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Find video protocols related to scientific articles indexed in Pubmed.
Coronary stents seeded with human trophoblastic endovascular progenitor cells show accelerated strut coverage without excessive neointimal proliferation in a porcine model.
EuroIntervention
PUBLISHED: 10-21-2014
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The success of percutaneous coronary intervention (PCI) has been limited by restenosis and stent thrombosis. Delayed or incomplete endothelial regeneration is believed to be a key factor responsible for these events. Developing a stent with an accelerated healing profile may be of benefit. We aimed to evaluate the feasibility and safety of seeding a bare metal stent (BMS) with human trophoblastic endovascular progenitor cells (hTEC) derived from human embryonic stem cells. A porcine coronary artery model was used to compare the rate and extent of endothelial regeneration and the degree of neointimal proliferation. Characterisation of hTEC confirmed a mixed progenitor and endothelial cell phenotype. The biodistribution and fate of hTEC were studied using radiolabelled 111Indium oxine and fluorescent in situ hybridisation. Scanning electron microscopy showed earlier endothelial coverage in hTEC-seeded stents as compared to similar BMS. hTEC-seeded BMS achieved complete stent coverage in three days. Quantitative coronary angiography, intravascular ultrasound assessment and histomorphometry showed no difference in neointimal hyperplasia between hTEC-seeded and control BMS. hTEC seeding of coronary stents is a novel and safe approach to accelerate endothelial regeneration without increasing neointimal proliferation.
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Berberine Attenuates Adverse Left Ventricular Remodeling and Cardiac Dysfunction after Acute Myocardial Infarction in Rats: Role of Autophagy.
Clin. Exp. Pharmacol. Physiol.
PUBLISHED: 09-17-2014
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This study aimed to test the hypothesis that berberine, a plant derived antioxidant, attenuates adverse left ventricular remodeling and improves cardiac function in a rat model of myocardial infarction (MI). Moreover, the potential mechanisms that mediated the cardioprotective actions of berberine, in particular the effect on autophagy, were also investigated. Acute MI was induced by ligating left anterior descending coronary artery of Sprague-Dawley rats. Cardiac function was assessed by transthoracic echocardiography. The protein activity/levels of autophagy related to signaling pathways (e.g. LC-3B, Beclin-1) were measured in myocardial tissue by immunohistochemical staining and Western blot. Four weeks after MI, berberine significantly prevented cardiac dysfunction and adverse cardiac remodeling. MI rats treated with low dose berberine (10mg/kg/day) showed higher left ventricular ejection fraction and fractional shortening than those treated with high dose berberine (50mg/kg/day). Both doses reduced interstitial fibrosis and post-MI adverse cardiac remodeling. The cardioprotective action of berberine was associated with increased LC3-II/I and Beclin-1 expressions. Furthermore, cardioprotection with BBR was potentially related to p38 MAPK inhibition and phospho-Akt activation. This in vivo study demonstrated that berberine is effective in promoting autophagy and subsequently attenuating left ventricular remodeling and cardiac dysfunction after MI. The potential underlying mechanism is augmentation of autophagy through inhibition of p38 MAPK and activation of phospho-Akt signaling pathways. This article is protected by copyright. All rights reserved.
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Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease-analysis of CREDO-Kyoto registry.
Circ. J.
PUBLISHED: 07-07-2014
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SYNTAX score II (SSII) provides individualized estimates of 4-year mortality after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in order to facilitate decision-making between these revascularization methods. The purpose of the present study was to assess SSII in a real-world multicenter registry with distinct regional and epidemiological characteristics.
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Detection of morphometric differentiation in Sattar snowtrout, Schizothorax curvifrons (Cypriniformes: Cyprinidae) from Kashmir Himalaya using a truss network system.
Rev. Biol. Trop.
PUBLISHED: 06-11-2014
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Schizothorax curvifrons is a morphometrically and meristically most variable and economically valuable promising fish food from Kashmir Valley. Since there is a lack of information on stock structure of wild populations on this species, this study was aimed to investigate the intraspecific variation of this important snowtrout. For this, two rivers and one lake in Kashmir Himalaya were sampled from January 2011 to October 2012. Fish body measurements were taken and morphometric characters using the truss network system was constructed. Altogether, 506 fish specimens were collected. Data were subjected to principal component analysis, discriminant function analysis and univariate analysis of variance. The first principal component explained 63.44% of total variation, while second and third components explained 8.34% and 5.31%, respectively. The step-wise discriminant function analysis retained two variables that significantly discriminated the populations. Using these variables 83.4% of the original specimens were classified into their correct groups and 81.1% of the cross-validated (leave one out procedure) specimens were classified into their correct groups. All of the total 31 transformed truss measurements exhibited highly significant (p<0.001) differences between the populations. This represents the first attempt on stock structure of S. curvifrons; therefore, this study will hopefully guide fisheries taxonomists about its current stock structure and would help in its management and conservation programme across Kashmir Himalaya area.
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Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials.
Chin. Med. J.
PUBLISHED: 06-04-2014
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Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.
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Repeat coronary angiography with previously normal arteries: A futile exercise?
Catheter Cardiovasc Interv
PUBLISHED: 05-06-2014
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Up to 20% of coronary angiograms reveal normal arteries. How long they stay normal is poorly understood. This study investigated the fate of normal coronary arteries and determined the rate of development of coronary artery disease.
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In vitro validation and comparison of different software packages or algorithms for coronary bifurcation analysis using calibrated phantoms: Implications for clinical practice and research of bifurcation stenting.
