901
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Heckman MG, Soto-Ortolaza AI, Diehl NN, Rayaprolu S, Brott TG, Wszolek ZK, Meschia JF, Ross OA. Genetic variants associated with myocardial infarction in the PSMA6 gene and Chr9p21 are also associated with ischaemic stroke. Eur J Neurol 2012; 20:300-8. [PMID: 22882272 DOI: 10.1111/j.1468-1331.2012.03846.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/05/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ischaemic stroke shares common traditional risk factors with coronary artery disease (CAD) and myocardial infarction (MI). This study evaluated whether genetic risk factors for CAD and MI also affect susceptibility to ischaemic stroke in Caucasians and African Americans. METHODS Included in the study were a Caucasian series (713 ischaemic stroke patients, 708 controls) and a small African American series (166 ischaemic stroke patients, 117 controls). Twenty single-nucleotide polymorphisms (SNPs) previously shown to be associated with CAD or MI were genotyped and assessed for association with ischaemic stroke and ischaemic stroke subtypes using odds ratios (ORs) from multivariable logistic regression models. RESULTS In Caucasians, four SNPs on chromosome 9p21 were significantly associated with risk of cardioembolic stroke, the strongest of which was rs1333040 (OR 1.55, P = 0.0007); similar but weaker trends were observed for small vessel stroke, with no associations observed regarding large vessel stroke. Chromosome 9p21 SNPs were also associated with risk of ischaemic stroke in African Americans (rs1333040, OR 0.65, P = 0.023; rs1333042, OR 0.55, P = 0.070; rs2383207, OR 0.55, P = 0.070). The PSMA6 SNP rs1048990 on chromosome 14q13 was associated with overall ischaemic stroke in both Caucasians (OR 0.80, P = 0.036) and African Americans (OR 0.31, P = 0.020). CONCLUSIONS Our results provide evidence that chromosome 9p21 variants are associated with cardioembolic ischaemic stroke in Caucasians and with overall ischaemic stroke in African Americans. The PSMA6 variant rs1048990 also appears to affect susceptibility to ischaemic stroke in both populations. These findings require validation, particularly the preliminary findings regarding African Americans given the small size of that series.
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Affiliation(s)
- M G Heckman
- Biostatistics Unit, Mayo Clinic, Jacksonville, FL 32224, USA.
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902
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Giridharan GA, Lee TJ, Ising M, Sobieski MA, Koenig SC, Gray LA, Slaughter MS. Miniaturization of mechanical circulatory support systems. Artif Organs 2012; 36:731-9. [PMID: 22882443 PMCID: PMC3810069 DOI: 10.1111/j.1525-1594.2012.01523.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is increasing worldwide and represents a major burden in terms of health care resources and costs. Despite advances in medical care, prognosis with HF remains poor, especially in advanced stages. The large patient population with advanced HF and the limited number of donor organs stimulated the development of mechanical circulatory support (MCS) devices as a bridge to transplant and for destination therapy. However, MCS devices require a major operative intervention, cardiopulmonary bypass, and blood component exposure, which have been associated with significant adverse event rates, and long recovery periods. Miniaturization of MCS devices and the development of an efficient and reliable transcutaneous energy transfer system may provide the vehicle to overcome these limitations and usher in a new clinical paradigm in heart failure therapy by enabling less invasive beating heart surgical procedures for implantation, reduce cost, and improve patient outcomes and quality of life. Further, it is anticipated that future ventricular assist device technology will allow for a much wider application of the therapy in the treatment of heart failure including its use for myocardial recovery and as a platform for support for cell therapy in addition to permanent long-term support.
