1
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Al Tibi G, Alexander M, Miller S, Chronos N. A Retrospective Comparison of Medication Recommendations Between a Cardiologist and ChatGPT-4 for Hypertension Patients in a Rural Clinic. Cureus 2024; 16:e55789. [PMID: 38586651 PMCID: PMC10999165 DOI: 10.7759/cureus.55789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Background With ChatGPT demonstrating impressive abilities in solving clinical vignettes and medical questions, there is still a lack of studies assessing ChatGPT using real patient data. With real-world cases offering added complexity, ChatGPT's utility in treatment using such data must be tested to better assess its accuracy and dependability. In this study, we compared a rural cardiologist's medication recommendations to that of GPT-4 for patients with lab review appointments. Methodology We reviewed the lab review appointments of 40 hypertension patients, noting their age, sex, medical conditions, medications and dosage, and current and past lab values. The cardiologist's medication recommendations (decreasing dose, increasing dose, stopping, or adding medications) from the most recent lab visit, if any, were recorded for each patient. Data collected from each patient was inputted into GPT-4 using a set prompt and the resulting medication recommendations from the model were recorded. Results Out of the 40 patients, 95% had conflicting overall recommendations between the physician and GPT-4, with only 10.2% of the specific medication recommendations matching between the two. Cohen's kappa coefficient was -0.0127, indicating no agreement between the cardiologist and GPT-4 for providing medication changes overall for a patient. Possible reasons for this discrepancy can be differing optimal lab value ranges, lack of holistic analysis by GPT-4, and a need for providing further supplementary information to the model. Conclusions The study findings showed a significant difference between the cardiologist's medication recommendations and that of ChatGPT-4. Future research should continue to test GPT-4 in clinical settings to validate its abilities in the real world where more intricacies and challenges exist.
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Affiliation(s)
- Ghaith Al Tibi
- College of Medicine, Albert Einstein College of Medicine, Bronx, USA
| | - Melvin Alexander
- College of Medicine, Albert Einstein College of Medicine, Bronx, USA
| | - Samuel Miller
- College of Medicine, Rush University Medical Center, Chicago, USA
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2
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Sehly A, He A, Jaltotage B, Lan NSR, Joyner J, Flack J, Sokolov J, Chronos N, Ko B, Chow B, Dwivedi G, Ihdayhid AR. Coronary artery stenosis and vulnerable plaque quantification on CCTA by deep learning methods. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary computed tomography angiography (CCTA) has emerged as a reliable non-invasive modality to assess coronary artery stenosis (CAS) severity and vulnerable plaque (VP). However, comprehensive CCTA assessment, especially VP, is time-consuming and dependent on reader expertise, limiting CCTA's true potential.
Purpose
In this study, we aim to develop and validate a deep learning (DL) based system capable of evaluating CAS severity and characterising VP on CCTA.
Methods
A DL system was trained to assess CAS severity on 3909 expert annotated vessels. A subset of 824 vessels was used to train the model to assess for the presence of VP. The model was based on a 2D U-Net and 3D convolutional neural network architecture. The system automatically performed vessel tracking and segmentation to quantify stenosis severity and characterise the presence of VP. CAS severity was categorised as 0%, 1–49% and ≥50%. VP was defined as: low attenuation plaque (LAP; ≤30 Hounsfield units), positive remodelling (PR; ≥10% diameter) and spotty calcification (SC; <3mm). The model was then tested on 1435 vessels for CAS (mean calcium score 197±502) and a subset of 365 vessels for VP (mean calcium score 419±551), and its diagnostic performance compared with expert readers.
Results
The CAS testing data had a prevalence of 75% (1080/1435), 18% (257/1435) and 6.8% (98/1435) for 0%, 1–49% and ≥50% stenosis, respectively. VP was present in 20% (72/365) in the respective dataset with 44% (32/72) LAP, 19% (14/72) PR and 36% (26/72) SC. Average analysis time for CAS severity and VP was 3.7±2.0s and 3.5±1.8s, respectively. Diagnostic performance of our system is summarised in Tables 1 (CAS severity) and 2 (VP characteristics).
Conclusions
We developed an DL based system capable of rapidly evaluating CAS severity and characterising VP on CCTA. Our system demonstrated high specificity and accuracy for both CAS severity and VP quantification when compared with expert readers.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sehly
- Fiona Stanley Hospital , Perth , Australia
| | - A He
- Fiona Stanley Hospital , Perth , Australia
| | | | - N S R Lan
- Fiona Stanley Hospital , Perth , Australia
| | | | | | - J Sokolov
- University of Southern California, School of Medicine , Los Angeles , United States of America
| | - N Chronos
- School of Medicine , Stanford , United States of America
| | - B Ko
- Monash Heart , Melbourne , Australia
| | - B Chow
- Ottawa Heart Institute , Ottawa , Canada
| | - G Dwivedi
- Harry Perkins Institute of Medical Research , Perth , Australia
| | - A R Ihdayhid
- Harry Perkins Institute of Medical Research , Perth , Australia
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3
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He A, Sehly A, Jaltotage B, Lan N, Joyner J, Flack J, Sokolov J, Chronos N, Ko B, Chow B, Dwivedi G, Ihdayhid A. 448 Comprehensive Assessment Of Coronary Artery Disease On CCTA Using Deep Learning Methods. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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He A, Sehly A, Lan N, Jaltotage B, Kwok S, Flack J, Joyner J, Chronos N, Chow B, Ko B, Figtree G, Dwivedi G, Ihdayhid A. Automated Assessment of CT Coronary Artery Stenosis Using a Deep Learning Approach. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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5
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Janes SL, Wilson DJ, Chronos N, Goodall AH. Evaluation of Whole Blood Flow Cytometric Detection of Platelet Bound Fibrinogen on Normal Subjects and Patients with Activated Platelets. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649645] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryActivated platelets can be detected by measuring platelet-bound fibrinogen in a whole blood, flow cytometric assay, using a fluorescently-conjugated polyclonal antibody.Fibrinogen binding to unstimulated platelets from normal subjects was low in this assay, as was expression of the CD63 antigen. Single cell counting of samples prepared for flow cytometric analysis showed platelet aggregates do not form during the assay procedure. Immune complexes were not seen, and fibrinogen binding to the platelets was unaffected by the CD32 MAb, IV.3. Artefactual activation of the unfixed samples could be minimised by control of phlebotomy, time and temperature of incubation. Variations in platelet count in the range 140–430 × 109 1-1 and in plasma fibrinogen in the range 2–6 g 1-1 did not affect the assay results.Comparison of fibrinogen binding with expression of CD63 antigen on normal platelets, stimulated with agonists in vitro, demonstrated that fibrinogen binding detects an earlier stage of platelet activation.Platelet bound fibrinogen was shown to be sensitive in detecting small numbers of activated platelets in clinical samples in twelve patients on intensive care, four undergoing haemofiltration. The patients had a significantly higher median percentage of circulating platelets with bound fibrinogen (p <0.005), but fibrinogen binding was significantly lower (p <0.02) in response to 10-5 M ADP, compared to twelve age-matched normal Controls.