Catheter Cardiovasc Interv
PUBLISHED: 03-18-2014
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Background: The accuracy and precision of quantitative coronary angiography (QCA) software dedicated for bifurcation lesions compared with conventional single vessel analysis remains unknown. Furthermore, comparison of different bifurcation analysis algorithms has not been performed. Methods: Six plexiglas phantoms with 18 bifurcations were manufactured with a tolerance <10?m. The bifurcation angiograms were analyzed using CAAS (Version 5.10, Pie Medical Imaging, Maastricht, The Netherlands) and QAngio XA (Version 7.3, Medis Medical Imaging System BV, Leiden, The Netherlands) software packages. Results: Conventional single vessel analysis underestimated the reference vessel diameter and percent diameter stenosis in the proximal main vessel while it overestimated these parameters in the distal main vessel and side-branch. CAAS software showed better overall accuracy and precision than QAngio XA (with automatic Y or T-shape bifurcation algorithm selection) for various phantom diameters including minimum lumen diameter (0.012±0.103 mm vs. 0.041±0.322 mm, p=0.003), reference vessel diameter (-0.050±0.043 mm vs. 0.116±0.610 mm, p=0.026), and % diameter stenosis (-0.94±4.07 % vs. 1.74±7.49 %, p=0.041). QAngio XA demonstrated higher minimal lumen diameter, reference vessel diameter and % diameter stenosis when compared to the actual phantom diameters; however, the accuracy of these parameters improved to a similar level as CAAS when the sole T-shape algorithm in the QAnxio XA was used. Conclusion: The use of the single-vessel QCA method is inaccurate in bifurcation lesions. Both CAAS and QAngio XA (when the T-shape is systematically used) bifurcation software packages are suitable for quantitative assessment of bifurcations. © 2014 Wiley Periodicals, Inc.
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Significance of serum magnesium levels in critically ill-patients.
Int J Appl Basic Med Res
PUBLISHED: 03-07-2014
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Magnesium is one of the major electrolytes, deficiency of which is frequently overlooked in critical illness, leading to an adverse clinical outcome if not monitored regularly.
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Early (before 6 months), late (6-12 months) and very late (after 12 months) angiographic scaffold restenosis in the ABSORB Cohort B trial.
EuroIntervention
PUBLISHED: 02-28-2014
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Aims: The long-term follow-up of the first-in-man ABSORB Cohort B trial showed that angiographic binary restenosis can occur early, late or very late after implantation of the Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb BVS). Since the mechanical support of the scaffold decreases during bioresorption, the mechanism of in-segment restenosis (ISR) of the Absorb BVS might be different from that of metallic stents. The objective of the current analysis was to review the multimodality imaging of cases with binary restenosis to elucidate the mechanism of ISR after Absorb BVS implantation. Methods and results: The ABSORB Cohort B trial enrolled 101 patients with a maximum of two de novo coronary lesions. At the three-year imaging and clinical follow-up, there were six cases of in-segment binary restenosis: two early ISR (<6 months), one late ISR (6-12 months) and three very late ISR (>12 months). Three of these ISR cases seemed to be induced by anatomical or procedural factors. In the other three cases, intravascular imaging (IVUS/OCT) demonstrated that the main mechanism of restenosis was significant intra-scaffold tissue growth, while the structural circularity and diameter of the scaffold were not affected. Conclusions: Early and late restenosis after implantation of the Absorb bioresorbable scaffold could be related to anatomical or procedural factors. In this small cohort of patients late or very late restenosis seems to be attributed to pure intra-scaffold tissue growth without extrinsic encroachment of the scaffold.
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Prognostic value of site SYNTAX score and rationale for combining anatomic and clinical factors in decision making: insights from the SYNTAX trial.
J. Am. Coll. Cardiol.
PUBLISHED: 02-19-2014
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The results of SYNTAX trial have been reported based on "corelab" calculated SS (cSS). It has been shown that reproducibility of SS is better among the core laboratory technicians than interventional cardiologists. Thus, the prognostic value and clinical implication of the "site" SYNTAX SS (sSS) remain unknown.
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3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting.
EuroIntervention
PUBLISHED: 02-18-2014
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Aims: We describe three-dimensional optical coherence tomography (3D-OCT) guided bifurcation stenting and the clinical utility of 3D-OCT. Methods and results: Twenty-two consecutive patients who underwent OCT examination to confirm the recrossing position after stent implantation in a bifurcation lesion were enrolled. Frequency domain OCT images were obtained to check the recrossing position and 3D reconstructions were performed off-line. The recrossing position was clearly visualised in 18/22 (81.8%) cases. In 13 cases, serial 3D-OCT could be assessed both before and after final kissing balloon post-dilation (FKBD). We divided these cases into two groups according to the presence of the link between hoops at the carina: free carina type (n=7) and connecting to carina type (n=6). All free carina types complied with the distal rewiring. The percentage of incomplete stent apposition (%ISA) of free carina type at the bifurcation segment after FKBD was significantly smaller than that of the connecting to carina type (0.7±0.9% vs. 12.2±6.5%, p=0.0074). Conclusions: 3D-OCT confirmation of the recrossing into the jailed side branch is feasible during PCI and may help to achieve distal rewiring and favourable stent positioning against the side branch ostium, leading to reduction in ISA and potentially better clinical outcomes.
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Effect of eplerenone in percutaneous coronary intervention-treated post-myocardial infarction patients with left ventricular systolic dysfunction: a subanalysis of the EPHESUS trial.
Eur. J. Heart Fail.
