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|---|---|---|---|---|---|---|---|
28,463,737 | D000368:Aged; D000638:Amiodarone; D000889:Anti-Arrhythmia Agents; D003422:Critical Care; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol; D008875:Middle Aged; D011405:Propafenone; D012189:Retrospective Studies; D012772:Shock, Septic; D013617:Tachycardia, Supraventricular; D016896:Treatment Outcome | [
"D000368",
"D000638",
"D000889",
"D003422",
"D004554",
"D005260",
"D006801",
"D008297",
"D008790",
"D008875",
"D011405",
"D012189",
"D012772",
"D013617",
"D016896"
] | Propafenone for supraventricular arrhythmias in septic shock-Comparison to amiodarone and metoprolol. | The occurence of supraventricular arrhythmias associate with an unfavourable prognosis in septic shock. Propafenone could be a feasible antiarrhythmic.
Patients collected over a period of 24months were divided into the three groups based on antiarrhythmic: Group1(amiodarone), Group2(propafenone), Group3(metoprolol). Type of arrhythmia, cardioversion rates, demographic, haemodynamic, laboratory parameters were recorded in the first 24h. The outcome data were compared between the groups.
234 patients (99.1% ventilated) were included, the prevailing arrhythmia was acute onset atrial fibrillation (AF,69.7%). Except for the dosage of noradrenaline (0.35(0.14-0.78) in Group1(n=142)vs 0.25(0.10-0.50),p<0.01 in Group2(n=78)vs 0.14(0.07-0.25)μg/kg·min,p<0.05 in Group3(n=14)) the ejection fraction of left ventricle, rates of renal replacement therapy, arterial lactate and procalcitonin levels were not different between the groups. The cardioversion rate in Group1(74%) was lower than in Group2(89%) and Group3(92%). ICU and 28-day mortalities of Group1 were not significantly higher than in Group2 and Group3. Multivariate analysis demonstrated higher 12-month mortality in Group1 than in Group2 (HR1.58(1.04;2.38),p=0.03).
Propafenone demonstrated a higher cardioversion rate than amiodarone with a similar impact on the outcome. Patients remaining in acute onset arrhythmia did not demonstrate significantly higher ICU, 28-day and 12-month mortalities compared to those successfully cardioverted or to those having chronic AF. | null | false | Propafenone for supraventricular arrhythmias in septic shock-Comparison to amiodarone and metoprolol. The occurence of supraventricular arrhythmias associate with an unfavourable prognosis in septic shock. Propafenone could be a feasible antiarrhythmic.
Patients collected over a period of 24months were divided into the three groups based on antiarrhythmic: Group1(amiodarone), Group2(propafenone), Group3(metoprolol). Type of arrhythmia, cardioversion rates, demographic, haemodynamic, laboratory parameters were recorded in the first 24h. The outcome data were compared between the groups.
234 patients (99.1% ventilated) were included, the prevailing arrhythmia was acute onset atrial fibrillation (AF,69.7%). Except for the dosage of noradrenaline (0.35(0.14-0.78) in Group1(n=142)vs 0.25(0.10-0.50),p<0.01 in Group2(n=78)vs 0.14(0.07-0.25)μg/kg·min,p<0.05 in Group3(n=14)) the ejection fraction of left ventricle, rates of renal replacement therapy, arterial lactate and procalcitonin levels were not different between the groups. The cardioversion rate in Group1(74%) was lower than in Group2(89%) and Group3(92%). ICU and 28-day mortalities of Group1 were not significantly higher than in Group2 and Group3. Multivariate analysis demonstrated higher 12-month mortality in Group1 than in Group2 (HR1.58(1.04;2.38),p=0.03).
Propafenone demonstrated a higher cardioversion rate than amiodarone with a similar impact on the outcome. Patients remaining in acute onset arrhythmia did not demonstrate significantly higher ICU, 28-day and 12-month mortalities compared to those successfully cardioverted or to those having chronic AF. |
28,625,194 | D000886:Anthropometry; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D044342:Malnutrition; D010372:Pediatrics; D011183:Postoperative Complications; D011300:Preoperative Care; D012044:Regression Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014861:Washington | [
"D000886",
"D006348",
"D002675",
"D016208",
"D005260",
"D006330",
"D006776",
"D006801",
"D007223",
"D007231",
"D007902",
"D008297",
"D044342",
"D010372",
"D011183",
"D011300",
"D012044",
"D012121",
"D012189",
"D012307",
"D013997",
"D014861"
] | Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. | BACKGROUND
Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery.
METHODS
We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children's Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes.
RESULTS
We found a non-linear relationship between low height-for-age and weight-for-age z-scores and mortality after surgery. In the range of z-score ⩽-2, each additional unit decrease in height-for-age or weight-for-age z-score was associated with a 2.9 or 2.1% increased risk for mortality, respectively. Each unit decrease in height-for-age z-score was associated with a 1.2% increased risk for cardiac arrest, 1.1% increased risk for infection, and an average of 1.7 additional hours of mechanical ventilation, 6 hours longer ICU stay, and 13 hours longer hospital stay. Each unit decrease in weight-for-age z-score was associated with a 0.7% increased risk for cardiac arrest, 0.8% increased risk for infection, and an average of 1.9 additional hours of mechanical ventilation and 5.3 additional hours of ICU stay.
CONCLUSIONS
This study is unique in demonstrating a significant association between malnutrition and 30-day mortality and other adverse outcomes after paediatric cardiac surgery in a mixed population of CHD patients. By evaluating nutritional status as a continuous variable, we were able to clearly distinguish the point at which malnutrition begins to affect mortality. | null | false | Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. BACKGROUND
Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery.
METHODS
We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children's Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes.
RESULTS
We found a non-linear relationship between low height-for-age and weight-for-age z-scores and mortality after surgery. In the range of z-score ⩽-2, each additional unit decrease in height-for-age or weight-for-age z-score was associated with a 2.9 or 2.1% increased risk for mortality, respectively. Each unit decrease in height-for-age z-score was associated with a 1.2% increased risk for cardiac arrest, 1.1% increased risk for infection, and an average of 1.7 additional hours of mechanical ventilation, 6 hours longer ICU stay, and 13 hours longer hospital stay. Each unit decrease in weight-for-age z-score was associated with a 0.7% increased risk for cardiac arrest, 0.8% increased risk for infection, and an average of 1.9 additional hours of mechanical ventilation and 5.3 additional hours of ICU stay.
CONCLUSIONS
This study is unique in demonstrating a significant association between malnutrition and 30-day mortality and other adverse outcomes after paediatric cardiac surgery in a mixed population of CHD patients. By evaluating nutritional status as a continuous variable, we were able to clearly distinguish the point at which malnutrition begins to affect mortality. |
16,615,228 | D000368:Aged; D001012:Aorta, Abdominal; D017544:Aortic Aneurysm, Abdominal; D001018:Aortic Diseases; D005260:Female; D006801:Humans; D007412:Intestinal Fistula; D007494:Ireland; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula; D014656:Vascular Surgical Procedures | [
"D000368",
"D001012",
"D017544",
"D001018",
"D005260",
"D006801",
"D007412",
"D007494",
"D008297",
"D013997",
"D016896",
"D016157",
"D014656"
] | Aorto-enteric fistula: changing management strategies. | BACKGROUND
Traditionally treatment of aorto-enteric fistulae involved placement of an extra-anatomic bypass and graft excision. This is associated with limb loss (10-40%) and high mortality (10-70%). More recently in situ revascularisation has been advocated.
OBJECTIVE
To examine our experience with the changing management of aorto-enteric fistulae over a 22-year period.
METHODS
Demographic, clinical, operative and pathological data were recorded retrospectively.
RESULTS
Twenty-one patients were included. Seven had primary fistulae. Six died prior to intervention. Five had an extra-anatomical bypass (60% mortality, 40% limb loss), four had in-situ revascularisation (25% mortality), four had a primary repair (25% mortality) and two had insertion of a tube graft (primary fistulae). The overall survival rate was 38%. The postoperative survival rate was 6o%.
CONCLUSIONS
Techniques for operative management continue to evolve. The current trend is towards a local surgical approach with prolonged and intensive postoperative antimicrobial therapy. In our experience this approach has yielded acceptable outcomes. | null | false | Aorto-enteric fistula: changing management strategies. BACKGROUND
Traditionally treatment of aorto-enteric fistulae involved placement of an extra-anatomic bypass and graft excision. This is associated with limb loss (10-40%) and high mortality (10-70%). More recently in situ revascularisation has been advocated.
OBJECTIVE
To examine our experience with the changing management of aorto-enteric fistulae over a 22-year period.
METHODS
Demographic, clinical, operative and pathological data were recorded retrospectively.
RESULTS
Twenty-one patients were included. Seven had primary fistulae. Six died prior to intervention. Five had an extra-anatomical bypass (60% mortality, 40% limb loss), four had in-situ revascularisation (25% mortality), four had a primary repair (25% mortality) and two had insertion of a tube graft (primary fistulae). The overall survival rate was 38%. The postoperative survival rate was 6o%.
CONCLUSIONS
Techniques for operative management continue to evolve. The current trend is towards a local surgical approach with prolonged and intensive postoperative antimicrobial therapy. In our experience this approach has yielded acceptable outcomes. |
7,614,923 | D000368:Aged; D002544:Cerebral Infarction; D002561:Cerebrovascular Disorders; D004569:Electroencephalography; D004828:Epilepsies, Partial; D005260:Female; D007839:Functional Laterality; D006801:Humans; D002542:Intracranial Embolism and Thrombosis; D002546:Ischemic Attack, Transient; D008279:Magnetic Resonance Imaging; D008297:Male; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed | [
"D000368",
"D002544",
"D002561",
"D004569",
"D004828",
"D005260",
"D007839",
"D006801",
"D002542",
"D002546",
"D008279",
"D008297",
"D015899",
"D014057"
] | Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts. | In a population-based study, we evaluated seizures occurring in the first 15 days after strokes among 1,640 consecutive patients who had ischemic (814 infarcts with atheroma and 126 with cardiogenic embolism, 273 lacunar infarcts, 259 transient ischemic attacks) or hemorrhagic stroke (129 supratentorial hematomas and 24 subarachnoïd hemorrhage) on computed tomography (CT) scan. Ninety patients had an epileptic seizure in the first 15 days after stroke onset. Thirteen of the 90 had a lenticulostriate infarct, diagnosed on CT scan, without an apparent ipsilateral cortical ischemic lesion. No lenticulostriate hematoma was observed with seizures. To determine the possible existence of an ipsilateral cortical lesion, magnetic resonance imaging (MRI) with gadolinium perfusion, and HMPAO single photon emission CT (SPECT) were performed in the 13 patients with seizures. MRI showed an associated ipsilateral posterofrontal or anterotemporal cortical ischemic lesion in 11 cases, and SPECT showed decreased blood flow in the ipsilateral frontal area in all cases (superficial sylvian territory). Overall, 56 patients had a lenticulostriate infarct and clinical, CT, and MRI data from the 13 with seizures was compared with those of the 43 without seizures. Two criteria differentiated the two groups: the size of the lenticulostriate infarct was larger (8.3 vs. 3.9 cm3) and ipsilateral cortical ischemic lesions were more frequent in the group with seizures (84 vs. 9%). | 8,717,584 | true | Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts. In a population-based study, we evaluated seizures occurring in the first 15 days after strokes among 1,640 consecutive patients who had ischemic (814 infarcts with atheroma and 126 with cardiogenic embolism, 273 lacunar infarcts, 259 transient ischemic attacks) or hemorrhagic stroke (129 supratentorial hematomas and 24 subarachnoïd hemorrhage) on computed tomography (CT) scan. Ninety patients had an epileptic seizure in the first 15 days after stroke onset. Thirteen of the 90 had a lenticulostriate infarct, diagnosed on CT scan, without an apparent ipsilateral cortical ischemic lesion. No lenticulostriate hematoma was observed with seizures. To determine the possible existence of an ipsilateral cortical lesion, magnetic resonance imaging (MRI) with gadolinium perfusion, and HMPAO single photon emission CT (SPECT) were performed in the 13 patients with seizures. MRI showed an associated ipsilateral posterofrontal or anterotemporal cortical ischemic lesion in 11 cases, and SPECT showed decreased blood flow in the ipsilateral frontal area in all cases (superficial sylvian territory). Overall, 56 patients had a lenticulostriate infarct and clinical, CT, and MRI data from the 13 with seizures was compared with those of the 43 without seizures. Two criteria differentiated the two groups: the size of the lenticulostriate infarct was larger (8.3 vs. 3.9 cm3) and ipsilateral cortical ischemic lesions were more frequent in the group with seizures (84 vs. 9%). |
7,447,563 | D000527:Alprostadil; D000787:Angina Pectoris; D000818:Animals; D001792:Blood Platelets; D004285:Dogs; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D008297:Male; D009206:Myocardium; D010101:Oxygen Consumption; D010973:Platelet Adhesiveness; D010974:Platelet Aggregation; D011459:Prostaglandins E, Synthetic; D051381:Rats; D013921:Thrombocytopenia; D014655:Vascular Resistance | [
"D000527",
"D000787",
"D000818",
"D001792",
"D004285",
"D004562",
"D005260",
"D006439",
"D008297",
"D009206",
"D010101",
"D010973",
"D010974",
"D011459",
"D051381",
"D013921",
"D014655"
] | Pharmacological evaluation of OP 1206, a prostaglandin E1 derivative, as an antianginal agent. | Effects of OP 1206 were studied on the cardiovascular system and platelet functions to assess OP 1206 as an antianginal agent. OP 1206 given orally at more than 100 micrograms/kg relieved vasopressin-induced ST depression of rat electrocardiogram (ECG), an animal model of angina pectoris, concomitant with slight hypotension. Intra-coronary injection of OP 1206 (1-100 ng/kg) in dogs resulted in a remarkable increase of coronary blood flow without any influence on heart rate, blood pressure, myocardial oxygen consumption and redox potential. Resistance in both large and small vessels of dog coronary artery was decreased by intravenous injection of OP 1206 (1-3 micrograms/kg). Platelet aggregation, adhesiveness, bleeding time, and thrombocytopenia induced by ADP and collagen infusion in guinea-pigs were inhibited by oral administration of OP 1206 at the same doses or doses less than those relieving vasopressin-induced ST depression of ECG. These results suggest that OP 1206 contributes to the improvement of cardiac imbalance between oxygen demand and supply, and suppression of thrombus formation in atherosclerotic heart. | 5,204,872 | true | Pharmacological evaluation of OP 1206, a prostaglandin E1 derivative, as an antianginal agent. Effects of OP 1206 were studied on the cardiovascular system and platelet functions to assess OP 1206 as an antianginal agent. OP 1206 given orally at more than 100 micrograms/kg relieved vasopressin-induced ST depression of rat electrocardiogram (ECG), an animal model of angina pectoris, concomitant with slight hypotension. Intra-coronary injection of OP 1206 (1-100 ng/kg) in dogs resulted in a remarkable increase of coronary blood flow without any influence on heart rate, blood pressure, myocardial oxygen consumption and redox potential. Resistance in both large and small vessels of dog coronary artery was decreased by intravenous injection of OP 1206 (1-3 micrograms/kg). Platelet aggregation, adhesiveness, bleeding time, and thrombocytopenia induced by ADP and collagen infusion in guinea-pigs were inhibited by oral administration of OP 1206 at the same doses or doses less than those relieving vasopressin-induced ST depression of ECG. These results suggest that OP 1206 contributes to the improvement of cardiac imbalance between oxygen demand and supply, and suppression of thrombus formation in atherosclerotic heart. |
36,394,512 | D006801:Humans; D006333:Heart Failure; D013318:Stroke Volume; D000273:Adipose Tissue; D010496:Pericardium; D009765:Obesity | [
"D006801",
"D006333",
"D013318",
"D000273",
"D010496",
"D009765"
] | Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: mechanisms, management and modern perspectives. | Obesity is very common in patients with heart failure with preserved ejection fraction (HFpEF) and it has been suggested that obesity plays an important role in the pathophysiology of this disease. While body mass index defines the presence of obesity, this measure provides limited information on visceral adiposity, which is probably more relevant in the pathophysiology of HFpEF. Epicardial adipose tissue is the visceral fat situated directly adjacent to the heart and recent data demonstrate that accumulation of epicardial adipose tissue is associated with the onset, symptomatology and outcome of HFpEF. However, the mechanisms by which epicardial adipose tissue may be involved in HFpEF remain unclear. It is also questioned whether epicardial adipose tissue may be a specific target for therapy for this disease. In the present review, we describe the physiology of epicardial adipose tissue and the pathophysiological transformation of epicardial adipose tissue in response to chronic inflammatory diseases, and we postulate conceptual mechanisms on how epicardial adipose tissue may be involved in HFpEF pathophysiology. Lastly, we outline potential treatment strategies, knowledge gaps and directions for further research. | 13,787,418 | true | Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: mechanisms, management and modern perspectives. Obesity is very common in patients with heart failure with preserved ejection fraction (HFpEF) and it has been suggested that obesity plays an important role in the pathophysiology of this disease. While body mass index defines the presence of obesity, this measure provides limited information on visceral adiposity, which is probably more relevant in the pathophysiology of HFpEF. Epicardial adipose tissue is the visceral fat situated directly adjacent to the heart and recent data demonstrate that accumulation of epicardial adipose tissue is associated with the onset, symptomatology and outcome of HFpEF. However, the mechanisms by which epicardial adipose tissue may be involved in HFpEF remain unclear. It is also questioned whether epicardial adipose tissue may be a specific target for therapy for this disease. In the present review, we describe the physiology of epicardial adipose tissue and the pathophysiological transformation of epicardial adipose tissue in response to chronic inflammatory diseases, and we postulate conceptual mechanisms on how epicardial adipose tissue may be involved in HFpEF pathophysiology. Lastly, we outline potential treatment strategies, knowledge gaps and directions for further research. |
21,425,378 | D000975:Antioxidants; D001792:Blood Platelets; D001809:Blood Viscosity; D002109:Caffeic Acids; D018651:Cichorium intybus; D004907:Erythrocyte Deformability; D004912:Erythrocytes; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D019746:Intramolecular Oxidoreductases; D008263:Macrophage Migration-Inhibitory Factors; D008297:Male; D010936:Plant Extracts; D018517:Plant Roots; D010974:Platelet Aggregation; D059808:Polyphenols; D013927:Thrombosis; D055815:Young Adult | [
"D000975",
"D001792",
"D001809",
"D002109",
"D018651",
"D004907",
"D004912",
"D005247",
"D005260",
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"D019746",
"D008263",
"D008297",
"D010936",
"D018517",
"D010974",
"D059808",
"D013927",
"D055815"
] | Thrombosis preventive potential of chicory coffee consumption: a clinical study. | The protective effects of plant polyphenol intake on cardiovascular morbidity and mortality are widely acknowledged. Caffeine-free chicory coffee is a rich source of plant phenolics, including caffeic acid, which inhibits in vitro platelet aggregation, and also phenylpyruvate tautomerase enzymatic activity of the proinflammatory cytokine, macrophage migration inhibitory factor (MIF). To assess whether chicory coffee consumption might confer cardiovascular benefits a clinical intervention study was performed with 27 healthy volunteers, who consumed 300 mL chicory coffee every day for 1 week. The dietary intervention produced variable effects on platelet aggregation, depending on the inducer used for the aggregation test. Whole blood and plasma viscosity were both significantly decreased, along with serum MIF levels, after 1 week of chicory coffee consumption. Moreover, significant improvements were seen in red blood cell deformability. No changes in hematocrit, fibrinogen level or red blood cell counts were detected. The full spectrum of these effects is unlikely to be attributable to a single compound present in chicory coffee, nevertheless, the phenolics, including caffeic acid, are expected to play a substantial role. In conclusion, our study offers an encouraging starting-point to delineate the antithrombotic and antiinflammatory effects of phenolic compounds found in chicory coffee. | 2,981,097 | true | Thrombosis preventive potential of chicory coffee consumption: a clinical study. The protective effects of plant polyphenol intake on cardiovascular morbidity and mortality are widely acknowledged. Caffeine-free chicory coffee is a rich source of plant phenolics, including caffeic acid, which inhibits in vitro platelet aggregation, and also phenylpyruvate tautomerase enzymatic activity of the proinflammatory cytokine, macrophage migration inhibitory factor (MIF). To assess whether chicory coffee consumption might confer cardiovascular benefits a clinical intervention study was performed with 27 healthy volunteers, who consumed 300 mL chicory coffee every day for 1 week. The dietary intervention produced variable effects on platelet aggregation, depending on the inducer used for the aggregation test. Whole blood and plasma viscosity were both significantly decreased, along with serum MIF levels, after 1 week of chicory coffee consumption. Moreover, significant improvements were seen in red blood cell deformability. No changes in hematocrit, fibrinogen level or red blood cell counts were detected. The full spectrum of these effects is unlikely to be attributable to a single compound present in chicory coffee, nevertheless, the phenolics, including caffeic acid, are expected to play a substantial role. In conclusion, our study offers an encouraging starting-point to delineate the antithrombotic and antiinflammatory effects of phenolic compounds found in chicory coffee. |
3,799,447 | D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction; D011379:Prognosis | [
"D000328",
"D000368",
"D001499",
"D005080",
"D005500",
"D006801",
"D008875",
"D009203",
"D011379"
] | Prediction of 1-year outcome after complicated and uncomplicated myocardial infarction: Bayesian analysis of predischarge exercise test results in 300 patients. | After myocardial infarction (MI), the additive prognostic value of exercise variables to clinical variables has been questioned. The merits of a symptom-limited predischarge exercise test were therefore evaluated in clinically defined subgroups of patients. Exercise tests were consecutively performed by 208 survivors of uncomplicated MI (no heart failure, postinfarction angina, recurrent infarction, or late arrhythmias) and by 92 survivors of complicated MI. After uncomplicated MI (1-year mortality rate 4%), an achieved workload greater than 70% of age-predicted maximum identified 145 patients at very low risk (predictive value for survival 98%). After complicated MI (1-year mortality rate 13%), an exaggerated heart rate response was the best predictor of outcome, but had low (92%) predictive value of survival at 155 bpm. It is concluded that stress testing has only limited value after complicated MI. After uncomplicated MI, exercise variables are extremely helpful in identifying patients at very low risk in whom further investigations are not warranted. | 12,115,061 | true | Prediction of 1-year outcome after complicated and uncomplicated myocardial infarction: Bayesian analysis of predischarge exercise test results in 300 patients. After myocardial infarction (MI), the additive prognostic value of exercise variables to clinical variables has been questioned. The merits of a symptom-limited predischarge exercise test were therefore evaluated in clinically defined subgroups of patients. Exercise tests were consecutively performed by 208 survivors of uncomplicated MI (no heart failure, postinfarction angina, recurrent infarction, or late arrhythmias) and by 92 survivors of complicated MI. After uncomplicated MI (1-year mortality rate 4%), an achieved workload greater than 70% of age-predicted maximum identified 145 patients at very low risk (predictive value for survival 98%). After complicated MI (1-year mortality rate 13%), an exaggerated heart rate response was the best predictor of outcome, but had low (92%) predictive value of survival at 155 bpm. It is concluded that stress testing has only limited value after complicated MI. After uncomplicated MI, exercise variables are extremely helpful in identifying patients at very low risk in whom further investigations are not warranted. |
32,330,197 | D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional | [
"D000368",
"D002908",
"D017023",
"D054059",
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"D006801",
"D008297",
"D062645",
"D012189",
"D016896",
"D018084"
] | Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion. | Recently, the importance of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) has been emphasized with greater success rates. In the antegrade wire based approach, it is generally considered that the guidewire would not advance from the subintimal space to the intimal space without dissection re-entry device. However, it is sometimes observed by intravascular ultrasound (IVUS) that the guidewire within the subintimal space advanced into the distal true lumen. The purpose of this study was to investigate specific conditions or characteristics which were associated with "antegrade true-sub-true" phenomenon in CTO-PCI.
We retrospectively reviewed consecutive 320 CTO lesions that underwent CTO-PCI in our institution. Among them, 16 lesions in which the IVUS confirmed the "antegrade true-sub-true" phenomenon were categorized as the true-sub-true group, whereas 27 lesions that resulted in unsuccessful CTO-PCI were categorized as the unsuccessful group. We compared the clinical, lesion, and procedural characteristics between the true-sub-true group and the unsuccessful group.
The prevalence of bifurcation with abrupt type in CTO exit-sites was significantly higher in the true-sub-true group in comparison to the unsuccessful group (75.0% vs. 25.9%, p = 0.002). The multivariate logistic regression analysis revealed that bifurcation with abrupt type in CTO exit-site (OR 8.017; 95%CI: 1.484-43.304; p = 0.016) was independent predictor of the antegrade true-sub-true phenomenon.
In CTO-PCI, the antegrade true-sub-true phenomenon is rare, but can be a last chance for successful PCI. Bifurcation with abrupt type in CTO exit-site was significantly associated with the antegrade true-sub-true phenomenon. | null | false | Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion. Recently, the importance of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) has been emphasized with greater success rates. In the antegrade wire based approach, it is generally considered that the guidewire would not advance from the subintimal space to the intimal space without dissection re-entry device. However, it is sometimes observed by intravascular ultrasound (IVUS) that the guidewire within the subintimal space advanced into the distal true lumen. The purpose of this study was to investigate specific conditions or characteristics which were associated with "antegrade true-sub-true" phenomenon in CTO-PCI.
We retrospectively reviewed consecutive 320 CTO lesions that underwent CTO-PCI in our institution. Among them, 16 lesions in which the IVUS confirmed the "antegrade true-sub-true" phenomenon were categorized as the true-sub-true group, whereas 27 lesions that resulted in unsuccessful CTO-PCI were categorized as the unsuccessful group. We compared the clinical, lesion, and procedural characteristics between the true-sub-true group and the unsuccessful group.
The prevalence of bifurcation with abrupt type in CTO exit-sites was significantly higher in the true-sub-true group in comparison to the unsuccessful group (75.0% vs. 25.9%, p = 0.002). The multivariate logistic regression analysis revealed that bifurcation with abrupt type in CTO exit-site (OR 8.017; 95%CI: 1.484-43.304; p = 0.016) was independent predictor of the antegrade true-sub-true phenomenon.
In CTO-PCI, the antegrade true-sub-true phenomenon is rare, but can be a last chance for successful PCI. Bifurcation with abrupt type in CTO exit-site was significantly associated with the antegrade true-sub-true phenomenon. |
22,576,029 | D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease; D003331:Coronary Vessels; D004724:Endoscopy; D006355:Heart-Lung Machine; D006801:Humans; D012371:Robotics; D016896:Treatment Outcome | [
"D001026",
"D003324",
"D003331",
"D004724",
"D006355",
"D006801",
"D012371",
"D016896"
] | Robotic totally endoscopic multivessel coronary artery bypass grafting: procedure development, challenges, results. | Closed-chest totally endoscopic coronary artery bypass grafting (TECAB) is feasible using robotic technology. During the early phases, TECAB was restricted to single bypass grafts to the left anterior descending artery system. Because most patients referred for coronary artery bypass surgery have multivessel disease, development of endoscopic multiple bypass grafting is mandatory. Experimental work on multivessel TECAB was carried out in the early 2000s, and first clinical cases were already performed. With further technological development of operating robots, double, triple, and quadruple TECAB has become feasible both on the arrested heart and on the beating heart. To date, 161 cases of multivessel TECAB using the da Vinci telemanipulation systems are published in the literature. The main advances enabling multivessel TECAB were the availability of a robotic endostabilizer for beating heart procedures and increased surgeon skills using remote access heart-lung machine perfusion and endo-cardioplegia. Both internal mammary arteries can be harvested and both radial artery and vein graft can be used in multivessel TECAB. Y-grafting and sequential grafting are feasible. Multivessel endoscopic surgical revascularization can be combined with percutaneous coronary interventions in advanced hybrid coronary revascularization. Time requirements for multivessel TECAB are significant, and conversion rates to larger thoracic incisions are higher than those observed for single-vessel TECAB. Clinical short- and long-term outcomes, however, seem to meet the standards of open coronary bypass surgery through sternotomy. The main advantages of multivessel TECAB are a completely preserved sternum, use of double internal mammary artery even in risk groups, and a remarkably short recovery time. | 6,328,407 | true | Robotic totally endoscopic multivessel coronary artery bypass grafting: procedure development, challenges, results. Closed-chest totally endoscopic coronary artery bypass grafting (TECAB) is feasible using robotic technology. During the early phases, TECAB was restricted to single bypass grafts to the left anterior descending artery system. Because most patients referred for coronary artery bypass surgery have multivessel disease, development of endoscopic multiple bypass grafting is mandatory. Experimental work on multivessel TECAB was carried out in the early 2000s, and first clinical cases were already performed. With further technological development of operating robots, double, triple, and quadruple TECAB has become feasible both on the arrested heart and on the beating heart. To date, 161 cases of multivessel TECAB using the da Vinci telemanipulation systems are published in the literature. The main advances enabling multivessel TECAB were the availability of a robotic endostabilizer for beating heart procedures and increased surgeon skills using remote access heart-lung machine perfusion and endo-cardioplegia. Both internal mammary arteries can be harvested and both radial artery and vein graft can be used in multivessel TECAB. Y-grafting and sequential grafting are feasible. Multivessel endoscopic surgical revascularization can be combined with percutaneous coronary interventions in advanced hybrid coronary revascularization. Time requirements for multivessel TECAB are significant, and conversion rates to larger thoracic incisions are higher than those observed for single-vessel TECAB. Clinical short- and long-term outcomes, however, seem to meet the standards of open coronary bypass surgery through sternotomy. The main advantages of multivessel TECAB are a completely preserved sternum, use of double internal mammary artery even in risk groups, and a remarkably short recovery time. |
2,472,560 | D002545:Brain Ischemia; D002560:Cerebrovascular Circulation; D006801:Humans; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D014978:Xenon | [
"D002545",
"D002560",
"D006801",
"D011237",
"D014057",
"D014978"
] | Comparison of dynamic and xenon computed tomography in the evaluation of cerebrovascular ischemia. | Dynamic computed tomographic (DCT) scans with iodine contrast enhancement were compared with simultaneously obtained xenon CT studies of cerebral blood flow (CBF) in 15 patients with subacute or chronic cerebrovascular ischemic disease. Specifically, the width and corrected first moment (cMT1), as demonstrated by DCT, were compared with the regional CBF (rCBF) data and the rCBF map obtained with xenon CT. The DCT and rCBF images were well correlated in patients without, but poorly correlated in those with, leptomeningeal anastomotic collateral circulation. The correlation of rCBF and 1/width with 1/cMT1 was significant (r = 0.78, p less than 0.01) in the former, but not in the latter. These data were thought to reflect a difference in the tracer inflow pattern between the patients with and those without leptomeningeal anastomoses. Our series did not include patients with acute cerebral infarction or recanalization, which are thought to be associated with marked changes in cerebral blood volume in the affected region. However, the influence of cerebral blood volume should be studied in detail in our subacute or chronic series. | 6,705,376 | true | Comparison of dynamic and xenon computed tomography in the evaluation of cerebrovascular ischemia. Dynamic computed tomographic (DCT) scans with iodine contrast enhancement were compared with simultaneously obtained xenon CT studies of cerebral blood flow (CBF) in 15 patients with subacute or chronic cerebrovascular ischemic disease. Specifically, the width and corrected first moment (cMT1), as demonstrated by DCT, were compared with the regional CBF (rCBF) data and the rCBF map obtained with xenon CT. The DCT and rCBF images were well correlated in patients without, but poorly correlated in those with, leptomeningeal anastomotic collateral circulation. The correlation of rCBF and 1/width with 1/cMT1 was significant (r = 0.78, p less than 0.01) in the former, but not in the latter. These data were thought to reflect a difference in the tracer inflow pattern between the patients with and those without leptomeningeal anastomoses. Our series did not include patients with acute cerebral infarction or recanalization, which are thought to be associated with marked changes in cerebral blood volume in the affected region. However, the influence of cerebral blood volume should be studied in detail in our subacute or chronic series. |
21,545,796 | D000818:Animals; D017209:Apoptosis; D001854:Bone Marrow Cells; D002452:Cell Count; D042783:Endothelial Cells; D005334:Fever; D016179:Granulocyte Colony-Stimulating Factor; D018883:Heat Stroke; D022781:Hepatocytes; D006801:Humans; D007022:Hypotension; D007031:Hypothalamus; D007249:Inflammation; D007668:Kidney; D008297:Male; D009414:Nerve Growth Factors; D009474:Neurons; D051381:Rats; D017207:Rats, Sprague-Dawley; D011994:Recombinant Proteins; D013234:Stem Cells; D016019:Survival Analysis; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A | [
"D000818",
"D017209",
"D001854",
"D002452",
"D042783",
"D005334",
"D016179",
"D018883",
"D022781",
"D006801",
"D007022",
"D007031",
"D007249",
"D007668",
"D008297",
"D009414",
"D009474",
"D051381",
"D017207",
"D011994",
"D013234",
"D016019",
"D013997",
"D042461"
] | A potential for granulocyte-colony stimulating factor for use as a prophylactic agent for heatstroke in rats. | Heatstroke is a form of excessive hyperthermia associated with a systemic inflammatory response that leads to multi-organ dysfunction in which central nervous system disorders predominate. Herein we determined to ascertain whether heat-induced multi-organ dysfunction in rats could be attenuated by granulocyte-colony stimulating factor (G-CSF) preconditioning. Anesthetized rats were divided into 2 major groups and given vehicle solution (isotonic saline, 0.3 ml, subcutaneously) or G-CSF (50-200 μg/kg body weight in 0.3 ml normal saline, subcutaneously) daily and consecutively for 5 days before the start of thermal experiments. They were exposed to an ambient temperature of 43°C for 68 min to induce heatstroke. G-CSF preconditioning significantly prolonged the survival time in heatstroke rats in a dose-related way (82-98 min vs 127-243 min). The non-preconditioning heatstroke animals showed hyperthermia, arterial hypotension, increased serum levels of systemic inflammatory response molecules, increased hypothalamic apoptotic cell numbers as well as neuronal damage scores, and increased serum levels of renal and hepatic dysfunction indicators. These heatstroke syndromes could be significantly reduced by G-CSF preconditioning. Thus our results revealed a potential for G-CSF used as a prophylactic agent for heatstroke in rats. | 15,251,441 | true | A potential for granulocyte-colony stimulating factor for use as a prophylactic agent for heatstroke in rats. Heatstroke is a form of excessive hyperthermia associated with a systemic inflammatory response that leads to multi-organ dysfunction in which central nervous system disorders predominate. Herein we determined to ascertain whether heat-induced multi-organ dysfunction in rats could be attenuated by granulocyte-colony stimulating factor (G-CSF) preconditioning. Anesthetized rats were divided into 2 major groups and given vehicle solution (isotonic saline, 0.3 ml, subcutaneously) or G-CSF (50-200 μg/kg body weight in 0.3 ml normal saline, subcutaneously) daily and consecutively for 5 days before the start of thermal experiments. They were exposed to an ambient temperature of 43°C for 68 min to induce heatstroke. G-CSF preconditioning significantly prolonged the survival time in heatstroke rats in a dose-related way (82-98 min vs 127-243 min). The non-preconditioning heatstroke animals showed hyperthermia, arterial hypotension, increased serum levels of systemic inflammatory response molecules, increased hypothalamic apoptotic cell numbers as well as neuronal damage scores, and increased serum levels of renal and hepatic dysfunction indicators. These heatstroke syndromes could be significantly reduced by G-CSF preconditioning. Thus our results revealed a potential for G-CSF used as a prophylactic agent for heatstroke in rats. |
28,438,659 | D000804:Angiotensin II; D000818:Animals; D009320:Atrial Natriuretic Factor; D002478:Cells, Cultured; D004195:Disease Models, Animal; D005353:Fibronectins; D054477:Glutaredoxins; D006321:Heart; D006801:Humans; D008297:Male; D009203:Myocardial Infarction; D051267:NF-E2-Related Factor 2; D052250:Nitric Oxide Synthase Type III; D009828:Oleanolic Acid; D010084:Oxidation-Reduction; D034741:RNA, Small Interfering; D051381:Rats; D017207:Rats, Sprague-Dawley; D015398:Signal Transduction; D020257:Ventricular Remodeling | [
"D000804",
"D000818",
"D009320",
"D002478",
"D004195",
"D005353",
"D054477",
"D006321",
"D006801",
"D008297",
"D009203",
"D051267",
"D052250",
"D009828",
"D010084",
"D034741",
"D051381",
"D017207",
"D015398",
"D020257"
] | The NRF2 activator DH404 attenuates adverse ventricular remodeling post-myocardial infarction by modifying redox signalling. | The novel synthetic triterpenoid, bardoxolone methyl, has the ability to upregulate cytoprotective proteins via induction of the nuclear factor erythroid-2-related factor 2 (Nrf2) pathway. This makes it a promising therapeutic agent in disease states characterized by dysregulated oxidative signalling. We have examined the effect of a Nrf2 activator, dihydro-CDDO-trifluoroethyl amide (DH404), a derivative of bardoxolone methyl, on post-infarct cardiac remodeling in rats.
DH404, administered from day 2 post myocardial infarction (MI: 30min transient ischemia followed by reperfusion) resulted in almost complete protection against adverse ventricular remodeling as assessed at day 28 (left ventricular end-systolic area: sham 0.14±0.01cm2, MI vehicle 0.29±0.04cm2 vs. MI DH404 0.18±0.02cm2, P<0.05); infarct size (21.3±3.4% MI vehicle vs. 10.9±2.3% MI DH404, P<0.05) with associated benefits on systolic function (fractional shortening: sham 71.9±2.6%, MI vehicle 36.2±1.9% vs. MI DH404 58.6±4.0%, P<0.05). These structural and functional benefits were associated with lower myocardial expression of atrial natriuretic peptide (ANP, P<0.01 vs. MI vehicle), and decreased fibronectin (P<0.01 vs. MI vehicle) in DH404-treated MI rats at 28 days. MI increased glutathionylation of endothelial nitric oxide synthase (eNOS) in vitro - a molecular switch that uncouples the enzyme, increasing superoxide production and decreasing nitric oxide (NO) bioavailability. MI-induced eNOS glutathionylation was substantially ameliorated by DH404. An associated increase in glutaredoxin 1 (Grx1) co-immunoprecipitation with eNOS without a change in expression was mechanistically intriguing. Indeed, in parallel in vitro experiments, silencing of Grx1 abolished the protective effect of DH404 against Angiotensin II-induced eNOS uncoupling.
The bardoxolone derivative DH404 significantly attenuated cardiac remodeling post MI, at least in part, by re-coupling of eNOS and increasing the functional interaction of Grx1 with eNOS. This agent may have clinical benefits protecting against post MI cardiomyopathy. | null | false | The NRF2 activator DH404 attenuates adverse ventricular remodeling post-myocardial infarction by modifying redox signalling. The novel synthetic triterpenoid, bardoxolone methyl, has the ability to upregulate cytoprotective proteins via induction of the nuclear factor erythroid-2-related factor 2 (Nrf2) pathway. This makes it a promising therapeutic agent in disease states characterized by dysregulated oxidative signalling. We have examined the effect of a Nrf2 activator, dihydro-CDDO-trifluoroethyl amide (DH404), a derivative of bardoxolone methyl, on post-infarct cardiac remodeling in rats.