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Affiliation(s)
- Sarah L Janes
- Department of Haematology, St Georges Hospital Medical School, London SW17, UK
- The Haemophilia Centre and Haemostasis Unit, Royal Free Hospital and School of Medicine, London, UK
| | - Darren J Wilson
- Vascular Cell Biology Laboratory, Department of Chemical Pathology & Human Metabolism, Royal Free Hospital School of Medicine, London 2PF, UK
- The Haemophilia Centre and Haemostasis Unit, Royal Free Hospital and School of Medicine, London, UK
| | - Nicolas Chronos
- Vascular Cell Biology Laboratory, Department of Chemical Pathology & Human Metabolism, Royal Free Hospital School of Medicine, London 2PF, UK
- The Haemophilia Centre and Haemostasis Unit, Royal Free Hospital and School of Medicine, London, UK
| | - Alison H Goodall
- Vascular Cell Biology Laboratory, Department of Chemical Pathology & Human Metabolism, Royal Free Hospital School of Medicine, London 2PF, UK
- The Haemophilia Centre and Haemostasis Unit, Royal Free Hospital and School of Medicine, London, UK
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6
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Abstract
SummaryThromboembolic complications have been attributed to the use of radiographic contrast media (CM) during interventional procedures for arterial revascularization. However, due to the low frequency of adverse events, comparisons between different CM have been difficult to perform, although it has been suggested that ionic (vs. non-ionic) CM may be associated with fewer thrombotic events. The present study was undertaken using well-characterized baboon thrombosis models in order to compare different CM under physiologically relevant and controlled conditions of blood flow, exposure time, and CM concentration. Three CM were studied: ioxaglate, iohexol, and iodixanol. CM were locally infused into the proximal segment of femoral arteriovenous shunts. Palmaz-Schatz stents (4 mm i.d.) and expanded tubular segments (9 mm i.d.), which exhibited venous-type flow recirculation and stasis, were deployed into the shunts distally. Saline was infused in identical control studies. Blood flow was maintained at 100 ml/min. Thrombosis was measured over a blood exposure period of 2 hours by gamma camera imaging of 111In-platelets and by gamma counting of deposited 125I-fibrin. CM concentrations within the flowfield were predicted using computational fluid dynamics. At infusion rates of 0.1 and 0.3 ml/min, the low-osmolar ionic CM ioxaglate reduced both platelet and fibrin deposition on the stents by 75-80% (p <0.005), while both iohexol and iodixanol reduced platelet deposition by 30-50% (p <0.05). In the regions of low shear flow, ioxaglate (0.3 ml/min) also reduced platelet deposition significantly (by 52% vs. control results; p <0.05). Thus the three agents evaluated – ioxaglate, iohexol, and iodixanol – all produced anticoagulant and antiplatelet effects and were inherently antithrombotic in vivo. The most striking effects were seen with the low osmolarity, ionic contrast agent ioxaglate.
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7
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Sîrbulescu RF, Boehm CK, Soon E, Wilks MQ, Ilieş I, Yuan H, Maxner B, Chronos N, Kaittanis C, Normandin MD, El Fakhri G, Orgill DP, Sluder AE, Poznansky MC. Mature B cells accelerate wound healing after acute and chronic diabetic skin lesions. Wound Repair Regen 2017; 25:774-791. [PMID: 28922523 DOI: 10.1111/wrr.12584] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
Abstract
Chronic wounds affect 12-15% of patients with diabetes and are associated with a drastic decrease in their quality of life. Here, we demonstrate that purified mature naive B220+ /CD19+ /IgM+ /IgD+ B cells improve healing of acute and diabetic murine wounds after a single topical application. B cell treatment significantly accelerated acute wound closure by 2-3 days in wild-type mice and 5-6 days in obese diabetic mice. The treatment led to full closure in 43% of chronic diabetic wounds, as compared to only 5% in saline-treated controls. Applying equivalent numbers of T cells or disrupted B cells failed to reproduce these effects, indicating that live B cells mediated pro-healing responses. Topically applied B cell treatment was associated with significantly reduced scar size, increased collagen deposition and maturation, enhanced angiogenesis, and increased nerve growth into and under the healing wound. β-III tubulin+ nerve endings in scars of wounds treated acutely with B cells showed increased relative expression of growth-associated protein 43. The improved healing associated with B cell treatment was supported by significantly increased fibroblast proliferation and decreased apoptosis in the wound bed and edges, altered kinetics of neutrophil infiltration, as well as an increase in TGF-β and a significant reduction in MMP2 expression in wound granulation tissue. Our findings indicate that the timeline and efficacy of wound healing can be experimentally manipulated through the direct application of mature, naive B cells, which effectively modify the balance of mature immune cell populations within the wound microenvironment and accelerate the healing process.
