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36,475,546 | D000369:Aged, 80 and over; D006801:Humans; D005260:Female; D008297:Male; D000072657:ST Elevation Myocardial Infarction; D000088642:Nonagenarians; D012189:Retrospective Studies; D017052:Hospital Mortality; D062645:Percutaneous Coronary Intervention; D006761:Hospitals | [
"D000369",
"D006801",
"D005260",
"D008297",
"D000072657",
"D000088642",
"D012189",
"D017052",
"D062645",
"D006761"
] | In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. | BACKGROUND
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
METHODS
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
RESULTS
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
CONCLUSIONS
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge. | null | false | In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. BACKGROUND
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
METHODS
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
RESULTS
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
CONCLUSIONS
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge. |
727,717 | D001157:Arterial Occlusive Diseases; D001158:Arteries; D001160:Arterioles; D001921:Brain; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin; D013116:Spinal Cord; D013577:Syndrome | [
"D001157",
"D001158",
"D001160",
"D001921",
"D006801",
"D008297",
"D008875",
"D012867",
"D013116",
"D013577"
] | Papulosis atrophicans maligna (Köhlmeier-Degos disease): a disseminated occlusive vasculopathy. | Malignant atrophic papulosis usually presents as pathognomonic skin lesions followed by acute abdominal pain, bowel perforation, peritonitis, and death. Rare patients who may lack gastrointestinal symptoms present with central nervous system manifestations, including headache, paresthesias, weakness, and rapid deterioration to death. The patient reported here was a 47-year-old man whose neurological symptoms apparently preceded his cutaneous lesions. His course consisted of a disseminated neurological disease and exacerbated following a herpes zoster infection. His condition rapidly deteriorated despite corticotropin, glucocorticoids, and low-molecular-weight dextran. Necropsy revealed a disseminated occlusive vasculopathy and diffuse encephalomyelomalacia of the brain and spinal cord. A review of autopsied patients with central nervous system involvement is provided. | 10,075,269 | true | Papulosis atrophicans maligna (Köhlmeier-Degos disease): a disseminated occlusive vasculopathy. Malignant atrophic papulosis usually presents as pathognomonic skin lesions followed by acute abdominal pain, bowel perforation, peritonitis, and death. Rare patients who may lack gastrointestinal symptoms present with central nervous system manifestations, including headache, paresthesias, weakness, and rapid deterioration to death. The patient reported here was a 47-year-old man whose neurological symptoms apparently preceded his cutaneous lesions. His course consisted of a disseminated neurological disease and exacerbated following a herpes zoster infection. His condition rapidly deteriorated despite corticotropin, glucocorticoids, and low-molecular-weight dextran. Necropsy revealed a disseminated occlusive vasculopathy and diffuse encephalomyelomalacia of the brain and spinal cord. A review of autopsied patients with central nervous system involvement is provided. |
33,835,396 | D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D015897:Comorbidity; D006333:Heart Failure; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists; D013318:Stroke Volume | [
"D000319",
"D057911",
"D015897",
"D006333",
"D006801",
"D000451",
"D013318"
] | Update on the Impact of Comorbidities on the Efficacy and Safety of Heart Failure Medications. | Multiple newer medications benefit patients with heart failure with reduced ejection fraction (HFrEF). While these therapies benefit the broad population with HFrEF, the efficacy and safety of these therapies have been less well characterized in patients with significant comorbidities.
Common comorbidities of high interest in heart failure (HF) include diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation, and obesity, and each has potential implications for clinical management. As the burden of comorbidities increases in HF populations, risk-benefit assessments of HF therapies in the context of different comorbidities are increasingly relevant for clinical practice. This review summarizes data regarding the core HFrEF therapies in the context of comorbidities, with specific attention to sodium-glucose cotransporter 2 inhibitors, sacubitril/valsartan, mineralocorticoid receptor antagonists (MRAs), and beta-blockers. In general, studies support consistent treatment effects with regard to clinical outcome benefits in the presence of comorbidities. Likewise, safety profiles are relatively consistent irrespective of comorbidities, with the exception of heightened risk of hyperkalemia with MRA therapy in patients with severe CKD. In conclusion, while HF management is complex in the context of multiple comorbidities, the totality of evidence strongly supports guideline-directed medical therapies as foundational for improving outcomes in these high-risk patients. | null | false | Update on the Impact of Comorbidities on the Efficacy and Safety of Heart Failure Medications. Multiple newer medications benefit patients with heart failure with reduced ejection fraction (HFrEF). While these therapies benefit the broad population with HFrEF, the efficacy and safety of these therapies have been less well characterized in patients with significant comorbidities.
Common comorbidities of high interest in heart failure (HF) include diabetes mellitus, chronic kidney disease (CKD), atrial fibrillation, and obesity, and each has potential implications for clinical management. As the burden of comorbidities increases in HF populations, risk-benefit assessments of HF therapies in the context of different comorbidities are increasingly relevant for clinical practice. This review summarizes data regarding the core HFrEF therapies in the context of comorbidities, with specific attention to sodium-glucose cotransporter 2 inhibitors, sacubitril/valsartan, mineralocorticoid receptor antagonists (MRAs), and beta-blockers. In general, studies support consistent treatment effects with regard to clinical outcome benefits in the presence of comorbidities. Likewise, safety profiles are relatively consistent irrespective of comorbidities, with the exception of heightened risk of hyperkalemia with MRA therapy in patients with severe CKD. In conclusion, while HF management is complex in the context of multiple comorbidities, the totality of evidence strongly supports guideline-directed medical therapies as foundational for improving outcomes in these high-risk patients. |
3,425,367 | D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D004243:Divorce; D005260:Female; D006801:Humans; D006814:Hungary; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D009497:Neurotic Disorders; D012307:Risk Factors; D013405:Suicide; D013406:Suicide, Attempted | [
"D000328",
"D000368",
"D000428",
"D004243",
"D005260",
"D006801",
"D006814",
"D006973",
"D008297",
"D008875",
"D009497",
"D012307",
"D013405",
"D013406"
] | Neurotics at risk and suicidal behaviour in the Hungarian population. | On the basis of a study of 5,871 persons representative of the Hungarian population over the age of 20 by age, sex, place of residence and occupation, an analysis was made of the relationships between neurosis risk, suicidal behaviour, drinking habits and social and lifestyle characteristics. Measured by the Juhász Neurosis Rating Scale, the proportion of those at neurosis risk in the population was 23.6%, but considerable regional differences were found. Suicide attempts and the suicide rate by county proved relatively independent of each other. In the counties with higher suicides rates (South-East Hungary) and in the counties around the capital which have high rates of suicide attempts the proportion of those at neurosis risk was very high. The closest correlation with suicide attempts was found in the case of suicide in the family. Where there had been a suicide in the family, 26% of the subjects attempted suicide in the course of their life and where there had been no suicide, the proportion of persons making attempts was only 1%. | 3,817,374 | true | Neurotics at risk and suicidal behaviour in the Hungarian population. On the basis of a study of 5,871 persons representative of the Hungarian population over the age of 20 by age, sex, place of residence and occupation, an analysis was made of the relationships between neurosis risk, suicidal behaviour, drinking habits and social and lifestyle characteristics. Measured by the Juhász Neurosis Rating Scale, the proportion of those at neurosis risk in the population was 23.6%, but considerable regional differences were found. Suicide attempts and the suicide rate by county proved relatively independent of each other. In the counties with higher suicides rates (South-East Hungary) and in the counties around the capital which have high rates of suicide attempts the proportion of those at neurosis risk was very high. The closest correlation with suicide attempts was found in the case of suicide in the family. Where there had been a suicide in the family, 26% of the subjects attempted suicide in the course of their life and where there had been no suicide, the proportion of persons making attempts was only 1%. |
29,897,569 | D015502:Absorptiometry, Photon; D001012:Aorta, Abdominal; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke; D066027:Transplant Recipients; D061205:Vascular Calcification | [
"D015502",
"D001012",
"D005260",
"D006801",
"D016030",
"D008297",
"D008875",
"D009203",
"D009426",
"D016016",
"D012189",
"D012307",
"D020521",
"D066027",
"D061205"
] | A high abdominal aortic calcification score by dual X-ray absorptiometry is associated with cardiovascular events after kidney transplantation. | Aortic calcification is associated with an increased risk for cardiovascular events in renal transplant recipients. This study focused on the association of abdominal aortic calcification (AAC) and cardiovascular events assessed using a dual-energy X-ray absorptiometry (DXA) scoring methodology for AAC.
From 2008 to 2014, renal transplant recipients referred for a DXA procedure within 6 months after transplantation were included in a retrospective, single-centre study. The primary endpoint was the occurrence of cardiovascular events, defined as myocardial infarction, cerebrovascular accident or transient ischaemic attack, after transplantation. AAC was quantified using an 8-point scoring system and patients were divided into three groups; a control group (AAC = 0), a low AAC group (AAC = 1-3) and a high AAC group (AAC = 4-8).
We evaluated 701 patients, 267 (38.1%) had detectable calcifications (low AAC 190 patients, high AAC 77 patients) and 434 (61.9%) had no calcifications. Cardiovascular events were seen in 37 (8.5%) patients in the control group, in 18 (9.5%) in the low AAC group and in 20 (26.0%) in the high AAC group. Univariate Cox proportional hazards analysis of the high AAC score showed a hazard ratio (HR) of 4.23 [95% confidence interval (CI) 2.44-7.33; P < 0.01] for cardiovascular events, while results were not significant for the low AAC score. Multivariate analysis showed an independent significant association between a high AAC score and cardiovascular events [HR 2.78 (95% CI 1.05-7.64); P = 0.04]. Assessment of the continuous net reclassification index (NRI), comparing the combined clinical variables with a model of both AAC scoring and clinical variables, showed an NRI of 0.76 (95% CI 0.65-0.86; P < 0.01).
An independent association between a high AAC score, assessed by DXA, and cardiovascular events was identified and provides an opportunity for early cardiovascular risk stratification in renal transplant recipients. | null | false | A high abdominal aortic calcification score by dual X-ray absorptiometry is associated with cardiovascular events after kidney transplantation. Aortic calcification is associated with an increased risk for cardiovascular events in renal transplant recipients. This study focused on the association of abdominal aortic calcification (AAC) and cardiovascular events assessed using a dual-energy X-ray absorptiometry (DXA) scoring methodology for AAC.
From 2008 to 2014, renal transplant recipients referred for a DXA procedure within 6 months after transplantation were included in a retrospective, single-centre study. The primary endpoint was the occurrence of cardiovascular events, defined as myocardial infarction, cerebrovascular accident or transient ischaemic attack, after transplantation. AAC was quantified using an 8-point scoring system and patients were divided into three groups; a control group (AAC = 0), a low AAC group (AAC = 1-3) and a high AAC group (AAC = 4-8).
We evaluated 701 patients, 267 (38.1%) had detectable calcifications (low AAC 190 patients, high AAC 77 patients) and 434 (61.9%) had no calcifications. Cardiovascular events were seen in 37 (8.5%) patients in the control group, in 18 (9.5%) in the low AAC group and in 20 (26.0%) in the high AAC group. Univariate Cox proportional hazards analysis of the high AAC score showed a hazard ratio (HR) of 4.23 [95% confidence interval (CI) 2.44-7.33; P < 0.01] for cardiovascular events, while results were not significant for the low AAC score. Multivariate analysis showed an independent significant association between a high AAC score and cardiovascular events [HR 2.78 (95% CI 1.05-7.64); P = 0.04]. Assessment of the continuous net reclassification index (NRI), comparing the combined clinical variables with a model of both AAC scoring and clinical variables, showed an NRI of 0.76 (95% CI 0.65-0.86; P < 0.01).
An independent association between a high AAC score, assessed by DXA, and cardiovascular events was identified and provides an opportunity for early cardiovascular risk stratification in renal transplant recipients. |
7,354,369 | D000377:Agnosia; D001933:Brain Stem; D002544:Cerebral Infarction; D006225:Hand; D006801:Humans; D008526:Medulla Oblongata; D009133:Muscular Atrophy; D011149:Pons; D013577:Syndrome; D014110:Touch; D014715:Vertebrobasilar Insufficiency | [
"D000377",
"D001933",
"D002544",
"D006225",
"D006801",
"D008526",
"D009133",
"D011149",
"D013577",
"D014110",
"D014715"
] | Studies on asterognosis and amyotrophy of the hand in brainstem syndromes. Relation to the symptomatology of tumours at the spinocranial junction. | Fifteen patients with symptoms of an ischaemic lesion in the vertebrobasilar territory were investigated with respect to the presence of asterognosis and amyotrophy of the hand muscles. Stereognostic disturbances were noted in 4 patients with a medullary lesion and in two patients with brainstem syndromes of less defined level. The findings in these cases suggested a lesion of the medial lemniscus. Amyotrophy of the hand muscles was not seen in these patients. The absence of association of astereognosis and amyotrophy of the hand muscles in syndromes due to lower brainstem lesions supports the view that these symptoms, when occurring conjointly in foramen magnum tumours, originate from two different lesions and are caused by different mechanisms. | 10,317,108 | true | Studies on asterognosis and amyotrophy of the hand in brainstem syndromes. Relation to the symptomatology of tumours at the spinocranial junction. Fifteen patients with symptoms of an ischaemic lesion in the vertebrobasilar territory were investigated with respect to the presence of asterognosis and amyotrophy of the hand muscles. Stereognostic disturbances were noted in 4 patients with a medullary lesion and in two patients with brainstem syndromes of less defined level. The findings in these cases suggested a lesion of the medial lemniscus. Amyotrophy of the hand muscles was not seen in these patients. The absence of association of astereognosis and amyotrophy of the hand muscles in syndromes due to lower brainstem lesions supports the view that these symptoms, when occurring conjointly in foramen magnum tumours, originate from two different lesions and are caused by different mechanisms. |
30,516,639 | D001921:Brain; D019468:Disease Management; D006801:Humans; D033162:Incidental Findings; D002532:Intracranial Aneurysm; D008279:Magnetic Resonance Imaging; D011788:Quality of Life; D012307:Risk Factors | [
"D001921",
"D019468",
"D006801",
"D033162",
"D002532",
"D008279",
"D011788",
"D012307"
] | Management of patients with unruptured intracranial aneurysms. | Intracranial aneurysms are frequent incidental findings on cranial imaging. The decision for preventive treatment depends on the presumed risk of rupture, the efficacy and risk of complications of preventive treatment, and the quality of life having to live with an unruptured aneurysms. Data on all these factors are still incomplete, and additional data are needed.
The current review describes advances of the last 2 years in assessment of risk of rupture, on risks of preventive aneurysms occlusion, on follow-up imaging and on medical management of patients with unruptured intracranial aneurysms.
In addition to risk factors used to predict absolute risks of rupture, also aneurysm irregularity and aneurysm growth during follow-up are potential risk factors for rupture. To what extent these factors improve risk prediction in absolute terms is yet uncertain. Uncertainty also continues on whether endovascular or surgical occlusion is the preferred method, but a trial comparing these two strategies is ongoing. Aneurysm growth can now be predicted in absolute risks. Enhancement of the aneurysm wall on MRI probably is also related to aneurysm instability and reflects inflammation. A trial assessing the effects of anti-inflammatory treatment and blood pressure lowering on aneurysm growth and rupture is currently ongoing. | null | false | Management of patients with unruptured intracranial aneurysms. Intracranial aneurysms are frequent incidental findings on cranial imaging. The decision for preventive treatment depends on the presumed risk of rupture, the efficacy and risk of complications of preventive treatment, and the quality of life having to live with an unruptured aneurysms. Data on all these factors are still incomplete, and additional data are needed.
The current review describes advances of the last 2 years in assessment of risk of rupture, on risks of preventive aneurysms occlusion, on follow-up imaging and on medical management of patients with unruptured intracranial aneurysms.
In addition to risk factors used to predict absolute risks of rupture, also aneurysm irregularity and aneurysm growth during follow-up are potential risk factors for rupture. To what extent these factors improve risk prediction in absolute terms is yet uncertain. Uncertainty also continues on whether endovascular or surgical occlusion is the preferred method, but a trial comparing these two strategies is ongoing. Aneurysm growth can now be predicted in absolute risks. Enhancement of the aneurysm wall on MRI probably is also related to aneurysm instability and reflects inflammation. A trial assessing the effects of anti-inflammatory treatment and blood pressure lowering on aneurysm growth and rupture is currently ongoing. |
28,411,357 | D000328:Adult; D000783:Aneurysm; D001926:Brain Death; D003928:Diabetic Nephropathies; D046148:Donor Selection; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012077:Renal Artery; D014019:Tissue Donors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures | [
"D000328",
"D000783",
"D001926",
"D003928",
"D046148",
"D005260",
"D006801",
"D016030",
"D008297",
"D008875",
"D009392",
"D012077",
"D014019",
"D016896",
"D014656"
] | Kidney Transplant From a Deceased Donor With Renal Artery Aneurysm: A Case Report. | The use of marginal kidneys or kidneys with pathologic problems (such as renal artery aneurysms in a living or deceased donor) is on the rise due to organ shortages and improvements in surgical techniques. When renal vascular abnormalities are detected during a transplant, it puts the surgeon in a difficult position to decide what to do with the organ. In this study, we report a case of a kidney from a deceased donor who had 2 renal artery saccular aneurysms, which we were able to use for transplant. The recipient was a 61-year-old male patient with diabetic nephropathy and significant comorbidities. Kidney transplant was performed successfully with a good outcome. Recent advancements in surgical techniques have allowed the use of kidneys with renal artery aneurysms for kidney transplant, thus helping to overcome shortages of transplantable organs. | 1,414,558 | true | Kidney Transplant From a Deceased Donor With Renal Artery Aneurysm: A Case Report. The use of marginal kidneys or kidneys with pathologic problems (such as renal artery aneurysms in a living or deceased donor) is on the rise due to organ shortages and improvements in surgical techniques. When renal vascular abnormalities are detected during a transplant, it puts the surgeon in a difficult position to decide what to do with the organ. In this study, we report a case of a kidney from a deceased donor who had 2 renal artery saccular aneurysms, which we were able to use for transplant. The recipient was a 61-year-old male patient with diabetic nephropathy and significant comorbidities. Kidney transplant was performed successfully with a good outcome. Recent advancements in surgical techniques have allowed the use of kidneys with renal artery aneurysms for kidney transplant, thus helping to overcome shortages of transplantable organs. |
27,852,274 | D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004522:Educational Status; D005260:Female; D005783:Gender Identity; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D000369",
"D001938",
"D004522",
"D005260",
"D005783",
"D054624",
"D006801",
"D006973",
"D016015",
"D008297",
"D008875",
"D044469",
"D012737",
"D012959",
"D055815"
] | Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil. | Hypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race.
We analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education.
Age-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men.
In this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race - a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective. | null | false | Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil. Hypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race.
We analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education.
Age-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men.
In this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race - a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective. |
9,431,629 | D000368:Aged; D006801:Humans; D007383:Intermittent Claudication; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013117:Spinal Cord Compression; D013130:Spinal Stenosis | [
"D000368",
"D006801",
"D007383",
"D016015",
"D008159",
"D008875",
"D011446",
"D011859",
"D013117",
"D013130"
] | A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings. | METHODS
A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis.
OBJECTIVE
To evaluate symptoms and signs in patients undergoing surgery for central spinal stenosis and to correlate the findings to age, preoperative duration of symptoms, and radiographically detected constriction.
BACKGROUND
The degree of constriction of the spinal canal considered to be symptomatic of lumbar canal stenosis is not clear, nor is the relation between the clinical appearance of the disease and the degree of radiographically verified constriction.
METHODS
One hundred five consecutive patients scheduled for decompression surgery were included in a prospective study. The day before surgery, all patients were interviewed and examined, using a defined protocol that included data on age, gender, preoperative duration of symptoms, walking ability, and occurrence of pain at rest and at night. Included were data recording straight leg raising test results, reflex disturbance, and extensor hallucis longus muscle weakness. All radiographs were examined by a neuroradiologist. The anteroposterior diameters at each site from L1-L2 to L5-S1 were recorded. For the computer analysis, the site of and width at the narrowest site was registered, as well as the number of sites with an anteroposterior diameter of less than 10 mm. A statistical analysis was performed using chi-square analysis, nonparametric tests, analysis of variance, and logistic regression.
RESULTS
Pain at rest and at night was reported by 68 and 60 patients, respectively, and was more common in younger patients (P = 0.065 and 0.015, respectively). A severe reduction of walking ability (< 0.5 km) was reported by 70 patients. The straight leg raising test results were negative in 70 patients, positive > 60 degrees in 16, positive 30-60 degrees in 14, and positive < 30 degrees in 5. Younger patients had a positive straight leg raising result (P = 0.028, analysis of variance) more often. Reflex disturbances correlated to patient age: Older patients had reflex disturbances more often. There was no correlation between preoperative duration and pain or neurologic disturbances: Patients with longer preoperative duration of symptoms did not demonstrate more severe symptoms. There was a total myelographic block of the spinal canal in 13 patients. The mean value of the antero-posterior diameter in the other patients was 6.8 mm (range, 4-11 mm). In patients younger than 70 years L4-L5 was the site for the most pronounced constriction, whereas L3-L4 was the narrowest site in the older patients. Degenerative spondylolisthesis was found in 32 patients, and they had a more pronounced constriction of the spinal canal (5.6 mm compared with 6.7 mm in those without displacement, P = 0.02). There was a (nonsignificant) tendency toward more walking disturbances in patients with a more pronounced constriction of the spine. There was no correlation between reflex disturbances or extensor hallucis longus weakness and radiographically detected constriction.
CONCLUSIONS
Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction. | null | false | A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part I: Clinical features related to radiographic findings. METHODS
A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis.
OBJECTIVE
To evaluate symptoms and signs in patients undergoing surgery for central spinal stenosis and to correlate the findings to age, preoperative duration of symptoms, and radiographically detected constriction.
BACKGROUND
The degree of constriction of the spinal canal considered to be symptomatic of lumbar canal stenosis is not clear, nor is the relation between the clinical appearance of the disease and the degree of radiographically verified constriction.
METHODS
One hundred five consecutive patients scheduled for decompression surgery were included in a prospective study. The day before surgery, all patients were interviewed and examined, using a defined protocol that included data on age, gender, preoperative duration of symptoms, walking ability, and occurrence of pain at rest and at night. Included were data recording straight leg raising test results, reflex disturbance, and extensor hallucis longus muscle weakness. All radiographs were examined by a neuroradiologist. The anteroposterior diameters at each site from L1-L2 to L5-S1 were recorded. For the computer analysis, the site of and width at the narrowest site was registered, as well as the number of sites with an anteroposterior diameter of less than 10 mm. A statistical analysis was performed using chi-square analysis, nonparametric tests, analysis of variance, and logistic regression.
RESULTS
Pain at rest and at night was reported by 68 and 60 patients, respectively, and was more common in younger patients (P = 0.065 and 0.015, respectively). A severe reduction of walking ability (< 0.5 km) was reported by 70 patients. The straight leg raising test results were negative in 70 patients, positive > 60 degrees in 16, positive 30-60 degrees in 14, and positive < 30 degrees in 5. Younger patients had a positive straight leg raising result (P = 0.028, analysis of variance) more often. Reflex disturbances correlated to patient age: Older patients had reflex disturbances more often. There was no correlation between preoperative duration and pain or neurologic disturbances: Patients with longer preoperative duration of symptoms did not demonstrate more severe symptoms. There was a total myelographic block of the spinal canal in 13 patients. The mean value of the antero-posterior diameter in the other patients was 6.8 mm (range, 4-11 mm). In patients younger than 70 years L4-L5 was the site for the most pronounced constriction, whereas L3-L4 was the narrowest site in the older patients. Degenerative spondylolisthesis was found in 32 patients, and they had a more pronounced constriction of the spinal canal (5.6 mm compared with 6.7 mm in those without displacement, P = 0.02). There was a (nonsignificant) tendency toward more walking disturbances in patients with a more pronounced constriction of the spine. There was no correlation between reflex disturbances or extensor hallucis longus weakness and radiographically detected constriction.
CONCLUSIONS
Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction. |
552,727 | D000818:Animals; D002417:Cattle; D002418:Cattle Diseases; D004322:Drainage; D005260:Female; D010493:Pericarditis; D010496:Pericardium; D013492:Suppuration | [
"D000818",
"D002417",
"D002418",
"D004322",
"D005260",
"D010493",
"D010496",
"D013492"
] | Suppurative pericarditis treated by pericardiotomy in a cow. | The successful treatment of a single case of traumatic reticulopericarditis is described. Under general anaesthesia the pericardial sac was approached by resection of the distal part of the fifth rib and allowed to drain directly to the exterior. The discussion reviews the surgical technique. | 8,748,395 | true | Suppurative pericarditis treated by pericardiotomy in a cow. The successful treatment of a single case of traumatic reticulopericarditis is described. Under general anaesthesia the pericardial sac was approached by resection of the distal part of the fifth rib and allowed to drain directly to the exterior. The discussion reviews the surgical technique. |
18,507,271 | D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension; D007407:Interviews as Topic; D008297:Male; D008568:Memory; D008875:Middle Aged; D009657:North Carolina; D011581:Psychological Tests; D012044:Regression Analysis | [
"D000328",
"D001741",
"D000368",
"D000369",
"D001794",
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"D003430",
"D005260",
"D006801",
"D006973",
"D007407",
"D008297",
"D008568",
"D008875",
"D009657",
"D011581",
"D012044"
] | Blood pressure and memory in older African Americans. | The rates of high blood pressure among African Americans, as a group, are the highest in the world. The implications for higher average blood pressure include complications for many major chronic conditions, such as cardiovascular disease and diabetes. Less well studied is the effect of blood pressure on the cognitive functioning of African Americans. The purpose of this study was to examine the effect of blood pressure on memory measures in a sample of adult African Americans. Analyses were conducted on a sample of 361 African American adults (mean age 61.50 years, standard deviation 9.39 years). We found significant correlations between systolic blood pressure and most cognitive measures but only for one of the measures and diastolic blood pressure. Regressions revealed significant effects for systolic blood pressure on Digit Symbol, Telephone Interview of Cognitive Status, and Immediate Recall on the Wechsler Logical Memory test. These findings suggest that blood pressure is a source of individual variability in cognitive aging among African Americans. | 96,763 | true | Blood pressure and memory in older African Americans. The rates of high blood pressure among African Americans, as a group, are the highest in the world. The implications for higher average blood pressure include complications for many major chronic conditions, such as cardiovascular disease and diabetes. Less well studied is the effect of blood pressure on the cognitive functioning of African Americans. The purpose of this study was to examine the effect of blood pressure on memory measures in a sample of adult African Americans. Analyses were conducted on a sample of 361 African American adults (mean age 61.50 years, standard deviation 9.39 years). We found significant correlations between systolic blood pressure and most cognitive measures but only for one of the measures and diastolic blood pressure. Regressions revealed significant effects for systolic blood pressure on Digit Symbol, Telephone Interview of Cognitive Status, and Immediate Recall on the Wechsler Logical Memory test. These findings suggest that blood pressure is a source of individual variability in cognitive aging among African Americans. |
9,362,266 | D000818:Animals; D066298:In Vitro Techniques; D008297:Male; D009203:Myocardial Infarction; D017202:Myocardial Ischemia; D009206:Myocardium; D051381:Rats; D017208:Rats, Wistar; D013654:Taurine; D015091:beta-Alanine | [
"D000818",
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"D008297",
"D009203",
"D017202",
"D009206",
"D051381",
"D017208",
"D013654",
"D015091"
] | Taurine depletion, a novel mechanism for cardioprotection from regional ischemia. | Three processes that have been implicated in ischemic injury are impaired Ca2+ movement, altered osmoregulation, and membrane remodeling. Because the amino acid, taurine, affects all three processes, it seemed logical that changes in the myocardial content of taurine might affect ischemic injury. To test this hypothesis, infarct size and areas at risk were compared in isolated hearts from control and taurine-depleted rats after a 45-min ligation of the left anterior descending coronary artery and 2 h of reperfusion. Hearts of rats treated for 4 wk with the taurine inhibitor, beta-alanine, exhibited a 57% reduction in the infarct size-to-risk area ratio. The degree of cardioprotection was found to correlate (r = 0.85) with the extent of taurine depletion, the latter dependent on the length of beta-alanine feeding. When the taurine-depleted rats were fed taurine, myocardial taurine levels were restored and the cardioprotection was lost. However, addition of neither beta-alanine (3%) nor taurine (20 mM) to the perfusion medium altered infarct size. We conclude that taurine depletion renders the heart resistant to injury caused by regional ischemia. | 8,058,468 | true | Taurine depletion, a novel mechanism for cardioprotection from regional ischemia. Three processes that have been implicated in ischemic injury are impaired Ca2+ movement, altered osmoregulation, and membrane remodeling. Because the amino acid, taurine, affects all three processes, it seemed logical that changes in the myocardial content of taurine might affect ischemic injury. To test this hypothesis, infarct size and areas at risk were compared in isolated hearts from control and taurine-depleted rats after a 45-min ligation of the left anterior descending coronary artery and 2 h of reperfusion. Hearts of rats treated for 4 wk with the taurine inhibitor, beta-alanine, exhibited a 57% reduction in the infarct size-to-risk area ratio. The degree of cardioprotection was found to correlate (r = 0.85) with the extent of taurine depletion, the latter dependent on the length of beta-alanine feeding. When the taurine-depleted rats were fed taurine, myocardial taurine levels were restored and the cardioprotection was lost. However, addition of neither beta-alanine (3%) nor taurine (20 mM) to the perfusion medium altered infarct size. We conclude that taurine depletion renders the heart resistant to injury caused by regional ischemia. |
10,203,398 | D001049:Apnea; D001530:Belgium; D016009:Chi-Square Distribution; D003142:Communication; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006323:Heart Arrest; D006801:Humans; D008020:Life Support Care; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors | [
"D001049",
"D001530",
"D016009",
"D003142",
"D004632",
"D004634",
"D006323",
"D006801",
"D008020",
"D011446",
"D015996",
"D013997"
] | Do victims of an out-of-hospital cardiac arrest benefit from a training program for emergency medical dispatchers? | In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects. | 10,901,718 | true | Do victims of an out-of-hospital cardiac arrest benefit from a training program for emergency medical dispatchers? In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects. |
26,976,877 | D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D000077144:Clopidogrel; D017023:Coronary Angiography; D003324:Coronary Artery Disease; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction; D009204:Myocardial Revascularization; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors; D013988:Ticlopidine; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States | [
"D000367",
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"D000369",
"D006328",
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"D003324",
"D005260",
"D006801",
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"D006278",
"D009203",
"D009204",
"D010351",
"D010975",
"D058921",
"D012017",
"D012042",
"D012307",
"D013988",
"D013997",
"D016896",
"D014481"
] | Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital Revascularization. | BACKGROUND
While use of P2Y12 receptor inhibitor is recommended by guidelines, few studies have examined its effectiveness among older non-ST-segment elevation myocardial infarction patients who did not undergo coronary revascularization.
RESULTS
We included unrevascularized non-ST-segment elevation myocardial infarction patients ≥65 years discharged home from 463 ACTION Registry-GWTG hospitals from 2007 to 2010. Rates of discharge clopidogrel use were described for patients with no angiography, angiography without obstructive coronary artery disease (CAD; ≥50% stenosis in ≥1 vessel), and angiography with obstructive CAD. Two-year outcomes were ascertained from linked Medicare data and included composite major adverse cardiac events (defined as all-cause death, myocardial infarction readmission, or revascularization), and individual components. Outcomes associated with clopidogrel use were adjusted using inverse probability-weighted propensity modeling. Of 14 154 unrevascularized patients, 54.7% (n=7745) did not undergo angiography, 10.6% (n=1494) had angiography without CAD, and 34.7% (n=4915) had angiography with CAD. Discharge clopidogrel was prescribed for 42.2% of all unrevascularized patients: 37.8% without angiography, 34.1% without obstructive CAD at angiography, and 51.6% with obstructive CAD at angiography. Discharge clopidogrel use was not associated with major adverse cardiac events in any group: without angiography (adjusted hazard ratio [95% CI]: 0.99 [0.93-1.06]), angiography without CAD (1.04 [0.74-1.47]), and angiography with CAD (1.12 [1.00-1.25], Pinteraction=0.20).
CONCLUSIONS
We found no association between discharge clopidogrel use and long-term risk of major adverse cardiac events among older, unrevascularized non-ST-segment elevation myocardial infarction patients. Clopidogrel use in this population requires further prospective evaluation. | null | false | Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital Revascularization. BACKGROUND
While use of P2Y12 receptor inhibitor is recommended by guidelines, few studies have examined its effectiveness among older non-ST-segment elevation myocardial infarction patients who did not undergo coronary revascularization.
RESULTS
We included unrevascularized non-ST-segment elevation myocardial infarction patients ≥65 years discharged home from 463 ACTION Registry-GWTG hospitals from 2007 to 2010. Rates of discharge clopidogrel use were described for patients with no angiography, angiography without obstructive coronary artery disease (CAD; ≥50% stenosis in ≥1 vessel), and angiography with obstructive CAD. Two-year outcomes were ascertained from linked Medicare data and included composite major adverse cardiac events (defined as all-cause death, myocardial infarction readmission, or revascularization), and individual components. Outcomes associated with clopidogrel use were adjusted using inverse probability-weighted propensity modeling. Of 14 154 unrevascularized patients, 54.7% (n=7745) did not undergo angiography, 10.6% (n=1494) had angiography without CAD, and 34.7% (n=4915) had angiography with CAD. Discharge clopidogrel was prescribed for 42.2% of all unrevascularized patients: 37.8% without angiography, 34.1% without obstructive CAD at angiography, and 51.6% with obstructive CAD at angiography. Discharge clopidogrel use was not associated with major adverse cardiac events in any group: without angiography (adjusted hazard ratio [95% CI]: 0.99 [0.93-1.06]), angiography without CAD (1.04 [0.74-1.47]), and angiography with CAD (1.12 [1.00-1.25], Pinteraction=0.20).
CONCLUSIONS
We found no association between discharge clopidogrel use and long-term risk of major adverse cardiac events among older, unrevascularized non-ST-segment elevation myocardial infarction patients. Clopidogrel use in this population requires further prospective evaluation. |
21,558,772 | D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine; D003428:Cross Infection; D004311:Double-Blind Method; D005260:Female; D006330:Heart Defects, Congenital; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009067:Mouthwashes; D009910:Oral Hygiene; D018410:Pneumonia, Bacterial; D053717:Pneumonia, Ventilator-Associated; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D013997:Time Factors | [
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"D002710",
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"D008297",
"D009067",
"D009910",
"D018410",
"D053717",
"D012121",
"D018709",
"D013997"
] | Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. | OBJECTIVE
To evaluate the effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.
METHODS
Prospective, randomized, double-blind, placebo-controlled trial.
METHODS
Pediatric intensive care unit (PICU) at a tertiary care hospital.
METHODS
One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: chlorhexidine (n = 87) and control (n = 73).
METHODS
Oral hygiene with 0.12% chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.
RESULTS
Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months; P = .72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups; P = .17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (P = .46) and the incidence of VAP was 18.3% versus 15% (P = .57) in the chlorhexidine and the control group, respectively. There was no difference in intubation time (P = .34), need for reintubation (P = .37), time interval between hospitalization and nosocomial pneumonia diagnosis (P = .63), time interval between surgery and nosocomial pneumonia diagnosis (P = .10), and time on antibiotics (P = .77) and vasoactive drugs (P = .16) between groups. Median length of PICU stay (3 vs 4 days; P = .53), median length of hospital stay (12 vs 11 days; P = .67), and 28-day mortality (5.7% vs 6.8%; P = .77) were also similar in the chlorhexidine and the control group.
CONCLUSIONS
Oral hygiene with 0.12% chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.
BACKGROUND
ClinicalTrials.gov identifier: NCT00829842 . | null | false | Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. OBJECTIVE
To evaluate the effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.
METHODS
Prospective, randomized, double-blind, placebo-controlled trial.
METHODS
Pediatric intensive care unit (PICU) at a tertiary care hospital.