DH404, administered from day 2 post myocardial infarction (MI: 30min transient ischemia followed by reperfusion) resulted in almost complete protection against adverse ventricular remodeling as assessed at day 28 (left ventricular end-systolic area: sham 0.14±0.01cm2, MI vehicle 0.29±0.04cm2 vs. MI DH404 0.18±0.02cm2, P<0.05); infarct size (21.3±3.4% MI vehicle vs. 10.9±2.3% MI DH404, P<0.05) with associated benefits on systolic function (fractional shortening: sham 71.9±2.6%, MI vehicle 36.2±1.9% vs. MI DH404 58.6±4.0%, P<0.05). These structural and functional benefits were associated with lower myocardial expression of atrial natriuretic peptide (ANP, P<0.01 vs. MI vehicle), and decreased fibronectin (P<0.01 vs. MI vehicle) in DH404-treated MI rats at 28 days. MI increased glutathionylation of endothelial nitric oxide synthase (eNOS) in vitro - a molecular switch that uncouples the enzyme, increasing superoxide production and decreasing nitric oxide (NO) bioavailability. MI-induced eNOS glutathionylation was substantially ameliorated by DH404. An associated increase in glutaredoxin 1 (Grx1) co-immunoprecipitation with eNOS without a change in expression was mechanistically intriguing. Indeed, in parallel in vitro experiments, silencing of Grx1 abolished the protective effect of DH404 against Angiotensin II-induced eNOS uncoupling.
The bardoxolone derivative DH404 significantly attenuated cardiac remodeling post MI, at least in part, by re-coupling of eNOS and increasing the functional interaction of Grx1 with eNOS. This agent may have clinical benefits protecting against post MI cardiomyopathy. |
19,483,648 | D015703:Antigens, CD; D000951:Antigens, Neoplasm; D018414:CD8-Positive T-Lymphocytes; D019496:Cancer Vaccines; D045744:Cell Line, Tumor; D003429:Cross Reactions; D003602:Cytotoxicity, Immunologic; D003713:Dendritic Cells; D018984:Epitopes, T-Lymphocyte; D005260:Female; D058851:GPI-Linked Proteins; D015789:HLA-A2 Antigen; D006801:Humans; D016219:Immunotherapy, Adoptive; D007371:Interferon-gamma; D058965:MART-1 Antigen; D008297:Male; D008562:Membrane Glycoproteins; D009101:Multiple Myeloma; D009363:Neoplasm Proteins; D010455:Peptides | [
"D015703",
"D000951",
"D018414",
"D019496",
"D045744",
"D003429",
"D003602",
"D003713",
"D018984",
"D005260",
"D058851",
"D015789",
"D006801",
"D016219",
"D007371",
"D058965",
"D008297",
"D008562",
"D009101",
"D009363",
"D010455"
] | Melan-A/MART1 analog peptide triggers anti-myeloma T-cells through crossreactivity with HM1.24. | The Melan-A(aa26-35) (EAAGIGILTV) peptide is a human leukocyte antigen (HLA)-A2-restricted T-cell epitope within the Melan-A/MART-1 tumor antigen expressed on malignant melanoma cells. Melan-A and Melan-A analog (ELAGIGILTV, Melan-A(aa26-35*A27L)) specific T-cells can be expanded reliably for immunotherapeutic approaches in vitro. We studied the ability of Melan-A analog (ELAGIGILTV, Melan-A(aa26-35*A27L)) specific T-cells to recognize the HM1.24(aa22-30) (LLLGIGILV) peptide within the HM1.24 antigen presented by normal and malignant plasma cells. Peripheral blood mononuclear cells from HLA-A2+ healthy donors and HLA-A2+ multiple myeloma (MM) patients were stimulated with Melan-A analog peptide-loaded autologous dendritic cells, and expanded in vitro. T-cell activation was assessed by interferon-gamma specific enzyme-linked immunosorbent spot and cytotoxicity by (51)Chromium-release-assays. The frequency of Melan-A analog specific CD8+ T-cells was detected by using tetramers. Melan-A analog specific T-cells from HLA-A2+ healthy donors and HLA-A2+ MM patients showed a interferon-gamma secretion mediated by HM1.24(aa22-30) peptide-pulsed T2 cells and lysed the HLA-A2+ HM1.24+ U266 and XG-1 human myeloma derived cell-lines as well as the B-lymphoblastoid cell-line IM-9. Melan-A analog specific T-cells from MM patients specifically lysed autologous MM cells. The current data demonstrate that Melan-A analog specific T-cells crossreact with HM1.24(aa22-30). They might be a tool for the future use in immunotherapy against MM. | 10,725,176 | true | Melan-A/MART1 analog peptide triggers anti-myeloma T-cells through crossreactivity with HM1.24. The Melan-A(aa26-35) (EAAGIGILTV) peptide is a human leukocyte antigen (HLA)-A2-restricted T-cell epitope within the Melan-A/MART-1 tumor antigen expressed on malignant melanoma cells. Melan-A and Melan-A analog (ELAGIGILTV, Melan-A(aa26-35*A27L)) specific T-cells can be expanded reliably for immunotherapeutic approaches in vitro. We studied the ability of Melan-A analog (ELAGIGILTV, Melan-A(aa26-35*A27L)) specific T-cells to recognize the HM1.24(aa22-30) (LLLGIGILV) peptide within the HM1.24 antigen presented by normal and malignant plasma cells. Peripheral blood mononuclear cells from HLA-A2+ healthy donors and HLA-A2+ multiple myeloma (MM) patients were stimulated with Melan-A analog peptide-loaded autologous dendritic cells, and expanded in vitro. T-cell activation was assessed by interferon-gamma specific enzyme-linked immunosorbent spot and cytotoxicity by (51)Chromium-release-assays. The frequency of Melan-A analog specific CD8+ T-cells was detected by using tetramers. Melan-A analog specific T-cells from HLA-A2+ healthy donors and HLA-A2+ MM patients showed a interferon-gamma secretion mediated by HM1.24(aa22-30) peptide-pulsed T2 cells and lysed the HLA-A2+ HM1.24+ U266 and XG-1 human myeloma derived cell-lines as well as the B-lymphoblastoid cell-line IM-9. Melan-A analog specific T-cells from MM patients specifically lysed autologous MM cells. The current data demonstrate that Melan-A analog specific T-cells crossreact with HM1.24(aa22-30). They might be a tool for the future use in immunotherapy against MM. |
10,506,778 | D000784:Aortic Dissection; D015906:Angioplasty, Balloon, Coronary; D003323:Coronary Aneurysm; D017023:Coronary Angiography; D020878:Device Removal; D019544:Equipment Failure Analysis; D005260:Female; D006083:Graft Occlusion, Vascular; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction; D012008:Recurrence; D019233:Retreatment; D015607:Stents | [
"D000784",
"D015906",
"D003323",
"D017023",
"D020878",
"D019544",
"D005260",
"D006083",
"D006801",
"D008875",
"D009203",
"D012008",
"D019233",
"D015607"
] | Inadvertent stenting of left main coronary artery complicated by later in-stent restenosis. | Stenting of both the protected and unprotected left main coronary artery has been described. This case presents a patient who had inadvertent left main stent deployment. A 47-year-old female presented with a non-Q-wave infarction and subsequent angina leading to angiography and angioplasty of her proximal ramus intermedius artery. Recurrent angina and ECG changes necessitated repeat coronary angiography and angioplasty on the same day with Wiktor stent deployment to treat a resultant dissection. Poststent deployment pictures revealed that the stent had been partially deployed in the left main coronary artery. Additional balloon dilatations were performed at the ostia of the left anterior descending and circumflex arteries through the stent. Three months later the patient presented with progressive angina and was discovered to have severe distal left main stenosis. In a case such as this, stent removal may be preferable to leaving an unnecessary stent within the left main coronary artery. Cathet. Cardiovasc. Intervent. 48:194-197, 1999. | 7,075,984 | true | Inadvertent stenting of left main coronary artery complicated by later in-stent restenosis. Stenting of both the protected and unprotected left main coronary artery has been described. This case presents a patient who had inadvertent left main stent deployment. A 47-year-old female presented with a non-Q-wave infarction and subsequent angina leading to angiography and angioplasty of her proximal ramus intermedius artery. Recurrent angina and ECG changes necessitated repeat coronary angiography and angioplasty on the same day with Wiktor stent deployment to treat a resultant dissection. Poststent deployment pictures revealed that the stent had been partially deployed in the left main coronary artery. Additional balloon dilatations were performed at the ostia of the left anterior descending and circumflex arteries through the stent. Three months later the patient presented with progressive angina and was discovered to have severe distal left main stenosis. In a case such as this, stent removal may be preferable to leaving an unnecessary stent within the left main coronary artery. Cathet. Cardiovasc. Intervent. 48:194-197, 1999. |
20,432,959 | D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005260:Female; D006801:Humans; D007267:Injections; D008269:Macular Edema; D008297:Male; D008875:Middle Aged; D012170:Retinal Vein Occlusion; D012189:Retrospective Studies; D016896:Treatment Outcome; D014822:Vitreous Body | [
"D000368",
"D000369",
"D020533",
"D000911",
"D061067",
"D000068258",
"D005260",
"D006801",
"D007267",
"D008269",
"D008297",
"D008875",
"D012170",
"D012189",
"D016896",
"D014822"
] | [Short-term effects of intravitreal injection of bevacizumab on macular edema due to central retinal vein occlusion]. | OBJECTIVE
To examine the short-term effects of intravitreal injections of bevacizumab on macular edema due to central retinal vein occlusion (CRVO).
METHODS
Twenty one eyes of 21 consecutive patients with macular edema due to CRVO were included. The patients received intravitreal injections of 1.25 mg bevacizumab at the initial examination. They were followed up with best-corrected visual acuity (BVCA), fluorescein angiography, and central macular thickness (CMT) by optical coherence tomography for more than 4 months. Whenever the macular edema recurred, another intravitreal bevacizumab was given.
RESULTS
The mean age of the patients was 68.1 +/- 11.8 and the mean follow up was 6.5 +/- 2.6 months. The mean baseline BVCA (logMAR) and CMT were 0.79 +/- 0.45 and 699 +/- 194 microm, respectively. After treatment, the mean BVCA improved significantly at 1 week (0.52 +/- 0.46, p<0.001), 1 month (0.48 +/- 0.46, p<0.001), 2 months(0.56 +/- 0.43, p<0.02), and 4 months (0.51 +/- 0.47, p<0.001). The mean CMT also decreased significantly at 1 week (296 +/- 86 microm, p<0.001), 1 month (286 +/-132 microm, p<0.001), 2 months (464 +/- 249 microm, p<0.05) and 4 months (362 +/- 198 microm, p<0.001). Similar effects on reducing CMT were obtained both after the initial injection and the second injection of bevacizumab.
CONCLUSIONS
Intravitreal injection of bevacizumab improved visual acuity and macular edema due to CRVO. | null | false | [Short-term effects of intravitreal injection of bevacizumab on macular edema due to central retinal vein occlusion]. OBJECTIVE
To examine the short-term effects of intravitreal injections of bevacizumab on macular edema due to central retinal vein occlusion (CRVO).
METHODS
Twenty one eyes of 21 consecutive patients with macular edema due to CRVO were included. The patients received intravitreal injections of 1.25 mg bevacizumab at the initial examination. They were followed up with best-corrected visual acuity (BVCA), fluorescein angiography, and central macular thickness (CMT) by optical coherence tomography for more than 4 months. Whenever the macular edema recurred, another intravitreal bevacizumab was given.
RESULTS
The mean age of the patients was 68.1 +/- 11.8 and the mean follow up was 6.5 +/- 2.6 months. The mean baseline BVCA (logMAR) and CMT were 0.79 +/- 0.45 and 699 +/- 194 microm, respectively. After treatment, the mean BVCA improved significantly at 1 week (0.52 +/- 0.46, p<0.001), 1 month (0.48 +/- 0.46, p<0.001), 2 months(0.56 +/- 0.43, p<0.02), and 4 months (0.51 +/- 0.47, p<0.001). The mean CMT also decreased significantly at 1 week (296 +/- 86 microm, p<0.001), 1 month (286 +/-132 microm, p<0.001), 2 months (464 +/- 249 microm, p<0.05) and 4 months (362 +/- 198 microm, p<0.001). Similar effects on reducing CMT were obtained both after the initial injection and the second injection of bevacizumab.
CONCLUSIONS
Intravitreal injection of bevacizumab improved visual acuity and macular edema due to CRVO. |
28,465,012 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome | [
"D000328",
"D000368",
"D000369",
"D016887",
"D005260",
"D006801",
"D007036",
"D016015",
"D008297",
"D008875",
"D016017",
"D058687",
"D057216",
"D012042",
"D012189",
"D015996",
"D013548",
"D016896"
] | Mild induced hypothermia and survival after out-of-hospital cardiac arrest. | BACKGROUND
Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.
METHODS
Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.
RESULTS
Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p<0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p=0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p=0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.
CONCLUSIONS
Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders. | null | false | Mild induced hypothermia and survival after out-of-hospital cardiac arrest. BACKGROUND
Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.
METHODS
Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.
RESULTS
Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p<0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p=0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p=0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.
CONCLUSIONS
Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders. |
20,144,268 | D054058:Acute Coronary Syndrome; D000368:Aged; D050197:Atherosclerosis; D001916:Brachial Artery; D002339:Carotid Arteries; D017023:Coronary Angiography; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D017539:Tunica Intima; D017540:Tunica Media; D014463:Ultrasonography; D014664:Vasodilation | [
"D054058",
"D000368",
"D050197",
"D001916",
"D002339",
"D017023",
"D003331",
"D005260",
"D006801",
"D008297",
"D008875",
"D012039",
"D012720",
"D017539",
"D017540",
"D014463",
"D014664"
] | The assessment of atherosclerosis on vascular structures in patients with acute coronary syndrome. | BACKGROUND
Endothelial dysfunction plays a crucial role in the process of atherosclerotic diseases and has been accepted as an early stage of atherosclerosis. Carotid intima-media-thickness (CIMT) and flow-mediated-dilatation (FMD) of the brachial artery have been recommended as noninvasive methods to assess endothelial structure and function. Angiographic properties of patients with acute coronary syndrome (ACS) are closely associated with cardiovascular events. In this study, we investigated the relation of atherosclerotic properties of coronary, brachial and carotid arteries with CIMT, FMD and coronary angiography in patients with ACS.
METHODS
We enrolled 133 patients who were diagnosed with ACS into this study. Exclusion criteria were known coronary artery disease, diabetes mellitus and hypertension. Coronary angiography, CIMT and FMD were measured in all patients. The numbers of major stenotic coronary vessels with > or = 50% or > or = 70% were defined as diseased vessel. Gensini score was used to evaluate the severity of atherosclerosis. Morphologic properties of stenotic lesion were defined. Cutoff levels were 7% for FMD and 0.9 mm for CIMT.
RESULTS
Mean age was 59.7 + or - 11.8 years. FMD, CIMT and Gensini score were 8.3 + or - 5.9%, 0.80 + or - 0.19 mm and 7.8 + or - 3.5, respectively. Only 44% of patients with ACS had impaired FMD. Gensini score, number of diseased vessels and number of critical lesions were higher in patients with impaired FMD. (Gensini: 8.7 + or - 3.6 vs. 7.0 + or - 3.1, p = 0.009, diseased vessels: 2.7 + or - 0.4 vs. 2.3 + or - 0.7, p < 0.0001, critical lesions: 3.0 + or - 2.1 vs. 2.2 + or - 1.4, p = 0.02). Increased CIMT was found in only 33% of patients. Gensini score and number of diseased vessels were significantly higher in patients with increased CIMT. Significant but weak correlations were found between CIMT, FMD and angiographic severity of coronary atherosclerosis. Angiographic properties and lesion morphology were similar between CIMT and FMD groups.
CONCLUSIONS
There appears to be a relationship between CIMT, FMD and severity of coronary atherosclerosis in patients with ACS. However, in patients with ACS, morphologic properties of stenotic lesions are not associated with CIMT and FMD in brachial artery. | null | false | The assessment of atherosclerosis on vascular structures in patients with acute coronary syndrome. BACKGROUND
Endothelial dysfunction plays a crucial role in the process of atherosclerotic diseases and has been accepted as an early stage of atherosclerosis. Carotid intima-media-thickness (CIMT) and flow-mediated-dilatation (FMD) of the brachial artery have been recommended as noninvasive methods to assess endothelial structure and function. Angiographic properties of patients with acute coronary syndrome (ACS) are closely associated with cardiovascular events. In this study, we investigated the relation of atherosclerotic properties of coronary, brachial and carotid arteries with CIMT, FMD and coronary angiography in patients with ACS.
METHODS
We enrolled 133 patients who were diagnosed with ACS into this study. Exclusion criteria were known coronary artery disease, diabetes mellitus and hypertension. Coronary angiography, CIMT and FMD were measured in all patients. The numbers of major stenotic coronary vessels with > or = 50% or > or = 70% were defined as diseased vessel. Gensini score was used to evaluate the severity of atherosclerosis. Morphologic properties of stenotic lesion were defined. Cutoff levels were 7% for FMD and 0.9 mm for CIMT.
RESULTS
Mean age was 59.7 + or - 11.8 years. FMD, CIMT and Gensini score were 8.3 + or - 5.9%, 0.80 + or - 0.19 mm and 7.8 + or - 3.5, respectively. Only 44% of patients with ACS had impaired FMD. Gensini score, number of diseased vessels and number of critical lesions were higher in patients with impaired FMD. (Gensini: 8.7 + or - 3.6 vs. 7.0 + or - 3.1, p = 0.009, diseased vessels: 2.7 + or - 0.4 vs. 2.3 + or - 0.7, p < 0.0001, critical lesions: 3.0 + or - 2.1 vs. 2.2 + or - 1.4, p = 0.02). Increased CIMT was found in only 33% of patients. Gensini score and number of diseased vessels were significantly higher in patients with increased CIMT. Significant but weak correlations were found between CIMT, FMD and angiographic severity of coronary atherosclerosis. Angiographic properties and lesion morphology were similar between CIMT and FMD groups.
CONCLUSIONS
There appears to be a relationship between CIMT, FMD and severity of coronary atherosclerosis in patients with ACS. However, in patients with ACS, morphologic properties of stenotic lesions are not associated with CIMT and FMD in brachial artery. |
2,721,020 | D000293:Adolescent; D000328:Adult; D003241:Consanguinity; D004535:Ehlers-Danlos Syndrome; D004576:Electromyography; D005128:Eye Diseases; D005260:Female; D006801:Humans; D008297:Male; D011115:Polyneuropathies; D012600:Scoliosis | [
"D000293",
"D000328",
"D003241",
"D004535",
"D004576",
"D005128",
"D005260",
"D006801",
"D008297",
"D011115",
"D012600"
] | Ehlers-Danlos syndrome: a new oculo-scoliotic type with associated polyneuropathy? | Two siblings born to consanguineous Bedouin parents and grandparents are reported with the phenotypic features of Ehlers-Danlos Syndrome (EDS), type VI. In addition, the affected individuals have a polyneuropathy as confirmed by nerve conduction velocity, electromyographic and muscle biopsy studies. We propose that this clinical combination represents a distinct type of EDS. | 7,613,602 | true | Ehlers-Danlos syndrome: a new oculo-scoliotic type with associated polyneuropathy? Two siblings born to consanguineous Bedouin parents and grandparents are reported with the phenotypic features of Ehlers-Danlos Syndrome (EDS), type VI. In addition, the affected individuals have a polyneuropathy as confirmed by nerve conduction velocity, electromyographic and muscle biopsy studies. We propose that this clinical combination represents a distinct type of EDS. |
25,486,961 | D058070:Asymptomatic Diseases; D019468:Disease Management; D006801:Humans; D008998:Monoclonal Gammopathy of Undetermined Significance; D009101:Multiple Myeloma; D011379:Prognosis | [
"D058070",
"D019468",
"D006801",
"D008998",
"D009101",
"D011379"
] | Asymptomatic monoclonal gammopathies. | Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) represent the earlier phases of plasma cell dyscrasias. Their definition is based on absence of end-organ damage with presence of a malignant clone that grows in the bone marrow. They share, as a common feature, the risk of progression to a symptomatic disease. MGUS progression risk is approximately 1% per year, and SMM has a risk of progression of 10% for the first 5 years which tapers off over time. The main purpose of identification of these earlier phases of the plasma cell dyscrasia was to identify patients who do not warrant treatment with chemotherapy, in whom the risk of treatment outweighs the benefit. Over the years, the definitions have not been modified to incorporate developments in imaging (magnetic resonance or positron emission and computed tomography), or genomics to identify patients at highest risk of progression within 2 years, where wait and watch might not be an appropriate option. In the absence of such definition, patients who have only a 50% chance of progression within 2 years are being offered therapy, which might also not be an optimal approach. In this review, we provide an overview of the definition, current prognostic factors, and risk stratifications in asymptomatic gammopathies, and discuss clinical trial outcomes in high-risk SMM. | 719,568 | true | Asymptomatic monoclonal gammopathies. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) represent the earlier phases of plasma cell dyscrasias. Their definition is based on absence of end-organ damage with presence of a malignant clone that grows in the bone marrow. They share, as a common feature, the risk of progression to a symptomatic disease. MGUS progression risk is approximately 1% per year, and SMM has a risk of progression of 10% for the first 5 years which tapers off over time. The main purpose of identification of these earlier phases of the plasma cell dyscrasia was to identify patients who do not warrant treatment with chemotherapy, in whom the risk of treatment outweighs the benefit. Over the years, the definitions have not been modified to incorporate developments in imaging (magnetic resonance or positron emission and computed tomography), or genomics to identify patients at highest risk of progression within 2 years, where wait and watch might not be an appropriate option. In the absence of such definition, patients who have only a 50% chance of progression within 2 years are being offered therapy, which might also not be an optimal approach. In this review, we provide an overview of the definition, current prognostic factors, and risk stratifications in asymptomatic gammopathies, and discuss clinical trial outcomes in high-risk SMM. |
14,657,933 | D001783:Blood Flow Velocity; D004487:Edema; D005260:Female; D006801:Humans; D008875:Middle Aged; D016491:Peripheral Vascular Diseases; D012720:Severity of Illness Index; D013924:Thrombophlebitis; D014648:Varicose Veins | [
"D001783",
"D004487",
"D005260",
"D006801",
"D008875",
"D016491",
"D012720",
"D013924",
"D014648"
] | [Tissue pressure in patients with phlebogenic edema]. | This paper describes the results of tissue pressure measurement according to the Emmet technique in the subcutaneous fat at phlebogenic edema in 31 patients with lower extremity varicosity. The changes in the pressure were recorded over a length of 5-10 after needle impaction. The rate of tissue fluid resorption was measured. The indicators appeared normal in 16% of patients, absorption was accelerated in 39%, and deceleration of absorption was marked in 45% of patients. In the event of decelerated resorption, chronic edema was observed more frequently. The rate of saline resorption in health exceeded 4.8-fold the rate of tissue fluid absorption. In valvular insufficiency of the deep veins, this indicator is up to 4.8-fold as increased. Cessation of tissue fluid and/or saline resorption points to tissue swelling at the microcirculatory level. The given technique allows to diagnose latent edema, to objectively evaluate the patient tissue response to a specific drug and elastic appliance, to work out the well-founded indications for phlebectomy, especially in young people. Also, it enables the assessment of the results of surgical intervention and making the early diagnosis of disease recurrences. | null | false | [Tissue pressure in patients with phlebogenic edema]. This paper describes the results of tissue pressure measurement according to the Emmet technique in the subcutaneous fat at phlebogenic edema in 31 patients with lower extremity varicosity. The changes in the pressure were recorded over a length of 5-10 after needle impaction. The rate of tissue fluid resorption was measured. The indicators appeared normal in 16% of patients, absorption was accelerated in 39%, and deceleration of absorption was marked in 45% of patients. In the event of decelerated resorption, chronic edema was observed more frequently. The rate of saline resorption in health exceeded 4.8-fold the rate of tissue fluid absorption. In valvular insufficiency of the deep veins, this indicator is up to 4.8-fold as increased. Cessation of tissue fluid and/or saline resorption points to tissue swelling at the microcirculatory level. The given technique allows to diagnose latent edema, to objectively evaluate the patient tissue response to a specific drug and elastic appliance, to work out the well-founded indications for phlebectomy, especially in young people. Also, it enables the assessment of the results of surgical intervention and making the early diagnosis of disease recurrences. |
18,752,069 | D000596:Amino Acids; D000818:Animals; D001786:Blood Glucose; D048909:Diabetes Complications; D003925:Diabetic Angiopathies; D004727:Endothelium; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia; D050356:Lipid Metabolism; D008075:Lipoproteins, HDL; D013058:Mass Spectrometry; D053858:Metabolic Networks and Pathways; D052250:Nitric Oxide Synthase Type III; D010084:Oxidation-Reduction; D018384:Oxidative Stress; D009195:Peroxidase | [
"D000596",
"D000818",
"D001786",
"D048909",
"D003925",
"D004727",
"D006442",
"D006801",
"D006943",
"D050356",
"D008075",
"D013058",
"D053858",
"D052250",
"D010084",
"D018384",
"D009195"
] | Mass spectrometric quantification of amino acid oxidation products identifies oxidative mechanisms of diabetic end-organ damage. | Diabetes mellitus is increasingly prevalent worldwide. Diabetic individuals are at markedly increased risk for premature death due to cardiovascular disease. Furthermore, substantial morbidity results from microvascular complications which include retinopathy, nephropathy, and neuropathy. Clinical studies involving diabetic patients have suggested that degree of diabetic hyperglycemia correlates with risk of complications. Recent evidence implicates a central role for oxidative stress and vascular inflammation in all forms of insulin resistance, obesity, diabetes and its complications. Although, glucose promotes glycoxidation reactions in vitro and products of glycoxidation and lipoxidation are elevated in plasma and tissue in diabetics, the exact relationships among hyperglycemia, the diabetic state, and oxidative stress are not well-understood. Using a combination of in vitro and in vivo experiments, we have identified amino acid oxidation markers that serve as molecular fingerprints of specific oxidative pathways. Quantification of these products utilizing highly sensitive and specific gas chromatography/mass spectrometry in animal models of diabetic complications and in humans has provided insights in oxidative pathways that result in diabetic complications. Our studies strongly support the hypothesis that unique oxidants are generated in the microenvironment of tissues vulnerable to diabetic damage. Potential therapies interrupting these reactive pathways in target tissue are likely to be beneficial in preventing diabetic complications. | 7,008,401 | true | Mass spectrometric quantification of amino acid oxidation products identifies oxidative mechanisms of diabetic end-organ damage. Diabetes mellitus is increasingly prevalent worldwide. Diabetic individuals are at markedly increased risk for premature death due to cardiovascular disease. Furthermore, substantial morbidity results from microvascular complications which include retinopathy, nephropathy, and neuropathy. Clinical studies involving diabetic patients have suggested that degree of diabetic hyperglycemia correlates with risk of complications. Recent evidence implicates a central role for oxidative stress and vascular inflammation in all forms of insulin resistance, obesity, diabetes and its complications. Although, glucose promotes glycoxidation reactions in vitro and products of glycoxidation and lipoxidation are elevated in plasma and tissue in diabetics, the exact relationships among hyperglycemia, the diabetic state, and oxidative stress are not well-understood. Using a combination of in vitro and in vivo experiments, we have identified amino acid oxidation markers that serve as molecular fingerprints of specific oxidative pathways. Quantification of these products utilizing highly sensitive and specific gas chromatography/mass spectrometry in animal models of diabetic complications and in humans has provided insights in oxidative pathways that result in diabetic complications. Our studies strongly support the hypothesis that unique oxidants are generated in the microenvironment of tissues vulnerable to diabetic damage. Potential therapies interrupting these reactive pathways in target tissue are likely to be beneficial in preventing diabetic complications. |
6,397,336 | D000070:Acebutolol; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D011188:Potassium; D011674:Pulse; D013997:Time Factors; D014527:Uric Acid | [
"D000070",
"D000328",
"D000368",
"D001794",
"D002986",
"D004338",
"D005260",
"D006801",
"D006852",
"D006973",
"D008297",
"D008875",
"D011188",
"D011674",
"D013997",
"D014527"
] | The efficacy and acceptability of the combination of acebutolol and hydrochlorothiazide in the treatment of essential hypertension. | The efficacy and acceptability of a single half-tablet daily of a fixed combination of 400 mg acebutolol and 25 mg hydrochlorothiazide was assessed in a study of 35 patients suffering from mild to moderate essential hypertension. The results of the 22 patients who completed the 3-month active drug period showed that treatment produced a significant reduction in supine systolic and diastolic blood pressure. This effect was apparent from the first week and was maintained throughout the trial. Pulse rate was also lowered by therapy. No clinically significant changes from normal were observed in mean serum potassium and uric acid levels, and no side-effects of treatment were reported. | 7,050,869 | true | The efficacy and acceptability of the combination of acebutolol and hydrochlorothiazide in the treatment of essential hypertension. The efficacy and acceptability of a single half-tablet daily of a fixed combination of 400 mg acebutolol and 25 mg hydrochlorothiazide was assessed in a study of 35 patients suffering from mild to moderate essential hypertension. The results of the 22 patients who completed the 3-month active drug period showed that treatment produced a significant reduction in supine systolic and diastolic blood pressure. This effect was apparent from the first week and was maintained throughout the trial. Pulse rate was also lowered by therapy. No clinically significant changes from normal were observed in mean serum potassium and uric acid levels, and no side-effects of treatment were reported. |
36,894,006 | D008297:Male; D006801:Humans; D008875:Middle Aged; D004621:Embolization, Therapeutic; D000792:Angiography; D001164:Arteriovenous Fistula; D012447:Sacrum | [
"D008297",
"D006801",
"D008875",
"D004621",
"D000792",
"D001164",
"D012447"
] | Left Distal Transradial Approach for the Treatment of a Sacral Extradural Arteriovenous Fistula: A Technical Note and Literature Review. | BACKGROUND
Sacral extradural arteriovenous fistula (SEAVF) is relatively rare, and its etiology is unknown. They are mostly fed by the lateral sacral artery (LSA). For endovascular treatment, both the stability of the guiding catheter and accessibility of the microcatheter to the fistula, distal to the LSA are required for sufficient embolization of the fistulous point. Cannulation of these vessels requires either crossover at the aortic bifurcation or retrograde cannulation using the transfemoral approach. However, atherosclerotic femoral and tortuous aortoiliac vessels can make the procedure technically difficult. Although the right transradial approach (TRA) can reduce this difficulty by straightening the access route, a potential risk remains for cerebral embolism because it passes the aortic arch. Herein, we present a case of successful embolization of a SEAVF using a left distal TRA.
METHODS
We report a case of a 47-year-old man with SEAVF treated with embolization using a left distal TRA. Lumbar spinal angiography showed a SEAVF with an intradural vein through the epidural venous plexus fed by the left LSA. A 6-French guiding sheath was cannulated into the internal iliac artery via the descending aorta using the left distal TRA. A microcatheter could be advanced into the extradural venous plexus over the fistula point from the intermediate catheter placed at the LSA. Embolization with coils and n-butyl cyanoacrylate was successfully performed.
RESULTS
The SEAVF completely disappeared on neuroimaging, and the patient gradually recovered.
CONCLUSIONS
Left distal TRA could be a useful, safe, and less invasive option for the embolization of SEAVF, especially for patients with high-risk factors for aortogenic embolism or puncture site complications. | null | false | Left Distal Transradial Approach for the Treatment of a Sacral Extradural Arteriovenous Fistula: A Technical Note and Literature Review. BACKGROUND
Sacral extradural arteriovenous fistula (SEAVF) is relatively rare, and its etiology is unknown. They are mostly fed by the lateral sacral artery (LSA). For endovascular treatment, both the stability of the guiding catheter and accessibility of the microcatheter to the fistula, distal to the LSA are required for sufficient embolization of the fistulous point. Cannulation of these vessels requires either crossover at the aortic bifurcation or retrograde cannulation using the transfemoral approach. However, atherosclerotic femoral and tortuous aortoiliac vessels can make the procedure technically difficult. Although the right transradial approach (TRA) can reduce this difficulty by straightening the access route, a potential risk remains for cerebral embolism because it passes the aortic arch. Herein, we present a case of successful embolization of a SEAVF using a left distal TRA.
METHODS
We report a case of a 47-year-old man with SEAVF treated with embolization using a left distal TRA. Lumbar spinal angiography showed a SEAVF with an intradural vein through the epidural venous plexus fed by the left LSA. A 6-French guiding sheath was cannulated into the internal iliac artery via the descending aorta using the left distal TRA. A microcatheter could be advanced into the extradural venous plexus over the fistula point from the intermediate catheter placed at the LSA. Embolization with coils and n-butyl cyanoacrylate was successfully performed.
RESULTS
The SEAVF completely disappeared on neuroimaging, and the patient gradually recovered.
CONCLUSIONS
Left distal TRA could be a useful, safe, and less invasive option for the embolization of SEAVF, especially for patients with high-risk factors for aortogenic embolism or puncture site complications. |
11,433,767 | D001528:Behcet Syndrome; D001921:Brain; D002819:Chorea; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged | [
"D001528",
"D001921",
"D002819",
"D006801",
"D008279",
"D008297",
"D008875"
] | [A case of neuro-Behçet's disease presenting with chorea]. | A 46-year-old man was admitted to our hospital because of emotional instability and involuntary movement of the right upper limb. Neurological examination revealed inability to concentrate, emotional incontinence, recent memory disturbance, chorea of bilateral upper limbs and neck, and bilateral pyramidal signs. Brain MRI showed atrophy of bilateral caudate nucleus and diffuse abnormal intensity area with low intensity on T1-weighted images and high intensity on T2-weighted images in cerebral white matter around the lateral ventricles. Huntington's disease was suspected at first, but it was ruled out by DNA analysis. After admission, oral and genital aphthae developed and the CSF examination showed pleocytosis (273 leukocytes/mm3; 39 polymorphonuclear leukocytes and 234 lymphocytes), so we diagnosed this case as neuro-Behçet's disease. Although basal ganglia is occasionally involved in neuro-Behçet's disease, chorea is rare. Neuro-Behçet's disease should be considered as a cause of chorea. | null | false | [A case of neuro-Behçet's disease presenting with chorea]. A 46-year-old man was admitted to our hospital because of emotional instability and involuntary movement of the right upper limb. Neurological examination revealed inability to concentrate, emotional incontinence, recent memory disturbance, chorea of bilateral upper limbs and neck, and bilateral pyramidal signs. Brain MRI showed atrophy of bilateral caudate nucleus and diffuse abnormal intensity area with low intensity on T1-weighted images and high intensity on T2-weighted images in cerebral white matter around the lateral ventricles. Huntington's disease was suspected at first, but it was ruled out by DNA analysis. After admission, oral and genital aphthae developed and the CSF examination showed pleocytosis (273 leukocytes/mm3; 39 polymorphonuclear leukocytes and 234 lymphocytes), so we diagnosed this case as neuro-Behçet's disease. Although basal ganglia is occasionally involved in neuro-Behçet's disease, chorea is rare. Neuro-Behçet's disease should be considered as a cause of chorea. |
11,097,446 | D003925:Diabetic Angiopathies; D004188:Disarticulation; D005260:Female; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases; D011446:Prospective Studies; D013524:Surgical Flaps; D014945:Wound Healing | [
"D003925",
"D004188",
"D005260",
"D006801",
"D007719",
"D008297",
"D008875",
"D016491",
"D011446",
"D013524",
"D014945"
] | North American experience with knee disarticulation with use of a posterior myofasciocutaneous flap. Healing rate and functional results in seventy-seven patients. | BACKGROUND
A method for closure of a knee disarticulation wound with use of the posterior calf skin and gastrocnemius muscle bellies as an integral flap, without destruction of the perforating vessels, was described by Klaes and Eigler in 1985. The purposes of the present study were to report our experience with use of this technique in a prospective series of knee disarticulations and to determine the healing rate and the functional result after use of the flap.
METHODS
Eighty knee disarticulations, performed with use of the flap described by Klaes and Eigler, in seventy-seven patients were evaluated in a prospective manner. The patients ranged in age from nineteen to ninety-two years (mean, sixty-four years). Thirty-one patients had diabetes mellitus with peripheral vascular disease, and twenty-nine had peripheral vascular disease alone as the primary cause of gangrene. Fourteen patients had a traumatic injury, two had a sarcoma, and one had Ollier disease.
RESULTS
Five patients died in the early postoperative period, leaving seventy-five stumps available for evaluation. A total of sixty-seven stumps (89 percent) healed; sixty-three (84 percent) of them healed primarily. Major wound dehiscence occurred in seven stumps (9 percent), requiring revision to the transfemoral level. Six of those patients had a serum albumin level of less than thirty millimoles per liter. Twenty-two (81 percent) of the twenty-seven patients who could walk before surgery were able to walk with a prosthesis after it.
CONCLUSIONS
This simple technique offers reliable healing of knee disarticulation wounds in properly selected patients with a variety of conditions. It also provides comfortable end-bearing for prosthesis wearers because the distal flap is thick and mobile. | null | false | North American experience with knee disarticulation with use of a posterior myofasciocutaneous flap. Healing rate and functional results in seventy-seven patients. BACKGROUND
A method for closure of a knee disarticulation wound with use of the posterior calf skin and gastrocnemius muscle bellies as an integral flap, without destruction of the perforating vessels, was described by Klaes and Eigler in 1985. The purposes of the present study were to report our experience with use of this technique in a prospective series of knee disarticulations and to determine the healing rate and the functional result after use of the flap.
METHODS
Eighty knee disarticulations, performed with use of the flap described by Klaes and Eigler, in seventy-seven patients were evaluated in a prospective manner. The patients ranged in age from nineteen to ninety-two years (mean, sixty-four years). Thirty-one patients had diabetes mellitus with peripheral vascular disease, and twenty-nine had peripheral vascular disease alone as the primary cause of gangrene. Fourteen patients had a traumatic injury, two had a sarcoma, and one had Ollier disease.
RESULTS
Five patients died in the early postoperative period, leaving seventy-five stumps available for evaluation. A total of sixty-seven stumps (89 percent) healed; sixty-three (84 percent) of them healed primarily. Major wound dehiscence occurred in seven stumps (9 percent), requiring revision to the transfemoral level. Six of those patients had a serum albumin level of less than thirty millimoles per liter. Twenty-two (81 percent) of the twenty-seven patients who could walk before surgery were able to walk with a prosthesis after it.
CONCLUSIONS
This simple technique offers reliable healing of knee disarticulation wounds in properly selected patients with a variety of conditions. It also provides comfortable end-bearing for prosthesis wearers because the distal flap is thick and mobile. |
14,633,083 | D000317:Adrenergic alpha-Antagonists; D000368:Aged; D018592:Cross-Over Studies; D004244:Dizziness; D006261:Headache; D006801:Humans; D007024:Hypotension, Orthostatic; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes; D017060:Patient Satisfaction; D010879:Piperazines; D011470:Prostatic Hyperplasia; D011788:Quality of Life; D013449:Sulfonamides; D000077409:Tamsulosin; D016896:Treatment Outcome; D014555:Urination Disorders | [
"D000317",
"D000368",
"D018592",
"D004244",
"D006261",
"D006801",
"D007024",
"D008297",
"D008875",
"D009281",
"D017060",
"D010879",
"D011470",
"D011788",
"D013449",
"D000077409",
"D016896",
"D014555"
] | Usefulness of tamsulosin hydrochloride and naftopidil in patients with urinary disturbances caused by benign prostatic hyperplasia: a comparative, randomized, two-drug crossover study. | BACKGROUND
The aim of the study presented here was to stratify drug therapy for patients with benign prostatic hyperplasia (BPH) displaying various voiding symptoms.
