in both in vitro and in vivo models of pulmonary hypertension and human disease. Pharmacological inhibition of p38 MAPKα in both chronic hypoxic and monocrotaline rodent models of pulmonary hypertension prevented and reversed the pulmonary hypertensive phenotype. Furthermore, with the use of a novel and clinically available p38 MAPKα antagonist, reversal of pulmonary hypertension was obtained in both experimental models. Increased expression of phosphorylated p38 MAPK and p38 MAPKα was observed in the pulmonary vasculature from patients with idiopathic pulmonary arterial hypertension, suggesting a role for activation of this pathway in the PVremod A reduction of IL-6 levels in serum and lung tissue was found in the drug-treated animals, suggesting a potential mechanism for this reversal in PVremod. This study suggests that the p38 MAPK and the α-isoform plays a pathogenic role in both human disease and rodent models of pulmonary hypertension potentially mediated through IL-6. Selective inhibition of this pathway may provide a novel therapeutic approach that targets both remodeling and inflammatory pathways in pulmonary vascular disease. | 4,127,122 | true | The reversal of pulmonary vascular remodeling through inhibition of p38 MAPK-alpha: a potential novel anti-inflammatory strategy in pulmonary hypertension. The p38 mitogen-activated protein kinase (MAPK) system is increasingly recognized as an important inflammatory pathway in systemic vascular disease but its role in pulmonary vascular disease is unclear. Previous in vitro studies suggest p38 MAPKα is critical in the proliferation of pulmonary artery fibroblasts, an important step in the pathogenesis of pulmonary vascular remodeling (PVremod). In this study the role of the p38 MAPK pathway was investigated in both in vitro and in vivo models of pulmonary hypertension and human disease. Pharmacological inhibition of p38 MAPKα in both chronic hypoxic and monocrotaline rodent models of pulmonary hypertension prevented and reversed the pulmonary hypertensive phenotype. Furthermore, with the use of a novel and clinically available p38 MAPKα antagonist, reversal of pulmonary hypertension was obtained in both experimental models. Increased expression of phosphorylated p38 MAPK and p38 MAPKα was observed in the pulmonary vasculature from patients with idiopathic pulmonary arterial hypertension, suggesting a role for activation of this pathway in the PVremod A reduction of IL-6 levels in serum and lung tissue was found in the drug-treated animals, suggesting a potential mechanism for this reversal in PVremod. This study suggests that the p38 MAPK and the α-isoform plays a pathogenic role in both human disease and rodent models of pulmonary hypertension potentially mediated through IL-6. Selective inhibition of this pathway may provide a novel therapeutic approach that targets both remodeling and inflammatory pathways in pulmonary vascular disease. |
31,256,189 | D000368:Aged; D000686:Amyloidosis; D006528:Carcinoma, Hepatocellular; D058409:Cardiac Resynchronization Therapy Devices; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases; D006333:Heart Failure; D006801:Humans; D008113:Liver Neoplasms; D012307:Risk Factors; D019851:Thrombophilia; D013927:Thrombosis; D014057:Tomography, X-Ray Computed | [
"D000368",
"D000686",
"D006528",
"D058409",
"D004452",
"D005260",
"D006331",
"D006333",
"D006801",
"D008113",
"D012307",
"D019851",
"D013927",
"D014057"
] | Intracardiac Thrombosis and Heart Failure in a Patient with Hepatocellular Carcinoma and Cardiac Amyloidosis and an Implanted Cardiac Resynchronization Therapy Device. | BACKGROUND Intracardiac thrombosis has been known to be associated with not only hepatocellular carcinoma but also with amyloidosis and use of a cardiac implantable electronic device. We report a case of a continuous tumor thrombus with hepatocellular carcinoma from the portal vein and hepatic vein to the right atrium via the inferior vena cava in a patient with a cardiac amyloidosis and an implanted cardiac resynchronization therapy (CRT) device. CASE REPORT A 68-year-old female first admitted to our hospital because of heart failure with an AL type primary cardiac amyloidosis. After 3 years, she underwent an implantation of a CRT device for biventricular pacing following repeated episodes of heart failure and low left ventricular ejection fraction of 34% with NYHA class III. Again, she presented with symptoms of heart failure and cardiomegaly on chest x-ray at 7 years after the CRT device implantation. The echocardiography showed a huge echogenic mass occupying the right atrium, and 64 multi-detector computed tomography showed a lobulated heterogeneously enhancing mass of hepatocellular carcinoma in the right upper lobe of her liver and a continuous tumor thrombus from the portal vein and hepatic vein to the right atrium via the inferior vena cava. CONCLUSIONS Intracardiac thrombosis and heart failure occurred in a patient with hepatocellular carcinoma and cardiac amyloidosis, who had an implanted CRT device, which resulted not only in hypercoagulability by the hepatocellular carcinoma itself and the accumulation of various risk factors, but also the progression of myocardial damage with the development of amyloidosis. | 4,815,918 | true | Intracardiac Thrombosis and Heart Failure in a Patient with Hepatocellular Carcinoma and Cardiac Amyloidosis and an Implanted Cardiac Resynchronization Therapy Device. BACKGROUND Intracardiac thrombosis has been known to be associated with not only hepatocellular carcinoma but also with amyloidosis and use of a cardiac implantable electronic device. We report a case of a continuous tumor thrombus with hepatocellular carcinoma from the portal vein and hepatic vein to the right atrium via the inferior vena cava in a patient with a cardiac amyloidosis and an implanted cardiac resynchronization therapy (CRT) device. CASE REPORT A 68-year-old female first admitted to our hospital because of heart failure with an AL type primary cardiac amyloidosis. After 3 years, she underwent an implantation of a CRT device for biventricular pacing following repeated episodes of heart failure and low left ventricular ejection fraction of 34% with NYHA class III. Again, she presented with symptoms of heart failure and cardiomegaly on chest x-ray at 7 years after the CRT device implantation. The echocardiography showed a huge echogenic mass occupying the right atrium, and 64 multi-detector computed tomography showed a lobulated heterogeneously enhancing mass of hepatocellular carcinoma in the right upper lobe of her liver and a continuous tumor thrombus from the portal vein and hepatic vein to the right atrium via the inferior vena cava. CONCLUSIONS Intracardiac thrombosis and heart failure occurred in a patient with hepatocellular carcinoma and cardiac amyloidosis, who had an implanted CRT device, which resulted not only in hypercoagulability by the hepatocellular carcinoma itself and the accumulation of various risk factors, but also the progression of myocardial damage with the development of amyloidosis. |
32,070,706 | D000818:Animals; D001794:Blood Pressure; D002460:Cell Line; D018932:Chemokine CCL2; D000074049:Cytokine TWEAK; D004195:Disease Models, Animal; D005260:Female; D005346:Fibroblast Growth Factors; D006321:Heart; D006333:Heart Failure; D006801:Humans; D007249:Inflammation; D008264:Macrophages; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D016328:NF-kappa B; D015398:Signal Transduction; D000074050:TWEAK Receptor; D000079424:Tumor Necrosis Factor Inhibitors; D015854:Up-Regulation | [
"D000818",
"D001794",
"D002460",
"D018932",
"D000074049",
"D004195",
"D005260",
"D005346",
"D006321",
"D006333",
"D006801",
"D007249",
"D008264",
"D008297",
"D051379",
"D008810",
"D016328",
"D015398",
"D000074050",
"D000079424",
"D015854"
] | Fibroblast growth factor-inducible 14 mediates macrophage infiltration in heart to promote pressure overload-induced cardiac dysfunction. | OBJECTIVE
Heart failure (HF) is characterized by compromised cardiac structure and function. Previous work has identified a link between upregulation of pro-inflammatory cytokines and HF. Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) is a pro-inflammatory cytokine, which binds to fibroblast growth factor inducible 14 (Fn14), a ubiquitously expressed cell-surface receptor. The objective of this study was to investigate the role of TWEAK/Fn14 pathway in promoting cardiac inflammation under non ischemic stress conditions.
METHODS
Wild type (WT) and Fn14 knock out (Fn14-/-) mice were subjected to pressure overload [transaortic constriction (TAC)] for 1 or 6 weeks. A subset of WT TAC animals were treated with the Fn14 antagonist L524-0366. Cardiac function was measured by echocardiography. Cardiac fibrosis and macrophage infiltration were quantified using immunohistochemistry and flow cytometry, respectively. Cardiac fibroblasts were isolated for quantifying TWEAK-induced chemokine release.
RESULTS
Fn14-/- mice displayed improved cardiac function, reduced fibrosis and lower macrophage infiltration in heart compared to WT following TAC. L524-0366 mitigated maladaptive remodeling with TAC. TWEAK induced secretion of the pro-inflammatory chemokine, monocyte chemoattractant protein 1 from WT but not Fn14-/- fibroblasts in vitro, in part through activation of non-canonical NF-κB signaling. Finally, Fn14 expression was increased in mouse following TAC and in human failing hearts.
CONCLUSIONS
Our findings support an important role for the TWEAK/Fn14 promoting macrophage infiltration and fibrosis in heart under non-ischemic stress, with potential for therapeutic intervention to improve cardiac function in the setting of HF. | null | false | Fibroblast growth factor-inducible 14 mediates macrophage infiltration in heart to promote pressure overload-induced cardiac dysfunction. OBJECTIVE
Heart failure (HF) is characterized by compromised cardiac structure and function. Previous work has identified a link between upregulation of pro-inflammatory cytokines and HF. Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) is a pro-inflammatory cytokine, which binds to fibroblast growth factor inducible 14 (Fn14), a ubiquitously expressed cell-surface receptor. The objective of this study was to investigate the role of TWEAK/Fn14 pathway in promoting cardiac inflammation under non ischemic stress conditions.
METHODS
Wild type (WT) and Fn14 knock out (Fn14-/-) mice were subjected to pressure overload [transaortic constriction (TAC)] for 1 or 6 weeks. A subset of WT TAC animals were treated with the Fn14 antagonist L524-0366. Cardiac function was measured by echocardiography. Cardiac fibrosis and macrophage infiltration were quantified using immunohistochemistry and flow cytometry, respectively. Cardiac fibroblasts were isolated for quantifying TWEAK-induced chemokine release.
RESULTS
Fn14-/- mice displayed improved cardiac function, reduced fibrosis and lower macrophage infiltration in heart compared to WT following TAC. L524-0366 mitigated maladaptive remodeling with TAC. TWEAK induced secretion of the pro-inflammatory chemokine, monocyte chemoattractant protein 1 from WT but not Fn14-/- fibroblasts in vitro, in part through activation of non-canonical NF-κB signaling. Finally, Fn14 expression was increased in mouse following TAC and in human failing hearts.
CONCLUSIONS
Our findings support an important role for the TWEAK/Fn14 promoting macrophage infiltration and fibrosis in heart under non-ischemic stress, with potential for therapeutic intervention to improve cardiac function in the setting of HF. |
10,476,241 | D000328:Adult; D002312:Cardiomyopathy, Hypertrophic; D003327:Coronary Disease; D015444:Exercise; D005340:Fibrinogen; D006801:Humans; D007249:Inflammation; D008875:Middle Aged; D012084:Renin-Angiotensin System; D018570:Risk Assessment | [
"D000328",
"D002312",
"D003327",
"D015444",
"D005340",
"D006801",
"D007249",
"D008875",
"D012084",
"D018570"
] | High intensity training and the heart. | Absence may make the heart grow fonder, but exercise makes the heart grow stronger. This review discusses the cardiac impact of high intensity training, and discusses the possible mechanisms underlying the risk and benefit of such training. | 12,192,571 | true | High intensity training and the heart. Absence may make the heart grow fonder, but exercise makes the heart grow stronger. This review discusses the cardiac impact of high intensity training, and discusses the possible mechanisms underlying the risk and benefit of such training. |
3,711,522 | D000328:Adult; D003327:Coronary Disease; D005260:Female; D006689:Hodgkin Disease; D006801:Humans; D008297:Male; D011832:Radiation Injuries; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D013997:Time Factors | [
"D000328",
"D003327",
"D005260",
"D006689",
"D006801",
"D008297",
"D011832",
"D011836",
"D011879",
"D013997"
] | Radiation-induced coronary artery disease. | This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease. | 6,021,636 | true | Radiation-induced coronary artery disease. This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease. |
15,714,902 | D000368:Aged; D000369:Aged, 80 and over; D001072:Apraxias; D001925:Brain Damage, Chronic; D002544:Cerebral Infarction; D005260:Female; D007839:Functional Laterality; D006236:Handwriting; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009949:Orientation; D012016:Reference Values; D013028:Space Perception | [
"D000368",
"D000369",
"D001072",
"D001925",
"D002544",
"D005260",
"D007839",
"D006236",
"D006801",
"D033182",
"D008297",
"D008875",
"D009483",
"D009949",
"D012016",
"D013028"
] | Drawing from childhood experience: constructional apraxia and the production of oblique lines. | We report the performance of two patients (ECR and RA) with constructional apraxia on a drawing task previously used to test the development of planning abilities in children. Patients and controls were required to produce both oblique and horizontal/vertical lines that formed a right angle. Planning demands were manipulated across conditions by providing additional spatial information to constrain the drawing. Both patients produced drawings that were less accurate than controls. In addition, ECR was particularly poor at producing oblique lines compared to both RA and controls, even under conditions with minimal planning demands. This pattern of performance is qualitatively similar to that of children under eight years (see Broderick and Laszlo, 1988). Taken together these results provide further evidence that constructional apraxia is not a unitary disorder (with differential performance between patients) and that those differences are not necessarily related to laterality of damage (as both patients had right-hemisphere lesions). We argue for a more quantitative approach to the study of drawing abilities in neuropsychological testing in order to facilitate a finer grained analysis of the disorder and of comparison between patients. | 2,466,865 | true | Drawing from childhood experience: constructional apraxia and the production of oblique lines. We report the performance of two patients (ECR and RA) with constructional apraxia on a drawing task previously used to test the development of planning abilities in children. Patients and controls were required to produce both oblique and horizontal/vertical lines that formed a right angle. Planning demands were manipulated across conditions by providing additional spatial information to constrain the drawing. Both patients produced drawings that were less accurate than controls. In addition, ECR was particularly poor at producing oblique lines compared to both RA and controls, even under conditions with minimal planning demands. This pattern of performance is qualitatively similar to that of children under eight years (see Broderick and Laszlo, 1988). Taken together these results provide further evidence that constructional apraxia is not a unitary disorder (with differential performance between patients) and that those differences are not necessarily related to laterality of damage (as both patients had right-hemisphere lesions). We argue for a more quantitative approach to the study of drawing abilities in neuropsychological testing in order to facilitate a finer grained analysis of the disorder and of comparison between patients. |
7,484,758 | D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D003324:Coronary Artery Disease; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional | [
"D000328",
"D000368",
"D015906",
"D017225",
"D003324",
"D003331",
"D005260",
"D006801",
"D008297",
"D008875",
"D015607",
"D016896",
"D018084"
] | Influence of plaque composition on luminal gain after balloon angioplasty, directional atherectomy, and coronary stenting. | This study was conducted to correlate the acute luminal enlargement achieved by three different nonsurgical revascularization procedures in 79 patients (32 treated by balloon angioplasty, 29 by directional atherectomy, and 18 by coronary stenting) with the morphologic characteristics of coronary plaques assessed by preprocedure intravascular ultrasound. The absolute luminal gain was 2.41 +/- 1.54 mm2 for balloon angioplasty, 3.17 +/- 1.8 mm2 for directional atherectomy, and 4.56 +/- 1.45 mm2 for coronary stenting (p = 0.00005). However, when luminal gain was corrected for the external vessel area (luminal gain index), such difference was no longer present (0.22 +/- 0.12 for balloon angioplasty, 0.24 +/- 0.15 for directional atherectomy, and 0.30 +/- 0.12 for coronary stenting, p = not significant). Concentric plaques treated by coronary stenting had a higher luminal gain index than eccentric plaques (p = 0.01). A comparison of the three devices showed that a similar luminal gain index was achieved in soft plaques, whereas coronary stenting was superior to directional atherectomy (0.41 +/- 0.10 vs 0.20 +/- 0.09, p = 0.002) and balloon angioplasty (0.41 +/- 0.10 vs 0.19 +/- 0.08, p = 0.0005) in concentric plaques. Coronary stenting also induced a greater luminal gain index than directional atherectomy in calcific plaques (0.30 +/- 0.11 vs 0.18 +/- 0.09, p = 0.04). In conclusion, these data show that plaque morphology assessed by preprocedure intracoronary ultrasound influences the acute luminal enlargement achieved by different coronary interventions. The knowledge of plaque composition may be useful in guiding the choice of the device to be used to obtain a larger acute luminal gain. | 14,962,534 | true | Influence of plaque composition on luminal gain after balloon angioplasty, directional atherectomy, and coronary stenting. This study was conducted to correlate the acute luminal enlargement achieved by three different nonsurgical revascularization procedures in 79 patients (32 treated by balloon angioplasty, 29 by directional atherectomy, and 18 by coronary stenting) with the morphologic characteristics of coronary plaques assessed by preprocedure intravascular ultrasound. The absolute luminal gain was 2.41 +/- 1.54 mm2 for balloon angioplasty, 3.17 +/- 1.8 mm2 for directional atherectomy, and 4.56 +/- 1.45 mm2 for coronary stenting (p = 0.00005). However, when luminal gain was corrected for the external vessel area (luminal gain index), such difference was no longer present (0.22 +/- 0.12 for balloon angioplasty, 0.24 +/- 0.15 for directional atherectomy, and 0.30 +/- 0.12 for coronary stenting, p = not significant). Concentric plaques treated by coronary stenting had a higher luminal gain index than eccentric plaques (p = 0.01). A comparison of the three devices showed that a similar luminal gain index was achieved in soft plaques, whereas coronary stenting was superior to directional atherectomy (0.41 +/- 0.10 vs 0.20 +/- 0.09, p = 0.002) and balloon angioplasty (0.41 +/- 0.10 vs 0.19 +/- 0.08, p = 0.0005) in concentric plaques. Coronary stenting also induced a greater luminal gain index than directional atherectomy in calcific plaques (0.30 +/- 0.11 vs 0.18 +/- 0.09, p = 0.04). In conclusion, these data show that plaque morphology assessed by preprocedure intracoronary ultrasound influences the acute luminal enlargement achieved by different coronary interventions. The knowledge of plaque composition may be useful in guiding the choice of the device to be used to obtain a larger acute luminal gain. |