METHODS
One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: chlorhexidine (n = 87) and control (n = 73).
METHODS
Oral hygiene with 0.12% chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.
RESULTS
Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months; P = .72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups; P = .17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (P = .46) and the incidence of VAP was 18.3% versus 15% (P = .57) in the chlorhexidine and the control group, respectively. There was no difference in intubation time (P = .34), need for reintubation (P = .37), time interval between hospitalization and nosocomial pneumonia diagnosis (P = .63), time interval between surgery and nosocomial pneumonia diagnosis (P = .10), and time on antibiotics (P = .77) and vasoactive drugs (P = .16) between groups. Median length of PICU stay (3 vs 4 days; P = .53), median length of hospital stay (12 vs 11 days; P = .67), and 28-day mortality (5.7% vs 6.8%; P = .77) were also similar in the chlorhexidine and the control group.
CONCLUSIONS
Oral hygiene with 0.12% chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.
BACKGROUND
ClinicalTrials.gov identifier: NCT00829842 . |
15,256,222 | D000818:Animals; D000975:Antioxidants; D001204:Ascorbate Oxidase; D001205:Ascorbic Acid; D001921:Brain; D002851:Chromatography, High Pressure Liquid; D003683:Dehydroascorbic Acid; D005609:Free Radicals; D005978:Glutathione; D006605:Hibernation; D010084:Oxidation-Reduction; D010100:Oxygen; D015427:Reperfusion Injury; D012589:Sciuridae; D013696:Temperature; D013997:Time Factors; D014018:Tissue Distribution; D014527:Uric Acid | [
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"D003683",
"D005609",
"D005978",
"D006605",
"D010084",
"D010100",
"D015427",
"D012589",
"D013696",
"D013997",
"D014018",
"D014527"
] | Ascorbate distribution during hibernation is independent of ascorbate redox state. | Distribution of ascorbate into tissues is an essential process in ascorbate antioxidant defense. Hibernating animals are studied as a model of tolerance to ischemia-reperfusion because of their tolerance to fluctuations in blood flow associated with prolonged torpor and periodic arousal episodes. Throughout hibernation, plasma ascorbate concentration ([Asc](p)) repetitively increases during torpor, then falls during periodic arousal bouts. We previously proposed that high [Asc](p) provides a ready source of antioxidant protection for distribution to the central nervous system and peripheral tissues during arousal. Here we tested whether deliberate oxidation of plasma ascorbate by intravenous administration of ascorbate oxidase (AO), prior to arousal, compromised tissue levels of ascorbate or the other water-soluble antioxidants, glutathione (GSH) and urate. Although AO decreased [Asc](p) to below the level of detection during torpor and after arousal, ascorbate oxidation did not decrease post-arousal tissue levels of reduced ascorbate, glutathione, or urate in any tissue examined, except liver. The data imply that ascorbate is taken up equally well into brain and other tissues as either ascorbate or its oxidized product dehydroascorbate, with subsequent intracellular reduction of dehydroascorbate. Lack of effect of ascorbate oxidation on tissue levels of GSH or urate indicates that dehydroascorbate uptake and reduction do not compromise tissue concentrations of these other water-soluble antioxidants. Thus, we show equal availability of reduced and oxidized plasma ascorbate during metabolically demanding thermogenesis and reperfusion associated with arousal from hibernation. | 6,155,104 | true | Ascorbate distribution during hibernation is independent of ascorbate redox state. Distribution of ascorbate into tissues is an essential process in ascorbate antioxidant defense. Hibernating animals are studied as a model of tolerance to ischemia-reperfusion because of their tolerance to fluctuations in blood flow associated with prolonged torpor and periodic arousal episodes. Throughout hibernation, plasma ascorbate concentration ([Asc](p)) repetitively increases during torpor, then falls during periodic arousal bouts. We previously proposed that high [Asc](p) provides a ready source of antioxidant protection for distribution to the central nervous system and peripheral tissues during arousal. Here we tested whether deliberate oxidation of plasma ascorbate by intravenous administration of ascorbate oxidase (AO), prior to arousal, compromised tissue levels of ascorbate or the other water-soluble antioxidants, glutathione (GSH) and urate. Although AO decreased [Asc](p) to below the level of detection during torpor and after arousal, ascorbate oxidation did not decrease post-arousal tissue levels of reduced ascorbate, glutathione, or urate in any tissue examined, except liver. The data imply that ascorbate is taken up equally well into brain and other tissues as either ascorbate or its oxidized product dehydroascorbate, with subsequent intracellular reduction of dehydroascorbate. Lack of effect of ascorbate oxidation on tissue levels of GSH or urate indicates that dehydroascorbate uptake and reduction do not compromise tissue concentrations of these other water-soluble antioxidants. Thus, we show equal availability of reduced and oxidized plasma ascorbate during metabolically demanding thermogenesis and reperfusion associated with arousal from hibernation. |
25,306,428 | D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D055815:Young Adult | [
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"D014481",
"D055815"
] | Prognostic value of automatically detected early repolarization. | Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. We therefore assessed the prevalence and prognostic significance of AER in 211,920 patients aged 18 to 75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded electrocardiogram of each individual from 2000 to 2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated electrocardiographic interpretations were reviewed for accuracy by a board-certified cardiologist. The primary end point was death during a median follow-up of 8.0 ± 2.6 years. AER was present in 3,450 subjects (1.6%). The prevalence varied significantly with race (African-Americans 2.2%, Hispanics 1.5%, and non-Hispanic whites 0.9%, p <0.01) and gender (male 2.4% vs female 0.6%, p <0.001). In a Cox proportional hazards model controlling for age, smoking status, heart rate, QTc, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, and coronary artery disease, there was no significant difference in mortality regardless of race or gender (relative risk 0.98, 95% confidence interval 0.89 to 1.07). This was true even if J waves were present. In conclusion, AER was not associated with an increased risk of death, regardless of race or gender, and should not trigger additional diagnostic testing. | 13,353,812 | true | Prognostic value of automatically detected early repolarization. Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. We therefore assessed the prevalence and prognostic significance of AER in 211,920 patients aged 18 to 75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded electrocardiogram of each individual from 2000 to 2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated electrocardiographic interpretations were reviewed for accuracy by a board-certified cardiologist. The primary end point was death during a median follow-up of 8.0 ± 2.6 years. AER was present in 3,450 subjects (1.6%). The prevalence varied significantly with race (African-Americans 2.2%, Hispanics 1.5%, and non-Hispanic whites 0.9%, p <0.01) and gender (male 2.4% vs female 0.6%, p <0.001). In a Cox proportional hazards model controlling for age, smoking status, heart rate, QTc, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, and coronary artery disease, there was no significant difference in mortality regardless of race or gender (relative risk 0.98, 95% confidence interval 0.89 to 1.07). This was true even if J waves were present. In conclusion, AER was not associated with an increased risk of death, regardless of race or gender, and should not trigger additional diagnostic testing. |
12,670,851 | D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009203:Myocardial Infarction; D016584:Panic Disorder; D010346:Patient Care Management; D010360:Patient Transfer; D011787:Quality of Health Care; D012017:Referral and Consultation; D012449:Safety | [
"D003951",
"D004636",
"D006801",
"D008297",
"D008505",
"D008875",
"D009203",
"D016584",
"D010346",
"D010360",
"D011787",
"D012017",
"D012449"
] | Profiles in patient safety: emergency care transitions. | A 59-year-old man presented to the emergency department (ED) with the chief complaint of "panic attacks." In total, he was evaluated by 14 faculty physicians, 2 fellows, and 16 residents from emergency medicine, cardiology, neurology, psychiatry, and internal medicine. These multiple transitions were responsible, in part, for the perpetuation of a failure to accurately diagnose the patient's underlying medical illness. The case illustrates the discontinuity of care that occurs at transitions, which may threaten the safety and quality of patient care. Considerable effort must be directed at making transitions effective and safe. Recommendations to improve transitions include a heightened awareness of cognitive biases operating at these vulnerable times, improving team situational awareness and communication, and exploring systems to facilitate effective transfer of relevant data. | 9,367,473 | true | Profiles in patient safety: emergency care transitions. A 59-year-old man presented to the emergency department (ED) with the chief complaint of "panic attacks." In total, he was evaluated by 14 faculty physicians, 2 fellows, and 16 residents from emergency medicine, cardiology, neurology, psychiatry, and internal medicine. These multiple transitions were responsible, in part, for the perpetuation of a failure to accurately diagnose the patient's underlying medical illness. The case illustrates the discontinuity of care that occurs at transitions, which may threaten the safety and quality of patient care. Considerable effort must be directed at making transitions effective and safe. Recommendations to improve transitions include a heightened awareness of cognitive biases operating at these vulnerable times, improving team situational awareness and communication, and exploring systems to facilitate effective transfer of relevant data. |
15,559,220 | D000367:Age Factors; D000368:Aged; D000596:Amino Acids; D002545:Brain Ischemia; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018697:Nootropic Agents; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D013349:Subclavian Steal Syndrome; D016896:Treatment Outcome | [
"D000367",
"D000368",
"D000596",
"D002545",
"D004305",
"D005500",
"D006801",
"D008875",
"D018697",
"D017410",
"D011379",
"D012307",
"D013349",
"D016896"
] | [Clinical and pathogenetical peculiarities and treatment policy in ischemic stroke of elderly and old age]. | The data on randomized study of 2 groups of patients with ischemic brain hemisphere stroke of elderly and old (over 70 years) as well as middle (under 60 years) age are presented. In elderly and old age, stroke develops on the basis of common affection of major vessels, with a great role of the "steal syndrome" in its pathogenesis. In authors' opinion, in treatment of ischemic stroke of elderly and old age attention should be paid to metabolic therapy, in particular to using high dosages of Cerebrolysin. Basing on clinical and paraclinical study, efficacy of this medication is revealed. | null | false | [Clinical and pathogenetical peculiarities and treatment policy in ischemic stroke of elderly and old age]. The data on randomized study of 2 groups of patients with ischemic brain hemisphere stroke of elderly and old (over 70 years) as well as middle (under 60 years) age are presented. In elderly and old age, stroke develops on the basis of common affection of major vessels, with a great role of the "steal syndrome" in its pathogenesis. In authors' opinion, in treatment of ischemic stroke of elderly and old age attention should be paid to metabolic therapy, in particular to using high dosages of Cerebrolysin. Basing on clinical and paraclinical study, efficacy of this medication is revealed. |
30,464,137 | D000368:Aged; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D014655:Vascular Resistance; D016278:Ventricular Function, Right | [
"D000368",
"D001783",
"D006328",
"D004452",
"D015150",
"D005260",
"D006352",
"D006439",
"D006801",
"D006976",
"D008297",
"D008875",
"D020097",
"D014655",
"D016278"
] | Analysis of Biphasic Right Ventricular Outflow Doppler Waveform in Patients with Pulmonary Hypertension. | Pulmonary hypertension (PH) with pulmonary vascular disease (PVD) is a progressive and debilitating disease associated with increased pulmonary vascular resistance (PVR). Biphasic right ventricular outflow tract (RVOT) Doppler flow is frequently seen in severe PH patients with PVD. In association with hemodynamics, the precise analysis of biphasic RVOT Doppler flow (RVDF) has not been fully elucidated. Therefore, the purpose of the present study is to analyze the relation between the hemodynamics and indices of biphasic RVDF in PH patients with PVD.Seventy PH patients with biphasic RVDF were analyzed. All patients underwent transthoracic echocardiography and right heart catheterization. For the analysis of biphasic RVDF, the early waveform was determined as P1 while the late waveform was determined as P2. For each P1 and P2, the duration (D, seconds) and peak flow velocity (PFV, in m/second) were measured.P1D and P2PFV were significantly correlated with PVR (P1D: r = -0.542, P < 0.0001, P2PFV: r = -0.513, P < 0.0001). Therefore, we propose a novel RVDF formula for estimation of PVR, as follows. PVR = 26 - 77 × P1D - 14 × P2PFV. The PVR could be estimated by this proposed formula (r = 0.649, P < 0.0001), which is derived from one Doppler image only unlike previously used PVR prediction formula.P1D and P2PFV were associated with PVR. Moreover, this simple RVDF formula proposed herein can estimate PVR in PH patients with PVD. | null | false | Analysis of Biphasic Right Ventricular Outflow Doppler Waveform in Patients with Pulmonary Hypertension. Pulmonary hypertension (PH) with pulmonary vascular disease (PVD) is a progressive and debilitating disease associated with increased pulmonary vascular resistance (PVR). Biphasic right ventricular outflow tract (RVOT) Doppler flow is frequently seen in severe PH patients with PVD. In association with hemodynamics, the precise analysis of biphasic RVOT Doppler flow (RVDF) has not been fully elucidated. Therefore, the purpose of the present study is to analyze the relation between the hemodynamics and indices of biphasic RVDF in PH patients with PVD.Seventy PH patients with biphasic RVDF were analyzed. All patients underwent transthoracic echocardiography and right heart catheterization. For the analysis of biphasic RVDF, the early waveform was determined as P1 while the late waveform was determined as P2. For each P1 and P2, the duration (D, seconds) and peak flow velocity (PFV, in m/second) were measured.P1D and P2PFV were significantly correlated with PVR (P1D: r = -0.542, P < 0.0001, P2PFV: r = -0.513, P < 0.0001). Therefore, we propose a novel RVDF formula for estimation of PVR, as follows. PVR = 26 - 77 × P1D - 14 × P2PFV. The PVR could be estimated by this proposed formula (r = 0.649, P < 0.0001), which is derived from one Doppler image only unlike previously used PVR prediction formula.P1D and P2PFV were associated with PVR. Moreover, this simple RVDF formula proposed herein can estimate PVR in PH patients with PVD. |
16,275,434 | D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D015607:Stents | [
"D000368",
"D000369",
"D019917",
"D002343",
"D016893",
"D002560",
"D005260",
"D005500",
"D006801",
"D015994",
"D020766",
"D008279",
"D008297",
"D008875",
"D011183",
"D011446",
"D011474",
"D011475",
"D012307",
"D015607"
] | Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study. | BACKGROUND
This was a prospective single-center study to assess and analyze cerebral embolization resulting from carotid artery stenting with neuroprotective filter devices in patients considered as poor surgical candidates for surgical carotid endarterectomy.
METHODS
Fifty-three consecutive patients with an internal carotid artery stenosis were treated by placement of carotid Wallstents with two different types of temporary distal filter protection devices: the Spider filter and the FilterWire. Diffusion-weighted magnetic resonance imaging (DWI) of the brain was obtained 24 hours before the procedure and within 5 to 30 hours after the procedure to detect ischemic brain lesions resulting from the procedure. Inclusion criteria were symptomatic (> or =70%) or asymptomatic (> or =80%) stenoses in surgical high-risk patients.
RESULTS
Two (4%) regressive minor strokes occurred. Postprocedural DWI detected new focal ischemic lesions in 21 patients (40%). The average number of lesions was 5.9 per patient, and the mean lesion volume was 1 mL or less in 19 patients (90%). Small differences were found in the lesion distribution: homolateral anterior circulation in eight cases (15.1%), other vascular territories in seven cases (13.2%), and homolateral anterior circulation plus other vascular territories in six cases (11.3%). The microembolization risk seemed nonpredictable on the basis of clinical parameters and internal carotid artery lesion characteristics. An increased risk in the rate of ipsilateral hemispheric embolization has been observed in difficult carotid arch implantations (P = .04).
CONCLUSIONS
The incidence of new focal ischemic lesions detected by DWI is higher than expected on the basis of previous reports. Embolization from the aortic arch or common carotid arteries could account for most of those events in patients considered as surgical high-risk patients. Although 90% of the events were clinically silent, this high rate of microembolization raises questions about the possible consequences on cerebral cognitive functions. | null | false | Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study. BACKGROUND
This was a prospective single-center study to assess and analyze cerebral embolization resulting from carotid artery stenting with neuroprotective filter devices in patients considered as poor surgical candidates for surgical carotid endarterectomy.
METHODS
Fifty-three consecutive patients with an internal carotid artery stenosis were treated by placement of carotid Wallstents with two different types of temporary distal filter protection devices: the Spider filter and the FilterWire. Diffusion-weighted magnetic resonance imaging (DWI) of the brain was obtained 24 hours before the procedure and within 5 to 30 hours after the procedure to detect ischemic brain lesions resulting from the procedure. Inclusion criteria were symptomatic (> or =70%) or asymptomatic (> or =80%) stenoses in surgical high-risk patients.
RESULTS
Two (4%) regressive minor strokes occurred. Postprocedural DWI detected new focal ischemic lesions in 21 patients (40%). The average number of lesions was 5.9 per patient, and the mean lesion volume was 1 mL or less in 19 patients (90%). Small differences were found in the lesion distribution: homolateral anterior circulation in eight cases (15.1%), other vascular territories in seven cases (13.2%), and homolateral anterior circulation plus other vascular territories in six cases (11.3%). The microembolization risk seemed nonpredictable on the basis of clinical parameters and internal carotid artery lesion characteristics. An increased risk in the rate of ipsilateral hemispheric embolization has been observed in difficult carotid arch implantations (P = .04).