PUBLISHED: 02-14-2014
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EPHESUS was a multicentre, double-blind clinical trial in which 6632 patients with acute myocardial infarction (AMI) complicated by LV systolic dysfunction (LVSD) were randomized to receive eplerenone (n = 3319) or placebo (n = 3313). A total of 1580 EPHESUS patients were treated with PCI, which is now the standard treatment for AMI. This EPHESUS substudy examined the effects of eplerenone upon cardiovascular outcomes in PCI-treated patients.
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Effect of the endothelial shear stress patterns on neointimal proliferation following drug-eluting bioresorbable vascular scaffold implantation: an optical coherence tomography study.
JACC Cardiovasc Interv
PUBLISHED: 02-13-2014
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This study sought to investigate the effect of endothelial shear stress (ESS) on neointimal formation following an Absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) implantation.
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Predicting 3-year mortality after percutaneous coronary intervention: updated logistic clinical SYNTAX score based on patient-level data from 7 contemporary stent trials.
JACC Cardiovasc Interv
PUBLISHED: 02-04-2014
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This study aimed to update the Logistic Clinical SYNTAX score to predict 3-year survival after percutaneous coronary intervention (PCI) and compare the performance with the SYNTAX score alone.
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Comparison of acute gain and late lumen loss after PCI with bioresorbable vascular scaffolds versus everolimus-eluting stents: an exploratory observational study prior to a randomised trial.
EuroIntervention
PUBLISHED: 01-30-2014
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The study sought to compare the acute gain and two-year follow-up late lumen loss (LLL) between the Absorb bioresorbable vascular scaffold (BVS) and the analogous everolimus-eluting metallic stent (EES). The current analysis included all the patients recruited in the ABSORB Cohort B and SPIRIT II trials implanted with a single 3.0×18 mm device (Absorb BVS or EES) who underwent serial angiographic examinations at baseline and at two-year follow-up. The acute gain was defined as the difference between post- and preprocedural minimal lumen diameter (MLD). The in-stent/scaffold LLL was calculated as the difference in stent/scaffold segment between the post-procedural MLD and follow-up MLD. Thirty-three patients (33 lesions) implanted with the Absorb BVS, and 26 patients (28 lesions) implanted with the EES were studied. The acute gain was similar in the Absorb BVS group (1.23±0.38 mm) compared to the EES group (1.32±0.26 mm, p=0.29). The in-stent/scaffold LLL at two-year follow-up in the Absorb BVS group (0.26±0.19 mm) was also similar compared to the EES group (0.22±0.22 mm, p=0.29). Although the two groups had similar two-year clinical outcomes (major adverse cardiac events: Absorb BVS: 6.1% vs. EES: 0.0%), patients treated with the Absorb BVS exhibited a significantly lower two-year in-stent/scaffold MLD compared to the EES (2.02±0.26 mm vs. 2.22±0.34 mm, p=0.01). Although BVS and EES demonstrated similar two-year clinical outcomes, patients treated with the Absorb BVS exhibited a significantly lower two-year in-stent/scaffold MLD compared to patients treated with the EES. Appropriately powered randomised trials are necessary to confirm these exploratory results and evaluate their prognostic and clinical significance.
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Lessons learned from acute and late scaffold failures in the ABSORB EXTEND trial.
EuroIntervention
PUBLISHED: 01-29-2014
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Bioresorbable scaffolds are increasingly used in patients with coronary artery disease undergoing percutaneous coronary interventions. ABSORB EXTEND is an ongoing study that will recruit 800 patients. This report evaluates acute and late scaffold failure in the first 450 patients enrolled in ABSORB EXTEND who have completed 12 months follow-up.
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Selection of a mineralocorticoid receptor antagonist for patients with hypertension or heart failure.
Eur. J. Heart Fail.
PUBLISHED: 01-28-2014
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Clinical trials have demonstrated morbidity and mortality benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either spironolactone or eplerenone as the MRA. It is generally believed that these two agents have the same effects, and the data from studies using one drug could be extrapolated for the other. National and international guidelines do not generally discriminate between spironolactone and eplerenone, but strongly recommend using an MRA for patients with heart failure due to LV systolic dysfunction and post-infarct LV systolic dysfunction. There are no major clinical trials directly comparing the efficacy of these two drugs. This article aims to compare the pharmacokinetics and pharmacodynamics of spironolactone and eplerenone, and to analyse the available data for their cardiovascular indications and adverse effects. We have also addressed the role of special circumstances including co-morbidities, concomitant drug therapy, cost, and licensing restrictions in choosing an appropriate MRA for a particular patient, thus combining an evidence-based approach with personalized medicine.
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Berberine improves pressure overload-induced cardiac hypertrophy and dysfunction through enhanced autophagy.
Eur. J. Pharmacol.
PUBLISHED: 01-16-2014
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Cardiac hypertrophy is a maladaptive change in response to pressure overload, and is also an important risk for developing heart failure. Berberine is known to have cardioprotective effects in patients with hypertension and in animal models of cardiac hypertrophy. In the current study, we observed that transverse aortic contraction (TAC) surgery induced a marked increase in heart size, the ratio of heart weight to body weight, cardiomyocyte apoptosis, myocardial fibrosis, and hypertrophic marker brain natriuretic peptide, all of which were effectively suppressed by berberine administration. In addition, berberine enhanced autophagy in hypertrophic hearts, which was accompanied by a decrease in heart size, cardiac apoptosis, and the attenuation of cardiac dysfunction. Furthermore, use of autophagy inhibitor 3-methyladenine (3-MA) blocked berberine-induced autophagy level, and abrogated the protection of berberine against heart hypertrophy, cardiac dysfunction, and apoptosis. Berberine ameliorated TAC-induced endoplasmic reticulum stress, which was also abolished by 3-MA. Moreover, berberine significantly inhibited the upstream signaling of autophagy, such as the mammalian target of rapamycin (mTOR), extracellular signal-regulated kinase (ERK1/2), and p38 mitogen-activated protein kinase (MAPK) phosphorylation. We conclude that berberine could attenuate left ventricular remodeling and cardiomyocyte apoptosis through an autophagy-dependent mechanism in a rat model of cardiac hypertrophy, which is, at least in part, associated with enhanced autophagy through inhibition of mTOR, p38 and ERK1/2 MAPK signaling pathways.