METHODS
Two different alpha1-adrenoceptor antagonists; tamsulosin hydrochloride (Tam) and naftopidil (Naf ), were administered to 96 patients with BPH for 8 weeks in a crossover study.
RESULTS
With the administration of both drugs, the International Prostate Symptom Score (I-PSS) significantly decreased and the maximum urinary flow significantly increased. Whereas Naf monotherapy decreased the I-PSS for storage symptoms, Tam monotherapy decreased the I-PSS for voiding symptoms. In both the Naf-to-Tam and Tam-to-Naf groups, crossover was effective when the initial drug was judged subjectively and objectively to have been ineffective. Compliance was acceptable with both drugs.
CONCLUSIONS
Our results show that either Naf or Tam can be used to treat patients on the basis of objective and subjective assessment of voiding symptoms. Our findings should be helpful for patient guidance and treatment of BPH. | null | false | Usefulness of tamsulosin hydrochloride and naftopidil in patients with urinary disturbances caused by benign prostatic hyperplasia: a comparative, randomized, two-drug crossover study. BACKGROUND
The aim of the study presented here was to stratify drug therapy for patients with benign prostatic hyperplasia (BPH) displaying various voiding symptoms.
METHODS
Two different alpha1-adrenoceptor antagonists; tamsulosin hydrochloride (Tam) and naftopidil (Naf ), were administered to 96 patients with BPH for 8 weeks in a crossover study.
RESULTS
With the administration of both drugs, the International Prostate Symptom Score (I-PSS) significantly decreased and the maximum urinary flow significantly increased. Whereas Naf monotherapy decreased the I-PSS for storage symptoms, Tam monotherapy decreased the I-PSS for voiding symptoms. In both the Naf-to-Tam and Tam-to-Naf groups, crossover was effective when the initial drug was judged subjectively and objectively to have been ineffective. Compliance was acceptable with both drugs.
CONCLUSIONS
Our results show that either Naf or Tam can be used to treat patients on the basis of objective and subjective assessment of voiding symptoms. Our findings should be helpful for patient guidance and treatment of BPH. |
8,505,101 | D000818:Animals; D001483:Base Sequence; D001794:Blood Pressure; D001808:Blood Vessels; D015152:Blotting, Northern; D003900:Desoxycorticosterone; D019332:Endothelin-1; D016232:Endothelins; D015870:Gene Expression; D006973:Hypertension; D008297:Male; D015335:Molecular Probes; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011498:Protein Precursors; D012333:RNA, Messenger; D051381:Rats; D017207:Rats, Sprague-Dawley; D012965:Sodium Chloride | [
"D000818",
"D001483",
"D001794",
"D001808",
"D015152",
"D003900",
"D019332",
"D016232",
"D015870",
"D006973",
"D008297",
"D015335",
"D008969",
"D016133",
"D011498",
"D012333",
"D051381",
"D017207",
"D012965"
] | Increased expression of endothelin-1 gene in blood vessels of deoxycorticosterone acetate-salt hypertensive rats. | We have recently shown that the content of immunoreactive endothelin-1 is increased in acid extracts from blood vessels of deoxycorticosterone acetate (DOCA)-salt hypertensive rats compared with uninephrectomized control rats. We have also found by immunohistochemistry a significant increase in immunoreactive endothelin-1 in endothelial cells of aorta and mesenteric arteries of DOCA-salt hypertensive rats. In the present study, we investigated preproendothelin-1 gene expression in blood vessels of DOCA-salt hypertensive rats and uninephrectomized control rats. Northern blot analysis using a specific 32P-labeled complementary RNA probe for rat preproendothelin-1 of 319 base pairs revealed a fourfold to fivefold increase in abundance of preproendothelin-1 messenger RNA transcripts in both aorta and mesenteric arteries from DOCA-salt hypertensive rats. Thus, increased immunoreactive endothelin-1 content in blood vessels of DOCA-salt hypertensive rats is secondary to increased preproendothelin-1 gene expression. Exaggerated expression of the preproendothelin-1 gene in mineralocorticoid hypertension may contribute to the maintenance of elevated blood pressure. | 10,692,629 | true | Increased expression of endothelin-1 gene in blood vessels of deoxycorticosterone acetate-salt hypertensive rats. We have recently shown that the content of immunoreactive endothelin-1 is increased in acid extracts from blood vessels of deoxycorticosterone acetate (DOCA)-salt hypertensive rats compared with uninephrectomized control rats. We have also found by immunohistochemistry a significant increase in immunoreactive endothelin-1 in endothelial cells of aorta and mesenteric arteries of DOCA-salt hypertensive rats. In the present study, we investigated preproendothelin-1 gene expression in blood vessels of DOCA-salt hypertensive rats and uninephrectomized control rats. Northern blot analysis using a specific 32P-labeled complementary RNA probe for rat preproendothelin-1 of 319 base pairs revealed a fourfold to fivefold increase in abundance of preproendothelin-1 messenger RNA transcripts in both aorta and mesenteric arteries from DOCA-salt hypertensive rats. Thus, increased immunoreactive endothelin-1 content in blood vessels of DOCA-salt hypertensive rats is secondary to increased preproendothelin-1 gene expression. Exaggerated expression of the preproendothelin-1 gene in mineralocorticoid hypertension may contribute to the maintenance of elevated blood pressure. |
10,047,653 | D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D007375:Interleukin-1; D016753:Interleukin-10; D015850:Interleukin-6; D016209:Interleukin-8; D008297:Male; D011182:Postoperative Care; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha | [
"D002315",
"D002648",
"D002675",
"D005260",
"D006330",
"D006440",
"D006801",
"D007223",
"D007375",
"D016753",
"D015850",
"D016209",
"D008297",
"D011182",
"D011446",
"D014409"
] | Venovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study. | BACKGROUND
Cardiopulmonary bypass is associated with the production of both proinflammatory and anti-inflammatory cytokines, the balance of which leads to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified ultrafiltration is a modification of this technique, which has the potentially added advantage of eliminating the obligatory left-to-right shunt associated with arteriovenous modified ultrafiltration. We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass.
METHODS
Thirty-eight pediatric patients were randomly assigned to undergo conventional, venovenous (n = 13), or no ultrafiltration venovenous (n = 13), and controls (n = 12). Perioperative, cardiopulmonary, and cytokine (tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, interleukin-8, and interleukin-10) data were collected for statistical analysis.
RESULTS
Compared with patients in the conventional ultrafiltration and control groups, patients undergoing venovenous modified ultrafiltration had the greatest volume of ultrafiltrate removed (46. 9 +/- 8.4 mL/kg vs 20.1 +/- 5.0 mL/kg and 0 mL/kg for conventional ultrafiltration and control groups, respectively; P =.0001), least increase in total body water (1.91% +/- 1.49% vs 3.90% +/- 1.86% and 8.24% +/- 3.41%; P =.05), greatest rise in hematocrit (39.7% +/- 1. 7% vs 33.8% +/- 2.1% and 29.6% +/- 2.3%; P =.006), and shortest length of hospital stay (4.41 +/- 0.28 days vs 6.69 +/- 1.47 days and 8.38 +/- 1.11 days; P =.03, P =.03).
CONCLUSIONS
Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass. | null | false | Venovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study. BACKGROUND
Cardiopulmonary bypass is associated with the production of both proinflammatory and anti-inflammatory cytokines, the balance of which leads to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified ultrafiltration is a modification of this technique, which has the potentially added advantage of eliminating the obligatory left-to-right shunt associated with arteriovenous modified ultrafiltration. We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass.
METHODS
Thirty-eight pediatric patients were randomly assigned to undergo conventional, venovenous (n = 13), or no ultrafiltration venovenous (n = 13), and controls (n = 12). Perioperative, cardiopulmonary, and cytokine (tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, interleukin-8, and interleukin-10) data were collected for statistical analysis.
RESULTS
Compared with patients in the conventional ultrafiltration and control groups, patients undergoing venovenous modified ultrafiltration had the greatest volume of ultrafiltrate removed (46. 9 +/- 8.4 mL/kg vs 20.1 +/- 5.0 mL/kg and 0 mL/kg for conventional ultrafiltration and control groups, respectively; P =.0001), least increase in total body water (1.91% +/- 1.49% vs 3.90% +/- 1.86% and 8.24% +/- 3.41%; P =.05), greatest rise in hematocrit (39.7% +/- 1. 7% vs 33.8% +/- 2.1% and 29.6% +/- 2.3%; P =.006), and shortest length of hospital stay (4.41 +/- 0.28 days vs 6.69 +/- 1.47 days and 8.38 +/- 1.11 days; P =.03, P =.03).
CONCLUSIONS
Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass. |
16,882,824 | D000328:Adult; D001284:Atrophy; D001921:Brain; D001925:Brain Damage, Chronic; D002140:California; D002544:Cerebral Infarction; D002547:Cerebral Palsy; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005006:Ethnicity; D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008423:Maternal Age; D011247:Pregnancy; D012306:Risk; D012307:Risk Factors; D047929:Term Birth; D013997:Time Factors; D014057:Tomography, X-Ray Computed | [
"D000328",
"D001284",
"D001921",
"D001925",
"D002140",
"D002544",
"D002547",
"D015331",
"D036861",
"D005006",
"D005260",
"D005317",
"D006801",
"D007231",
"D008279",
"D008423",
"D011247",
"D012306",
"D012307",
"D047929",
"D013997",
"D014057"
] | Cerebral palsy in a term population: risk factors and neuroimaging findings. | OBJECTIVE
The purpose of this work was to study risk factors and neuroimaging characteristics of cerebral palsy in term and near-term infants.
METHODS
Among a cohort of 334,339 infants > or = 36 weeks' gestation born at Kaiser Permanente Medical Care Program in northern California in 1991-2003, we identified infants with cerebral palsy and obtained clinical data from electronic and medical charts. Risk factors for cerebral palsy among infants with different brain abnormalities were compared using polytomous logistic regression.
RESULTS
Of 377 infants with cerebral palsy (prevalence: 1.1 per 1000), 273 (72%) received a head computed tomography or MRI. Abnormalities included focal arterial infarction (22%), brain malformation (14%), and periventricular white matter abnormalities (12%). Independent risk factors for cerebral palsy were maternal age > 35, black race, and intrauterine growth restriction. Intrauterine growth restriction was more strongly associated with periventricular white matter injury than with other neuroimaging findings. Nighttime delivery was associated with cerebral palsy accompanied by generalized brain atrophy but not with cerebral palsy accompanied by other brain lesions.
CONCLUSIONS
Cerebral palsy is a heterogeneous syndrome with focal arterial infarction and brain malformation representing the most common neuroimaging abnormalities in term and near-term infants. Risk factors for cerebral palsy differ depending on the type of underlying brain abnormality. | null | false | Cerebral palsy in a term population: risk factors and neuroimaging findings. OBJECTIVE
The purpose of this work was to study risk factors and neuroimaging characteristics of cerebral palsy in term and near-term infants.
METHODS
Among a cohort of 334,339 infants > or = 36 weeks' gestation born at Kaiser Permanente Medical Care Program in northern California in 1991-2003, we identified infants with cerebral palsy and obtained clinical data from electronic and medical charts. Risk factors for cerebral palsy among infants with different brain abnormalities were compared using polytomous logistic regression.
RESULTS
Of 377 infants with cerebral palsy (prevalence: 1.1 per 1000), 273 (72%) received a head computed tomography or MRI. Abnormalities included focal arterial infarction (22%), brain malformation (14%), and periventricular white matter abnormalities (12%). Independent risk factors for cerebral palsy were maternal age > 35, black race, and intrauterine growth restriction. Intrauterine growth restriction was more strongly associated with periventricular white matter injury than with other neuroimaging findings. Nighttime delivery was associated with cerebral palsy accompanied by generalized brain atrophy but not with cerebral palsy accompanied by other brain lesions.
CONCLUSIONS
Cerebral palsy is a heterogeneous syndrome with focal arterial infarction and brain malformation representing the most common neuroimaging abnormalities in term and near-term infants. Risk factors for cerebral palsy differ depending on the type of underlying brain abnormality. |
21,946,826 | D000818:Animals; D002315:Cardiopulmonary Bypass; D003072:Cognition Disorders; D004618:Embolism, Air; D020766:Intracranial Embolism; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D013997:Time Factors; D016896:Treatment Outcome; D014978:Xenon | [
"D000818",
"D002315",
"D003072",
"D004618",
"D020766",
"D008297",
"D051381",
"D017207",
"D013997",
"D016896",
"D014978"
] | Xenon administration immediately after but not before or during cardiopulmonary bypass with cerebral air embolism impairs cerebral outcome in rats. | BACKGROUND
The neuroprotective properties of xenon might improve cerebral outcome after cardiac surgery using cardiopulmonary bypass. However, in the presence of cerebral air emboli, xenon impaired cognitive and histological outcome in a rat cardiopulmonary bypass model, a result which is due to the property of xenon to expand air bubbles.
OBJECTIVE
The current study was designed to assess whether cerebral outcome in the setting of cardiopulmonary bypass with cerebral air embolism could be altered by administration of xenon restricted to periods when the occurrence of cerebral air embolism is unlikely.
METHODS
With institutional review board approval, 40 rats were allocated randomly to one of four groups (n = 10) which determined the period of xenon inhalation: 'before', 'during' or 'after' cardiopulmonary bypass or 'none'.
METHODS
Rats were subjected to 90 min of normothermic cardiopulmonary bypass combined with 10 small cerebral air emboli. Xenon was administered according to group assignment: the 'none' group received no xenon; in the other groups, the lungs were ventilated with 56% xenon before, during or after cardiopulmonary bypass and cerebral air embolism.
METHODS
Motor and cognitive outcomes were tested using the modified hole-board test. Cerebral infarction volumes were determined on postoperative day 21.
RESULTS
Animals that received xenon after cardiopulmonary bypass and cerebral air embolism had impaired motor function scores [after: median 6.6 (range 0.25-8), before: 0.5 (0-3), during: 1.5 (0.25-2.75), none: 1 (0-1.75)] and cognitive performance [after: 9 (6.5-9), before: 0 (0-5.5), during: 1 (0-5.5), none: 1 (0-4)] compared with all other groups (P < 0.05). Administration of xenon after cardiopulmonary bypass and cerebral air embolism also led to larger cerebral infarction volumes [after: 74 μl (54-157), before: 45 μl (20-82), during: 33 μl (23-54), none: 22 μl (17-78)] compared with the groups that received xenon during cardiopulmonary bypass and cerebral air embolism or no xenon at all (P < 0.05).
CONCLUSIONS
Xenon administered immediately after cardiopulmonary bypass and cerebral air embolism impaired motor, cognitive and histological outcome in rats. At no time did inhalation of xenon lead to any beneficial effects on cerebral outcome when compared with inhalation of nitrogen. | null | false | Xenon administration immediately after but not before or during cardiopulmonary bypass with cerebral air embolism impairs cerebral outcome in rats. BACKGROUND
The neuroprotective properties of xenon might improve cerebral outcome after cardiac surgery using cardiopulmonary bypass. However, in the presence of cerebral air emboli, xenon impaired cognitive and histological outcome in a rat cardiopulmonary bypass model, a result which is due to the property of xenon to expand air bubbles.
OBJECTIVE
The current study was designed to assess whether cerebral outcome in the setting of cardiopulmonary bypass with cerebral air embolism could be altered by administration of xenon restricted to periods when the occurrence of cerebral air embolism is unlikely.
METHODS
With institutional review board approval, 40 rats were allocated randomly to one of four groups (n = 10) which determined the period of xenon inhalation: 'before', 'during' or 'after' cardiopulmonary bypass or 'none'.
METHODS
Rats were subjected to 90 min of normothermic cardiopulmonary bypass combined with 10 small cerebral air emboli. Xenon was administered according to group assignment: the 'none' group received no xenon; in the other groups, the lungs were ventilated with 56% xenon before, during or after cardiopulmonary bypass and cerebral air embolism.
METHODS
Motor and cognitive outcomes were tested using the modified hole-board test. Cerebral infarction volumes were determined on postoperative day 21.
RESULTS
Animals that received xenon after cardiopulmonary bypass and cerebral air embolism had impaired motor function scores [after: median 6.6 (range 0.25-8), before: 0.5 (0-3), during: 1.5 (0.25-2.75), none: 1 (0-1.75)] and cognitive performance [after: 9 (6.5-9), before: 0 (0-5.5), during: 1 (0-5.5), none: 1 (0-4)] compared with all other groups (P < 0.05). Administration of xenon after cardiopulmonary bypass and cerebral air embolism also led to larger cerebral infarction volumes [after: 74 μl (54-157), before: 45 μl (20-82), during: 33 μl (23-54), none: 22 μl (17-78)] compared with the groups that received xenon during cardiopulmonary bypass and cerebral air embolism or no xenon at all (P < 0.05).
CONCLUSIONS
Xenon administered immediately after cardiopulmonary bypass and cerebral air embolism impaired motor, cognitive and histological outcome in rats. At no time did inhalation of xenon lead to any beneficial effects on cerebral outcome when compared with inhalation of nitrogen. |
15,993,169 | D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004558:Electric Stimulation; D005260:Female; D005726:Ganglia, Parasympathetic; D011859:Radiography; D013345:Subarachnoid Hemorrhage; D020301:Vasospasm, Intracranial | [
"D000818",
"D004195",
"D004285",
"D004558",
"D005260",
"D005726",
"D011859",
"D013345",
"D020301"
] | Reversal of cerebral vasospasm by sphenopalatine ganglion stimulation in a dog model of subarachnoid hemorrhage. | BACKGROUND
Sphenopalatine ganglion stimulation dilates the ipsilateral arteries of the normal dog anterior circle of Willis. This experiment tested whether similar stimulation would reverse cerebral vasospasm.
METHODS
Six dogs underwent baseline angiography followed by creation of subarachnoid hemorrhage (SAH) by injection of autologous blood into the cisterna magna. Two days later, subarachnoid blood injection was repeated. Seven days later, angiography was repeated and the left sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was then stimulated electrically 3 times and angiography repeated during, and 15 and 30 minutes after stimulation. The protocol was repeated again. Adequacy of stimulation was confirmed by the presence of immediate ipsilateral nasal mucus production.
RESULTS
Subarachnoid hemorrhage was associated with significant vasospasm of both middle cerebral arteries (11% +/- 4% and 18% +/- 7%, P < .05, paired t tests). Exposure of the ganglion and sham stimulation produced no substantial changes in arterial diameters compared with the diameter before stimulation and after ganglion exposure (n = 2-6 per measurement, paired t tests). Ganglion stimulation produced significant dilatation of the ipsilateral extracranial and intracranial internal carotid, middle cerebral, and anterior cerebral arteries compared with the contralateral arteries (13% +/- 6% to 32% +/- 14%, P < .05, paired t tests).
CONCLUSIONS
The mild to moderate vasospasm that results from SAH in dogs was reversed by sphenopalatine ganglion stimulation. Since this method carries a potential for human application, additional studies are warranted to determine the effects on more severe vasospasm. | null | false | Reversal of cerebral vasospasm by sphenopalatine ganglion stimulation in a dog model of subarachnoid hemorrhage. BACKGROUND
Sphenopalatine ganglion stimulation dilates the ipsilateral arteries of the normal dog anterior circle of Willis. This experiment tested whether similar stimulation would reverse cerebral vasospasm.
METHODS
Six dogs underwent baseline angiography followed by creation of subarachnoid hemorrhage (SAH) by injection of autologous blood into the cisterna magna. Two days later, subarachnoid blood injection was repeated. Seven days later, angiography was repeated and the left sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was then stimulated electrically 3 times and angiography repeated during, and 15 and 30 minutes after stimulation. The protocol was repeated again. Adequacy of stimulation was confirmed by the presence of immediate ipsilateral nasal mucus production.
RESULTS
Subarachnoid hemorrhage was associated with significant vasospasm of both middle cerebral arteries (11% +/- 4% and 18% +/- 7%, P < .05, paired t tests). Exposure of the ganglion and sham stimulation produced no substantial changes in arterial diameters compared with the diameter before stimulation and after ganglion exposure (n = 2-6 per measurement, paired t tests). Ganglion stimulation produced significant dilatation of the ipsilateral extracranial and intracranial internal carotid, middle cerebral, and anterior cerebral arteries compared with the contralateral arteries (13% +/- 6% to 32% +/- 14%, P < .05, paired t tests).
CONCLUSIONS
The mild to moderate vasospasm that results from SAH in dogs was reversed by sphenopalatine ganglion stimulation. Since this method carries a potential for human application, additional studies are warranted to determine the effects on more severe vasospasm. |
3,302,151 | D000311:Adrenal Glands; D000818:Animals; D002395:Catecholamines; D005938:Glucocorticoids; D006977:Hypertension, Renal; D008297:Male; D010625:Phenylethanolamine N-Methyltransferase; D051381:Rats; D011919:Rats, Inbred Strains; D012083:Renin | [
"D000311",
"D000818",
"D002395",
"D005938",
"D006977",
"D008297",
"D010625",
"D051381",
"D011919",
"D012083"
] | Elevated plasma catecholamines and adrenal phenylethanolamine N-methyl transferase in experimental renal hypertension. | The participation of plasma catecholamine alterations in the development of renal hypertension is uncertain. Therefore, plasma catecholamines and phenylethanolamine N-methyl transferase (PNMT) activity in the adrenal gland were studied in rats with aortic ligation between the renal arteries. Blood pressure reached a plateau after 12 days (mean arterial pressure (MAP): 194 +/- 3 mmHg; P less than 0.001) and its elevation was accompanied by a biphasic elevation in plasma adrenaline. The first elevation (4-fold above control levels; P less than 0.001) occurred at 24 h after aortic ligation and lasted for 4 days. The second elevation commenced on day 6, reached its zenith at day 9 (16-fold increase; P less than 0.005) and lasted for 6 days. The first elevation was associated with the highest levels of plasma renin activity (PRA) (34-fold increase; P less than 0.001) and glucocorticoids (74% increase; P less than 0.001) but plasma noradrenaline, plasma dopamine and adrenal PNMT activity were minimally affected. However, a statistically significant increase in PNMT activity preceded and accompanied the second adrenaline elevation. Despite falling PRA and glucocorticoid levels, marked increases in plasma noradrenaline (5-fold increase; P less than 0.001) and plasma dopamine (2.5-fold increase; P less than 0.010) were observed. These experiments identify an early activation of the sympatho-adrenal axis in renal hypertension. Apparently there is a rapid release of the adrenaline pool followed by an elevation in PNMT activity. The results suggest that the sympatho-neuronal axis is also activated leading to increases in both plasma noradrenaline and dopamine levels. | 13,882,403 | true | Elevated plasma catecholamines and adrenal phenylethanolamine N-methyl transferase in experimental renal hypertension. The participation of plasma catecholamine alterations in the development of renal hypertension is uncertain. Therefore, plasma catecholamines and phenylethanolamine N-methyl transferase (PNMT) activity in the adrenal gland were studied in rats with aortic ligation between the renal arteries. Blood pressure reached a plateau after 12 days (mean arterial pressure (MAP): 194 +/- 3 mmHg; P less than 0.001) and its elevation was accompanied by a biphasic elevation in plasma adrenaline. The first elevation (4-fold above control levels; P less than 0.001) occurred at 24 h after aortic ligation and lasted for 4 days. The second elevation commenced on day 6, reached its zenith at day 9 (16-fold increase; P less than 0.005) and lasted for 6 days. The first elevation was associated with the highest levels of plasma renin activity (PRA) (34-fold increase; P less than 0.001) and glucocorticoids (74% increase; P less than 0.001) but plasma noradrenaline, plasma dopamine and adrenal PNMT activity were minimally affected. However, a statistically significant increase in PNMT activity preceded and accompanied the second adrenaline elevation. Despite falling PRA and glucocorticoid levels, marked increases in plasma noradrenaline (5-fold increase; P less than 0.001) and plasma dopamine (2.5-fold increase; P less than 0.010) were observed. These experiments identify an early activation of the sympatho-adrenal axis in renal hypertension. Apparently there is a rapid release of the adrenaline pool followed by an elevation in PNMT activity. The results suggest that the sympatho-neuronal axis is also activated leading to increases in both plasma noradrenaline and dopamine levels. |
7,315,713 | D000208:Acute Disease; D004452:Echocardiography; D006322:Heart Aneurysm; D006341:Heart Rupture; D006345:Heart Septal Defects, Ventricular; D006801:Humans; D009200:Myocardial Contraction; D009203:Myocardial Infarction; D011379:Prognosis | [
"D000208",
"D004452",
"D006322",
"D006341",
"D006345",
"D006801",
"D009200",
"D009203",
"D011379"
] | Role of two-dimensional echocardiography in the evaluation of patients with ventricular septal rupture postmyocardial infarction. | In 18 consecutive patients with a new murmur following acute myocardial infarction (AMI), examination by two-dimensional echocardiography (2DE) correctly excluded ventricular septal defects (VSD) in eight patients and enabled direct visualization of the VSD in 10 patients. In three patients, 2DE was the first technique to establish the diagnosis. In all patients with VSD, 2DE diagnosis was confirmed by catheterization, surgery, and/or postmortem examination. In six patients with VSD, 2DE contrast studies were performed and were positive. 2DE enabled localization of the VSD in all patients (five inferior, five anterior). To evaluate left ventricular (LV) function, a 2DE wall motion index (WMI) was calculated using an 11 segment model of the LV. While there was no difference (p greater than 0.2) in AMI-VSD survivors versus nonsurvivors in age, kinase, and AVO2 difference, there was no overlap in WMI (p = 0.004) of survivors (0.80 +/- 0.36) versus nonsurvivors (1.66 +/- 0.19). Thus 2DE allows accurate detection and localization of postmyocardial infarction VSD and enables determination of prognosis of these patients. | 14,465,482 | true | Role of two-dimensional echocardiography in the evaluation of patients with ventricular septal rupture postmyocardial infarction. In 18 consecutive patients with a new murmur following acute myocardial infarction (AMI), examination by two-dimensional echocardiography (2DE) correctly excluded ventricular septal defects (VSD) in eight patients and enabled direct visualization of the VSD in 10 patients. In three patients, 2DE was the first technique to establish the diagnosis. In all patients with VSD, 2DE diagnosis was confirmed by catheterization, surgery, and/or postmortem examination. In six patients with VSD, 2DE contrast studies were performed and were positive. 2DE enabled localization of the VSD in all patients (five inferior, five anterior). To evaluate left ventricular (LV) function, a 2DE wall motion index (WMI) was calculated using an 11 segment model of the LV. While there was no difference (p greater than 0.2) in AMI-VSD survivors versus nonsurvivors in age, kinase, and AVO2 difference, there was no overlap in WMI (p = 0.004) of survivors (0.80 +/- 0.36) versus nonsurvivors (1.66 +/- 0.19). Thus 2DE allows accurate detection and localization of postmyocardial infarction VSD and enables determination of prognosis of these patients. |
8,421,830 | D000818:Animals; D001794:Blood Pressure; D002536:Cerebral Arteries; D002544:Cerebral Infarction; D004195:Disease Models, Animal; D002542:Intracranial Embolism and Thrombosis; D017075:Laser Coagulation; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D017208:Rats, Wistar; D013045:Species Specificity | [
"D000818",
"D001794",
"D002536",
"D002544",
"D004195",
"D002542",
"D017075",
"D008297",
"D051381",
"D017207",
"D017208",
"D013045"
] | Comparative histopathologic consequences of photothrombotic occlusion of the distal middle cerebral artery in Sprague-Dawley and Wistar rats. | OBJECTIVE
We have developed a minimally invasive model of photothrombotic occlusion of the distal middle cerebral artery in rats and have evaluated the patterns and features of the resulting histopathologic injury in two normotensive strains.
METHODS
Food-deprived male Sprague-Dawley (n = 14) and Wistar (n = 10) rats anesthetized with halothane/nitrous oxide underwent a small craniotomy to expose the right distal middle cerebral artery just above the rhinal fissure. The animals were injected intravenously with the photosensitizing dye rose bengal, and the distal middle cerebral artery was irradiated with light from an argon laser-activated dye laser at three separate points to induce thrombotic occlusion. The ipsilateral common carotid artery was then permanently occluded, and the contralateral common carotid artery was occluded for 60 minutes. Three days later, the brains were perfusion-fixed and prepared for histopathologic examination, and infarct volume was determined by quantitative planimetry.
RESULTS
In Sprague-Dawley rats, a large consistent temporoparietal cortical infarct was observed; mean +/- SD infarct volume was 130.5 +/- 40.0 mm3 (coefficient of variation, 30.7%) and a relatively small adjacent zone of selective neuronal necrosis ("incomplete infarction"), amounting to only 9.1% of the total injury volume, was also seen. By contrast, Wistar rats had smaller and more variable cortical infarcts (volume, 48.4 +/- 26.9 mm3; coefficient of variation, 55.6%) but displayed a much more substantial zone of incomplete cortical infarction (volume, 20.8 +/- 10.1 mm3; 30.1% of the total injury volume). In neither strain was infarct size related to alterations of blood pressure. In both strains, infarcts were limited to the cortex, typically involving the parietal cortex, somatosensory cortex, and forelimb region. Three rats exhibited infarcts in the contralateral hemisphere.
CONCLUSIONS
This model has the advantages of necessitating only minimal surgery, allowing the dura to remain intact, and avoiding mechanical trauma to the brain surface. In Sprague-Dawley rats, the resulting large cortical infarct exhibited relatively small interanimal variation, making the model suitable, for example, for replicate studies of pharmacotherapy. In Wistar rats, the large zone of incomplete infarction, a unique feature heretofore undescribed in rodent models of permanent focal ischemia, lends the model to the study of the pathomechanisms underlying graded cortical ischemic injury. | null | false | Comparative histopathologic consequences of photothrombotic occlusion of the distal middle cerebral artery in Sprague-Dawley and Wistar rats. OBJECTIVE
We have developed a minimally invasive model of photothrombotic occlusion of the distal middle cerebral artery in rats and have evaluated the patterns and features of the resulting histopathologic injury in two normotensive strains.
METHODS
Food-deprived male Sprague-Dawley (n = 14) and Wistar (n = 10) rats anesthetized with halothane/nitrous oxide underwent a small craniotomy to expose the right distal middle cerebral artery just above the rhinal fissure. The animals were injected intravenously with the photosensitizing dye rose bengal, and the distal middle cerebral artery was irradiated with light from an argon laser-activated dye laser at three separate points to induce thrombotic occlusion. The ipsilateral common carotid artery was then permanently occluded, and the contralateral common carotid artery was occluded for 60 minutes. Three days later, the brains were perfusion-fixed and prepared for histopathologic examination, and infarct volume was determined by quantitative planimetry.
RESULTS
In Sprague-Dawley rats, a large consistent temporoparietal cortical infarct was observed; mean +/- SD infarct volume was 130.5 +/- 40.0 mm3 (coefficient of variation, 30.7%) and a relatively small adjacent zone of selective neuronal necrosis ("incomplete infarction"), amounting to only 9.1% of the total injury volume, was also seen. By contrast, Wistar rats had smaller and more variable cortical infarcts (volume, 48.4 +/- 26.9 mm3; coefficient of variation, 55.6%) but displayed a much more substantial zone of incomplete cortical infarction (volume, 20.8 +/- 10.1 mm3; 30.1% of the total injury volume). In neither strain was infarct size related to alterations of blood pressure. In both strains, infarcts were limited to the cortex, typically involving the parietal cortex, somatosensory cortex, and forelimb region. Three rats exhibited infarcts in the contralateral hemisphere.
CONCLUSIONS
This model has the advantages of necessitating only minimal surgery, allowing the dura to remain intact, and avoiding mechanical trauma to the brain surface. In Sprague-Dawley rats, the resulting large cortical infarct exhibited relatively small interanimal variation, making the model suitable, for example, for replicate studies of pharmacotherapy. In Wistar rats, the large zone of incomplete infarction, a unique feature heretofore undescribed in rodent models of permanent focal ischemia, lends the model to the study of the pathomechanisms underlying graded cortical ischemic injury. |
30,661,433 | D005333:Fetus; D006330:Heart Defects, Congenital; D006801:Humans; D008297:Male; D011664:Pulmonary Valve | [
"D005333",
"D006330",
"D006801",
"D008297",
"D011664"
] | Absent Pulmonary Valve Syndrome in a Fetus: A Case Report and Literature Review. | BACKGROUND
The main characteristics of absent pulmonary valve syndrome (APVS) include the absence or hypoplasia of the pulmonary valve, stenosis of the pulmonary valve annulus, and aneurysmal dilatation of the pulmonary trunk and its branches. In the more common type 1, the tetralogy of Fallot-like type, there is a ventricular septal defect, overriding aorta, pulmonary arterial dilatation, and absence of ductus arteriosus, The second type has an intact ventricular septum, less pulmonary artery dilatation, and a patent ductus arteriosus, with or without tricuspid atresia.
METHODS
This APVS had an intact ventricular septum with an absent ductus arteriosus.
CONCLUSIONS
The APVS with intact ventricular septum with an absent ductus arteriosus may represent a third type of APVS. | null | false | Absent Pulmonary Valve Syndrome in a Fetus: A Case Report and Literature Review. BACKGROUND
The main characteristics of absent pulmonary valve syndrome (APVS) include the absence or hypoplasia of the pulmonary valve, stenosis of the pulmonary valve annulus, and aneurysmal dilatation of the pulmonary trunk and its branches. In the more common type 1, the tetralogy of Fallot-like type, there is a ventricular septal defect, overriding aorta, pulmonary arterial dilatation, and absence of ductus arteriosus, The second type has an intact ventricular septum, less pulmonary artery dilatation, and a patent ductus arteriosus, with or without tricuspid atresia.
METHODS
This APVS had an intact ventricular septum with an absent ductus arteriosus.
CONCLUSIONS
The APVS with intact ventricular septum with an absent ductus arteriosus may represent a third type of APVS. |
15,226,426 | D000818:Animals; D000903:Antibiotics, Antineoplastic; D001011:Aorta; D006332:Cardiomegaly; D005260:Female; D005333:Fetus; D018507:Gene Expression Regulation, Developmental; D051379:Mice; D018345:Mice, Knockout; D008822:Mice, Transgenic; D009929:Organ Size; D019869:Phosphatidylinositol 3-Kinases; D010805:Physical Conditioning, Animal; D017526:Receptor, IGF Type 1; D038744:Ribosomal Protein S6 Kinases, 90-kDa; D015398:Signal Transduction; D020123:Sirolimus; D013314:Stress, Mechanical; D013550:Swimming | [
"D000818",
"D000903",
"D001011",
"D006332",
"D005260",
"D005333",
"D018507",
"D051379",
"D018345",
"D008822",
"D009929",
"D019869",
"D010805",
"D017526",
"D038744",
"D015398",
"D020123",
"D013314",
"D013550"
] | Deletion of ribosomal S6 kinases does not attenuate pathological, physiological, or insulin-like growth factor 1 receptor-phosphoinositide 3-kinase-induced cardiac hypertrophy. | Ribosomal S6 kinases (S6Ks) have been depicted as critical effectors downstream of growth factor pathways, which play an important role in the regulation of protein synthesis by phosphorylating the ribosomal protein, S6. The goal of this study was to determine whether S6Ks regulate heart size, are critical for the induction of cardiac hypertrophy in response to a pathological or physiological stimulus, and whether S6Ks are critical downstream effectors of the insulin-like growth factor 1 (IGF1)-phosphoinositide 3-kinase (PI3K) pathway. For this purpose, we generated and characterized cardiac-specific S6K1 and S6K2 transgenic mice and subjected S6K1(-/-), S6K2(-/-), and S6K1(-/-) S6K2(-/-) mice to a pathological stress (aortic banding) or a physiological stress (exercise training). To determine the genetic relationship between S6Ks and the IGF1-PI3K pathway, S6K transgenic and knockout mice were crossed with cardiac-specific transgenic mice overexpressing the IGF1 receptor (IGF1R) or PI3K mutants. Here we show that overexpression of S6K1 induced a modest degree of hypertrophy, whereas overexpression of S6K2 resulted in no obvious cardiac phenotype. Unexpectedly, deletion of S6K1 and S6K2 had no impact on the development of pathological, physiological, or IGF1R-PI3K-induced cardiac hypertrophy. These studies suggest that S6Ks alone are not essential for the development of cardiac hypertrophy. | 1,577,804 | true | Deletion of ribosomal S6 kinases does not attenuate pathological, physiological, or insulin-like growth factor 1 receptor-phosphoinositide 3-kinase-induced cardiac hypertrophy. Ribosomal S6 kinases (S6Ks) have been depicted as critical effectors downstream of growth factor pathways, which play an important role in the regulation of protein synthesis by phosphorylating the ribosomal protein, S6. The goal of this study was to determine whether S6Ks regulate heart size, are critical for the induction of cardiac hypertrophy in response to a pathological or physiological stimulus, and whether S6Ks are critical downstream effectors of the insulin-like growth factor 1 (IGF1)-phosphoinositide 3-kinase (PI3K) pathway. For this purpose, we generated and characterized cardiac-specific S6K1 and S6K2 transgenic mice and subjected S6K1(-/-), S6K2(-/-), and S6K1(-/-) S6K2(-/-) mice to a pathological stress (aortic banding) or a physiological stress (exercise training). To determine the genetic relationship between S6Ks and the IGF1-PI3K pathway, S6K transgenic and knockout mice were crossed with cardiac-specific transgenic mice overexpressing the IGF1 receptor (IGF1R) or PI3K mutants. Here we show that overexpression of S6K1 induced a modest degree of hypertrophy, whereas overexpression of S6K2 resulted in no obvious cardiac phenotype. Unexpectedly, deletion of S6K1 and S6K2 had no impact on the development of pathological, physiological, or IGF1R-PI3K-induced cardiac hypertrophy. These studies suggest that S6Ks alone are not essential for the development of cardiac hypertrophy. |
24,483,029 | D018784:Abdominal Abscess; D003082:Colectomy; D003248:Constipation; D003646:Debridement; D004238:Diverticulitis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007416:Intestinal Perforation; D008641:Mesenteric Vascular Occlusion; D008875:Middle Aged; D017773:Pelvic Floor; D056887:Pelvic Organ Prolapse; D011126:Polypropylenes; D013526:Surgical Mesh; D013927:Thrombosis | [
"D018784",
"D003082",
"D003248",
"D003646",
"D004238",
"D017809",
"D005260",
"D006801",
"D007044",
"D007416",
"D008641",
"D008875",
"D017773",
"D056887",
"D011126",
"D013526",
"D013927"
] | [Severe complications of total pelvic floor repair using polypropylene mesh--case report]. | The authors present a case of 58 years old woman suffering from complex pelvic floor pathology diagnosed with rectal prolapse, genitary organs prolapse, descending pelvic floor, rectocele and enterocele as well as advanced diverticular disease of the left colon. She suffered from chronic constipation. The surgery consisted of left hemicolectomy, hysterectomy, reconstruction of the pelvic floor and sacrocoloporectopexy using polypropylene mesh. The out-come complicated mesenteric vessels thrombosis, small bowel perforations and intraabdominal abscesses. Despite intensive care and subsequent ileal resections, debridement and drainage of the abscesses the patient died five months after beacause of multi organs insufficiency. | null | false | [Severe complications of total pelvic floor repair using polypropylene mesh--case report]. The authors present a case of 58 years old woman suffering from complex pelvic floor pathology diagnosed with rectal prolapse, genitary organs prolapse, descending pelvic floor, rectocele and enterocele as well as advanced diverticular disease of the left colon. She suffered from chronic constipation. The surgery consisted of left hemicolectomy, hysterectomy, reconstruction of the pelvic floor and sacrocoloporectopexy using polypropylene mesh. The out-come complicated mesenteric vessels thrombosis, small bowel perforations and intraabdominal abscesses. Despite intensive care and subsequent ileal resections, debridement and drainage of the abscesses the patient died five months after beacause of multi organs insufficiency. |
1,221,552 | D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D004437:Ebstein Anomaly; D005260:Female; D006345:Heart Septal Defects, Ventricular; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D011666:Pulmonary Valve Stenosis; D013771:Tetralogy of Fallot; D014188:Transposition of Great Vessels | [
"D000293",
"D000328",
"D006348",
"D004437",
"D005260",
"D006345",
"D006801",
"D008297",
"D008875",
"D011651",
"D011666",
"D013771",
"D014188"
] | Adult cyanotic congenital heart disease. | The surgical treatment of cyanotic heart disease in the adult poses some technical difficulties in correcting severe anatomical deformities and compromised physiological states over a wide range of conditions. Various abnormalities and their surgical management have been reviewed. Forty-six patients over the age of 18 years have been operated with 10 operative deaths. Of the survivors, 63% have had excellent clinical result; 69.5% of the total group had an excellent or good result following surgery. It is concluded that the age of the patient is not a bar to the complete repair of these deformities, and all cases of adult cyanotic heart disease should be investigated with a view to surgical correction. | 1,719,008 | true | Adult cyanotic congenital heart disease. The surgical treatment of cyanotic heart disease in the adult poses some technical difficulties in correcting severe anatomical deformities and compromised physiological states over a wide range of conditions. Various abnormalities and their surgical management have been reviewed. Forty-six patients over the age of 18 years have been operated with 10 operative deaths. Of the survivors, 63% have had excellent clinical result; 69.5% of the total group had an excellent or good result following surgery. It is concluded that the age of the patient is not a bar to the complete repair of these deformities, and all cases of adult cyanotic heart disease should be investigated with a view to surgical correction. |
27,880,841 | D000328:Adult; D002585:Cesarean Section; D004617:Embolism; D005260:Female; D006801:Humans; D006973:Hypertension; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage; D011247:Pregnancy; D012189:Retrospective Studies; D014421:Turkey | [
"D000328",
"D002585",
"D004617",
"D005260",
"D006801",
"D006973",
"D008428",
"D006473",
"D011247",
"D012189",
"D014421"
] | Association between Maternal Mortality and Cesarean Section: Turkey Experience. | BACKGROUND
To investigate the cesarean Section (C/S) rates and maternal mortality (MM) causes and its relation between 2002 and 2013.