CONCLUSIONS
The incidence of new focal ischemic lesions detected by DWI is higher than expected on the basis of previous reports. Embolization from the aortic arch or common carotid arteries could account for most of those events in patients considered as surgical high-risk patients. Although 90% of the events were clinically silent, this high rate of microembolization raises questions about the possible consequences on cerebral cognitive functions. |
20,846,597 | D015415:Biomarkers; D001706:Biopsy; D009202:Cardiomyopathies; D019091:Critical Pathways; D004452:Echocardiography; D006801:Humans; D007501:Iron; D019190:Iron Overload; D008279:Magnetic Resonance Imaging; D009206:Myocardium; D014057:Tomography, X-Ray Computed | [
"D015415",
"D001706",
"D009202",
"D019091",
"D004452",
"D006801",
"D007501",
"D019190",
"D008279",
"D009206",
"D014057"
] | Iron overload cardiomyopathy: better understanding of an increasing disorder. | The prevalence of iron overload cardiomyopathy (IOC) is increasing. The spectrum of symptoms of IOC is varied. Early in the disease process, patients may be asymptomatic, whereas severely overloaded patients can have terminal heart failure complaints that are refractory to treatment. It has been shown that early recognition and intervention may alter outcomes. Biochemical markers and tissue biopsy, which have traditionally been used to diagnose and guide therapy, are not sensitive enough to detect early cardiac iron deposition. Newer diagnostic modalities such as magnetic resonance imaging are noninvasive and can assess quantitative cardiac iron load. Phlebotomy and chelating drugs are suboptimal means of treating IOC; hence, the roles of gene therapy, hepcidin, and calcium channel blockers are being actively investigated. There is a need for the development of clinical guidelines in order to improve the management of this emerging complex disease. | 11,653,542 | true | Iron overload cardiomyopathy: better understanding of an increasing disorder. The prevalence of iron overload cardiomyopathy (IOC) is increasing. The spectrum of symptoms of IOC is varied. Early in the disease process, patients may be asymptomatic, whereas severely overloaded patients can have terminal heart failure complaints that are refractory to treatment. It has been shown that early recognition and intervention may alter outcomes. Biochemical markers and tissue biopsy, which have traditionally been used to diagnose and guide therapy, are not sensitive enough to detect early cardiac iron deposition. Newer diagnostic modalities such as magnetic resonance imaging are noninvasive and can assess quantitative cardiac iron load. Phlebotomy and chelating drugs are suboptimal means of treating IOC; hence, the roles of gene therapy, hepcidin, and calcium channel blockers are being actively investigated. There is a need for the development of clinical guidelines in order to improve the management of this emerging complex disease. |
27,697,440 | D000991:Antithrombins; D000066491:Clinical Decision-Making; D000069604:Dabigatran; D065427:Factor Xa Inhibitors; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D020300:Intracranial Hemorrhages; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013923:Thromboembolism | [
"D000991",
"D000066491",
"D000069604",
"D065427",
"D006471",
"D006801",
"D020300",
"D017410",
"D018570",
"D013923"
] | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. | Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. | 8,080,679 | true | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. |
27,697,440 | D000991:Antithrombins; D000066491:Clinical Decision-Making; D000069604:Dabigatran; D065427:Factor Xa Inhibitors; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D020300:Intracranial Hemorrhages; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013923:Thromboembolism | [
"D000991",
"D000066491",
"D000069604",
"D065427",
"D006471",
"D006801",
"D020300",
"D017410",
"D018570",
"D013923"
] | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. | Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. | 10,141,236 | true | Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed. Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. This review provides guidance for clinicians regarding if and when a patient should be re-initiated on DOAC therapy following a major hemorrhage, based on the existing evidence. |
160,516 | D000368:Aged; D006332:Cardiomegaly; D004935:Esophageal Diseases; D005260:Female; D006325:Heart Atria; D006801:Humans; D011189:Potassium Chloride; D014456:Ulcer | [
"D000368",
"D006332",
"D004935",
"D005260",
"D006325",
"D006801",
"D011189",
"D014456"
] | Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement. | Ulceration of the oesophagus was suspected clinically and confirmed radiologically in a patient with an enlarged left atrium while on treatment with slow release potassium chloride. Its discontinuation resulted in resolution of symptoms. This potentially serious complication of treatment should be considered in patients with enlargement of the left atrium who develop dysphagia. It is avoided by using soluble forms of potassium chloride replacement. | 1,081,703 | true | Oesophageal ulceration due to slow-release potassium in the presence of left atrial enlargement. Ulceration of the oesophagus was suspected clinically and confirmed radiologically in a patient with an enlarged left atrium while on treatment with slow release potassium chloride. Its discontinuation resulted in resolution of symptoms. This potentially serious complication of treatment should be considered in patients with enlargement of the left atrium who develop dysphagia. It is avoided by using soluble forms of potassium chloride replacement. |
33,805,763 | D064987:Cell- and Tissue-Based Therapy; D006333:Heart Failure; D006801:Humans; D009206:Myocardium; D032383:Myocytes, Cardiac; D023822:Tissue Engineering | [
"D064987",
"D006333",
"D006801",
"D009206",
"D032383",
"D023822"
] | Cardiac Cell Therapy for Heart Repair: Should the Cells Be Left Out? | Cardiovascular disease (CVD) is still the leading cause of death worldwide. Coronary artery occlusion, or myocardial infarction (MI) causes massive loss of cardiomyocytes. The ischemia area is eventually replaced by a fibrotic scar. From the mechanical dysfunctions of the scar in electronic transduction, contraction and compliance, pathological cardiac dilation and heart failure develops. Once end-stage heart failure occurs, the only option is to perform heart transplantation. The sequential changes are termed cardiac remodeling, and are due to the lack of endogenous regenerative actions in the adult human heart. Regenerative medicine and biomedical engineering strategies have been pursued to repair the damaged heart and to restore normal cardiac function. Such strategies include both cellular and acellular products, in combination with biomaterials. In addition, substantial progress has been made to elucidate the molecular and cellular mechanisms underlying heart repair and regeneration. In this review, we summarize and discuss current therapeutic approaches for cardiac repair and provide a perspective on novel strategies that holding potential opportunities for future research and clinical translation. | 4,444,606 | true | Cardiac Cell Therapy for Heart Repair: Should the Cells Be Left Out? Cardiovascular disease (CVD) is still the leading cause of death worldwide. Coronary artery occlusion, or myocardial infarction (MI) causes massive loss of cardiomyocytes. The ischemia area is eventually replaced by a fibrotic scar. From the mechanical dysfunctions of the scar in electronic transduction, contraction and compliance, pathological cardiac dilation and heart failure develops. Once end-stage heart failure occurs, the only option is to perform heart transplantation. The sequential changes are termed cardiac remodeling, and are due to the lack of endogenous regenerative actions in the adult human heart. Regenerative medicine and biomedical engineering strategies have been pursued to repair the damaged heart and to restore normal cardiac function. Such strategies include both cellular and acellular products, in combination with biomaterials. In addition, substantial progress has been made to elucidate the molecular and cellular mechanisms underlying heart repair and regeneration. In this review, we summarize and discuss current therapeutic approaches for cardiac repair and provide a perspective on novel strategies that holding potential opportunities for future research and clinical translation. |
24,951,664 | D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001786:Blood Glucose; D002880:Chromosomes, Human, Pair 11; D015331:Cohort Studies; D053418:Death Domain Receptor Signaling Adaptor Proteins; D003924:Diabetes Mellitus, Type 2; D005215:Fasting; D005260:Female; D005787:Gene Frequency; D014644:Genetic Variation; D055106:Genome-Wide Association Study; D023281:Genomics; D020662:Guanine Nucleotide Exchange Factors; D006331:Heart Diseases; D006801:Humans; D007328:Insulin; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D017422:Sequence Analysis, DNA | [
"D000368",
"D000369",
"D000375",
"D001786",
"D002880",
"D015331",
"D053418",
"D003924",
"D005215",
"D005260",
"D005787",
"D014644",
"D055106",
"D023281",
"D020662",
"D006331",
"D006801",
"D007328",
"D008297",
"D008875",
"D020641",
"D017422"
] | Association of levels of fasting glucose and insulin with rare variants at the chromosome 11p11.2-MADD locus: Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium Targeted Sequencing Study. | BACKGROUND
Common variation at the 11p11.2 locus, encompassing MADD, ACP2, NR1H3, MYBPC3, and SPI1, has been associated in genome-wide association studies with fasting glucose and insulin (FI). In the Cohorts for Heart and Aging Research in Genomic Epidemiology Targeted Sequencing Study, we sequenced 5 gene regions at 11p11.2 to identify rare, potentially functional variants influencing fasting glucose or FI levels.
RESULTS
Sequencing (mean depth, 38×) across 16.1 kb in 3566 individuals without diabetes mellitus identified 653 variants, 79.9% of which were rare (minor allele frequency <1%) and novel. We analyzed rare variants in 5 gene regions with FI or fasting glucose using the sequence kernel association test. At NR1H3, 53 rare variants were jointly associated with FI (P=2.73×10(-3)); of these, 7 were predicted to have regulatory function and showed association with FI (P=1.28×10(-3)). Conditioning on 2 previously associated variants at MADD (rs7944584, rs10838687) did not attenuate this association, suggesting that there are >2 independent signals at 11p11.2. One predicted regulatory variant, chr11:47227430 (hg18; minor allele frequency=0.00068), contributed 20.6% to the overall sequence kernel association test score at NR1H3, lies in intron 2 of NR1H3, and is a predicted binding site for forkhead box A1 (FOXA1), a transcription factor associated with insulin regulation. In human HepG2 hepatoma cells, the rare chr11:47227430 A allele disrupted FOXA1 binding and reduced FOXA1-dependent transcriptional activity.
CONCLUSIONS
Sequencing at 11p11.2-NR1H3 identified rare variation associated with FI. One variant, chr11:47227430, seems to be functional, with the rare A allele reducing transcription factor FOXA1 binding and FOXA1-dependent transcriptional activity. | null | false | Association of levels of fasting glucose and insulin with rare variants at the chromosome 11p11.2-MADD locus: Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium Targeted Sequencing Study. BACKGROUND
Common variation at the 11p11.2 locus, encompassing MADD, ACP2, NR1H3, MYBPC3, and SPI1, has been associated in genome-wide association studies with fasting glucose and insulin (FI). In the Cohorts for Heart and Aging Research in Genomic Epidemiology Targeted Sequencing Study, we sequenced 5 gene regions at 11p11.2 to identify rare, potentially functional variants influencing fasting glucose or FI levels.
RESULTS
Sequencing (mean depth, 38×) across 16.1 kb in 3566 individuals without diabetes mellitus identified 653 variants, 79.9% of which were rare (minor allele frequency <1%) and novel. We analyzed rare variants in 5 gene regions with FI or fasting glucose using the sequence kernel association test. At NR1H3, 53 rare variants were jointly associated with FI (P=2.73×10(-3)); of these, 7 were predicted to have regulatory function and showed association with FI (P=1.28×10(-3)). Conditioning on 2 previously associated variants at MADD (rs7944584, rs10838687) did not attenuate this association, suggesting that there are >2 independent signals at 11p11.2. One predicted regulatory variant, chr11:47227430 (hg18; minor allele frequency=0.00068), contributed 20.6% to the overall sequence kernel association test score at NR1H3, lies in intron 2 of NR1H3, and is a predicted binding site for forkhead box A1 (FOXA1), a transcription factor associated with insulin regulation. In human HepG2 hepatoma cells, the rare chr11:47227430 A allele disrupted FOXA1 binding and reduced FOXA1-dependent transcriptional activity.
CONCLUSIONS
Sequencing at 11p11.2-NR1H3 identified rare variation associated with FI. One variant, chr11:47227430, seems to be functional, with the rare A allele reducing transcription factor FOXA1 binding and FOXA1-dependent transcriptional activity. |
23,336,931 | D017311:Amlodipine; D000818:Animals; D000959:Antihypertensive Agents; D000069059:Atorvastatin; D002340:Carotid Artery Diseases; D017536:Carotid Artery, Common; D018932:Chemokine CCL2; D050759:Cyclin-Dependent Kinase Inhibitor p21; D004359:Drug Therapy, Combination; D042783:Endothelial Cells; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008297:Male; D011758:Pyrroles; D051381:Rats; D056564:Sirtuin 1; D016159:Tumor Suppressor Protein p53 | [
"D017311",
"D000818",
"D000959",
"D000069059",
"D002340",
"D017536",
"D018932",
"D050759",
"D004359",
"D042783",
"D006538",
"D019161",
"D008297",
"D011758",
"D051381",
"D056564",
"D016159"
] | Combination benefit of amlodipine plus atorvastatin treatment on carotid atherosclerosis in Zucker metabolic rats. | OBJECTIVE
Obesity is the major risk factor for metabolic syndrome and atherosclerotic cardiocerebrovascular diseases.
METHODS
We studied effects of amlodipine, atorvastatin, and their combination on carotid arteriosclerotic processes in a metabolic syndrome model of Zucker fatty rats. Zucker fatty rats were treated with vehicle, amlodipine, atorvastatin, or combination amlodipine plus atorvastatin for 28 days.
RESULTS
Compared with the single treatment with amlodipine or atorvastatin, the combination of amlodipine plus atorvastatin treatment prevented arteriosclerotic processes, and induced a strong recovery of Sirtuin1 (Sirt1) expression and a marked reduction in p53, p21, and monocyte chemoattractant protein-1 (MCP-1).
CONCLUSIONS
As Sirt1 is a longevity gene that prevents endothelial atherosclerotic processes, and p53, p21, and MCP-1 play pivotal roles in the initiation and development of atherosclerosis, these data suggest a strong synergistic benefit of combination therapy with amlodipine and atorvastatin for preventing atherosclerotic processes, and potentially reducing the clinical risk of cerebrovascular events in metabolic obesity patients. | null | false | Combination benefit of amlodipine plus atorvastatin treatment on carotid atherosclerosis in Zucker metabolic rats. OBJECTIVE
Obesity is the major risk factor for metabolic syndrome and atherosclerotic cardiocerebrovascular diseases.
METHODS
We studied effects of amlodipine, atorvastatin, and their combination on carotid arteriosclerotic processes in a metabolic syndrome model of Zucker fatty rats. Zucker fatty rats were treated with vehicle, amlodipine, atorvastatin, or combination amlodipine plus atorvastatin for 28 days.
RESULTS
Compared with the single treatment with amlodipine or atorvastatin, the combination of amlodipine plus atorvastatin treatment prevented arteriosclerotic processes, and induced a strong recovery of Sirtuin1 (Sirt1) expression and a marked reduction in p53, p21, and monocyte chemoattractant protein-1 (MCP-1).
CONCLUSIONS
As Sirt1 is a longevity gene that prevents endothelial atherosclerotic processes, and p53, p21, and MCP-1 play pivotal roles in the initiation and development of atherosclerosis, these data suggest a strong synergistic benefit of combination therapy with amlodipine and atorvastatin for preventing atherosclerotic processes, and potentially reducing the clinical risk of cerebrovascular events in metabolic obesity patients. |
8,060,581 | D000328:Adult; D001786:Blood Glucose; D004039:Diet, Sodium-Restricted; D005260:Female; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension; D007328:Insulin; D008297:Male; D008875:Middle Aged | [
"D000328",
"D001786",
"D004039",
"D005260",
"D018149",
"D005951",
"D006801",
"D006973",
"D007328",
"D008297",
"D008875"
] | Dietary NaCl restriction deteriorates oral glucose tolerance in hypertensive patients with impairment of glucose tolerance. | This study investigated whether the change of glycemic response to oral glucose loading with an increase of dietary NaCl intake is different between salt-sensitive and salt-resistant groups, or whether it is related to glucose tolerance on a low NaCl diet independent of salt sensitivity. The plasma glucose and insulin response to 75 g oral glucose intake was assessed on low (34 mmol/day) and high (342 mmol/day) NaCl diets in 31 patients with essential hypertension, and the area under the curve for both variables (AUCglu and AUCins) was calculated. The data on the high NaCl diet were corrected for change in hematocrit. The percentage change in systolic, diastolic, and mean blood pressure between the two diets was defined as the salt sensitivity index (SSI) for systolic blood pressure (SSISBP), diastolic blood pressure (SSIDBP), and mean blood pressure (SSIMBP), respectively. The mean values of both AUCglu and AUCins decreased significantly with increase of NaCl intake; however, there was no significant correlation between SSI (SSISBP, SSIDBP, or SSIMBP) and the percentage changes in AUCglu and AUCins. Meanwhile, the percentage changes in AUCglu and AUCins significantly correlated with the respective values of AUCglu and AUCins on the low NaCl diet. These results suggest that extreme NaCl restriction may deteriorate glucose metabolism in hypertensive patients, especially in those with diabetes mellitus or impaired glucose tolerance. | 7,575,587 | true | Dietary NaCl restriction deteriorates oral glucose tolerance in hypertensive patients with impairment of glucose tolerance. This study investigated whether the change of glycemic response to oral glucose loading with an increase of dietary NaCl intake is different between salt-sensitive and salt-resistant groups, or whether it is related to glucose tolerance on a low NaCl diet independent of salt sensitivity. The plasma glucose and insulin response to 75 g oral glucose intake was assessed on low (34 mmol/day) and high (342 mmol/day) NaCl diets in 31 patients with essential hypertension, and the area under the curve for both variables (AUCglu and AUCins) was calculated. The data on the high NaCl diet were corrected for change in hematocrit. The percentage change in systolic, diastolic, and mean blood pressure between the two diets was defined as the salt sensitivity index (SSI) for systolic blood pressure (SSISBP), diastolic blood pressure (SSIDBP), and mean blood pressure (SSIMBP), respectively. The mean values of both AUCglu and AUCins decreased significantly with increase of NaCl intake; however, there was no significant correlation between SSI (SSISBP, SSIDBP, or SSIMBP) and the percentage changes in AUCglu and AUCins. Meanwhile, the percentage changes in AUCglu and AUCins significantly correlated with the respective values of AUCglu and AUCins on the low NaCl diet. These results suggest that extreme NaCl restriction may deteriorate glucose metabolism in hypertensive patients, especially in those with diabetes mellitus or impaired glucose tolerance. |
2,310,255 | D000293:Adolescent; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria; D006327:Heart Block; D006346:Heart Septum; D006801:Humans; D013617:Tachycardia, Supraventricular | [
"D000293",
"D004562",
"D015716",
"D005260",
"D006325",
"D006327",
"D006346",
"D006801",
"D013617"
] | Surgical cure of automatic atrial tachycardia by partial left atrial isolation. | Partial left atrial isolation was performed in a 16-year-old girl with persistent atrial tachycardia refractory to antiarrhythmic agents for 3 years. Intraoperative atrial epicardial and endocardial mapping showed that the earliest atrial activation occurred in an area lateral to the junction of the right superior pulmonary vein and the left atrium. An incision isolating the right half of the left atrial body containing the area of the earliest atrial activation and both right pulmonary veins from the remainder of the left atrium was made. The incision was then reapproximated. An excision encircling the interatrial septum containing the upper anterior portion of the septum with early activation was also made, and the atrial septal defect was repaired with a pericardial patch. The patient has been in sinus rhythm and free of arrhythmia for a follow-up period of 12 months. | 7,445,756 | true | Surgical cure of automatic atrial tachycardia by partial left atrial isolation. Partial left atrial isolation was performed in a 16-year-old girl with persistent atrial tachycardia refractory to antiarrhythmic agents for 3 years. Intraoperative atrial epicardial and endocardial mapping showed that the earliest atrial activation occurred in an area lateral to the junction of the right superior pulmonary vein and the left atrium. An incision isolating the right half of the left atrial body containing the area of the earliest atrial activation and both right pulmonary veins from the remainder of the left atrium was made. The incision was then reapproximated. An excision encircling the interatrial septum containing the upper anterior portion of the septum with early activation was also made, and the atrial septal defect was repaired with a pericardial patch. The patient has been in sinus rhythm and free of arrhythmia for a follow-up period of 12 months. |
22,721,898 | D000293:Adolescent; D000328:Adult; D000368:Aged; D005165:Factor V; D005260:Female; D005838:Genotype; D006801:Humans; D020767:Intracranial Thrombosis; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D008875:Middle Aged; D011110:Polymorphism, Genetic; D020641:Polymorphism, Single Nucleotide; D011516:Prothrombin; D012307:Risk Factors; D014416:Tunisia; D020246:Venous Thrombosis; D055815:Young Adult | [
"D000293",
"D000328",
"D000368",
"D005165",
"D005260",
"D005838",
"D006801",
"D020767",
"D008297",
"D042965",
"D008875",
"D011110",
"D020641",
"D011516",
"D012307",
"D014416",
"D020246",
"D055815"
] | Thrombophilic polymorphisms - factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T - in Tunisian patients with cerebral venous thrombosis. | Cerebral venous thrombosis (CVT) has been associated with thrombophilic defects. We performed a study to evaluate the role of three single nucleotide polymorphisms (SNP), factor V Leiden G1691A (FVL), prothrombin gene mutation G20210A (FII-G20210A) and methylenotetrahydrofolate reductase variant C677T (MTHFR-C677T), as risk factors for CVT in Tunisian patients. A single center case-control study (26 patients with CVT and 197 controls) was performed. Genomic DNA was tested for the three SNP. The principle finding was the association between FVL and CVT (p<0.001, Odds ratio=6.1, 95% confidence interval=2.3-16.5). However, neither the FII-G20210 (p=0.536) nor the homozygous MTHFR-C677T genotype (p=0.325) variant contributed to the risk of CVT in these Tunisian patients. | 13,980,158 | true | Thrombophilic polymorphisms - factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T - in Tunisian patients with cerebral venous thrombosis. Cerebral venous thrombosis (CVT) has been associated with thrombophilic defects. We performed a study to evaluate the role of three single nucleotide polymorphisms (SNP), factor V Leiden G1691A (FVL), prothrombin gene mutation G20210A (FII-G20210A) and methylenotetrahydrofolate reductase variant C677T (MTHFR-C677T), as risk factors for CVT in Tunisian patients. A single center case-control study (26 patients with CVT and 197 controls) was performed. Genomic DNA was tested for the three SNP. The principle finding was the association between FVL and CVT (p<0.001, Odds ratio=6.1, 95% confidence interval=2.3-16.5). However, neither the FII-G20210 (p=0.536) nor the homozygous MTHFR-C677T genotype (p=0.325) variant contributed to the risk of CVT in these Tunisian patients. |
37,166,820 | D006801:Humans; D000068258:Bevacizumab; D012170:Retinal Vein Occlusion; D008269:Macular Edema; D020533:Angiogenesis Inhibitors; D040262:Receptors, Vascular Endothelial Growth Factor; D011993:Recombinant Fusion Proteins; D058449:Intravitreal Injections | [
"D006801",
"D000068258",
"D012170",
"D008269",
"D020533",
"D040262",
"D011993",
"D058449"
] | Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial. | Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.