25,361,361 | D000925:Anticoagulants; D001562:Benzimidazoles; D000069604:Dabigatran; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D009025:Morpholines; D019637:Orthopedic Procedures; D011183:Postoperative Complications; D011720:Pyrazoles; D011728:Pyridones; D000069552:Rivaroxaban; D013876:Thiophenes; D054556:Venous Thromboembolism; D015091:beta-Alanine | [
"D000925",
"D001562",
"D000069604",
"D006495",
"D006801",
"D009025",
"D019637",
"D011183",
"D011720",
"D011728",
"D000069552",
"D013876",
"D054556",
"D015091"
] | A systematic review and adjusted indirect comparison of oral anticoagulants. | EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize the high risk of postoperative venous thromboembolism (VTE) in patients undergoing major orthopedic surgery. 2. Distinguish the different pharmacological mechanisms of VTE prophylaxis drugs. 3. Delineate the advantages and disadvantages of each VTE prophylaxis drug. 4. Recognize that rivaroxaban is as efficacious as apixaban but can increase the risk of hemorrhage. Patients undergoing major orthopedic surgery are at high risk for developing postoperative venous thromboembolism (VTE). The authors analyzed the available evidence on the efficacy and safety of dabigatran, apixaban, and rivaroxaban vs low-molecular-weight heparins (LMWHs) as VTE prophylaxis in major orthopedic surgery. Outcomes evaluated included total VTE, deep venous thrombosis (DVT), pulmonary embolism (PE), death, and major bleeding. Rivaroxaban and apixaban are more efficacious than dabigatran and are as safe as dabigatran. Rivaroxaban is as efficacious as apixaban but can increase the risk of hemorrhage. | 784,814 | true | A systematic review and adjusted indirect comparison of oral anticoagulants. EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize the high risk of postoperative venous thromboembolism (VTE) in patients undergoing major orthopedic surgery. 2. Distinguish the different pharmacological mechanisms of VTE prophylaxis drugs. 3. Delineate the advantages and disadvantages of each VTE prophylaxis drug. 4. Recognize that rivaroxaban is as efficacious as apixaban but can increase the risk of hemorrhage. Patients undergoing major orthopedic surgery are at high risk for developing postoperative venous thromboembolism (VTE). The authors analyzed the available evidence on the efficacy and safety of dabigatran, apixaban, and rivaroxaban vs low-molecular-weight heparins (LMWHs) as VTE prophylaxis in major orthopedic surgery. Outcomes evaluated included total VTE, deep venous thrombosis (DVT), pulmonary embolism (PE), death, and major bleeding. Rivaroxaban and apixaban are more efficacious than dabigatran and are as safe as dabigatran. Rivaroxaban is as efficacious as apixaban but can increase the risk of hemorrhage. |
7,449,157 | D000293:Adolescent; D000328:Adult; D000368:Aged; D001611:Beta Rhythm; D002561:Cerebrovascular Disorders; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D006801:Humans; D008875:Middle Aged; D012640:Seizures; D013036:Spasms, Infantile | [
"D000293",
"D000328",
"D000368",
"D001611",
"D002561",
"D002648",
"D002675",
"D004569",
"D006801",
"D008875",
"D012640",
"D013036"
] | Significance of focal and lateralized beta activity in the EEG. | In a group of 16,432 EEGs studied in a five year period, a total of 43 with focal, lateralized or paroxysmal beta activity were noted. The focal beta activity was mainly seen in children suffering from intractable seizures secondary to A-V malformation, porencephalic cysts or tumors. This was practically an epileptiform discharge with a high clinical pathologic correlation. The lateralized beta activity was seen mainly in adults suffering from cerebrovascular disease or tumor. In the cerebrovascular group the lateralized activity was seen on the contra-lateral side of the lesion. The paroxysmal beta activity is a rare phenomenon seen purely as an ictal manifestation, and mainly seen in children with Lennox-Gastaut Syndrome or infantile spasms. The importance of proper technique to record such abnormalities is emphasized. | 5,205,609 | true | Significance of focal and lateralized beta activity in the EEG. In a group of 16,432 EEGs studied in a five year period, a total of 43 with focal, lateralized or paroxysmal beta activity were noted. The focal beta activity was mainly seen in children suffering from intractable seizures secondary to A-V malformation, porencephalic cysts or tumors. This was practically an epileptiform discharge with a high clinical pathologic correlation. The lateralized beta activity was seen mainly in adults suffering from cerebrovascular disease or tumor. In the cerebrovascular group the lateralized activity was seen on the contra-lateral side of the lesion. The paroxysmal beta activity is a rare phenomenon seen purely as an ictal manifestation, and mainly seen in children with Lennox-Gastaut Syndrome or infantile spasms. The importance of proper technique to record such abnormalities is emphasized. |
1,481,759 | D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic; D002545:Brain Ischemia; D004558:Electric Stimulation; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm; D007431:Intraoperative Complications; D008297:Male; D008475:Median Nerve; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009460:Neurologic Examination; D011183:Postoperative Complications; D011930:Reaction Time; D013979:Tibial Nerve | [
"D000328",
"D000368",
"D001925",
"D002545",
"D004558",
"D004569",
"D005073",
"D005260",
"D006801",
"D002532",
"D007431",
"D008297",
"D008475",
"D008875",
"D016343",
"D009460",
"D011183",
"D011930",
"D013979"
] | Somatosensory evoked potential monitoring during intracranial surgery. | In the neurosurgical approach to intracranial aneurysms which are often accompanied by arterial spasm and cortical ischaemia, monitoring procedures aim to obtain useful information on cerebral function. SEPs evoked by stimulation of the median nerve at the wrist and of the tibial nerve at the medial malleolus were registered in 45 patients with intracranial aneurysms during neurosurgical procedures. Our results show SEP abnormalities during different stages of neurosurgical procedures in 36 patients out of the monitored 45. Significant abnormalities of SEPs with respect to the control group were decrease of the amplitude of N 20-P 25 complex, lengthening of the absolute latency of the waves N 20- and P 25 and lengthening of the central conduction time (CCT) (N 13-N 20). The greatest SEP abnormalities were registered during the neurosurgical approach to aneurysm and during the clipping procedure. However, the changes were reversible in the majority of the patients. The aim of this paper was to focus on early detection of some cerebral function disturbances during the neurosurgical procedure as well as the prevention of possible brain damage. | 13,110,107 | true | Somatosensory evoked potential monitoring during intracranial surgery. In the neurosurgical approach to intracranial aneurysms which are often accompanied by arterial spasm and cortical ischaemia, monitoring procedures aim to obtain useful information on cerebral function. SEPs evoked by stimulation of the median nerve at the wrist and of the tibial nerve at the medial malleolus were registered in 45 patients with intracranial aneurysms during neurosurgical procedures. Our results show SEP abnormalities during different stages of neurosurgical procedures in 36 patients out of the monitored 45. Significant abnormalities of SEPs with respect to the control group were decrease of the amplitude of N 20-P 25 complex, lengthening of the absolute latency of the waves N 20- and P 25 and lengthening of the central conduction time (CCT) (N 13-N 20). The greatest SEP abnormalities were registered during the neurosurgical approach to aneurysm and during the clipping procedure. However, the changes were reversible in the majority of the patients. The aim of this paper was to focus on early detection of some cerebral function disturbances during the neurosurgical procedure as well as the prevention of possible brain damage. |
34,562,929 | D050197:Atherosclerosis; D000069196:Gastrointestinal Microbiome; D006801:Humans; D017895:Manganese Compounds; D008744:Methylamines; D010087:Oxides; D051436:Renal Insufficiency, Chronic | [
"D050197",
"D000069196",
"D006801",
"D017895",
"D008744",
"D010087",
"D051436"
] | Rapid Detection of Gut Microbial Metabolite Trimethylamine N-Oxide for Chronic Kidney Disease Prevention. | The gut microbiota plays a critical role in chronic kidney disease (CKD) and hypertension. Trimethylamine-N-oxide (TMAO) and trimethylamine (TMA) are gut microbiota-derived metabolites, and both are known uraemic toxins that are implicated in CKD, atherosclerosis, colorectal cancer and cardiovascular risk. Therefore, the detection and quantification of TMAO, which is a metabolite from gut microbes, are important for the diagnosis of diseases such as atherosclerosis, thrombosis and colorectal cancer. In this study, a new "colour-switch" method that is based on the combination of a plasma separation pad/absorption pad and polyallylamine hydrochloride-capped manganese dioxide (PAH@MnO2) nanozyme was developed for the direct quantitative detection of TMAO in whole blood without blood sample pretreatment. As a proof of concept, a limit of quantitation (LOQ) of less than 6.7 μM for TMAO was obtained with a wide linear quantification range from 15.6 to 500 μM through quantitative analysis, thereby suggesting potential clinical applications in blood TMAO monitoring for CKD patients. | null | false | Rapid Detection of Gut Microbial Metabolite Trimethylamine N-Oxide for Chronic Kidney Disease Prevention. The gut microbiota plays a critical role in chronic kidney disease (CKD) and hypertension. Trimethylamine-N-oxide (TMAO) and trimethylamine (TMA) are gut microbiota-derived metabolites, and both are known uraemic toxins that are implicated in CKD, atherosclerosis, colorectal cancer and cardiovascular risk. Therefore, the detection and quantification of TMAO, which is a metabolite from gut microbes, are important for the diagnosis of diseases such as atherosclerosis, thrombosis and colorectal cancer. In this study, a new "colour-switch" method that is based on the combination of a plasma separation pad/absorption pad and polyallylamine hydrochloride-capped manganese dioxide (PAH@MnO2) nanozyme was developed for the direct quantitative detection of TMAO in whole blood without blood sample pretreatment. As a proof of concept, a limit of quantitation (LOQ) of less than 6.7 μM for TMAO was obtained with a wide linear quantification range from 15.6 to 500 μM through quantitative analysis, thereby suggesting potential clinical applications in blood TMAO monitoring for CKD patients. |
27,655,998 | D000367:Age Factors; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014842:von Willebrand Diseases | [
"D000367",
"D005260",
"D006801",
"D006973",
"D008297",
"D008875",
"D015995",
"D012307",
"D014842"
] | Prevalence and Risk Factors Associated With Hypertension in von Willebrand Disease. | BACKGROUND
von Willebrand factor (VWF) is a biomarker for endothelial damage. Increased VWF levels are observed in hypertension (HTN) and disorders of endothelial dysfunction, for example, atherosclerotic heart disease (ASHD) and diabetes. Whether low VWF protects against HTN is unknown.
METHODS
To determine prevalence and risk factors for HTN in patients with von Willebrand disease (VWD), we conducted a cross-sectional analysis of discharge data from the National Inpatient Sample, 2009 to 2011. Group comparisons were performed by Rao-Scott χ2 test. Odds of HTN and HTN outcomes in VWD were estimated by weighted multivariable logistic regression.
RESULTS
The prevalence of hypertension in patients with VWD (N = 7556), 37.35%, was significantly lower than that in non-VWD patients (N = 19 918 970), 49.40%, P < .0001. Hypertension risk factors (hyperlipidemia, diabetes, smoking, hepatitis C, and HIV) and HTN outcomes (ASHD, myocardial infarction [MI], ischemic stroke, and renal failure) were less common in patients with VWD than in non-VWD patients, all P ≤ .0001. Patients with VWD were younger, 49.67 versus 57.30 years, Caucasian, 82.23% versus 68.35%, and female, 75.44% versus 59.61%, P < .0001. Patients with HTN were older, 67.55 versus 47.29 years, male, 45.99% versus 34.90%, and had more HTN risk factors and HTN outcomes than those without HTN, all P < .0001, including male and female subgroups, each P < .0001. The unadjusted odds of HTN in patients with VWD (odds ratio [OR] = 0.611, P < .0001) and of HTN outcomes in patients with VWD (ASHD, OR = 0.509; MI, OR = 0.422; ischemic stroke, OR = 0.521; renal failure, OR = 0.420, all P < .0001) became insignificant after adjustment for HTN risk factors plus demographics (age/race/gender), OR = 1.035, P = .260.
CONCLUSIONS
The risk of HTN is reduced in patients with VWD, but not after adjustment for HTN risk factors plus demographics, as patients with VWD not having HTN are also typically young, Caucasian, and female. | null | false | Prevalence and Risk Factors Associated With Hypertension in von Willebrand Disease. BACKGROUND
von Willebrand factor (VWF) is a biomarker for endothelial damage. Increased VWF levels are observed in hypertension (HTN) and disorders of endothelial dysfunction, for example, atherosclerotic heart disease (ASHD) and diabetes. Whether low VWF protects against HTN is unknown.
METHODS
To determine prevalence and risk factors for HTN in patients with von Willebrand disease (VWD), we conducted a cross-sectional analysis of discharge data from the National Inpatient Sample, 2009 to 2011. Group comparisons were performed by Rao-Scott χ2 test. Odds of HTN and HTN outcomes in VWD were estimated by weighted multivariable logistic regression.
RESULTS
The prevalence of hypertension in patients with VWD (N = 7556), 37.35%, was significantly lower than that in non-VWD patients (N = 19 918 970), 49.40%, P < .0001. Hypertension risk factors (hyperlipidemia, diabetes, smoking, hepatitis C, and HIV) and HTN outcomes (ASHD, myocardial infarction [MI], ischemic stroke, and renal failure) were less common in patients with VWD than in non-VWD patients, all P ≤ .0001. Patients with VWD were younger, 49.67 versus 57.30 years, Caucasian, 82.23% versus 68.35%, and female, 75.44% versus 59.61%, P < .0001. Patients with HTN were older, 67.55 versus 47.29 years, male, 45.99% versus 34.90%, and had more HTN risk factors and HTN outcomes than those without HTN, all P < .0001, including male and female subgroups, each P < .0001. The unadjusted odds of HTN in patients with VWD (odds ratio [OR] = 0.611, P < .0001) and of HTN outcomes in patients with VWD (ASHD, OR = 0.509; MI, OR = 0.422; ischemic stroke, OR = 0.521; renal failure, OR = 0.420, all P < .0001) became insignificant after adjustment for HTN risk factors plus demographics (age/race/gender), OR = 1.035, P = .260.
CONCLUSIONS
The risk of HTN is reduced in patients with VWD, but not after adjustment for HTN risk factors plus demographics, as patients with VWD not having HTN are also typically young, Caucasian, and female. |
23,965,491 | D000368:Aged; D050197:Atherosclerosis; D048909:Diabetes Complications; D054873:Dipeptidyl-Peptidase IV Inhibitors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D014498:Uracil | [
"D000368",
"D050197",
"D048909",
"D054873",
"D005260",
"D006801",
"D008297",
"D008875",
"D010880",
"D014498"
] | Rationale, design, and baseline characteristics of a trial for the prevention of diabetic atherosclerosis using a DPP-4 inhibitor: the Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A). | OBJECTIVE
Alogliptin, an efficacious inhibitor of DPP-4 that improves glycemic control, as well as the pancreatic beta-cell function, is now increasingly used to accomplish glycemic targets in type 2 diabetic patients. Interestingly, recent experimental studies have shown that alogliptin exerts anti-atherosclerotic effects in GLP-1-dependent and -independent manners. The aim of the present ongoing study is to investigate the preventive effects of alogliptin on the progression of atherosclerosis in type 2 diabetic subjects using the carotid intima-media thickness (IMT), an established marker of cardiovascular disease.
RESULTS
The Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A) is a prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group, comparative study. Between March 2011 and March 2012, 341 participants were recruited at 11 clinical sites, and were randomly allocated either to an alogliptin treatment group (172 patients) or a conventional treatment group (169 patients). The primary outcomes are the changes in the maximum and mean IMT of the common carotid artery during a 24-month treatment period, as measured by carotid arterial echography. The secondary outcomes include the changes in glycemic control, parameters related to beta-cell function and diabetic nephropathy, the occurrence of cardiovascular events and adverse events and biochemical measurements reflecting vascular function.
CONCLUSIONS
This is the first study to address the effects of DPP-4 inhibitors on the progression of changes in the carotid IMT, with the patients without DPP-4 inhibitor treatment serving as a control group. The results will be available soon, and these findings are expected to provide clinical data that will be helpful in the prevention of diabetic atherosclerosis and subsequent cardiovascular disease. | null | false | Rationale, design, and baseline characteristics of a trial for the prevention of diabetic atherosclerosis using a DPP-4 inhibitor: the Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A). OBJECTIVE
Alogliptin, an efficacious inhibitor of DPP-4 that improves glycemic control, as well as the pancreatic beta-cell function, is now increasingly used to accomplish glycemic targets in type 2 diabetic patients. Interestingly, recent experimental studies have shown that alogliptin exerts anti-atherosclerotic effects in GLP-1-dependent and -independent manners. The aim of the present ongoing study is to investigate the preventive effects of alogliptin on the progression of atherosclerosis in type 2 diabetic subjects using the carotid intima-media thickness (IMT), an established marker of cardiovascular disease.
RESULTS
The Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A) is a prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group, comparative study. Between March 2011 and March 2012, 341 participants were recruited at 11 clinical sites, and were randomly allocated either to an alogliptin treatment group (172 patients) or a conventional treatment group (169 patients). The primary outcomes are the changes in the maximum and mean IMT of the common carotid artery during a 24-month treatment period, as measured by carotid arterial echography. The secondary outcomes include the changes in glycemic control, parameters related to beta-cell function and diabetic nephropathy, the occurrence of cardiovascular events and adverse events and biochemical measurements reflecting vascular function.