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Displacement of cortisol from human heart by acute administration of a mineralocorticoid receptor antagonist.
J. Clin. Endocrinol. Metab.
PUBLISHED: 01-16-2014
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Mineralocorticoid receptor (MR) antagonists have beneficial effects in patients with heart failure and myocardial infarction, often attributed to blocking aldosterone action in the myocardium. However, binding of aldosterone to MR requires local activity of the enzyme 11?-hydroxysteroid dehydrogenase type 2 (11?-HSD2), which inactivates cortisol to cortisone and thereby prevents receptor occupancy by cortisol. In vivo activity of 11?-HSD2 and potential occupancy of MR by cortisol in human heart have not been quantified.
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The impact of everolimus versus other rapamycin derivative-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 16 randomized trials.
J Cardiol
PUBLISHED: 01-06-2014
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Everolimus-eluting stent (EES) are considered to have better clinical outcomes than other rapamycin derivative-eluting stents; however, the individual trials may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of EES against other rapamycin derivative-eluting stents.
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Role of frailty assessment in patients undergoing cardiac interventions.
Open Heart
PUBLISHED: 01-01-2014
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Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. The need for a more accurate method of risk stratification incorporating frailty, particularly for elderly patients is pressing. This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice.
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Endothelial repair process and its relevance to longitudinal neointimal tissue patterns: comparing histology with in silico modelling.
J R Soc Interface
PUBLISHED: 01-01-2014
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Re-establishing a functional endothelium following endovascular treatment is an important factor in arresting neointimal proliferation. In this study, both histology (in vivo) and computational simulations (in silico) are used to evaluate neointimal growth patterns within coronary arteries along the axial direction of the stent. Comparison of the growth configurations in vivo and in silico was undertaken to identify candidate mechanisms for endothelial repair. Stent, lumen and neointimal areas were measured from histological sections obtained from eight right coronary stented porcine arteries. Two re-endothelialization scenarios (endothelial cell (EC) random seeding and EC growth from proximal and distal ends) were implemented in silico to evaluate their influence on the morphology of the simulated lesions. Subject to the assumptions made in the current simulations, comparison between in vivo and in silico results suggests that endothelial growth does not occur from the proximal and distal ends alone, but is more consistent with the assumption of a random seeding process. This may occur either from the patches of endothelium which survive following stent implantation or from attachment of circulating endothelial progenitor cells.
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Bioresorbable scaffolds: rationale, current status, challenges, and future.
Eur. Heart J.
PUBLISHED: 12-23-2013
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Current generation of drug-eluting stents has significantly improved the outcomes of percutaneous coronary intervention by substantially reducing in-stent restenosis and stent thrombosis. However, a potential limitation of these stents is the permanent presence of a metallic foreign body within the artery, which may cause vascular inflammation, restenosis, thrombosis, and neoatherosclerosis. The permanent stents also indefinitely impair the physiological vasomotor function of the vessel and future potential of grafting the stented segment. Bioresorbable scaffolds (BRSs) have the potential to overcome these limitations as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage and restoring pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. While a number of BRSs are under development, two devices with substantial clinical data have already received a Conformité Européenne marking. This review article presents the current status of these devices and evaluates the challenges that need to be overcome before BRSs can become the workhorse device in coronary intervention.
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Bioresorbable drug-eluting magnesium-alloy scaffold for treatment of coronary artery disease.
Int J Mol Sci
PUBLISHED: 10-21-2013
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The introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothelialization and healing process resulting in late persistent or acquired malapposition of the permanent metallic implant. Delayed endotheliaization and malapposition may lead to late and very late stent thrombosis. Bioresorbable scaffolds (BRS) have been introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Magnesium is an essential mineral needed for a variety of physiological functions in the human body and its bioresorbable alloy has the strength-to-weight ratio comparable with that of strong aluminum alloys and alloy steels. The aim of this review is to present the new developments in Magnesium BRS technology, to describe its clinical application and to discuss the future prospects of this innovative therapy.
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Optimal revascularization for complex coronary artery disease.
Nat Rev Cardiol
PUBLISHED: 09-17-2013
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Patients with major or symptomatic coronary artery disease (CAD) commonly undergo revascularization--either with CABG surgery, which has been the mainstay of revascularization for more than half a century, or with percutaneous coronary intervention (PCI), which has become the more-commonly used strategy in the past decade. PCI has been tested in more randomized clinical trials than any other procedure in contemporary practice. In general, PCI is the preferred option for treating patients with simple coronary artery lesions and CABG surgery remains the standard of care for patients with complex CAD. Technical advancements in PCI and CABG surgery make comparisons of historical data for these strategies difficult. In this Review, we evaluate the evidence-based use of PCI and CABG surgery in treating patients with multivessel and unprotected left main stem disease and for specific patient groups, including those with diabetes mellitus, chronic heart failure, or chronic kidney disease. Finally, we highlight the available tools to aid decision-making, including clinical guidelines, risk scoring systems, and the role of the heart team.