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Affiliation(s)
- Guruprasad A Giridharan
- Departments of Bioengineering & Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
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903
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Di Mario C, Syrseloudis D, Viceconte SJ, Wijns W. STEMI guidelines: from formulation to implementation. EUROINTERVENTION 2012; 8 Suppl P:P11-7. [DOI: 10.4244/eijv8spa4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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904
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Chrysant SG, Littlejohn T, Izzo JL, Kereiakes DJ, Oparil S, Melino M, Lee J, Fernandez V, Heyrman R. Triple-Combination therapy with olmesartan, amlodipine, and hydrochlorothiazide in black and non-black study participants with hypertension: the TRINITY randomized, double-blind, 12-week, parallel-group study. Am J Cardiovasc Drugs 2012; 12:233-43. [PMID: 22799613 DOI: 10.1007/bf03261832] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although awareness of hypertension in Black patients has increased, blood pressure (BP) is frequently inadequately controlled. OBJECTIVE This prespecified subgroup analysis of the TRINITY study evaluated the efficacy and safety of olmesartan medoxomil (OM) 40 mg, amlodipine besylate (AML) 10 mg, and hydrochlorothiazide (HCTZ) 25 mg triple-combination treatment compared with the component dual-combination treatments in Black and non-Black study participants. STUDY DESIGN TRINITY was a 12-week, randomized, double-blind, parallel-group evaluation. The first patient was enrolled in May 2008 and the last patient completed the study in February 2009. The study consisted of a 3-week washout period for participants receiving antihypertensive therapy and a 12-week double-blind treatment period. For the treatment phase, all study participants were stratified by age, race, and diabetes mellitus status and randomized to a treatment sequence that led to their final treatment assignment, which they received from weeks 4 to 12 (OM 40 mg/AML 10 mg/HCTZ 25 mg, OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg). In the first 2 weeks of the double-blind treatment period, all participants received either dual-combination treatment or placebo. Participants assigned to dual-combination treatment continued treatment until week 4, and participants receiving placebo were switched at week 2 to receive one of the dual-combination treatments until week 4. At week 4, participants either continued dual-combination treatment or randomly received triple-combination treatment until week 12. SETTING 317 clinical sites in the USA and Puerto Rico were included in the study. PATIENTS Study participants eligible for randomization (N = 2492) were ≥18 years of age with mean seated blood pressure (SeBP) ≥140/100 mmHg or ≥160/90 mmHg (off antihypertensive medication). INTERVENTION The intervention was with dual- or triple-combination antihypertensive treatment: OM 40 mg/AML 10 mg/HCTZ 25 mg, OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg. MAIN OUTCOME MEASURE The primary efficacy variable was the change in least squares (LS) mean seated diastolic BP (SeDBP) from baseline to week 12. Secondary efficacy variables included the LS mean change in seated systolic BP (SeSBP), percentage of study participants reaching BP goal, and safety parameters. RESULTS In both Black and non-Black participants, triple-combination treatment resulted in significant and similar mean reductions in SeDBP and SeSBP (p ≤ 0.0001 vs each dual-combination treatment) with a greater proportion of participants reaching BP goal compared with dual-combination treatments, regardless of race. Most treatment-emergent adverse events were mild or moderate in severity and no new safety concerns were identified. CONCLUSION Triple-combination treatment provided greater BP reductions than dual-combination treatments regardless of race. CLINICAL TRIAL REGISTRATION Registered at ClinicalTrials.gov as NCT00649389.
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Affiliation(s)
- Steven G Chrysant
- Oklahoma Cardiovascular and Hypertension Center and University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
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905
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906
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Laible M, Schoenberg SO, Weckbach S, Lettau M, Winnik E, Bischof J, Franke R, Reiser M, Kramer H. Whole-body MRI and MRA for evaluation of the prevalence of atherosclerosis in a cohort of subjectively healthy individuals. Insights Imaging 2012; 3:485-93. [PMID: 22836780 PMCID: PMC3443278 DOI: 10.1007/s13244-012-0180-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/23/2012] [Accepted: 06/04/2012] [Indexed: 01/07/2023] Open
Abstract
Objectives To assess the prevalence of cardiovascular findings in asymptomatic individuals by means of 1.5-T whole-body magnetic resonance imaging and angiography. Methods A cohort of 138 individuals (118 men, 20 women) with a mean age of 54 years (SD ± 7.55) was referred to whole-body MRI at 1.5-T, including contrast-enhanced whole-body MR angiography (MRA) and cardiac MRI. A total of 2,065/2,070 vessel segments (99.8%) and cardiac function were evaluated. Results Approximately one-fourth of the participating individuals had vascular abnormalities. In 17 subjects (12.3% of all subjects) significant luminal narrowing was observed in at least one vascular segment. Luminal narrowing (mild to severe) was observed in 1 (0.7% of all subjects respectively) of the renal arteries, 7 (5.0%) of the carotid arteries, and 3 (2.2%) of the pelvic and upper leg arteries, and in 17 segments (12.3%) of arteries in the lower leg. In cardiac function and perfusion imaging, wall motion disorders were observed in six patients (4.3%), with additional delayed enhancement and isolated delayed enhancement present in two cases. Functional parameters differed from reference values in 55 cases. Conclusions Even in an asymptomatic cohort of middle-aged predominantly male individuals, atherosclerotic disease is not uncommon and is detectable by whole-body MRI. Main Messages In middle-aged predominantly male individuals, atherosclerotic disease is not uncommon. Even in an asymptomatic collective, approximately one fourth had vascular abnormalities. Using whole-body MR angiography (MRA), 99.8% of 2,070 vessel segments could be evaluated.