To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.
This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.
Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).
Incremental cost-utility ratio.
The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.
While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition. | null | false | Cost-Utility Comparison of Bevacizumab and Aflibercept in the Treatment of Central or Hemiretinal Vein Occlusion in the SCORE2 Trial. Retinal vein occlusion is the second most common retinal vascular disease. Bevacizumab was demonstrated in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) to be noninferior to aflibercept with respect to visual acuity in study participants with macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) following 6 months of therapy. In this study, the cost-utility of bevacizumab vs aflibercept for treatment of CRVO is evaluated.
To investigate the relative cost-effectiveness of bevacizumab vs aflibercept for treatment of macular edema associated with CRVO or HRVO.
This economic evaluation study used a microsimulation cohort of patients with clinical and demographic characteristics similar to those of SCORE2 participants and a Markov process. Parameters were estimated and validated using a split-sample approach of the SCORE2 population. The simulated cohort included 5000 patients who were evaluated 100 times, each with a different set of characteristics randomly selected based on the SCORE2 trial. SCORE2 data were collected from September 2014 October 2019, and data were analyzed from October 2019 to July 2021.
Bevacizumab (followed by aflibercept among patients with a protocol-defined poor or marginal response to bevacizumab at month 6) vs aflibercept (followed by a dexamethasone implant among patients with a protocol-defined poor or marginal response to aflibercept at month 6).
Incremental cost-utility ratio.
The simulation demonstrated that patients treated with aflibercept will have an expected cost $18 127 greater than those treated with bevacizumab in the year following initiation. When coupled with the lack of clinical superiority over bevacizumab (ie, patients treated with bevacizumab had a gain over aflibercept in visual acuity letter score of 4 in the treated eye and 2 in the fellow eye), these results demonstrate that first-line treatment with bevacizumab dominated aflibercept in the simulated cohort of SCORE2 participants. At current price levels, aflibercept would be considered the preferred cost-effective option only if treatment restored the patient to nearly perfect health.
While there will be some patients with CRVO-associated or HRVO-associated macular edema who will benefit from first-line treatment with aflibercept rather than bevacizumab, given the minimal differences in visual acuity outcomes and large cost differences for bevacizumab vs aflibercept, first-line treatment with bevacizumab is cost-effective for this condition. |
32,028,046 | D000328:Adult; D016757:Death, Sudden, Cardiac; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult | [
"D000328",
"D016757",
"D005260",
"D006801",
"D015994",
"D008297",
"D008875",
"D011159",
"D056910",
"D012189",
"D018570",
"D012307",
"D055815"
] | Short stature is associated with incident sudden cardiac death in a large Asian cohort. | Few data on the association between height and the risk of sudden cardiac death (SCD) in Asian populations are available.
The purpose of this study was to assess the risk of SCD as related to height both in a representative Korean population and in specific subgroups.
This is a retrospective cohort study of 410,119 Koreans age ≥20 years from the Korean National Health Insurance Service-National Sample Cohort, who underwent a national health examination. SCD cases were adjudicated based on information within the claims database. Cox proportional hazard models were applied to estimate hazard ratios and 95% confidence intervals for the association between height and SCD. Potential mediators included demographic factors, health-related habits, and specific cardiovascular comorbidities.
During an 8.45-year follow-up period, a total of 1341 SCDs occurred. Various factors, including short stature, were identified as risk factors for SCD. Multivariable regression analysis revealed that a 10-cm increase in height was associated with a 14% decreased risk for SCD. This relationship remained significant among the elderly, postmenopausal women, and individuals without cardiovascular disease.
Our results indicate that short stature is a significant risk factor for SCD in a Korean population, thus supporting previously published findings correlating height to SCD risk in non-Asian populations. | null | false | Short stature is associated with incident sudden cardiac death in a large Asian cohort. Few data on the association between height and the risk of sudden cardiac death (SCD) in Asian populations are available.
The purpose of this study was to assess the risk of SCD as related to height both in a representative Korean population and in specific subgroups.
This is a retrospective cohort study of 410,119 Koreans age ≥20 years from the Korean National Health Insurance Service-National Sample Cohort, who underwent a national health examination. SCD cases were adjudicated based on information within the claims database. Cox proportional hazard models were applied to estimate hazard ratios and 95% confidence intervals for the association between height and SCD. Potential mediators included demographic factors, health-related habits, and specific cardiovascular comorbidities.
During an 8.45-year follow-up period, a total of 1341 SCDs occurred. Various factors, including short stature, were identified as risk factors for SCD. Multivariable regression analysis revealed that a 10-cm increase in height was associated with a 14% decreased risk for SCD. This relationship remained significant among the elderly, postmenopausal women, and individuals without cardiovascular disease.
Our results indicate that short stature is a significant risk factor for SCD in a Korean population, thus supporting previously published findings correlating height to SCD risk in non-Asian populations. |
18,413,598 | D017667:Adipocytes; D050156:Adipogenesis; D000273:Adipose Tissue; D000818:Animals; D002135:Calcium-Binding Proteins; D009202:Cardiomyopathies; D003924:Diabetes Mellitus, Type 2; D020022:Genetic Predisposition to Disease; D005934:Glucagon; D007328:Insulin; D036341:Intercellular Signaling Peptides and Proteins; D024821:Metabolic Syndrome; D051379:Mice; D008822:Mice, Transgenic; D009765:Obesity; D010179:Pancreas; D011401:Promoter Regions, Genetic; D012333:RNA, Messenger; D054411:Receptors, Leptin; D051780:Sterol Regulatory Element Binding Protein 1; D019076:Transgenes | [
"D017667",
"D050156",
"D000273",
"D000818",
"D002135",
"D009202",
"D003924",
"D020022",
"D005934",
"D007328",
"D036341",
"D024821",
"D051379",
"D008822",
"D009765",
"D010179",
"D011401",
"D012333",
"D054411",
"D051780",
"D019076"
] | Adipogenic capacity and the susceptibility to type 2 diabetes and metabolic syndrome. | To determine whether adipocyte storage capacity influences the onset and severity of type 2 diabetes and other components of the metabolic syndrome, we made normal and db/db mice resistant to obesity by overexpressing leptin receptor-b on the aP2-Lepr-b promoter. On a 4% diet, these mice have no phenotype, but on a 60% fat diet, they resist diet-induced obesity because constitutive adipocyte-specific overexpression of Lepr-b prevents obesity via the antilipogenic autocrine/paracrine action of leptin on adipocytes. After 8 months on the same 60% fat diet, body fat of transgenic mice was 70% below WT controls. Cardiac and liver fat was elevated in the transgenics, and their hyperinsulinemia was more marked, suggesting greater insulin resistance. The aP2-Lepr-b transgene also prevented obesity in db/db mice; at 10 weeks of age their body fat was half that of the db/db mice. This lack of obesity was attributable to reduced expression of sterol regulatory element binding protein-1c and its target lipogenic enzymes in adipose tissue and a 6-fold increase in Pref-1 mRNA. Severe diabetes was present in transgenics at 4 weeks of age, 10 weeks before db/db controls. Echocardiographic evidence of cardiomyopathy appeared at 10 weeks, weeks before the db/db mice. Histologically, loss of beta cells and myocardial fibrosis was present in the transgenic group at least 6 weeks before the db/db mice. These results suggest that the expression level of genes that regulate the adipogenic response to overnutrition profoundly influences the age of onset and severity of diet-induced type 2 diabetes and co-morbidities. | 2,852,628 | true | Adipogenic capacity and the susceptibility to type 2 diabetes and metabolic syndrome. To determine whether adipocyte storage capacity influences the onset and severity of type 2 diabetes and other components of the metabolic syndrome, we made normal and db/db mice resistant to obesity by overexpressing leptin receptor-b on the aP2-Lepr-b promoter. On a 4% diet, these mice have no phenotype, but on a 60% fat diet, they resist diet-induced obesity because constitutive adipocyte-specific overexpression of Lepr-b prevents obesity via the antilipogenic autocrine/paracrine action of leptin on adipocytes. After 8 months on the same 60% fat diet, body fat of transgenic mice was 70% below WT controls. Cardiac and liver fat was elevated in the transgenics, and their hyperinsulinemia was more marked, suggesting greater insulin resistance. The aP2-Lepr-b transgene also prevented obesity in db/db mice; at 10 weeks of age their body fat was half that of the db/db mice. This lack of obesity was attributable to reduced expression of sterol regulatory element binding protein-1c and its target lipogenic enzymes in adipose tissue and a 6-fold increase in Pref-1 mRNA. Severe diabetes was present in transgenics at 4 weeks of age, 10 weeks before db/db controls. Echocardiographic evidence of cardiomyopathy appeared at 10 weeks, weeks before the db/db mice. Histologically, loss of beta cells and myocardial fibrosis was present in the transgenic group at least 6 weeks before the db/db mice. These results suggest that the expression level of genes that regulate the adipogenic response to overnutrition profoundly influences the age of onset and severity of diet-induced type 2 diabetes and co-morbidities. |
37,043,326 | D006801:Humans; D000818:Animals; D051379:Mice; D004195:Disease Models, Animal; D061088:Photoacoustic Techniques; D012151:Resuscitation; D006323:Heart Arrest; D000860:Hypoxia | [
"D006801",
"D000818",
"D051379",
"D004195",
"D061088",
"D012151",
"D006323",
"D000860"
] | Neurovascular Hypoxia Trajectories Assessed by Photoacoustic Imaging in a Murine Model of Cardiac Arrest and Resuscitation. | Cardiac arrest is a common cause of death annually mainly due to postcardiac arrest syndrome that leads to multiple organ global hypoxia and dysfunction after resuscitation. The ability to quantify vasculature changes and tissue oxygenation is crucial to adapt patient treatment in order to minimize major outcomes after resuscitation. For the first time, we applied high-resolution ultrasound associated with photoacoustic imaging (PAI) to track neurovascular oxygenation and cardiac function trajectories in a murine model of cardiac arrest and resuscitation. We report the preservation of brain oxygenation is greater compared to that in peripheral tissues during the arrest. Furthermore, distinct patterns of cerebral oxygen decay may relate to the support of vital brain functions. In addition, we followed trajectories of cerebral perfusion and cardiac function longitudinally after induced cardiac arrest and resuscitation. Volumetric cerebral oxygen saturation (sO2) decreased 24 h postarrest, but these levels rebounded at one week. However, systolic and diastolic cardiac dysfunction persisted throughout and correlated with cerebral hypoxia. Pathophysiologic biomarker trends, identified via cerebral PAI in preclinical models, could provide new insights into understanding the pathophysiology of cardiac arrest and resuscitation. | null | false | Neurovascular Hypoxia Trajectories Assessed by Photoacoustic Imaging in a Murine Model of Cardiac Arrest and Resuscitation. Cardiac arrest is a common cause of death annually mainly due to postcardiac arrest syndrome that leads to multiple organ global hypoxia and dysfunction after resuscitation. The ability to quantify vasculature changes and tissue oxygenation is crucial to adapt patient treatment in order to minimize major outcomes after resuscitation. For the first time, we applied high-resolution ultrasound associated with photoacoustic imaging (PAI) to track neurovascular oxygenation and cardiac function trajectories in a murine model of cardiac arrest and resuscitation. We report the preservation of brain oxygenation is greater compared to that in peripheral tissues during the arrest. Furthermore, distinct patterns of cerebral oxygen decay may relate to the support of vital brain functions. In addition, we followed trajectories of cerebral perfusion and cardiac function longitudinally after induced cardiac arrest and resuscitation. Volumetric cerebral oxygen saturation (sO2) decreased 24 h postarrest, but these levels rebounded at one week. However, systolic and diastolic cardiac dysfunction persisted throughout and correlated with cerebral hypoxia. Pathophysiologic biomarker trends, identified via cerebral PAI in preclinical models, could provide new insights into understanding the pathophysiology of cardiac arrest and resuscitation. |
37,558,295 | D006801:Humans; D006331:Heart Diseases; D005820:Genetic Testing; D009202:Cardiomyopathies; D001145:Arrhythmias, Cardiac; D005817:Genetic Counseling | [
"D006801",
"D006331",
"D005820",
"D009202",
"D001145",
"D005817"
] | A Practical Guide to Genetic Testing in Inherited Heart Disease. | Genetic testing has increasingly been shown to provide critical information regarding the treatment and management of patients with hereditary cardiomyopathies and arrhythmias and is available for a wide variety of conditions. It can provide information regarding arrhythmia risk, lifestyle recommendations, such as exercise avoidance, pharmaceutical therapies, and prognosis. Beyond the proband, genetic testing can be a valuable tool for cascade screening in the family. Genetic testing should be accompanied with genetic counseling, as genetic tests should be accompanied by expert interpretation, support in cascade family evaluation, and psychosocial considerations. Overall, it should be routinely implemented in arrhythmia and cardiomyopathy clinics. | null | false | A Practical Guide to Genetic Testing in Inherited Heart Disease. Genetic testing has increasingly been shown to provide critical information regarding the treatment and management of patients with hereditary cardiomyopathies and arrhythmias and is available for a wide variety of conditions. It can provide information regarding arrhythmia risk, lifestyle recommendations, such as exercise avoidance, pharmaceutical therapies, and prognosis. Beyond the proband, genetic testing can be a valuable tool for cascade screening in the family. Genetic testing should be accompanied with genetic counseling, as genetic tests should be accompanied by expert interpretation, support in cascade family evaluation, and psychosocial considerations. Overall, it should be routinely implemented in arrhythmia and cardiomyopathy clinics. |
8,538,901 | D017545:Aortic Aneurysm, Thoracic; D002102:Cadaver; D006801:Humans; D006965:Hyperplasia; D011093:Polyethylene Terephthalates; D019736:Prostheses and Implants; D017539:Tunica Intima | [
"D017545",
"D002102",
"D006801",
"D006965",
"D011093",
"D019736",
"D017539"
] | Pathological study of implanted dacron grafts in surgery of thoracic aortic aneurysms. | We studied woven dacron grafts that had been implanted in 5 patients of thoracic aortic aneurysms. In addition to usual stains, immunocytochemical analysis was performed using monoclonal antibodies to the muscle actin (HHF35) and to the macrophage (HAM56). In the graft of 5 and 24 days implantation, thin thrombi containing red cells and fibrin covered the luminal surface in some places, and macrophages came into the thrombi. In the grafts of 12 and 38 months implantation, intimal hyperplasia of 0.2-1.0 mm thickness was seen at the anastomotic segments with the accumulation of smooth muscle cells. Except for the anastomotic segments, connective tissue matrix with collagen fibers covered the luminal surface, and in some hollows of the graft crimps, old and fresh thombi were seen in layers. Organizing thrombi of 1.0 mm thickness attached where the branched graft was anastomosed to the main graft. Anastomotic intimal hyperplasia in the graft of 148 month implantation was 0.4-1.0 mm in thickness and 5-10 mm in length, and aside from the intimal hyperplasia, an endothelial lining did not cover the luminal surface of the graft. In the thoracic aorta, woven dacron graft implantation did not cause a critical stenosis with the intimal hyperplasia. The mural thrombi formed at the branched graft, however, threatened to result in graft occlusion or embolization. | 14,348,338 | true | Pathological study of implanted dacron grafts in surgery of thoracic aortic aneurysms. We studied woven dacron grafts that had been implanted in 5 patients of thoracic aortic aneurysms. In addition to usual stains, immunocytochemical analysis was performed using monoclonal antibodies to the muscle actin (HHF35) and to the macrophage (HAM56). In the graft of 5 and 24 days implantation, thin thrombi containing red cells and fibrin covered the luminal surface in some places, and macrophages came into the thrombi. In the grafts of 12 and 38 months implantation, intimal hyperplasia of 0.2-1.0 mm thickness was seen at the anastomotic segments with the accumulation of smooth muscle cells. Except for the anastomotic segments, connective tissue matrix with collagen fibers covered the luminal surface, and in some hollows of the graft crimps, old and fresh thombi were seen in layers. Organizing thrombi of 1.0 mm thickness attached where the branched graft was anastomosed to the main graft. Anastomotic intimal hyperplasia in the graft of 148 month implantation was 0.4-1.0 mm in thickness and 5-10 mm in length, and aside from the intimal hyperplasia, an endothelial lining did not cover the luminal surface of the graft. In the thoracic aorta, woven dacron graft implantation did not cause a critical stenosis with the intimal hyperplasia. The mural thrombi formed at the branched graft, however, threatened to result in graft occlusion or embolization. |