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Transcatheter aortic valve update 2013.
EuroIntervention
PUBLISHED: 09-13-2013
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Cumulative evidence has demonstrated that transcatheter aortic valve implantation (TAVI) constitutes an effective treatment option for patients with severe symptomatic aortic stenosis and a high operative risk. New valve designs and TAVI-enabling devices have simplified the procedure, reduced the risk of complications, and broadened the applications of this treatment. The global adoption of TAVI allows us to appreciate the advantages, potentialities and caveats of the technology, identify patients who would benefit from TAVI and stratify more accurately the risk of complications. The focus of this article is to discuss the advances in this field, present the current evidence, and highlight the developments and strategies proposed to address the limitations of TAVI treatment.
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The ginsenoside Rg1 prevents transverse aortic constriction-induced left ventricular hypertrophy and cardiac dysfunction by inhibiting fibrosis and enhancing angiogenesis.
J. Cardiovasc. Pharmacol.
PUBLISHED: 07-13-2013
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Ginsenoside Rg1, an important and active ingredient of Panax ginseng, has been shown to exert cardioprotective effects in vivo. The present study aimed to test the hypothesis that ginsenoside Rg1 attenuates cardiac dysfunction in a transverse aortic constriction (TAC)-induced left ventricular hypertrophy in vivo via proangiogenic and antifibrotic effects.
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Intimal Flaps Detected by Optical Frequency Domain Imaging in the Proximal Segments of Native Coronary Arteries.
Circ. J.
PUBLISHED: 06-20-2013
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Background:?The prevalence and clinical sequelae of optical frequency domain imaging (OFDI)-detected intimal flaps caused by vessel trauma or plaque rupture in the proximal native coronary arteries have not been described. Methods and Results:?OFDI investigation was performed following stent implantation in patients with ST-segment elevation myocardial infarction (STEMI). We defined a flap-like structure (FS) as a disruption or discontinuation of the endoluminal vessel surface, and classified as actual flap or artifact. FS in the left main stem, or maximally 20mm distal to the guiding catheter in the proximal right coronary artery were assessed. A total of 8,931 frames in 97 patients were analyzed in a frame-by-frame fashion (0.125-mm interval). OFDI identified 8 FS in 7 patients, none of which was evident angiographically. All FS were left untreated because the operators per protocol were blinded to the OFDI images. A total of 5 FS in 5 patients (5.1%) appeared to be actual flaps in which only the intima was involved (mean distance from guiding catheter: 4.8±2.7mm). The remaining 3 FS in 3 patients were artifacts; namely, residual blood and interface light reflectivity. There were no adverse cardiac events during 6-months follow-up. Conclusions:?In 5.1% of STEMI patients, post-procedural OFDI identified flaps with minimal involvement of the intima in the proximal coronary arteries. A precise interpretation of FS may help decision making to avoid unnecessary procedures. (Clinical Trial Registration Information: ClinicalTrials.gov identifier: NCT01271361.).
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Intimal flaps detected by optical frequency domain imaging in the proximal segments of native coronary arteries: an innocent bystander? Insights from the TROFI Trial.
Circ. J.
PUBLISHED: 06-15-2013
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The prevalence and clinical sequelae of optical frequency domain imaging (OFDI)-detected intimal flaps caused by vessel trauma or plaque rupture in the proximal native coronary arteries have not been described.
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Incidence and predictors of stent thrombosis: a single-centre study of 5,833 consecutive patients undergoing coronary artery stenting.
EuroIntervention
PUBLISHED: 05-21-2013
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Stent thrombosis (ST) is an infrequent but potentially fatal complication of PCI. The reported incidence of ST varies from 0-5%, due to differences in definition of ST, inclusion/exclusion criteria, and the type of stent and dual antiplatelet therapy used. We aimed to examine the incidence of ST and associated risk factors in this "real-world, all-comers" study.
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Coronary stents: historical development, current status and future directions.
Br. Med. Bull.
PUBLISHED: 03-26-2013
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Coronary angioplasty with stenting has revolutionized the treatment of coronary artery disease. This article describes the history of coronary angioplasty and stenting, reviews the contemporary stents and recommendations and highlights the on-going work and potential future directions.
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11?-hydroxysteroid dehydrogenase type 1 deficiency in bone marrow-derived cells reduces atherosclerosis.
FASEB J.
PUBLISHED: 01-09-2013
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11?-Hydroxysteroid dehydrogenase type-1 (11?-HSD1) converts inert cortisone into active cortisol, amplifying intracellular glucocorticoid action. 11?-HSD1 deficiency improves cardiovascular risk factors in obesity but exacerbates acute inflammation. To determine the effects of 11?-HSD1 deficiency on atherosclerosis and its inflammation, atherosclerosis-prone apolipoprotein E-knockout (ApoE-KO) mice were treated with a selective 11?-HSD1 inhibitor or crossed with 11?-HSD1-KO mice to generate double knockouts (DKOs) and challenged with an atherogenic Western diet. 11?-HSD1 inhibition or deficiency attenuated atherosclerosis (74-76%) without deleterious effects on plaque structure. This occurred without affecting plasma lipids or glucose, suggesting independence from classical metabolic risk factors. KO plaques were not more inflamed and indeed had 36% less T-cell infiltration, associated with 38% reduced circulating monocyte chemoattractant protein-1 (MCP-1) and 36% lower lesional vascular cell adhesion molecule-1 (VCAM-1). Bone marrow (BM) cells are key to the atheroprotection, since transplantation of DKO BM to irradiated ApoE-KO mice reduced atherosclerosis by 51%. 11?-HSD1-null macrophages show 76% enhanced cholesterol ester export. Thus, 11?-HSD1 deficiency reduces atherosclerosis without exaggerated lesional inflammation independent of metabolic risk factors. Selective 11?-HSD1 inhibitors promise novel antiatherosclerosis effects over and above their benefits for metabolic risk factors via effects on BM cells, plausibly macrophages.