METHODS
Data were gathered from Turkish Ministry of Health and Istanbul Health Administration. The Annual Clinical Reports for 2002-2013 were reviewed and analyzed: C/Ss and maternal deaths in women who gave birth ≥20 weeks between January 1, 2002, and December 31, 2013, in any hospital in Turkey and Istanbul.
RESULTS
The major causes of MM were hemorrhage (20%), hypertensive disorders (18.2%), embolism (10.3%), cardiovascular conditions (9%), infection (8.5%), and other causes (10.4%). Overall, the average annual CS delivery rate was 46.4% in Istanbul and 36.6% in Turkey. There was a significant increase in the CS rates in Istanbul and Turkey from 2008 to 2013 relative to those from 2002 to 2007 (p = 0.004). There was a statistically significant and inverse relationship (97.2%) between the MMR and CS rate from 2002 to 2013 in Turkey (p = 0.001). However, no significant relationship was detected between the MMR and CS rate from 2002 to 2013 in Istanbul (p > 0.05). There was a significant inverse correlation (66.3%) between the CS rate and peripartumhemorrhage in Turkey (p = 0.019) and there was a significant inverse correlation (66.5%) between the CS rate and peripartumhemorrhage(p = 0.018) in Istanbul between 2007 to 2013. There were no significant differences in ante-intrapartum haemorrhage bleeding (p > 0.05) or postpartum hemorrhage (p > 0.05) from 2007 to 2013.
CONCLUSIONS
This study demonstrates that there was a inverse correlation between increased CS and maternal mortality rates during the previous decade in Turkey. Although cesarean rates increase excessively, it appears that improved health care facilities have a positive effect on MMRs in Turkey. | null | false | Association between Maternal Mortality and Cesarean Section: Turkey Experience. BACKGROUND
To investigate the cesarean Section (C/S) rates and maternal mortality (MM) causes and its relation between 2002 and 2013.
METHODS
Data were gathered from Turkish Ministry of Health and Istanbul Health Administration. The Annual Clinical Reports for 2002-2013 were reviewed and analyzed: C/Ss and maternal deaths in women who gave birth ≥20 weeks between January 1, 2002, and December 31, 2013, in any hospital in Turkey and Istanbul.
RESULTS
The major causes of MM were hemorrhage (20%), hypertensive disorders (18.2%), embolism (10.3%), cardiovascular conditions (9%), infection (8.5%), and other causes (10.4%). Overall, the average annual CS delivery rate was 46.4% in Istanbul and 36.6% in Turkey. There was a significant increase in the CS rates in Istanbul and Turkey from 2008 to 2013 relative to those from 2002 to 2007 (p = 0.004). There was a statistically significant and inverse relationship (97.2%) between the MMR and CS rate from 2002 to 2013 in Turkey (p = 0.001). However, no significant relationship was detected between the MMR and CS rate from 2002 to 2013 in Istanbul (p > 0.05). There was a significant inverse correlation (66.3%) between the CS rate and peripartumhemorrhage in Turkey (p = 0.019) and there was a significant inverse correlation (66.5%) between the CS rate and peripartumhemorrhage(p = 0.018) in Istanbul between 2007 to 2013. There were no significant differences in ante-intrapartum haemorrhage bleeding (p > 0.05) or postpartum hemorrhage (p > 0.05) from 2007 to 2013.
CONCLUSIONS
This study demonstrates that there was a inverse correlation between increased CS and maternal mortality rates during the previous decade in Turkey. Although cesarean rates increase excessively, it appears that improved health care facilities have a positive effect on MMRs in Turkey. |
18,804,095 | D000818:Animals; D017209:Apoptosis; D001253:Astrocytes; D002545:Brain Ischemia; D053148:Caspase 3; D002478:Cells, Cultured; D017077:Culture Media, Conditioned; D048049:Extracellular Signal-Regulated MAP Kinases; D051100:Glial Cell Line-Derived Neurotrophic Factor; D007511:Ischemia; D017628:Microglia; D048052:Mitogen-Activated Protein Kinase 3; D016328:NF-kappa B; D009474:Neurons; D018696:Neuroprotective Agents; D051057:Proto-Oncogene Proteins c-akt; D051381:Rats; D017207:Rats, Sprague-Dawley; D015398:Signal Transduction | [
"D000818",
"D017209",
"D001253",
"D002545",
"D053148",
"D002478",
"D017077",
"D048049",
"D051100",
"D007511",
"D017628",
"D048052",
"D016328",
"D009474",
"D018696",
"D051057",
"D051381",
"D017207",
"D015398"
] | Ischemic brain cell-derived conditioned medium protects astrocytes against ischemia through GDNF/ERK/NF-kB signaling pathway. | Conditioned medium (CM) collected from cultures of ischemic microglia, astrocytes, and neurons were protective to astrocytes under the in vitro ischemic condition (deprivation of oxygen, glucose and serum). Molecular and signaling pathway(s) responsible for the CMs protective activity were investigated. Results showed that CMs from the ischemic microglia (MCM), astrocytes (ACM) and neurons (NCM) contained glial cell line-derived neurotrophic factor (GDNF), which protects astrocytes against the in vitro ischemia. Expression of extra cellular signal-regulated kinase (ERK1/2) and nuclear factor-kappa B (NF-kB) by GDNF led to the inhibition of apoptosis of the ischemic astrocytes in a caspase 3-independent manner. However, CMs- and GDNF-mediated protection of the ischemic astrocytes was protein kinase B (Akt) independent. These results provided mechanistic data regarding how GDNF- and CMs-mediated protection of the ischemic astrocytes is taking place. These observations provide information for the use of GDNF and GDNF containing CMs in the control of cerebral ischemia. | 7,548,089 | true | Ischemic brain cell-derived conditioned medium protects astrocytes against ischemia through GDNF/ERK/NF-kB signaling pathway. Conditioned medium (CM) collected from cultures of ischemic microglia, astrocytes, and neurons were protective to astrocytes under the in vitro ischemic condition (deprivation of oxygen, glucose and serum). Molecular and signaling pathway(s) responsible for the CMs protective activity were investigated. Results showed that CMs from the ischemic microglia (MCM), astrocytes (ACM) and neurons (NCM) contained glial cell line-derived neurotrophic factor (GDNF), which protects astrocytes against the in vitro ischemia. Expression of extra cellular signal-regulated kinase (ERK1/2) and nuclear factor-kappa B (NF-kB) by GDNF led to the inhibition of apoptosis of the ischemic astrocytes in a caspase 3-independent manner. However, CMs- and GDNF-mediated protection of the ischemic astrocytes was protein kinase B (Akt) independent. These results provided mechanistic data regarding how GDNF- and CMs-mediated protection of the ischemic astrocytes is taking place. These observations provide information for the use of GDNF and GDNF containing CMs in the control of cerebral ischemia. |
10,867,205 | D000595:Amino Acid Sequence; D016564:Amyloid beta-Protein Precursor; D000818:Animals; D015153:Blotting, Western; D002545:Brain Ischemia; D017536:Carotid Artery, Common; D002908:Chronic Disease; D005110:Extracellular Space; D007150:Immunohistochemistry; D008026:Ligation; D008297:Male; D008969:Molecular Sequence Data; D051381:Rats; D017207:Rats, Sprague-Dawley | [
"D000595",
"D016564",
"D000818",
"D015153",
"D002545",
"D017536",
"D002908",
"D005110",
"D007150",
"D008026",
"D008297",
"D008969",
"D051381",
"D017207"
] | Cleavage of amyloid precursor protein elicited by chronic cerebral hypoperfusion. | In the present study, we sought to determine whether low-grade, chronic vascular insufficiency induced in a rodent model of chronic cerebrohypoperfusion is sufficient, in and of itself, to trigger cleavage of the amyloid precursor protein (APP) into beta A-sized fragments. We report that chronic two vessel occlusion (2VO) results in progressive accumulation of beta A peptides detected by Western analysis in aged rats correlating with a shift in the immunohistochemical localization of APP from neurons to extracellular deposits in brain parenchyma. These data indicate that the 2VO paradigm reproduces features of beta A biogenesis characteristic of sporadic Alzheimer's disease. | 5,885,784 | true | Cleavage of amyloid precursor protein elicited by chronic cerebral hypoperfusion. In the present study, we sought to determine whether low-grade, chronic vascular insufficiency induced in a rodent model of chronic cerebrohypoperfusion is sufficient, in and of itself, to trigger cleavage of the amyloid precursor protein (APP) into beta A-sized fragments. We report that chronic two vessel occlusion (2VO) results in progressive accumulation of beta A peptides detected by Western analysis in aged rats correlating with a shift in the immunohistochemical localization of APP from neurons to extracellular deposits in brain parenchyma. These data indicate that the 2VO paradigm reproduces features of beta A biogenesis characteristic of sporadic Alzheimer's disease. |
17,297,207 | D000328:Adult; D000962:Antimalarials; D006801:Humans; D008012:Lidocaine; D008288:Malaria; D008297:Male; D011188:Potassium; D011803:Quinine; D012307:Risk Factors; D018434:Sickness Impact Profile; D012848:Sinoatrial Block; D018879:Ventricular Premature Complexes | [
"D000328",
"D000962",
"D006801",
"D008012",
"D008288",
"D008297",
"D011188",
"D011803",
"D012307",
"D018434",
"D012848",
"D018879"
] | Quinine-induced arrhythmia in a patient with severe malaria. | It was reported that there was a case of severe malaria patient with jaundice who presented with arrhythmia (premature ventricular contraction) while getting quinine infusion was reported. A man, 25 years old, was admitted to hospital with high fever, chill, vomiting, jaundice. The patient was fully conscious, blood pressure 120/80 mmHg, pulse rate 100 x/minute, regular. On admission, laboratory examination showed Plasmodium falciparum (++++), total bilirubin 8.25 mg/dL, conjugated bilirubin 4.36 mg/dL, unconjugated bilirubin 3.89 mg/dL, potassium 3.52 meq/L Patient was diagnosed as severe malaria with jaundice and got quinine infusion in dextrose 5% 500 mg/8 hour. On the second day the patient had vomitus, diarrhea, tinnitus, loss of hearing. After 30 hours of quinine infusion the patient felt palpitation and electrocardiography (ECG) recording showed premature ventricular contraction (PVC) > 5 x/minute, trigemini, constant type--sinoatrial block, positive U wave. He was treated with lidocaine 50 mg intravenously followed by infusion 1500 mg in dextrose 5%/24 hour and potassium aspartate tablet. Quinine infusion was discontinued and changed with sulfate quinine tablets. Three hours later the patient felt better, the frequency of PVC reduced to 4 - 5 x/minute and on the third day ECG was normal, potassium level was 3.34 meq/L. He was discharged on 7th day in good condition. Quinine, like quinidine, is a chincona alkaloid that has anti-arrhythmic property, although it also pro-arrhythmic that can cause various arrhythmias, including severe arrhythmia such as multiple PVC. Administration of parenteral quinine must be done carefully and with good observation because of its pro-arrhythmic effect, especially in older patients who have heart diseases or patients with electrolyte disorder (hypokalemia) which frequently occurs due to vomiting and or diarrhea in malaria cases. | 4,149,254 | true | Quinine-induced arrhythmia in a patient with severe malaria. It was reported that there was a case of severe malaria patient with jaundice who presented with arrhythmia (premature ventricular contraction) while getting quinine infusion was reported. A man, 25 years old, was admitted to hospital with high fever, chill, vomiting, jaundice. The patient was fully conscious, blood pressure 120/80 mmHg, pulse rate 100 x/minute, regular. On admission, laboratory examination showed Plasmodium falciparum (++++), total bilirubin 8.25 mg/dL, conjugated bilirubin 4.36 mg/dL, unconjugated bilirubin 3.89 mg/dL, potassium 3.52 meq/L Patient was diagnosed as severe malaria with jaundice and got quinine infusion in dextrose 5% 500 mg/8 hour. On the second day the patient had vomitus, diarrhea, tinnitus, loss of hearing. After 30 hours of quinine infusion the patient felt palpitation and electrocardiography (ECG) recording showed premature ventricular contraction (PVC) > 5 x/minute, trigemini, constant type--sinoatrial block, positive U wave. He was treated with lidocaine 50 mg intravenously followed by infusion 1500 mg in dextrose 5%/24 hour and potassium aspartate tablet. Quinine infusion was discontinued and changed with sulfate quinine tablets. Three hours later the patient felt better, the frequency of PVC reduced to 4 - 5 x/minute and on the third day ECG was normal, potassium level was 3.34 meq/L. He was discharged on 7th day in good condition. Quinine, like quinidine, is a chincona alkaloid that has anti-arrhythmic property, although it also pro-arrhythmic that can cause various arrhythmias, including severe arrhythmia such as multiple PVC. Administration of parenteral quinine must be done carefully and with good observation because of its pro-arrhythmic effect, especially in older patients who have heart diseases or patients with electrolyte disorder (hypokalemia) which frequently occurs due to vomiting and or diarrhea in malaria cases. |
9,066,940 | D000328:Adult; D000906:Antibodies; D000925:Anticoagulants; D003429:Cross Reactions; D003875:Drug Eruptions; D017984:Enoxaparin; D005260:Female; D006493:Heparin; D006801:Humans; D009336:Necrosis; D012128:Respiratory Distress Syndrome; D013921:Thrombocytopenia; D013924:Thrombophlebitis | [
"D000328",
"D000906",
"D000925",
"D003429",
"D003875",
"D017984",
"D005260",
"D006493",
"D006801",
"D009336",
"D012128",
"D013921",
"D013924"
] | Enoxaparin-associated dermal necrosis: a consequence of cross-reactivity with heparin-mediated antibodies. | OBJECTIVE
To describe a patient with enoxaparin-induced dermal necrosis and to review previously reported cases of skin manifestations associated with low-molecular-weight heparins.
METHODS
A 43-year-old white woman with adult respiratory distress syndrome developed localized dermal necrosis and thrombocytopenia secondary to subcutaneous administration of unfractionated heparin. Upper extremity thrombi that had developed after administration of subcutaneous heparin at an outside hospital were treated with subcutaneous enoxaparin. Although platelet counts remained stable during enoxaparin therapy, dermal necrosis developed at the injection site. Parenteral anticoagulant therapy was discontinued and the necrotic lesions secondary to enoxaparin resolved with minimal local care.
CONCLUSIONS
Numerous cases of dermal necrosis secondary to heparin administration have been reported while this reaction secondary to enoxaparin use has been reported only briefly. It has been postulated that dermal necrosis secondary to heparin is associated with heparin-induced thrombocytopenia and is a result of heparin-mediated thrombosis in the microvasculature. Antibodies to heparin have cross-reactivity with enoxaparin; therefore, dermal necrosis secondary to enoxaparin may occur by a similar mechanism.
CONCLUSIONS
Although enoxaparin-associated dermal necrosis appears to be a rare occurrence, we advise against the use of enoxaparin or other low-molecular-weight heparins in patients with a previous history of heparin-associated thrombocytopenia or heparin-induced dermal necrosis. | null | false | Enoxaparin-associated dermal necrosis: a consequence of cross-reactivity with heparin-mediated antibodies. OBJECTIVE
To describe a patient with enoxaparin-induced dermal necrosis and to review previously reported cases of skin manifestations associated with low-molecular-weight heparins.
METHODS
A 43-year-old white woman with adult respiratory distress syndrome developed localized dermal necrosis and thrombocytopenia secondary to subcutaneous administration of unfractionated heparin. Upper extremity thrombi that had developed after administration of subcutaneous heparin at an outside hospital were treated with subcutaneous enoxaparin. Although platelet counts remained stable during enoxaparin therapy, dermal necrosis developed at the injection site. Parenteral anticoagulant therapy was discontinued and the necrotic lesions secondary to enoxaparin resolved with minimal local care.
CONCLUSIONS
Numerous cases of dermal necrosis secondary to heparin administration have been reported while this reaction secondary to enoxaparin use has been reported only briefly. It has been postulated that dermal necrosis secondary to heparin is associated with heparin-induced thrombocytopenia and is a result of heparin-mediated thrombosis in the microvasculature. Antibodies to heparin have cross-reactivity with enoxaparin; therefore, dermal necrosis secondary to enoxaparin may occur by a similar mechanism.
CONCLUSIONS
Although enoxaparin-associated dermal necrosis appears to be a rare occurrence, we advise against the use of enoxaparin or other low-molecular-weight heparins in patients with a previous history of heparin-associated thrombocytopenia or heparin-induced dermal necrosis. |
20,224,843 | D000015:Abnormalities, Multiple; D000293:Adolescent; D000886:Anthropometry; D044383:Black People; D002648:Child; D002675:Child, Preschool; D002872:Chromosome Deletion; D002892:Chromosomes, Human, Pair 22; D005147:Facial Bones; D005260:Female; D006330:Heart Defects, Congenital; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013019:South Africa; D014463:Ultrasonography | [
"D000015",
"D000293",
"D000886",
"D044383",
"D002648",
"D002675",
"D002872",
"D002892",
"D005147",
"D005260",
"D006330",
"D006801",
"D017404",
"D007223",
"D007231",
"D008297",
"D011446",
"D013019",
"D014463"
] | Cardiac abnormalities and facial anthropometric measurements in children from the Free State and Northern Cape provinces of South Africa with chromosome 22q11.2 microdeletion. | BACKGROUND
Microdeletions of chromosome 22 are common and have a prevalence of at least 1/4 000. Cardiac abnormalities, abnormal facial features and palatal abnormalities are frequently present in these patients.
OBJECTIVE
To describe the cardiac lesions and selected measurable facial features in children from the Free State and Northern Cape presenting at the Cardiology Unit of the Universitas Academic Hospital complex in Bloemfontein.
METHODS
This was a prospective study in which patients with abnormal facial characteristics were tested using a fluorescence in situ hybridisation (FISH) probe for the 22q11.2 microdeletion. Forty children tested positive for the microdeletion. All patients underwent an echocardiogram and where possible, facial anthropometric measurements were performed.
RESULTS
The median age at diagnosis was 3.6 years (range 0.04 years, i.e. 2 weeks to 16.2 years). Tetralogy with or without pulmonary atresia was diagnosed in 43% (n = 17) of the children and truncus arteriosus in 20% (n = 8). A rightsided aortic arch was present in 43% (n = 17) of the patients. Mid-facial height was slightly longer (median = 1.0; range -0.5 to 3.3) and width narrower (median = -1.4; range -2.2 to 0.1) than normal. Ear height and width were notably small compared to normal, with median -scores = -3.3 (range -4.8 to -2.6) and = -2.4 (range -3.4 to -1.4), respectively.
CONCLUSIONS
Microdeletions of chromosome 22q11 are present in children from the Free State and Northern Cape. Conotruncal cyanotic heart lesions, especially tetralogy with or without pulmonary atresia and truncus arteriosus were the most frequent congenital cardiac diagnoses. A right-sided aortic arch was also commonly present in these children. Facial features varied and small ears were the most noteworthy anthropometric feature. A right-sided aortic arch with or without a congenital cardiac lesion, a long, narrow mid-face and small ears should alert the physician to the possibility of a microdeletion on the long arm of chromosome 22. | null | false | Cardiac abnormalities and facial anthropometric measurements in children from the Free State and Northern Cape provinces of South Africa with chromosome 22q11.2 microdeletion. BACKGROUND
Microdeletions of chromosome 22 are common and have a prevalence of at least 1/4 000. Cardiac abnormalities, abnormal facial features and palatal abnormalities are frequently present in these patients.
OBJECTIVE
To describe the cardiac lesions and selected measurable facial features in children from the Free State and Northern Cape presenting at the Cardiology Unit of the Universitas Academic Hospital complex in Bloemfontein.
METHODS
This was a prospective study in which patients with abnormal facial characteristics were tested using a fluorescence in situ hybridisation (FISH) probe for the 22q11.2 microdeletion. Forty children tested positive for the microdeletion. All patients underwent an echocardiogram and where possible, facial anthropometric measurements were performed.
RESULTS
The median age at diagnosis was 3.6 years (range 0.04 years, i.e. 2 weeks to 16.2 years). Tetralogy with or without pulmonary atresia was diagnosed in 43% (n = 17) of the children and truncus arteriosus in 20% (n = 8). A rightsided aortic arch was present in 43% (n = 17) of the patients. Mid-facial height was slightly longer (median = 1.0; range -0.5 to 3.3) and width narrower (median = -1.4; range -2.2 to 0.1) than normal. Ear height and width were notably small compared to normal, with median -scores = -3.3 (range -4.8 to -2.6) and = -2.4 (range -3.4 to -1.4), respectively.
CONCLUSIONS
Microdeletions of chromosome 22q11 are present in children from the Free State and Northern Cape. Conotruncal cyanotic heart lesions, especially tetralogy with or without pulmonary atresia and truncus arteriosus were the most frequent congenital cardiac diagnoses. A right-sided aortic arch was also commonly present in these children. Facial features varied and small ears were the most noteworthy anthropometric feature. A right-sided aortic arch with or without a congenital cardiac lesion, a long, narrow mid-face and small ears should alert the physician to the possibility of a microdeletion on the long arm of chromosome 22. |
19,075,541 | D000208:Acute Disease; D000310:Adrenal Gland Neoplasms; D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009205:Myocarditis; D010673:Pheochromocytoma; D012770:Shock, Cardiogenic | [
"D000208",
"D000310",
"D000328",
"D003937",
"D006801",
"D008297",
"D009205",
"D010673",
"D012770"
] | Pheochromocytoma presenting as acute myocarditis with cardiogenic shock in two cases. | Pheochromocytoma is a rare, catecholamine-secreting tumor. The classic symptoms are headache, diaphoresis, and tachycardia with paroxysmal hypertension. Other less common cardio-vascular manifestations, such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, acute heart failure, and cardiogenic shock, have occasionally been reported. Here, we report two middle-aged men with acute myocarditis and cardiogenic shock, who needed an intra-aortic balloon pump and extra-corporeal membrane oxygenation for life support. They were diagnosed with pheochromocytoma and underwent laparoscopic adrenectomy that restored cardiac function. These cases illustrate diagnostic and management considerations in pheochromocytoma complicated by acute myocarditis and cardiogenic shock. | 969,534 | true | Pheochromocytoma presenting as acute myocarditis with cardiogenic shock in two cases. Pheochromocytoma is a rare, catecholamine-secreting tumor. The classic symptoms are headache, diaphoresis, and tachycardia with paroxysmal hypertension. Other less common cardio-vascular manifestations, such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, acute heart failure, and cardiogenic shock, have occasionally been reported. Here, we report two middle-aged men with acute myocarditis and cardiogenic shock, who needed an intra-aortic balloon pump and extra-corporeal membrane oxygenation for life support. They were diagnosed with pheochromocytoma and underwent laparoscopic adrenectomy that restored cardiac function. These cases illustrate diagnostic and management considerations in pheochromocytoma complicated by acute myocarditis and cardiogenic shock. |
21,685,265 | D000818:Animals; D003331:Coronary Vessels; D051545:Cyclooxygenase 1; D051546:Cyclooxygenase 2; D016861:Cyclooxygenase Inhibitors; D004195:Disease Models, Animal; D065128:Endothelin Receptor Antagonists; D016232:Endothelins; D004791:Enzyme Inhibitors; D005260:Female; D008297:Male; D009203:Myocardial Infarction; D009569:Nitric Oxide; D052250:Nitric Oxide Synthase Type III; D010101:Oxygen Consumption; D005082:Physical Exertion; D011453:Prostaglandins; D017466:Receptors, Endothelin; D013552:Swine; D014661:Vasoconstriction; D014664:Vasodilation; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left | [
"D000818",
"D003331",
"D051545",
"D051546",
"D016861",
"D004195",
"D065128",
"D016232",
"D004791",
"D005260",
"D008297",
"D009203",
"D009569",
"D052250",
"D010101",
"D005082",
"D011453",
"D017466",
"D013552",
"D014661",
"D014664",
"D014665",
"D018487"
] | Prostanoids suppress the coronary vasoconstrictor influence of endothelin after myocardial infarction. | Myocardial infarction (MI) is associated with endothelial dysfunction resulting in an imbalance in endothelium-derived vasodilators and vasoconstrictors. We have previously shown that despite increased endothelin (ET) plasma levels, the coronary vasoconstrictor effect of endogenous ET is abolished after MI. In normal swine, nitric oxide (NO) and prostanoids modulate the vasoconstrictor effect of ET. In light of the interaction among NO, prostanoids, and ET combined with endothelial dysfunction present after MI, we investigated this interaction in control of coronary vasomotor tone in the remote noninfarcted myocardium after MI. Studies were performed in chronically instrumented swine (18 normal swine; 13 swine with MI) at rest and during treadmill exercise. Furthermore, endothelial nitric oxide synthase (eNOS) and cyclooxygenase protein levels were measured in the anterior (noninfarcted) wall of six normal and six swine with MI. eNOS inhibition with N(ω)-nitro-L-arginine (L-NNA) and cyclooxygenase inhibition with indomethacin each resulted in coronary vasoconstriction at rest and during exercise, as evidenced by a decrease in coronary venous oxygen levels. The effect of l-NNA was slightly decreased in swine with MI, although eNOS expression was not altered. Conversely, in accordance with the unaltered expression of cyclooxygenase-1 after MI, the effect of indomethacin was similar in normal and MI swine. L-NNA enhanced the vasodilator effect of the ET(A/B) receptor blocker tezosentan but exclusively during exercise in both normal and MI swine. Interestingly, this effect of L-NNA was blunted in MI compared with normal swine. In contrast, whereas indomethacin increased the vasodilator effect of tezosentan only during exercise in normal swine, indomethacin unmasked a coronary vasodilator effect of tezosentan in MI swine both at rest and during exercise. In conclusion, the present study shows that endothelial control of the coronary vasculature is altered in post-MI remodeled myocardium. Thus the overall vasodilator influences of NO as well as its inhibition of the vasoconstrictor influence of ET on the coronary resistance vessels were reduced after MI. In contrast, while the overall prostanoid vasodilator influence was maintained, its inhibition of ET vasoconstrictor influences was enhanced in post-MI remote myocardium. | 5,705,153 | true | Prostanoids suppress the coronary vasoconstrictor influence of endothelin after myocardial infarction. Myocardial infarction (MI) is associated with endothelial dysfunction resulting in an imbalance in endothelium-derived vasodilators and vasoconstrictors. We have previously shown that despite increased endothelin (ET) plasma levels, the coronary vasoconstrictor effect of endogenous ET is abolished after MI. In normal swine, nitric oxide (NO) and prostanoids modulate the vasoconstrictor effect of ET. In light of the interaction among NO, prostanoids, and ET combined with endothelial dysfunction present after MI, we investigated this interaction in control of coronary vasomotor tone in the remote noninfarcted myocardium after MI. Studies were performed in chronically instrumented swine (18 normal swine; 13 swine with MI) at rest and during treadmill exercise. Furthermore, endothelial nitric oxide synthase (eNOS) and cyclooxygenase protein levels were measured in the anterior (noninfarcted) wall of six normal and six swine with MI. eNOS inhibition with N(ω)-nitro-L-arginine (L-NNA) and cyclooxygenase inhibition with indomethacin each resulted in coronary vasoconstriction at rest and during exercise, as evidenced by a decrease in coronary venous oxygen levels. The effect of l-NNA was slightly decreased in swine with MI, although eNOS expression was not altered. Conversely, in accordance with the unaltered expression of cyclooxygenase-1 after MI, the effect of indomethacin was similar in normal and MI swine. L-NNA enhanced the vasodilator effect of the ET(A/B) receptor blocker tezosentan but exclusively during exercise in both normal and MI swine. Interestingly, this effect of L-NNA was blunted in MI compared with normal swine. In contrast, whereas indomethacin increased the vasodilator effect of tezosentan only during exercise in normal swine, indomethacin unmasked a coronary vasodilator effect of tezosentan in MI swine both at rest and during exercise. In conclusion, the present study shows that endothelial control of the coronary vasculature is altered in post-MI remodeled myocardium. Thus the overall vasodilator influences of NO as well as its inhibition of the vasoconstrictor influence of ET on the coronary resistance vessels were reduced after MI. In contrast, while the overall prostanoid vasodilator influence was maintained, its inhibition of ET vasoconstrictor influences was enhanced in post-MI remote myocardium. |
7,506,334 | D004232:Diuretics; D006333:Heart Failure; D006801:Humans; D007674:Kidney Diseases; D013449:Sulfonamides; D000077786:Torsemide | [
"D004232",
"D006333",
"D006801",
"D007674",
"D013449",
"D000077786"
] | Pharmacokinetics and pharmacodynamics of torasemide in health and disease. | Torasemide is a new loop diuretic that differs from others in this class in that only 20% of the drug is excreted unchanged in the urine with the remaining 80% being eliminated by hepatic metabolism. The large component of nonrenal clearance would predict that torasemide would have only minimal accumulation and prolongation of half-life in patients with renal insufficiency, and this proves to be the case. In contrast, in patients with liver disease, impairment of hepatic elimination causes accumulation of torasemide in plasma with prolongation of half-life. In addition, in cirrhosis, there is increased elimination of unchanged drug into the urine compared to healthy controls. In patients with renal insufficiency, response to remaining nephrons is normal as has been observed with other loop diuretics. In patients with cirrhosis and in those with congestive heart failure, response is diminished, again as has been observed with other loop diuretics. Interestingly, in patients with cirrhosis, the increased delivery of drug into the urine is sufficient to compensate for the decreased pharmacodynamics of response so that overall response is similar to that which occurs in health subjects. | 6,892,460 | true | Pharmacokinetics and pharmacodynamics of torasemide in health and disease. Torasemide is a new loop diuretic that differs from others in this class in that only 20% of the drug is excreted unchanged in the urine with the remaining 80% being eliminated by hepatic metabolism. The large component of nonrenal clearance would predict that torasemide would have only minimal accumulation and prolongation of half-life in patients with renal insufficiency, and this proves to be the case. In contrast, in patients with liver disease, impairment of hepatic elimination causes accumulation of torasemide in plasma with prolongation of half-life. In addition, in cirrhosis, there is increased elimination of unchanged drug into the urine compared to healthy controls. In patients with renal insufficiency, response to remaining nephrons is normal as has been observed with other loop diuretics. In patients with cirrhosis and in those with congestive heart failure, response is diminished, again as has been observed with other loop diuretics. Interestingly, in patients with cirrhosis, the increased delivery of drug into the urine is sufficient to compensate for the decreased pharmacodynamics of response so that overall response is similar to that which occurs in health subjects. |
8,192,002 | D006801:Humans; D006978:Hypertension, Renovascular; D015588:Observer Variation; D010364:Pattern Recognition, Visual; D011237:Predictive Value of Tests; D012372:ROC Curve; D012078:Renal Artery Obstruction; D014465:Ultrasonics; D014463:Ultrasonography | [
"D006801",
"D006978",
"D015588",
"D010364",
"D011237",
"D012372",
"D012078",
"D014465",
"D014463"
] | Doppler evaluation of renal artery stenosis: interobserver agreement in the interpretation of waveform morphology. | OBJECTIVE
Analysis of Doppler waveform morphology for features of the tardus-parvus phenomenon has been promoted as a useful and accurate means for detecting renal artery stenosis. The purpose of this study was to examine and quantify the interobserver agreement of such an analysis and to determine if interobserver differences limit the value of this approach for predicting renal artery stenosis.
METHODS
Four observers independently categorized renal artery waveforms of 47 patients (94 kidneys) clinically selected for renovascular hypertension. Waveforms were classified into five categories based on the presence and severity of tardus-parvus changes in the systolic upstroke and early systolic peak. This categorization was then compared with angiographic findings, and the results were analyzed with receiver-operating-characteristic curves. Kappa statistics and agreement tables were computed to evaluate interobserver agreement.
RESULTS
Interobserver agreement in the waveform analysis for the four interpreters was statistically significant (p < 0.001). The receiver-operating-characteristic areas produced by the observers indicated, however, that such waveform classification was not strongly predictive of renal artery stenosis.
CONCLUSIONS
We conclude that substantial agreement in the interpretation of waveform morphology can be obtained between independent observers, and that such differences that do exist do not preclude the use of the pattern-recognition approach to waveform analysis. Even so, the specific application of this strategy to the waveform contours of early systole was not successful in predicting the presence or severity of renal artery stenosis. | null | false | Doppler evaluation of renal artery stenosis: interobserver agreement in the interpretation of waveform morphology. OBJECTIVE
Analysis of Doppler waveform morphology for features of the tardus-parvus phenomenon has been promoted as a useful and accurate means for detecting renal artery stenosis. The purpose of this study was to examine and quantify the interobserver agreement of such an analysis and to determine if interobserver differences limit the value of this approach for predicting renal artery stenosis.
METHODS
Four observers independently categorized renal artery waveforms of 47 patients (94 kidneys) clinically selected for renovascular hypertension. Waveforms were classified into five categories based on the presence and severity of tardus-parvus changes in the systolic upstroke and early systolic peak. This categorization was then compared with angiographic findings, and the results were analyzed with receiver-operating-characteristic curves. Kappa statistics and agreement tables were computed to evaluate interobserver agreement.
RESULTS
Interobserver agreement in the waveform analysis for the four interpreters was statistically significant (p < 0.001). The receiver-operating-characteristic areas produced by the observers indicated, however, that such waveform classification was not strongly predictive of renal artery stenosis.
CONCLUSIONS
We conclude that substantial agreement in the interpretation of waveform morphology can be obtained between independent observers, and that such differences that do exist do not preclude the use of the pattern-recognition approach to waveform analysis. Even so, the specific application of this strategy to the waveform contours of early systole was not successful in predicting the presence or severity of renal artery stenosis. |
16,950,630 | D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome | [
"D000368",
"D000369",
"D001021",
"D001024",
"D001705",
"D015150",
"D004812",
"D005260",
"D006350",
"D019918",
"D006801",
"D017379",
"D008297",
"D011474",
"D015607",
"D016896"
] | Stentless and stented aortic valve replacement in elderly patients: Factors affecting midterm clinical and hemodynamical outcome. | OBJECTIVE
To report on the midterm results of aortic valve replacement (AVR) with stented and stentless bioprosthesis in an elderly population by analyzing the factors affecting survival and hemodynamical performance.
METHODS
In a retrospective study, 145 patients with a Toronto stentless prosthesis are compared with 110 patients with a stented Carpentier-Edwards valve. The 5- to 10-year clinical outcome, transprosthetic gradients, and early and late left ventricular mass (LVM) regression are analyzed in view of specific prosthesis- and patient-related factors.
RESULTS
Actuarial survival at 5 years is 82% after stentless AVR versus 68% after stented AVR (p < 0.001) in elderly patients. However, there was no difference in survival at 8 years, being 55.9% and 59.5%, respectively. Univariate analysis revealed that advanced age at the time of operation, NYHA class IV, use of a stented xenograft, presence of patient-prosthesis mismatch (PPM) (IEOA < or = 0.85 cm2/m2), and severe preoperative left ventricular (LV) hypertrophy (LVMI > 180 g/m2) affected survival adversely. But multivariate analysis determined only age, NYHA class IV and excessive LV hypertrophy as independent predictors of late mortality. Stented and stentless xenografts were equally effective in terms of transprosthetic gradients and LVMI regression. The use of a stentless valve significantly reduced the occurrence of PPM (18% vs 41%, p < 0.01). Early LVMI regression at 1 year was optimized by the avoidance of PPM, indicated by a higher absolute (43.7+/-28.3 g/m2 vs 58.6+/-33.8 g/m2, p = 0.003) and relative (25.0+/-12.7% vs 31.4+/-14.9%, p=0.004) mass regression. However, late LV remodeling was predominantly affected by systemic hypertension and severe preoperative LV hypertrophy, resulting in the incomplete LVMI resolution in 61.3% and 66.7% of these patients, respectively.