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Affiliation(s)
- M Laible
- Department of Clinical Radiology, University Hospital Munich, Grosshadern Campus, Munich, Germany,
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907
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Uzarski JS, Van De Walle AB, McFetridge PS. Preimplantation processing of ex vivo-derived vascular biomaterials: effects on peripheral cell adhesion. J Biomed Mater Res A 2012; 101:123-31. [PMID: 22825780 DOI: 10.1002/jbm.a.34308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/25/2012] [Accepted: 05/25/2012] [Indexed: 01/22/2023]
Abstract
The use of ex vivo-derived scaffolds as vascular conduits has shown to be a clinically valid approach to repair or bypass occluded vessels. Implantation of allogeneic tissue grafts requires careful processing to lower immunogenicity and prevent bacterial infection. However, the mechanical/chemical treatments used to prepare biological scaffolds can result in significant alterations to the native structure and surface chemistry, which can affect in vivo performance. Of particular importance for vascular grafts are binding interactions between the implanted biomaterial and host cells from the circulation and adjacent vasculature. Here we present a comparison of four strategies used to decellularize allogeneic human umbilical vein (HUV) scaffolds: ethanol/acetone, sodium chloride, sodium dodecyl sulfate (SDS), or Triton X-100. Scanning electron microscopy revealed that all four techniques achieved removal of native cells from both the lumenal and ablumenal surfaces of HUV grafts. Platelets and promyelocytic HL-60 cells showed preferential binding on the more loosely structured ablumenal surface, although low surface coverage was observed overall by peripheral blood cells. Vascular endothelial cell adhesion was highest on HUV decellularized using ethanol/acetone, and significantly higher than on SDS-processed grafts (p = 0.016). Primary cells showed high viability on the lumenal surface regardless of decellularization technique (over 95% in all cases). These results demonstrate the critical effects of various chemical processing strategies on the adhesive properties of ex vivo-derived vascular grafts. Careful application-specific consideration is warranted when selecting a processing strategy that minimizes innate responses (e.g. thrombosis, inflammation) that are often deleterious to graft survival.
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Affiliation(s)
- Joseph S Uzarski
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611, USA
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908
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Whelton S, Chow GV, Ashen D, Blumenthal RS. Dyslipidemia Management for Secondary Prevention in Women with Cardiovascular Disease: What Can We Expect From Non-pharmacologic Strategies? CURRENT CARDIOVASCULAR RISK REPORTS 2012; 6:443-449. [PMID: 23110241 DOI: 10.1007/s12170-012-0254-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cardiovascular disease is the leading cause of death in women and the treatment of dyslipidemia is a cornerstone of secondary prevention. Pharmacologic therapy with statins can lower LDL-C by 30-50% and reduce the risk of recurrent coronary heart disease in both men and women. While significant reductions in LDL-C can be achieved with statin therapy, diet and lifestyle modification remain an essential part of the treatment regimen for cardiovascular disease. Moreover, a large proportion of the U.S. population is sedentary, overweight, and does not consume a heart-healthy diet. Non-pharmacologic treatment strategies also improve other cardiovascular risk factors and are generally easily accessible. In this review, we examine the effect of non-pharmacologic therapy on lipids as part of the secondary prevention strategy of cardiovascular disease in women.
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Affiliation(s)
- Seamus Whelton
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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909
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Stevanovic J, Postma MJ, Pechlivanoglou P. A systematic review on the application of cardiovascular risk prediction models in pharmacoeconomics, with a focus on primary prevention. Eur J Prev Cardiol 2012; 19:42-53. [DOI: 10.1177/2047487312448994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jelena Stevanovic
- Department of Pharmacoepidemiology and Pharmacoeconomics (PE2), University of Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacoepidemiology and Pharmacoeconomics (PE2), University of Groningen, The Netherlands
| | - Petros Pechlivanoglou
- Department of Pharmacoepidemiology and Pharmacoeconomics (PE2), University of Groningen, The Netherlands
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910
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Vavas E, Hong SN, Henry S, Rosen SE, Mieres JH. Imaging Tests, Provocative Tests, Including Exercise Testing in Women with Suspected Coronary Artery Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2012; 6:469-478. [PMID: 23002416 PMCID: PMC3433655 DOI: 10.1007/s12170-012-0251-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Evolving knowledge regarding sex differences in coronary heart disease has demonstrated that the prevalence, symptomatology, and pathophysiology of coronary atherosclerosis vary between genders. Women experience higher mortality rates and more adverse outcomes after acute myocardial infarction than men, despite a lower prevalence of obstructive coronary artery disease. Based on recent insights into the complex pathophysiology of coronary heart disease which includes a spectrum of obstructive coronary artery disease and dysfunction of the coronary microvasculature and endothelium, the term ischemic heart disease is a more accurate term for discussion of coronary atherosclerosis specific to women. In women, with clinical features and risk factors for ischemic heart disease, the detection and evaluation of ischemic heart disease is challenging due to the diverse pathogenic mechanisms of ischemic heart diseases in women. In this article, we discuss noninvasive imaging tests, provocative tests, including exercise testing in women with suspected ischemic heart disease.