CONCLUSIONS
This is the first study to address the effects of DPP-4 inhibitors on the progression of changes in the carotid IMT, with the patients without DPP-4 inhibitor treatment serving as a control group. The results will be available soon, and these findings are expected to provide clinical data that will be helpful in the prevention of diabetic atherosclerosis and subsequent cardiovascular disease. |
7,391,468 | D003327:Coronary Disease; D005069:Evaluation Studies as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009098:Multiphasic Screening; D010349:Patient Compliance; D012306:Risk | [
"D003327",
"D005069",
"D006801",
"D008297",
"D008875",
"D009098",
"D010349",
"D012306"
] | Assessing dietary adherence in the Multiple Risk Factor Intervention Trial (MRFIT). I. Use of a dietary monitoring tool. | Participants in the Multiple Risk Factor Intervention Trial (MRFIT) were taught not only how to modify the fat content of their diets but also how to assess their success in doing so. To simplify the process, a food scoring system was developed in which positive points are assigned to high-saturated-fat and high-cholesterol foods and negative points to foods and high-polyunsaturated-fat and low-cholesterol content. Using special forms supplied by MRFIT nutrition counselors, participants were able to self-monitor their dietary regimens. The method is described and forms are illustrated. | 8,890,711 | true | Assessing dietary adherence in the Multiple Risk Factor Intervention Trial (MRFIT). I. Use of a dietary monitoring tool. Participants in the Multiple Risk Factor Intervention Trial (MRFIT) were taught not only how to modify the fat content of their diets but also how to assess their success in doing so. To simplify the process, a food scoring system was developed in which positive points are assigned to high-saturated-fat and high-cholesterol foods and negative points to foods and high-polyunsaturated-fat and low-cholesterol content. Using special forms supplied by MRFIT nutrition counselors, participants were able to self-monitor their dietary regimens. The method is described and forms are illustrated. |
18,388,031 | D015415:Biomarkers; D002097:C-Reactive Protein; D008076:Cholesterol, HDL; D000077407:Cilostazol; D004311:Double-Blind Method; D005260:Female; D005542:Forearm; D006801:Humans; D006940:Hyperemia; D007383:Intermittent Claudication; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D010431:Pentoxifylline; D010991:Plethysmography; D012039:Regional Blood Flow; D012907:Smoking; D013777:Tetrazoles; D014665:Vasodilator Agents; D016138:Walking | [
"D015415",
"D002097",
"D008076",
"D000077407",
"D004311",
"D005260",
"D005542",
"D006801",
"D006940",
"D007383",
"D008297",
"D008875",
"D018384",
"D010431",
"D010991",
"D012039",
"D012907",
"D013777",
"D014665",
"D016138"
] | Effects of cilostazol and pentoxifylline on forearm reactive hyperemia response, lipid profile, oxidative stress, and inflammatory markers in patients with intermittent claudication. | Peripheral arterial disease may lead to lower limb claudication and increased risk of systemic vascular dysfunction. In this article, the authors have investigated the peripheral vascular dysfunction evaluating forearm blood flow using venous occlusion plethysmography, lipid profile, and C-reactive protein in 60 patients with moderate intermittent claudication treated during 20 weeks with placebo (n = 16), cilostazol (200 mg/d; n = 17), or pentoxifylline (1200 mg/d; n = 15) in a randomized double-blinded clinical trial, taking into account smoking. Forearm blood flow after reactive hyperemia response (FBF(h) ) or oral nitroglycerine spray to evaluate endothelial-dependent and endothelial-independent vasodilation, respectively, pain-free and maximal walking distance, levels of C-reactive protein, triglycerides, cholesterol, low-density lipoprotein, and high-density lipoprotein-cholesterol in plasma were determined. The results showed that there was an improvement in the high-density lipoprotein-cholesterol, pain-free and maximal walking distance, and FBF(h) independent of treatment in nonsmoking patients. Cilostazol increased high-density lipoprotein-cholesterol level, maximal walking distance, and FBF(h), whereas pentoxifylline reduced C-reactive protein level and increased maximal walking distance in total and nonsmoking groups. No treatment was effective in smokers. | 1,444,053 | true | Effects of cilostazol and pentoxifylline on forearm reactive hyperemia response, lipid profile, oxidative stress, and inflammatory markers in patients with intermittent claudication. Peripheral arterial disease may lead to lower limb claudication and increased risk of systemic vascular dysfunction. In this article, the authors have investigated the peripheral vascular dysfunction evaluating forearm blood flow using venous occlusion plethysmography, lipid profile, and C-reactive protein in 60 patients with moderate intermittent claudication treated during 20 weeks with placebo (n = 16), cilostazol (200 mg/d; n = 17), or pentoxifylline (1200 mg/d; n = 15) in a randomized double-blinded clinical trial, taking into account smoking. Forearm blood flow after reactive hyperemia response (FBF(h) ) or oral nitroglycerine spray to evaluate endothelial-dependent and endothelial-independent vasodilation, respectively, pain-free and maximal walking distance, levels of C-reactive protein, triglycerides, cholesterol, low-density lipoprotein, and high-density lipoprotein-cholesterol in plasma were determined. The results showed that there was an improvement in the high-density lipoprotein-cholesterol, pain-free and maximal walking distance, and FBF(h) independent of treatment in nonsmoking patients. Cilostazol increased high-density lipoprotein-cholesterol level, maximal walking distance, and FBF(h), whereas pentoxifylline reduced C-reactive protein level and increased maximal walking distance in total and nonsmoking groups. No treatment was effective in smokers. |
11,318,950 | D000818:Animals; D001806:Blood Urea Nitrogen; D050886:HSP20 Heat-Shock Proteins; D018840:HSP70 Heat-Shock Proteins; D006360:Heat-Shock Proteins; D006358:Hot Temperature; D007668:Kidney; D008297:Male; D009124:Muscle Proteins; D009195:Peroxidase; D011794:Quercetin; D012333:RNA, Messenger; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury | [
"D000818",
"D001806",
"D050886",
"D018840",
"D006360",
"D006358",
"D007668",
"D008297",
"D009124",
"D009195",
"D011794",
"D012333",
"D051381",
"D017207",
"D015427"
] | Induction of stress response proteins and experimental renal ischemia/reperfusion. | BACKGROUND
The induction of stress response (heat shock) proteins (HSPs) is a highly conserved response that protects many cell types from diverse physiological and environmental stressors. We tested the hypothesis that the induction of HSPs is protective in experimental renal ischemia/reperfusion injury.
METHODS
The effect of prior heat stress was examined in a rat model of renal ischemia. Postischemic renal function, histopathology, myeloperoxidase activity, and mortality were determined in hyperthermia and sham hyperthermia groups.
RESULTS
HSP84, HSP70, and HSP22 mRNA were increased after eight minutes but not four minutes of hyperthermia. The induction of HSP84 and HSP70 was blocked by pretreatment with quercetin. Improvement in renal function, mortality, and histologic abnormalities was seen with eight minutes of hyperthermia six hours before ischemia. Protection was dependent on the timing of ischemia relative to heat stress and was not observed when HSPs were not induced. Postischemic increases in renal myeloperoxidase activity were markedly attenuated in the hyperthermia compared with the sham hyperthermia group.
CONCLUSIONS
Endogenous protective mechanisms may be important in renal ischemia/reperfusion injury. | null | false | Induction of stress response proteins and experimental renal ischemia/reperfusion. BACKGROUND
The induction of stress response (heat shock) proteins (HSPs) is a highly conserved response that protects many cell types from diverse physiological and environmental stressors. We tested the hypothesis that the induction of HSPs is protective in experimental renal ischemia/reperfusion injury.
METHODS
The effect of prior heat stress was examined in a rat model of renal ischemia. Postischemic renal function, histopathology, myeloperoxidase activity, and mortality were determined in hyperthermia and sham hyperthermia groups.
RESULTS
HSP84, HSP70, and HSP22 mRNA were increased after eight minutes but not four minutes of hyperthermia. The induction of HSP84 and HSP70 was blocked by pretreatment with quercetin. Improvement in renal function, mortality, and histologic abnormalities was seen with eight minutes of hyperthermia six hours before ischemia. Protection was dependent on the timing of ischemia relative to heat stress and was not observed when HSPs were not induced. Postischemic increases in renal myeloperoxidase activity were markedly attenuated in the hyperthermia compared with the sham hyperthermia group.
CONCLUSIONS
Endogenous protective mechanisms may be important in renal ischemia/reperfusion injury. |
21,227,564 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia; D015415:Biomarkers; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007773:Lactates; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D000369",
"D000641",
"D015415",
"D016887",
"D004632",
"D005260",
"D005500",
"D006760",
"D006801",
"D007773",
"D008297",
"D008875",
"D058687",
"D011379",
"D011446",
"D012372",
"D012720",
"D055815"
] | Blood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest. | BACKGROUND
No reliable predictor for the prognosis of out-of-hospital cardiac arrest (OHCA) on arrival at hospital has been identified so far. We speculate that ammonia and lactate may predict patient outcome.
METHODS
This is a prospective observational study. Non-traumatic OHCA patients who gained sustained return of spontaneous circulation and were admitted to acute care unit were included. Blood ammonia and lactate levels were measured on arrival at hospital. The patients were classified into two groups: 'favourable outcome' group (Cerebral Performance Category CPC1-2 at 6-months' follow-up) and 'poor outcome' group (CPC3-5). Basal characteristics obtained from the Utstein template and biomarker levels were compared between these two outcome groups. Independent predictors were selected from all candidates using logistic regression analysis.
RESULTS
A total of 98 patients were included. Ammonia and lactate levels in the favourable outcome group (n=10) were significantly lower than those in poor outcome group (n=88) (p<0.05, respectively). On receiver operating characteristic analysis, the optimal cut-off value for predicting favourable outcome was determined as 170 μg dl(-1) of ammonia and 12.0 mmol l(-1) of lactate (area under the curve; 0.714 and 0.735, respectively). Logistic regression analysis identified ammonia (≤170 μg dl(-1)), therapeutic hypothermia and witnessed by emergency medical service personnel as independent predictors of favourable outcome. When both these biomarker levels were over threshold, positive predictive value (PPV) for poor outcome was calculated as 100%.
CONCLUSIONS
Blood ammonia and lactate levels on arrival are independent prognostic factors for OHCA. PPV with the combination of these biomarkers predicting poor outcome is high enough to be useful in clinical settings. | null | false | Blood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest. BACKGROUND
No reliable predictor for the prognosis of out-of-hospital cardiac arrest (OHCA) on arrival at hospital has been identified so far. We speculate that ammonia and lactate may predict patient outcome.
METHODS
This is a prospective observational study. Non-traumatic OHCA patients who gained sustained return of spontaneous circulation and were admitted to acute care unit were included. Blood ammonia and lactate levels were measured on arrival at hospital. The patients were classified into two groups: 'favourable outcome' group (Cerebral Performance Category CPC1-2 at 6-months' follow-up) and 'poor outcome' group (CPC3-5). Basal characteristics obtained from the Utstein template and biomarker levels were compared between these two outcome groups. Independent predictors were selected from all candidates using logistic regression analysis.
RESULTS
A total of 98 patients were included. Ammonia and lactate levels in the favourable outcome group (n=10) were significantly lower than those in poor outcome group (n=88) (p<0.05, respectively). On receiver operating characteristic analysis, the optimal cut-off value for predicting favourable outcome was determined as 170 μg dl(-1) of ammonia and 12.0 mmol l(-1) of lactate (area under the curve; 0.714 and 0.735, respectively). Logistic regression analysis identified ammonia (≤170 μg dl(-1)), therapeutic hypothermia and witnessed by emergency medical service personnel as independent predictors of favourable outcome. When both these biomarker levels were over threshold, positive predictive value (PPV) for poor outcome was calculated as 100%.
CONCLUSIONS
Blood ammonia and lactate levels on arrival are independent prognostic factors for OHCA. PPV with the combination of these biomarkers predicting poor outcome is high enough to be useful in clinical settings. |
8,484,135 | D003922:Diabetes Mellitus, Type 1; D003925:Diabetic Angiopathies; D006801:Humans; D007238:Infarction; D008297:Male; D008875:Middle Aged; D009132:Muscles; D013848:Thigh | [
"D003922",
"D003925",
"D006801",
"D007238",
"D008297",
"D008875",
"D009132",
"D013848"
] | Diabetic muscular infarction. | In the evaluation of patients with a painful atraumatic mass in an extremity, the clinician should consider a number of clinical entities: primary tumor of muscle, focal or localized nodular myositis, local muscular abscess or soft-tissue infection, osteomyelitis, and thrombophlebitis. A rare complication of diabetes, viz, diabetic muscular infarction, heretofore not reported in the rheumatic disease literature is reviewed. This entity is compared with the conditions of focal and localized nodular myositis, which are nearly as rare. | 1,733,633 | true | Diabetic muscular infarction. In the evaluation of patients with a painful atraumatic mass in an extremity, the clinician should consider a number of clinical entities: primary tumor of muscle, focal or localized nodular myositis, local muscular abscess or soft-tissue infection, osteomyelitis, and thrombophlebitis. A rare complication of diabetes, viz, diabetic muscular infarction, heretofore not reported in the rheumatic disease literature is reviewed. This entity is compared with the conditions of focal and localized nodular myositis, which are nearly as rare. |
30,516,116 | D000368:Aged; D000970:Antineoplastic Agents; D066126:Cardiotoxicity; D005260:Female; D006331:Heart Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma; D009842:Oligopeptides; D061988:Proteasome Inhibitors | [
"D000368",
"D000970",
"D066126",
"D005260",
"D006331",
"D006801",
"D008297",
"D008875",
"D009101",
"D009842",
"D061988"
] | Carfilzomib: A Tale of a Heartbreaking Moment: Case Report and Concise Review of the Literature. | Carfilzomib, a proteasome inhibitor, known as a therapeutical option for people who have already received one or more previous treatments for multiple myeloma, has well known cardiac and systemic adverse effects.
There is evidence supporting that adverse effects are dose dependent, yet there is no known patient phenotype characterized by worse associated consequences, nor are there widely accepted monitoring protocols.
In this article we describe two patients with cardiovascular adverse events related to carfilzomib treatment and their clinical course. Our goal was to present two cases of daily practice, which highlighted the complexity of their management and led to underline how baseline evaluation and close follow-up with echocardiography and cardiac biomarkers, including natriuretic peptides, remain an important tool for the cardiotoxicity surveillance.
These reflections should lead to further studies in order to identify high risk patients for cardiovascular adverse event and clarify the real incidence of cardiotoxicity of this drug and adequate follow-up timing. Finally further research is needed to evaluate strategies for prevention and attenuation of cardiovascular complications of cancer therapy. | null | false | Carfilzomib: A Tale of a Heartbreaking Moment: Case Report and Concise Review of the Literature. Carfilzomib, a proteasome inhibitor, known as a therapeutical option for people who have already received one or more previous treatments for multiple myeloma, has well known cardiac and systemic adverse effects.
There is evidence supporting that adverse effects are dose dependent, yet there is no known patient phenotype characterized by worse associated consequences, nor are there widely accepted monitoring protocols.
In this article we describe two patients with cardiovascular adverse events related to carfilzomib treatment and their clinical course. Our goal was to present two cases of daily practice, which highlighted the complexity of their management and led to underline how baseline evaluation and close follow-up with echocardiography and cardiac biomarkers, including natriuretic peptides, remain an important tool for the cardiotoxicity surveillance.