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Affiliation(s)
- Ruxandra F Sîrbulescu
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chloe K Boehm
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erin Soon
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Moses Q Wilks
- Gordon Center for Medical Imaging, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Iulian Ilieş
- Healthcare Systems Engineering Institute, Department of Mechanical and Industrial Engineering, College of Engineering, Northeastern University, Boston, Massachusetts
| | - Hushan Yuan
- Gordon Center for Medical Imaging, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ben Maxner
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicolas Chronos
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charalambos Kaittanis
- Gordon Center for Medical Imaging, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc D Normandin
- Gordon Center for Medical Imaging, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ann E Sluder
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark C Poznansky
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Rothman A, Arnold N, Abou Hanna J, Rowland H, Poff B, Macdonald K, Nagy M, Panian T, Sundaram B, Pham P, Forouzan O, Gunn J, Lawrie A, Chronos N. P612Feasibility and safety of a wireless pulmonary artery pressure monitoring system in chronic porcine models of pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Zhao J, Natarajan SK, Chronos N, Singh JP. Cerivastatin represses atherogenic gene expression through the induction of KLF2 via isoprenoid metabolic pathways. Cell Mol Biol Lett 2016; 20:825-39. [PMID: 26556845 DOI: 10.1515/cmble-2015-0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/22/2015] [Indexed: 01/08/2023] Open
Abstract
Earlier clinical studies have reported that cerivastatin has an anti-atherosclerotic effect that is unique among the statins. In our study, human THP-1 macrophage cells were used to study the effects of various statins on the expressions of the atherosclerotic genes and Kruppel-like factor 2 (KLF2). Cerivastatin significantly inhibited the two atherosclerotic genes, monocyte chemoattractant protein-1 (MCP-1) and C-C chemokine receptor type 2 (CCR2) at both the mRNA and protein levels, while the other statins did not. Accordingly, cerivastatin was also the most potent inducer of KLF2 transcription in the macrophages. An siRNA-induced reduction in KLF2 expression blocked the inhibition of MCP-1 and CCR2 by cerivastatin. When the cells were further treated with mevalonate, farnesylpyrophosphate (FPP) or geranylgeranyl pyrophosphate (GGPP), the effects of cerivastatin on KLF2, MCP-1 and CCR2 were obviously reversed. Thus, the results showed that cerivastatin was a potent inhibitor of the inflammation genes MCP-1 and CCR2 through the induction of KLF2. The regulation of MCP-1, CCR2 and KLF2 by cerivastatin was isoprenoid pathway dependent. Our studies suggest that the effect of cerivastatin on atherosclerotic genes and KLF2 expression may contribute to the cardioprotection observed in reported clinical studies.
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10
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Sumida A, Gogas BD, Nagai H, Li J, King SB, Chronos N, Hou D. A comparison of drug eluting stent biocompatibility between third generation NOBORI biolimus A9-eluting stent and second generation XIENCE V everolimus-eluting stent in a porcine coronary artery model. Cardiovascular Revascularization Medicine 2015; 16:351-7. [DOI: 10.1016/j.carrev.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/06/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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11
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Tondato F, Zeng H, Goodchild T, Ng FS, Chronos N, Peters NS. Autologous Dermal Fibroblast Injections Slow Atrioventricular Conduction and Ventricular Rate in Atrial Fibrillation in Swine. Circ Arrhythm Electrophysiol 2015; 8:439-46. [DOI: 10.1161/circep.114.001536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 01/20/2015] [Indexed: 11/16/2022]
Abstract
Background—
Nonpharmacological ventricular rate control in atrial fibrillation (AF) without producing atrioventricular (AV) block remains a clinical challenge. We investigated the hypothesis that autologous dermal fibroblast (ADF) injection into the AV nodal area would reduce ventricular response during AF without causing AV block.
Methods and Results—
Fourteen pigs underwent electrophysiology study before, immediately, and 28 days after ≈200 million cultured ADFs (n=8) or saline (n=6) were injected under electroanatomical guidance in the AV nodal area, with continuous 28-day ECG recording. In the ADF group at 28 days postinjection, there were prolongations of PR interval (after versus before: 130±13 versus 113±14 ms,
P
=0.04), of AH interval during both sinus rhythm (92±13 versus 76.8±8 ms,
P
<0.01) and atrial pacing at 400 ms (102±13 versus 91±9 ms,
P
<0.01), and of AV node Wenckebach cycle length (230±19 versus 213±24 ms,
P
<0.01), with no changes in the control group. The RR interval during induced AF 28 days after injections was 24% longer in ADF-treated group compared with controls (488±120 versus 386±116 ms,
P
<0.001). Histological analysis revealed presence of ADF-labeled cells in the AV nodal area at 28 days. Transient accelerated junctional rhythm during injections, and transient nocturnal Mobitz I AV conduction occurred early postinjection in both groups.
Conclusions—
Cells survived for 4 weeks and significantly slowed AV conduction and ventricular rate in acutely induced AF. Critically, despite a large number of injections in the AV nodal area and marked effects on AV conduction, AV block did not occur. Further studies are necessary to determine the clinical feasibility and safety of this strategy for ventricular rate control in AF.
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Affiliation(s)
- Fernando Tondato
- From the Myocardial Function Section, Imperial College & Imperial NHS Trust, London, United Kingdom (F.T., N.S.P.); and Saint Joseph’s Translational Research Institute/Saint Joseph’s Hospital of Atlanta, GA (F.T., H.Z., T.G., F.S.N., N.C.)
| | - Hong Zeng
- From the Myocardial Function Section, Imperial College & Imperial NHS Trust, London, United Kingdom (F.T., N.S.P.); and Saint Joseph’s Translational Research Institute/Saint Joseph’s Hospital of Atlanta, GA (F.T., H.Z., T.G., F.S.N., N.C.)
| | - Traci Goodchild
- From the Myocardial Function Section, Imperial College & Imperial NHS Trust, London, United Kingdom (F.T., N.S.P.); and Saint Joseph’s Translational Research Institute/Saint Joseph’s Hospital of Atlanta, GA (F.T., H.Z., T.G., F.S.N., N.C.)