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Endometrial cancer and venous thromboembolism in women under age 50 who take tamoxifen for prevention of breast cancer: a systematic review.
Cancer Treat. Rev.
PUBLISHED: 05-31-2011
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Breast cancer prevention with tamoxifen in high-risk women is limited due to concerns of endometrial cancer and thromboembolism. We report the risk of endometrial cancer, deep vein thrombosis and pulmonary embolism in women <50 years given tamoxifen for breast cancer prevention.
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Assessment of quality of life with imatinib mesylate as first-line treatment in chronic phase-chronic myeloid leukemia.
Leuk. Lymphoma
PUBLISHED: 05-03-2011
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Imatinib mesylate (IM) is a first-line treatment of chronic phase-chronic myeloid leukemia (CP-CML). The primary objective of this study was to assess the quality of life (QOL) in patients with CP-CML treated with IM. Ninety patients with newly diagnosed CP-CML were assessed for QOL with first-line IM. Patients completed the cancer-specific FACT-BRM questionnaire (functional assessment of cancer therapy-biologic response modifiers) at baseline and at 3 and 6 months. FACT-BRM consists of subscales including physical well-being (PWB), social and family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), BRM-physical, and BRM-mental. The primary endpoint was the Trial Outcome Index (TOI), created as a measure of physical function and well-being. An increase of ?5 from baseline was considered to be a clinically significant improvement. The mean TOI score increased from 75.5 at baseline to 85.2 (p<0.0001) at 6 months, representing a healthy QOL. When comparing the individual TOI subscales, there was a mean increase of 16.4 in the daily functioning and well-being score, and a mean decrease of 6.2, 4.9, and 16.1 was noted in fatigue, emotional/cognitive dysfunction, and side-effects scores at 6 months, respectively. Improvement was not affected by age, sex, or Sokal score. With prolonged treatment, IM results in a higher physical well-being, less fatigue and emotional and cognitive dysfunction, and very few side-effects.
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Enhanced expression of AtNHX1, in transgenic groundnut (Arachis hypogaea L.) improves salt and drought tolerence.
Mol. Biotechnol.
PUBLISHED: 04-02-2011
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Salinity and drought are main threat to agriculture productivity, to avoid further losses it is necessary to improve the genetic material of crops against these stresses In this present study, AtNHX1, a vacuolar type Na(+)/H(+) antiporter gene driven by 35S promoter was introduced into groundnut using Agrobacterium tumefaciens transformation system. The stable integration of the AtNHX1 gene was confirmed by polymerase chain reaction (PCR) and southern blot analysis. It was found that transgenic plants having AtNHX1 gene are more resistant to high concentration of salt and water deprivation than the wild type plants. Salt and proline level in the leaves of the transgenic plants were also much higher than that of wild type plants. The results showed that overexpression of AtNHX1 gene not only improved salt tolerance but also drought tolerance in transgenic groundnut. Our results suggest that these plants could be cultivated in salt and drought-affected soils.
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UK national survey of venous thromboembolism prophylaxis in ankle fracture patients treated with plaster casts.
Foot Ankle Surg
PUBLISHED: 02-12-2011
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Ankle fractures are one of the commonest orthopaedic injuries. A substantial proportion of these are treated non-operatively at outpatient clinics with cast immobilization. We conducted this survey to assess the current practice in UK regarding thromboembolism prophylaxis in these patients.
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Preferable colonic investigations for isolated abdominal pain.
South. Med. J.
PUBLISHED: 02-08-2011
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Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of serious pathology detected by optical colonoscopy (OC) has differed greatly in published series. This study aims to establish the yield of colonic investigations for isolated abdominal pain.
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Novel use of a pericardium-covered stent graft to treat bulky coronary artery thrombus.
Catheter Cardiovasc Interv
PUBLISHED: 01-18-2011
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We studied the acute safety and feasibility of a pericardium-covered stent (PCS) in the obliteration of massive coronary thrombus.
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Survival of women with locally advanced breast cancer at a teaching hospital in Lahore.
J Pak Med Assoc
PUBLISHED: 12-29-2010
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To correlate the clinical features of women presenting with locally advanced breast cancer with event-free survival (EFS) and overall survival (OS) and to evaluate the patterns of relapse.
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Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality.
Eur. J. Heart Fail.
PUBLISHED: 07-08-2010
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Chronic heart failure (CHF) due to left ventricular systolic dysfunction is associated with poor quality of life (QoL). This study aimed to assess factors affecting health-related QoL in CHF patients and their carers and the impact of QoL on clinical outcomes.
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Concomitant homozygosity for the prothrombin gene variant with mild deficiency of antithrombin III in a patient with multiple hepatic infarctions: a case report.
J Med Case Rep
PUBLISHED: 04-29-2010
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Hereditary causes of visceral thrombosis or thrombosis should be sought among young patients. We present a case of a young man presenting with multiple hepatic infarctions resulting in portal hypertension due to homozygosity of the prothrombin gene mutation not previously described in literature.
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Sustained superior long-term outcomes and cytogenetic responses with imatinib mesylate in chronic phase chronic myeloid leukaemia: report from a developing country.
Jpn. J. Clin. Oncol.