These reflections should lead to further studies in order to identify high risk patients for cardiovascular adverse event and clarify the real incidence of cardiotoxicity of this drug and adequate follow-up timing. Finally further research is needed to evaluate strategies for prevention and attenuation of cardiovascular complications of cancer therapy. |
19,081,864 | D000328:Adult; D000714:Anastomosis, Surgical; D001921:Brain; D002245:Carbon Dioxide; D016893:Carotid Stenosis; D005260:Female; D006801:Humans; D009072:Moyamoya Disease; D010291:Paresis; D015899:Tomography, Emission-Computed, Single-Photon | [
"D000328",
"D000714",
"D001921",
"D002245",
"D016893",
"D005260",
"D006801",
"D009072",
"D010291",
"D015899"
] | Brain single photon emission tomography and hypercapnia test in testing cerebrovascular reserve capacity, in Moya moya disease. | Moya moya is a progressive cerebral occlusive vasculopathy, rare in European countries. We describe a case of a young woman with right-hand side hemiparesis, mixed expressive aphasia, organic psychosyndrome and cognitive malfunction. Detailed imaging methods displayed bilateral stenosis of the internal carotid artery, bilateral ischemic cerebral changes and bilateral perfusion deficit, which guided us to the final diagnosis. Before the bypass surgery, cerebrovascular reserve capacity (vasoreactivity), by the brain single photon emission tomography and hypercapnia, were assessed and the lower cerebrovascular reserve was demonstrated. Bilateral bypass surgery with extracranial-intracranial anastomosis, improved the neurological deficit. Diagnosis was confirmed by histological examination of the vessel wall specimen. | 972,515 | true | Brain single photon emission tomography and hypercapnia test in testing cerebrovascular reserve capacity, in Moya moya disease. Moya moya is a progressive cerebral occlusive vasculopathy, rare in European countries. We describe a case of a young woman with right-hand side hemiparesis, mixed expressive aphasia, organic psychosyndrome and cognitive malfunction. Detailed imaging methods displayed bilateral stenosis of the internal carotid artery, bilateral ischemic cerebral changes and bilateral perfusion deficit, which guided us to the final diagnosis. Before the bypass surgery, cerebrovascular reserve capacity (vasoreactivity), by the brain single photon emission tomography and hypercapnia, were assessed and the lower cerebrovascular reserve was demonstrated. Bilateral bypass surgery with extracranial-intracranial anastomosis, improved the neurological deficit. Diagnosis was confirmed by histological examination of the vessel wall specimen. |
31,063,699 | D000818:Animals; D050197:Atherosclerosis; D001343:Autophagy; D018450:Disease Progression; D042783:Endothelial Cells; D005487:Foam Cells; D007249:Inflammation; D018799:Intercellular Adhesion Molecule-1; D008077:Lipoproteins, LDL; D008264:Macrophages; D008297:Male; D051379:Mice; D000074085:Mice, Knockout, ApoE; D019007:P-Selectin; D058226:Plaque, Atherosclerotic; D000067996:RAW 264.7 Cells; D042787:Receptor, TIE-2; D037761:Sirtuins; D019010:Vascular Cell Adhesion Molecule-1 | [
"D000818",
"D050197",
"D001343",
"D018450",
"D042783",
"D005487",
"D007249",
"D018799",
"D008077",
"D008264",
"D008297",
"D051379",
"D000074085",
"D019007",
"D058226",
"D000067996",
"D042787",
"D037761",
"D019010"
] | Sirt6 stabilizes atherosclerosis plaques by promoting macrophage autophagy and reducing contact with endothelial cells. | Sirt6 has been reported to play a protective role in macrophage foam cell formation, but whether Sirt6 controls atherosclerosis plaque stability and whether it can reduce the interaction between endothelial cells and macrophages remains unclear. The aim of this study was to investigate the effect of Sirt6 on atherosclerosis plaque stability and the underlying mechanisms. We used Tie2-Cre transgenic mice as a Cre-lox tool to delete Sirt6 floxed sequences in endothelial cells during adulthood to establish Sirt6-/- mice. ApoE-/-:Sirt6-/- and ApoE-/-:Sirt6Tg mice were used in our investigation. After a 16 week high-fat diet, the mice developed markedly atherosclerotic plaques. Sirt6 knockout exacerbated atherosclerotic plaque progression in both size and stability. In vitro, murine macrophage RAW264.7 cells were treated with ox-low density lipoproteins for 24 h to simulate atherosclerosis. Furthermore, Sirt6 overexpression remarkably increased autophagic flux in macrophages and inhibited macrophage apoptosis. Moreover, Sirt6 overexpression inhibited the expression of vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and platelet selectin (P-selectin), leading to reduced infiltration of macrophages and foam cells. In conclusion, our study indicates a new mechanism-based strategy to therapeutically stimulate atherosclerosis plaque stability. | null | false | Sirt6 stabilizes atherosclerosis plaques by promoting macrophage autophagy and reducing contact with endothelial cells. Sirt6 has been reported to play a protective role in macrophage foam cell formation, but whether Sirt6 controls atherosclerosis plaque stability and whether it can reduce the interaction between endothelial cells and macrophages remains unclear. The aim of this study was to investigate the effect of Sirt6 on atherosclerosis plaque stability and the underlying mechanisms. We used Tie2-Cre transgenic mice as a Cre-lox tool to delete Sirt6 floxed sequences in endothelial cells during adulthood to establish Sirt6-/- mice. ApoE-/-:Sirt6-/- and ApoE-/-:Sirt6Tg mice were used in our investigation. After a 16 week high-fat diet, the mice developed markedly atherosclerotic plaques. Sirt6 knockout exacerbated atherosclerotic plaque progression in both size and stability. In vitro, murine macrophage RAW264.7 cells were treated with ox-low density lipoproteins for 24 h to simulate atherosclerosis. Furthermore, Sirt6 overexpression remarkably increased autophagic flux in macrophages and inhibited macrophage apoptosis. Moreover, Sirt6 overexpression inhibited the expression of vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and platelet selectin (P-selectin), leading to reduced infiltration of macrophages and foam cells. In conclusion, our study indicates a new mechanism-based strategy to therapeutically stimulate atherosclerosis plaque stability. |
875,468 | D000293:Adolescent; D000328:Adult; D000531:Altitude; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D010568:Peru; D012737:Sex Factors | [
"D000293",
"D000328",
"D000531",
"D005260",
"D006801",
"D006973",
"D008297",
"D010568",
"D012737"
] | Altitude and hypertension. | In order to study the prevalence of hypertension and some of the factors relevant to its natural history, cross-sectional surveys were performed during the period 1967 to 1973 in five small Peruvian communities, two located at sea level and three above 13,000 feet of altitude. In total, 4,359 persons were studied at sea level (1,970 males and 2,389 females) and 3,055 at high altitude 2,189 males and 866 females). At high altitude, the age-adjusted prevalence of hypertension (particularly systolic) was definitely low; diastolic hypertension was more frequent in men than in women, and it was commoner than systolic hypertension. The reverse was observed in communities at sea level. Long-term blood pressure changes observed in natives accustomed to high altitudes but living at sea level, as well as in white persons usually living at sea level but residing at high altitude, appear to indicate that environmental forces are more important than genetic predispositions in determing the rarity of hypertension in the highlands. Among the environmental forces, chronic hypoxia seems to play an important causal role. | 7,697,403 | true | Altitude and hypertension. In order to study the prevalence of hypertension and some of the factors relevant to its natural history, cross-sectional surveys were performed during the period 1967 to 1973 in five small Peruvian communities, two located at sea level and three above 13,000 feet of altitude. In total, 4,359 persons were studied at sea level (1,970 males and 2,389 females) and 3,055 at high altitude 2,189 males and 866 females). At high altitude, the age-adjusted prevalence of hypertension (particularly systolic) was definitely low; diastolic hypertension was more frequent in men than in women, and it was commoner than systolic hypertension. The reverse was observed in communities at sea level. Long-term blood pressure changes observed in natives accustomed to high altitudes but living at sea level, as well as in white persons usually living at sea level but residing at high altitude, appear to indicate that environmental forces are more important than genetic predispositions in determing the rarity of hypertension in the highlands. Among the environmental forces, chronic hypoxia seems to play an important causal role. |
27,238,153 | D000704:Analysis of Variance; D000818:Animals; D000893:Anti-Inflammatory Agents; D002545:Brain Ischemia; D003072:Cognition Disorders; D015140:Dementia, Vascular; D004195:Disease Models, Animal; D004558:Electric Stimulation; D019695:Glycyrrhizic Acid; D006624:Hippocampus; D066298:In Vitro Techniques; D015227:Lipid Peroxidation; D017774:Long-Term Potentiation; D008297:Male; D008315:Malondialdehyde; D018782:Maze Learning; D018384:Oxidative Stress; D018408:Patch-Clamp Techniques; D051381:Rats; D017208:Rats, Wistar; D013482:Superoxide Dismutase; D061566:Voltage-Gated Sodium Channels | [
"D000704",
"D000818",
"D000893",
"D002545",
"D003072",
"D015140",
"D004195",
"D004558",
"D019695",
"D006624",
"D066298",
"D015227",
"D017774",
"D008297",
"D008315",
"D018782",
"D018384",
"D018408",
"D051381",
"D017208",
"D013482",
"D061566"
] | Glycyrrhizic Acid Ameliorates Cognitive Impairment in a Rat Model of Vascular Dementia Associated with Oxidative Damage and Inhibition of Voltage-Gated Sodium Channels. | Vascular dementia (VD) is the second most common cause of cognitive impairment in the elderly population. Our study aims to investigate the neuroprotective effects of glycyrrhizic acid (GA), a major active constituent of Glycyrrhiza glabra root, in a VD rat model induced by permanent occlusion of the bilateral common carotid arteries. Spatial cognitive function was examined by the Morris water maze test and synaptic plasticity was explored by assessing long-term potentiation. The results showed that GA (20 mg/kg for 5 days) significantly improved the performance of learning and memory of VD rats in the Morris water maze test and attenuated induction of long-term potentiation. Histopathological studies showed that GA significantly attenuated cell damage in VD rats. Malondialdehyde levels and superoxide dismutase activity were analyzed in the hippocampus and cortex to investigate anti-oxidant status. The results showed that GA decreased the level of lipid peroxidation and increased the activity of superoxide dismutase in VD rats. Lastly, whole-cell patch-clamp analysis was used to examine the effect of GA on voltage-gated sodium channels (VGSCs) in hippocampal CA1 pyramidal neurons. GA (10, 20 and 50 μM) inhibited the current amplitude of the VGSCs. These results suggest that the neuroprotective e.ects of GA in VD rats relate to the reduction of oxidative stress and inhibition of VGSCs. Our study provides experimental evidence for the application of GA in the treatment of cognitive deficits induced by Alzheimer's disease, stroke, or traumatic brain injury. | 12,395,083 | true | Glycyrrhizic Acid Ameliorates Cognitive Impairment in a Rat Model of Vascular Dementia Associated with Oxidative Damage and Inhibition of Voltage-Gated Sodium Channels. Vascular dementia (VD) is the second most common cause of cognitive impairment in the elderly population. Our study aims to investigate the neuroprotective effects of glycyrrhizic acid (GA), a major active constituent of Glycyrrhiza glabra root, in a VD rat model induced by permanent occlusion of the bilateral common carotid arteries. Spatial cognitive function was examined by the Morris water maze test and synaptic plasticity was explored by assessing long-term potentiation. The results showed that GA (20 mg/kg for 5 days) significantly improved the performance of learning and memory of VD rats in the Morris water maze test and attenuated induction of long-term potentiation. Histopathological studies showed that GA significantly attenuated cell damage in VD rats. Malondialdehyde levels and superoxide dismutase activity were analyzed in the hippocampus and cortex to investigate anti-oxidant status. The results showed that GA decreased the level of lipid peroxidation and increased the activity of superoxide dismutase in VD rats. Lastly, whole-cell patch-clamp analysis was used to examine the effect of GA on voltage-gated sodium channels (VGSCs) in hippocampal CA1 pyramidal neurons. GA (10, 20 and 50 μM) inhibited the current amplitude of the VGSCs. These results suggest that the neuroprotective e.ects of GA in VD rats relate to the reduction of oxidative stress and inhibition of VGSCs. Our study provides experimental evidence for the application of GA in the treatment of cognitive deficits induced by Alzheimer's disease, stroke, or traumatic brain injury. |
9,620,935 | D000818:Animals; D004285:Dogs; D065128:Endothelin Receptor Antagonists; D019332:Endothelin-1; D006439:Hemodynamics; D007150:Immunohistochemistry; D007189:Indans; D008168:Lung; D016040:Lung Transplantation; D009929:Organ Size; D011652:Pulmonary Circulation; D015427:Reperfusion Injury; D014655:Vascular Resistance | [
"D000818",
"D004285",
"D065128",
"D019332",
"D006439",
"D007150",
"D007189",
"D008168",
"D016040",
"D009929",
"D011652",
"D015427",
"D014655"
] | Efficacy of administering an endothelin-receptor antagonist (SB209670) in ameliorating ischemia-reperfusion injury in lung allografts. | The purpose of this study was to determine whether treatment with an endothelin-1 (ET-1)-receptor antagonist could prevent ET-1-mediated ischemia-reperfusion injury and early allograft dysfunction. Eleven dogs were subjected to left lung allotransplantation. Donor lungs were preserved with modified Eurocollins solution and stored at 4 degrees C for 18 to 20 h. Animals received an intravenous infusion of either the ET-receptor antagonist SB209670 (n = 6) (15 microg/kg/min) or saline (control, n = 5), in a blinded fashion. The infusion started 30 min before transplantation and continued for up to 6 h after transplantation. Hemodynamic measurements, blood gas tensions, and plasma samples were obtained with animals functioning solely on the transplanted lung. Open-lung biopsies were obtained for wet-to-dry-weight ratios and histologic and immunohistochemical analyses. Survival at 6 h after transplantation was 40% in the control group and 100% in the treatment group. Pulmonary vascular resistance and lung tissue wet-to-dry-weight ratio were significantly lower in treated animals at 3 and 6 h after transplantation. Histology of the transplanted lungs revealed more intense airway and interstitial inflammatory infiltration and edema in the control group. Arterial and venous plasma ET-1 concentrations increased after transplantation; however, they were significantly higher in the treatment group. Immunohistochemical analysis revealed more intense ET-1 immunostaining in the airways and parenchyma of the treatment group. We conclude that treatment of lung allografts with the mixed endothelin A/endothelin B (ETA/ETB) receptor antagonist SB209670 can ameliorate ischemia-reperfusion injury, resulting in improved graft function and survival after lung transplantation. | 6,796,205 | true | Efficacy of administering an endothelin-receptor antagonist (SB209670) in ameliorating ischemia-reperfusion injury in lung allografts. The purpose of this study was to determine whether treatment with an endothelin-1 (ET-1)-receptor antagonist could prevent ET-1-mediated ischemia-reperfusion injury and early allograft dysfunction. Eleven dogs were subjected to left lung allotransplantation. Donor lungs were preserved with modified Eurocollins solution and stored at 4 degrees C for 18 to 20 h. Animals received an intravenous infusion of either the ET-receptor antagonist SB209670 (n = 6) (15 microg/kg/min) or saline (control, n = 5), in a blinded fashion. The infusion started 30 min before transplantation and continued for up to 6 h after transplantation. Hemodynamic measurements, blood gas tensions, and plasma samples were obtained with animals functioning solely on the transplanted lung. Open-lung biopsies were obtained for wet-to-dry-weight ratios and histologic and immunohistochemical analyses. Survival at 6 h after transplantation was 40% in the control group and 100% in the treatment group. Pulmonary vascular resistance and lung tissue wet-to-dry-weight ratio were significantly lower in treated animals at 3 and 6 h after transplantation. Histology of the transplanted lungs revealed more intense airway and interstitial inflammatory infiltration and edema in the control group. Arterial and venous plasma ET-1 concentrations increased after transplantation; however, they were significantly higher in the treatment group. Immunohistochemical analysis revealed more intense ET-1 immunostaining in the airways and parenchyma of the treatment group. We conclude that treatment of lung allografts with the mixed endothelin A/endothelin B (ETA/ETB) receptor antagonist SB209670 can ameliorate ischemia-reperfusion injury, resulting in improved graft function and survival after lung transplantation. |
30,323,370 | D000328:Adult; D018771:Arthralgia; D001323:Autoantibodies; D004890:Erythema; D005148:Facial Dermatoses; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease; D019226:Oral Ulcer; D010154:Pakistan; D010787:Photosensitivity Disorders; D011928:Raynaud Disease; D017412:Ribonucleoprotein, U1 Small Nuclear; D013585:Synovitis; D055815:Young Adult | [
"D000328",
"D018771",
"D001323",
"D004890",
"D005148",
"D005260",
"D006801",
"D008297",
"D008875",
"D008947",
"D019226",
"D010154",
"D010787",
"D011928",
"D017412",
"D013585",
"D055815"
] | Clinical and immunological profile in patients with mixed connective tissue disease. | Mixed connective tissue disease (MCTD) is a rare disease and presents with varied overlapping symptoms of different connective tissue disorders. Many patients evolve into other connective tissue disorders with the passage of time. The case series included 20 patients with the diagnosis of MCTD, registered at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2010 to May 2015. Of these, 16 (80.0%) were female and 4 (20.0%) patients were male. The mean age was 30.5±8.9 years and the mean duration of illness was 4.5±2 years. Commonest presenting symptom was arthralgia in 17 (85%) patients. All the patients had positive ANA and anti-RNP antibodies. Over the disease course of 6 years, 2 (10%) patients evolved into Systemic lupus erythematosus (SLE); One each (5%) into Sjogren's syndrome, Scleroderma and Rheumatoid arthritis. | 2,185,901 | true | Clinical and immunological profile in patients with mixed connective tissue disease. Mixed connective tissue disease (MCTD) is a rare disease and presents with varied overlapping symptoms of different connective tissue disorders. Many patients evolve into other connective tissue disorders with the passage of time. The case series included 20 patients with the diagnosis of MCTD, registered at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2010 to May 2015. Of these, 16 (80.0%) were female and 4 (20.0%) patients were male. The mean age was 30.5±8.9 years and the mean duration of illness was 4.5±2 years. Commonest presenting symptom was arthralgia in 17 (85%) patients. All the patients had positive ANA and anti-RNP antibodies. Over the disease course of 6 years, 2 (10%) patients evolved into Systemic lupus erythematosus (SLE); One each (5%) into Sjogren's syndrome, Scleroderma and Rheumatoid arthritis. |
12,941,729 | D015415:Biomarkers; D002097:C-Reactive Protein; D002339:Carotid Arteries; D016893:Carotid Stenosis; D002784:Cholesterol; D003404:Creatinine; D003924:Diabetes Mellitus, Type 2; D003925:Diabetic Angiopathies; D006710:Homocysteine; D006801:Humans; D020138:Hyperhomocysteinemia; D020382:Interleukin-18; D008875:Middle Aged; D012016:Reference Values; D017539:Tunica Intima; D017540:Tunica Media | [
"D015415",
"D002097",
"D002339",
"D016893",
"D002784",
"D003404",
"D003924",
"D003925",
"D006710",
"D006801",
"D020138",
"D020382",
"D008875",
"D012016",
"D017539",
"D017540"
] | Relationships of plasma interleukin-18 concentrations to hyperhomocysteinemia and carotid intimal-media wall thickness in patients with type 2 diabetes. | OBJECTIVE
We compared plasma interleukin (IL)-18 concentrations in patients with type 2 diabetes with those in age-matched control subjects and investigated whether plasma IL-18 was associated with plasma total homocysteine (tHcy) concentration or carotid intimal-media wall thickness (IMT), an early marker of atherosclerosis, in these patients.
METHODS
We measured plasma IL-18 in 103 type 2 diabetic patients and 45 age-matched control subjects. We also measured patients' plasma tHcy and serum high-sensitivity C-reactive protein (hs-CRP). IMT was evaluated for both common carotid arteries.
RESULTS
Plasma IL-18 was significantly higher in diabetic patients than in control subjects (203 +/- 153 vs. 118 +/- 37 pg/ml, P < 0.001). High IL-18 was defined as equaling or exceeding the mean + 2 SD of plasma IL-18 in control subjects (192 pg/ml). Patients with high IL-18 showed a greater carotid IMT than those with normal IL-18. Carotid plaques were more numerous in diabetic patients with high IL-18 than in those with normal IL-18. Plasma tHcy concentrations were significantly higher in patients with high IL-18 than in those with normal IL-18. Univariate and multivariate analyses showed a strong independent association between tHcy and IL-18. Plasma IL-18 also correlated positively with serum hs-CRP.