CONCLUSIONS
In elderly patients, aortic valve replacement appears to be equally effective with a stentless or stented bioprosthesis. Midterm clinical outcome is mainly determined by patient-related factors such as age, advanced NYHA class, and severity of preoperative LV hypertrophy. Regarding post-AVR left ventricular remodeling, patient-prosthesis mismatch influences the early phase, whereas arterial hypertension affects the late regression more. However, the left ventricular remodeling is continuously compromised by the preoperative presence of excessive hypertrophy, despite the efficacy of the aortic valve replacement. | null | false | Stentless and stented aortic valve replacement in elderly patients: Factors affecting midterm clinical and hemodynamical outcome. OBJECTIVE
To report on the midterm results of aortic valve replacement (AVR) with stented and stentless bioprosthesis in an elderly population by analyzing the factors affecting survival and hemodynamical performance.
METHODS
In a retrospective study, 145 patients with a Toronto stentless prosthesis are compared with 110 patients with a stented Carpentier-Edwards valve. The 5- to 10-year clinical outcome, transprosthetic gradients, and early and late left ventricular mass (LVM) regression are analyzed in view of specific prosthesis- and patient-related factors.
RESULTS
Actuarial survival at 5 years is 82% after stentless AVR versus 68% after stented AVR (p < 0.001) in elderly patients. However, there was no difference in survival at 8 years, being 55.9% and 59.5%, respectively. Univariate analysis revealed that advanced age at the time of operation, NYHA class IV, use of a stented xenograft, presence of patient-prosthesis mismatch (PPM) (IEOA < or = 0.85 cm2/m2), and severe preoperative left ventricular (LV) hypertrophy (LVMI > 180 g/m2) affected survival adversely. But multivariate analysis determined only age, NYHA class IV and excessive LV hypertrophy as independent predictors of late mortality. Stented and stentless xenografts were equally effective in terms of transprosthetic gradients and LVMI regression. The use of a stentless valve significantly reduced the occurrence of PPM (18% vs 41%, p < 0.01). Early LVMI regression at 1 year was optimized by the avoidance of PPM, indicated by a higher absolute (43.7+/-28.3 g/m2 vs 58.6+/-33.8 g/m2, p = 0.003) and relative (25.0+/-12.7% vs 31.4+/-14.9%, p=0.004) mass regression. However, late LV remodeling was predominantly affected by systemic hypertension and severe preoperative LV hypertrophy, resulting in the incomplete LVMI resolution in 61.3% and 66.7% of these patients, respectively.
CONCLUSIONS
In elderly patients, aortic valve replacement appears to be equally effective with a stentless or stented bioprosthesis. Midterm clinical outcome is mainly determined by patient-related factors such as age, advanced NYHA class, and severity of preoperative LV hypertrophy. Regarding post-AVR left ventricular remodeling, patient-prosthesis mismatch influences the early phase, whereas arterial hypertension affects the late regression more. However, the left ventricular remodeling is continuously compromised by the preoperative presence of excessive hypertrophy, despite the efficacy of the aortic valve replacement. |
18,044,139 | D000368:Aged; D000925:Anticoagulants; D016903:Drug Monitoring; D000077425:Fondaparinux; D019983:Guideline Adherence; D006493:Heparin; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D011134:Polysaccharides; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency; D054556:Venous Thromboembolism | [
"D000368",
"D000925",
"D016903",
"D000077425",
"D019983",
"D006493",
"D006495",
"D006801",
"D011134",
"D017410",
"D051437",
"D054556"
] | Prevention and treatment of venous thromboembolism in the elderly patient. | Venous thromboembolism (VTE) is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH), all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use. | 9,467,520 | true | Prevention and treatment of venous thromboembolism in the elderly patient. Venous thromboembolism (VTE) is a common complication among hospitalized patients. Pharmacological thromboprophylaxis has emerged as the cornerstone for VTE prevention. As trials on thromboprophylaxis in medical patients have proven the efficacy of both low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH), all acutely medical ill patients should be considered for pharmacological thromboprophylaxis. Unlike in the surgical setting where the risk of associated VTE attributable to surgery is well recognized, and where widespread use of pharmacological thromboprophylaxis and early mobilization has resulted in significant reductions in the risk of VTE, appropriate VTE prophylaxis is under-used in medical patients. Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications. A consistent group among hospitalized medical patients is composed of elderly patients with impaired renal function, a condition potentially associated with bleeding. How these patients should be managed is discussed in this review. Particular attention is devoted to LMWHs and fondaparinux and to measures to improve the safety and the efficacy of their use. |
9,385,895 | D000641:Ammonia; D001026:Coronary Artery Bypass; D003327:Coronary Disease; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning; D009590:Nitrogen Radioisotopes; D018579:Patient Selection; D011183:Postoperative Complications; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014055:Tomography, Emission-Computed; D018487:Ventricular Dysfunction, Left | [
"D000641",
"D001026",
"D003327",
"D005260",
"D005462",
"D019788",
"D005500",
"D017052",
"D006801",
"D008297",
"D008875",
"D017682",
"D009590",
"D018579",
"D011183",
"D019275",
"D012189",
"D012307",
"D015996",
"D013997",
"D014055",
"D018487"
] | Preoperative positron emission tomographic viability assessment and perioperative and postoperative risk in patients with advanced ischemic heart disease. | OBJECTIVE
This study sought to investigate whether determination of tissue viability by means of positron emission tomography (PET) before coronary artery bypass graft surgery (CABG) affects clinical outcome with respect to both in-hospital mortality and 1-year survival rate.
BACKGROUND
Patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction are at higher risk for perioperative complications associated with CABG. Therefore, the selection of patients who will benefit from CABG is an important clinical issue.
METHODS
This study retrospectively evaluated 76 patients with advanced CAD and LV dysfunction (LV ejection fraction < or = 0.35) who were considered candidates for CABG. Thirty-five patients were selected for CABG on the basis of clinical presentation and angiographic data (group A), and 34 of 41 patients were selected according to extent of viable tissue determined by PET (group B) in addition to clinical presentation and angiographic data.
RESULTS
There were four in-hospital deaths (11.4%) in group A and none in group B (p = 0.04). After 12 months, the survival rate was 79% in group A and 97% in group B (p = 0.01). Postoperatively, group B patients had a less complicated recovery (p = 0.05). They required lower doses of catecholamines (p = 0.002) and demonstrated a significantly decreased incidence of low output syndrome (p = 0.05).
CONCLUSIONS
This retrospective data analysis suggests that selection of patients with impaired LV function on the basis of extent of viability supplementary to clinical and angiographic data may lead to postoperative recovery with a low early mortality and promising short-term survival. Therefore, viability studies permit selection of patients who are at low risk for serious perioperative complications. | null | false | Preoperative positron emission tomographic viability assessment and perioperative and postoperative risk in patients with advanced ischemic heart disease. OBJECTIVE
This study sought to investigate whether determination of tissue viability by means of positron emission tomography (PET) before coronary artery bypass graft surgery (CABG) affects clinical outcome with respect to both in-hospital mortality and 1-year survival rate.
BACKGROUND
Patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction are at higher risk for perioperative complications associated with CABG. Therefore, the selection of patients who will benefit from CABG is an important clinical issue.
METHODS
This study retrospectively evaluated 76 patients with advanced CAD and LV dysfunction (LV ejection fraction < or = 0.35) who were considered candidates for CABG. Thirty-five patients were selected for CABG on the basis of clinical presentation and angiographic data (group A), and 34 of 41 patients were selected according to extent of viable tissue determined by PET (group B) in addition to clinical presentation and angiographic data.
RESULTS
There were four in-hospital deaths (11.4%) in group A and none in group B (p = 0.04). After 12 months, the survival rate was 79% in group A and 97% in group B (p = 0.01). Postoperatively, group B patients had a less complicated recovery (p = 0.05). They required lower doses of catecholamines (p = 0.002) and demonstrated a significantly decreased incidence of low output syndrome (p = 0.05).
CONCLUSIONS
This retrospective data analysis suggests that selection of patients with impaired LV function on the basis of extent of viability supplementary to clinical and angiographic data may lead to postoperative recovery with a low early mortality and promising short-term survival. Therefore, viability studies permit selection of patients who are at low risk for serious perioperative complications. |
12,777,680 | D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000818:Animals; D001918:Brachytherapy; D002986:Clinical Trials as Topic; D023903:Coronary Restenosis; D023921:Coronary Stenosis; D004195:Disease Models, Animal; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D011859:Radiography; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents; D013552:Swine; D016896:Treatment Outcome | [
"D000368",
"D015906",
"D000818",
"D001918",
"D002986",
"D023903",
"D023921",
"D004195",
"D005500",
"D006801",
"D008297",
"D011829",
"D011859",
"D018570",
"D012680",
"D015607",
"D013552",
"D016896"
] | Mechanisms and methods to resolve edge effect. | Vascular brachytherapy (VBT) has established itself as a viable modality to treat in-stent restenosis (ISR). The problems associated with VBT have been understood well and remedied. Late thrombosis has been overcome to a great extent by prolonged antiplatelet therapy. Edge effect is another important limitation of VBT and is due to inadequate radiation coverage of the edges following VBT. It may be overcome by confining injury to the lesion segment and extending the radiation sources by a few millimeters from the injured segment. | 7,222,449 | true | Mechanisms and methods to resolve edge effect. Vascular brachytherapy (VBT) has established itself as a viable modality to treat in-stent restenosis (ISR). The problems associated with VBT have been understood well and remedied. Late thrombosis has been overcome to a great extent by prolonged antiplatelet therapy. Edge effect is another important limitation of VBT and is due to inadequate radiation coverage of the edges following VBT. It may be overcome by confining injury to the lesion segment and extending the radiation sources by a few millimeters from the injured segment. |
36,503,177 | D000368:Aged; D014481:United States; D006801:Humans; D017147:Defibrillators, Implantable; D006278:Medicare; D008991:Monitoring, Physiologic; D006333:Heart Failure; D003362:Cost-Benefit Analysis | [
"D000368",
"D014481",
"D006801",
"D017147",
"D006278",
"D008991",
"D006333",
"D003362"
] | Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial. | Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters.
The purpose of this study was to conduct a cost-consequence analysis to compare 3 postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies: (1) in-person evaluation (IPE) only; (2) RPM-conventional (hybrid of IPE and RPM); and (3) RPM-alert (alert-based ICD follow-up).
We constructed a decision-analytic Markov model to estimate the costs and benefits of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of nonactionable encounters. Cost data were obtained from the published literature. The primary outcome was incremental cost.
Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval [CI] -$2138 to +$638) and -$1,677 (95% CI -$3134 to -$304), respectively. Therefore, the RPM-alert strategy was most cost-effective, with an estimated cost-savings in 99% of simulations.
Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up. | null | false | Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial. Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters.
The purpose of this study was to conduct a cost-consequence analysis to compare 3 postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies: (1) in-person evaluation (IPE) only; (2) RPM-conventional (hybrid of IPE and RPM); and (3) RPM-alert (alert-based ICD follow-up).
We constructed a decision-analytic Markov model to estimate the costs and benefits of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of nonactionable encounters. Cost data were obtained from the published literature. The primary outcome was incremental cost.
Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval [CI] -$2138 to +$638) and -$1,677 (95% CI -$3134 to -$304), respectively. Therefore, the RPM-alert strategy was most cost-effective, with an estimated cost-savings in 99% of simulations.
Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up. |
9,456,971 | D000368:Aged; D015901:Angiography, Digital Subtraction; D001161:Arteriosclerosis; D002339:Carotid Arteries; D002340:Carotid Artery Diseases; D016893:Carotid Stenosis; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies | [
"D000368",
"D015901",
"D001161",
"D002339",
"D002340",
"D016893",
"D003287",
"D005260",
"D019786",
"D006801",
"D007091",
"D018810",
"D008297",
"D015588",
"D012372",
"D012189"
] | Extracranial atherosclerotic carotid artery disease: evaluation of non-breath-hold three-dimensional gadolinium-enhanced MR angiography. | OBJECTIVE
The purpose of this study was to compare the diagnostic information provided by a combination of two-dimensional and three-dimensional (3D) time-of-flight (TOF) techniques with that provided by non-breath-hold 3D spoiled gradient-echo gadolinium-enhanced MR angiography.
METHODS
Fifty patients suspected of having extracranial atherosclerotic carotid artery disease were examined with all three imaging techniques using a 1.5-T MR imaging system. Three observers independently and retrospectively measured the degree of stenosis according to the North American Symptomatic Carotid Endarterectomy trial criteria. The observers were unaware of the results of other MR imaging pulse sequences and digital subtraction angiography. The standard of reference was established by digital subtraction angiography. Results were evaluated with receiver operating characteristic curve analysis. The degree of interobserver agreement was determined using pairwise kappa statistics.
RESULTS
The grading of carotid artery stenosis as measured by the area under the receiver operating characteristic curve was less accurate with non-breath-hold 3D gadolinium-enhanced MR angiography than with TOF imaging. Interobserver variability was greater for non-breath-hold 3D gadolinium-enhanced MR angiography than for TOF techniques.
CONCLUSIONS
Routine evaluation of carotid artery stenosis at the level of the bifurcation using non-breath-hold 3D gadolinium-enhanced MR angiography is less accurate than is TOF imaging and is therefore not recommended. The weakness of this technique may be due to problems in timing the injection of gadolinium and the masking of the carotid bifurcation by the venous jugular system. | null | false | Extracranial atherosclerotic carotid artery disease: evaluation of non-breath-hold three-dimensional gadolinium-enhanced MR angiography. OBJECTIVE
The purpose of this study was to compare the diagnostic information provided by a combination of two-dimensional and three-dimensional (3D) time-of-flight (TOF) techniques with that provided by non-breath-hold 3D spoiled gradient-echo gadolinium-enhanced MR angiography.
METHODS
Fifty patients suspected of having extracranial atherosclerotic carotid artery disease were examined with all three imaging techniques using a 1.5-T MR imaging system. Three observers independently and retrospectively measured the degree of stenosis according to the North American Symptomatic Carotid Endarterectomy trial criteria. The observers were unaware of the results of other MR imaging pulse sequences and digital subtraction angiography. The standard of reference was established by digital subtraction angiography. Results were evaluated with receiver operating characteristic curve analysis. The degree of interobserver agreement was determined using pairwise kappa statistics.
RESULTS
The grading of carotid artery stenosis as measured by the area under the receiver operating characteristic curve was less accurate with non-breath-hold 3D gadolinium-enhanced MR angiography than with TOF imaging. Interobserver variability was greater for non-breath-hold 3D gadolinium-enhanced MR angiography than for TOF techniques.
CONCLUSIONS
Routine evaluation of carotid artery stenosis at the level of the bifurcation using non-breath-hold 3D gadolinium-enhanced MR angiography is less accurate than is TOF imaging and is therefore not recommended. The weakness of this technique may be due to problems in timing the injection of gadolinium and the masking of the carotid bifurcation by the venous jugular system. |
36,419,026 | D006801:Humans; D010166:Palliative Care; D017028:Caregivers; D003362:Cost-Benefit Analysis; D064946:Hospice and Palliative Care Nursing; D002908:Chronic Disease; D006333:Heart Failure | [
"D006801",
"D010166",
"D017028",
"D003362",
"D064946",
"D002908",
"D006333"
] | Effectiveness and cost effectiveness of palliative care interventions in people with chronic heart failure and their caregivers: a systematic review. | BACKGROUND
Chronic heart failure is a common condition, and its prevalence is expected to rise significantly over the next two decades. Research demonstrates the increasing multidimensional needs of patients and caregivers. However, access to palliative care services for this population has remained poor. This systematic review was to provide an evidence synthesis of the effectiveness and cost-effectiveness of palliative care interventions for people with chronic heart failure and their caregivers.
METHODS
Relevant publications were identified via electronic searches of MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL and HMIC from inception to June 2019. Grey literature databases, reference list, and citations of key review articles were also searched. Quality was assessed using the Revised Cochrane Risk of Bias Tool.
RESULTS
Of the 2083 records, 18 studies were identified including 17 having randomised controlled trial (RCT) designs and one mixed methods study with an RCT component. There was significant heterogeneity in study settings, control groups, interventions delivered, and outcome measures used. The most commonly assessed outcome measures were functional status (n = 9), psychological symptoms (n = 9), disease-specific quality of life (n = 9), and physical symptom control (n = 8). The outcome measures with the greatest evidence for benefit included general and disease-specific quality of life, psychological symptom control, satisfaction with care, physical symptom control, medical utilisation, and caregiver burden. Moreover, the methodological quality of these studies was mixed, with only four having an overall low risk of bias and the remaining studies either demonstrating high risk of bias (n = 10) or showing some concerns (n = 4) due to small sample sizes and poor retention. Only two studies reported on economic costs. Both found statistically significant results showing the intervention group to be more cost effective than the control group, but the quality of both studies was at high risk of bias.
CONCLUSIONS
This review supports the role of palliative care interventions in patients with chronic heart failure and their caregivers across various outcomes, particularly quality of life and psychological wellbeing. Due to the highly heterogeneous nature of palliative care interventions, it is not possible to provide definitive recommendations as to what guise palliative care interventions should take to best support the complex care of this population. Considerable future research, particularly focusing on quality of care after death and the caregiver population, is warranted. | null | false | Effectiveness and cost effectiveness of palliative care interventions in people with chronic heart failure and their caregivers: a systematic review. BACKGROUND
Chronic heart failure is a common condition, and its prevalence is expected to rise significantly over the next two decades. Research demonstrates the increasing multidimensional needs of patients and caregivers. However, access to palliative care services for this population has remained poor. This systematic review was to provide an evidence synthesis of the effectiveness and cost-effectiveness of palliative care interventions for people with chronic heart failure and their caregivers.
METHODS
Relevant publications were identified via electronic searches of MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL and HMIC from inception to June 2019. Grey literature databases, reference list, and citations of key review articles were also searched. Quality was assessed using the Revised Cochrane Risk of Bias Tool.
RESULTS
Of the 2083 records, 18 studies were identified including 17 having randomised controlled trial (RCT) designs and one mixed methods study with an RCT component. There was significant heterogeneity in study settings, control groups, interventions delivered, and outcome measures used. The most commonly assessed outcome measures were functional status (n = 9), psychological symptoms (n = 9), disease-specific quality of life (n = 9), and physical symptom control (n = 8). The outcome measures with the greatest evidence for benefit included general and disease-specific quality of life, psychological symptom control, satisfaction with care, physical symptom control, medical utilisation, and caregiver burden. Moreover, the methodological quality of these studies was mixed, with only four having an overall low risk of bias and the remaining studies either demonstrating high risk of bias (n = 10) or showing some concerns (n = 4) due to small sample sizes and poor retention. Only two studies reported on economic costs. Both found statistically significant results showing the intervention group to be more cost effective than the control group, but the quality of both studies was at high risk of bias.
CONCLUSIONS
This review supports the role of palliative care interventions in patients with chronic heart failure and their caregivers across various outcomes, particularly quality of life and psychological wellbeing. Due to the highly heterogeneous nature of palliative care interventions, it is not possible to provide definitive recommendations as to what guise palliative care interventions should take to best support the complex care of this population. Considerable future research, particularly focusing on quality of care after death and the caregiver population, is warranted. |
27,916,478 | D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal; D001019:Aortic Rupture; D019540:Area Under Curve; D015415:Biomarkers; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006454:Hemoglobins; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures | [
"D000367",
"D000368",
"D000369",
"D017544",
"D001019",
"D019540",
"D015415",
"D001794",
"D016887",
"D003661",
"D005260",
"D015600",
"D006454",
"D017052",
"D006801",
"D016015",
"D008297",
"D015999",
"D009426",
"D011237",
"D011446",
"D012372",
"D015203",
"D012189",
"D01... | Development and External Validation of a Model Predicting Death After Surgery in Patients With a Ruptured Abdominal Aortic Aneurysm: The Dutch Aneurysm Score. | OBJECTIVE
The decision whether or not to proceed with surgical intervention of a patient with a ruptured abdominal aortic aneurysm (rAAA) is very difficult in daily practice. The primary objective of the present study was to develop and to externally validate a new prediction model: the Dutch Aneurysm Score (DAS).
METHODS
With a prospective cohort of 10 hospitals (n = 508) the DAS was developed using a multivariate logistic regression model. Two retrospective cohorts with rAAA patients from two hospitals (n = 373) were used for external validation. The primary outcome was the combined 30 day and in-hospital death rate. Discrimination (AUC), calibration plots, and the ability to identify high risk patients were compared with the more commonly used Glasgow Aneurysm Score (GAS).
RESULTS
After multivariate logistic regression, four pre-operative variables were identified: age, lowest in hospital systolic blood pressure, cardiopulmonary resuscitation, and haemoglobin level. The area under the receiver operating curve (AUC) for the DAS was 0.77 (95% CI 0.72-0.82) compared with the GAS with an AUC of 0.72 (95% CI 0.67-0.77). The DAS showed a death rate in patients with a predicted death rate ≥80% of 83%.
CONCLUSIONS
The present study shows that the DAS has a higher discriminative performance (AUC) compared with the GAS. All clinical variables used for the DAS are easy to obtain. Identification of low risk patients with the DAS can potentially reduce turndown rates. The DAS can reliably be used by clinicians to make a more informed decision in dialogue with the patient and their family whether or not to proceed with surgical intervention. | null | false | Development and External Validation of a Model Predicting Death After Surgery in Patients With a Ruptured Abdominal Aortic Aneurysm: The Dutch Aneurysm Score. OBJECTIVE
The decision whether or not to proceed with surgical intervention of a patient with a ruptured abdominal aortic aneurysm (rAAA) is very difficult in daily practice. The primary objective of the present study was to develop and to externally validate a new prediction model: the Dutch Aneurysm Score (DAS).
METHODS
With a prospective cohort of 10 hospitals (n = 508) the DAS was developed using a multivariate logistic regression model. Two retrospective cohorts with rAAA patients from two hospitals (n = 373) were used for external validation. The primary outcome was the combined 30 day and in-hospital death rate. Discrimination (AUC), calibration plots, and the ability to identify high risk patients were compared with the more commonly used Glasgow Aneurysm Score (GAS).
RESULTS
After multivariate logistic regression, four pre-operative variables were identified: age, lowest in hospital systolic blood pressure, cardiopulmonary resuscitation, and haemoglobin level. The area under the receiver operating curve (AUC) for the DAS was 0.77 (95% CI 0.72-0.82) compared with the GAS with an AUC of 0.72 (95% CI 0.67-0.77). The DAS showed a death rate in patients with a predicted death rate ≥80% of 83%.
CONCLUSIONS
The present study shows that the DAS has a higher discriminative performance (AUC) compared with the GAS. All clinical variables used for the DAS are easy to obtain. Identification of low risk patients with the DAS can potentially reduce turndown rates. The DAS can reliably be used by clinicians to make a more informed decision in dialogue with the patient and their family whether or not to proceed with surgical intervention. |
25,201,417 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left | [
"D000328",
"D000368",
"D000369",
"D002304",
"D005260",
"D005500",
"D006333",
"D006801",
"D008137",
"D008297",
"D008875",
"D016896",
"D018487"
] | Long term impact of cardiac contractility modulation on QRS duration. | OBJECTIVE
Cardiac contractility modulation (CCM) is an implantable device treatment for heart failure with reduced ejection fraction. CCM therapy improves patient functional status but its effect on intra-ventricular conduction remains unknown.
METHODS
70 patients treated with CCM between 12/2002 and 5/2013 had 12-vector-ECG recordings made at baseline and final follow-up visits. QRS complex duration was measured at each time point.
RESULTS
Mean follow-up was 2.8 years. Mean QRS duration was unchanged from baseline (112.0 ms) to last follow up (112.9 ms, p=n.s.). These results are strikingly different from comparative published data of several studies with heart failure patients without CCM, consistently indicating an increase in QRS duration (6.0-23.4 ms) over a similar time period.
CONCLUSIONS
CCM prevents chronic ventricular depolarization delay that occurs in heart failure and that is associated with poorer outcomes. This supports the safety of long-term CCM therapy and suggests a possible long-term benefit in maintaining QRS duration. | null | false | Long term impact of cardiac contractility modulation on QRS duration. OBJECTIVE
Cardiac contractility modulation (CCM) is an implantable device treatment for heart failure with reduced ejection fraction. CCM therapy improves patient functional status but its effect on intra-ventricular conduction remains unknown.
METHODS
70 patients treated with CCM between 12/2002 and 5/2013 had 12-vector-ECG recordings made at baseline and final follow-up visits. QRS complex duration was measured at each time point.
RESULTS
Mean follow-up was 2.8 years. Mean QRS duration was unchanged from baseline (112.0 ms) to last follow up (112.9 ms, p=n.s.). These results are strikingly different from comparative published data of several studies with heart failure patients without CCM, consistently indicating an increase in QRS duration (6.0-23.4 ms) over a similar time period.
CONCLUSIONS
CCM prevents chronic ventricular depolarization delay that occurs in heart failure and that is associated with poorer outcomes. This supports the safety of long-term CCM therapy and suggests a possible long-term benefit in maintaining QRS duration. |
3,731,167 | D002540:Cerebral Cortex; D002543:Cerebral Hemorrhage; D002552:Cerebral Ventricles; D002557:Cerebrospinal Fluid Shunts; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D012127:Respiratory Distress Syndrome, Newborn; D013345:Subarachnoid Hemorrhage; D014057:Tomography, X-Ray Computed | [
"D002540",
"D002543",
"D002552",
"D002557",
"D002675",
"D004108",
"D005260",
"D005500",
"D006801",
"D006849",
"D007223",
"D007231",
"D007427",
"D012127",
"D013345",
"D014057"
] | Destructive hydrocephalus: a proposed new category. | A case is reported with hydrocephalus subsequent to neonatal intraventricular and intracerebral hemorrhage. Hydrocephalus was diagnosed as obstructive, secondary to subarachnoid hemorrhage. However, the lateral ventricle in the hemisphere in which the intracerebral hemorrhage occurred dilated much more than that in the contralateral hemisphere. Hydrocephalus occurring in regions of the brain that have suffered destructive changes from a cause other than that of the hydrocephalus, as in this reported case, is proposed as a new category, ("destruction hydrocephalus"). It is to be distinguished from hydrocephalus with dilated ventricles due simply to increased intraventricular pressure. In "destructive hydrocephalus" dilatation of the ventricles occurs irregularly and rapidly, leading to secondary cerebral destruction. Therefore, treatment to prevent the progressive cerebral damage is required immediately. | 14,582,262 | true | Destructive hydrocephalus: a proposed new category. A case is reported with hydrocephalus subsequent to neonatal intraventricular and intracerebral hemorrhage. Hydrocephalus was diagnosed as obstructive, secondary to subarachnoid hemorrhage. However, the lateral ventricle in the hemisphere in which the intracerebral hemorrhage occurred dilated much more than that in the contralateral hemisphere. Hydrocephalus occurring in regions of the brain that have suffered destructive changes from a cause other than that of the hydrocephalus, as in this reported case, is proposed as a new category, ("destruction hydrocephalus"). It is to be distinguished from hydrocephalus with dilated ventricles due simply to increased intraventricular pressure. In "destructive hydrocephalus" dilatation of the ventricles occurs irregularly and rapidly, leading to secondary cerebral destruction. Therefore, treatment to prevent the progressive cerebral damage is required immediately. |
7,824,492 | D000332:Aerobiosis; D000693:Anaerobiosis; D003327:Coronary Disease; D005081:Exercise Therapy; D006801:Humans | [
"D000332",
"D000693",
"D003327",
"D005081",
"D006801"
] | [Exercise training and rehabilitation techniques in patients with coronary disease]. | Exercise rehabilitation is widely prescribed for patients with coronary artery disease and requires the same rigorous approach as physical training in athletes. Training techniques have been carefully described, but the precise physiological justification remains to be elucidated. In order to target the physiological mechanisms which rehabilitation training is designed to improve, it is necessary to have a coherent strategy and apply the techniques with a clear idea of the objective to be attained. We describe the programme we propose to our patients. First, patients are advised to fraction their exercise into short relatively intense periods of exertion separated by rest periods as long as the exertion period. This method is designed to develop the "power" of the aerobic energy system. Later, we progressively introduce longer periods of training at moderate intensity. This part of the rehabilitation is designed to develop the "capacity" of the aerobic system. The decision to develop work capacity is based on the patient's response to the first part of the rehabilitation programme. | null | false | [Exercise training and rehabilitation techniques in patients with coronary disease]. Exercise rehabilitation is widely prescribed for patients with coronary artery disease and requires the same rigorous approach as physical training in athletes. Training techniques have been carefully described, but the precise physiological justification remains to be elucidated. In order to target the physiological mechanisms which rehabilitation training is designed to improve, it is necessary to have a coherent strategy and apply the techniques with a clear idea of the objective to be attained. We describe the programme we propose to our patients. First, patients are advised to fraction their exercise into short relatively intense periods of exertion separated by rest periods as long as the exertion period. This method is designed to develop the "power" of the aerobic energy system. Later, we progressively introduce longer periods of training at moderate intensity. This part of the rehabilitation is designed to develop the "capacity" of the aerobic system. The decision to develop work capacity is based on the patient's response to the first part of the rehabilitation programme. |
9,147,707 | D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents; D044383:Black People; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension; D007211:Indoles; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D014700:Verapamil | [
"D000328",
"D000368",
"D000959",
"D044383",
"D001794",
"D018660",
"D004305",
"D004338",
"D005260",
"D006801",
"D006973",
"D007211",
"D008297",
"D008875",
"D010349",
"D014700"
] | Once-daily fixed dose combinations of verapamil and trandolapril in black patients with mild to moderate hypertension: a new choice for first line treatment. | Using ambulatory blood pressure (BP) monitoring, a potent ACE-inhibitor/calcium channel blocker combination was tested in 21 Black patients (age 52 +/- 10 years; 10 males, 11 females) with mild to moderate hypertension (mean 12-hour daytime diastolic BP > or = 90 mmHg and < or = 114 mmHg). After a 14-day wash-out and a 14-day placebo run-in period, therapy was initiated with verapamil 180 mg plus trandolapril 2 mg. At monthly visits, if mean daytime diastolic BP remained > or = 90 mmHg, the dose combination was uptitrated stepwise to verapamil 240 mg plus trandolapril 4 mg, verapamil 360 mg plus trandolapril 4 mg, and finally hydrochlorothiazide 12.5 mg were added. Mean 24-hour BP dropped from 150 +/- 14/96 +/- 7 mmHg at baseline to 131 +/- 13/82 +/- 8 mmHg after 4 months treatment (p < 0.001). In 16 (76%) patients mean 24-hour diastolic BP was < 90 mmHg at the end of the trial and 15 (71%) patients achieved a reduction of > 10 mmHg. Five out of 5 patients finishing on dose I were controlled, 5/6 patients on dose II, 5/8 patients on dose III, and 1/2 patients who received additional hydrochlorothiazide. The 24-hour BP load fell from 72 +/- 8% at baseline to 35 +/- 25% in 4 months (p < 0.001). Mean diastolic BP drop for the 2 peak hours during daytime was 20 mmHg and for the last 2 hours of monitoring was 13 mmHg, resulting in a trough to peak ratio of 65%. There were no significant adverse events or biochemical abnormalities. It is concluded that the combination doses tested showed a sustained and marked antihypertensive effect throughout the 24-hour dosing interval, and the starting dose (verapamil 180 mg plus trandolapril 2 mg) seems appropriate in this group of patients. | 9,382,513 | true | Once-daily fixed dose combinations of verapamil and trandolapril in black patients with mild to moderate hypertension: a new choice for first line treatment. Using ambulatory blood pressure (BP) monitoring, a potent ACE-inhibitor/calcium channel blocker combination was tested in 21 Black patients (age 52 +/- 10 years; 10 males, 11 females) with mild to moderate hypertension (mean 12-hour daytime diastolic BP > or = 90 mmHg and < or = 114 mmHg). After a 14-day wash-out and a 14-day placebo run-in period, therapy was initiated with verapamil 180 mg plus trandolapril 2 mg. At monthly visits, if mean daytime diastolic BP remained > or = 90 mmHg, the dose combination was uptitrated stepwise to verapamil 240 mg plus trandolapril 4 mg, verapamil 360 mg plus trandolapril 4 mg, and finally hydrochlorothiazide 12.5 mg were added. Mean 24-hour BP dropped from 150 +/- 14/96 +/- 7 mmHg at baseline to 131 +/- 13/82 +/- 8 mmHg after 4 months treatment (p < 0.001). In 16 (76%) patients mean 24-hour diastolic BP was < 90 mmHg at the end of the trial and 15 (71%) patients achieved a reduction of > 10 mmHg. Five out of 5 patients finishing on dose I were controlled, 5/6 patients on dose II, 5/8 patients on dose III, and 1/2 patients who received additional hydrochlorothiazide. The 24-hour BP load fell from 72 +/- 8% at baseline to 35 +/- 25% in 4 months (p < 0.001). Mean diastolic BP drop for the 2 peak hours during daytime was 20 mmHg and for the last 2 hours of monitoring was 13 mmHg, resulting in a trough to peak ratio of 65%. There were no significant adverse events or biochemical abnormalities. It is concluded that the combination doses tested showed a sustained and marked antihypertensive effect throughout the 24-hour dosing interval, and the starting dose (verapamil 180 mg plus trandolapril 2 mg) seems appropriate in this group of patients. |
9,061,174 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007719:Knee Joint; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis; D010147:Pain Measurement; D011379:Prognosis; D016059:Range of Motion, Articular; D012086:Reoperation; D013923:Thromboembolism | [
"D000293",
"D000328",
"D000368",
"D000369",
"D001172",
"D005069",
"D005260",
"D006801",
"D007719",
"D007720",
"D008297",
"D008875",
"D010003",
"D010147",
"D011379",
"D016059",
"D012086",
"D013923"
] | Comparison of results of different types of knee arthroplasties. | We summarise our experience gained with knee arthroplasties over 18 years. Between 1976 and 1994 1103 knee arthroplasties (1044 primary cases, 59 revisions) were performed at the Orthopaedic Department of the National Institute of Rheumatology and Physiotherapy in Budapest, Hungary. The diagnoses were osteoarthritis (OA) in 50.9%, rheumatoid arthritis (RA) in 40.7% and other causes in 8.4%. The average age of the patients at the time of the operation was 57.6 years (range 14-81 years). The types of primary implant were as follows: 60 constrained (hinge) prostheses, 876 unconstrained (sledge) prostheses, 108 semiconstrained (total condylar) prostheses. The mean follow-up period was 11.4 years for the hinge-type prostheses, 10.3 years for the unconstrained prostheses and 1.6 years for the semiconstrained prostheses. Reviewing the 59 revision cases, we conclude that complications with the constrained prostheses reached 17.8% and, most presented within the 1st year. Because of this high complication rate, the use of hinge prostheses has been reduced in this department to only selected cases. After sledge prosthesis implantation most of the complications (overall 5.3%) appeared after 1 year in aseptic circumstances. Given the short follow-up period of the semi-constrained total condylar knee replacement, apart from one infection in a patient with rheumatoid arthritis no other complication has been recorded. Summarising these data, it can be concluded that on average the knee function, using a standardised scoring system, improved from 38% to over 80% by introducing the semiconstrained total condylar knee prosthesis. | 90,142 | true | Comparison of results of different types of knee arthroplasties. We summarise our experience gained with knee arthroplasties over 18 years. Between 1976 and 1994 1103 knee arthroplasties (1044 primary cases, 59 revisions) were performed at the Orthopaedic Department of the National Institute of Rheumatology and Physiotherapy in Budapest, Hungary. The diagnoses were osteoarthritis (OA) in 50.9%, rheumatoid arthritis (RA) in 40.7% and other causes in 8.4%. The average age of the patients at the time of the operation was 57.6 years (range 14-81 years). The types of primary implant were as follows: 60 constrained (hinge) prostheses, 876 unconstrained (sledge) prostheses, 108 semiconstrained (total condylar) prostheses. The mean follow-up period was 11.4 years for the hinge-type prostheses, 10.3 years for the unconstrained prostheses and 1.6 years for the semiconstrained prostheses. Reviewing the 59 revision cases, we conclude that complications with the constrained prostheses reached 17.8% and, most presented within the 1st year. Because of this high complication rate, the use of hinge prostheses has been reduced in this department to only selected cases. After sledge prosthesis implantation most of the complications (overall 5.3%) appeared after 1 year in aseptic circumstances. Given the short follow-up period of the semi-constrained total condylar knee replacement, apart from one infection in a patient with rheumatoid arthritis no other complication has been recorded. Summarising these data, it can be concluded that on average the knee function, using a standardised scoring system, improved from 38% to over 80% by introducing the semiconstrained total condylar knee prosthesis. |
1,303,315 | D002681:China; D003153:Community Health Services; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D010353:Patient Education as Topic | [
"D002681",
"D003153",
"D005260",
"D006801",
"D006973",
"D008297",
"D010353"
] | [Primary analysis on hypertension community control in East City]. | In order to carry out chronic disease prevention, a hypertension community control program has been conducted in Disease Surveillance Point, East City. Beijing since 1989. The resident committees were randomly divided into two groups. The community control activities were conducted in intervention group, which included home visit, health education. 3190 hypertensive cases were managed in 1991. Current smoking rate was decreased 8.37%, quit and reduce smoking increased 5.81%, drinking decreased 8.77%, reduced salt intake 5.45%, DBP < 95 mmHg increased 27.81%, when compared with base line survey in 1989. These indicators were significant between intervention and control groups. It means hypertension community control program is successful. | null | false | [Primary analysis on hypertension community control in East City]. In order to carry out chronic disease prevention, a hypertension community control program has been conducted in Disease Surveillance Point, East City. Beijing since 1989. The resident committees were randomly divided into two groups. The community control activities were conducted in intervention group, which included home visit, health education. 3190 hypertensive cases were managed in 1991. Current smoking rate was decreased 8.37%, quit and reduce smoking increased 5.81%, drinking decreased 8.77%, reduced salt intake 5.45%, DBP < 95 mmHg increased 27.81%, when compared with base line survey in 1989. These indicators were significant between intervention and control groups. It means hypertension community control program is successful. |
36,161,665 | D008297:Male; D006801:Humans; D008875:Middle Aged; D058406:Cardiac Resynchronization Therapy; D016896:Treatment Outcome; D017180:Tachycardia, Ventricular; D001145:Arrhythmias, Cardiac; D047548:Defibrillators | [
"D008297",
"D006801",
"D008875",
"D058406",
"D016896",
"D017180",
"D001145",
"D047548"
] | Lead switching to resolve undersensing of ventricular tachycardia by a cardiac resynchronization therapy defibrillator. | A 63-year-old man was admitted to the hospital due to ventricular tachycardia (VT) undersensing, caused by decreased R-wave amplitude in a cardiac resynchronization therapy defibrillator. The R-wave amplitude of VT sensed by the left ventricular (LV) lead was markedly higher than that by the right ventricular (RV) lead; therefore, we reconnected the IS-1 RV lead to the LV IS-1 port and the IS-1 LV lead to the RV IS-1 port to resolve this issue. After discharge, it was confirmed that VT was successfully terminated by the second sequence of intrinsic ATP (iATP, Medtronic, Minneapolis, MN, USA) from the LV lead. | 8,288,424 | true | Lead switching to resolve undersensing of ventricular tachycardia by a cardiac resynchronization therapy defibrillator. A 63-year-old man was admitted to the hospital due to ventricular tachycardia (VT) undersensing, caused by decreased R-wave amplitude in a cardiac resynchronization therapy defibrillator. The R-wave amplitude of VT sensed by the left ventricular (LV) lead was markedly higher than that by the right ventricular (RV) lead; therefore, we reconnected the IS-1 RV lead to the LV IS-1 port and the IS-1 LV lead to the RV IS-1 port to resolve this issue. After discharge, it was confirmed that VT was successfully terminated by the second sequence of intrinsic ATP (iATP, Medtronic, Minneapolis, MN, USA) from the LV lead. |
34,470,047 | D000818:Animals; D045744:Cell Line, Tumor; D006801:Humans; D015850:Interleukin-6; D051379:Mice; D009101:Multiple Myeloma; D016328:NF-kappa B; D009364:Neoplasm Recurrence, Local; D059016:Tumor Microenvironment | [
"D000818",
"D045744",
"D006801",
"D015850",
"D051379",
"D009101",
"D016328",
"D009364",
"D059016"
] | DKK1 activates noncanonical NF-κB signaling via IL-6-induced CKAP4 receptor in multiple myeloma. | Proteasome inhibitors, such as bortezomib (BTZ), represent the key elements in chemotherapy regimens for multiple myeloma (MM), whereas acquired chemoresistance and ultimately relapse remain a major obstacle. In the current study, we screened differently expressed cytokines in bortezomib-resistant MM cells and found that Dickkopf-1 (DKK1) level was remarkably augmented, whereas CD138 level was significantly suppressed. DKK1 in vitro specifically enhanced the resistance of myeloma cells to bortezomib treatment, and excessive DKK1 drove CD138 downregulation via inhibition of canonical Wnt signaling. Notably, DKK1 mainly induced drug resistance in MM cells via the receptor of CKAP4. Mechanistically, CKAP4 transduced DKK1 signal and evoked NF-κB pathway through recruiting and preventing cullin associated and neddylation dissociated 1 from hampering the assembly of E3 ligase-mediated ubiquitination of IκBα. In addition, we found that interleukin-6 (IL-6) stimulated CKAP4 expression to generate drug resistance, and disturbance of DKK1-CKAP4 axis improved sensitivity to BTZ treatment of MM and attenuated bone destruction in a mouse model. Collectively, our study revealed the previously unidentified role of DKK1 in myeloma drug resistance via Wnt signaling dependent and independent manners, and clarified the importance of antagonism of DKK1-IL-6 loop in bone marrow microenvironment. | 13,590,314 | true | DKK1 activates noncanonical NF-κB signaling via IL-6-induced CKAP4 receptor in multiple myeloma. Proteasome inhibitors, such as bortezomib (BTZ), represent the key elements in chemotherapy regimens for multiple myeloma (MM), whereas acquired chemoresistance and ultimately relapse remain a major obstacle. In the current study, we screened differently expressed cytokines in bortezomib-resistant MM cells and found that Dickkopf-1 (DKK1) level was remarkably augmented, whereas CD138 level was significantly suppressed. DKK1 in vitro specifically enhanced the resistance of myeloma cells to bortezomib treatment, and excessive DKK1 drove CD138 downregulation via inhibition of canonical Wnt signaling. Notably, DKK1 mainly induced drug resistance in MM cells via the receptor of CKAP4. Mechanistically, CKAP4 transduced DKK1 signal and evoked NF-κB pathway through recruiting and preventing cullin associated and neddylation dissociated 1 from hampering the assembly of E3 ligase-mediated ubiquitination of IκBα. In addition, we found that interleukin-6 (IL-6) stimulated CKAP4 expression to generate drug resistance, and disturbance of DKK1-CKAP4 axis improved sensitivity to BTZ treatment of MM and attenuated bone destruction in a mouse model. Collectively, our study revealed the previously unidentified role of DKK1 in myeloma drug resistance via Wnt signaling dependent and independent manners, and clarified the importance of antagonism of DKK1-IL-6 loop in bone marrow microenvironment. |
1,575,006 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants; D001241:Aspirin; D002423:Cause of Death; D002544:Cerebral Infarction; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension; D002546:Ischemic Attack, Transient; D008297:Male; D008875:Middle Aged; D015996:Survival Rate | [
"D000293",
"D000328",
"D000368",
"D000925",
"D001241",
"D002423",
"D002544",
"D004305",
"D004311",
"D005260",
"D006801",
"D006973",
"D002546",
"D008297",
"D008875",
"D015996"
] | Differences in the outcome of patients with TIA versus minor stroke. | In the Swedish aspirin low dose trial (SALT) 101 patients were enrolled from the Department of Medicine, Falun. 42 patients had experienced TIA/amaurosis fugax, whereas 59 patients had suffered a minor stroke/retinal infarction. History of hypertension treated or known untreated occurred statistically more frequently in the minor stroke group at randomisation (P less than 0.01) and the mean diastolic blood pressure (DBP) was higher in the minor stroke group during the observation time (P less than 0.05; ANOVA). The minor stroke group had less favourable outcomes according to survival curves (stroke or death) during a mean observation time of 34 months in each group (P less than 0.05 at 29 months). The findings of the present trial suggest that hypertension and the higher mean DBP during the observation time might explain the better outcome of end points of stroke or death in patients with TIA. | 10,784,165 | true | Differences in the outcome of patients with TIA versus minor stroke. In the Swedish aspirin low dose trial (SALT) 101 patients were enrolled from the Department of Medicine, Falun. 42 patients had experienced TIA/amaurosis fugax, whereas 59 patients had suffered a minor stroke/retinal infarction. History of hypertension treated or known untreated occurred statistically more frequently in the minor stroke group at randomisation (P less than 0.01) and the mean diastolic blood pressure (DBP) was higher in the minor stroke group during the observation time (P less than 0.05; ANOVA). The minor stroke group had less favourable outcomes according to survival curves (stroke or death) during a mean observation time of 34 months in each group (P less than 0.05 at 29 months). The findings of the present trial suggest that hypertension and the higher mean DBP during the observation time might explain the better outcome of end points of stroke or death in patients with TIA. |
15,972,333 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed | [
"D000328",
"D000368",
"D000369",
"D005260",
"D006801",
"D008297",
"D008875",
"D009203",
"D015425",
"D011237",
"D011446",
"D015203",
"D013997",
"D015899",
"D014057"
] | Late defect on delayed contrast-enhanced multi-detector row CT scans in the prediction of SPECT infarct size after reperfused acute myocardial infarction: initial experience. | OBJECTIVE
To prospectively assess the accuracy of multi-detector row computed tomography (CT) in the prediction of infarct size after successful reperfusion of acute myocardial infarction (MI) by using single photon emission computed tomography (SPECT) images obtained 6 weeks later as the reference standard.