| | - Fu Siong Ng
- From the Myocardial Function Section, Imperial College & Imperial NHS Trust, London, United Kingdom (F.T., N.S.P.); and Saint Joseph’s Translational Research Institute/Saint Joseph’s Hospital of Atlanta, GA (F.T., H.Z., T.G., F.S.N., N.C.)
| | - Nicolas Chronos
- From the Myocardial Function Section, Imperial College & Imperial NHS Trust, London, United Kingdom (F.T., N.S.P.); and Saint Joseph’s Translational Research Institute/Saint Joseph’s Hospital of Atlanta, GA (F.T., H.Z., T.G., F.S.N., N.C.)
| | - Nicholas S. Peters
- From the Myocardial Function Section, Imperial College & Imperial NHS Trust, London, United Kingdom (F.T., N.S.P.); and Saint Joseph’s Translational Research Institute/Saint Joseph’s Hospital of Atlanta, GA (F.T., H.Z., T.G., F.S.N., N.C.)
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12
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Yin X, Sumida A, Xu Y, Li J, Chen JP, Chronos N, King S, Hou D. CRT-159 Vasomotor Function among Coronary Arteries in Healthy Miniswine. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Suszynski TM, Rizzari MD, Scott WE, Eckman PM, Fonger JD, John R, Chronos N, Tempelman LA, Sutherland DER, Papas KK. Persufflation (gaseous oxygen perfusion) as a method of heart preservation. J Cardiothorac Surg 2013; 8:105. [PMID: 23607734 PMCID: PMC3639186 DOI: 10.1186/1749-8090-8-105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/11/2013] [Indexed: 01/10/2023] Open
Abstract
Persufflation (PSF; gaseous oxygen perfusion) is an organ preservation technique with a potential for use in donor heart preservation. Improved heart preservation with PSF may improve outcomes by maintaining cardiac tissue quality in the setting of longer cold ischemia times and possibly increasing the number of donor hearts available for allotransplant. Published data suggests that PSF is able to extend the cold storage times for porcine hearts up to 14 hours without compromising viability and function, and has been shown to resuscitate porcine hearts following donation after cardiac death. This review summarizes key published work on heart PSF, including prospective implications and future directions for PSF in heart transplantation. We emphasize the potential impact of extending preservation times and expanding donor selection criteria in heart allotransplant. Additionally, the key issues that need to be addressed before PSF were to become a widely utilized preservation strategy prior to clinical heart transplantation are summarized and discussed.
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Affiliation(s)
- Thomas M Suszynski
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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14
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Nagai H, Li J, Xu Y, Chen W, Wei Y, Li W, King SB, Chronos N, Hou D. CRT-120 Neointimal Contractility Inside Of Stent: IVUS Observation In a Porcine Coronary Model. JACC Cardiovasc Interv 2013. [DOI: 10.1016/j.jcin.2013.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Nakamura T, Jing C, Xinhua Y, Li J, Chen JP, King SB, Chronos N, McDonald JF, Hou D. Vasomotor function and molecular responses following drug-eluting stent in a porcine coronary model. Int J Cardiol 2012; 160:210-2. [DOI: 10.1016/j.ijcard.2012.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/30/2012] [Accepted: 06/08/2012] [Indexed: 11/26/2022]
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16
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Nakamura T, Winsor-Hines D, Yin X, Sushkova N, Chen JP, King SB, Chronos N, Eppihimer M, Huibregtse B, Dawkins KD, Hou D. Vasomotor function and re-endothelialisation after implantation of biodegradable abluminal polymer coated paclitaxel-eluting stents in rabbit iliac arteries: a time-course study. EUROINTERVENTION 2012; 8:493-500. [PMID: 22917733 DOI: 10.4244/eijv8i4a77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate the time-course of vasomotor function and re-endothelialisation after implantation of a novel platinum-chromium (PtCr) abluminal biodegradable polymer-coated paclitaxel-eluting stent (PES, Labcoat Element) in rabbit iliac arteries. METHODS AND RESULTS Either PES (n=18) or an identical platform of bare metal stents (BMS, Element, n=18) were implanted in rabbit iliac arteries (six animals per time-point). At 14, 30, and 90 days, acetylcholine- and nitroglycerine-induced vasomotor reactivity at 5-10 mm distal to the stent was measured. Subsequently, the animals were terminated. The stented artery was bisected longitudinally for either SEM or en face CD31 immunochemistry examination. All arteries were patent with normal angiographic flow. Decreased endothelial-dependent vasomotion was found at both 14 and 30 days for PES compared to BMS (p<0.01, respectively); however, these differences resolved by 90 days. Endothelial-independent vasorelaxation was similar at all three time-points. Both SEM and en face staining demonstrated equivalent endothelial coverage on the surface of the stented segments above and between struts at all time-points. CONCLUSIONS This novel bioabsorbable polymer abluminal-coated PES demonstrated vasomotor function comparable to BMS within three months post-deployment in the rabbit iliac model. Despite indistinguishable endothelial cell coverage on the stent surface between groups, earlier differences in vasomotion were detected: this finding suggests that the timing of restoration vasomotor function lags morphologic endothelial recovery.