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Affiliation(s)
- Eleni Vavas
- Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030 USA
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911
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Carey HV, Martin SL, Horwitz BA, Yan L, Bailey SM, Podrabsky J, Storz JF, Ortiz RM, Wong RP, Lathrop DA. Elucidating nature's solutions to heart, lung, and blood diseases and sleep disorders. Circ Res 2012; 110:915-21. [PMID: 22461362 DOI: 10.1161/circresaha.111.255398] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Evolution has provided a number of animal species with extraordinary phenotypes. Several of these phenotypes allow species to survive and thrive in environmental conditions that mimic disease states in humans. The study of evolved mechanisms responsible for these phenotypes may provide insights into the basis of human disease and guide the design of new therapeutic approaches. Examples include species that tolerate acute or chronic hypoxemia like deep-diving mammals and high-altitude inhabitants, as well as those that hibernate and interrupt their development when exposed to adverse environments. The evolved traits exhibited by these animal species involve modifications of common biological pathways that affect metabolic regulation, organ function, antioxidant defenses, and oxygen transport. In 2006, the National Heart, Lung, and Blood Institute released a funding opportunity announcement to support studies that were designed to elucidate the natural molecular and cellular mechanisms of adaptation in species that tolerate extreme environmental conditions. The rationale for this funding opportunity is detailed in this article, and the specific evolved mechanisms examined in the supported research are described. Also highlighted are past medical advances achieved through the study of animal species that have evolved extraordinary phenotypes as well as the expectations for new understanding of nature's solutions to heart, lung, blood, and sleep disorders through future research in this area.
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Affiliation(s)
- Hannah V Carey
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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912
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Kassem HS, Girolami F, Sanoudou D. Molecular genetics made simple. Glob Cardiol Sci Pract 2012; 2012:6. [PMID: 25610837 PMCID: PMC4239820 DOI: 10.5339/gcsp.2012.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/01/2012] [Indexed: 01/24/2023] Open
Abstract
Genetics have undoubtedly become an integral part of biomedical science and clinical practice, with important implications in deciphering disease pathogenesis and progression, identifying diagnostic and prognostic markers, as well as designing better targeted treatments. The exponential growth of our understanding of different genetic concepts is paralleled by a growing list of genetic terminology that can easily intimidate the unfamiliar reader. Rendering genetics incomprehensible to the clinician however, defeats the very essence of genetic research: its utilization for combating disease and improving quality of life. Herein we attempt to correct this notion by presenting the basic genetic concepts along with their usefulness in the cardiology clinic. Bringing genetics closer to the clinician will enable its harmonious incorporation into clinical care, thus not only restoring our perception of its simple and elegant nature, but importantly ensuring the maximal benefit for our patients.
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Affiliation(s)
- Heba Sh Kassem
- Pathology Department and Clinical Genomics Center, Alexandria Faculty of Medicine, Egypt ; Magdi Yacoub Foundation Serving Egypt, Egypt
| | | | - Despina Sanoudou
- Department of Pharmacology, Medical School, University of Athens, Greece
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913
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914
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Affiliation(s)
- Gregg W. Stone
- From the Columbia University Medical Center, New York-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY
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915
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Moreno PR, Purushothaman M, Purushothaman KR. Plaque neovascularization: defense mechanisms, betrayal, or a war in progress. Ann N Y Acad Sci 2012; 1254:7-17. [PMID: 22548565 DOI: 10.1111/j.1749-6632.2012.06497.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Angiogenesis is induced from sprouting of preexisting endothelial cells leading to neovascularization. Imbalance in the angiogenic and antiangiogenic mediators triggers angiogenesis, which may be physiological in the normal state or pathological in malignancy and atherosclerosis. Physiologic angiogenesis is instrumental for restoration of vessel wall normoxia and resolution inflammation, leading to atherosclerosis regression. However, pathological angiogenesis enhances disease progression, increasing macrophage infiltration and vessel wall thickness, perpetuating hypoxia and necrosis. In addition, thin-walled fragile neovessels may rupture, leading to intraplaque hemorrhage. Lipid-rich red blood cell membranes and free hemoglobin are detrimental to plaque composition, increasing inflammation, lipid core expansion, and oxidative stress. In addition, associated risk factors that include polymorphysms in the haptoglobin genotype and diabetes mellitus may modulate the features of plaque vulnerability. This review will focus on physiological and pathological angiogenesis in atherosclerosis and summarizes the current status of anti-vascular endothelial growth factor (VEGF) therapy, microvascular rarefaction, and possible statin-mediated effects in atherosclerosis neovascularization.
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Affiliation(s)
- Pedro R Moreno
- Zena and Michael A. Wiener Cardiovascular Institute, and the Marie-Josee and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York 10029, USA.
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916
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Uppal R, Ciesienski KL, Chonde DB, Loving GS, Caravan P. Discrete bimodal probes for thrombus imaging. J Am Chem Soc 2012; 134:10799-802. [PMID: 22698259 DOI: 10.1021/ja3045635] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Here we report a generalizable solid/solution-phase strategy for the synthesis of discrete bimodal fibrin-targeted imaging probes. A fibrin-specific peptide was conjugated with two distinct imaging reporters at the C- and N-termini. In vitro studies demonstrated retention of fibrin affinity and specificity. Imaging studies showed that these probes could detect fibrin over a wide range of probe concentrations by optical, magnetic resonance, and positron emission tomography imaging.