METHODS
Institutional review board approval and informed consent were obtained. A total of 34 patients (29 men and five women; mean age, 56 years +/- 13) underwent dual-phase 16-detector row CT within 3 days +/- 3 after successful reperfusion of acute MI. Iodinated contrast medium (1.5 mL per kilogram of body weight) was injected at a flow rate of 3.5 mL/sec. A first arterial phase acquisition was followed 5 minutes later by a late acquisition, without reinjection of contrast medium. A radiologist and a cardiologist used a 17-segment model in a blind analysis of images obtained during late acquisition. For each segment, presence of late defect or late enhancement was recorded. Findings were compared with SPECT studies analyzed by a nuclear medicine physician and a cardiologist 6 weeks after the acute event. CT defects were compared with SPECT defects on a segmental and per-patient basis. Mean number of segments with late defects on multi-detector row CT scans was compared with infarct size on SPECT images by using the t test.
RESULTS
All patients had late enhancement in the infarcted myocardium. In 27 of 34 patients, a late defect surrounded by a subepicardial late enhancement was detected. Segments with late defect on CT scans were predictive of residual perfusion defects at 6-week follow-up, with sensitivity of 78%, specificity of 91%, and accuracy of 90%. On a per-patient basis, sensitivity was 93%, specificity was 100%, and accuracy was 94%. Mean number of segments with late defects on multi-detector row CT scans (ie, 3.1 segments) was not significantly different from infarct size on SPECT images (eg, 2.5 segments) (P = .2).
CONCLUSIONS
Late defect on multi-detector row CT scans indicates residual perfusion SPECT defect and infarct size after successfully reperfused MI, with sensitivity of 93%, specificity of 100%, and accuracy of 94%. | null | false | Late defect on delayed contrast-enhanced multi-detector row CT scans in the prediction of SPECT infarct size after reperfused acute myocardial infarction: initial experience. OBJECTIVE
To prospectively assess the accuracy of multi-detector row computed tomography (CT) in the prediction of infarct size after successful reperfusion of acute myocardial infarction (MI) by using single photon emission computed tomography (SPECT) images obtained 6 weeks later as the reference standard.
METHODS
Institutional review board approval and informed consent were obtained. A total of 34 patients (29 men and five women; mean age, 56 years +/- 13) underwent dual-phase 16-detector row CT within 3 days +/- 3 after successful reperfusion of acute MI. Iodinated contrast medium (1.5 mL per kilogram of body weight) was injected at a flow rate of 3.5 mL/sec. A first arterial phase acquisition was followed 5 minutes later by a late acquisition, without reinjection of contrast medium. A radiologist and a cardiologist used a 17-segment model in a blind analysis of images obtained during late acquisition. For each segment, presence of late defect or late enhancement was recorded. Findings were compared with SPECT studies analyzed by a nuclear medicine physician and a cardiologist 6 weeks after the acute event. CT defects were compared with SPECT defects on a segmental and per-patient basis. Mean number of segments with late defects on multi-detector row CT scans was compared with infarct size on SPECT images by using the t test.
RESULTS
All patients had late enhancement in the infarcted myocardium. In 27 of 34 patients, a late defect surrounded by a subepicardial late enhancement was detected. Segments with late defect on CT scans were predictive of residual perfusion defects at 6-week follow-up, with sensitivity of 78%, specificity of 91%, and accuracy of 90%. On a per-patient basis, sensitivity was 93%, specificity was 100%, and accuracy was 94%. Mean number of segments with late defects on multi-detector row CT scans (ie, 3.1 segments) was not significantly different from infarct size on SPECT images (eg, 2.5 segments) (P = .2).
CONCLUSIONS
Late defect on multi-detector row CT scans indicates residual perfusion SPECT defect and infarct size after successfully reperfused MI, with sensitivity of 93%, specificity of 100%, and accuracy of 94%. |
7,570,731 | D001783:Blood Flow Velocity; D002536:Cerebral Arteries; D002544:Cerebral Infarction; D002560:Cerebrovascular Circulation; D005260:Female; D006423:Hemianopsia; D006801:Humans; D008297:Male; D009778:Occipital Lobe; D010775:Photic Stimulation; D015203:Reproducibility of Results; D012160:Retina; D017585:Ultrasonography, Doppler, Transcranial; D014786:Vision Disorders; D014794:Visual Fields | [
"D001783",
"D002536",
"D002544",
"D002560",
"D005260",
"D006423",
"D006801",
"D008297",
"D009778",
"D010775",
"D015203",
"D012160",
"D017585",
"D014786",
"D014794"
] | Photoreactive flow changes in the posterior cerebral artery in control subjects and patients with occipital lobe infarction. | OBJECTIVE
Photoreactive flow changes of the posterior cerebral artery (PCA) in control subjects and patients with unilateral occipital lobe infarction were investigated to study the hypothesis that occipital lobe infarction of varying extent leads to a reduced visually activated flow increase in the ipsilateral PCA.
METHODS
Maximum mean flow velocity (MFV) of the PCA was investigated by transcranial Doppler sonography after photic stimulation of the retina.
RESULTS
In 25 control subjects MFV was increased by 30.6 +/- 9.7%. In 13 patients with unilateral occipital lobe infarction the ipsilateral MFV increase was significantly lower than in control subjects. Nine patients with homonymous hemianopsia showed an ipsilateral MFV increase of 3.4 +/- 4.1% (P < .001) and four patients with incomplete occipital lobe infarction and homonymous quadrantanopsia had an MFV increase of 16.0 +/- 12.8% (P < .05).
CONCLUSIONS
We conclude that photoreactive flow changes of the PCA represent a noninvasive and reliable measure of functional impairment due to occipital infarction. | null | false | Photoreactive flow changes in the posterior cerebral artery in control subjects and patients with occipital lobe infarction. OBJECTIVE
Photoreactive flow changes of the posterior cerebral artery (PCA) in control subjects and patients with unilateral occipital lobe infarction were investigated to study the hypothesis that occipital lobe infarction of varying extent leads to a reduced visually activated flow increase in the ipsilateral PCA.
METHODS
Maximum mean flow velocity (MFV) of the PCA was investigated by transcranial Doppler sonography after photic stimulation of the retina.
RESULTS
In 25 control subjects MFV was increased by 30.6 +/- 9.7%. In 13 patients with unilateral occipital lobe infarction the ipsilateral MFV increase was significantly lower than in control subjects. Nine patients with homonymous hemianopsia showed an ipsilateral MFV increase of 3.4 +/- 4.1% (P < .001) and four patients with incomplete occipital lobe infarction and homonymous quadrantanopsia had an MFV increase of 16.0 +/- 12.8% (P < .05).
CONCLUSIONS
We conclude that photoreactive flow changes of the PCA represent a noninvasive and reliable measure of functional impairment due to occipital infarction. |
8,569,216 | D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000818:Animals; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D001794:Blood Pressure; D015152:Blotting, Northern; D001835:Body Weight; D004656:Enalapril; D006973:Hypertension; D007668:Kidney; D008297:Male; D009392:Nephrectomy; D009400:Nephrosclerosis; D011507:Proteinuria; D012333:RNA, Messenger; D051381:Rats; D011918:Rats, Inbred SHR; D011945:Receptors, Angiotensin; D012084:Renin-Angiotensin System; D012982:Sodium, Dietary; D013777:Tetrazoles; D014158:Transcription, Genetic | [
"D057911",
"D000806",
"D000818",
"D000959",
"D001562",
"D001713",
"D001794",
"D015152",
"D001835",
"D004656",
"D006973",
"D007668",
"D008297",
"D009392",
"D009400",
"D011507",
"D012333",
"D051381",
"D011918",
"D011945",
"D012084",
"D012982",
"D013777",
"D014158"
] | Renal responses to angiotensin receptor antagonist and angiotensin-converting enzyme inhibitor in partially nephrectomized spontaneously hypertensive rats. | To investigate the role of the renin-angiotensin system (RAS) on nephrosclerosis in salt-loaded, partially nephrectomized spontaneously hypertensive rats (SHR), we evaluated the effects of angiotensin II (ANGII) blockade on the progression of nephrosclerosis with an angiotensin type 1 receptor (AT1rec) antagonist [TCV-116 (TCV)] and an angiotensin-converting enzyme (ACE) inhibitor (enalapril) at the doses equivalent in reducing systemic blood pressure (BP). SHR were five/sixths nephrectomized and were fed a high-salt diet. In addition to being significantly preventive against an increase in systolic BP, both TCV and enalapril significantly attenuated the increases in proteinuria and the renal histopathological alterations. Transcription of AT1rec mRNA in the remnant kidney was enhanced with the progression of nephrosclerosis, but was inhibited by TCV as well as enalapril. In these aspects, there were no apparent differences between effects of TCV and enalapril. The RAS system plays an important role in nephrosclerosis in partially nephrectomized SHR despite a high-salt diet, and direct ANGII blockade certainly protected the kidney against hypertensive injury in this model. | 10,440,573 | true | Renal responses to angiotensin receptor antagonist and angiotensin-converting enzyme inhibitor in partially nephrectomized spontaneously hypertensive rats. To investigate the role of the renin-angiotensin system (RAS) on nephrosclerosis in salt-loaded, partially nephrectomized spontaneously hypertensive rats (SHR), we evaluated the effects of angiotensin II (ANGII) blockade on the progression of nephrosclerosis with an angiotensin type 1 receptor (AT1rec) antagonist [TCV-116 (TCV)] and an angiotensin-converting enzyme (ACE) inhibitor (enalapril) at the doses equivalent in reducing systemic blood pressure (BP). SHR were five/sixths nephrectomized and were fed a high-salt diet. In addition to being significantly preventive against an increase in systolic BP, both TCV and enalapril significantly attenuated the increases in proteinuria and the renal histopathological alterations. Transcription of AT1rec mRNA in the remnant kidney was enhanced with the progression of nephrosclerosis, but was inhibited by TCV as well as enalapril. In these aspects, there were no apparent differences between effects of TCV and enalapril. The RAS system plays an important role in nephrosclerosis in partially nephrectomized SHR despite a high-salt diet, and direct ANGII blockade certainly protected the kidney against hypertensive injury in this model. |
24,529,564 | D004247:DNA; D003924:Diabetes Mellitus, Type 2; D003930:Diabetic Retinopathy; D005260:Female; D005787:Gene Frequency; D005838:Genotype; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D015995:Prevalence; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013482:Superoxide Dismutase | [
"D004247",
"D003924",
"D003930",
"D005260",
"D005787",
"D005838",
"D006801",
"D007194",
"D008297",
"D008875",
"D011110",
"D015995",
"D000067759",
"D011971",
"D012189",
"D020133",
"D013482"
] | Association of RAGE (p.Gly82Ser) and MnSOD (p.Val16Ala) polymorphisms with diabetic retinopathy in T2DM patients from north India. | OBJECTIVE
The present study aimed to examine the association of RAGE (p.Gly82Ser) and MnSOD (p.Val16Ala) polymorphisms with diabetic retinopathy (DR) in north Indian T2DM patients.
METHODS
In this case-control association study, 758 T2DM patients were recruited. 446 with retinal neovascularization, microneurysms and hemorrhages were considered as cases (DR) and 312 patients with T2DM and no clinical signs of retinopathy (DNR), were recruited as controls. Genotypes for RAGE (p.Gly82Ser) and MnSOD (p.Val16Ala) polymorphisms were generated by direct sequencing of amplified products.
RESULTS
Genotype distribution of p.Gly82Ser (RAGE) and p.Val16Ala (MnSOD) polymorphisms were significantly different between DR and DNR (p<0.05) whereas distribution of allele frequency did not differ significantly (p>0.05). A significantly higher frequency of homozygous Ser82 genotype in DR patients was detected compared with DNR (2.4% vs 0.64%) for p.Gly82Ser (RAGE) polymorphism whereas there was a higher frequency of homozygous Ala16 genotype for p.Val16Ala (MnSOD) polymorphism in DR patients compared with DNR (22.6% vs 19.3%). Binary logistic analyses showed an association of homozygous recessive genotype Ser82 with DR (OR: 2.63%, 95% CI: 0.16-15.88, p<0.033) for p.Gly82Ser (RAGE) polymorphism. However, we did not find a significant association of p.Val16Ala polymorphism in MnSOD with retinopathy.
CONCLUSIONS
The findings indicate a statistically significant association of p.Gly82Ser polymorphism in RAGE with DR in T2DM patients. | null | false | Association of RAGE (p.Gly82Ser) and MnSOD (p.Val16Ala) polymorphisms with diabetic retinopathy in T2DM patients from north India. OBJECTIVE
The present study aimed to examine the association of RAGE (p.Gly82Ser) and MnSOD (p.Val16Ala) polymorphisms with diabetic retinopathy (DR) in north Indian T2DM patients.
METHODS
In this case-control association study, 758 T2DM patients were recruited. 446 with retinal neovascularization, microneurysms and hemorrhages were considered as cases (DR) and 312 patients with T2DM and no clinical signs of retinopathy (DNR), were recruited as controls. Genotypes for RAGE (p.Gly82Ser) and MnSOD (p.Val16Ala) polymorphisms were generated by direct sequencing of amplified products.
RESULTS
Genotype distribution of p.Gly82Ser (RAGE) and p.Val16Ala (MnSOD) polymorphisms were significantly different between DR and DNR (p<0.05) whereas distribution of allele frequency did not differ significantly (p>0.05). A significantly higher frequency of homozygous Ser82 genotype in DR patients was detected compared with DNR (2.4% vs 0.64%) for p.Gly82Ser (RAGE) polymorphism whereas there was a higher frequency of homozygous Ala16 genotype for p.Val16Ala (MnSOD) polymorphism in DR patients compared with DNR (22.6% vs 19.3%). Binary logistic analyses showed an association of homozygous recessive genotype Ser82 with DR (OR: 2.63%, 95% CI: 0.16-15.88, p<0.033) for p.Gly82Ser (RAGE) polymorphism. However, we did not find a significant association of p.Val16Ala polymorphism in MnSOD with retinopathy.
CONCLUSIONS
The findings indicate a statistically significant association of p.Gly82Ser polymorphism in RAGE with DR in T2DM patients. |
19,738,556 | D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005264:Femoral Fractures; D005343:Fibrinolytic Agents; D005500:Follow-Up Studies; D006801:Humans; D007869:Leg Injuries; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013978:Tibial Fractures; D020246:Venous Thrombosis; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D005260",
"D005264",
"D005343",
"D005500",
"D006801",
"D007869",
"D008297",
"D008875",
"D011379",
"D012189",
"D015912",
"D013978",
"D020246",
"D055815"
] | [Deep veins thrombosis prophylaxis in patients with fractures of long bones of the lower limbs]. | Analysis of the complex deep veins thrombosis prophylaxis, considering also pulmonary thromboembolism prevention, in 1180 patients (694 male and 486 female) with closed long bones fractures of the lower limbs. Thrombosis prophylaxis aimed venous blood flow acceleration, liquidation of blood congestion and fibrinolysis stimulation performed with the use of physical factors (nonspecific prophylaxis) and hemostasis normalization (specific prophylaxis). The study revealed that prophylactic measures in patients at low thrombotic risk can be limited to nonspecific prophylaxis. Whereas patients at high and medium thrombotic risk need anticoagulant and disaggregant therapy. The use of standard heparin should be justified only in the absence of other drugs because of the high rate of hemorrhagic complications (42,9%). Any low-molecular heparin is effective for the deep veins thrombosis prophylaxis, though Clexane showed to be the most effective (no complications in 87,5%, deep veins thrombosis in 7,9%, hemorrhagic complications in 5,0%, no registered cases of pulmonary thromboembolism). | null | false | [Deep veins thrombosis prophylaxis in patients with fractures of long bones of the lower limbs]. Analysis of the complex deep veins thrombosis prophylaxis, considering also pulmonary thromboembolism prevention, in 1180 patients (694 male and 486 female) with closed long bones fractures of the lower limbs. Thrombosis prophylaxis aimed venous blood flow acceleration, liquidation of blood congestion and fibrinolysis stimulation performed with the use of physical factors (nonspecific prophylaxis) and hemostasis normalization (specific prophylaxis). The study revealed that prophylactic measures in patients at low thrombotic risk can be limited to nonspecific prophylaxis. Whereas patients at high and medium thrombotic risk need anticoagulant and disaggregant therapy. The use of standard heparin should be justified only in the absence of other drugs because of the high rate of hemorrhagic complications (42,9%). Any low-molecular heparin is effective for the deep veins thrombosis prophylaxis, though Clexane showed to be the most effective (no complications in 87,5%, deep veins thrombosis in 7,9%, hemorrhagic complications in 5,0%, no registered cases of pulmonary thromboembolism). |
22,739,210 | D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D000450:Aldosterone; D000818:Animals; D001794:Blood Pressure; D003345:Corticosterone; D004195:Disease Models, Animal; D015971:Gene Expression Regulation, Enzymologic; D006977:Hypertension, Renal; D007668:Kidney; D008297:Male; D009392:Nephrectomy; D051381:Rats; D017207:Rats, Sprague-Dawley | [
"D043205",
"D043209",
"D000450",
"D000818",
"D001794",
"D003345",
"D004195",
"D015971",
"D006977",
"D007668",
"D008297",
"D009392",
"D051381",
"D017207"
] | Uninephrectomy reduces 11β-hydroxysteroid dehydrogenase type 1 and type 2 concomitantly with an increase in blood pressure in rats. | Renal allograft donors are at risk of developing hypertension. Here, we hypothesized that this risk is at least in part explained by an enhanced intracellular availability of 11β-hydroxyglucocorticoids due to an increased 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1), an intracellular prereceptor activator of biologically inactive 11-ketocorticosteroids in the liver, and/or a diminished 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), an inactivator of 11β-hydroxyglucocorticoids in the kidney. To test this hypothesis, uninephrectomized (UNX) (n=9) and sham-operated (n=10) adult Sprague-Dawley rats were investigated. Mean arterial blood pressure and heart rate were measured continuously by telemetry for 6 days in week 5 after UNX. The mRNA of 11β-Hsd1 and 11β-Hsd2 in liver and kidney tissues were assessed by RT-PCR and the 11β-HSD activities were directly quantified in their corresponding tissues by determining the ratios of (tetrahydrocorticosterone+5α-tetrahydrocorticosterone)/tetrahydrodehydrocorticosterone ((THB+5α-THB)/THA) and of corticosterone/dehydrocorticosterone (B/A) by gas chromatography-mass spectrometry. The apparent total body activities of 11β-HSD1 and 11β-HSD2 were estimated using the urinary and plasma ratios of (THB+5α-THB)/THA and B/A. Mean arterial blood pressure was increased after UNX when compared with sham operation. Hepatic mRNA content of 11β-Hsd1 and hepatic, plasma, and urinary ratios of (THB+5α-THB)/THA were decreased after UNX, indicating diminished access of glucocorticoids to its receptors. In renal tissue, 11β-Hsd2 mRNA was reduced and B/A ratios measured in kidney, plasma, and urine were increased, indicating reduced 11β-HSD2 activity and enhanced access of glucocorticoids to mineralocorticoid receptors. Both 11β-HSD1 and 11β-HSD2 are downregulated after UNX in rats, a constellation considered to induce hypertension. | 3,563,328 | true | Uninephrectomy reduces 11β-hydroxysteroid dehydrogenase type 1 and type 2 concomitantly with an increase in blood pressure in rats. Renal allograft donors are at risk of developing hypertension. Here, we hypothesized that this risk is at least in part explained by an enhanced intracellular availability of 11β-hydroxyglucocorticoids due to an increased 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1), an intracellular prereceptor activator of biologically inactive 11-ketocorticosteroids in the liver, and/or a diminished 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), an inactivator of 11β-hydroxyglucocorticoids in the kidney. To test this hypothesis, uninephrectomized (UNX) (n=9) and sham-operated (n=10) adult Sprague-Dawley rats were investigated. Mean arterial blood pressure and heart rate were measured continuously by telemetry for 6 days in week 5 after UNX. The mRNA of 11β-Hsd1 and 11β-Hsd2 in liver and kidney tissues were assessed by RT-PCR and the 11β-HSD activities were directly quantified in their corresponding tissues by determining the ratios of (tetrahydrocorticosterone+5α-tetrahydrocorticosterone)/tetrahydrodehydrocorticosterone ((THB+5α-THB)/THA) and of corticosterone/dehydrocorticosterone (B/A) by gas chromatography-mass spectrometry. The apparent total body activities of 11β-HSD1 and 11β-HSD2 were estimated using the urinary and plasma ratios of (THB+5α-THB)/THA and B/A. Mean arterial blood pressure was increased after UNX when compared with sham operation. Hepatic mRNA content of 11β-Hsd1 and hepatic, plasma, and urinary ratios of (THB+5α-THB)/THA were decreased after UNX, indicating diminished access of glucocorticoids to its receptors. In renal tissue, 11β-Hsd2 mRNA was reduced and B/A ratios measured in kidney, plasma, and urine were increased, indicating reduced 11β-HSD2 activity and enhanced access of glucocorticoids to mineralocorticoid receptors. Both 11β-HSD1 and 11β-HSD2 are downregulated after UNX in rats, a constellation considered to induce hypertension. |
25,247,051 | D000368:Aged; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D013479:Superior Vena Cava Syndrome; D013927:Thrombosis; D014463:Ultrasonography; D014683:Vena Cava, Superior | [
"D000368",
"D004636",
"D006801",
"D008297",
"D019095",
"D013479",
"D013927",
"D014463",
"D014683"
] | Ultrasound detection of superior vena cava thrombus. | Superior vena cava (SVC) syndrome is most commonly the insidious result of decreased vascular flow through the SVC due to malignancy, spontaneous thrombus, infections, and iatrogenic etiologies. Clinical suspicion usually leads to computed tomography to confirm the diagnosis. However, when a patient in respiratory distress requires emergent airway management, travel outside the emergency department is not ideal. With the growing implementation of point-of-care ultrasound (POCUS), clinicians may make critical diagnoses rapidly and safely. We present a case of SVC syndrome due to extensive thrombosis of the deep venous system cephalad to the SVC diagnosed by POCUS. | 1,147,637 | true | Ultrasound detection of superior vena cava thrombus. Superior vena cava (SVC) syndrome is most commonly the insidious result of decreased vascular flow through the SVC due to malignancy, spontaneous thrombus, infections, and iatrogenic etiologies. Clinical suspicion usually leads to computed tomography to confirm the diagnosis. However, when a patient in respiratory distress requires emergent airway management, travel outside the emergency department is not ideal. With the growing implementation of point-of-care ultrasound (POCUS), clinicians may make critical diagnoses rapidly and safely. We present a case of SVC syndrome due to extensive thrombosis of the deep venous system cephalad to the SVC diagnosed by POCUS. |
8,988,917 | D000328:Adult; D000368:Aged; D001161:Arteriosclerosis; D015992:Body Mass Index; D003198:Computer Simulation; D004041:Dietary Fats; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity; D012984:Software; D014481:United States | [
"D000328",
"D000368",
"D001161",
"D015992",
"D003198",
"D004041",
"D005260",
"D005951",
"D006801",
"D007333",
"D008297",
"D008875",
"D009765",
"D012984",
"D014481"
] | Dietary fat and insulin sensitivity in a triethnic population: the role of obesity. The Insulin Resistance Atherosclerosis Study (IRAS) | From the Insulin Resistance Atherosclerosis Study (IRAS), 1173 men and women of African-American, non-Hispanic white, and Hispanic ethnicity with no history of diabetes were included in an evaluation of the cross-sectional relation of habitual dietary fat intake with insulin sensitivity (SI) as assessed by minimal-model analysis of a 12-sample, insulin-modified frequently sampled intravenous-glucose-tolerance test. Dietary intake was measured by a food-frequency interview modified to enhance sensitivity to food choices within the three ethnic groups. Percentage of energy from total fat was associated with rank of SI (SI(rank); r = -0.06, P = 0.03), with log fasting insulin (r = 0.10, P < 0.001), and with BMI (r = 0.10, P < 0.001). Multiple-linear-regression models included SI(rank) as the dependent variable, dietary fat (g/d) as the primary independent variable adjusted sequentially for total energy, other covariates, body mass index, and waist-hip circumference ratio (WHR). For all subjects combined, total fat intake was inversely related to SI(rank), but this association was not significant (P = 0.14) and was attenuated by adjustment for body mass index and WHR (P = 0.44). The association of total fat (g/d) with SI(rank) differed significantly (P < 0.01) for obese compared with nonobese individuals. Higher fat intake was associated with lower SI(rank) among obese (beta = -1.40, P = 0.03) but not among nonobese persons (beta = 0.16, P = 0.80). Among the obese (body mass index < or = 63), adjustment for body mass index largely accounted for the observed association of dietary fat with SI(rank). These findings were generally consistent for monounsaturated, polyunsaturated, and saturated fats. Among individuals already at increased risk for non-insulin-dependent diabetes mellitus because of obesity, high intake of dietary fat may worsen insulin sensitivity. This effect may be mediated by the relation of dietary fat to obesity. | 4,665,445 | true | Dietary fat and insulin sensitivity in a triethnic population: the role of obesity. The Insulin Resistance Atherosclerosis Study (IRAS) From the Insulin Resistance Atherosclerosis Study (IRAS), 1173 men and women of African-American, non-Hispanic white, and Hispanic ethnicity with no history of diabetes were included in an evaluation of the cross-sectional relation of habitual dietary fat intake with insulin sensitivity (SI) as assessed by minimal-model analysis of a 12-sample, insulin-modified frequently sampled intravenous-glucose-tolerance test. Dietary intake was measured by a food-frequency interview modified to enhance sensitivity to food choices within the three ethnic groups. Percentage of energy from total fat was associated with rank of SI (SI(rank); r = -0.06, P = 0.03), with log fasting insulin (r = 0.10, P < 0.001), and with BMI (r = 0.10, P < 0.001). Multiple-linear-regression models included SI(rank) as the dependent variable, dietary fat (g/d) as the primary independent variable adjusted sequentially for total energy, other covariates, body mass index, and waist-hip circumference ratio (WHR). For all subjects combined, total fat intake was inversely related to SI(rank), but this association was not significant (P = 0.14) and was attenuated by adjustment for body mass index and WHR (P = 0.44). The association of total fat (g/d) with SI(rank) differed significantly (P < 0.01) for obese compared with nonobese individuals. Higher fat intake was associated with lower SI(rank) among obese (beta = -1.40, P = 0.03) but not among nonobese persons (beta = 0.16, P = 0.80). Among the obese (body mass index < or = 63), adjustment for body mass index largely accounted for the observed association of dietary fat with SI(rank). These findings were generally consistent for monounsaturated, polyunsaturated, and saturated fats. Among individuals already at increased risk for non-insulin-dependent diabetes mellitus because of obesity, high intake of dietary fat may worsen insulin sensitivity. This effect may be mediated by the relation of dietary fat to obesity. |
35,481,478 | D048868:Adaptor Proteins, Signal Transducing; D000818:Animals; D051017:Apoptosis Regulatory Proteins; D009202:Cardiomyopathies; D055786:Gene Knockout Techniques; D060045:Genes, Modifier; D015027:Zebrafish; D029961:Zebrafish Proteins; D000094704:RNA, Guide, CRISPR-Cas Systems | [
"D048868",
"D000818",
"D051017",
"D009202",
"D055786",
"D060045",
"D015027",
"D029961",
"D000094704"
] | Application of an F0-based genetic assay in adult zebrafish to identify modifier genes of an inherited cardiomyopathy. | Modifier genes contribute significantly to our understanding of pathophysiology in human diseases; however, effective approaches to identify modifier genes are still lacking. Here, we aim to develop a rapid F0-based genetic assay in adult zebrafish using the bag3 gene knockout (bag3e2/e2) cardiomyopathy model as a paradigm. First, by utilizing a classic genetic breeding approach, we identified dnajb6b as a deleterious modifier gene for bag3 cardiomyopathy. Next, we established an F0-based genetic assay in adult zebrafish through injection of predicted microhomology-mediated end joining (MMEJ)-inducing single guide RNA/Cas9 protein complex. We showed that effective gene knockdown is maintained in F0 adult fish, enabling recapitulation of both salutary modifying effects of the mtor haploinsufficiency and deleterious modifying effects of the dnajb6b gene on bag3 cardiomyopathy. We finally deployed the F0-based genetic assay to screen differentially expressed genes in the bag3 cardiomyopathy model. As a result, myh9b was identified as a novel modifier gene for bag3 cardiomyopathy. Together, these data prove the feasibility of an F0 adult zebrafish-based genetic assay that can be effectively used to discover modifier genes for inherited cardiomyopathy. | 8,145,107 | true | Application of an F0-based genetic assay in adult zebrafish to identify modifier genes of an inherited cardiomyopathy. Modifier genes contribute significantly to our understanding of pathophysiology in human diseases; however, effective approaches to identify modifier genes are still lacking. Here, we aim to develop a rapid F0-based genetic assay in adult zebrafish using the bag3 gene knockout (bag3e2/e2) cardiomyopathy model as a paradigm. First, by utilizing a classic genetic breeding approach, we identified dnajb6b as a deleterious modifier gene for bag3 cardiomyopathy. Next, we established an F0-based genetic assay in adult zebrafish through injection of predicted microhomology-mediated end joining (MMEJ)-inducing single guide RNA/Cas9 protein complex. We showed that effective gene knockdown is maintained in F0 adult fish, enabling recapitulation of both salutary modifying effects of the mtor haploinsufficiency and deleterious modifying effects of the dnajb6b gene on bag3 cardiomyopathy. We finally deployed the F0-based genetic assay to screen differentially expressed genes in the bag3 cardiomyopathy model. As a result, myh9b was identified as a novel modifier gene for bag3 cardiomyopathy. Together, these data prove the feasibility of an F0 adult zebrafish-based genetic assay that can be effectively used to discover modifier genes for inherited cardiomyopathy. |
33,719,401 | D000975:Antioxidants; D000086382:COVID-19; D016207:Cytokines; D006801:Humans; D006859:Hydrogen; D008264:Macrophages; D009080:Mucocutaneous Lymph Node Syndrome; D018384:Oxidative Stress; D015995:Prevalence; D000086402:SARS-CoV-2; D000093485:COVID-19 Drug Treatment | [
"D000975",
"D000086382",
"D016207",
"D006801",
"D006859",
"D008264",
"D009080",
"D018384",
"D015995",
"D000086402",
"D000093485"
] | Chemical and Biochemical Aspects of Molecular Hydrogen in Treating Kawasaki Disease and COVID-19. | Kawasaki disease (KD) is a systemic vasculitis and is the most commonly acquired heart disease among children in many countries, which was first reported 50 years ago in Japan. The 2019 coronavirus disease (COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) has been a pandemic in most of the world since 2020, and since late 2019 in China. Kawasaki-like disease caused by COVID-19 shares some symptoms with KD, referred to as multisystem inflammatory syndrome in children, and has been reported in the United States, Italy, France, England, and other areas of Europe, with an almost 6-10 times or more increase compared with previous years of KD prevalence. Hydrogen gas is a stable and efficient antioxidant, which has a positive effect on oxidative damage, inflammation, cell apoptosis, and abnormal blood vessel inflammation. This review reports the chemical and biochemical aspects of hydrogen gas inhalation in treating KD and COVID-19. | 13,408,580 | true | Chemical and Biochemical Aspects of Molecular Hydrogen in Treating Kawasaki Disease and COVID-19. Kawasaki disease (KD) is a systemic vasculitis and is the most commonly acquired heart disease among children in many countries, which was first reported 50 years ago in Japan. The 2019 coronavirus disease (COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) has been a pandemic in most of the world since 2020, and since late 2019 in China. Kawasaki-like disease caused by COVID-19 shares some symptoms with KD, referred to as multisystem inflammatory syndrome in children, and has been reported in the United States, Italy, France, England, and other areas of Europe, with an almost 6-10 times or more increase compared with previous years of KD prevalence. Hydrogen gas is a stable and efficient antioxidant, which has a positive effect on oxidative damage, inflammation, cell apoptosis, and abnormal blood vessel inflammation. This review reports the chemical and biochemical aspects of hydrogen gas inhalation in treating KD and COVID-19. |
11,251,358 | D000925:Anticoagulants; D001315:Australia; D002986:Clinical Trials as Topic; D003363:Cost Control; D017281:Cost of Illness; D016527:Drug Costs; D005060:Europe; D006495:Heparin, Low-Molecular-Weight; D006699:Home Care Services; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D009426:Netherlands; D009520:New Zealand; D010045:Outpatients; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D013594:Syringes; D020246:Venous Thrombosis | [
"D000925",
"D001315",
"D002986",
"D003363",
"D017281",
"D016527",
"D005060",
"D006495",
"D006699",
"D017721",
"D006760",
"D006801",
"D007902",
"D009426",
"D009520",
"D010045",
"D011446",
"D011788",
"D016032",
"D012648",
"D013594",
"D020246"
] | Does low-molecular-weight heparin reduce the costs of venous thromboembolism treatment? | The development of low-molecular-weight heparins (LMWHs) has revolutionized the dominant treatment strategy of established deep vein thrombosis and pulmonary embolism. In a further attempt to simplify treatment, outpatient management using LMWH has been proposed for these patients. This management strategy has now been shown to be as safe and effective as hospital treatment in a number of large clinical trials. The question remains whether such an out-of-hospital treatment strategy actually reduces costs. This paper summarizes the economic evaluations reported in the literature. Two large economic evaluations, based on prospectively collected data on resource use, have been reported. Both pointed to a large reduction in costs of 60% or more. The size of the cost reduction depends on the proportion of patients managed at home. Several studies show that approximately 80% qualify for out-of-hospital treatment. Local facilities for organizing home care may put an upper limit on this proportion. From a societal perspective, the economic evidence in favour of outpatient treatment with LMWH presents a rare case of dominance: a situation of reduced costs with no concessions in clinical outcomes. Nevertheless, attention should be paid to the parties that will bear the healthcare costs generated by the replacement of inpatient care by outpatient care. | 1,764,685 | true | Does low-molecular-weight heparin reduce the costs of venous thromboembolism treatment? The development of low-molecular-weight heparins (LMWHs) has revolutionized the dominant treatment strategy of established deep vein thrombosis and pulmonary embolism. In a further attempt to simplify treatment, outpatient management using LMWH has been proposed for these patients. This management strategy has now been shown to be as safe and effective as hospital treatment in a number of large clinical trials. The question remains whether such an out-of-hospital treatment strategy actually reduces costs. This paper summarizes the economic evaluations reported in the literature. Two large economic evaluations, based on prospectively collected data on resource use, have been reported. Both pointed to a large reduction in costs of 60% or more. The size of the cost reduction depends on the proportion of patients managed at home. Several studies show that approximately 80% qualify for out-of-hospital treatment. Local facilities for organizing home care may put an upper limit on this proportion. From a societal perspective, the economic evidence in favour of outpatient treatment with LMWH presents a rare case of dominance: a situation of reduced costs with no concessions in clinical outcomes. Nevertheless, attention should be paid to the parties that will bear the healthcare costs generated by the replacement of inpatient care by outpatient care. |
6,883,823 | D003937:Diagnosis, Differential; D004562:Electrocardiography; D006352:Heart Ventricles; D006801:Humans; D013610:Tachycardia | [
"D003937",
"D004562",
"D006352",
"D006801",
"D013610"
] | Ventricular tachycardia: newer insights. | Electrophysiology has provided insights into our understanding of ventricular tachycardia. The techniques of electrophysiology which were useful as a research tool have only recently come to be appreciated in clinical practice. As a result, we have expanded our knowledge of the mechanisms of ventricular arrhythmias; we can distinguish among tachycardias masquerading as ventricular tachycardia; we can predict the response to drug and pacemaker treatment, and we can select out those who require surgical management. | 5,498,933 | true | Ventricular tachycardia: newer insights. Electrophysiology has provided insights into our understanding of ventricular tachycardia. The techniques of electrophysiology which were useful as a research tool have only recently come to be appreciated in clinical practice. As a result, we have expanded our knowledge of the mechanisms of ventricular arrhythmias; we can distinguish among tachycardias masquerading as ventricular tachycardia; we can predict the response to drug and pacemaker treatment, and we can select out those who require surgical management. |
25,384,349 | D000293:Adolescent; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1; D003971:Diastole; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain; D012372:ROC Curve; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left; D016277:Ventricular Function, Left | [
"D000293",
"D001794",
"D018660",
"D003430",
"D003922",
"D003971",
"D042241",
"D015150",
"D005260",
"D005500",
"D006801",
"D008297",
"D020097",
"D012372",
"D012189",
"D018487",
"D016277"
] | Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings. | OBJECTIVE
To evaluate the relationship between 24-h blood pressure (BP) measurements and diastolic heart function evaluated by Doppler tissue imaging and B-type natriuretic peptide (BNP) levels in children with type 1 diabetes mellitus (DM).