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Affiliation(s)
- Takamitsu Nakamura
- Saint Joseph's Translational Research Institute/Saint Joseph's Hospital of Atlanta, GA, USA
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17
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Abstract
AIMS The concept of fully biodegradable stents has emerged as an attractive alternative to current permanent metallic stents, mainly as a potential solution to avoid late stent thrombotic events. We sought to evaluate a novel, fully bioabsorbable sirolimus-eluting stent (SES) synthesised entirely from a unique salicylic-acid polymer, in a clinically relevant animal model. METHODS AND RESULTS Fully biodegradable balloon-expandable stents (n=45) were implanted in a porcine coronary arteries using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) to optimise stent apposition. Dose density of sirolimus was 8.3 µg/mm of stent length with in vitro studies demonstrating elution over 30 days and complete stent degradation over 12 months. Animals were terminated at 7, 14, 30, 90, and 180 days for complete histological analysis. Optical coherence tomography (OCT) was also performed for the 90- and 180-days samples. All stents were deployed successfully without notable mechanical difficulties. Angiographic diameter stenosis (DS) was 20±16%, 24±4%, and 23±17%, at one, three, and six months, respectively. In parallel, IVUS showed good stent apposition with DS of 21±9%, 25±7%, and 18±3%; and area stenosis (AS) of 35±13%, 33±7%, and 32±4% at one, three, and six months,respectively. OCT further demonstrated good stent apposition with DS of 28±7% and 20±6%, and AS of 37±10% and 33±13% at three and six months, respectively. OCT showed reduction of stent thickness by 23% from three to six months. Histologic analysis confirmed these in vivo findings and revealed a favourable healing process of absorbable stent incorporation into the arterial wall, without excessive thrombotic or inflammatory reactions. CONCLUSIONS This study shows favourable vascular compatibility and efficacy for a novel fully bioabsorbable salicylate-based SES. This device has good mechanical performance during deployment and stays well-apposed to the vessel wall at long-term follow-up. These initial results are highly encouraging and support progress into more extensive preclinical studies as well as early clinical testing.
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Affiliation(s)
- Refat Jabara
- Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Suszynski T, Scott W, Weegman B, Li J, Lam A, Fonger J, Ritter J, Rizzari M, Eckman P, Tempelman L, John R, Chronos N, Papas K. 423 Persufflation (i.e., Gas Perfusion) May Extend Allowable Ischemia Time during Donor Heart Preservation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Matthews KA, Gogas BD, Sumida A, Nagai H, King SB, Chronos N, Hou D. Anomalous right coronary artery originating from the left sinus of Valsalva in a Yucatan minipig. Comp Med 2012; 62:127-130. [PMID: 22546919 PMCID: PMC3318250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/17/2011] [Accepted: 11/02/2011] [Indexed: 05/31/2023]
Abstract
A 39.2-kg, castrated male Yucatan minipig (Sus scrofa domestica) was presented for enrollment in a coronary artery study. Angiography revealed an anomalous right coronary artery originating from the left sinus of Valsalva. The left anterior descending, left circumflex, and anomalous right coronary arteries were implanted with metallic stents without complications. The minipig remained on the study for 3 mo until it reached its predetermined study endpoint, during which time it showed no clinical signs of disease. Histologic examination of the implanted coronary arteries revealed no differences between the normal (left anterior descending and left circumflex arteries) and the anomalous right coronary artery. Swine are important models for coronary research. Although several cases of anomalous human coronary arteries have been documented, the current case is the first report of a coronary artery anomaly in a minipig.
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Affiliation(s)
| | - Bill D Gogas
- Saint Joseph's Translational Research Institute, Atlanta, Georgia and
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arihiro Sumida
- Saint Joseph's Translational Research Institute, Atlanta, Georgia and
| | - Hiroyuki Nagai
- Saint Joseph's Translational Research Institute, Atlanta, Georgia and
| | - Spencer B King
- Saint Joseph's Translational Research Institute, Atlanta, Georgia and
| | - Nicolas Chronos
- Saint Joseph's Translational Research Institute, Atlanta, Georgia and
| | - Dongming Hou
- Saint Joseph's Translational Research Institute, Atlanta, Georgia and
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Pendyala LK, Matsumoto D, Shinke T, Iwasaki T, Sugimoto R, Hou D, Chen JP, Singh J, King SB, Chronos N, Li J. Nobori Stent Shows Less Vascular Inflammation and Early Recovery of Endothelial Function Compared With Cypher Stent. JACC Cardiovasc Interv 2012; 5:436-44. [DOI: 10.1016/j.jcin.2011.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/22/2011] [Accepted: 11/21/2011] [Indexed: 11/28/2022]
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Sumida A, Nagai H, Gogas B, Li J, Singh J, King S, Chronos N, Hou D. NEOINTIMAL TISSUE CLASSIFICATION USING OPTIMAL COHERENCE TOMOGRAPHY AFTER PACLITAXEL-COATING BALLOON TREATMENT IN PIG IN-STENT STENOSIS MODEL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lam AS, Li J, Ritter J, Hou D, Matsumoto D, Matsumoto D, Jabara R, King SB, Singh J, Chronos N. Shorter degradation period in BTI stents after porcine coronary artery implantation. Cardiovascular Revascularization Medicine 2012. [DOI: 10.1016/j.carrev.2012.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sumida A, Nagai H, Gogas B, Li J, Hou D, King S, Singh J, Chronos N. COMPARISONS OF CORONARY ARTERY ENDOTHELIAL FUNCTION AFTER NOBORI AND XIENCE V STENT IMPLANTATION IN SWINE MODEL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60059-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Li J, Yue J, Nakamura T, Hou D, White J, Singh J, Chronos N. Denuded iliac endothelium with long-term high-cholesterol-diet-induced vascular dysfunction and accelerated atherosclerosis as well as neointimal formations after BMS implantation. Cardiovascular Revascularization Medicine 2012. [DOI: 10.1016/j.carrev.2012.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sumida A, Nikanorov A, Shinke T, Li J, King S, Chronos N, Hou D. Paclitaxel-coated balloon study: quantitative coronary angiography and optical coherence tomography evaluation in a swine in-stent stenosis model. Heart 2011. [DOI: 10.1136/heartjnl-2011-300867.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pendyala L, Goodchild T, Gadesam RR, Chen J, Robinson K, Chronos N, Hou D. Cellular cardiomyoplasty and cardiac regeneration. Curr Cardiol Rev 2011; 4:72-80. [PMID: 19936280 PMCID: PMC2779354 DOI: 10.2174/157340308784245748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 02/15/2008] [Accepted: 02/18/2008] [Indexed: 12/21/2022] Open
Abstract
Despite of vast improvements in treatment, myocardial infarction often leads to heart failure (HF) which remains the leading cause of death in developed countries. Other than heart transplantation, therapeutic options have a limited role in improving out comes in patients with severe HF. It is therefore no surprise that cardiac cell therapy has raised many hopes as a novel therapeutic approach aimed at cardiac myocyte replacement/regeneration termed "cellular cardiomyoplasty". However, the ideal source, cell type, critical cell number, and mode of application for optimal therapeutic effect have not been defined thus far. Recent observations of the beneficial effect of cell transplantation in animal experiments have generated tremendous excitement and stimulated clinical studies suggesting that this approach is feasible, safe, and potentially effective in humans. Cell-based myocardial regeneration is currently being explored for a wide range of cardiac disease states, including acute and chronic ischemic myocardial damage, cardiomyopathy and as biological heart pacemakers. The main purpose of this article is to review recent literature on the use of various cells for the examination of their in vitro cardiogenic potential and their in vivo capacity to engraft and improve the functional properties of the infarcted heart.