16,583,933 | D001024:Aortic Valve Stenosis; D002404:Catheterization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome; D014463:Ultrasonography | [
"D001024",
"D002404",
"D006801",
"D007223",
"D007231",
"D008297",
"D016896",
"D014463"
] | [Transluminal balloon valvuloplasty in neonates and infants with critical aortic stenosis]. | The purpose of this study was to evaluate children who underwent balloon valvuloplasty due to critical aortic stenosis following clinical (low cardiac output, cardiogenic shock, congestive heart failure) and echocardiographic criteria (morphological evidence of left ventricular hypertrophy, with depression of left ventricular function, irrespective of transvalvular gradient). We assessed the effectiveness of balloon valvuloplasty in 5 children (all male) who were submitted to aortic valve balloon dilatation over 3.5 years (10.1998-05.2003). The age at dilatation was 29+/-24 days, BW 3.92+/-0.82 kg and BSA 0.24+/-0.03 m2. In all children the balloon valvuloplasty was performed with manual inflation of balloon at 4-6 bars through the femoral artery. The mean systolic pressure gradient across the aortic valve decreased from 68+/-20.5 mmHg to 9+/-10.95 mmHg, i.e. by 85%, (p<0.01). Aortic valve ring diameter was 9.2+0.84 mm, and balloon/aortic ring ratio 0.8-0.04. The degree of aortic insufficiency immediately after the dilatation did not significantly increase. Dilatation was performed without complications. Long term results were evaluated in all patients 3.2 - 54 months after valvuloplasty and revealed the continuously increasing residual aortic valve gradient (Doppler measurement) 33+/-10.95 mmHg to be significantly lower (p<0.01) than before valvuloplasty. None of the children was showing clinical symptoms of the disease. According to echocardiographic analysis two of them developed aortic valvar insufficiency grade II, two had trivial insufficiency, one was without insufficiency. One child is an candidate for the Ross procedure in future (gradient 50 mmHg, insufficiency grade II, age 4.5 years.). Balloon valvuloplasty provides effective interventional method in the treatment of the neonates and infants with critical aortic stenosis. | null | false | [Transluminal balloon valvuloplasty in neonates and infants with critical aortic stenosis]. The purpose of this study was to evaluate children who underwent balloon valvuloplasty due to critical aortic stenosis following clinical (low cardiac output, cardiogenic shock, congestive heart failure) and echocardiographic criteria (morphological evidence of left ventricular hypertrophy, with depression of left ventricular function, irrespective of transvalvular gradient). We assessed the effectiveness of balloon valvuloplasty in 5 children (all male) who were submitted to aortic valve balloon dilatation over 3.5 years (10.1998-05.2003). The age at dilatation was 29+/-24 days, BW 3.92+/-0.82 kg and BSA 0.24+/-0.03 m2. In all children the balloon valvuloplasty was performed with manual inflation of balloon at 4-6 bars through the femoral artery. The mean systolic pressure gradient across the aortic valve decreased from 68+/-20.5 mmHg to 9+/-10.95 mmHg, i.e. by 85%, (p<0.01). Aortic valve ring diameter was 9.2+0.84 mm, and balloon/aortic ring ratio 0.8-0.04. The degree of aortic insufficiency immediately after the dilatation did not significantly increase. Dilatation was performed without complications. Long term results were evaluated in all patients 3.2 - 54 months after valvuloplasty and revealed the continuously increasing residual aortic valve gradient (Doppler measurement) 33+/-10.95 mmHg to be significantly lower (p<0.01) than before valvuloplasty. None of the children was showing clinical symptoms of the disease. According to echocardiographic analysis two of them developed aortic valvar insufficiency grade II, two had trivial insufficiency, one was without insufficiency. One child is an candidate for the Ross procedure in future (gradient 50 mmHg, insufficiency grade II, age 4.5 years.). Balloon valvuloplasty provides effective interventional method in the treatment of the neonates and infants with critical aortic stenosis. |
30,870,037 | D000287:Administration, Topical; D017719:Diabetic Foot; D016503:Drug Delivery Systems; D000076722:Drug Development; D055808:Drug Discovery; D006801:Humans; D004364:Pharmaceutical Preparations; D014945:Wound Healing; D014947:Wounds and Injuries | [
"D000287",
"D017719",
"D016503",
"D000076722",
"D055808",
"D006801",
"D004364",
"D014945",
"D014947"
] | The discovery and development of topical medicines for wound healing. | Chronic, nonhealing skin wounds claim >3% of the health-care budget in industrialized countries, and the incidence is rising. Currently, two parallel trends influence innovations within the field of wound healing: the need to reduce spread of antibiotic resistance and the emerging use of health economy and value-based models. Areas covered: This review focuses on the discovery of drug candidates and development of treatments aiming to enhance wound healing in the heterogeneous group of patients with nonhealing wounds. Expert opinion: Nonhealing wounds are multifaceted and recognized as difficult indications. The majority of products currently in use are medical device dressings, or concepts of negative pressure or hyperbaric oxygen treatment. Global best practice guidelines for the treatment of diabetic foot ulcers recommend debridement, redressing, as well as infection control, and are critical to the lack of coherent clinical evidence for many approved products in active wound care. To accelerate wound healing, there is an emerging trend toward biologics, gene therapy, and novel concepts for drug delivery in research and in the pipeline for clinical trials. Scientific delineation of the therapeutic mechanism of action is, in our opinion, vital for clinical trial success and for an increased fraction of medical products in the pharmaceutical pipeline. | null | false | The discovery and development of topical medicines for wound healing. Chronic, nonhealing skin wounds claim >3% of the health-care budget in industrialized countries, and the incidence is rising. Currently, two parallel trends influence innovations within the field of wound healing: the need to reduce spread of antibiotic resistance and the emerging use of health economy and value-based models. Areas covered: This review focuses on the discovery of drug candidates and development of treatments aiming to enhance wound healing in the heterogeneous group of patients with nonhealing wounds. Expert opinion: Nonhealing wounds are multifaceted and recognized as difficult indications. The majority of products currently in use are medical device dressings, or concepts of negative pressure or hyperbaric oxygen treatment. Global best practice guidelines for the treatment of diabetic foot ulcers recommend debridement, redressing, as well as infection control, and are critical to the lack of coherent clinical evidence for many approved products in active wound care. To accelerate wound healing, there is an emerging trend toward biologics, gene therapy, and novel concepts for drug delivery in research and in the pipeline for clinical trials. Scientific delineation of the therapeutic mechanism of action is, in our opinion, vital for clinical trial success and for an increased fraction of medical products in the pharmaceutical pipeline. |
2,234,326 | D000818:Animals; D001769:Blood; D004195:Disease Models, Animal; D004912:Erythrocytes; D005263:Femoral Artery; D006801:Humans; D002546:Ischemic Attack, Transient; D007962:Leukocytes; D008297:Male; D010949:Plasma; D051381:Rats; D011919:Rats, Inbred Strains | [
"D000818",
"D001769",
"D004195",
"D004912",
"D005263",
"D006801",
"D002546",
"D007962",
"D008297",
"D010949",
"D051381",
"D011919"
] | A rat femoral artery model for vasospasm. | A new animal model for vasospasm using rat femoral artery has been developed. Whole blood, washed erythrocytes, or leukocytes in platelet-rich plasma were selectively applied to the adventitial surface of the femoral artery for 7 days in 15 rats, after which the vessels were perfusion-fixed and examined by light and transmission electron microscopy and immunohistochemistry. As compared with matched control arteries, there was a prominent reduction in luminal cross-sectional area after 7 days in vessels exposed to whole blood or washed erythrocytes, but not in those exposed to leukocytes in platelet-rich plasma. In arteries with luminal narrowing, light and transmission electron microscopy demonstrated marked morphological changes throughout the vessel wall similar to those seen in cerebral vasospasm after subarachnoid hemorrhage. Immunohistochemistry disclosed a prominent loss of immunoreactive actin in smooth muscle cells of arteries exposed to whole blood or erythrocytes. To assess the time course of arterial narrowing in this model, whole blood was selectively applied to the adventitial surface of femoral arteries in 23 rats for periods from 2 to 20 days. As compared with control arteries, arterial narrowing was variably present at 2 days, progressively increased by 5 days, was maximal at 7 to 10 days, and returned to near control levels by 20 days. The presence and severity of ultrastructural changes in vessel wall corresponded to the degree of arterial narrowing over time. These results suggest that chronic narrowing in rat femoral artery exposed to periadventitial blood is analogous to that observed in cerebral arterial vasospasm after subarachnoid hemorrhage. This new model represents a simple and reliable means to investigate pathogenic mechanisms and potential therapies for vasospasm. | 14,509,119 | true | A rat femoral artery model for vasospasm. A new animal model for vasospasm using rat femoral artery has been developed. Whole blood, washed erythrocytes, or leukocytes in platelet-rich plasma were selectively applied to the adventitial surface of the femoral artery for 7 days in 15 rats, after which the vessels were perfusion-fixed and examined by light and transmission electron microscopy and immunohistochemistry. As compared with matched control arteries, there was a prominent reduction in luminal cross-sectional area after 7 days in vessels exposed to whole blood or washed erythrocytes, but not in those exposed to leukocytes in platelet-rich plasma. In arteries with luminal narrowing, light and transmission electron microscopy demonstrated marked morphological changes throughout the vessel wall similar to those seen in cerebral vasospasm after subarachnoid hemorrhage. Immunohistochemistry disclosed a prominent loss of immunoreactive actin in smooth muscle cells of arteries exposed to whole blood or erythrocytes. To assess the time course of arterial narrowing in this model, whole blood was selectively applied to the adventitial surface of femoral arteries in 23 rats for periods from 2 to 20 days. As compared with control arteries, arterial narrowing was variably present at 2 days, progressively increased by 5 days, was maximal at 7 to 10 days, and returned to near control levels by 20 days. The presence and severity of ultrastructural changes in vessel wall corresponded to the degree of arterial narrowing over time. These results suggest that chronic narrowing in rat femoral artery exposed to periadventitial blood is analogous to that observed in cerebral arterial vasospasm after subarachnoid hemorrhage. This new model represents a simple and reliable means to investigate pathogenic mechanisms and potential therapies for vasospasm. |
2,755,121 | D000818:Animals; D001145:Arrhythmias, Cardiac; D003243:Consciousness; D003327:Coronary Disease; D004110:Diltiazem; D004562:Electrocardiography; D006339:Heart Rate; D008297:Male; D015428:Myocardial Reperfusion Injury; D009543:Nifedipine; D051381:Rats; D011919:Rats, Inbred Strains; D013610:Tachycardia; D014693:Ventricular Fibrillation; D014700:Verapamil | [
"D000818",
"D001145",
"D003243",
"D003327",
"D004110",
"D004562",
"D006339",
"D008297",
"D015428",
"D009543",
"D051381",
"D011919",
"D013610",
"D014693",
"D014700"
] | Reperfusion-induced arrhythmias in the conscious rat: a comparative study with three calcium antagonists. | The effects of three calcium antagonists (diltiazem, verapamil, and nifedipine) on reperfusion-induced arrhythmias were compared in a conscious rat preparation with coronary artery occlusion and implanted electrocardiogram limb electrodes. Upon reperfusion after a 5-min period of occlusion, all (15/15) untreated control rats exhibited immediate ventricular tachycardia, which rapidly deteriorated to ventricular fibrillation; 87% (13/15) of the rats died as a consequence of these rhythm disturbances. In the groups treated with calcium antagonists, each drug (diltiazem, verapamil, or nifedipine) was given as an intravenous bolus 10 min prior to coronary occlusion (n = 12 in each group). The incidence of ventricular fibrillation was significantly reduced by all three calcium antagonists and this antifibrillatory effect resulted in a significantly lower mortality in all drug-treated groups. With diltiazem (0.5 and 2.0 mg/kg) mortality fell from 87 to 42% (P less than 0.05) and 35% (P less than 0.01), respectively; with verapamil (0.5 and 5.0 mg/kg) it fell to 25% (P less than 0.01) and 0% (P less than 0.001); and with nifedipine (5.0 and 50 micrograms/kg), it fell to 25% (P less than 0.01) and 8% (P less than 0.001). At a dose of 5.0 mg/kg, verapamil caused a large reduction in heart rate both prior to and during coronary occlusion and reperfusion; however, with other doses and drugs no significant changes in heart rate were observed. ST segment elevation during the 5-min ischemic period was reduced by pretreatment with all drugs. In conclusion, in the conscious rat, pretreatment with diltiazem, verapamil, or nifedipine affords some protection against reperfusion-induced arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS) | 7,665,470 | true | Reperfusion-induced arrhythmias in the conscious rat: a comparative study with three calcium antagonists. The effects of three calcium antagonists (diltiazem, verapamil, and nifedipine) on reperfusion-induced arrhythmias were compared in a conscious rat preparation with coronary artery occlusion and implanted electrocardiogram limb electrodes. Upon reperfusion after a 5-min period of occlusion, all (15/15) untreated control rats exhibited immediate ventricular tachycardia, which rapidly deteriorated to ventricular fibrillation; 87% (13/15) of the rats died as a consequence of these rhythm disturbances. In the groups treated with calcium antagonists, each drug (diltiazem, verapamil, or nifedipine) was given as an intravenous bolus 10 min prior to coronary occlusion (n = 12 in each group). The incidence of ventricular fibrillation was significantly reduced by all three calcium antagonists and this antifibrillatory effect resulted in a significantly lower mortality in all drug-treated groups. With diltiazem (0.5 and 2.0 mg/kg) mortality fell from 87 to 42% (P less than 0.05) and 35% (P less than 0.01), respectively; with verapamil (0.5 and 5.0 mg/kg) it fell to 25% (P less than 0.01) and 0% (P less than 0.001); and with nifedipine (5.0 and 50 micrograms/kg), it fell to 25% (P less than 0.01) and 8% (P less than 0.001). At a dose of 5.0 mg/kg, verapamil caused a large reduction in heart rate both prior to and during coronary occlusion and reperfusion; however, with other doses and drugs no significant changes in heart rate were observed. ST segment elevation during the 5-min ischemic period was reduced by pretreatment with all drugs. In conclusion, in the conscious rat, pretreatment with diltiazem, verapamil, or nifedipine affords some protection against reperfusion-induced arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS) |
17,532,413 | D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D004724:Endoscopy; D005260:Female; D006338:Heart Neoplasms; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome | [
"D000293",
"D000328",
"D000368",
"D006348",
"D004724",
"D005260",
"D006338",
"D006801",
"D008297",
"D008875",
"D012189",
"D016896"
] | Endoscopic cardiac tumor resection. | BACKGROUND
The purpose of this study is to report our 9 years' experience with endoscopic cardiac tumor resection using the port access approach.
METHODS
From March 1997 to December 2005, 27 patients (mean age, 56.2 +/- 16.9 years; 70% female) underwent endoscopic cardiac tumor resection using endocardiopulmonary bypass and endoaortic-balloon clamp technique. Nineteen (70%) patients presented in New York Heart Association class I, 4 patients presented with embolic stroke, and 4 patients presented with atrial arrhythmias. All patients underwent echocardiography on admission, intraoperatively, at discharge, and at follow-up evaluation. Eight patients additionally required mitral valve replacement (n = 1), tricuspid valve replacement (n = 1), mitral valve repair (n = 2), mini-maze (n = 1), and closure of patent foramen ovale (n = 3). Mean follow-up was 3.4 +/- 2.7 years.
RESULTS
Mean endoaortic-balloon clamp and endocardiopulmonary bypass times were 68.8 +/- 30.8 minutes and 112.2 +/- 41.5 minutes, respectively. There were no conversions to sternotomy. Tumors resected were classified as left atrial myxoma (n = 20), right atrial myxoma (n = 3), lipoma (n = 1), intravenous leiomyoma involving the inferior vena cava and the tricuspid valve (n = 1), plexiform tumor of the sinoatrial node (n = 1), and papillary fibroelastoma of aortic valve noncoronary cusp (n = 1). There were no hospital deaths. Mean intensive care unit and hospital stays were 1.4 +/- 1.1 days and 7.3 +/- 3.4 days, respectively. Postoperative complications were evolving stroke (n = 1), re-exploration for bleeding (n = 1), and myocardial ischemia requiring stenting (n = 1). Follow-up failed to demonstrate residual or recurrent tumor. One patient had a small residual atrial septal defect. Ninety-two percent of patients appreciated the cosmetic result and fast recovery.