METHODS
A total of 32 diabetic and 18 healthy children were enrolled. Spectral Doppler analysis and tissue Doppler measurements were performed by conventional echocardiography. The 24-h ambulatory BP and serum BNP levels were measured.
RESULTS
Analysis of ambulatory blood pressure monitoring (ABPM) recordings showed that median daytime diastolic BP load were significantly higher in diabetic patients compared to controls [12.35 (4.23-27.23) vs. 2.5 (0-8.7), p = 0.007]. Patients with elevated daytime systolic and diastolic BP loads had significantly higher BNP values compared to patients with normal BP load (31.4 ± 24.36 vs. 11.84 ± 11.25 pg/mL, p = 0.03 and 23.21 ± 15.12 vs. 12.12 ± 14.65 pg/mL, p = 0.03, respectively). Isovolemic contraction time (47.43 ± 7.84 vs. 42.27 ± 7.47, p = 0.045), isovolemic relaxation time (68.84 ± 10.43 vs. 58.77 ± 10.02, p = 0.02), and myocardial performance index (0.45 ± 0.10 vs. 0.37 ± 0.09, p = 0.02) as determined by tissue Doppler echocardiography were significantly high in diabetic patients compared to that of control cases. Ratio of mitral peak early diastolic flow velocity (E) to peak early diastolic myocardial velocities by tissue Doppler echocardiography (E') was also higher in patients with elevated daytime systolic BP load (E/E', 6.71 ± 1.97 vs. 4.91 ± 1.02, p = 0.04).
CONCLUSIONS
Elevated BP loads detected by 24-h ambulatory BP measurements in children with type 1 diabetes are associated with increased BNP levels and abnormal tissue Doppler echocardiography indices, indicating early stage cardiac dysfunction. | null | false | Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings. OBJECTIVE
To evaluate the relationship between 24-h blood pressure (BP) measurements and diastolic heart function evaluated by Doppler tissue imaging and B-type natriuretic peptide (BNP) levels in children with type 1 diabetes mellitus (DM).
METHODS
A total of 32 diabetic and 18 healthy children were enrolled. Spectral Doppler analysis and tissue Doppler measurements were performed by conventional echocardiography. The 24-h ambulatory BP and serum BNP levels were measured.
RESULTS
Analysis of ambulatory blood pressure monitoring (ABPM) recordings showed that median daytime diastolic BP load were significantly higher in diabetic patients compared to controls [12.35 (4.23-27.23) vs. 2.5 (0-8.7), p = 0.007]. Patients with elevated daytime systolic and diastolic BP loads had significantly higher BNP values compared to patients with normal BP load (31.4 ± 24.36 vs. 11.84 ± 11.25 pg/mL, p = 0.03 and 23.21 ± 15.12 vs. 12.12 ± 14.65 pg/mL, p = 0.03, respectively). Isovolemic contraction time (47.43 ± 7.84 vs. 42.27 ± 7.47, p = 0.045), isovolemic relaxation time (68.84 ± 10.43 vs. 58.77 ± 10.02, p = 0.02), and myocardial performance index (0.45 ± 0.10 vs. 0.37 ± 0.09, p = 0.02) as determined by tissue Doppler echocardiography were significantly high in diabetic patients compared to that of control cases. Ratio of mitral peak early diastolic flow velocity (E) to peak early diastolic myocardial velocities by tissue Doppler echocardiography (E') was also higher in patients with elevated daytime systolic BP load (E/E', 6.71 ± 1.97 vs. 4.91 ± 1.02, p = 0.04).
CONCLUSIONS
Elevated BP loads detected by 24-h ambulatory BP measurements in children with type 1 diabetes are associated with increased BNP levels and abnormal tissue Doppler echocardiography indices, indicating early stage cardiac dysfunction. |
25,796,994 | D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest; D006801:Humans; D007223:Infant; D008297:Male; D011787:Quality of Health Care; D012189:Retrospective Studies; D014741:Video Recording | [
"D016887",
"D002648",
"D002675",
"D004632",
"D005260",
"D019983",
"D006323",
"D006801",
"D007223",
"D008297",
"D011787",
"D012189",
"D014741"
] | Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department. | OBJECTIVE
To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording.
METHODS
Resuscitations in a tertiary pediatric ED are videorecorded as part of a quality improvement project. Patients receiving CPR under videorecorded conditions were eligible for inclusion. CPR parameters were quantified by retrospective review. Data were described by 30-s epoch (compression rate, ventilation rate, compression:ventilation ratio), by segment (duration of single providers' compressions) and by overall event (compression fraction). Duration of interruptions in compressions was measured; tasks completed during pauses were tabulated.
RESULTS
33 children received CPR under videorecorded conditions. A total of 650 min of CPR were analyzed. Chest compressions were performed at <100/min in 90/714 (13%) of epochs; 100-120/min in 309/714 (43%); >120/min in 315/714 (44%). Ventilations were 6-12 breaths/min in 201/708 (23%) of epochs and >12/min in 489/708 (70%). During CPR without an artificial airway, compression:ventilation coordination (15:2) was done in 93/234 (40%) of epochs. 178 pauses in CPR occurred; 120 (67%) were <10s in duration. Of 370 segments of compressions by individual providers, 282/370 (76%) were <2 min in duration. Median compression fraction was 91% (range 88-100%).
CONCLUSIONS
CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording. | null | false | Videographic assessment of cardiopulmonary resuscitation quality in the pediatric emergency department. OBJECTIVE
To describe the adherence to guidelines for CPR in a tertiary pediatric emergency department (ED) where resuscitations are reviewed by videorecording.
METHODS
Resuscitations in a tertiary pediatric ED are videorecorded as part of a quality improvement project. Patients receiving CPR under videorecorded conditions were eligible for inclusion. CPR parameters were quantified by retrospective review. Data were described by 30-s epoch (compression rate, ventilation rate, compression:ventilation ratio), by segment (duration of single providers' compressions) and by overall event (compression fraction). Duration of interruptions in compressions was measured; tasks completed during pauses were tabulated.
RESULTS
33 children received CPR under videorecorded conditions. A total of 650 min of CPR were analyzed. Chest compressions were performed at <100/min in 90/714 (13%) of epochs; 100-120/min in 309/714 (43%); >120/min in 315/714 (44%). Ventilations were 6-12 breaths/min in 201/708 (23%) of epochs and >12/min in 489/708 (70%). During CPR without an artificial airway, compression:ventilation coordination (15:2) was done in 93/234 (40%) of epochs. 178 pauses in CPR occurred; 120 (67%) were <10s in duration. Of 370 segments of compressions by individual providers, 282/370 (76%) were <2 min in duration. Median compression fraction was 91% (range 88-100%).
CONCLUSIONS
CPR in a tertiary pediatric ED frequently met recommended parameters for compression rate, pause duration, and compression fraction. Hyperventilation and failure of C:V coordination were very common. Future studies should focus on the impact of training methods on CPR performance as documented by videorecording. |
36,116,396 | D006801:Humans; D008297:Male; D066127:White Matter; D001924:Brain Concussion; D002543:Cerebral Hemorrhage; D008279:Magnetic Resonance Imaging; D003071:Cognition | [
"D006801",
"D008297",
"D066127",
"D001924",
"D002543",
"D008279",
"D003071"
] | White matter degradation near cerebral microbleeds is associated with cognitive change after mild traumatic brain injury. | To explore how cerebral microbleeds (CMBs) accompanying mild traumatic brain injury (mTBI) reflect white matter (WM) degradation and cognitive decline, magnetic resonance images were acquired from 62 mTBI adults (imaged ∼7 days and ∼6 months post-injury) and 203 matched healthy controls. On average, mTBI participants had a count of 2.7 ± 2.6 traumatic CMBs in WM, located 6.1 ± 4.4 mm from cortex. At ∼6-month follow-up, 97% of CMBs were associated with significant reductions (34% ± 11%, q < 0.05) in the fractional anisotropy of WM streamlines within ∼1 cm of CMB locations. Male sex and older age were significant risk factors for larger reductions (q < 0.05). For CMBs in the corpus callosum, cingulum bundle, inferior and middle longitudinal fasciculi, fractional anisotropy changes were significantly and positively associated with changes in cognitive functions mediated by these structures (q < 0.05). Our findings distinguish traumatic from non-traumatic CMBs by virtue of surrounding WM alterations and challenge the assumption that traumatic CMBs are neurocognitively silent. Thus, mTBI with CMB findings can be described as a clinical endophenotype warranting longitudinal cognitive assessment. | 2,133,635 | true | White matter degradation near cerebral microbleeds is associated with cognitive change after mild traumatic brain injury. To explore how cerebral microbleeds (CMBs) accompanying mild traumatic brain injury (mTBI) reflect white matter (WM) degradation and cognitive decline, magnetic resonance images were acquired from 62 mTBI adults (imaged ∼7 days and ∼6 months post-injury) and 203 matched healthy controls. On average, mTBI participants had a count of 2.7 ± 2.6 traumatic CMBs in WM, located 6.1 ± 4.4 mm from cortex. At ∼6-month follow-up, 97% of CMBs were associated with significant reductions (34% ± 11%, q < 0.05) in the fractional anisotropy of WM streamlines within ∼1 cm of CMB locations. Male sex and older age were significant risk factors for larger reductions (q < 0.05). For CMBs in the corpus callosum, cingulum bundle, inferior and middle longitudinal fasciculi, fractional anisotropy changes were significantly and positively associated with changes in cognitive functions mediated by these structures (q < 0.05). Our findings distinguish traumatic from non-traumatic CMBs by virtue of surrounding WM alterations and challenge the assumption that traumatic CMBs are neurocognitively silent. Thus, mTBI with CMB findings can be described as a clinical endophenotype warranting longitudinal cognitive assessment. |
21,862,939 | D000818:Animals; D015415:Biomarkers; D002545:Brain Ischemia; D002540:Cerebral Cortex; D004195:Disease Models, Animal; D008297:Male; D051379:Mice; D016513:Mice, SCID; D058953:Neural Stem Cells; D055495:Neurogenesis; D061251:Primary Cell Culture; D017966:Pyramidal Cells | [
"D000818",
"D015415",
"D002545",
"D002540",
"D004195",
"D008297",
"D051379",
"D016513",
"D058953",
"D055495",
"D061251",
"D017966"
] | Ischemia-induced neural stem/progenitor cells express pyramidal cell markers. | Adult brain-derived neural stem cells have acquired a lot of interest as an endurable neuronal cell source that can be used for central nervous system repair in a wide range of neurological disorders such as ischemic stroke. Recently, we identified injury-induced neural stem/progenitor cells in the poststroke murine cerebral cortex. In this study, we show that, after differentiation in vitro, injury-induced neural stem/progenitor cells express pyramidal cell markers Emx1 and CaMKIIα, as well as mature neuron markers MAP2 and Tuj1. 5-bromo-2-deoxyuridinine-positive neurons in the peristroke cortex also express such pyramidal markers. The presence of newly regenerated pyramidal neurons in the poststroke brain might provide a noninvasive therapeutic strategy for stroke treatment with functional recovery. | 2,764,958 | true | Ischemia-induced neural stem/progenitor cells express pyramidal cell markers. Adult brain-derived neural stem cells have acquired a lot of interest as an endurable neuronal cell source that can be used for central nervous system repair in a wide range of neurological disorders such as ischemic stroke. Recently, we identified injury-induced neural stem/progenitor cells in the poststroke murine cerebral cortex. In this study, we show that, after differentiation in vitro, injury-induced neural stem/progenitor cells express pyramidal cell markers Emx1 and CaMKIIα, as well as mature neuron markers MAP2 and Tuj1. 5-bromo-2-deoxyuridinine-positive neurons in the peristroke cortex also express such pyramidal markers. The presence of newly regenerated pyramidal neurons in the poststroke brain might provide a noninvasive therapeutic strategy for stroke treatment with functional recovery. |
26,612,104 | D000013:Congenital Abnormalities; D019468:Disease Management; D042241:Early Diagnosis; D006439:Hemodynamics; D059446:Heterotaxy Syndrome; D006801:Humans; D011379:Prognosis | [
"D000013",
"D019468",
"D042241",
"D006439",
"D059446",
"D006801",
"D011379"
] | Cardiac and Non-Cardiac Abnormalities in Heterotaxy Syndrome. | Thoraco-abdominal viscera have unique morphological asymmetry, unlike the body's external organs. Heterotaxy syndrome is a disorder in which there is a loss of normal left to right asymmetry of thoraco-abdominal viscera and their naturally proscribed spatial relationship. It has multiple anatomical alterations, culminating into physiological and hemodynamic consequences. It is divided into two groups on the basis of morphology of the two atrial appendages. These subgroups are - 1) Isomerism of right atrial appendage (asplenia syndrome); 2) Isomerism of left atrial appendage (polysplenia syndrome); Patients from group I, usually have severe cardiac malformations and present early. They may have duct dependent lesions and eventually may undergo Fontan surgery. However, extracardiac anomalies are more common in group II. All the patients must be evaluated in detail to rule out anomalies like gut-malrotation. Patients must be provided with special care for their susceptibility to infection due to absence of spleen or presence of splenic malfunction. Majority of these patients may have genetic link and may present in families. Hence, genetic evaluation is necessary before assuming long term outcome. | 10,644,710 | true | Cardiac and Non-Cardiac Abnormalities in Heterotaxy Syndrome. Thoraco-abdominal viscera have unique morphological asymmetry, unlike the body's external organs. Heterotaxy syndrome is a disorder in which there is a loss of normal left to right asymmetry of thoraco-abdominal viscera and their naturally proscribed spatial relationship. It has multiple anatomical alterations, culminating into physiological and hemodynamic consequences. It is divided into two groups on the basis of morphology of the two atrial appendages. These subgroups are - 1) Isomerism of right atrial appendage (asplenia syndrome); 2) Isomerism of left atrial appendage (polysplenia syndrome); Patients from group I, usually have severe cardiac malformations and present early. They may have duct dependent lesions and eventually may undergo Fontan surgery. However, extracardiac anomalies are more common in group II. All the patients must be evaluated in detail to rule out anomalies like gut-malrotation. Patients must be provided with special care for their susceptibility to infection due to absence of spleen or presence of splenic malfunction. Majority of these patients may have genetic link and may present in families. Hence, genetic evaluation is necessary before assuming long term outcome. |
32,129,261 | D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured; D002543:Cerebral Hemorrhage; D005260:Female; D006406:Hematoma; D006784:Hospitals, Teaching; D006801:Humans; D007493:Iraq; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D020521:Stroke; D013345:Subarachnoid Hemorrhage | [
"D000328",
"D000368",
"D017542",
"D002543",
"D005260",
"D006406",
"D006784",
"D006801",
"D007493",
"D008297",
"D008875",
"D019635",
"D020521",
"D013345"
] | Surgical Intervention of Intracerebral Hematoma Caused by Ruptured Middle Cerebral Artery Aneurysm in Neurosurgery Teaching Hospital, Baghdad, Iraq. | BACKGROUND
The incidence of intracerebral hematoma among patients with aneurysmal subarachnoid hemorrhage is up to third of the cases (12%-35%). The presence of an aneurysm with ICH negatively influences the patient's presentation, course, and outcome, and may be associated with an increased re-hemorrhage rate, vasospasm, cerebral edema, and hydrocephalus. Aneurysm obliteration and hematoma evacuation have been associated with a favourable outcome.
OBJECTIVE
To explore the effectiveness and the prognostic factors for patients with middle cerebral artery aneurysm associated with intracerebral hematoma treated by early surgical clipping of the aneurysm with hematoma evacuation.
METHODS
We analysed 21 patients with intracerebral hematoma caused by ruptured middle cerebral artery aneurysm presented to the Neurosurgery teaching hospital from January 2017 to January 2019. Parameters included five broad categories: demographic, clinical, radiological, surgical, and outcome.
RESULTS
We found the following factors significantly related with unfavorable patient outcome: Preoperative cranial nerves deficit, dysphasia, severe contralateral weakness, presence of dilated ventricles in CT scan, presence of IVH in CT scan, aneurysm location in the dominant (left) hemisphere, high modified-Fisher grade, duration of surgery more than six hours, occurrence of intraoperative aneurysm rupture, poor postoperative GCS, occurrence postoperative vasospasm, more severe postoperative contralateral weakness, and the presence of postoperative seizure. While the good initial GCS and early surgery significantly related to favourable patient outcome.
CONCLUSIONS
Early surgical intervention of intracerebral hematoma caused by ruptured middle cerebral artery aneurysm has a favourable outcome in general and should be supported with consideration of the significant prognostic factors for each patient before the commencement of the surgery. | null | false | Surgical Intervention of Intracerebral Hematoma Caused by Ruptured Middle Cerebral Artery Aneurysm in Neurosurgery Teaching Hospital, Baghdad, Iraq. BACKGROUND
The incidence of intracerebral hematoma among patients with aneurysmal subarachnoid hemorrhage is up to third of the cases (12%-35%). The presence of an aneurysm with ICH negatively influences the patient's presentation, course, and outcome, and may be associated with an increased re-hemorrhage rate, vasospasm, cerebral edema, and hydrocephalus. Aneurysm obliteration and hematoma evacuation have been associated with a favourable outcome.
OBJECTIVE
To explore the effectiveness and the prognostic factors for patients with middle cerebral artery aneurysm associated with intracerebral hematoma treated by early surgical clipping of the aneurysm with hematoma evacuation.
METHODS
We analysed 21 patients with intracerebral hematoma caused by ruptured middle cerebral artery aneurysm presented to the Neurosurgery teaching hospital from January 2017 to January 2019. Parameters included five broad categories: demographic, clinical, radiological, surgical, and outcome.
RESULTS
We found the following factors significantly related with unfavorable patient outcome: Preoperative cranial nerves deficit, dysphasia, severe contralateral weakness, presence of dilated ventricles in CT scan, presence of IVH in CT scan, aneurysm location in the dominant (left) hemisphere, high modified-Fisher grade, duration of surgery more than six hours, occurrence of intraoperative aneurysm rupture, poor postoperative GCS, occurrence postoperative vasospasm, more severe postoperative contralateral weakness, and the presence of postoperative seizure. While the good initial GCS and early surgery significantly related to favourable patient outcome.
CONCLUSIONS
Early surgical intervention of intracerebral hematoma caused by ruptured middle cerebral artery aneurysm has a favourable outcome in general and should be supported with consideration of the significant prognostic factors for each patient before the commencement of the surgery. |
37,229,299 | D000328:Adult; D006801:Humans; D008875:Middle Aged; D003430:Cross-Sectional Studies; D059168:Carotid Intima-Media Thickness; D009549:Nigeria; D002339:Carotid Arteries; D014463:Ultrasonography; D050197:Atherosclerosis | [
"D000328",
"D006801",
"D008875",
"D003430",
"D059168",
"D009549",
"D002339",
"D014463",
"D050197"
] | Ultra sonographic indices of the carotid artery in healthy adult population of southwest, Nigeria: a cross-sectional study. | atherosclerosis develops insidiously, offering time and opportunities for early detection. Screening for subclinical atherosclerosis via structural wall changes and flow velocities among apparently healthy adults using carotid ultrasonography may help its early detection, offer timely intervention and reduce morbidity and mortality.
a cross-sectional study of 100 participants with a mean age of 56.1 ± 6.9 years, were enrolled from a community population. Both carotid arteries were examined for plaques, carotid intima-media thickness (CIMT), and flow velocities - peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) using 4-12MHz linear array transducer. Visceral obesity, serum lipids, and blood glucose were also evaluated and correlated with ultrasound findings.
the mean CIMT was 0.07 ± 0.02cm and 15% of the participants had increased CIMT. Statistically significance but weak correlations were observed between CIMT and FBG (r = 0.199, p = 0.047), EDV (r =0.204, p= 0.041), PI (r = -0.287, p = 0.004) and RI (r = -0.268, p =0.007). Statistically significance with modest correlations were observed between EDV and PSV (r = 0.48, p = 0.000), PI (r = -0.635, p = 0.000) and RI (r = -0.637, p = 0.000). The PI and RI showed strong correlation with statistical significance (r= 0.972, p = 0.000).
statistical significance in the flow velocities, derived flow indices and increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, ultrasonography may facilitate its early detection and possible prevention of complications. | null | false | Ultra sonographic indices of the carotid artery in healthy adult population of southwest, Nigeria: a cross-sectional study. atherosclerosis develops insidiously, offering time and opportunities for early detection. Screening for subclinical atherosclerosis via structural wall changes and flow velocities among apparently healthy adults using carotid ultrasonography may help its early detection, offer timely intervention and reduce morbidity and mortality.
a cross-sectional study of 100 participants with a mean age of 56.1 ± 6.9 years, were enrolled from a community population. Both carotid arteries were examined for plaques, carotid intima-media thickness (CIMT), and flow velocities - peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) using 4-12MHz linear array transducer. Visceral obesity, serum lipids, and blood glucose were also evaluated and correlated with ultrasound findings.
the mean CIMT was 0.07 ± 0.02cm and 15% of the participants had increased CIMT. Statistically significance but weak correlations were observed between CIMT and FBG (r = 0.199, p = 0.047), EDV (r =0.204, p= 0.041), PI (r = -0.287, p = 0.004) and RI (r = -0.268, p =0.007). Statistically significance with modest correlations were observed between EDV and PSV (r = 0.48, p = 0.000), PI (r = -0.635, p = 0.000) and RI (r = -0.637, p = 0.000). The PI and RI showed strong correlation with statistical significance (r= 0.972, p = 0.000).
statistical significance in the flow velocities, derived flow indices and increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, ultrasonography may facilitate its early detection and possible prevention of complications. |
1,411,000 | D003971:Diastole; D015150:Echocardiography, Doppler; D006331:Heart Diseases; D016277:Ventricular Function, Left | [
"D003971",
"D015150",
"D006331",
"D016277"
] | [Non-invasive assessment of left ventricular diastolic function disorder using Doppler echocardiography]. | Symptoms of a variety of cardiac diseases may well be caused predominantly by diastolic dysfunction, which appears to be one of the first detectable cardiac alterations. Diastole represents a complex interplay of multiple factors. Doppler echocardiography offers a noninvasive and relative simple method to assess left ventricular volumetric filling rates. The pulsed-wave Doppler method enables us to measure mitral flow velocities. Two distinct mitral flow velocity patterns have been recognized for situations with diastolic dysfunction. The pattern of delayed relaxation was reported in primary and in secondary left ventricular hypertrophy, myocardial ischemia and infarction and in dilated cardiomyopathy. The pattern of increased stiffness was described in constrictive pericarditis, restrictive processes and in heart transplant rejection. Doppler echocardiography has shown to be a helpful diagnostic tool, but a number of factors influencing mitral flow measurements have to be considered in each case, as there are age, heart rate, loading conditions and mitral regurgitation. Further studies are needed with respect to future control of therapeutic interventions and prognostic statements. | null | false | [Non-invasive assessment of left ventricular diastolic function disorder using Doppler echocardiography]. Symptoms of a variety of cardiac diseases may well be caused predominantly by diastolic dysfunction, which appears to be one of the first detectable cardiac alterations. Diastole represents a complex interplay of multiple factors. Doppler echocardiography offers a noninvasive and relative simple method to assess left ventricular volumetric filling rates. The pulsed-wave Doppler method enables us to measure mitral flow velocities. Two distinct mitral flow velocity patterns have been recognized for situations with diastolic dysfunction. The pattern of delayed relaxation was reported in primary and in secondary left ventricular hypertrophy, myocardial ischemia and infarction and in dilated cardiomyopathy. The pattern of increased stiffness was described in constrictive pericarditis, restrictive processes and in heart transplant rejection. Doppler echocardiography has shown to be a helpful diagnostic tool, but a number of factors influencing mitral flow measurements have to be considered in each case, as there are age, heart rate, loading conditions and mitral regurgitation. Further studies are needed with respect to future control of therapeutic interventions and prognostic statements. |
27,532,799 | D000368:Aged; D002681:China; D003680:Deglutition Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D020521:Stroke; D062606:Tertiary Care Centers | [
"D000368",
"D002681",
"D003680",
"D005260",
"D006801",
"D008297",
"D008875",
"D010351",
"D020521",
"D062606"
] | Nursing management of post-stroke dysphagia in a tertiary hospital: a best practice implementation project. | Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological conditions such as stroke. Nurses, who are available to patients 24 hours a day in hospital are in an ideal position to identify individuals with swallowing difficulties and initiate interventions that may prevent further complications until a formal assessment can be undertaken.
The aim of this evidence implementation project was to improve nursing management of dysphagia in acute stroke patients and prevent the occurrence of aspiration in patients admitted to the neurology ward of Huashan Hospital, Fudan University, Shanghai.
This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools. The same six audit criteria were used for the baseline and the follow-up clinical audits. The baseline audit was followed by the implementation of strategies targeted to address the identified barriers and the follow-up audit evaluated changes in practice. The same sample size (20 nurses and 30 patients) was used for both audits.
Improvements in practice were observed for all six audit criteria. The result of the post-implementation audit showed 100% compliance for the following recommendations: use of a validated tool, nurse-initiated dysphagia screening, appropriate referral to Speech and Language Therapy and education for nurses on dysphagia screening. The lowest compliance rate was for criterion 4 (patient education before discharge), which was 80%. The compliance rate for criterion 3 (screening within 24 hours from admission) was 93%.
This project has demonstrated significant improvements in nursing practice related to dysphagia screening and management. The project was successful not only in increasing the knowledge and skills of nurses but also in implementing a formalized process for dysphagia screening and referral. Strategies to sustain practice change should be developed, and regular audit cycles need to be carried out to monitor the process and evaluate outcomes. | null | false | Nursing management of post-stroke dysphagia in a tertiary hospital: a best practice implementation project. Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological conditions such as stroke. Nurses, who are available to patients 24 hours a day in hospital are in an ideal position to identify individuals with swallowing difficulties and initiate interventions that may prevent further complications until a formal assessment can be undertaken.
The aim of this evidence implementation project was to improve nursing management of dysphagia in acute stroke patients and prevent the occurrence of aspiration in patients admitted to the neurology ward of Huashan Hospital, Fudan University, Shanghai.
This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools. The same six audit criteria were used for the baseline and the follow-up clinical audits. The baseline audit was followed by the implementation of strategies targeted to address the identified barriers and the follow-up audit evaluated changes in practice. The same sample size (20 nurses and 30 patients) was used for both audits.
Improvements in practice were observed for all six audit criteria. The result of the post-implementation audit showed 100% compliance for the following recommendations: use of a validated tool, nurse-initiated dysphagia screening, appropriate referral to Speech and Language Therapy and education for nurses on dysphagia screening. The lowest compliance rate was for criterion 4 (patient education before discharge), which was 80%. The compliance rate for criterion 3 (screening within 24 hours from admission) was 93%.
This project has demonstrated significant improvements in nursing practice related to dysphagia screening and management. The project was successful not only in increasing the knowledge and skills of nurses but also in implementing a formalized process for dysphagia screening and referral. Strategies to sustain practice change should be developed, and regular audit cycles need to be carried out to monitor the process and evaluate outcomes. |
25,562,186 | D000368:Aged; D015415:Biomarkers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D000067759:Receptor for Advanced Glycation End Products; D013318:Stroke Volume; D016277:Ventricular Function, Left | [
"D000368",
"D015415",
"D005260",
"D006801",
"D008297",
"D008875",
"D009203",
"D062645",
"D011446",
"D000067759",
"D013318",
"D016277"
] | Dynamic changes in sRAGE levels and relationship with cardiac function in STEMI patients. | OBJECTIVE
Soluble receptor of advanced glycation end-products (sRAGE) may be a predictive biomarker in coronary artery disease (CAD). Patients with acute myocardial infarction (AMI) have higher sRAGE levels compared to healthy subjects. Accordingly, the aim of this study was to investigate the dynamic changes in sRAGE levels during AMI and relationship with cardiac dysfunction.
METHODS
We prospectively included 80 patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). sRAGE concentrations were measured before pPCI, immediately after pPCI and again on the first and second following days. Left ventricular ejection fraction (LVEF) was evaluated 1-3 days after the pPCI and again at a median of 7months by echocardiography, and infarct size was measured by cardiac magnetic resonance.
RESULTS
sRAGE levels were high in the early phase of AMI; sRAGE levels significantly increased after pPCI compared with sRAGE before pPCI (median ratio: 1.25, 95% CI: 1.15-1.35, P<0.001), and the increase was observed prior to Troponin I (TnI). sRAGE levels decreased notably the first day after pPCI (median ratio: 0.34, 95% CI: 0.30-0.39, P<0.001). Peak sRAGE independently associated with long-term cardiac dysfunction estimated by LVEF (P=0.008). Furthermore, sRAGE measured after pPCI associated with infarct size (P=0.038).
CONCLUSIONS
sRAGE levels were high in the early phase rather than in the days after AMI and pPCI. The increase in sRAGE was seen before detectable changes in TnI. In addition, sRAGE was independently associated with long-term cardiac dysfunction. | null | false | Dynamic changes in sRAGE levels and relationship with cardiac function in STEMI patients. OBJECTIVE
Soluble receptor of advanced glycation end-products (sRAGE) may be a predictive biomarker in coronary artery disease (CAD). Patients with acute myocardial infarction (AMI) have higher sRAGE levels compared to healthy subjects. Accordingly, the aim of this study was to investigate the dynamic changes in sRAGE levels during AMI and relationship with cardiac dysfunction.
METHODS
We prospectively included 80 patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). sRAGE concentrations were measured before pPCI, immediately after pPCI and again on the first and second following days. Left ventricular ejection fraction (LVEF) was evaluated 1-3 days after the pPCI and again at a median of 7months by echocardiography, and infarct size was measured by cardiac magnetic resonance.
RESULTS
sRAGE levels were high in the early phase of AMI; sRAGE levels significantly increased after pPCI compared with sRAGE before pPCI (median ratio: 1.25, 95% CI: 1.15-1.35, P<0.001), and the increase was observed prior to Troponin I (TnI). sRAGE levels decreased notably the first day after pPCI (median ratio: 0.34, 95% CI: 0.30-0.39, P<0.001). Peak sRAGE independently associated with long-term cardiac dysfunction estimated by LVEF (P=0.008). Furthermore, sRAGE measured after pPCI associated with infarct size (P=0.038).
CONCLUSIONS
sRAGE levels were high in the early phase rather than in the days after AMI and pPCI. The increase in sRAGE was seen before detectable changes in TnI. In addition, sRAGE was independently associated with long-term cardiac dysfunction. |
23,271,640 | D000818:Animals; D015153:Blotting, Western; D019208:Brain-Derived Neurotrophic Factor; D016022:Case-Control Studies; D053148:Caspase 3; D003710:Demography; D003921:Diabetes Mellitus, Experimental; D003930:Diabetic Retinopathy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051381:Rats; D020813:Receptor, trkB; D012160:Retina | [
"D000818",
"D015153",
"D019208",
"D016022",
"D053148",
"D003710",
"D003921",
"D003930",
"D005260",
"D006801",
"D008297",
"D008875",
"D051381",
"D020813",
"D012160"
] | Reduced levels of brain derived neurotrophic factor (BDNF) in the serum of diabetic retinopathy patients and in the retina of diabetic rats. | Diabetic retinopathy (DR) is widely recognized as a neurovascular disease. Retina, being a neuronal tissue of the eye, produces neurotrophic factors for its maintenance. However, diabetes dysregulates their levels and thereby may damage the retina. Among neurotrophins, brain derived neurotrophic factor (BDNF) is the most abundant in the retina. In this study, we investigated the level of BDNF in the serum of patients with DR and also in the serum and retina of streptozotocin-induced diabetic rats. The level of BDNF was significantly decreased in the serum of proliferative diabetic retinopathy patients as compared to that of non-diabetic healthy controls (25.5 ± 8.5-10.0 ± 8.1 ng/ml, p < 0.001) as well as compared to that of diabetic patients with no retinopathy (21.8 ± 4.7-10.0 ± 8.1 ng/ml, p < 0.001), as measured by ELISA techniques. The levels of BDNF in the serum and retina of diabetic rats were also significantly reduced compared to that of non-diabetic controls (p < 0.05). In addition, the expression level of tropomyosin-related kinase B (TrkB) was significantly decreased in diabetic rat retina compared to that of non-diabetic controls as determined by Western blotting technique. Caspase-3 activity was increased in diabetic rat retina after 3 weeks of diabetes and remained elevated until 10 weeks, which negatively correlated with the level of BDNF (r = -0.544, p = 0.013). Our results indicate that reduced levels of BDNF in diabetes may cause apoptosis and neurodegeneration early in diabetic retina, which may lead to neuro-vascular damage later in DR. | 10,429,051 | true | Reduced levels of brain derived neurotrophic factor (BDNF) in the serum of diabetic retinopathy patients and in the retina of diabetic rats. Diabetic retinopathy (DR) is widely recognized as a neurovascular disease. Retina, being a neuronal tissue of the eye, produces neurotrophic factors for its maintenance. However, diabetes dysregulates their levels and thereby may damage the retina. Among neurotrophins, brain derived neurotrophic factor (BDNF) is the most abundant in the retina. In this study, we investigated the level of BDNF in the serum of patients with DR and also in the serum and retina of streptozotocin-induced diabetic rats. The level of BDNF was significantly decreased in the serum of proliferative diabetic retinopathy patients as compared to that of non-diabetic healthy controls (25.5 ± 8.5-10.0 ± 8.1 ng/ml, p < 0.001) as well as compared to that of diabetic patients with no retinopathy (21.8 ± 4.7-10.0 ± 8.1 ng/ml, p < 0.001), as measured by ELISA techniques. The levels of BDNF in the serum and retina of diabetic rats were also significantly reduced compared to that of non-diabetic controls (p < 0.05). In addition, the expression level of tropomyosin-related kinase B (TrkB) was significantly decreased in diabetic rat retina compared to that of non-diabetic controls as determined by Western blotting technique. Caspase-3 activity was increased in diabetic rat retina after 3 weeks of diabetes and remained elevated until 10 weeks, which negatively correlated with the level of BDNF (r = -0.544, p = 0.013). Our results indicate that reduced levels of BDNF in diabetes may cause apoptosis and neurodegeneration early in diabetic retina, which may lead to neuro-vascular damage later in DR. |
36,512,889 | D006801:Humans; D000368:Aged; D015331:Cohort Studies; D011446:Prospective Studies; D000094362:Sleep Duration; D018070:Biological Specimen Banks; D000095225:East Asian People; D012890:Sleep; D020521:Stroke; D006973:Hypertension; D012307:Risk Factors; D002681:China | [
"D006801",
"D000368",
"D015331",
"D011446",
"D000094362",
"D018070",
"D000095225",
"D012890",
"D020521",
"D006973",
"D012307",
"D002681"
] | Association of sleep duration and napping with stroke mortality in older Chinese: A 14-year prospective cohort study of the Guangzhou Biobank Cohort study. | Evidence regarding the association of short sleep duration and napping with stroke remains limited and controversial. We examined the association of sleep duration and napping with risk of stroke mortality in an older Chinese cohort.
Sleep duration and daytime napping were assessed by face-to-face interview during 2003-2008. Information of causes of death until April 30, 2021 was collected via record linkage with the Death Registry. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).