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Affiliation(s)
- Ritika Uppal
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Suite 2301, Charlestown, Massachusetts 02129, USA
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917
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Depta JP, Fowler J, Novak E, Katzan I, Bakdash S, Kottke-Marchant K, Bhatt DL. Clinical outcomes using a platelet function-guided approach for secondary prevention in patients with ischemic stroke or transient ischemic attack. Stroke 2012; 43:2376-81. [PMID: 22713488 DOI: 10.1161/strokeaha.112.655084] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Antiplatelet therapy nonresponse is associated with worse clinical outcomes. We studied the clinical outcomes associated with platelet function-guided modifications in antiplatelet therapy in patients with ischemic stroke or transient ischemic attack. METHODS From January 2005 to August 2007, 324 patients with ischemic stroke underwent platelet function testing using platelet aggregometry. Aspirin nonresponse was defined as a mean platelet aggregation ≥20% with 0.5 mg/mL arachidonic acid and/or ≥70% with 5 μmol/L adenosine diphosphate. Clopidogrel nonresponse was defined as a mean platelet aggregation ≥40% with 5 μmol/L adenosine diphosphate. A modification was any increase in antiplatelet therapy occurring after testing. Clinical outcomes were compared between patients with and without platelet function-guided antiplatelet therapy modifications using univariate and propensity score-adjusted analyses. RESULTS In patients with ischemic stroke or transient ischemic attack, 43% (n=128) and 35% (n=54) were nonresponders to aspirin and clopidogrel, respectively. After platelet function testing, antiplatelet therapy was increased in 23% of patients (n=73). After propensity score matching (n=61 in each group), antiplatelet therapy modification was associated with significantly increased rates of death, ischemic events, or bleeding (hazard ratio, 2.24; 95% CI, 1.12-4.47; P=0.02) compared with no modification in antiplatelet therapy and a trend toward increased bleeding (hazard ratio, 3.56; 95% CI, 0.98-12.95; P=0.05). No differences in ischemic events were observed. CONCLUSIONS Platelet function-guided modification in antiplatelet therapy after an ischemic stroke or transient ischemic attack was associated with significantly higher rates of adverse clinical outcomes.
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Affiliation(s)
- Jeremiah P Depta
- VA Boston Healthcare System, 1400 VFW Parkway, Boston, MA 02132, USA
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918
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González-Juanatey JR. Hipertensión arterial y enfermedad arterial periférica. Una asociación peligrosa. Med Clin (Barc) 2012; 139:67-9. [DOI: 10.1016/j.medcli.2012.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/23/2012] [Indexed: 11/29/2022]
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919
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Piacentino III V, Milano CA, Bolanos M, Schroder J, Messina E, Cockrell AS, Jones E, Krol A, Bursac N, Mao L, Devi GR, Samulski RJ, Bowles DE. X-linked inhibitor of apoptosis protein-mediated attenuation of apoptosis, using a novel cardiac-enhanced adeno-associated viral vector. Hum Gene Ther 2012; 23:635-46. [PMID: 22339372 PMCID: PMC3392616 DOI: 10.1089/hum.2011.186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 02/09/2012] [Indexed: 12/31/2022] Open
Abstract
Successful amelioration of cardiac dysfunction and heart failure through gene therapy approaches will require a transgene effective at attenuating myocardial injury, and subsequent remodeling, using an efficient and safe delivery vehicle. Our laboratory has established a well-curated, high-quality repository of human myocardial tissues that we use as a discovery engine to identify putative therapeutic transgene targets, as well as to better understand the molecular basis of human heart failure. By using this rare resource we were able to examine age- and sex-matched left ventricular samples from (1) end-stage failing human hearts and (2) nonfailing human hearts and were able to identify the X-linked inhibitor of apoptosis protein (XIAP) as a novel target for treating cardiac dysfunction. We demonstrate that XIAP is diminished in failing human hearts, indicating that this potent inhibitor of apoptosis may be central in protecting the human heart from cellular injury culminating in heart failure. Efforts to ameliorate heart failure through delivery of XIAP compelled the design of a novel adeno-associated viral (AAV) vector, termed SASTG, that achieves highly efficient transduction in mouse heart and in cultured neonatal rat cardiomyocytes. Increased XIAP expression achieved with the SASTG vector inhibits caspase-3/7 activity in neonatal cardiomyocytes after induction of apoptosis through three common cardiac stresses: protein kinase C-γ inhibition, hypoxia, or β-adrenergic receptor agonist. These studies demonstrate the potential benefit of XIAP to correct heart failure after highly efficient delivery to the heart with the rationally designed SASTG AAV vector.