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Affiliation(s)
- Lakshmana Pendyala
- Saint Joseph's Translational Research Institute / Saint Joseph's Hospital of Atlanta, GA, USA
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Perin EC, Silva G, Gahremanpour A, Canales J, Zheng Y, Cabreira-Hansen MG, Mendelsohn F, Chronos N, Haley R, Willerson JT, Annex BH. A randomized, controlled study of autologous therapy with bone marrow-derived aldehyde dehydrogenase bright cells in patients with critical limb ischemia. Catheter Cardiovasc Interv 2011; 78:1060-7. [PMID: 21594960 DOI: 10.1002/ccd.23066] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 02/07/2011] [Accepted: 02/17/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The safety and efficacy of direct intramuscular injections of aldehyde dehydrogenase bright (ALDH(br)) cells isolated from autologous bone marrow mononuclear cells (ABMMNCs) and ABMMNCs were studied in patients with critical limb ischemia (CLI) who were not eligible for percutaneous or surgical revascularization. BACKGROUND Many CLI patients are not candidates for current revascularization procedures, and amputation rates are high in these patients. Cell therapy may be a viable option for CLI patients. METHODS Safety was the primary objective and was evaluated by occurrence of adverse events. Efficacy, the secondary objective, was evaluated by assessment of Rutherford category, ankle-brachial index (ABI), transcutaneous partial pressure of oxygen (TcPO(2)), quality of life, and pain. RESULTS ALDH(br) cells and ABMMNCs were successfully administered to all patients. No therapy-related serious adverse events occurred. Patients treated with ALDH(br) cells (n = 11) showed significant improvements in Rutherford category from baseline to 12 weeks (mean, 4.09 ± 0.30 to 3.46 ± 1.04; P = 0.05) and in ABI at 6 (mean, 0.22 ± 0.19 to 0.30 ± 0.24; P = 0.02), and 12 weeks (mean, 0.36 ± 0.18; P = 0.03) compared with baseline. Patients in the ABMMNC group (n = 10) showed no significant improvements at 6 or 12 weeks in Rutherford category but did show improvement in ABI from baseline to 12 weeks (0.38 ± 0.06 to 0.52 ± 0.16; P = 0.03). No significant changes from baseline were noted in ischemic ulcer grade or TcPO(2) in either group. CONCLUSIONS Administration of autologous ALDH(br) cells appears to be safe and warrants further study in patients with CLI.
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Affiliation(s)
- Emerson C Perin
- Stem Cell Center, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Yue J, Nakamura T, Wang Y, Fu W, Guo D, Chronos N. Effects of circumferential stretch vs. deep injury on the in-stent neointimal formation in the atherosclerotic iliac rabbit arteries. Cardiovascular Revascularization Medicine 2011. [DOI: 10.1016/j.carrev.2011.04.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Natarajan SK, Hou D, Nakamura T, Li J, Goodchild T, Chavan S, Chronos N, Singh JP. Understanding the impact of drug-eluting stent on vascular function and the nitric oxide pathway genes using a pig coronary artery stent implantation model. Cardiovascular Revascularization Medicine 2011. [DOI: 10.1016/j.carrev.2011.04.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Li J, Yue J, Hou D, Musimuto D, Nakamura T, Jabara R, King SB, Singh J, Chronos N. Vascular function of bioabsorbable stented site after complete absorption of the stent. Cardiovascular Revascularization Medicine 2011. [DOI: 10.1016/j.carrev.2011.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Matsumoto D, Shinke T, Nakamura T, Shite J, Hirata K, Hou D, Chronos N. MORPHOLOGICAL EVALUATION OF VASCULAR RESPONSE AFTER DRUG-ELUTING STENT IMPLANT WITH OPTICAL COHERENCE TOMOGRAPHY IN RELATION TO HISTOLOGICAL FINDINGS AND VASCULAR FUNCTION IN PIG CORONARY MODEL. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chen J, Goodchild TT, Brott BC, Li J, King SB, Chronos N, Jiang H, Hou D. Microarray applications in occlusive vascular disease. Cardiovasc Hematol Agents Med Chem 2011; 9:84-94. [PMID: 21434865 DOI: 10.2174/187152511796196515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/24/2011] [Indexed: 05/30/2023]
Abstract
Interventional cardiology procedures and drug therapy have been widely applied for the treatment of occlusive vascular disease. However, there remains a critical lack of understanding of the disease process at a molecular level. Microarray technology has the unique advantage in the ability to analyze thousands of genes simultaneously. So far, several studies based on microarray analysis have already provided valuable expression data in diseases such as atherosclerosis and in-stent stenosis. This review summarizes: a) latest microarray research indentifying gene-expression profiles; b) the methodological analysis of the available microarray studies; c) generation of biological processes or pathways; d) detection of better diagnostic and therapeutic targets in atherosclerosis and in-stent stenosis. Further improvements in microarray interpretation as well as in study design, combined with definition and evaluation in the clinical arena, will enhance our understanding of the causes and mechanisms contributing to occlusive vascular diseases, and therefore will help to improve treatment of patients suffering from these diseases.