CONCLUSIONS
In patients with type 2 diabetes, plasma IL-18 concentrations are greater than in nondiabetic subjects. Plasma IL-18 is an independent determinant of plasma tHcy, which is linked independently with atherosclerotic carotid wall thickening. | null | false | Relationships of plasma interleukin-18 concentrations to hyperhomocysteinemia and carotid intimal-media wall thickness in patients with type 2 diabetes. OBJECTIVE
We compared plasma interleukin (IL)-18 concentrations in patients with type 2 diabetes with those in age-matched control subjects and investigated whether plasma IL-18 was associated with plasma total homocysteine (tHcy) concentration or carotid intimal-media wall thickness (IMT), an early marker of atherosclerosis, in these patients.
METHODS
We measured plasma IL-18 in 103 type 2 diabetic patients and 45 age-matched control subjects. We also measured patients' plasma tHcy and serum high-sensitivity C-reactive protein (hs-CRP). IMT was evaluated for both common carotid arteries.
RESULTS
Plasma IL-18 was significantly higher in diabetic patients than in control subjects (203 +/- 153 vs. 118 +/- 37 pg/ml, P < 0.001). High IL-18 was defined as equaling or exceeding the mean + 2 SD of plasma IL-18 in control subjects (192 pg/ml). Patients with high IL-18 showed a greater carotid IMT than those with normal IL-18. Carotid plaques were more numerous in diabetic patients with high IL-18 than in those with normal IL-18. Plasma tHcy concentrations were significantly higher in patients with high IL-18 than in those with normal IL-18. Univariate and multivariate analyses showed a strong independent association between tHcy and IL-18. Plasma IL-18 also correlated positively with serum hs-CRP.
CONCLUSIONS
In patients with type 2 diabetes, plasma IL-18 concentrations are greater than in nondiabetic subjects. Plasma IL-18 is an independent determinant of plasma tHcy, which is linked independently with atherosclerotic carotid wall thickening. |
31,806,596 | D000293:Adolescent; D001921:Brain; D002545:Brain Ischemia; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009072:Moyamoya Disease; D010100:Oxygen; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke | [
"D000293",
"D001921",
"D002545",
"D002648",
"D015331",
"D005260",
"D006801",
"D008279",
"D008297",
"D009072",
"D010100",
"D012189",
"D012306",
"D020521"
] | Predicting Ischemic Risk Using Blood Oxygen Level-Dependent MRI in Children with Moyamoya. | Moyamoya is a progressive steno-occlusive arteriopathy. MR imaging assessment of cerebrovascular reactivity can be performed by measuring the blood oxygen level-dependent cerebrovascular reactivity response to vasoactive stimuli. Our objective was to determine whether negative blood oxygen level-dependent cerebrovascular reactivity status is predictive of ischemic events in childhood moyamoya.
We conducted a retrospective study of a consecutive cohort of children with moyamoya who underwent assessment of blood oxygen level-dependent cerebrovascular reactivity. The charts of patients with written informed consent were reviewed for the occurrence of arterial ischemic stroke, transient ischemic attack, or silent infarcts. We used logistic regression to calculate the OR and 95% CI for ischemic events based on steal status. Hazard ratios for ischemic events based on age at blood oxygen level-dependent cerebrovascular reactivity imaging, sex, and moyamoya etiology were calculated using Cox hazards models.
Thirty-seven children (21 female; median age, 10.7 years; interquartile range, 7.5-14.7 years) were followed for a median of 28.8 months (interquartile range, 13.7-84.1 months). Eleven (30%) had ischemic events, 82% of which were TIA without infarcts. Steal was present in 15 of 16 (93.8%) hemispheres in which ischemic events occurred versus 25 of 58 (43.1%) ischemic-free hemispheres (OR = 19.8; 95% CI, 2.5-160; P = .005). Children with idiopathic moyamoya were at significantly greater risk of ischemic events (hazard ratio, 3.71; 95% CI, 1.1-12.8; P = .037).
Our study demonstrates that idiopathic moyamoya and the presence of steal are independently associated with ischemic events. The use of blood oxygen level-dependent cerebrovascular reactivity could potentially assist in the selection of patients for revascularization surgery and the direction of therapy in children with moyamoya. | null | false | Predicting Ischemic Risk Using Blood Oxygen Level-Dependent MRI in Children with Moyamoya. Moyamoya is a progressive steno-occlusive arteriopathy. MR imaging assessment of cerebrovascular reactivity can be performed by measuring the blood oxygen level-dependent cerebrovascular reactivity response to vasoactive stimuli. Our objective was to determine whether negative blood oxygen level-dependent cerebrovascular reactivity status is predictive of ischemic events in childhood moyamoya.
We conducted a retrospective study of a consecutive cohort of children with moyamoya who underwent assessment of blood oxygen level-dependent cerebrovascular reactivity. The charts of patients with written informed consent were reviewed for the occurrence of arterial ischemic stroke, transient ischemic attack, or silent infarcts. We used logistic regression to calculate the OR and 95% CI for ischemic events based on steal status. Hazard ratios for ischemic events based on age at blood oxygen level-dependent cerebrovascular reactivity imaging, sex, and moyamoya etiology were calculated using Cox hazards models.
Thirty-seven children (21 female; median age, 10.7 years; interquartile range, 7.5-14.7 years) were followed for a median of 28.8 months (interquartile range, 13.7-84.1 months). Eleven (30%) had ischemic events, 82% of which were TIA without infarcts. Steal was present in 15 of 16 (93.8%) hemispheres in which ischemic events occurred versus 25 of 58 (43.1%) ischemic-free hemispheres (OR = 19.8; 95% CI, 2.5-160; P = .005). Children with idiopathic moyamoya were at significantly greater risk of ischemic events (hazard ratio, 3.71; 95% CI, 1.1-12.8; P = .037).
Our study demonstrates that idiopathic moyamoya and the presence of steal are independently associated with ischemic events. The use of blood oxygen level-dependent cerebrovascular reactivity could potentially assist in the selection of patients for revascularization surgery and the direction of therapy in children with moyamoya. |
29,747,067 | D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005121:Extremities; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D004856:Postural Balance; D020521:Stroke; D000071939:Stroke Rehabilitation | [
"D000328",
"D000368",
"D001696",
"D005121",
"D005260",
"D005684",
"D006801",
"D008297",
"D008875",
"D018482",
"D004856",
"D020521",
"D000071939"
] | More symmetrical gait after split-belt treadmill walking does not modify dynamic and postural balance in individuals post-stroke. | Spontaneous gait is often asymmetrical in individuals post-stroke, despite their ability to walk more symmetrically on demand. Given the sensorimotor deficits in the paretic limb, this asymmetrical gait may facilitate balance maintenance. We used a split-belt walking protocol to alter gait asymmetry and determine the effects on dynamic and postural balance. Twenty individuals post-stroke walked on a split-belt treadmill. In two separate periods, the effects of walking with the non-paretic leg, and then the paretic one, on the faster belt on spatio-temporal symmetry and balance were compared before and after these perturbation periods. Kinematic and kinetic data were collected using a motion analysis system and an instrumented treadmill to determine symmetry ratios of spatiotemporal parameters and dynamic and postural balance. Balance, quantified by the concepts of stabilizing and destabilizing forces, was compared before and after split-belt walking for subgroups of participants who improved and worsened their symmetry. The side on the slow belt during split-belt walking, but not the changes in asymmetry, affected balance. Difficulty in maintaining balance was higher during stance phase of the leg that was on the slow belt and lower on the contralateral side after split-belt walking, mostly because the center of pressure was closer (higher difficulty) or further (lower difficulty) from the limit of the base of support, respectively. Changes in spatiotemporal parameters may be sought without additional alteration of balance during gait post-stroke. | 7,763,493 | true | More symmetrical gait after split-belt treadmill walking does not modify dynamic and postural balance in individuals post-stroke. Spontaneous gait is often asymmetrical in individuals post-stroke, despite their ability to walk more symmetrically on demand. Given the sensorimotor deficits in the paretic limb, this asymmetrical gait may facilitate balance maintenance. We used a split-belt walking protocol to alter gait asymmetry and determine the effects on dynamic and postural balance. Twenty individuals post-stroke walked on a split-belt treadmill. In two separate periods, the effects of walking with the non-paretic leg, and then the paretic one, on the faster belt on spatio-temporal symmetry and balance were compared before and after these perturbation periods. Kinematic and kinetic data were collected using a motion analysis system and an instrumented treadmill to determine symmetry ratios of spatiotemporal parameters and dynamic and postural balance. Balance, quantified by the concepts of stabilizing and destabilizing forces, was compared before and after split-belt walking for subgroups of participants who improved and worsened their symmetry. The side on the slow belt during split-belt walking, but not the changes in asymmetry, affected balance. Difficulty in maintaining balance was higher during stance phase of the leg that was on the slow belt and lower on the contralateral side after split-belt walking, mostly because the center of pressure was closer (higher difficulty) or further (lower difficulty) from the limit of the base of support, respectively. Changes in spatiotemporal parameters may be sought without additional alteration of balance during gait post-stroke. |
28,543,795 | D000328:Adult; D054537:Atrioventricular Block; D002036:Bundle of His; D002304:Cardiac Pacing, Artificial; D000080041:Congenitally Corrected Transposition of the Great Arteries; D004562:Electrocardiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010138:Pacemaker, Artificial; D014188:Transposition of Great Vessels | [
"D000328",
"D054537",
"D002036",
"D002304",
"D000080041",
"D004562",
"D006801",
"D008279",
"D008297",
"D010138",
"D014188"
] | Permanent nonselective His bundle pacing in an adult with L-transposition of the great arteries and complete AV block. | We report the placement of a permanent transvenous nonselective His bundle pacing lead in conjunction with a transvenous pacemaker/implantable cardioverter-defibrillator in an adult with Levo-Transposition of the Great Arteries (L-TGA) and a stenotic coronary sinus (CS) ostium, which would not accommodate a transvenous left ventricular (LV) pacing lead. Nonselective His bundle pacing provided a nearly identical ventricular activation pattern in this previously unpaced patient. Many L-TGA patients will have an eventual need for permanent pacing and, given the challenges of CS cannulation, His bundle pacing may represent a preferred modality rather than pure morphologic LV pacing or surgical systemic ventricular lead placement to achieve optimal electrical synchrony. | 8,465,127 | true | Permanent nonselective His bundle pacing in an adult with L-transposition of the great arteries and complete AV block. We report the placement of a permanent transvenous nonselective His bundle pacing lead in conjunction with a transvenous pacemaker/implantable cardioverter-defibrillator in an adult with Levo-Transposition of the Great Arteries (L-TGA) and a stenotic coronary sinus (CS) ostium, which would not accommodate a transvenous left ventricular (LV) pacing lead. Nonselective His bundle pacing provided a nearly identical ventricular activation pattern in this previously unpaced patient. Many L-TGA patients will have an eventual need for permanent pacing and, given the challenges of CS cannulation, His bundle pacing may represent a preferred modality rather than pure morphologic LV pacing or surgical systemic ventricular lead placement to achieve optimal electrical synchrony. |
31,216,900 | D000223:Adaptation, Psychological; D003221:Confusion; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018454:Spouses; D020521:Stroke; D000071939:Stroke Rehabilitation | [
"D000223",
"D003221",
"D005260",
"D006801",
"D008137",
"D008297",
"D008875",
"D010351",
"D018454",
"D020521",
"D000071939"
] | "Just got to live life as it comes": A case study of the spousal-dyad longitudinal mild stroke transitional experience. | Objective: To longitudinally explore the transition home for a spousal dyad following mild stroke, in the context of a mild stroke-specific health service. Research Design: A case study approach, using an Interpretative Phenomenological Analysis (IPA), was identified as suitable for this study, as it enabled the essence of the phenomenon to be examined. Method: Participants were purposively chosen from a Randomised Control Trial (RCT), to reflect the average age, gender and marital status of the mild stroke population. The participants were a male (age 64) and his wife (age 62). Participants received the RCT intervention. Semi-structured interviews were completed separately with participants at 1-, 3-, 6- and 9- months post stroke. Results: Two themes were identified: (1) The Unexpected, Undesirable and Short-Lived, and (2) The New 'Normal'. The first theme reflects the confusion, adjustment and adaptation that occurred for the couple, especially during the first month at home. The second represents the couple's journey back to their everyday lives following hospital discharge, but also the questions and changes that remained present at 9-months post-discharge. Conclusions: Themes demonstrate an ongoing process of adjustment and the contextual nature of the transitional experience. Results also indicate the need to ensure that individuals have access to mild-stroke specific information across the transition continuum. | null | false | "Just got to live life as it comes": A case study of the spousal-dyad longitudinal mild stroke transitional experience. Objective: To longitudinally explore the transition home for a spousal dyad following mild stroke, in the context of a mild stroke-specific health service. Research Design: A case study approach, using an Interpretative Phenomenological Analysis (IPA), was identified as suitable for this study, as it enabled the essence of the phenomenon to be examined. Method: Participants were purposively chosen from a Randomised Control Trial (RCT), to reflect the average age, gender and marital status of the mild stroke population. The participants were a male (age 64) and his wife (age 62). Participants received the RCT intervention. Semi-structured interviews were completed separately with participants at 1-, 3-, 6- and 9- months post stroke. Results: Two themes were identified: (1) The Unexpected, Undesirable and Short-Lived, and (2) The New 'Normal'. The first theme reflects the confusion, adjustment and adaptation that occurred for the couple, especially during the first month at home. The second represents the couple's journey back to their everyday lives following hospital discharge, but also the questions and changes that remained present at 9-months post-discharge. Conclusions: Themes demonstrate an ongoing process of adjustment and the contextual nature of the transitional experience. Results also indicate the need to ensure that individuals have access to mild-stroke specific information across the transition continuum. |
11,308,205 | D001705:Bioprosthesis; D002815:Chordae Tendineae; D006349:Heart Valve Diseases; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008943:Mitral Valve; D011474:Prosthesis Design; D012680:Sensitivity and Specificity; D013536:Suture Techniques | [
"D001705",
"D002815",
"D006349",
"D006350",
"D019918",
"D006801",
"D008943",
"D011474",
"D012680",
"D013536"
] | Artificial mitral valve chordae replacement made simple. | Mitral valve repair techniques are now widely applied in patients with myxomatous valve disease. The use of artificial chords to achieve correct height adjustment of the prolapsing anterior leaflet segment can often be challenging. We describe a simple method of artificial chord reconstruction performed after annuloplasty, which allows for easy identification of functional prolapse and accurate chordal height adjustment. | 10,408,489 | true | Artificial mitral valve chordae replacement made simple. Mitral valve repair techniques are now widely applied in patients with myxomatous valve disease. The use of artificial chords to achieve correct height adjustment of the prolapsing anterior leaflet segment can often be challenging. We describe a simple method of artificial chord reconstruction performed after annuloplasty, which allows for easy identification of functional prolapse and accurate chordal height adjustment. |
15,637,994 | D001164:Arteriovenous Fistula; D002550:Cerebral Veins; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations; D014463:Ultrasonography | [
"D001164",
"D002550",
"D005260",
"D006801",
"D007231",
"D002538",
"D014463"
] | [Ultrasound diagnosis of aneurysm of the vein of Galen in children]. | Aneurysm of the vein of Galen is rare and complex vascular disorder that develops during embriogenesis and provokes significant haemodynamic changes. Boys are more frequently involved. During the foetal period Ballantyne syndrome may develop, and postnatal clinical presentation vary with ages. Serious haemodynamic changes are followed by congestive heart failure and, if not treated, with lethal exitus. Fast and correct diagnosis is very important. Ultrasound examination of central nervous system supported with Duplex-Doppler and Colour-Doppler examination of the head and heart enables the diagnosis. This text comments ultrasound presentation of the malformation and ultrasound diagnostic possibilities. | null | false | [Ultrasound diagnosis of aneurysm of the vein of Galen in children]. Aneurysm of the vein of Galen is rare and complex vascular disorder that develops during embriogenesis and provokes significant haemodynamic changes. Boys are more frequently involved. During the foetal period Ballantyne syndrome may develop, and postnatal clinical presentation vary with ages. Serious haemodynamic changes are followed by congestive heart failure and, if not treated, with lethal exitus. Fast and correct diagnosis is very important. Ultrasound examination of central nervous system supported with Duplex-Doppler and Colour-Doppler examination of the head and heart enables the diagnosis. This text comments ultrasound presentation of the malformation and ultrasound diagnostic possibilities. |
17,696,830 | D000368:Aged; D006331:Heart Diseases; D006801:Humans; D007037:Hypothyroidism; D012449:Safety; D013974:Thyroxine | [
"D000368",
"D006331",
"D006801",
"D007037",
"D012449",
"D013974"
] | Treatment of hypothyroidism in elderly patients and in patients with cardiac disease. | Hypothyroidism is often associated with adverse cardiovascular risk factors such as high cholesterol together with hypertension, endothelial dysfunction, and other atherosclerotic cardiovascular risk factors. The changed hemodynamic characteristics result in reduced cardiac index, and the renal perfusion is impaired with hyponatremia, and low renin and aldosterone production. The ischemic abnormalities are probably related to long-term consequences of a slow development of hypothyroidism, while the hemodynamic changes can develop in very short-term hypothyroidism. Replacement of hypothyroidism with levothyroxine is associated with a normalization of basal metabolic rate. Most patients with preexisting angina experience a gradual amelioration of symptoms, but in some cases the initial therapy may precipitate an unrecognized ischemic state, worsen a preexisting angina, or even result in myocardial infarction. It is therefore advisable to start replacement slowly and if needed perform a stress test and/or coronary angiography before. It may also in some cases be necessary to monitor the patients closely in a hospital setting during initiation of levothyroxine. Elderly hypothyroid patients with unstable angina pose a particular challenging problem, especially if coronary vascular surgery is indicated. No increased risk of peri- or postoperative death has been noted in small studies, although more complications have been described. It may be relevant to treat the cardiac vascular occlusion before starting replacement with levothyroxine in some cases, after careful weighting of pros and cons in each individual case. | 2,454,378 | true | Treatment of hypothyroidism in elderly patients and in patients with cardiac disease. Hypothyroidism is often associated with adverse cardiovascular risk factors such as high cholesterol together with hypertension, endothelial dysfunction, and other atherosclerotic cardiovascular risk factors. The changed hemodynamic characteristics result in reduced cardiac index, and the renal perfusion is impaired with hyponatremia, and low renin and aldosterone production. The ischemic abnormalities are probably related to long-term consequences of a slow development of hypothyroidism, while the hemodynamic changes can develop in very short-term hypothyroidism. Replacement of hypothyroidism with levothyroxine is associated with a normalization of basal metabolic rate. Most patients with preexisting angina experience a gradual amelioration of symptoms, but in some cases the initial therapy may precipitate an unrecognized ischemic state, worsen a preexisting angina, or even result in myocardial infarction. It is therefore advisable to start replacement slowly and if needed perform a stress test and/or coronary angiography before. It may also in some cases be necessary to monitor the patients closely in a hospital setting during initiation of levothyroxine. Elderly hypothyroid patients with unstable angina pose a particular challenging problem, especially if coronary vascular surgery is indicated. No increased risk of peri- or postoperative death has been noted in small studies, although more complications have been described. It may be relevant to treat the cardiac vascular occlusion before starting replacement with levothyroxine in some cases, after careful weighting of pros and cons in each individual case. |