CONCLUSIONS
Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy. | null | false | Endoscopic cardiac tumor resection. BACKGROUND
The purpose of this study is to report our 9 years' experience with endoscopic cardiac tumor resection using the port access approach.
METHODS
From March 1997 to December 2005, 27 patients (mean age, 56.2 +/- 16.9 years; 70% female) underwent endoscopic cardiac tumor resection using endocardiopulmonary bypass and endoaortic-balloon clamp technique. Nineteen (70%) patients presented in New York Heart Association class I, 4 patients presented with embolic stroke, and 4 patients presented with atrial arrhythmias. All patients underwent echocardiography on admission, intraoperatively, at discharge, and at follow-up evaluation. Eight patients additionally required mitral valve replacement (n = 1), tricuspid valve replacement (n = 1), mitral valve repair (n = 2), mini-maze (n = 1), and closure of patent foramen ovale (n = 3). Mean follow-up was 3.4 +/- 2.7 years.
RESULTS
Mean endoaortic-balloon clamp and endocardiopulmonary bypass times were 68.8 +/- 30.8 minutes and 112.2 +/- 41.5 minutes, respectively. There were no conversions to sternotomy. Tumors resected were classified as left atrial myxoma (n = 20), right atrial myxoma (n = 3), lipoma (n = 1), intravenous leiomyoma involving the inferior vena cava and the tricuspid valve (n = 1), plexiform tumor of the sinoatrial node (n = 1), and papillary fibroelastoma of aortic valve noncoronary cusp (n = 1). There were no hospital deaths. Mean intensive care unit and hospital stays were 1.4 +/- 1.1 days and 7.3 +/- 3.4 days, respectively. Postoperative complications were evolving stroke (n = 1), re-exploration for bleeding (n = 1), and myocardial ischemia requiring stenting (n = 1). Follow-up failed to demonstrate residual or recurrent tumor. One patient had a small residual atrial septal defect. Ninety-two percent of patients appreciated the cosmetic result and fast recovery.
CONCLUSIONS
Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy. |
17,578,050 | D000368:Aged; D000925:Anticoagulants; D001021:Aortic Valve; D017984:Enoxaparin; D005240:Feasibility Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006470:Hemorrhage; D006801:Humans; D019934:International Normalized Ratio; D008943:Mitral Valve; D019990:Perioperative Care; D011446:Prospective Studies; D012042:Registries; D013923:Thromboembolism | [
"D000368",
"D000925",
"D001021",
"D017984",
"D005240",
"D006350",
"D019918",
"D006470",
"D006801",
"D019934",
"D008943",
"D019990",
"D011446",
"D012042",
"D013923"
] | Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. | OBJECTIVE
The study aim was to determine the safety and feasibility of a standardized bridging regimen in patients with mechanical heart valves at high thromboembolic risk, using low-molecular-weight heparin (LMWH).
METHODS
Since the year 2000, all patients at the authors' institution, with mechanical heart valves and a need for periprocedural interruption of oral anticoagulation (OAC), were prospectively enrolled in this registry. Patients were treated with enoxaparin following a pre-specified, standardized bridging regimen. The main outcome measures were the incidence of hemorrhagic or thromboembolic events. The follow up period was 30 days after hospital discharge.
RESULTS
A total of 116 patients was included (31 with mitral valve replacement, 76 aortic valve replacement, nine double valve replacement). Patients underwent either major surgery (n = 25), minor surgery (n = 36), pacemaker implantation (n = 21), or coronary catheterization (n = 34). Bridging therapy with enoxaparin was administered for a mean of 7.0 +/- 4.6 days. Eighteen patients (15.5%) were treated as outpatients. In 35 patients (34%) with renal impairment (creatinine clearance <50 ml/min), LMWH dosage was halved. No thromboembolic (95% CI 0-3.1%) and only one major bleeding complication occurred (0.86%; 95% CI 0.02-4.7%); minor bleeding occurred in 10 patients (8.6%; 95% CI 4.2-15.3%). The hemorrhages arose after a mean of 5.4 +/- 1.4 days LMWH therapy.
CONCLUSIONS
Bridging therapy following a standardized LMWH-based regimen with enoxaparin was effective and relatively safe in a large cohort of patients with mechanical heart valves. Extended duration of LMWH therapy seems to promote the incidence of hemorrhage. Neither dose reduction in patients with renal impairment nor outpatient treatment affected the safety and efficacy of this bridging regimen. These findings warrant that more extensive studies be conducted to investigate the safety of this approach. | null | false | Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. OBJECTIVE
The study aim was to determine the safety and feasibility of a standardized bridging regimen in patients with mechanical heart valves at high thromboembolic risk, using low-molecular-weight heparin (LMWH).
METHODS
Since the year 2000, all patients at the authors' institution, with mechanical heart valves and a need for periprocedural interruption of oral anticoagulation (OAC), were prospectively enrolled in this registry. Patients were treated with enoxaparin following a pre-specified, standardized bridging regimen. The main outcome measures were the incidence of hemorrhagic or thromboembolic events. The follow up period was 30 days after hospital discharge.
RESULTS
A total of 116 patients was included (31 with mitral valve replacement, 76 aortic valve replacement, nine double valve replacement). Patients underwent either major surgery (n = 25), minor surgery (n = 36), pacemaker implantation (n = 21), or coronary catheterization (n = 34). Bridging therapy with enoxaparin was administered for a mean of 7.0 +/- 4.6 days. Eighteen patients (15.5%) were treated as outpatients. In 35 patients (34%) with renal impairment (creatinine clearance <50 ml/min), LMWH dosage was halved. No thromboembolic (95% CI 0-3.1%) and only one major bleeding complication occurred (0.86%; 95% CI 0.02-4.7%); minor bleeding occurred in 10 patients (8.6%; 95% CI 4.2-15.3%). The hemorrhages arose after a mean of 5.4 +/- 1.4 days LMWH therapy.
CONCLUSIONS
Bridging therapy following a standardized LMWH-based regimen with enoxaparin was effective and relatively safe in a large cohort of patients with mechanical heart valves. Extended duration of LMWH therapy seems to promote the incidence of hemorrhage. Neither dose reduction in patients with renal impairment nor outpatient treatment affected the safety and efficacy of this bridging regimen. These findings warrant that more extensive studies be conducted to investigate the safety of this approach. |
20,881,568 | D017542:Aneurysm, Ruptured; D002543:Cerebral Hemorrhage; D002552:Cerebral Ventricles; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome | [
"D017542",
"D002543",
"D002552",
"D015331",
"D005260",
"D006801",
"D002532",
"D016015",
"D008297",
"D008875",
"D015999",
"D009422",
"D011237",
"D012189",
"D012720",
"D016896"
] | Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. | BACKGROUND
Intraventricular hemorrhage (IVH) predicts worse outcomes following aneurysmal subarachnoid hemorrhage (SAH). One potential mechanism is that IVH predisposes to the development of delayed ischemic neurological deficits (DINDs). No previous studies have evaluated the association between IVH volume (in milliliters) and subsequent development of DINDs or poor outcomes.
OBJECTIVE
To assess the association between the volume of IVH and the subsequent development of DINDs, delayed cerebral infarction, death, and poor neurological outcomes, specifically among patients with concomitant SAH and IVH.
METHODS
We performed a cohort study involving 152 consecutive patients with concomitant SAH and IVH. To determine volume of IVH, we used the IVH Score, shown to correlate well with computerized volumetric assessment. To determine the relative quantity of subarachnoid blood, we applied the SAH Sum Score. Multivariate logistic regression was used to adjust for potential confounders.
RESULTS
There was no significant association between IVH volume and the development of DINDs or delayed infarction. In contrast, patients with poor neurological outcomes had significantly larger baseline IVH volume (mean, 11.8 mL vs 3.8 mL, P = .001). In the multivariate analysis, IVH volume was an independent predictor of poor outcomes (OR per mL: 1.11 [1.04-1.18]). Patients in the highest quartile for IVH volume were far more likely to progress to poor outcome compared with those in the lowest quartile (OR 4.09 [1.32-12.65]). Interobserver agreement in the determination of IVH Score was moderate to good.
CONCLUSIONS
IVH volume is an independent predictor of poor neurological outcomes, even after adjusting for the amount of subarachnoid blood. The pathophysiology of this association does not appear to involve an increased risk of DINDs or delayed infarction. Measures aimed at accelerating IVH clearance, such as intraventricular thrombolysis, merit further evaluation. | null | false | Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. BACKGROUND
Intraventricular hemorrhage (IVH) predicts worse outcomes following aneurysmal subarachnoid hemorrhage (SAH). One potential mechanism is that IVH predisposes to the development of delayed ischemic neurological deficits (DINDs). No previous studies have evaluated the association between IVH volume (in milliliters) and subsequent development of DINDs or poor outcomes.
OBJECTIVE
To assess the association between the volume of IVH and the subsequent development of DINDs, delayed cerebral infarction, death, and poor neurological outcomes, specifically among patients with concomitant SAH and IVH.
METHODS
We performed a cohort study involving 152 consecutive patients with concomitant SAH and IVH. To determine volume of IVH, we used the IVH Score, shown to correlate well with computerized volumetric assessment. To determine the relative quantity of subarachnoid blood, we applied the SAH Sum Score. Multivariate logistic regression was used to adjust for potential confounders.
RESULTS
There was no significant association between IVH volume and the development of DINDs or delayed infarction. In contrast, patients with poor neurological outcomes had significantly larger baseline IVH volume (mean, 11.8 mL vs 3.8 mL, P = .001). In the multivariate analysis, IVH volume was an independent predictor of poor outcomes (OR per mL: 1.11 [1.04-1.18]). Patients in the highest quartile for IVH volume were far more likely to progress to poor outcome compared with those in the lowest quartile (OR 4.09 [1.32-12.65]). Interobserver agreement in the determination of IVH Score was moderate to good.
CONCLUSIONS
IVH volume is an independent predictor of poor neurological outcomes, even after adjusting for the amount of subarachnoid blood. The pathophysiology of this association does not appear to involve an increased risk of DINDs or delayed infarction. Measures aimed at accelerating IVH clearance, such as intraventricular thrombolysis, merit further evaluation. |
12,939,567 | D003327:Coronary Disease; D006801:Humans; D006973:Hypertension; D007333:Insulin Resistance | [
"D003327",
"D006801",
"D006973",
"D007333"
] | Insulin resistance, hypertension, and coronary heart disease. | The goals of this review are two-fold: to examine the evidence in support of a role for insulin resistance and compensatory hyperinsulinemia in the pathogenesis of essential hypertension, and to evaluate the hypothesis that insulin resistance and its manifestations play major roles in the development of coronary heart disease in patients with essential hypertension. In both instances, only experimental results in human beings will be considered. Although it remains a scientific issue of great importance, the scope of this review precludes a discussion of the mechanistic link between insulin resistance/hyperinsulinemia and essential hypertension. | 6,421,089 | true | Insulin resistance, hypertension, and coronary heart disease. The goals of this review are two-fold: to examine the evidence in support of a role for insulin resistance and compensatory hyperinsulinemia in the pathogenesis of essential hypertension, and to evaluate the hypothesis that insulin resistance and its manifestations play major roles in the development of coronary heart disease in patients with essential hypertension. In both instances, only experimental results in human beings will be considered. Although it remains a scientific issue of great importance, the scope of this review precludes a discussion of the mechanistic link between insulin resistance/hyperinsulinemia and essential hypertension. |
9,391,222 | D000368:Aged; D002121:Calcium Channel Blockers; D002561:Cerebrovascular Disorders; D003680:Deglutition Disorders; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009543:Nifedipine; D010865:Pilot Projects | [
"D000368",
"D002121",
"D002561",
"D003680",
"D004311",
"D005260",
"D006801",
"D008297",
"D009543",
"D010865"
] | Pharmacological treatment of dysphagia in stroke. | The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was repeated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressive heart failure. Initial assessment showed impairment in the pharyngeal phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspiration was seen in 4 patients (active 2, placebo 2). Improvement in swallowing was seen in 8 patients (active 5, placebo 3) at the end of 4 weeks. There were significant changes in the pharyngeal transit time (mean -1.34 second; 95% C.I. -2.56, -0.11) and swallow delay (mean -1.91 seconds; 95% C.I. -3.58, -0.24) in the active group suggesting improvement in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change was not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke-related dysphagia and merit further investigation. | 2,903,413 | true | Pharmacological treatment of dysphagia in stroke. The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was repeated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressive heart failure. Initial assessment showed impairment in the pharyngeal phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspiration was seen in 4 patients (active 2, placebo 2). Improvement in swallowing was seen in 8 patients (active 5, placebo 3) at the end of 4 weeks. There were significant changes in the pharyngeal transit time (mean -1.34 second; 95% C.I. -2.56, -0.11) and swallow delay (mean -1.91 seconds; 95% C.I. -3.58, -0.24) in the active group suggesting improvement in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change was not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke-related dysphagia and merit further investigation. |
29,878,125 | D000199:Actins; D000293:Adolescent; D000328:Adult; D000818:Animals; D002311:Cardiomyopathy, Dilated; D016022:Case-Control Studies; D051338:Cofilin 1; D005260:Female; D006321:Heart; D006801:Humans; D034904:Lamin Type A; D008297:Male; D051379:Mice; D008875:Middle Aged; D019950:Mitogen-Activated Protein Kinase 1; D048052:Mitogen-Activated Protein Kinase 3; D009154:Mutation; D010766:Phosphorylation; D015398:Signal Transduction; D055815:Young Adult | [
"D000199",
"D000293",
"D000328",
"D000818",
"D002311",
"D016022",
"D051338",
"D005260",
"D006321",
"D006801",
"D034904",
"D008297",
"D051379",
"D008875",
"D019950",
"D048052",
"D009154",
"D010766",
"D015398",
"D055815"
] | Cofilin-1 phosphorylation catalyzed by ERK1/2 alters cardiac actin dynamics in dilated cardiomyopathy caused by lamin A/C gene mutation. | Hyper-activation of extracellular signal-regulated kinase (ERK) 1/2 contributes to heart dysfunction in cardiomyopathy caused by mutations in the lamin A/C gene (LMNA cardiomyopathy). The mechanism of how this affects cardiac function is unknown. We show that active phosphorylated ERK1/2 directly binds to and catalyzes the phosphorylation of the actin depolymerizing factor cofilin-1 on Thr25. Cofilin-1 becomes active and disassembles actin filaments in a large array of cellular and animal models of LMNA cardiomyopathy. In vivo expression of cofilin-1, phosphorylated on Thr25 by endogenous ERK1/2 signaling, leads to alterations in left ventricular function and cardiac actin. These results demonstrate a novel role for cofilin-1 on actin dynamics in cardiac muscle and provide a rationale on how increased ERK1/2 signaling leads to LMNA cardiomyopathy. | 4,535,839 | true | Cofilin-1 phosphorylation catalyzed by ERK1/2 alters cardiac actin dynamics in dilated cardiomyopathy caused by lamin A/C gene mutation. Hyper-activation of extracellular signal-regulated kinase (ERK) 1/2 contributes to heart dysfunction in cardiomyopathy caused by mutations in the lamin A/C gene (LMNA cardiomyopathy). The mechanism of how this affects cardiac function is unknown. We show that active phosphorylated ERK1/2 directly binds to and catalyzes the phosphorylation of the actin depolymerizing factor cofilin-1 on Thr25. Cofilin-1 becomes active and disassembles actin filaments in a large array of cellular and animal models of LMNA cardiomyopathy. In vivo expression of cofilin-1, phosphorylated on Thr25 by endogenous ERK1/2 signaling, leads to alterations in left ventricular function and cardiac actin. These results demonstrate a novel role for cofilin-1 on actin dynamics in cardiac muscle and provide a rationale on how increased ERK1/2 signaling leads to LMNA cardiomyopathy. |
15,338,141 | D002545:Brain Ischemia; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke; D019851:Thrombophilia | [
"D002545",
"D002986",
"D015897",
"D019317",
"D005260",
"D005343",
"D005858",
"D006801",
"D015994",
"D008297",
"D015995",
"D018570",
"D012307",
"D020521",
"D019851"
] | [Thrombophilias in patients with ischemic stroke. Indication and calculated costs for evidence-based diagnostics and treatment]. | Patients with ischemic stroke are sometimes found to have an underlying inherited (deficiency of protein C, protein S, antithrombin III, activated protein C resistance, prothrombin gene mutation, hyperhomocysteinemia) or acquired thrombophilia (lupus anticoagulant and anticardiolipin antibodies, hyperhomocysteinemia). Patient selection for thrombophilia screening is, therefore, a frequent question in managing patients with ischemic stroke. In this review we discuss patient selection and timing for laboratory tests for thrombophilia screening in stroke patients based on a literature review and we calculated overall costs per year in Germany for testing patients older than 18 years with an ischemic stroke of undetermined cause. As there is a lack of studies comparing anticoagulation with antiplatelet therapy in patients with diagnosed thrombophilia, laboratory screening for thrombophilia even in a selected group of patients with cryptogenic ischemic stroke remains of questionable value at present. An exception appears to be testing for lupus anticoagulant and anticardiolipin antibodies in younger patients with suspected antiphospholipid syndrome (two positive test results necessary), because anticoagulation seems to be superior to aspirin in patients with antiphospholipid syndrome. | null | false | [Thrombophilias in patients with ischemic stroke. Indication and calculated costs for evidence-based diagnostics and treatment]. Patients with ischemic stroke are sometimes found to have an underlying inherited (deficiency of protein C, protein S, antithrombin III, activated protein C resistance, prothrombin gene mutation, hyperhomocysteinemia) or acquired thrombophilia (lupus anticoagulant and anticardiolipin antibodies, hyperhomocysteinemia). Patient selection for thrombophilia screening is, therefore, a frequent question in managing patients with ischemic stroke. In this review we discuss patient selection and timing for laboratory tests for thrombophilia screening in stroke patients based on a literature review and we calculated overall costs per year in Germany for testing patients older than 18 years with an ischemic stroke of undetermined cause. As there is a lack of studies comparing anticoagulation with antiplatelet therapy in patients with diagnosed thrombophilia, laboratory screening for thrombophilia even in a selected group of patients with cryptogenic ischemic stroke remains of questionable value at present. An exception appears to be testing for lupus anticoagulant and anticardiolipin antibodies in younger patients with suspected antiphospholipid syndrome (two positive test results necessary), because anticoagulation seems to be superior to aspirin in patients with antiphospholipid syndrome. |
19,436,803 | D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency; D001024:Aortic Valve Stenosis; D002648:Child; D004697:Endocarditis, Bacterial; D005260:Female; D006330:Heart Defects, Congenital; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography; D055815:Young Adult | [
"D000293",
"D000328",
"D000367",
"D000368",
"D001021",
"D001022",
"D001024",
"D002648",
"D004697",
"D005260",
"D006330",
"D017052",
"D006801",
"D008297",
"D008875",
"D011379",
"D016016",
"D012189",
"D018570",
"D012307",
"D014463",
"D055815"
] | Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. | We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only independent predictor associated with an increased risk of death (hazard ratio, 2.19; 95% confidence interval, 1.1-4.5; P = 0.031).In our study, patients with infective endocarditis in a bicuspid aortic valve were younger and had a higher incidence of periannular complications. Although a worse prognosis has been reported previously, we found that infective endocarditis in a native bicuspid aortic valve is not likely to increase the risk of death in comparison with infective endocarditis in native tricuspid aortic valves. | 2,240,429 | true | Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only independent predictor associated with an increased risk of death (hazard ratio, 2.19; 95% confidence interval, 1.1-4.5; P = 0.031).In our study, patients with infective endocarditis in a bicuspid aortic valve were younger and had a higher incidence of periannular complications. Although a worse prognosis has been reported previously, we found that infective endocarditis in a native bicuspid aortic valve is not likely to increase the risk of death in comparison with infective endocarditis in native tricuspid aortic valves. |
23,443,603 | D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents; D006083:Graft Occlusion, Vascular; D006470:Hemorrhage; D006493:Heparin; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058729:Peripheral Arterial Disease; D012307:Risk Factors; D013927:Thrombosis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency | [
"D000328",
"D000368",
"D000369",
"D019917",
"D004305",
"D004334",
"D005260",
"D005343",
"D006083",
"D006470",
"D006493",
"D006495",
"D006801",
"D035002",
"D008297",
"D008875",
"D018579",
"D058729",
"D012307",
"D013927",
"D013997",
"D016896",
"D014654"
] | Risk-adjusted strategies in the prevention of early arterial thrombosis following lower extremity arterial reconstruction: a comparison of unfractionated versus low molecular weight heparin. | OBJECTIVE
In vascular surgery postoperative thrombosis prophylaxis must sufficiently prevent arterial thrombosis. This cohort study examines different therapeutic approaches of unfractionated heparin (UFH) or low molecular weight heparin (LMWH) after vascular reconstruction.