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Affiliation(s)
- Jing Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, China
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Chen J, Huang A, Nakamura T, Matyunina L, Yu J, Li J, Singh J, McDonald JF, Chronos N, Hou D. MICROARRAY GENE EXPRESSION PROFILING IDENTIFIES PATHOPHYSIOLOGICAL VASCULAR RESPONSES TO IMPLANTATION OF OVERLAPPING DRUG-ELUTING STENTS INTO PORCINE CORONARY ARTERIES. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Goodchild TT, Chronos N, Hou D. The next generation of review for cardiac cell therapies. Cardiovasc Ther 2011; 29:1. [PMID: 21241458 DOI: 10.1111/j.1755-5922.2010.00224.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yue J, Wang Y, Guo D, Xu X, Chen B, Jiang J, Yang J, Li J, Hou D, Chronos N, Fu W. Individualized cerebrospinal fluid drainage for preventing spinal cord ischemia in secondary TEVAR for type B dissection. Cardiovascular Revascularization Medicine 2010. [DOI: 10.1016/j.carrev.2010.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chen J, Nakamura T, Matsumoto D, Chronos N, Hou D. e0041 Vasomotor function following newer generation of bare metal stent overstretch in a porcine coronary model. Heart 2010. [DOI: 10.1136/hrt.2010.208967.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shinke T, Li J, Chen JP, Pendyala L, Goodchild T, Jabara R, Geva S, Ueno T, Chronos N, Robinson K, Hou D. High incidence of intramural thrombus after overlapping paclitaxel-eluting stent implantation: angioscopic and histopathologic analysis in porcine coronary arteries. Circ Cardiovasc Interv 2010; 1:28-35. [PMID: 20031652 DOI: 10.1161/circinterventions.108.770008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Systematic analysis of in vivo angioscopy and postmortem histopathology for paclitaxel-eluting stents (PES) has not been previously reported. We assessed 1-month angioscopic and histopathologic sequelae of overlapping PES in pig coronary arteries. METHODS AND RESULTS Overlapping PES and bare-metal stents (BMS; n=9, one pair per pig) were implanted, and animals were euthanized at 1 month. Late lumen loss was reduced in PES compared with BMS (0.46+/-0.63 mm versus 1.30+/-0.50 mm; P=0.01). Angioscopically, PES stent struts were clearly visible and accompanied by substantial red material indicating mural thrombi. In contrast, stent struts and mural thrombi were barely visible in BMS (P<0.001 versus PES). Macroscopically, mural thrombi were abundant but distributed irregularly throughout the PES, with greater concentration in overlapping segments. Only occasional mural thrombi were noted for BMS. Microscopically, neointima of BMS was fibrocellular and mature, whereas only a thin layer of immature neointima was seen in PES. Neointimal thickness was less in PES than BMS (0.11+/-0.07 mm versus 0.33+/-0.12 mm; P=0.018). Additionally, extensive para-strut and intramural thrombi, red blood cell debris, and minute luminal thrombi were observed in PES. Despite normal angioscopic appearance of both proximal and distal nonstented reference segments, endothelium-dependent relaxation to substance P was notably diminished (PES, 0+/-7% versus BMS, 10+/-6%; P=0.007), whereas nitroglycerin response was preserved (PES, 9+/-5% versus BMS, 12+/-7%; P=0.34). CONCLUSIONS In the porcine coronary model, overlapping PES is associated with marked intramural thrombi, which was accurately detected on angioscopy at 1 month. Moreover, despite normal luminal angioscopic appearance, adjacent nonstented reference segments demonstrated impaired endothelium-dependent vasoreactivity.
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Affiliation(s)
- Toshiro Shinke
- Saint Joseph's Translational Research Institute/Saint Joseph's Hospital of Atlanta, GA 30342, USA
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Pendyala L, Yin X, Li J, Shinke T, Xu Y, Chen JP, King SB, Colley K, Goodchild T, Chronos N, Hou D. Polymer-free cerivastatin-eluting stent shows superior neointimal inhibition with preserved vasomotor function compared to polymer-based paclitaxel-eluting stent in rabbit iliac arteries. EUROINTERVENTION 2010; 6:126-133. [PMID: 20542808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIMS The present study was designed to evaluate vasomotor function and vascular biological responses following a novel non-polymeric cerivastatin-eluting stent (CES) versus polymer-based paclitaxel-eluting stent (PES) in a rabbit iliac artery model. Optimisation of DES components and non-polymeric stents may contribute to vascular healing and beneficial to vasomotor function. METHODS AND RESULTS In vitro human aortic and coronary smooth muscle cells (hASMC & hCSMC), as well as endothelial cells (hAEC & hCEC) were cultured. IC50 curves were determined for cerivastatin (CER). In vivo PES (n=6) and CES (n=12) stents were implanted in nine rabbits. Vasomotor function was investigated at 28 days by acetylcholine (ACh) followed by histopathological and histomorphometric analyses. CER was cytotoxic to hASMC and hCSMC (IC50s of 10-6 M and 10-5 M, respectively), although such cytotoxic effects were not observed for hAEC and hCEC at maximal study dose. PES-associated vasodilation response to endothelial-dependent ACh was significantly suppressed at both proximal and distal adjacent arterial segments, as compared to CES. Furthermore, microscopically, neointimal inhibition quantified by the neointimal cross-sectional area (IA) was superior with CES (0.60 + or - 0.27 mm(2)) compared to PES (1.35 + or - 0.16 mm(2); P <0.05). Medial area was smaller for PES (0.3 + or - 0.04 mm(2)) than CES (0.5 + or - 0.03 mm(2), p <0.001). Additionally, significant inflammation and fibrin deposition was clearly evidenced in PES compared to CES (p <0.05). CONCLUSIONS CER elicits a differential effect on hSMC compared to hEC in vitro. In contrast to PES, a novel bioabsorbable sol-gel coated CES demonstrated effective neointimal inhibition with less vessel wall toxicity accompanied by preservation of vasomotor function in the rabbit iliac model.