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Affiliation(s)
- Valentino Piacentino III
- Cardiothoracic Division, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Carmelo A. Milano
- Cardiothoracic Division, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Michael Bolanos
- Cardiothoracic Division, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Jacob Schroder
- Cardiothoracic Division, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Emily Messina
- Cardiothoracic Division, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Adam S. Cockrell
- Carolina Vaccine Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Edward Jones
- Cardiothoracic Division, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Ava Krol
- Department of Biomedical Engineering, Duke University, Durham, NC 27710
| | - Nenad Bursac
- Department of Biomedical Engineering, Duke University, Durham, NC 27710
| | - Lan Mao
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710
| | - Gayathri R. Devi
- Department of Pathology, Duke University Medical Center, Durham, NC 27710
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - R. Jude Samulski
- Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Dawn E. Bowles
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, Durham, NC 27710
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920
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Olson ES, Whitney MA, Friedman B, Aguilera TA, Crisp JL, Baik FM, Jiang T, Baird SM, Tsimikas S, Tsien RY, Nguyen QT. In vivo fluorescence imaging of atherosclerotic plaques with activatable cell-penetrating peptides targeting thrombin activity. Integr Biol (Camb) 2012; 4:595-605. [PMID: 22534729 PMCID: PMC3689578 DOI: 10.1039/c2ib00161f] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thrombin and other coagulation enzymes have been shown to be important during atherosclerotic disease development. Study of these proteases is currently limited because of lack of robust molecular imaging agents for imaging protease activity in vivo. Activatable cell penetrating peptides (ACPPs) have been used to monitor MMP activity in tumors and, in principle, can be modified to detect other proteases. We have developed a probe that incorporates the peptide sequence DPRSFL from the proteinase activated receptor 1 (PAR-1) into an ACPP and shown that it is preferentially cleaved by purified thrombin. Active thrombin in serum cleaves DPRSFL-ACPP with >90% inhibition by lepirudin or argatroban. The DPRSFL-ACPP cleavage product accumulated in advanced atherosclerotic lesions in living mice, with 85% reduction in retention upon pre-injection of mice with hirudin. Uptake of the ACPP cleavage product was highest in plaques with histological features associated with more severe disease. Freshly resected human atheromas bathed in DPRSFL-ACPP retained 63% greater cleavage product compared to control ACPP. In conclusion, DPRSFL-ACPP can be used to study thrombin activity in coagulation and atherosclerosis with good spatial and temporal resolution. Thrombin-sensitive ACPPs may be developed into probes for early detection and intraoperative imaging of high risk atherosclerotic plaques.
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Affiliation(s)
- Emilia S. Olson
- Department of Pharmacology, University of California at San Diego, La Jolla, CA 92093-0647, USA
- Medical Scientist Training Program, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Michael A. Whitney
- Department of Pharmacology, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Beth Friedman
- Department of Pharmacology, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Todd A. Aguilera
- Department of Pharmacology, University of California at San Diego, La Jolla, CA 92093-0647, USA
- Medical Scientist Training Program, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Jessica L. Crisp
- Department of Chemistry and Biochemistry, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Fred M. Baik
- UCSD School of Medicine, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Tao Jiang
- Howard Hughes Medical Institute, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Stephen M. Baird
- Department of Pathology, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Sotirios Tsimikas
- Department of Medicine, University of California at San Diego, La Jolla, CA 92093-0682, USA
| | - Roger Y. Tsien
- Department of Pharmacology, University of California at San Diego, La Jolla, CA 92093-0647, USA
- Howard Hughes Medical Institute, University of California at San Diego, La Jolla, CA 92093-0647, USA
| | - Quyen T. Nguyen
- Division of Otolaryngology-Head and Neck Surgery, University of California at San Diego, La Jolla, CA 92093-0647, USA; Fax: +1 858 534-5270; Tel: +1 858 822-3965
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921
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Fuchs TA, Brill A, Wagner DD. Neutrophil extracellular trap (NET) impact on deep vein thrombosis. Arterioscler Thromb Vasc Biol 2012; 32:1777-83. [PMID: 22652600 DOI: 10.1161/atvbaha.111.242859] [Citation(s) in RCA: 384] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Deep vein thrombosis (DVT) is a major health problem that requires improved prophylaxis and treatment. Inflammatory conditions such as infection, cancer, and autoimmune diseases are risk factors for DVT. We and others have recently shown that extracellular DNA fibers produced in inflammation and known as neutrophil extracellular traps (NETs) contribute to experimental DVT. NETs stimulate thrombus formation and coagulation and are abundant in thrombi in animal models of DVT. It appears that, in addition to fibrin and von Willebrand factor, NETs represent a third thrombus scaffold. Here, we review how NETs stimulate thrombosis and discuss known and potential interactions of NETs with endothelium, platelets, red blood cells, and coagulation factors and how NETs could influence thrombolysis. We propose that drugs that inhibit NET formation or facilitate NET degradation may prevent or treat DVT.
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Affiliation(s)
- Tobias A Fuchs
- Immune Disease Institute, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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922
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Koracevic GP. Time to individualize duration of parenteral anticoagulation in pulmonary thromboembolism? Am J Emerg Med 2012; 30:1004-6. [PMID: 22633707 DOI: 10.1016/j.ajem.2012.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022] Open
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923
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Abstract
Cardiovascular disease encompasses a range of conditions extending from myocardial infarction to congenital heart disease, most of which are heritable. Enormous effort has been invested in understanding the genes and specific DNA sequence variants that are responsible for this heritability. Here, we review the lessons learned for monogenic and common, complex forms of cardiovascular disease. We also discuss key challenges that remain for gene discovery and for moving from genomic localization to mechanistic insights, with an emphasis on the impact of next-generation sequencing and the use of pluripotent human cells to understand the mechanism by which genetic variation contributes to disease.