METHODS
Four hundred seventy-five patients entered the study between 2005 and 2008. Our clinical routine made a differentiation between low-risk patients (N.=375) and patients with peripheral bypass, which were grouped as high-risk (N.=148). We changed our postoperative anticoagulation management after 24 months in the low-risk and after each 16 months in the high-risk group. The anticoagulation of low-risk patients consisted of either two applications of 7.500 IU UFH subcutaneously (N.=158) or one daily application of 40 mg LMWH each up to discharge (N.=169). High-risk patients received either 25.000 IU UFH i.v. over 24 hours and 4 days (N.=48), 2-times (N.=51) or one-time weight-adjusted LMWH (N.=49) up to discharge (1 mg/kg body weight). Minor complications (bleedings) were differentiated from major early graft occlusion during the postoperative course. Further follow-up was not done for this study.
RESULTS
Low risk: under LMWH, complications could be significantly reduced (P=0.001). Under LMWH significantly fewer occlusion complications occurred (P=0.01) and operation-induced hemorrhages were less frequently observed (P=0.05), this was significant in the complete low-risk group. High-risk: the one-time weight-adjusted LMWH group similarly exhibited many occlusions, like the unfractionated group (NS). The two-time LMWH treatment was significantly superior to the one-time application with respect to occlusion followed by amputations (P=0.03). Minor complications could be minimized overall by administration of LMWH and its dose reduction (NS).
CONCLUSIONS
The differentiation between patients with high and low risk seems reasonable. An improvement could be achieved by differentiated LMWH application. Synthetic specific antifactor Xa substances (fondaparinux) or other medications could lead in future to other changes in the management of vascular surgery patients and should be further evaluated. | null | false | Risk-adjusted strategies in the prevention of early arterial thrombosis following lower extremity arterial reconstruction: a comparison of unfractionated versus low molecular weight heparin. OBJECTIVE
In vascular surgery postoperative thrombosis prophylaxis must sufficiently prevent arterial thrombosis. This cohort study examines different therapeutic approaches of unfractionated heparin (UFH) or low molecular weight heparin (LMWH) after vascular reconstruction.
METHODS
Four hundred seventy-five patients entered the study between 2005 and 2008. Our clinical routine made a differentiation between low-risk patients (N.=375) and patients with peripheral bypass, which were grouped as high-risk (N.=148). We changed our postoperative anticoagulation management after 24 months in the low-risk and after each 16 months in the high-risk group. The anticoagulation of low-risk patients consisted of either two applications of 7.500 IU UFH subcutaneously (N.=158) or one daily application of 40 mg LMWH each up to discharge (N.=169). High-risk patients received either 25.000 IU UFH i.v. over 24 hours and 4 days (N.=48), 2-times (N.=51) or one-time weight-adjusted LMWH (N.=49) up to discharge (1 mg/kg body weight). Minor complications (bleedings) were differentiated from major early graft occlusion during the postoperative course. Further follow-up was not done for this study.
RESULTS
Low risk: under LMWH, complications could be significantly reduced (P=0.001). Under LMWH significantly fewer occlusion complications occurred (P=0.01) and operation-induced hemorrhages were less frequently observed (P=0.05), this was significant in the complete low-risk group. High-risk: the one-time weight-adjusted LMWH group similarly exhibited many occlusions, like the unfractionated group (NS). The two-time LMWH treatment was significantly superior to the one-time application with respect to occlusion followed by amputations (P=0.03). Minor complications could be minimized overall by administration of LMWH and its dose reduction (NS).
CONCLUSIONS
The differentiation between patients with high and low risk seems reasonable. An improvement could be achieved by differentiated LMWH application. Synthetic specific antifactor Xa substances (fondaparinux) or other medications could lead in future to other changes in the management of vascular surgery patients and should be further evaluated. |
20,044,737 | D030541:Databases, Genetic; D005260:Female; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D006973:Hypertension; D008297:Male; D011941:Receptors, Adrenergic | [
"D030541",
"D005260",
"D056726",
"D020022",
"D006801",
"D006973",
"D008297",
"D011941"
] | Synopsis and data synthesis of genetic association studies in hypertension for the adrenergic receptor family genes: the CUMAGAS-HYPERT database. | BACKGROUND
The adrenergic receptor (adrenoceptor) family genes have been extensively studied as candidate genes in hypertension but the results of individual genetic association studies (GAS) are controversial and inconclusive. To clarify these data, a systematic assessment of GAS for adrenoceptor family genes in hypertension was conducted.
METHODS
Data from 163 GAS involving 7 genes and 37 distinct genetic variants were analyzed and cataloged in CUMAGAS-HYPERT (Cumulative Meta-analysis of Genetic Association Studies-HYPERTension; a web-based information system, which allows the retrieval and synthesis of data from GAS in hypertension, available at http://biomath.med.uth.gr). Data from genome-wide association studies involving the adrenoceptor family genes were also systematically searched.
RESULTS
Individual GAS reported inconsistent associations and had limited power to detect modest genetic effects, with only 1.2% having power >80%. Thirteen variants were investigated by three or more studies and their results were subject to meta-analysis. In the main meta-analyses, significant results were shown for five variants (ADRB1 p.Arg389Gly, ADRB1 p.Ser49Gly, ADRB2 g.9368308A>G, ADRB3 p.Trp64Arg, and ADRA1A p.Cys347Arg) under the allelic contrast and/or the dominant model. Subgroup analyses by ethnicity and gender detected significant associations for three variants (ADRB1 p.Arg389Gly in east Asians, ADRB2 p.Gln27Glu in whites, and ADRB3 p.Trp64Arg in whites and in males). Heterogeneity ranged from none to high. No significant associations were recorded from genome-wide studies.
CONCLUSIONS
There is evidence to implicate adrenoceptor genes in hypertension, although future studies designed to investigate epistatic and gene-environment interactions would allow more solid conclusions to be drawn about the role of these genes in hypertension. | null | false | Synopsis and data synthesis of genetic association studies in hypertension for the adrenergic receptor family genes: the CUMAGAS-HYPERT database. BACKGROUND
The adrenergic receptor (adrenoceptor) family genes have been extensively studied as candidate genes in hypertension but the results of individual genetic association studies (GAS) are controversial and inconclusive. To clarify these data, a systematic assessment of GAS for adrenoceptor family genes in hypertension was conducted.
METHODS
Data from 163 GAS involving 7 genes and 37 distinct genetic variants were analyzed and cataloged in CUMAGAS-HYPERT (Cumulative Meta-analysis of Genetic Association Studies-HYPERTension; a web-based information system, which allows the retrieval and synthesis of data from GAS in hypertension, available at http://biomath.med.uth.gr). Data from genome-wide association studies involving the adrenoceptor family genes were also systematically searched.
RESULTS
Individual GAS reported inconsistent associations and had limited power to detect modest genetic effects, with only 1.2% having power >80%. Thirteen variants were investigated by three or more studies and their results were subject to meta-analysis. In the main meta-analyses, significant results were shown for five variants (ADRB1 p.Arg389Gly, ADRB1 p.Ser49Gly, ADRB2 g.9368308A>G, ADRB3 p.Trp64Arg, and ADRA1A p.Cys347Arg) under the allelic contrast and/or the dominant model. Subgroup analyses by ethnicity and gender detected significant associations for three variants (ADRB1 p.Arg389Gly in east Asians, ADRB2 p.Gln27Glu in whites, and ADRB3 p.Trp64Arg in whites and in males). Heterogeneity ranged from none to high. No significant associations were recorded from genome-wide studies.
CONCLUSIONS
There is evidence to implicate adrenoceptor genes in hypertension, although future studies designed to investigate epistatic and gene-environment interactions would allow more solid conclusions to be drawn about the role of these genes in hypertension. |
30,797,031 | D000368:Aged; D000784:Aortic Dissection; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic; D019917:Blood Vessel Prosthesis Implantation; D002140:California; D057510:Endovascular Procedures; D006764:Hospitals, Community; D016304:Hospitals, Private; D006801:Humans; D061214:Patient Safety; D011183:Postoperative Complications; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome | [
"D000368",
"D000784",
"D001013",
"D017545",
"D019917",
"D002140",
"D057510",
"D006764",
"D016304",
"D006801",
"D061214",
"D011183",
"D018570",
"D012307",
"D013997",
"D016896"
] | Hybrid Aortic Arch Debranching and TEVAR Is Safe in a Private, Community Hospital. | BACKGROUND
Hybrid open cervical vessel debranching and thoracic endovascular aortic repair (TEVAR) is a treatment option in the management of aortic arch or proximal descending thoracic aortic aneurysms. However, these patients are often referred to tertiary care academic centers for aneurysm repair. Our study looks to assess the safety and outcomes of open cervical debranching and TEVAR within a private, community hospital setting.
METHODS
A total of 12 patients underwent hybrid open cervical vessel debranch with staged TEVAR from 2015 to 2018 at Riverside Community Hospital (Riverside, California). Three patients underwent open sternotomy with innominate artery bypass; four patients underwent combined carotid-carotid bypass with left carotid-axillary bypass or left subclavian transposition; three patients solely underwent left carotid-axillary bypass or left subclavian transposition. In cases involving multiple cervical bypasses, two surgeons were present. TEVAR was performed in a staged fashion during the same hospitalization.
RESULTS
There were no patient deaths, MI, or stroke within the 30-day postoperative period and at 1-year follow-up. One patient suffered a small subdural bleed after ascending aorta to innominate bypass involving redo sternotomy and hypothermic circulatory arrest. The mean aortic zone stented was zone 1. On follow-up imaging, all bypass grafts were patent, all aneurysms demonstrated thrombosis without endoleak. Average follow-up was 20 months.
CONCLUSIONS
Hybrid cervical debranching with staged TEVAR can be safely performed by experienced vascular surgeons in the community setting. Staged repair appears to confer better operative and patient outcomes. | null | false | Hybrid Aortic Arch Debranching and TEVAR Is Safe in a Private, Community Hospital. BACKGROUND
Hybrid open cervical vessel debranching and thoracic endovascular aortic repair (TEVAR) is a treatment option in the management of aortic arch or proximal descending thoracic aortic aneurysms. However, these patients are often referred to tertiary care academic centers for aneurysm repair. Our study looks to assess the safety and outcomes of open cervical debranching and TEVAR within a private, community hospital setting.
METHODS
A total of 12 patients underwent hybrid open cervical vessel debranch with staged TEVAR from 2015 to 2018 at Riverside Community Hospital (Riverside, California). Three patients underwent open sternotomy with innominate artery bypass; four patients underwent combined carotid-carotid bypass with left carotid-axillary bypass or left subclavian transposition; three patients solely underwent left carotid-axillary bypass or left subclavian transposition. In cases involving multiple cervical bypasses, two surgeons were present. TEVAR was performed in a staged fashion during the same hospitalization.
RESULTS
There were no patient deaths, MI, or stroke within the 30-day postoperative period and at 1-year follow-up. One patient suffered a small subdural bleed after ascending aorta to innominate bypass involving redo sternotomy and hypothermic circulatory arrest. The mean aortic zone stented was zone 1. On follow-up imaging, all bypass grafts were patent, all aneurysms demonstrated thrombosis without endoleak. Average follow-up was 20 months.
CONCLUSIONS
Hybrid cervical debranching with staged TEVAR can be safely performed by experienced vascular surgeons in the community setting. Staged repair appears to confer better operative and patient outcomes. |
16,639,688 | D000368:Aged; D001243:Assisted Circulation; D002294:Carcinoma, Squamous Cell; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008175:Lung Neoplasms; D008297:Male; D011013:Pneumonectomy; D019106:Postoperative Hemorrhage; D011651:Pulmonary Artery; D012770:Shock, Cardiogenic; D012771:Shock, Hemorrhagic | [
"D000368",
"D001243",
"D002294",
"D003131",
"D015199",
"D006801",
"D007423",
"D008175",
"D008297",
"D011013",
"D019106",
"D011651",
"D012770",
"D012771"
] | Mechanical circulatory support for profound cardiac circulatory shock status due to postoperative pulmonary artery bleeding. | A 77-year-old patient suffering from life-threatening pulmonary artery bleeding after pulmonary lobectomy was resuscitated but had refractory cardiogenic shock after the bleeding was controlled. We used mechanical circulatory support with extracorporeal membrane oxygenation and intra-aortic balloon pump to overcome the hemorrhagic shock-related cardiac suppression and multi-organ injury in the post-resuscitation critical period. | 11,887,378 | true | Mechanical circulatory support for profound cardiac circulatory shock status due to postoperative pulmonary artery bleeding. A 77-year-old patient suffering from life-threatening pulmonary artery bleeding after pulmonary lobectomy was resuscitated but had refractory cardiogenic shock after the bleeding was controlled. We used mechanical circulatory support with extracorporeal membrane oxygenation and intra-aortic balloon pump to overcome the hemorrhagic shock-related cardiac suppression and multi-organ injury in the post-resuscitation critical period. |
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in Data Studio
PubMed Cardiovascular Subset Dataset
This dataset is a curated subset of PubMed articles filtered to include those related to Cardiovascular Disease and its associated subcategories ("children"). It is designed to support research and analysis in cardiovascular health, epidemiology, and related biomedical fields by providing structured metadata along with the article text.
Dataset Overview
- Source: Derived from PubMed, the dataset includes articles indexed with relevance to cardiovascular conditions.
- Scope: Focused on cardiovascular disease, including its broader categories and subtypes, ensuring that users can perform detailed analyses on relevant biomedical literature.
- Curation: Articles were selected using MeSH term filtering, where both the primary term for Cardiovascular Disease and its children terms were used to narrow the selection.
Dataset Structure
The dataset is structured with the following columns:
pmid:
A unique PubMed Identifier for each article. This numeric code allows easy cross-referencing with the full PubMed record.mesh_terms:
A string containing Medical Subject Headings (MeSH) terms with their corresponding codes (e.g., "D000369:Aged, 80 and over"). These terms classify the content and facilitate detailed filtering based on biomedical topics.mesh_terms_ui_list:
A list of MeSH term unique identifiers extracted from themesh_termsfield. This format aids in programmatic filtering and analysis by isolating the identifier codes.title:
The title of the research article. It offers a brief overview of the study focus, allowing users to quickly gauge the article's relevance.abstract:
A summary of the article, including background, methods, results, and conclusions. This field provides a concise yet informative snapshot of the research content.index:
Position in pubmed_en. In case of not being contained, it is null.in_total_pubmed:
A boolean indicator that shows whether the article is part of the broader PubMed_en dataset.text:
A consolidated field combining key elements (often the title and abstract) into one text block.
Example Record
{
"pmid": 36475546,
"mesh_terms": "D000369:Aged, 80 and over; D006801:Humans; D005260:Female; D008297:Male; D000072657:ST Elevation Myocardial Infarction; D000088642:Nonagenarians; D012189:Retrospective Studies; D017052:Hospital Mortality; D062645:Percutaneous Coronary Intervention; D006761:Hospitals",
"mesh_terms_ui_list": [
"D000369",
"D006801",
"D005260",
"D008297",
"D000072657",
"D000088642",
"D012189",
"D017052",
"D062645",
"D006761"
],
"title": "In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention.",
"abstract": "BACKGROUND\nThe aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI)...",
"index": null,
"in_total_pubmed": false,
"text": "In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. BACKGROUND\nThe aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI)..."
}
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