PUBLISHED: 02-26-2010
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Imatinib mesylate is now a standard treatment for chronic myeloid leukaemia. Primary objective of our study was to report long-term survival outcomes in patients receiving Imatinib in chronic phase. Secondary objectives included determination of cytogenetic responses and toxicity profile of Imatinib mesylate.
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Worsened oncologic outcomes for women of lower socio-economic status (SES) treated for locally advanced breast cancer (LABC) in Pakistan.
Breast
PUBLISHED: 09-08-2009
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Two hundred and thirty-seven women, undergoing multimodality treatment for locally advanced breast cancer (LABC), were retrospectively analyzed for age, menopausal status, socio-economic status (SES), tumor size, nodal involvement, tumor grade, estrogen and progesterone receptor (ER, PR) status and tumor stage. Primary purpose was to assess outcomes of these patients treated in a low-income country as defined by the World Bank and using limited-level treatment resources as defined by Breast Health Global Initiative (BHGI) guidelines. Secondary objectives included correlation of predictive and prognostic features with event-free survival (EFS) and overall survival (OS) at 5 years. Predictors of decreased EFS or OS included lower SES [P=0.05 (95%CI 0.34-1.0) and P=0.1 (CI 0.29-1.14)], larger tumor size [P=0.01 (95%CI 1.06-1.59) and P=0.3 (CI 0.86-1.50)] and positive lymph node status [P=0.04 (95% CI 1.0-1.55) and P<0.0001 (CI 1.37-2.64). In women diagnosed with LABC in Pakistan, patients with lower SES had larger, more aggressive tumors with worsened survival outcomes. Optimal breast cancer care warrants consideration for health care policies that address access to diagnostic and treatment services for financially disadvantaged women.
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Garlic: natures protection against physiological threats.
Crit Rev Food Sci Nutr
PUBLISHED: 06-02-2009
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Currently reliance on natural products is gaining popularity to combat various physiological threats including oxidative stress, cardiovascular complexities, cancer insurgence, and immune dysfunction. The use of traditional remedies may encounter more frequently due to an array of scientific evidence in their favor. Garlic (Allium sativum) holds a unique position in history and was recognized for its therapeutic potential. Recent advancements in the field of immunonutrition, physiology, and pharmacology further explored its importance as a functional food against various pathologies. Extensive research work has been carried out on the health promoting properties of garlic, often referred to its sulfur containing metabolites i.e. allicin and its derivatives. Garlic in its preparations are effective against health risks and even used as dietary supplements such as age garlic extract (AGE) and garlic oil etc. Its components/formulations can scavenge free radicals and protect membranes from damage and maintains cell integrity. It also provides cardiovascular protection mediated by lowering of cholesterol, blood pressure, anti-platelet activities, and thromboxane formation thus providing protection against atherosclerosis and associated disorders. Besides this, it possesses antimutagenic and antiproliferative properties that are interesting in chemopreventive interventions. Several mechanisms have been reviewed in this context like activation of detoxification phase-I and II enzymes, reactive oxygen species (ROS) generation, and reducing DNA damage etc. Garlic could be useful in preventing the suppression of immune response associated with increased risk of malignancy as it stimulates the proliferation of lymphocytes, macrophage phagocytosis, stimulates the release of interleukin-2, tumor necrosis factor-alpha and interferon-gamma, and enhances natural killer cells. In this paper much emphasis has been placed on garlics ability to ameliorate oxidative stress, core role in cardiovascular cure, chemopreventive strategies, and indeed its prospective as immune booster.
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Comparison of Epidural Steroid Injections with conservative management in patients with lumbar radiculopathy.
J Coll Physicians Surg Pak
PUBLISHED: 05-13-2009
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To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections (ESIs) and conservative management in patients with lumbar radiculopathy.
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Therapeutic manipulation of glucocorticoid metabolism in cardiovascular disease.
Br. J. Pharmacol.
PUBLISHED: 02-23-2009
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The therapeutic potential for manipulation of glucocorticoid metabolism in cardiovascular disease was revolutionized by the recognition that access of glucocorticoids to their receptors is regulated in a tissue-specific manner by the isozymes of 11beta-hydroxysteroid dehydrogenase. Selective inhibitors of 11beta-hydroxysteroid dehydrogenase type 1 have been shown recently to ameliorate cardiovascular risk factors and inhibit the development of atherosclerosis. This article addresses the possibility that inhibition of 11beta-hydroxsteroid dehydrogenase type 1 activity in cells of the cardiovascular system contributes to this beneficial action. The link between glucocorticoids and cardiovascular disease is complex as glucocorticoid excess is linked with increased cardiovascular events but glucocorticoid administration can reduce atherogenesis and restenosis in animal models. There is considerable evidence that glucocorticoids can interact directly with cells of the cardiovascular system to alter their function and structure and the inflammatory response to injury. These actions may be regulated by glucocorticoid and/or mineralocorticoid receptors but are also dependent on the 11beta-hydroxysteroid dehydrogenases which may be expressed in cardiac, vascular (endothelial, smooth muscle) and inflammatory (macrophages, neutrophils) cells. The activity of 11beta-hydroxysteroid dehydrogenases in these cells is dependent upon differentiation state, the action of pro-inflammaotory cytokines and the influence of endogenous inhibitors (oxysterols, bile acids). Further investigations are required to clarify the link between glucocorticoid excess and cardiovascular events and to determine the mechanism through which glucocorticoid treatment inhibits atherosclerosis/restenosis. This will provide greater insights into the potential benefit of selective 11beta-hydroxysteroid dehydrogenase inhibitors in treatment of cardiovascular disease.