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Affiliation(s)
- Sekar Kathiresan
- Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114, USA.
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924
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Liu X. Beyond the time window of intravenous thrombolysis: standing by or by stenting? INTERVENTIONAL NEUROLOGY 2012; 1:3-15. [PMID: 25187761 PMCID: PMC4031767 DOI: 10.1159/000338389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intravenous administration of tissue plasminogen activator within 4.5 h of symptom onset is presently the 'golden rule' for treating acute ischemic stroke. However, many patients miss the time window and others reject this treatment due to a long list of contraindications. Mechanical embolectomy has recently progressed as a potential alternative for treating patients beyond the time window for IV thrombolysis. In this paper, recent progress in mechanical embolectomy, angioplasty, and stenting in acute stroke is reviewed. Despite worries concerning the long-term clinical outcomes and increased risk of intracranial hemorrhage, favorable clinical outcomes may be achieved after mechanical embolectomy in carefully selected patients even 4.5 h after stroke onset. Potential steps should be prepared and attempted in these patients whose opportunity for recovery will elapse in a flash.
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Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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925
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Yajuan Wang, Simon M, Bonde P, Harris BU, Teuteberg JJ, Kormos RL, Antaki JF. Prognosis of Right Ventricular Failure in Patients With Left Ventricular Assist Device Based on Decision Tree With SMOTE. ACTA ACUST UNITED AC 2012; 16:383-90. [DOI: 10.1109/titb.2012.2187458] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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926
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927
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Abstract
Congestive heart failure is an inexorable disease associated with unacceptably high morbidity and mortality. Preclinical results indicate that gene transfer using various proteins is a safe and effective approach for increasing function of the failing heart. In the current review, we provide a summary of cardiac gene transfer in general and summarize findings using adenylyl cyclase 6 as therapeutic gene in the failing heart. We also discuss the potential usefulness of a new treatment for congestive heart failure, paracrine-based gene transfer.
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Affiliation(s)
- T Tang
- Department of Medicine, University of California San Diego, CA, USA
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928
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Koepp GA, Snedden BJ, Flynn L, Puccinelli D, Huntsman B, Levine JA. Feasibility Analysis of Standing Desks for Sixth Graders. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/1941406412439414] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. In this pilot study, the authors aimed to examine the implementation of standing desks on classroom performance and behavior. They also examined how the standing desks affected in-class physical activity and body mass index. Methods. Eight sixth graders from Hope Lutheran elementary school participated in the study (age 11.3 ± 0.5 years). Baseline and 8-month postintervention measures were step counts using (W4L Classic pedometers), height, weight, and behavioral markers. Results. Data showed that there were no statistically significant changes in the participants’ body mass index (19.4 kg/m2 vs 19.3 kg/m2), step counts (1886 steps vs 2248 steps), and behavioral markers including classroom management, concentration, and discomfort. Height and weight changes were significant and are attributed to the normal growth rate associated with the age of the participants (146.8 cm vs 151.8 cm, P < .0001; 41.4 kg vs 44.5 kg, P > .0007). Conclusions. It is feasible to integrate standing desks into a classroom without negative effects. Although the authors observed over a 19% increase in pedometer activity, it was not statistically significant. This highlights the importance for larger experimental groups and the use of more advanced physical activity tracking and body composition technologies.
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Affiliation(s)
- Gabriel A. Koepp
- Idaho National Laboratory, Environmental Safety & Health, Idaho Falls, Idaho (BS, LF, BH)
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota (GAK, JAL)
| | - Bradley J. Snedden
- Idaho National Laboratory, Environmental Safety & Health, Idaho Falls, Idaho (BS, LF, BH)
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota (GAK, JAL)
| | - Laurel Flynn
- Idaho National Laboratory, Environmental Safety & Health, Idaho Falls, Idaho (BS, LF, BH)
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota (GAK, JAL)
| | - Deborah Puccinelli
- Idaho National Laboratory, Environmental Safety & Health, Idaho Falls, Idaho (BS, LF, BH)
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota (GAK, JAL)
| | - Bowen Huntsman
- Idaho National Laboratory, Environmental Safety & Health, Idaho Falls, Idaho (BS, LF, BH)
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota (GAK, JAL)
| | - James A. Levine
- Idaho National Laboratory, Environmental Safety & Health, Idaho Falls, Idaho (BS, LF, BH)
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota (GAK, JAL)
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929
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Affiliation(s)
- Chung-Wah Siu
- Cardiology Division, Department of Medicine, and the Research Centre of the Heart, Brain, Hormone and Healthy Ageing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, and the Research Centre of the Heart, Brain, Hormone and Healthy Ageing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
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930
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Duong TQ. Recent MRI advances in experimental stroke. Transl Stroke Res 2012; 3:1-3. [PMID: 24323749 PMCID: PMC4758113 DOI: 10.1007/s12975-012-0144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy Q Duong
- Research Imaging Institute, UT Health Science Center San Antonio, San Antonio, TX, USA,
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931
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Resolution of Inflammation, Statins, and Plaque Regression. JACC Cardiovasc Imaging 2012; 5:178-81. [DOI: 10.1016/j.jcmg.2012.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/09/2012] [Indexed: 11/17/2022]
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932
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Turnbull IC, Lieu DK, Li RA, Costa KD. Cardiac tissue engineering using human stem cell-derived cardiomyocytes for disease modeling and drug discovery. ACTA ACUST UNITED AC 2012; 9:e219-e227. [PMID: 33968153 DOI: 10.1016/j.ddmod.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiovascular disease (CVD) is the most prevalent health problem in the world, and the high mortality rate associated with irreversibly injured heart muscle motivates an urgent need for the development of novel therapies to treat damaged myocardium. Recently, human engineered cardiac tissues (hECT) have been created using cardiomyocytes derived from human embryonic stem cells and human induced pluripotent stem cells. Although a healthy adult phenotype remains elusive, such hECT display structural and functional properties that recapitulate key aspects of natural human myocardium, including dose related responses to compounds with known chronotropic, inotropic and arrhythmogenic effects. Thus, hECT offer the advantage over traditional in vitro culture models of providing a biomimetic 3D environment for the study of myocardial physiopathology, and may be used to generate preclinical models for the development and screening of therapies for CVD.