26,749,478 | D000328:Adult; D000792:Angiography; D001165:Arteriovenous Malformations; D004621:Embolization, Therapeutic; D000431:Ethanol; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D011677:Punctures; D016896:Treatment Outcome; D055815:Young Adult | [
"D000328",
"D000792",
"D001165",
"D004621",
"D000431",
"D005260",
"D005528",
"D006801",
"D008297",
"D011677",
"D016896",
"D055815"
] | Percutaneous embolization of arteriovenous malformations at the plantar aspect of the foot. | Peripheral arteriovenous malformations (AVM) remain most challenging among various congenital vascular malformations to be treated. Here we present three illustrative patients with Yakes type IIIb and type IV AVM at the plantar aspect of the foot who were successfully treated by minimally invasive embolization. The value of the Yakes AVM classification system to guide the therapeutic decision making by directing specific therapeutic procedures to specific AVM types defined by their angioarchitecture is demonstrated. Direct percutaneous AVM puncture with coiling of aneurysmal outflow vein and subsequent ethanol embolization is shown. Finally, the report illustrates that several AVM types can coexist. | 13,720,898 | true | Percutaneous embolization of arteriovenous malformations at the plantar aspect of the foot. Peripheral arteriovenous malformations (AVM) remain most challenging among various congenital vascular malformations to be treated. Here we present three illustrative patients with Yakes type IIIb and type IV AVM at the plantar aspect of the foot who were successfully treated by minimally invasive embolization. The value of the Yakes AVM classification system to guide the therapeutic decision making by directing specific therapeutic procedures to specific AVM types defined by their angioarchitecture is demonstrated. Direct percutaneous AVM puncture with coiling of aneurysmal outflow vein and subsequent ethanol embolization is shown. Finally, the report illustrates that several AVM types can coexist. |
1,607,269 | D000553:Ambulatory Care; D001794:Blood Pressure; D015924:Blood Pressure Monitors; D003951:Diagnostic Errors; D015716:Electrocardiography, Ambulatory; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011237:Predictive Value of Tests | [
"D000553",
"D001794",
"D015924",
"D003951",
"D015716",
"D005188",
"D005189",
"D005260",
"D006339",
"D006801",
"D006973",
"D008297",
"D008875",
"D008991",
"D011237"
] | Evaluation of clinic blood pressure measurements: assessment by daytime ambulatory blood pressure monitoring. | The clinical value of a set of three clinical blood pressure measurements as a predictor of daytime ambulatory hypertension was assessed by performing a set of clinical blood pressure measurements in 171 borderline hypertensives, and calculating their diagnostic accuracy, sensitivity, specificity and predictive value compared to the daytime average of ambulatory blood pressure monitoring. Diagnostic accuracy was 0.63, sensitivity was 81% and specificity was 47%. Positive and negative predictive values were 0.60 and 0.74, respectively. The set of clinical measurements detected 81% of hypertensives, but 36% of the population screened was mislabelled--48 patients (28%) as hypertensive and 15 (8%) as normotensive. A single set of clinic blood pressure measurements is quite sensitive for diagnosing daytime hypertension, although its accuracy, specificity and predictive value are low. The subpopulation incorrectly labelled as normotensive may have a different prognosis and merits further prospective study. | 8,639,450 | true | Evaluation of clinic blood pressure measurements: assessment by daytime ambulatory blood pressure monitoring. The clinical value of a set of three clinical blood pressure measurements as a predictor of daytime ambulatory hypertension was assessed by performing a set of clinical blood pressure measurements in 171 borderline hypertensives, and calculating their diagnostic accuracy, sensitivity, specificity and predictive value compared to the daytime average of ambulatory blood pressure monitoring. Diagnostic accuracy was 0.63, sensitivity was 81% and specificity was 47%. Positive and negative predictive values were 0.60 and 0.74, respectively. The set of clinical measurements detected 81% of hypertensives, but 36% of the population screened was mislabelled--48 patients (28%) as hypertensive and 15 (8%) as normotensive. A single set of clinic blood pressure measurements is quite sensitive for diagnosing daytime hypertension, although its accuracy, specificity and predictive value are low. The subpopulation incorrectly labelled as normotensive may have a different prognosis and merits further prospective study. |
29,939,942 | D000368:Aged; D055109:Ankle Brachial Index; D001011:Aorta; D058070:Asymptomatic Diseases; D050197:Atherosclerosis; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002340:Carotid Artery Diseases; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease; D003331:Coronary Vessels; D003430:Cross-Sectional Studies; D003971:Diastole; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013599:Systole; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification | [
"D000368",
"D055109",
"D001011",
"D058070",
"D050197",
"D001794",
"D018660",
"D002340",
"D059168",
"D003324",
"D003331",
"D003430",
"D003971",
"D005260",
"D006801",
"D008297",
"D008875",
"D013599",
"D014057",
"D061205"
] | Home blood pressure variability and subclinical atherosclerosis in multiple vascular beds: a population-based study. | The mechanism by which higher blood pressure (BP) variability causes cardiovascular events remains unclear. Experimental results indicate that alterations in vessel wall tension related to BP variability may initiate atherosclerosis through oscillatory shear stress. We examined associations of home BP variability with subclinical atherosclerosis at four anatomically distinct vascular beds.
In a cross-sectional population-based study of 1033 Japanese (mean age, 64.0 years; men, 88.7%) without known cardiovascular disease, we defined SBP and DBP variability as variability independent of the mean (VIM) across self-measured home BP values during seven consecutive days and quantified coronary and aortic artery calcification (CAC and AAC) by computed tomography, carotid intima-media thickness (CIMT) by ultrasonography, and ankle-brachial index (ABI).
In multivariable adjusted models including mean SBP, higher VIM of SBP was associated with CIMT greater than1.0 mm [relative risk (95% confidence interval) fourth versus first quartile, 1.71 (1.15-2.54)], AAC score greater than 0 [1.08 (1.02-1.15)], and ABI less than 1.1 [1.49 (1.12-1.97)], and linear trends were also statistically significant. However, there was no significant association between VIM of SBP and CAC score greater than 0. Meanwhile, higher VIM of DBP was associated only with AAC score greater than 0. The associations were similar when modeling subclinical atherosclerosis severity as continuous outcomes and were consistent across subgroups based on demographics, behavioural, and cardiovascular risk factors.
Higher variability in home BP, particularly in home SBP, was associated with greater carotid, aortic, and peripheral but not coronary atherosclerosis burdens independent of the mean home BP. | null | false | Home blood pressure variability and subclinical atherosclerosis in multiple vascular beds: a population-based study. The mechanism by which higher blood pressure (BP) variability causes cardiovascular events remains unclear. Experimental results indicate that alterations in vessel wall tension related to BP variability may initiate atherosclerosis through oscillatory shear stress. We examined associations of home BP variability with subclinical atherosclerosis at four anatomically distinct vascular beds.
In a cross-sectional population-based study of 1033 Japanese (mean age, 64.0 years; men, 88.7%) without known cardiovascular disease, we defined SBP and DBP variability as variability independent of the mean (VIM) across self-measured home BP values during seven consecutive days and quantified coronary and aortic artery calcification (CAC and AAC) by computed tomography, carotid intima-media thickness (CIMT) by ultrasonography, and ankle-brachial index (ABI).
In multivariable adjusted models including mean SBP, higher VIM of SBP was associated with CIMT greater than1.0 mm [relative risk (95% confidence interval) fourth versus first quartile, 1.71 (1.15-2.54)], AAC score greater than 0 [1.08 (1.02-1.15)], and ABI less than 1.1 [1.49 (1.12-1.97)], and linear trends were also statistically significant. However, there was no significant association between VIM of SBP and CAC score greater than 0. Meanwhile, higher VIM of DBP was associated only with AAC score greater than 0. The associations were similar when modeling subclinical atherosclerosis severity as continuous outcomes and were consistent across subgroups based on demographics, behavioural, and cardiovascular risk factors.
Higher variability in home BP, particularly in home SBP, was associated with greater carotid, aortic, and peripheral but not coronary atherosclerosis burdens independent of the mean home BP. |
3,754,294 | D000818:Animals; D007559:Ivermectin; D007783:Lactones; D008252:Macaca fascicularis; D008992:Monkey Diseases; D009349:Nematode Infections; D011014:Pneumonia; D011655:Pulmonary Embolism; D011657:Pulmonary Eosinophilia; D014657:Vasculitis | [
"D000818",
"D007559",
"D007783",
"D008252",
"D008992",
"D009349",
"D011014",
"D011655",
"D011657",
"D014657"
] | Verminous vasculitis, pneumonia and pulmonary infarction in a cynomolgus monkey after treatment with ivermectin. | An apparently healthy cynomolgus monkey (Macaca fascicularis) died 2 hours after routine inhalation anesthesia and implantation of a femoral catheter. Gross necropsy findings included patchy raised areas of severe pulmonary hemorrhage and consolidation. Filarioid nematodes (Edesonfilaria malayensis) were located in pulmonary blood vessels and in numerous 0.1-2 cm fibrous cysts on the pleural surfaces of the lungs, pericardium, diaphragm, retroperitoneum, and in the urinary bladder wall. Microscopic lesions included verminous vasculitis, pulmonary infarcts and pneumonia. Many of the nematodes were more necrotic than the surrounding host tissue. During quarantine, 17 days before surgery, the monkey had been given a single dose of ivermectin (200 micrograms/Kg, intramuscular) as an anthelminthic for gastrointestinal nematodes. It is postulated that many of the filarioid nematodes were killed by this treatment. These parasitic emboli caused pulmonary infarction and the severe inflammatory reaction. The resulting pulmonary disease compromised pulmonary function and contributed to death after anesthesia. This complication should be considered if monkeys possibly harboring filarioid nematodes are treated with ivermectin. | 6,763,960 | true | Verminous vasculitis, pneumonia and pulmonary infarction in a cynomolgus monkey after treatment with ivermectin. An apparently healthy cynomolgus monkey (Macaca fascicularis) died 2 hours after routine inhalation anesthesia and implantation of a femoral catheter. Gross necropsy findings included patchy raised areas of severe pulmonary hemorrhage and consolidation. Filarioid nematodes (Edesonfilaria malayensis) were located in pulmonary blood vessels and in numerous 0.1-2 cm fibrous cysts on the pleural surfaces of the lungs, pericardium, diaphragm, retroperitoneum, and in the urinary bladder wall. Microscopic lesions included verminous vasculitis, pulmonary infarcts and pneumonia. Many of the nematodes were more necrotic than the surrounding host tissue. During quarantine, 17 days before surgery, the monkey had been given a single dose of ivermectin (200 micrograms/Kg, intramuscular) as an anthelminthic for gastrointestinal nematodes. It is postulated that many of the filarioid nematodes were killed by this treatment. These parasitic emboli caused pulmonary infarction and the severe inflammatory reaction. The resulting pulmonary disease compromised pulmonary function and contributed to death after anesthesia. This complication should be considered if monkeys possibly harboring filarioid nematodes are treated with ivermectin. |
12,169,799 | D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D020521:Stroke; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome | [
"D000328",
"D000367",
"D000368",
"D000369",
"D015331",
"D015897",
"D005260",
"D015600",
"D006801",
"D008297",
"D008875",
"D012044",
"D020521",
"D014057",
"D016896"
] | Characteristics and outcome of acute stroke patients not investigated with computerised tomography scan. | BACKGROUND
It is desirable that all acute stroke patients are investigated with a computerised tomography (CT) scan, but there may be situations when this is not possible.
OBJECTIVE
To investigate the characteristics and outcome of acute stroke patients not investigated with a CT scan and whether 'not performing a CT scan' influences mortality.
METHODS
Consecutive acute stroke patients admitted to a general hospital were studied for baseline characteristics, previous stroke, pre-stroke Rankin score, post-stroke neurological details, functional disability, complications and acute phase and 3-month mortality. Patients were categorised into two groups depending on whether or not they were investigated with a CT scan. chi(2) and regression analysis were performed to study characteristics and mortality.
RESULTS
Ninety-four of the 296 patients did not undergo investigation with a CT scan. These patients were older (p = 0.001), had suffered previous strokes and had a poorer general health prior to admission (p < 0.001). Although there was no difference in clinical stroke syndromes and immediate post-stroke functional impairment, they had a greater impairment of level of consciousness (p = 0.003) and had a higher acute phase and 3-month mortality (p = 0.001). Not being investigated with a CT scan had an adverse influence on 3-month mortality independent of other variables.
CONCLUSIONS
Whilst not investigating with a CT scan in acute stroke patients carries a poor prognosis, a group of patients may be managed without this investigation because of their poor pre-existing general health. These facts may be considered when preparing local guidelines for brain imaging for acute stroke patients. | null | false | Characteristics and outcome of acute stroke patients not investigated with computerised tomography scan. BACKGROUND
It is desirable that all acute stroke patients are investigated with a computerised tomography (CT) scan, but there may be situations when this is not possible.
OBJECTIVE
To investigate the characteristics and outcome of acute stroke patients not investigated with a CT scan and whether 'not performing a CT scan' influences mortality.
METHODS
Consecutive acute stroke patients admitted to a general hospital were studied for baseline characteristics, previous stroke, pre-stroke Rankin score, post-stroke neurological details, functional disability, complications and acute phase and 3-month mortality. Patients were categorised into two groups depending on whether or not they were investigated with a CT scan. chi(2) and regression analysis were performed to study characteristics and mortality.
RESULTS
Ninety-four of the 296 patients did not undergo investigation with a CT scan. These patients were older (p = 0.001), had suffered previous strokes and had a poorer general health prior to admission (p < 0.001). Although there was no difference in clinical stroke syndromes and immediate post-stroke functional impairment, they had a greater impairment of level of consciousness (p = 0.003) and had a higher acute phase and 3-month mortality (p = 0.001). Not being investigated with a CT scan had an adverse influence on 3-month mortality independent of other variables.
CONCLUSIONS
Whilst not investigating with a CT scan in acute stroke patients carries a poor prognosis, a group of patients may be managed without this investigation because of their poor pre-existing general health. These facts may be considered when preparing local guidelines for brain imaging for acute stroke patients. |
3,940,444 | D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D001827:Body Height; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005190:Family; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension; D007022:Hypotension; D007484:Iowa; D008297:Male; D012044:Regression Analysis; D012885:Skinfold Thickness | [
"D000293",
"D000328",
"D001794",
"D001827",
"D001835",
"D002648",
"D002675",
"D004812",
"D005190",
"D005260",
"D006339",
"D006801",
"D006973",
"D007022",
"D007484",
"D008297",
"D012044",
"D012885"
] | Aggregation of blood pressure in the families of children with labile high systolic blood pressure. The Muscatine Study. | The aggregation of systolic blood pressure, diastolic blood pressure, and heart rate is compared among the relatives of three groups of index children: children with low systolic blood pressure (less than the 5th percentile), middle range systolic blood pressure (between the 5th and 95th percentiles), or labile high blood pressure (above the 95th percentile when first sampled but below the 95th percentile when resampled four to six months later). Both systolic and diastolic blood pressures aggregate more strongly in the families of children with labile high systolic blood pressure than in the families of children with middle or low range systolic blood pressure. The degree of aggregation of heart rate does not differ among the three groups. Since blood pressures aggregate so strongly in families of children with labile high systolic blood pressure, study of these children and their families may yield important information about the etiology of hypertension. | 9,839,238 | true | Aggregation of blood pressure in the families of children with labile high systolic blood pressure. The Muscatine Study. The aggregation of systolic blood pressure, diastolic blood pressure, and heart rate is compared among the relatives of three groups of index children: children with low systolic blood pressure (less than the 5th percentile), middle range systolic blood pressure (between the 5th and 95th percentiles), or labile high blood pressure (above the 95th percentile when first sampled but below the 95th percentile when resampled four to six months later). Both systolic and diastolic blood pressures aggregate more strongly in the families of children with labile high systolic blood pressure than in the families of children with middle or low range systolic blood pressure. The degree of aggregation of heart rate does not differ among the three groups. Since blood pressures aggregate so strongly in families of children with labile high systolic blood pressure, study of these children and their families may yield important information about the etiology of hypertension. |
18,356,713 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes; D019299:Decompression, Surgical; D005126:Eye Burns; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension; D009916:Orbital Diseases; D012189:Retrospective Studies; D012307:Risk Factors | [
"D000293",
"D000328",
"D000368",
"D000369",
"D002648",
"D002675",
"D003161",
"D019299",
"D005126",
"D005260",
"D005440",
"D006801",
"D007429",
"D008297",
"D008875",
"D009798",
"D009916",
"D012189",
"D012307"
] | Orbital compartment syndrome in burn patients. | OBJECTIVE
To identify clinical characteristics of burn patients requiring emergent orbital decompression for vision-threatening orbital compartment syndrome.
METHODS
A retrospective review of 28 burn patients at a trauma center provided data regarding demographics, physical examination findings, and resuscitation fluid volumes. Patients requiring orbital decompression were compared with those who did not, using t tests and Fisher exact test. Linear regression was used to test for an association between peak intraocular pressure and fluid volume. Logistic regression was used to assess associations between need for orbital decompression and fluid volume.