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Contribution of endogenous glucocorticoids and their intravascular metabolism by 11?-HSDs to postangioplasty neointimal proliferation in mice.
Endocrinology
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Exogenous glucocorticoids inhibit neointimal proliferation in animals. We aimed to test the hypothesis that endogenous glucocorticoids influence neointimal proliferation; this may be mediated by effects on systemic risk factors or locally in vessels and modulated by either adrenal secretion or enzymes expressed in vessels that mediate local inactivation [11?-hydroxysteroid dehydrogenase type II (11?-HSD2) in endothelium] or regeneration [11?-hydroxysteroid dehydrogenase type I (11?-HSD1) in smooth muscle] of glucocorticoids. Femoral artery wire angioplasty was conducted in C57BL/6J, Apo-E(-/-), 11?-HSD1(-/-), Apo-E, 11?-HSD1(-/-) (double knockout), and 11?-HSD2(-/-) mice after glucocorticoid administration, adrenalectomy, glucocorticoid or mineralocorticoid receptor antagonism, or selective 11?-HSD1 inhibition. In C57BL/6J mice, neointimal proliferation was reduced by systemic or local glucocorticoid administration, unaffected by adrenalectomy, reduced by the mineralocorticoid receptor antagonist eplerenone, and increased by the glucocorticoid receptor antagonist RU38486. 11?-HSD2 deletion had no effect on neointimal proliferation, with or without eplerenone. 11?-HSD1 inhibition or deletion had no effect in chow-fed C57BL/6J mice but reduced neointimal proliferation in Apo-E(-/-) mice on Western diet. Reductions in neointimal size were accompanied by reduced macrophage and increased collagen content. We conclude that pharmacological administration of glucocorticoid receptor agonists or of mineralocorticoid receptor antagonists may be useful in reducing neointimal proliferation. Endogenous corticosteroids induce beneficial glucocorticoid receptor activation and adverse mineralocorticoid receptor activation. However, manipulation of glucocorticoid metabolism has beneficial effects only in mice with exaggerated systemic risk factors, suggesting effects mediated primarily in liver and adipose rather than intravascular glucocorticoid signaling. Reducing glucocorticoid action with 11?-HSD1 inhibitors that are being developed for type 2 diabetes appears not to risk enhanced neointimal proliferation.
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Identifying acute coronary syndrome patients approaching end-of-life.
PLoS ONE
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Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL.
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Recycling between cortisol and cortisone in human splanchnic, subcutaneous adipose, and skeletal muscle tissues in vivo.
Diabetes
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11?-Hydroxysteroid dehydrogenase type 1 (11?HSD1) is a therapeutic target in metabolic syndrome because it catalyses reductase regeneration of cortisol from cortisone in adipose and liver. 11?HSD1 can also catalyze the reverse dehydrogenase reaction in vitro (e.g., if cofactor is limited). We used stable isotope tracers to test the hypothesis that both 11?HSD1-reductase and -dehydrogenase activities occur in human metabolic tissues in vivo. 1,2-[(2)H](2)-Cortisone (d2-cortisone) was validated as a tracer for 11?-dehydrogenase activity and its inhibition by licorice. d2-Cortisone and 9,11,12,12-[(2)H](4)-cortisol (d4-cortisol) (to measure 11?-reductase activity) were coinfused and venous samples obtained from skeletal muscle, subcutaneous adipose (n = 6), and liver (n = 4). Steroids were measured by liquid chromatography-tandem mass spectrometry and arteriovenous differences adjusted for blood flow. Data are means ± SEM. 11?-Reductase and -dehydrogenase activities were detected in muscle (cortisol release 19.7 ± 4.1 pmol/100 mL/min, d3-cortisol 5.9 ± 1.8 pmol/100 mL/min, and cortisone 15.2 ± 5.8 pmol/100 mL/min) and splanchnic (cortisol 64.0 ± 11.4 nmol/min, d3-cortisol 12.9 ± 2.1 nmol/min, and cortisone 19.5 ± 2.8 nmol/min) circulations. In adipose, dehydrogenase was more readily detected than reductase (cortisone release 38.7 ± 5.8 pmol/100 g/min). Active recycling between cortisol and cortisone in metabolic tissues in vivo may facilitate dynamic control of intracellular cortisol but makes consequences of dysregulation of 11?HSD1 transcription in obesity and diabetes unpredictable. Disappointing efficacy of 11?HSD1 inhibitors in phase II studies could be explained by lack of selectivity for 11?-reductase.
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Pregnancy outcomes in patients with chronic myeloid leukemia treated with imatinib mesylate: short report from a developing country.
Leuk. Lymphoma
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ABSTRACT Treatment of chronic myeloid leukemia (CML) is challenging in patients who want to conceive. We followed 809 patients of CML treated with imatinib mesylate (IM). We observed outcomes in 90 pregnancies from 61 patients (females = 21, males = 40) who conceived while on IM. Information was obtained on duration of exposure to IM, pregnancy termination, and congenital abnormalities. Hematological and cytogenetic responses were also recorded. Twenty-eight pregnancies occurred among females while 62 were reported from male patients. Among females patients, 19 (67.9%) pregnancies were uneventful while 6 (21.4%) ended in adverse-events. Only 12 (57%) females reported their pregnancy. Three (4.4%) adverse-events were reported from male patients. Pregnancy is important part of life in our young patients due to cultural and societal pressures. It is paramount to counsel pregnant patients to switch to the drugs with no adverse effect on developing fetus. However, lack of communication is major factor preventing physicians from counseling patients about conception.
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