Of 27,254 participants aged average 62.0 (standard deviation = 7.1) years, 818 stroke deaths occurred within 388,798 person-years (mean = 14.3 years) of follow-up. A U-shaped relation between sleep duration and risk of stroke mortality was observed. Participants with short (≤5 h/day) or long sleep duration (≥9 h/day) showed higher risks of total stroke mortality, with adjusted HRs (95% CIs) being 1.27 (1.01-1.59) and 1.37 (1.07-1.75), respectively. However, non-significant association of short or long sleep duration with hemorrhagic or ischemic stroke mortality was found. The associations of short and long sleep duration with total stroke mortality were more pronounced in those with hypertension (P for interaction with hypertension = 0.01), with HRs (95% CIs) being 1.37 (1.04-1.82) and 1.77 (1.33-2.36), respectively. No association between napping and risk of stroke mortality was found.
Both short and long sleep duration, but not daytime napping, were associated with higher risk of stroke mortality. Public health messages to encourage good sleep hygiene may be important, especially for people with hypertension. | null | false | Association of sleep duration and napping with stroke mortality in older Chinese: A 14-year prospective cohort study of the Guangzhou Biobank Cohort study. Evidence regarding the association of short sleep duration and napping with stroke remains limited and controversial. We examined the association of sleep duration and napping with risk of stroke mortality in an older Chinese cohort.
Sleep duration and daytime napping were assessed by face-to-face interview during 2003-2008. Information of causes of death until April 30, 2021 was collected via record linkage with the Death Registry. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).
Of 27,254 participants aged average 62.0 (standard deviation = 7.1) years, 818 stroke deaths occurred within 388,798 person-years (mean = 14.3 years) of follow-up. A U-shaped relation between sleep duration and risk of stroke mortality was observed. Participants with short (≤5 h/day) or long sleep duration (≥9 h/day) showed higher risks of total stroke mortality, with adjusted HRs (95% CIs) being 1.27 (1.01-1.59) and 1.37 (1.07-1.75), respectively. However, non-significant association of short or long sleep duration with hemorrhagic or ischemic stroke mortality was found. The associations of short and long sleep duration with total stroke mortality were more pronounced in those with hypertension (P for interaction with hypertension = 0.01), with HRs (95% CIs) being 1.37 (1.04-1.82) and 1.77 (1.33-2.36), respectively. No association between napping and risk of stroke mortality was found.
Both short and long sleep duration, but not daytime napping, were associated with higher risk of stroke mortality. Public health messages to encourage good sleep hygiene may be important, especially for people with hypertension. |
22,875,486 | D015415:Biomarkers; D018450:Disease Progression; D006333:Heart Failure; D006801:Humans; D006962:Hyperparathyroidism, Secondary; D010281:Parathyroid Hormone; D011237:Predictive Value of Tests; D011379:Prognosis; D012084:Renin-Angiotensin System; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index | [
"D015415",
"D018450",
"D006333",
"D006801",
"D006962",
"D010281",
"D011237",
"D011379",
"D012084",
"D018570",
"D012307",
"D012680",
"D012720"
] | Can parathyroid hormone be used as a biomarker for heart failure? | Secondary hyperparathyroidism in heart failure is a consequence of renin-angiotensin-aldosterone activation, chronic hyperaldosteronism, and loop diuretic usage, resulting in calcium excretion. The result is an inflammatory state with adverse effects on myocardial remodeling and systemic complications. Recent literature has suggested that elevated parathyroid hormone predicts adverse outcomes in patients with heart failure independent of serum calcium and phosphate, vitamin D deficiency, and renal insufficiency. Parathyroid hormone has been correlated with elevated brain natriuretic peptide levels, an established biomarker of heart failure severity. There are several limitations to the utilization of parathyroid hormone as a biomarker for heart failure, and further prospective studies need to be conducted to assess the value of multiple parathyroid hormone measurements over time and elucidate the role of parathyroid hormone in diastolic dysfunction. Pending further validation, there is promise for parathyroid hormone as a complementary biomarker in heart failure. | 6,448,438 | true | Can parathyroid hormone be used as a biomarker for heart failure? Secondary hyperparathyroidism in heart failure is a consequence of renin-angiotensin-aldosterone activation, chronic hyperaldosteronism, and loop diuretic usage, resulting in calcium excretion. The result is an inflammatory state with adverse effects on myocardial remodeling and systemic complications. Recent literature has suggested that elevated parathyroid hormone predicts adverse outcomes in patients with heart failure independent of serum calcium and phosphate, vitamin D deficiency, and renal insufficiency. Parathyroid hormone has been correlated with elevated brain natriuretic peptide levels, an established biomarker of heart failure severity. There are several limitations to the utilization of parathyroid hormone as a biomarker for heart failure, and further prospective studies need to be conducted to assess the value of multiple parathyroid hormone measurements over time and elucidate the role of parathyroid hormone in diastolic dysfunction. Pending further validation, there is promise for parathyroid hormone as a complementary biomarker in heart failure. |
36,209,257 | D006801:Humans; D051379:Mice; D000818:Animals; D061988:Proteasome Inhibitors; D009101:Multiple Myeloma; D056921:Nuclear Receptor Coactivator 3; D045744:Cell Line, Tumor; D003546:Cysteine Endopeptidases; D019008:Drug Resistance, Neoplasm; D054875:Ubiquitination; D000860:Hypoxia; D059016:Tumor Microenvironment | [
"D006801",
"D051379",
"D000818",
"D061988",
"D009101",
"D056921",
"D045744",
"D003546",
"D019008",
"D054875",
"D000860",
"D059016"
] | Hypoxia induces chemoresistance to proteasome inhibitors through orchestrating deSUMOylation and ubiquitination of SRC-3 in multiple myeloma. | The bone marrow microenvironment in multiple myeloma (MM) is hypoxic and provides multi-advantages for the initiation of chemoresistance, but the underlying mechanisms and key regulators are still indistinct. In the current study, we found that hypoxia stimulus easily induced chemoresistance to proteasome inhibitors (PIs), and the steroid receptor coactivator 3 (SRC-3) expression was remarkably augmented at posttranslational level. Protein interactome analysis identified SENP1 as a key modifier of SRC-3 stability, as SENP1-mediated deSUMOylation attenuated the K11-linked polyubiquitination of SRC-3. SENP1 depletion in the SENP1fl/flCD19Cre/+ B cells showed impaired SRC3 stability, and knockdown of SENP1 in MM cells by CRISPR/cas9 sgRNA accelerated the degradation of SRC-3 and remarkably overcame the resistance to PIs. In the Vk*Myc and 5TGM1 mouse models as well as patient-derived xenograft (PDX) of myeloma, SENP1 inhibitor Momordin Ιc (Mc) increased the sensitivity to PIs in MM cells. Importantly, SENP1 level was positively correlated with SRC-3 level in the tissues from refractory/relapsed MM, as well as in xenograft tissues from mice treated with bortezomib and Mc. Taken together, our findings suggest that hypoxia-induced SENP1 is a crucial regulator of chemoresistance to PIs, and shed light on developing therapeutic strategies to overcome chemoresistance by using small molecules targeting SENP1 or SRC-3. | null | false | Hypoxia induces chemoresistance to proteasome inhibitors through orchestrating deSUMOylation and ubiquitination of SRC-3 in multiple myeloma. The bone marrow microenvironment in multiple myeloma (MM) is hypoxic and provides multi-advantages for the initiation of chemoresistance, but the underlying mechanisms and key regulators are still indistinct. In the current study, we found that hypoxia stimulus easily induced chemoresistance to proteasome inhibitors (PIs), and the steroid receptor coactivator 3 (SRC-3) expression was remarkably augmented at posttranslational level. Protein interactome analysis identified SENP1 as a key modifier of SRC-3 stability, as SENP1-mediated deSUMOylation attenuated the K11-linked polyubiquitination of SRC-3. SENP1 depletion in the SENP1fl/flCD19Cre/+ B cells showed impaired SRC3 stability, and knockdown of SENP1 in MM cells by CRISPR/cas9 sgRNA accelerated the degradation of SRC-3 and remarkably overcame the resistance to PIs. In the Vk*Myc and 5TGM1 mouse models as well as patient-derived xenograft (PDX) of myeloma, SENP1 inhibitor Momordin Ιc (Mc) increased the sensitivity to PIs in MM cells. Importantly, SENP1 level was positively correlated with SRC-3 level in the tissues from refractory/relapsed MM, as well as in xenograft tissues from mice treated with bortezomib and Mc. Taken together, our findings suggest that hypoxia-induced SENP1 is a crucial regulator of chemoresistance to PIs, and shed light on developing therapeutic strategies to overcome chemoresistance by using small molecules targeting SENP1 or SRC-3. |
23,154,756 | D000818:Animals; D002339:Carotid Arteries; D049109:Cell Proliferation; D003094:Collagen; D003187:Compliance; D004195:Disease Models, Animal; D004549:Elastin; D005109:Extracellular Matrix; D005260:Female; D005317:Fetal Growth Retardation; D005865:Gestational Age; D006025:Glycosaminoglycans; D006973:Hypertension; D008297:Male; D011247:Pregnancy; D012756:Sheep; D014469:Umbilical Arteries; D059289:Vascular Stiffness | [
"D000818",
"D002339",
"D049109",
"D003094",
"D003187",
"D004195",
"D004549",
"D005109",
"D005260",
"D005317",
"D005865",
"D006025",
"D006973",
"D008297",
"D011247",
"D012756",
"D014469",
"D059289"
] | Increased arterial stiffness and extracellular matrix reorganization in intrauterine growth-restricted fetal sheep. | BACKGROUND
Fetal intrauterine growth restriction (IUGR) results in increased placental resistance to blood flow, fetal hypertension, and increased pulsatility stresses shown to lead to vascular remodeling. We tested our hypothesis that IUGR causes decreased compliance in the carotid and umbilical arteries due to altered extracellular matrix (ECM) composition and structure.
METHODS
A sheep model of placental insufficiency-induced IUGR (PI-IUGR) was created by exposure of the pregnant ewe to elevated ambient temperatures. Umbilical and carotid arteries from near-term fetuses were tested with pressure-diameter measurements to compare passive compliance in control and PI-IUGR tissues. ECM composition was measured via biochemical assay, and the organization was determined by using histology and second-harmonic generation imaging.
RESULTS
We found that PI-IUGR increased arterial stiffness with increased collagen engagement, or transition stretch. PI-IUGR carotid arteries exhibited increased collagen and elastin quantity, and PI-IUGR umbilical arteries exhibited increased sulfated glycosaminoglycans. Histomorphology showed altered collagen-to-elastin ratios with altered cellular proliferation. Increased stiffness indicates altered collagen-to-elastin ratios with less elastin contribution leading to increased collagen engagement.
CONCLUSIONS
Because vessel stiffness is a significant predictor in the development of hypertension, disrupted ECM deposition in IUGR provides a potential link between IUGR and adult hypertension. | null | false | Increased arterial stiffness and extracellular matrix reorganization in intrauterine growth-restricted fetal sheep. BACKGROUND
Fetal intrauterine growth restriction (IUGR) results in increased placental resistance to blood flow, fetal hypertension, and increased pulsatility stresses shown to lead to vascular remodeling. We tested our hypothesis that IUGR causes decreased compliance in the carotid and umbilical arteries due to altered extracellular matrix (ECM) composition and structure.
METHODS
A sheep model of placental insufficiency-induced IUGR (PI-IUGR) was created by exposure of the pregnant ewe to elevated ambient temperatures. Umbilical and carotid arteries from near-term fetuses were tested with pressure-diameter measurements to compare passive compliance in control and PI-IUGR tissues. ECM composition was measured via biochemical assay, and the organization was determined by using histology and second-harmonic generation imaging.
RESULTS
We found that PI-IUGR increased arterial stiffness with increased collagen engagement, or transition stretch. PI-IUGR carotid arteries exhibited increased collagen and elastin quantity, and PI-IUGR umbilical arteries exhibited increased sulfated glycosaminoglycans. Histomorphology showed altered collagen-to-elastin ratios with altered cellular proliferation. Increased stiffness indicates altered collagen-to-elastin ratios with less elastin contribution leading to increased collagen engagement.
CONCLUSIONS
Because vessel stiffness is a significant predictor in the development of hypertension, disrupted ECM deposition in IUGR provides a potential link between IUGR and adult hypertension. |
34,481,024 | D000818:Animals; D000925:Anticoagulants; D001792:Blood Platelets; D006629:Hirudins; D051379:Mice; D011355:Prodrugs; D051381:Rats; D013927:Thrombosis | [
"D000818",
"D000925",
"D001792",
"D006629",
"D051379",
"D011355",
"D051381",
"D013927"
] | Engineering a "three-in-one" hirudin prodrug to reduce bleeding risk: A proof-of-concept study. | An ideal anticoagulant should have at least three properties including targeted delivery to the thrombosis site, local activation or releasing to centralize the anti-thrombosis effects and thus reduce the bleeding risks, and long persistence in circulation to avoid repeated administration. In the present study, we sought to test a "three-in-one" strategy to design new protein anticoagulants. Based on these criteria, we constructed two hirudin prodrugs, R824-HV-ABD and ABD-HV-R824. The R824 peptide can bind phosphatidylserine on the surface of the procoagulant platelets and thus guide the prodrug to the thrombosis sites; albumin-binding domain (ABDs) can bind the prodrug to albumin, and thereby increase its persistence in circulation; the hirudin (HV) core in the prodrug is flanked by factor Xa recognition sites, thus factor Xa at the thrombosis site can cleave the fusion proteins and release the activated hirudin locally. Hirudin prodrugs were able to bind with procoagulant platelets and human serum albumin in vitro with high affinity, targeted concentrated and prevented the formation of occlusive thrombi in rat carotid artery injury model. Their effective time was significantly extended compared to native hirudin, and R824-HV-ABD showed a significantly improved half-life of about 24 h in rats. The bleeding time of prodrug-treated mice was much shorter than that of hirudin-treated mice. The results from the proof-of-concept studies, for the first time, demonstrate that "three-in-one" prodrug strategy may be a good solution for protein or peptide anticoagulants to reduce their bleeding risks. | 13,594,207 | true | Engineering a "three-in-one" hirudin prodrug to reduce bleeding risk: A proof-of-concept study. An ideal anticoagulant should have at least three properties including targeted delivery to the thrombosis site, local activation or releasing to centralize the anti-thrombosis effects and thus reduce the bleeding risks, and long persistence in circulation to avoid repeated administration. In the present study, we sought to test a "three-in-one" strategy to design new protein anticoagulants. Based on these criteria, we constructed two hirudin prodrugs, R824-HV-ABD and ABD-HV-R824. The R824 peptide can bind phosphatidylserine on the surface of the procoagulant platelets and thus guide the prodrug to the thrombosis sites; albumin-binding domain (ABDs) can bind the prodrug to albumin, and thereby increase its persistence in circulation; the hirudin (HV) core in the prodrug is flanked by factor Xa recognition sites, thus factor Xa at the thrombosis site can cleave the fusion proteins and release the activated hirudin locally. Hirudin prodrugs were able to bind with procoagulant platelets and human serum albumin in vitro with high affinity, targeted concentrated and prevented the formation of occlusive thrombi in rat carotid artery injury model. Their effective time was significantly extended compared to native hirudin, and R824-HV-ABD showed a significantly improved half-life of about 24 h in rats. The bleeding time of prodrug-treated mice was much shorter than that of hirudin-treated mice. The results from the proof-of-concept studies, for the first time, demonstrate that "three-in-one" prodrug strategy may be a good solution for protein or peptide anticoagulants to reduce their bleeding risks. |
11,529,254 | D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results | [
"D000368",
"D000369",
"D001281",
"D018660",
"D005260",
"D006801",
"D006973",
"D008297",
"D008875",
"D015203"
] | [Is ambulatory blood pressure monitoring reliable in hypertensive patients with atrial fibrillation?]. | Atrial fibrillation (AF) is commonly seen in patients (pts) with systemic hypertension. They are usually excluded from ambulatory blood pressure monitoring (ABPM) because its accuracy is unknown. The aim of our study was to determine if ABPM can be used to assess 24 hour BP in pts with AF. We included hypertensive pts with chronic (> 6 months) AF, controlled heart rate (60-100 c.p.m), under therapy and also hypertensive pts in sinus rhythm (control group--CG). They were submitted to 24 hour ABPM (Spacelabs 90207). Manual BP with a standard mercury sphygmomanometer was taken during 3 visits (office BP) and on the day of ambulatory monitoring. Simultaneous measurements with a T-Tube were also performed. Thirty pts with chronic AF (63% males), mean age 73 +/- 8 years (52-85) and 18 pts in sinus rhythm (CG) were studied. The age, gender, office BP, ambulatory BP and proportion of successful measurements was similar in the 2 groups. In CG systolic and diastolic office BP did not differ from day ambulatory BP (148 +/- 14/84 +/- 7 vs 138 +/- 18/76 +/- 11 mmHg) and the same was seen in pts in AF (table). In this group, only the systolic BP taken immediately before the ambulatory device was put on, was significantly different from day ambulatory BP (148 +/- 21 vs 137 +/- 19 mmHg, p = 0.04). The proportion of successful measurements in AF group was 94 +/- 8 (65-98) with 93% > 80%. In 64 simultaneous measurements the differences were 6 +/- 5 and 5 +/- 5 mmHg for systolic and diastolic BP. Casual and ambulatory heart rate was also similar in the two groups (76 +/- 7/76 +/- 12--AF group; 78 +/- 10/78 +/- 8--control group). In conclusion, this study demonstrates that ABPM can be used to assess BP in patients with atrial fibrillation. There was a high percentage of successful recordings (93%). As in patients in sinus rhythm, there was no significantly difference in mean office blood pressure and daytime ambulatory blood pressure. | null | false | [Is ambulatory blood pressure monitoring reliable in hypertensive patients with atrial fibrillation?]. Atrial fibrillation (AF) is commonly seen in patients (pts) with systemic hypertension. They are usually excluded from ambulatory blood pressure monitoring (ABPM) because its accuracy is unknown. The aim of our study was to determine if ABPM can be used to assess 24 hour BP in pts with AF. We included hypertensive pts with chronic (> 6 months) AF, controlled heart rate (60-100 c.p.m), under therapy and also hypertensive pts in sinus rhythm (control group--CG). They were submitted to 24 hour ABPM (Spacelabs 90207). Manual BP with a standard mercury sphygmomanometer was taken during 3 visits (office BP) and on the day of ambulatory monitoring. Simultaneous measurements with a T-Tube were also performed. Thirty pts with chronic AF (63% males), mean age 73 +/- 8 years (52-85) and 18 pts in sinus rhythm (CG) were studied. The age, gender, office BP, ambulatory BP and proportion of successful measurements was similar in the 2 groups. In CG systolic and diastolic office BP did not differ from day ambulatory BP (148 +/- 14/84 +/- 7 vs 138 +/- 18/76 +/- 11 mmHg) and the same was seen in pts in AF (table). In this group, only the systolic BP taken immediately before the ambulatory device was put on, was significantly different from day ambulatory BP (148 +/- 21 vs 137 +/- 19 mmHg, p = 0.04). The proportion of successful measurements in AF group was 94 +/- 8 (65-98) with 93% > 80%. In 64 simultaneous measurements the differences were 6 +/- 5 and 5 +/- 5 mmHg for systolic and diastolic BP. Casual and ambulatory heart rate was also similar in the two groups (76 +/- 7/76 +/- 12--AF group; 78 +/- 10/78 +/- 8--control group). In conclusion, this study demonstrates that ABPM can be used to assess BP in patients with atrial fibrillation. There was a high percentage of successful recordings (93%). As in patients in sinus rhythm, there was no significantly difference in mean office blood pressure and daytime ambulatory blood pressure. |
24,612,637 | D003299:Cooperative Behavior; D004739:England; D006801:Humans; D036301:Qualitative Research; D058996:Quality Improvement; D020521:Stroke | [
"D003299",
"D004739",
"D006801",
"D036301",
"D058996",
"D020521"
] | How collaborative are quality improvement collaboratives: a qualitative study in stroke care. | BACKGROUND
Quality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. Our study drew in part on the literature on collective action and inter-organizational collaboration. This literature has been relatively neglected in evaluations of QICs, even though they are founded on principles of co-operation and sharing.
METHODS
We interviewed 32 professionals in hospitals that participated in Stroke 90:10, conducted a focus group with the QIC faculty team, and reviewed purposively sampled documents including reports and newsletters. Analysis was based on a modified form of Framework Analysis, combining sensitizing constructs derived from the literature and new, empirically derived thematic categories.
RESULTS
Improvements in stroke care were attributed to QIC participation by many professionals. They described how the QIC fostered a sense of community and increased attention to stroke care within their organizations. However, participants' experiences of the QIC varied. Starting positions were different; some organizations were achieving higher levels of performance than others before the QIC began, and some had more pre-existing experience of quality improvement methods. Some participants had more to learn, others more to teach. Some evidence of free-riding was found. Benchmarking improvement was variously experienced as friendly rivalry or as time-consuming and stressful. Participants' competitive desire to demonstrate success sometimes conflicted with collaborative aims; some experienced competing organizational pressures or saw the QIC as duplication of effort. Experiences of inter-organizational collaboration were influenced by variations in intra-organizational support.
CONCLUSIONS
Collaboration is not the only mode of behavior likely to occur within a QIC. Our study revealed a mixed picture of collaboration, free-riding and competition. QICs should learn from work on the challenges of collective action; set realistic goals; account for context; ensure sufficient time and resources are made available; and carefully manage the collaborative to mitigate the risks of collaborative inertia and unhelpful competitive or anti-cooperative behaviors. Individual organizations should assess the costs and benefits of collaboration as a means of attaining quality improvement. | null | false | How collaborative are quality improvement collaboratives: a qualitative study in stroke care. BACKGROUND
Quality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. Our study drew in part on the literature on collective action and inter-organizational collaboration. This literature has been relatively neglected in evaluations of QICs, even though they are founded on principles of co-operation and sharing.
METHODS
We interviewed 32 professionals in hospitals that participated in Stroke 90:10, conducted a focus group with the QIC faculty team, and reviewed purposively sampled documents including reports and newsletters. Analysis was based on a modified form of Framework Analysis, combining sensitizing constructs derived from the literature and new, empirically derived thematic categories.
RESULTS
Improvements in stroke care were attributed to QIC participation by many professionals. They described how the QIC fostered a sense of community and increased attention to stroke care within their organizations. However, participants' experiences of the QIC varied. Starting positions were different; some organizations were achieving higher levels of performance than others before the QIC began, and some had more pre-existing experience of quality improvement methods. Some participants had more to learn, others more to teach. Some evidence of free-riding was found. Benchmarking improvement was variously experienced as friendly rivalry or as time-consuming and stressful. Participants' competitive desire to demonstrate success sometimes conflicted with collaborative aims; some experienced competing organizational pressures or saw the QIC as duplication of effort. Experiences of inter-organizational collaboration were influenced by variations in intra-organizational support.
CONCLUSIONS
Collaboration is not the only mode of behavior likely to occur within a QIC. Our study revealed a mixed picture of collaboration, free-riding and competition. QICs should learn from work on the challenges of collective action; set realistic goals; account for context; ensure sufficient time and resources are made available; and carefully manage the collaborative to mitigate the risks of collaborative inertia and unhelpful competitive or anti-cooperative behaviors. Individual organizations should assess the costs and benefits of collaboration as a means of attaining quality improvement. |
21,825,233 | D000818:Animals; D001253:Astrocytes; D002490:Central Nervous System; D004452:Echocardiography; D055785:Gene Knockdown Techniques; D006321:Heart; D006333:Heart Failure; D006439:Hemodynamics; D007150:Immunohistochemistry; D008297:Male; D008526:Medulla Oblongata; D051379:Mice; D008810:Mice, Inbred C57BL; D018345:Mice, Knockout; D018613:Microscopy, Confocal; D009474:Neurons; D018377:Neurotransmitter Agents; D009569:Nitric Oxide; D052250:Nitric Oxide Synthase Type III; D016376:Oligonucleotides, Antisense; D010286:Paraventricular Hypothalamic Nucleus; D051381:Rats; D017208:Rats, Wistar | [
"D000818",
"D001253",
"D002490",
"D004452",
"D055785",
"D006321",
"D006333",
"D006439",
"D007150",
"D008297",
"D008526",
"D051379",
"D008810",
"D018345",
"D018613",
"D009474",
"D018377",
"D009569",
"D052250",
"D016376",
"D010286",
"D051381",
"D017208"
] | Contribution of central nervous system endothelial nitric oxide synthase to neurohumoral activation in heart failure rats. | Neurohumoral activation, a hallmark in heart failure (HF), is linked to the progression and mortality of HF patients. Thus, elucidating its precise underlying mechanisms is of critical importance. Other than its classic peripheral vasodilatory actions, the gas NO is a pivotal neurotransmitter in the central nervous system control of the circulation. While accumulating evidence supports a contribution of blunted NO function to neurohumoral activation in HF, the precise cellular sources, and NO synthase (NOS) isoforms involved, remain unknown. Here, we used a multidisciplinary approach to study the expression, cellular distribution, and functional relevance of the endothelial NOS isoform within the hypothalamic paraventricular nucleus in sham and HF rats. Our results show high expression of endothelial NOS in the paraventricular nucleus (mostly confined to astroglial cells), which contributes to constitutive NO bioavailability, as well as tonic inhibition of presympathetic neuronal activity and sympathoexcitatory outflow from the paraventricular nucleus. A diminished endothelial NOS expression and endothelial NOS-derived NO availability were found in the paraventricular nucleus of HF rats, resulting, in turn, in blunted NO inhibitory actions on neuronal activity and sympathoexcitatory outflow. Taken together, our study supports blunted central nervous system endothelial NOS-derived NO as a pathophysiological mechanism underlying neurohumoral activation in HF. | 8,217,257 | true | Contribution of central nervous system endothelial nitric oxide synthase to neurohumoral activation in heart failure rats. Neurohumoral activation, a hallmark in heart failure (HF), is linked to the progression and mortality of HF patients. Thus, elucidating its precise underlying mechanisms is of critical importance. Other than its classic peripheral vasodilatory actions, the gas NO is a pivotal neurotransmitter in the central nervous system control of the circulation. While accumulating evidence supports a contribution of blunted NO function to neurohumoral activation in HF, the precise cellular sources, and NO synthase (NOS) isoforms involved, remain unknown. Here, we used a multidisciplinary approach to study the expression, cellular distribution, and functional relevance of the endothelial NOS isoform within the hypothalamic paraventricular nucleus in sham and HF rats. Our results show high expression of endothelial NOS in the paraventricular nucleus (mostly confined to astroglial cells), which contributes to constitutive NO bioavailability, as well as tonic inhibition of presympathetic neuronal activity and sympathoexcitatory outflow from the paraventricular nucleus. A diminished endothelial NOS expression and endothelial NOS-derived NO availability were found in the paraventricular nucleus of HF rats, resulting, in turn, in blunted NO inhibitory actions on neuronal activity and sympathoexcitatory outflow. Taken together, our study supports blunted central nervous system endothelial NOS-derived NO as a pathophysiological mechanism underlying neurohumoral activation in HF. |
22,809,777 | D000368:Aged; D003633:Dichlorodiphenyl Dichloroethylene; D004147:Dioxins; D004781:Environmental Exposure; D004785:Environmental Pollutants; D004787:Environmental Pollution; D005260:Female; D055768:Halogenated Diphenyl Ethers; D006801:Humans; D006843:Hydrocarbons, Chlorinated; D008297:Male; D010575:Pesticides; D011078:Polychlorinated Biphenyls; D000072317:Polychlorinated Dibenzodioxins; D020521:Stroke | [
"D000368",
"D003633",
"D004147",
"D004781",
"D004785",
"D004787",
"D005260",
"D055768",
"D006801",
"D006843",
"D008297",
"D010575",
"D011078",
"D000072317",
"D020521"
] | Background exposure to persistent organic pollutants predicts stroke in the elderly. | Background exposure to persistent organic pollutants (POPs), lipophilic xenobiotics that accumulate mainly in adipose tissue, has recently emerged as a new risk factor for cardiovascular diseases. This prospective study was performed to evaluate if plasma concentrations of selected POPs predict incident stroke among the elderly. Twenty-one POPs (including 16 polychlorinated biphenyl (PCB) congeners, 3 organochlorine (OC) pesticides, 1 brominated diphenyl ether (BDE), and 1 dioxin) were measured in plasma collected at baseline in 898 participants aged 70 years of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). Stroke diagnosis was validated by hospital records. During the five year follow-up, 35 subjects developed hospital-treated stroke. After adjusting for known stroke risk factors, most PCBs with 4, 5, or 6 chlorine atoms, p,p'-DDE, trans-nonachlor, and octachlorodibenzo-p-dioxin significantly predicted the risk of stroke. Across quartiles of summary measures of PCBs and OC pesticides, the adjusted ORs were 1.0, 0.8 (95% confidence interval: 0.2-2.5), 1.2 (0.4-3.4), and 2.1 (0.7-6.2) for PCBs and 1.0, 1.2 (0.3-4.2), 2.3 (0.7-6.9), and 3.0 (1.0-9.4) for OC pesticides (P for trend=0.11 and 0.03, respectively). The adjusted ORs among participants ≥ 90th percentile of the summary measures were 5.5 (1.7-18.1) for PCBs and 4.0 (1.1-14.6) for OC pesticides; corresponding ORs for those ≥ 95th percentile were 7.8 (2.1-29.6) and 9.5 (2.3-38.9). Background exposure to POPs may play an important role in development or progression of stroke in the elderly. | 4,344,653 | true | Background exposure to persistent organic pollutants predicts stroke in the elderly. Background exposure to persistent organic pollutants (POPs), lipophilic xenobiotics that accumulate mainly in adipose tissue, has recently emerged as a new risk factor for cardiovascular diseases. This prospective study was performed to evaluate if plasma concentrations of selected POPs predict incident stroke among the elderly. Twenty-one POPs (including 16 polychlorinated biphenyl (PCB) congeners, 3 organochlorine (OC) pesticides, 1 brominated diphenyl ether (BDE), and 1 dioxin) were measured in plasma collected at baseline in 898 participants aged 70 years of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). Stroke diagnosis was validated by hospital records. During the five year follow-up, 35 subjects developed hospital-treated stroke. After adjusting for known stroke risk factors, most PCBs with 4, 5, or 6 chlorine atoms, p,p'-DDE, trans-nonachlor, and octachlorodibenzo-p-dioxin significantly predicted the risk of stroke. Across quartiles of summary measures of PCBs and OC pesticides, the adjusted ORs were 1.0, 0.8 (95% confidence interval: 0.2-2.5), 1.2 (0.4-3.4), and 2.1 (0.7-6.2) for PCBs and 1.0, 1.2 (0.3-4.2), 2.3 (0.7-6.9), and 3.0 (1.0-9.4) for OC pesticides (P for trend=0.11 and 0.03, respectively). The adjusted ORs among participants ≥ 90th percentile of the summary measures were 5.5 (1.7-18.1) for PCBs and 4.0 (1.1-14.6) for OC pesticides; corresponding ORs for those ≥ 95th percentile were 7.8 (2.1-29.6) and 9.5 (2.3-38.9). Background exposure to POPs may play an important role in development or progression of stroke in the elderly. |
21,418,884 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020526:Brain Stem Infarctions; D016022:Case-Control Studies; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome | [
"D000328",
"D000368",
"D000369",
"D020526",
"D016022",
"D048909",
"D005260",
"D006801",
"D016015",
"D008297",
"D008875",
"D015999",
"D011379",
"D012307",
"D016896"
] | [An evaluation of clinical characteristics and prognosis of brain-stem infarction in diabetics]. | OBJECTIVE
To analyze the relationship between diabetics and the onset, clinical outcomes and prognosis of brainstem infarction, and to evaluate the impact of diabetes on brainstem infarction.
METHODS
Compare 172 cases of acute brainstem infarction in patients with or without diabetes. Analyze the associated risk factors of patients with brain-stem infarction in diabetics by multi-variate logistic regression analysis. Compare the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS) Score, pathogenetic condition and the outcome of the two groups in different times.
RESULTS
The systolic blood pressure (SBP), TG, LDL-C, apolipoprotein B (Apo B), glutamyl transpeptidase (γ-GT), fibrinogen (Fb), fasting blood glucose (FPG) and glycosylated hemoglobin(HbA1c)in diabetic group were higher than those in non-diabetic group, which was statistically significant (P < 0.05). From multi-variate logistic regression analysis, γ-GT, Apo B and FPG were the risk predictors of diabetes with brainstem infarction(OR = 1.017, 4.667 and 3.173, respectively), while HDL-C was protective (OR = 0.288). HbA1c was a risk predictor of severity for acute brainstem infarction (OR = 1.299), while Apo A was beneficial (OR = 0.212). Compared with brain-stem infarction in non-diabetic group, NIHSS score and intensive care therapy of diabetic groups on the admission had no statistically significance, while the NIHSS score on discharge and the outcome at 6 months' of follow-up were statistically significant.
CONCLUSIONS
Diabetes is closely associated with brainstem infarction. Brainstem infarction with diabetes cause more rapid progression, poorer prognosis, higher rates of mortality as well as disability and higher recurrence rate of cerebral infarction. | null | false | [An evaluation of clinical characteristics and prognosis of brain-stem infarction in diabetics]. OBJECTIVE
To analyze the relationship between diabetics and the onset, clinical outcomes and prognosis of brainstem infarction, and to evaluate the impact of diabetes on brainstem infarction.
METHODS
Compare 172 cases of acute brainstem infarction in patients with or without diabetes. Analyze the associated risk factors of patients with brain-stem infarction in diabetics by multi-variate logistic regression analysis. Compare the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS) Score, pathogenetic condition and the outcome of the two groups in different times.
RESULTS
The systolic blood pressure (SBP), TG, LDL-C, apolipoprotein B (Apo B), glutamyl transpeptidase (γ-GT), fibrinogen (Fb), fasting blood glucose (FPG) and glycosylated hemoglobin(HbA1c)in diabetic group were higher than those in non-diabetic group, which was statistically significant (P < 0.05). From multi-variate logistic regression analysis, γ-GT, Apo B and FPG were the risk predictors of diabetes with brainstem infarction(OR = 1.017, 4.667 and 3.173, respectively), while HDL-C was protective (OR = 0.288). HbA1c was a risk predictor of severity for acute brainstem infarction (OR = 1.299), while Apo A was beneficial (OR = 0.212). Compared with brain-stem infarction in non-diabetic group, NIHSS score and intensive care therapy of diabetic groups on the admission had no statistically significance, while the NIHSS score on discharge and the outcome at 6 months' of follow-up were statistically significant.
CONCLUSIONS
Diabetes is closely associated with brainstem infarction. Brainstem infarction with diabetes cause more rapid progression, poorer prognosis, higher rates of mortality as well as disability and higher recurrence rate of cerebral infarction. |
21,723,277 | D000818:Animals; D017209:Apoptosis; D053148:Caspase 3; D005786:Gene Expression Regulation; D006352:Heart Ventricles; D066298:In Vitro Techniques; D007770:L-Lactate Dehydrogenase; D047311:Luteolin; D008297:Male; D009119:Muscle Contraction; D032383:Myocytes, Cardiac; D009336:Necrosis; D019253:Proto-Oncogene Proteins c-bcl-2; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury; D051028:bcl-2-Associated X Protein | [
"D000818",
"D017209",
"D053148",
"D005786",
"D006352",
"D066298",
"D007770",
"D047311",
"D008297",
"D009119",
"D032383",
"D009336",
"D019253",
"D051381",
"D017207",
"D015427",
"D051028"
] | Luteolin improves contractile function and attenuates apoptosis following ischemia-reperfusion in adult rat cardiomyocytes. | Luteolin occurs in a variety of plants and possesses antioxidant and anti-inflammatory properties. However, its role in protection against ischemia-reperfusion injury in Sprague-Dawley rats has not been elucidated. In the present study, we tested the contractile function of left ventricular cardiomyocytes with different concentrations of luteolin: 0.5, 1.5, 2.5 and 5.0 μg/ml after simulated. We investigated the direct effect of luteolin against necrosis and apoptosis following ischemia-reperfusion in cardiomyocytes. We further observed the function of isolated hearts subjected to ischemia-reperfusion with or without 10.0 μg/ml luteolin pretreatment. Following 24h incubation with or without luteolin, adult rat cardiomyocytes were subjected to 3h of ischemia followed by 2h of reperfusion for contractile function and necrosis (trypan blue exclusion and lactate dehydrogenase release) or 18 h of reperfusion for apoptosis studies. The cardiomyocyte shortening amplitude depended on different concentrations of luteolin, increasing significantly at 2.5 μg/ml luteolin (P<0.01). Necrosis and apoptosis were reduced by luteolin at 2.5 μg/ml. In addition, the expression of Bcl-2 was upregulated by luteolin and the ratio of Bax to Bcl-2 was decreased. Luteolin inhibited the activation of Caspase3 after ischemia-reperfusion in cardiomyocytes. Furthermore, luteolin at 10.0 μg/ml improved ischemia-reperfusion induced myocardial function, by improving heart rate, +dp/dt(max) and -dp/dt(max), and also limiting the decline of left ventricular systolic pressure (LVSP) and elevation of left ventricular end-diastolic pressure (LVEDP) to some extent. Our results demonstrated that luteolin prevents ischemia-reperfusion injury by reducing necrosis and apoptosis in rat cardiomyocytes. | 6,603,821 | true | Luteolin improves contractile function and attenuates apoptosis following ischemia-reperfusion in adult rat cardiomyocytes. Luteolin occurs in a variety of plants and possesses antioxidant and anti-inflammatory properties. However, its role in protection against ischemia-reperfusion injury in Sprague-Dawley rats has not been elucidated. In the present study, we tested the contractile function of left ventricular cardiomyocytes with different concentrations of luteolin: 0.5, 1.5, 2.5 and 5.0 μg/ml after simulated. We investigated the direct effect of luteolin against necrosis and apoptosis following ischemia-reperfusion in cardiomyocytes. We further observed the function of isolated hearts subjected to ischemia-reperfusion with or without 10.0 μg/ml luteolin pretreatment. Following 24h incubation with or without luteolin, adult rat cardiomyocytes were subjected to 3h of ischemia followed by 2h of reperfusion for contractile function and necrosis (trypan blue exclusion and lactate dehydrogenase release) or 18 h of reperfusion for apoptosis studies. The cardiomyocyte shortening amplitude depended on different concentrations of luteolin, increasing significantly at 2.5 μg/ml luteolin (P<0.01). Necrosis and apoptosis were reduced by luteolin at 2.5 μg/ml. In addition, the expression of Bcl-2 was upregulated by luteolin and the ratio of Bax to Bcl-2 was decreased. Luteolin inhibited the activation of Caspase3 after ischemia-reperfusion in cardiomyocytes. Furthermore, luteolin at 10.0 μg/ml improved ischemia-reperfusion induced myocardial function, by improving heart rate, +dp/dt(max) and -dp/dt(max), and also limiting the decline of left ventricular systolic pressure (LVSP) and elevation of left ventricular end-diastolic pressure (LVEDP) to some extent. Our results demonstrated that luteolin prevents ischemia-reperfusion injury by reducing necrosis and apoptosis in rat cardiomyocytes. |
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