RESULTS
Eight of 28 patients required emergent orbital decompression, which immediately reduced intraocular pressure from 59.4 +/- 15.9 mm Hg to 28.6 +/- 8.2 mm Hg (p < 0.001). There was a positive relationship between fluid volume in the first 24 hours and peak intraocular pressure (p < 0.001). Patients who were treated with orbital decompression were resuscitated with a higher fluid volume in the first 24 hours than those who were not (37,218 +/- 14,405 ml versus 24,649 +/- 12,339 ml, p = 0.015). This was no longer statistically significant when adjusted for periocular burns. The relative risk for undergoing orbital decompression in patients receiving > or =8.6 ml/kg/% total body surface area burned in the first 24 hours was 4.4 (p = 0.03).
CONCLUSIONS
Risk factors for vision-threatening orbital compartment syndrome include fluid volume and periocular burns. Signs of vision-threatening orbital compartment syndrome should be addressed early with orbital decompression. | null | false | Orbital compartment syndrome in burn patients. OBJECTIVE
To identify clinical characteristics of burn patients requiring emergent orbital decompression for vision-threatening orbital compartment syndrome.
METHODS
A retrospective review of 28 burn patients at a trauma center provided data regarding demographics, physical examination findings, and resuscitation fluid volumes. Patients requiring orbital decompression were compared with those who did not, using t tests and Fisher exact test. Linear regression was used to test for an association between peak intraocular pressure and fluid volume. Logistic regression was used to assess associations between need for orbital decompression and fluid volume.
RESULTS
Eight of 28 patients required emergent orbital decompression, which immediately reduced intraocular pressure from 59.4 +/- 15.9 mm Hg to 28.6 +/- 8.2 mm Hg (p < 0.001). There was a positive relationship between fluid volume in the first 24 hours and peak intraocular pressure (p < 0.001). Patients who were treated with orbital decompression were resuscitated with a higher fluid volume in the first 24 hours than those who were not (37,218 +/- 14,405 ml versus 24,649 +/- 12,339 ml, p = 0.015). This was no longer statistically significant when adjusted for periocular burns. The relative risk for undergoing orbital decompression in patients receiving > or =8.6 ml/kg/% total body surface area burned in the first 24 hours was 4.4 (p = 0.03).
CONCLUSIONS
Risk factors for vision-threatening orbital compartment syndrome include fluid volume and periocular burns. Signs of vision-threatening orbital compartment syndrome should be addressed early with orbital decompression. |
29,038,876 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011655:Pulmonary Embolism; D012082:Renal Veins; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis | [
"D000328",
"D000368",
"D000369",
"D020878",
"D005260",
"D005500",
"D006801",
"D008297",
"D008875",
"D010690",
"D011655",
"D012082",
"D012189",
"D012307",
"D014057",
"D016896",
"D016306",
"D014682",
"D020246"
] | Complications and Retrieval Data of Vena Cava Filters Based on Specific Infrarenal Location. | OBJECTIVE
Although recommended placement of IVC filters is with their tips positioned at the level of the renal vein inflow, in practice, adherence is limited due to clinical situation or IVC anatomy. We seek to evaluate the indwelling and retrieval complications of IVC filters based on their specific position within the infrarenal IVC.
METHODS
Retrospective, single institution study of 333 consecutive infrarenal vena cava filters placed by interventional radiologists in patients with an average age of 62.2 ± 15.7 years was performed between 2013 and 2015. Primary indication was venous thromboembolic disease (n = 320, 96.1%). Filters were classified based on location of the apex below the lowest renal vein inflow on the procedural venogram: less than 1 cm (n = 180, 54.1%), 1-2 cm (n = 96, 28.8%), and greater than 2 cm (n = 57, 17.1%). Denali (n = 171, 51.4%) and Celect (n = 162, 48.6%) filters were evaluated. CT follow-up, indwelling complications, and retrieval data were obtained.
RESULTS
Follow-up CT imaging performed for symptomatic indications occurred for 38.3% of filters placed < 1 cm below the lowest renal vein, 27.1% of filters placed 1-2 cm, and 36.8% placed > 2 cm (p = .16). There was no difference in caval strut penetration, penetration of adjacent viscera, time to penetration, filter migration, or tilt (p = .15, .27, .41, .57, .93). No filter fractures occurred. There was no difference in the incidence of breakthrough PE or complex filter retrieval (p = .83, .59). Only one retrieval failure occurred.
CONCLUSIONS
This study suggests filter apex location within the infrarenal IVC, including placement > 2 cm below the level of the renal vein inflow, is not associated with differences in indwelling or retrieval complications.
METHODS
Level 3 non-randomized controlled follow-up study. | null | false | Complications and Retrieval Data of Vena Cava Filters Based on Specific Infrarenal Location. OBJECTIVE
Although recommended placement of IVC filters is with their tips positioned at the level of the renal vein inflow, in practice, adherence is limited due to clinical situation or IVC anatomy. We seek to evaluate the indwelling and retrieval complications of IVC filters based on their specific position within the infrarenal IVC.
METHODS
Retrospective, single institution study of 333 consecutive infrarenal vena cava filters placed by interventional radiologists in patients with an average age of 62.2 ± 15.7 years was performed between 2013 and 2015. Primary indication was venous thromboembolic disease (n = 320, 96.1%). Filters were classified based on location of the apex below the lowest renal vein inflow on the procedural venogram: less than 1 cm (n = 180, 54.1%), 1-2 cm (n = 96, 28.8%), and greater than 2 cm (n = 57, 17.1%). Denali (n = 171, 51.4%) and Celect (n = 162, 48.6%) filters were evaluated. CT follow-up, indwelling complications, and retrieval data were obtained.
RESULTS
Follow-up CT imaging performed for symptomatic indications occurred for 38.3% of filters placed < 1 cm below the lowest renal vein, 27.1% of filters placed 1-2 cm, and 36.8% placed > 2 cm (p = .16). There was no difference in caval strut penetration, penetration of adjacent viscera, time to penetration, filter migration, or tilt (p = .15, .27, .41, .57, .93). No filter fractures occurred. There was no difference in the incidence of breakthrough PE or complex filter retrieval (p = .83, .59). Only one retrieval failure occurred.
CONCLUSIONS
This study suggests filter apex location within the infrarenal IVC, including placement > 2 cm below the level of the renal vein inflow, is not associated with differences in indwelling or retrieval complications.
METHODS
Level 3 non-randomized controlled follow-up study. |
8,962,557 | D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D006502:Budd-Chiari Syndrome; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014652:Vascular Diseases; D014682:Vena Cava, Inferior | [
"D000293",
"D000328",
"D000800",
"D006502",
"D003251",
"D005260",
"D005500",
"D006801",
"D008297",
"D008875",
"D011859",
"D014652",
"D014682"
] | Successful treatment by percutaneous balloon angioplasty of Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava: 8-year follow-up study. | OBJECTIVE
This study sought to report the long-term result (up to 8 years) of percutaneous transluminal balloon angioplasty (PTBA) for Budd-Chiari syndrome (BCS) caused by membranous obstruction of the inferior vena cava (MOVC).
BACKGROUND
We previously reported on this nonoperative form of therapy in a smaller series of patients and found the short-term results to be excellent.
METHODS
We studied the long-term results of PTBA in the treatment of BCS caused by MOVC in 42 patients who underwent PTBA with the Inoue balloon catheter between June 1988 and February 1996. There were 28 men and 14 women with a mean age of 35.6 years (range 16 to 56). MOVC was incomplete in 27 patients and complete in 15. PTBA was successful in 38 patients (91%). The longest follow-up period was 8 years.
RESULTS
All 38 patients who successfully underwent PTBA showed marked symptomatic improvement. Immediately after PTBA, the diameter of the inferior vena cava at the MOVC increased from 1.7 +/- 2 to 19.9 +/- 3.5 mm (p < 0.0001), the caval pressure below the MOVC decreased from 23.6 +/- 8.5 to 12.0 +/- 6.5 mm Hg (p < 0.0001), and the enlarged liver size decreased from 6.5 +/- 1.5 to 2.0 +/- 1.5 cm below the right costal margin at the midclavicular line (p < 0.0001). Over a follow-up period of up to 8 years (7 to 8 years in 4 patients, 5 to 7 years in 12, 3 to 5 years in 11, 2 to 3 years in 6 and < 2 years in 9), MOVC returned in only 1 patient. This patient, our first, required a second PTBA 3 years later and a third 4.25 years after the second PTBA, in combination with stent placement for recurrence of stenosis.
CONCLUSIONS
PTBA with the Inoue balloon catheter is an effective, safe and long-lasting alternative to surgical treatment of patients with BCS due to MOVC. | null | false | Successful treatment by percutaneous balloon angioplasty of Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava: 8-year follow-up study. OBJECTIVE
This study sought to report the long-term result (up to 8 years) of percutaneous transluminal balloon angioplasty (PTBA) for Budd-Chiari syndrome (BCS) caused by membranous obstruction of the inferior vena cava (MOVC).
BACKGROUND
We previously reported on this nonoperative form of therapy in a smaller series of patients and found the short-term results to be excellent.
METHODS
We studied the long-term results of PTBA in the treatment of BCS caused by MOVC in 42 patients who underwent PTBA with the Inoue balloon catheter between June 1988 and February 1996. There were 28 men and 14 women with a mean age of 35.6 years (range 16 to 56). MOVC was incomplete in 27 patients and complete in 15. PTBA was successful in 38 patients (91%). The longest follow-up period was 8 years.
RESULTS
All 38 patients who successfully underwent PTBA showed marked symptomatic improvement. Immediately after PTBA, the diameter of the inferior vena cava at the MOVC increased from 1.7 +/- 2 to 19.9 +/- 3.5 mm (p < 0.0001), the caval pressure below the MOVC decreased from 23.6 +/- 8.5 to 12.0 +/- 6.5 mm Hg (p < 0.0001), and the enlarged liver size decreased from 6.5 +/- 1.5 to 2.0 +/- 1.5 cm below the right costal margin at the midclavicular line (p < 0.0001). Over a follow-up period of up to 8 years (7 to 8 years in 4 patients, 5 to 7 years in 12, 3 to 5 years in 11, 2 to 3 years in 6 and < 2 years in 9), MOVC returned in only 1 patient. This patient, our first, required a second PTBA 3 years later and a third 4.25 years after the second PTBA, in combination with stent placement for recurrence of stenosis.
CONCLUSIONS
PTBA with the Inoue balloon catheter is an effective, safe and long-lasting alternative to surgical treatment of patients with BCS due to MOVC. |
2,631,855 | D000328:Adult; D001019:Aortic Rupture; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D012850:Sinus of Valsalva; D013997:Time Factors | [
"D000328",
"D001019",
"D004452",
"D004562",
"D006801",
"D008297",
"D012850",
"D013997"
] | [Aneurysm of the Valsalva sinus. Echocardiographic diagnosis. Apropos of a case of long post-rupture survival]. | The authors present a case of aneurysm of the right sinus of Valsalva with rupture and aorto-cardiac shunt to the exit chamber of right ventricle. Based on clinical information, one can assume that it could be a case which has been with few symptoms for a period of seven years or more. The diagnosis was made possible due to the images obtained by M mode and two dimensional echocardiography, which allowed an unmistakable view of an aneurysmatic dilatation and the site of the rupture which was confirmed later by Doppler echocardiography with colour codification and and anatomical assessment at surgery. | null | false | [Aneurysm of the Valsalva sinus. Echocardiographic diagnosis. Apropos of a case of long post-rupture survival]. The authors present a case of aneurysm of the right sinus of Valsalva with rupture and aorto-cardiac shunt to the exit chamber of right ventricle. Based on clinical information, one can assume that it could be a case which has been with few symptoms for a period of seven years or more. The diagnosis was made possible due to the images obtained by M mode and two dimensional echocardiography, which allowed an unmistakable view of an aneurysmatic dilatation and the site of the rupture which was confirmed later by Doppler echocardiography with colour codification and and anatomical assessment at surgery. |
16,275,125 | D000077407:Cilostazol; D006801:Humans; D015994:Incidence; D007564:Japan; D010975:Platelet Aggregation Inhibitors; D016032:Randomized Controlled Trials as Topic; D020521:Stroke; D013777:Tetrazoles; D016896:Treatment Outcome | [
"D000077407",
"D006801",
"D015994",
"D007564",
"D010975",
"D016032",
"D020521",
"D013777",
"D016896"
] | Cilostazol in secondary prevention of stroke: impact of the Cilostazol Stroke Prevention Study. | According to recent epidemiological data in Japan, stroke affects roughly 5.3 males and 3.9 females per 1000 person-years and is the third leading cause of mortality. At present, management strategies for secondary prevention of stroke include aggressive treatment of cardiovascular risk factors (i.e., hypertension, smoking cessation, etc.). Antiplatelet drugs in Japan, namely aspirin and cilostazol, are utilized regularly for the prevention of secondary stroke. While aspirin is beneficial for a wide range of cardiovascular endpoints, including total and ischemic strokes, it is also associated with significantly increased risks for hemorrhagic infarction. Cilostazol, by contrast, has been shown to significantly reduce the risk of recurrent strokes without affecting the occurrence of intracranial hemorrhage. In the Cilostazol Stroke Prevention Study, a randomized double-blind, placebo-controlled trial involving more than 1000 Japanese patients, cilostazol was found to reduce the risk of secondary stroke by 41.7% compared with placebo, a statistically significant reduction (P = 0.015). The greatest risk reduction (43.4% in cilostazol versus placebo, P = 0.0373) was found in patients who initially had a lacunar infarction, suggesting that cilostazol has a specific effect against small-vessel disease. In addition, cilostazol achieved significant risk reductions on a number of combined endpoints (e.g., cerebral infarction, intracranial hemorrhage, myocardial infarction, or vascular death), and was associated with benefits in intent-to-treat analyses. These findings indicate that cilostazol may have a role as a vascular neuroprotectant, but the clinical implications are limited by the fact that patients were randomized to placebo instead of aspirin, which is the standard of care. | 11,164,868 | true | Cilostazol in secondary prevention of stroke: impact of the Cilostazol Stroke Prevention Study. According to recent epidemiological data in Japan, stroke affects roughly 5.3 males and 3.9 females per 1000 person-years and is the third leading cause of mortality. At present, management strategies for secondary prevention of stroke include aggressive treatment of cardiovascular risk factors (i.e., hypertension, smoking cessation, etc.). Antiplatelet drugs in Japan, namely aspirin and cilostazol, are utilized regularly for the prevention of secondary stroke. While aspirin is beneficial for a wide range of cardiovascular endpoints, including total and ischemic strokes, it is also associated with significantly increased risks for hemorrhagic infarction. Cilostazol, by contrast, has been shown to significantly reduce the risk of recurrent strokes without affecting the occurrence of intracranial hemorrhage. In the Cilostazol Stroke Prevention Study, a randomized double-blind, placebo-controlled trial involving more than 1000 Japanese patients, cilostazol was found to reduce the risk of secondary stroke by 41.7% compared with placebo, a statistically significant reduction (P = 0.015). The greatest risk reduction (43.4% in cilostazol versus placebo, P = 0.0373) was found in patients who initially had a lacunar infarction, suggesting that cilostazol has a specific effect against small-vessel disease. In addition, cilostazol achieved significant risk reductions on a number of combined endpoints (e.g., cerebral infarction, intracranial hemorrhage, myocardial infarction, or vascular death), and was associated with benefits in intent-to-treat analyses. These findings indicate that cilostazol may have a role as a vascular neuroprotectant, but the clinical implications are limited by the fact that patients were randomized to placebo instead of aspirin, which is the standard of care. |
7,132,411 | D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital; D006345:Heart Septal Defects, Ventricular; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D008722:Methods; D011666:Pulmonary Valve Stenosis; D014188:Transposition of Great Vessels; D014339:Truncus Arteriosus, Persistent | [
"D002675",
"D005260",
"D006330",
"D006345",
"D006350",
"D006801",
"D007223",
"D008297",
"D008722",
"D011666",
"D014188",
"D014339"
] | Reconstruction of the pulmonary outflow tract without prosthetic conduit. | New techniques of correction of complex congenital anomalies, avoiding the use of prosthetic conduits, are presented. In transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis, the technique comprised the resection of infundibular septum, the suturing of an intraventricular baffle directing blood from the left ventricle to the aorta, and the reconstruction of the pulmonary outflow tract by direct implantation of the posterior rim of the pulmonary arterial trunk on the right ventricle, completed by an anterior patch. In most cases, the pulmonary bifurcation was translated anterior to the ascending aorta. This technique was feasible even in infants and in patients with a small VSD. Thirteen patients, from 3 months to 8 years of age, were treated by this technique, with four deaths, one residual VSD (reoperated), and eight good results (4 to 16 months). A similar repair was used in three cases of double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary stenosis or pulmonary artery banding, with two operative deaths and one good result. The same technique of pulmonary outflow tract reconstruction was used in four cases of truncus arteriosus. Two deaths were attributed to severe pulmonary regurgitation, a complication which should be prevented in future cases by a reliable method of inserting a valve in the pulmonary outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk, the continuity between the right ventricle and the pulmonary branches was established via an arterial tube resected from the ascending aorta. This technique was successfully used in one child with extremely small pulmonary branches. These preliminary results led us to conclude that many complex congenital cardiac anomalies can be effectively treated without a prosthetic conduit. | 506,704 | true | Reconstruction of the pulmonary outflow tract without prosthetic conduit. New techniques of correction of complex congenital anomalies, avoiding the use of prosthetic conduits, are presented. In transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis, the technique comprised the resection of infundibular septum, the suturing of an intraventricular baffle directing blood from the left ventricle to the aorta, and the reconstruction of the pulmonary outflow tract by direct implantation of the posterior rim of the pulmonary arterial trunk on the right ventricle, completed by an anterior patch. In most cases, the pulmonary bifurcation was translated anterior to the ascending aorta. This technique was feasible even in infants and in patients with a small VSD. Thirteen patients, from 3 months to 8 years of age, were treated by this technique, with four deaths, one residual VSD (reoperated), and eight good results (4 to 16 months). A similar repair was used in three cases of double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary stenosis or pulmonary artery banding, with two operative deaths and one good result. The same technique of pulmonary outflow tract reconstruction was used in four cases of truncus arteriosus. Two deaths were attributed to severe pulmonary regurgitation, a complication which should be prevented in future cases by a reliable method of inserting a valve in the pulmonary outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk, the continuity between the right ventricle and the pulmonary branches was established via an arterial tube resected from the ascending aorta. This technique was successfully used in one child with extremely small pulmonary branches. These preliminary results led us to conclude that many complex congenital cardiac anomalies can be effectively treated without a prosthetic conduit. |