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Affiliation(s)
- Irene C Turnbull
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY
| | - Deborah K Lieu
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY.,Department of Internal Medicine, Division of Cardiovascular Medicine, University of California, Davis, CA
| | - Ronald A Li
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY.,Stem Cell & Regenerative Medicine Consortium, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.,Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.,Department of Physiology, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Kevin D Costa
- Cardiovascular Research Center, Mount Sinai School of Medicine, New York, NY
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933
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Varyani N, Tripathi S, Thukral A, Mishra M, Garg S, Tripathi K, Dwivedi AND. Correlation of Serum Endothelial Dysfunction Markers with CT Angiographic Findings in Ischemic Stroke. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60115-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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934
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Di Mario C, Viceconte N. Primary angioplasty in Europe: From trials to practice. Glob Cardiol Sci Pract 2012; 2012:36-42. [PMID: 24688989 PMCID: PMC3963722 DOI: 10.5339/gcsp.2012.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/22/2012] [Indexed: 11/24/2022] Open
Abstract
Abstract: This manuscript is focused around two key messages from the current Guidelines of the European Society of Cardiology on ST elevation myocardial infarction; the need to use primary angioplasty whenever timely and effectively applicable and the importance of organisational changes in the emergency system to implement this indication. Based on a review of the trials motivating these guidelines and the successful experience of many European countries, practical indications are provided on the methods to overcome resistances and malpractices that prevent the delivery of optimal care in these critically ill patients.
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Affiliation(s)
- Carlo Di Mario
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Imperial College, London, United Kingdom
| | - Nicola Viceconte
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Imperial College, London, United Kingdom
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935
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Dupclay L, Eaddy M, Jackson J, Raju A, Shim A. Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence. Patient Prefer Adherence 2012; 6:499-507. [PMID: 22927746 PMCID: PMC3422118 DOI: 10.2147/ppa.s31417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patient medication adherence is multidimensional and poses significant concerns to health care professionals. One aspect of adherence is a patient forgetting to take their prescribed medication, which may be improved with reminder packaging (RP). The objective of this analysis was to assess the impact of RP on patient adherence to antihypertensive therapy. METHODS This retrospective, propensity score-matched study evaluated patients switching to a single-pill combination of valsartan-hydrochlorothiazide in RP compared with patients remaining on the combination without reminder packaging (non-RP). Patients receiving combination therapy between April 1, 2009 and July 31, 2010 were eligible for inclusion. Patients were propensity score-matched on baseline adherence and background demographic variables, including comorbidities. Medication possession ratio, proportion of days covered, time to refill, and time to discontinuation were evaluated as primary measures of subsequent adherence and persistence. RESULTS In a total of 9266 matched patients (4633 participants in both cohorts), adherence was significantly higher in the RP cohort compared with patients in the non-RP cohort (medication possession ratio, RP 80% versus non-RP 73%; proportion of days covered, RP 76% versus non-RP 63%; both P < 0.001). Refill timing was 10 days for RP patients versus 16 days for non-RP patients (P < 0.001). Similar trends were observed with respect to time to discontinuation (RP 196 days, non-RP 174 days; P < 0.001). A higher proportion of RP patients remained on therapy compared with non-RP patients, with patients in the RP group being 17% less likely to discontinue therapy compared with patients in the non-RP group (hazards ratio 0.833; 95% confidence interval 0.793-0.875). CONCLUSION This real-world assessment of differences in adherence and persistence rates demonstrated that patients receiving RP were more adherent and persistent with their treatment regimens.
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Affiliation(s)
| | - Michael Eaddy
- Xcenda, Palm Harbor, FL, USA
- Correspondence: Michael Eaddy, 4114 Woodlands Parkway, Suite 500 Palm Harbor, FL 34685, USA, Tel 727 771 4126, Fax 727 771 4144, Email
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