25,972,027 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D057510:Endovascular Procedures; D005260:Female; D006417:Hematuria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014515:Ureteral Diseases; D014548:Urinary Fistula; D016157:Vascular Fistula; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D000369",
"D002648",
"D015897",
"D057510",
"D005260",
"D006417",
"D006801",
"D008297",
"D008875",
"D011237",
"D012307",
"D015607",
"D016896",
"D014515",
"D014548",
"D016157",
"D055815"
] | Ureteroarterial fistula: A review of the literature. | Ureteroarterial fistulas are rare, erosive defects that occur between the distal segments of the ureter and the adjacent blood vessels in individuals with urologic and vascular comorbidities. Characterized by diffuse, pulsatile bleeding into the urinary tract, this condition carries a significant mortality rate in the absence of early recognition. Recent treatment efforts have focused on use of endovascular stenting techniques as an alternative to open surgical closure of the underlying defects in hemodynamically stable patients. We provide a literature review detailing the characteristics, mechanism, and management of ureteroarterial fistulas. | 9,539,839 | true | Ureteroarterial fistula: A review of the literature. Ureteroarterial fistulas are rare, erosive defects that occur between the distal segments of the ureter and the adjacent blood vessels in individuals with urologic and vascular comorbidities. Characterized by diffuse, pulsatile bleeding into the urinary tract, this condition carries a significant mortality rate in the absence of early recognition. Recent treatment efforts have focused on use of endovascular stenting techniques as an alternative to open surgical closure of the underlying defects in hemodynamically stable patients. We provide a literature review detailing the characteristics, mechanism, and management of ureteroarterial fistulas. |
16,078,121 | D001017:Aortic Coarctation; D001021:Aortic Valve; D016122:Brachiocephalic Trunk; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D004374:Ductus Arteriosus, Patent; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012135:Respiratory Sounds; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis | [
"D001017",
"D001021",
"D016122",
"D001999",
"D003937",
"D004374",
"D005500",
"D006801",
"D007223",
"D008297",
"D012135",
"D014057",
"D014135"
] | Congenital stridor: unusual manifestation of coarctation of the aorta. | Coarctation of the aorta is a relatively common congenital condition. Most infantile presentations of aortic coarctation are related to the associated congenital cardiac abnormalities leading to congestive heart failure or systemic hypoperfusion. We describe a 4-month-old infant who presented with stridor as the sole manifestation of coarctation. Radiologic studies revealed enlarged innominate artery due to the aortic coarctation that resulted in tracheal compression. After surgical correction, respiratory signs and symptoms completely resolved. This case report describes a unique cause of stridor in newborn infants and discusses the potential for vascular anomalies to result in tracheal narrowing. | 14,883,267 | true | Congenital stridor: unusual manifestation of coarctation of the aorta. Coarctation of the aorta is a relatively common congenital condition. Most infantile presentations of aortic coarctation are related to the associated congenital cardiac abnormalities leading to congestive heart failure or systemic hypoperfusion. We describe a 4-month-old infant who presented with stridor as the sole manifestation of coarctation. Radiologic studies revealed enlarged innominate artery due to the aortic coarctation that resulted in tracheal compression. After surgical correction, respiratory signs and symptoms completely resolved. This case report describes a unique cause of stridor in newborn infants and discusses the potential for vascular anomalies to result in tracheal narrowing. |
6,778,280 | D000328:Adult; D000368:Aged; D001323:Autoantibodies; D001327:Autoimmune Diseases; D005260:Female; D006680:HLA Antigens; D006801:Humans; D008228:Lymphoma, Non-Hodgkin; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D008258:Waldenstrom Macroglobulinemia | [
"D000328",
"D000368",
"D001323",
"D001327",
"D005260",
"D006680",
"D006801",
"D008228",
"D008297",
"D008875",
"D010375",
"D008258"
] | Waldenström's macroglobulinemia and autoimmune disease in a family. | We diagnosed Waldenström's macroglobulinemia in a father and three offspring. Clinical and subclinical autoimmune disorders occurred excessively in the family. The HLA haplotype A2, B8, DRw3 was detected in all patients with Waldenström's macroglobulinemia and all but one family member with autoimmune manifestations. A lod score [log odds] of 4.86 favors linkage to the HLA complex of a gene predisposing to lymphoproliferative and autoimmune disorders. Associated with this HLA haplotype were the B-cell alloantigens Ia-172 and 350, previously reported in patients with the lymphoma-prone sicca syndrome. | 14,270,410 | true | Waldenström's macroglobulinemia and autoimmune disease in a family. We diagnosed Waldenström's macroglobulinemia in a father and three offspring. Clinical and subclinical autoimmune disorders occurred excessively in the family. The HLA haplotype A2, B8, DRw3 was detected in all patients with Waldenström's macroglobulinemia and all but one family member with autoimmune manifestations. A lod score [log odds] of 4.86 favors linkage to the HLA complex of a gene predisposing to lymphoproliferative and autoimmune disorders. Associated with this HLA haplotype were the B-cell alloantigens Ia-172 and 350, previously reported in patients with the lymphoma-prone sicca syndrome. |
37,870,079 | D006801:Humans; D054855:Drug-Eluting Stents; D023903:Coronary Restenosis; D016896:Treatment Outcome; D015906:Angioplasty, Balloon, Coronary; D013927:Thrombosis; D020099:Coated Materials, Biocompatible; D003324:Coronary Artery Disease | [
"D006801",
"D054855",
"D023903",
"D016896",
"D015906",
"D013927",
"D020099",
"D003324"
] | The evolution and revolution of drug coated balloons in coronary angioplasty: An up-to-date review of literature data. | European Society of Cardiology (ESC) guidelines gave class I A indication for use of DCB in in-stent restenosis. However, no indication exists for the usage of DCB in de novo lesions. Although the current generation DES offer excellent results, as we embark more complex lesions such as calcified lesion and chronic total occlusion, restenosis and stent thrombosis are higher and tend to increase within the years. There is increasing desire to leave nothing behind to abolish the risk of restenosis and stent thrombosis and hence the absorbable scaffolds were introduced, but with disappointing results. In addition, they take several years to be absorbed. Drug coated balloons offer an alternative to stents with no permanent implant of metal or polymer. They are already in use in in Europe and Asia and they have been approved for the first time in the United States for clinical trials specifically for restenotic lesions. There is emerging data in de novo lesions which have shown that DCB are noninferior and in some studies maybe even superior to current generation DES especially in small vessels. In this article, we provide a comprehensive review of the literature on this expanding technology focussing on the evidence in both re-stenotic and de novo lesions. | null | false | The evolution and revolution of drug coated balloons in coronary angioplasty: An up-to-date review of literature data. European Society of Cardiology (ESC) guidelines gave class I A indication for use of DCB in in-stent restenosis. However, no indication exists for the usage of DCB in de novo lesions. Although the current generation DES offer excellent results, as we embark more complex lesions such as calcified lesion and chronic total occlusion, restenosis and stent thrombosis are higher and tend to increase within the years. There is increasing desire to leave nothing behind to abolish the risk of restenosis and stent thrombosis and hence the absorbable scaffolds were introduced, but with disappointing results. In addition, they take several years to be absorbed. Drug coated balloons offer an alternative to stents with no permanent implant of metal or polymer. They are already in use in in Europe and Asia and they have been approved for the first time in the United States for clinical trials specifically for restenotic lesions. There is emerging data in de novo lesions which have shown that DCB are noninferior and in some studies maybe even superior to current generation DES especially in small vessels. In this article, we provide a comprehensive review of the literature on this expanding technology focussing on the evidence in both re-stenotic and de novo lesions. |
6,971,020 | D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006322:Heart Aneurysm; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction; D013997:Time Factors; D014938:Work Capacity Evaluation | [
"D000203",
"D000328",
"D000368",
"D001026",
"D004185",
"D005500",
"D006322",
"D006801",
"D008875",
"D009203",
"D013997",
"D014938"
] | [Social fate (return to work) after coronary heart surgery and/or aneurysmectomy (author's transl)]. | The "return to work"-rate of 4 groups of patients with myocardial infarction (MI) is evaluated (all coronary angiography): Group 1: 314 patients after aorto-coronary bypass operation: mean age 50.5 years. Time after infarction 28 months, after surgery 18 months. The social fate of 52% were not yet decided. 20% got pension, 25% returned to work. Group 2: 86 patients after conservative treatment of myocardial infarction: mean age 42 years. Time after MI 18 months. The social fate of 21% was not yet decided, 41% got pension, 36% returned to work. Patients with one-vessel disease returned to work in 52%, with two-vessel disease in 20% and with three-vessel disease in 12.5%. Group 3: 24 patients after aneurysmectomy: mean age 47 years. Time after infarction 28 months, time after operation 11 months. Social fate of 8 out of 24 patients was not yet decided, 7 out of 24 got pension, 5 out of 24 returned to work. Group 4: 27 patients with conservatively treated left ventricular aneurysm: mean age 43 years. Time after infarction 42 months. The social fate of 2 out of 27 patients was not yet decided, 14 out of 27 got pension, and 8 out of 27 returned to work. Exercise-tolerance is no good indicator for the work status 18 months after myocardial infarction, 18 months after aorto-coronary bypass, 18 months after aneurysmectomy and 42 months after conservative treatment of left ventricular aneurysm. Selection of patients (all were examined by coronary angiography because of limitation by angina pectoris in daily life activities) may be partly responsible for the poor long-term work status. But more important seems to be the "tied social network". Decision for "return to work" or "pension" should be made 6 months after MI or after operation. | null | false | [Social fate (return to work) after coronary heart surgery and/or aneurysmectomy (author's transl)]. The "return to work"-rate of 4 groups of patients with myocardial infarction (MI) is evaluated (all coronary angiography): Group 1: 314 patients after aorto-coronary bypass operation: mean age 50.5 years. Time after infarction 28 months, after surgery 18 months. The social fate of 52% were not yet decided. 20% got pension, 25% returned to work. Group 2: 86 patients after conservative treatment of myocardial infarction: mean age 42 years. Time after MI 18 months. The social fate of 21% was not yet decided, 41% got pension, 36% returned to work. Patients with one-vessel disease returned to work in 52%, with two-vessel disease in 20% and with three-vessel disease in 12.5%. Group 3: 24 patients after aneurysmectomy: mean age 47 years. Time after infarction 28 months, time after operation 11 months. Social fate of 8 out of 24 patients was not yet decided, 7 out of 24 got pension, 5 out of 24 returned to work. Group 4: 27 patients with conservatively treated left ventricular aneurysm: mean age 43 years. Time after infarction 42 months. The social fate of 2 out of 27 patients was not yet decided, 14 out of 27 got pension, and 8 out of 27 returned to work. Exercise-tolerance is no good indicator for the work status 18 months after myocardial infarction, 18 months after aorto-coronary bypass, 18 months after aneurysmectomy and 42 months after conservative treatment of left ventricular aneurysm. Selection of patients (all were examined by coronary angiography because of limitation by angina pectoris in daily life activities) may be partly responsible for the poor long-term work status. But more important seems to be the "tied social network". Decision for "return to work" or "pension" should be made 6 months after MI or after operation. |
16,403,827 | D000328:Adult; D001158:Arteries; D001783:Blood Flow Velocity; D001799:Blood Sedimentation; D002097:C-Reactive Protein; D003187:Compliance; D005260:Female; D006801:Humans; D008875:Middle Aged; D011673:Pulsatile Flow; D013625:Takayasu Arteritis; D014655:Vascular Resistance | [
"D000328",
"D001158",
"D001783",
"D001799",
"D002097",
"D003187",
"D005260",
"D006801",
"D008875",
"D011673",
"D013625",
"D014655"
] | Takayasu's arteritis: a cause of prolonged arterial stiffness. | OBJECTIVE
Cardiovascular disease is a major cause of mortality and morbidity in patients with Takayasu's arteritis (TA). Increased arterial stiffness is an independent risk factor and predictor of cardiovascular mortality in a variety of diseases. Pulse wave velocity (PWV) and the augmentation index (AI) are used as clinical measurements of arterial stiffness.
METHODS
Data are presented from 10 patients with TA and 11 normal controls obtained between 2000 and 2004. Arterial compliance was assessed non-invasively by measurement of PWV, using the Complior system, and calculation of the aortic AI.
RESULTS
TA patients (mean age 40.8+/-13.2 yr) were compared with a control group of healthy women from a parallel study (mean age 32.3+/-5.5 yr). The mean carotid-femoral PWV (PWV-CF) was higher in TA patients (P = 0.03). In addition, both aortic AI derived from the radial artery (P = 0.002) and carotid AI (P = 0.03) were higher in TA patients compared with controls. PWV-CF did not correlate with CRP (r = - 0.23, P = 0.23) or ESR (r = - 0.19, P = 0.27). Similar results were obtained for the correlation of carotid-radial PWV with CRP (r = 0.15, P = 0.32) and ESR (r = 0.33, P = 0.14).
CONCLUSIONS
Our data show that TA is associated with elevated arterial stiffness in the central aorta, which may persist when the disease is quiescent. These data suggest that PWV represents a means by which cardiovascular risk can be detected and monitored in TA, and highlights the importance of effective management of cardiovascular risk factors in these patients. | null | false | Takayasu's arteritis: a cause of prolonged arterial stiffness. OBJECTIVE
Cardiovascular disease is a major cause of mortality and morbidity in patients with Takayasu's arteritis (TA). Increased arterial stiffness is an independent risk factor and predictor of cardiovascular mortality in a variety of diseases. Pulse wave velocity (PWV) and the augmentation index (AI) are used as clinical measurements of arterial stiffness.
METHODS
Data are presented from 10 patients with TA and 11 normal controls obtained between 2000 and 2004. Arterial compliance was assessed non-invasively by measurement of PWV, using the Complior system, and calculation of the aortic AI.
RESULTS
TA patients (mean age 40.8+/-13.2 yr) were compared with a control group of healthy women from a parallel study (mean age 32.3+/-5.5 yr). The mean carotid-femoral PWV (PWV-CF) was higher in TA patients (P = 0.03). In addition, both aortic AI derived from the radial artery (P = 0.002) and carotid AI (P = 0.03) were higher in TA patients compared with controls. PWV-CF did not correlate with CRP (r = - 0.23, P = 0.23) or ESR (r = - 0.19, P = 0.27). Similar results were obtained for the correlation of carotid-radial PWV with CRP (r = 0.15, P = 0.32) and ESR (r = 0.33, P = 0.14).
CONCLUSIONS
Our data show that TA is associated with elevated arterial stiffness in the central aorta, which may persist when the disease is quiescent. These data suggest that PWV represents a means by which cardiovascular risk can be detected and monitored in TA, and highlights the importance of effective management of cardiovascular risk factors in these patients. |
2,521,500 | D000208:Acute Disease; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D003327:Coronary Disease; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence | [
"D000208",
"D000328",
"D000368",
"D000800",
"D003327",
"D003331",
"D005260",
"D006801",
"D008297",
"D008875",
"D012008"
] | Acute occlusion in multiple lesion coronary angioplasty: frequency and management. | Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patients, 785 lesions) and a group undergoing multilesion single vessel angioplasty (366 patients, 765 lesions). The rate of acute occlusion was similar in both patient groups. The multivessel angioplasty group had a 2.9% rate per patient (n = 10) and a 1.7% rate per vessel; the multilesion single vessel group had a 3.3% rate per patient (n = 12) and a 2.1% rate per lesion. Five of the 10 patients from the multivessel group with acute occlusion, but only 1 of the 12 patients with occlusion in the single vessel multilesion group, required emergency open heart surgery. No patient in either group died as a consequence of coronary angioplasty. Occlusion occurred during angioplasty in 15 of the 22 patients, and 1 to 24 h after angioplasty in 7 of 22 patients. In the group with multivessel angioplasty, acute occlusion during the procedure was mainly linked with hypotension during the second vessel dilation, whereas in this group with delayed vessel closure and in the multilesion single vessel group, existence of intimal tearing constituted the most important factor for acute occlusion (12 of 16 patients). Closure of vessel per major coronary system was evenly distributed in the multivessel group, whereas significantly more left circumflex vessels closed in the single vessel multilesion group (6.1% versus 1.3% in the left anterior descending coronary artery and 1.1% in the right coronary artery; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS) | 4,296,095 | true | Acute occlusion in multiple lesion coronary angioplasty: frequency and management. Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patients, 785 lesions) and a group undergoing multilesion single vessel angioplasty (366 patients, 765 lesions). The rate of acute occlusion was similar in both patient groups. The multivessel angioplasty group had a 2.9% rate per patient (n = 10) and a 1.7% rate per vessel; the multilesion single vessel group had a 3.3% rate per patient (n = 12) and a 2.1% rate per lesion. Five of the 10 patients from the multivessel group with acute occlusion, but only 1 of the 12 patients with occlusion in the single vessel multilesion group, required emergency open heart surgery. No patient in either group died as a consequence of coronary angioplasty. Occlusion occurred during angioplasty in 15 of the 22 patients, and 1 to 24 h after angioplasty in 7 of 22 patients. In the group with multivessel angioplasty, acute occlusion during the procedure was mainly linked with hypotension during the second vessel dilation, whereas in this group with delayed vessel closure and in the multilesion single vessel group, existence of intimal tearing constituted the most important factor for acute occlusion (12 of 16 patients). Closure of vessel per major coronary system was evenly distributed in the multivessel group, whereas significantly more left circumflex vessels closed in the single vessel multilesion group (6.1% versus 1.3% in the left anterior descending coronary artery and 1.1% in the right coronary artery; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS) |
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