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Affiliation(s)
- Lakshmana Pendyala
- Saint Joseph's Translational Research Institute/Saint Joseph's Hospital of Atlanta, GA, USA
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Pendyala L, Yin X, Li J, Shinke T, Xu Y, Chen J, King III S, Colley K, Goodchild T, Chronos N, Hou D. Polymer-free cerivastatin-eluting stent shows superior neointimal inhibition with preserved vasomotor function compared to polymer-based paclitaxel-eluting stent in rabbit iliac arteries. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i1a19] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jabara R, Goodwin L, Chronos N, Goodchild T. VASCULAR PHYSIOLOGIC RESPONSES ASSOCIATED WITH DRUG-ELUTING STENTS: EVALUATION OF A STENT ELUTING SIROLIMUS FROM AN ABSORBABLE SALICYLATE POLYMER COATING. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jabara R, Gadesam R, Pendyala L, Chronos N, Chen J, Manoukian S. CONTRAST INDUCED NEPHROPATHY POST PERCUTANEOUS CORONARY INTERVENTION: WHAT IS THE RIGHT DEFINITION? J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li JS, Pendyala LK, Yin X, Yue J, Chen JP, Chronos N, Hou D. IMPAIRMENT OF VASOMOTOR FUNCTION OF CONDUIT BUT NOT RESISTANCE ARTERIES AFTER LONG-TERM FEMORAL ARTERY OCCLUSION. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Li JS, Yin X, Takamitsu N, Lakshmana PK, Brants I, Frohwein S, Chen JP, Chronos N, Matheny R, Hou D. PERCUTANEOUS INDUCED LEFT VENTRICLE MYOCARDIAL INFARCTION WITH RE-OPEN LAD IN A CLINICAL RELEVANT ANIMAL MODEL. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matsumoto D, Shinke T, Geva S, Chronos N, Jabara R. STENT DEGRADATION OF NOVEL FULLY BIOABSORBABLE SALICYLATE-BASED SIROLIMUS-ELUTING STENT EVALUATED BY OCT IN PIG CORONARY ARTERY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)62059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Li JS, Pendyala LK, Matsumoto D, Geva S, Shinke T, Hou D, Chen JP, Singh J, Chronos N. COMPARISON OF VASCULAR INFLAMMATION AND ENDOTHELIAL FUNCTION IN RESPONSE TO A NEW NOBORI AND CYPHER DRUG ELUTING STENTS IN PIG CORONARY ARTERIES. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jabara R, Gadesam R, Pendyala L, Chronos N, Chen J, King S, Manoukian S. WHAT IS THE RIGHT DEFINITION OF CONTRAST INDUCED NEPHROPATHY POST PERCUTANEOUS CORONARY INTERVENTION? J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nakamura T, Chen JP, Panchal D, Nguyen T, King SB, Chronos N, Hou D. The role of intravascular ultrasound to guide drug-eluting stents implantation. Cardiovasc Hematol Agents Med Chem 2010; 8:22-28. [PMID: 20214600 DOI: 10.2174/187152510790796147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Serial IVUS has demonstrated significant differences in intimal hyperplasia (IH) volume between drug-eluting stent (DES) and bare metal stents (BMS) in recent clinical trials. It has also been reported that IVUS is a useful tool in determining optimal DES implantation, especially for diabetes mellitus (DM) patients. Recent data have also suggested a critical role for, IVUS guidance in reduction of risk for DES thrombosis. IVUS has been invaluable in the elucidation of DES effects on the arterial wall, offering insight into the potential mechanisms of DES failure. Therefore, in this current manuscript, we review the potential benefits of intravascular ultrasound (IVUS) during drug eluting stent (DES) implantation.
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Affiliation(s)
- T Nakamura
- Saint Joseph's Translational Research Institute/Saint Joseph's Hospital Atlanta, 5671 Peachtree Dunwoody Road NE, Atlanta, GA 30342, USA
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Pendyala LK, Yin X, Li J, Chen JP, Chronos N, Hou D. The First-Generation Drug-Eluting Stents and Coronary Endothelial Dysfunction. JACC Cardiovasc Interv 2009; 2:1169-77. [DOI: 10.1016/j.jcin.2009.10.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 09/30/2009] [Accepted: 10/07/2009] [Indexed: 11/29/2022]
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Jabara R, Geva S, Ribeiro H, Chen J, Hou D, Li J, King S, Chronos N, Robinson K. A third generation ultra-thin strut cobalt chromium stent: histopathological evaluation in porcine coronary arteries. EUROINTERVENTION 2009; 5:619-26. [DOI: 10.4244/eijv5i5a99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pendyala L, Jabara R, Robinson K, Chronos N. Passive and active polymer coatings for intracoronary stents: novel devices to promote arterial healing. J Interv Cardiol 2009; 22:37-48. [PMID: 19281521 DOI: 10.1111/j.1540-8183.2009.00423.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Coronary stent implantation is the second great advance in the treatment of obstructive coronary artery disease since the introduction of balloon catheter angioplasty. However, in-stent restenosis (ISR) caused by neointimal hyperplasia has been a major limitation of stents, occurring in up to 30% of cases. Advances in coronary stent technology both in terms of stent design and function and especially drug-eluting stents (DES) have significantly improved the safety and efficacy of percutaneous coronary intervention (PCI) with stenting, including marked reduction in ISR. This has led to use of DES for increasingly challenging clinical and lesional subsets, with potential for increased risk of stent-associated complications, especially late stent thrombosis (LST). Because restenosis and stent thrombosis are caused by multiple and often interrelated factors, ideal agents for stent coatings should inhibit thrombus formation, inflammatory reaction, and cellular proliferation, while supporting reendothelialization. To avoid undesirable effects of currently applied (durable) polymers, biocompatible, and bioabsorbable polymers as well as DES delivery systems that minimize polymer burden have been produced and tested. Bioabsorbable stents, both polymeric and metallic, have been developed to decrease potential late complications after stent implantation. Novel strategies to address some of these challenges are in various stages of research and development. In this article we outline developments in the field of passive and active stent coatings and evaluate the ongoing role of such coatings in the contemporary era of DES.
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Affiliation(s)
- Lakshmana Pendyala
- Saint Joseph's Translational Research Institute/Saint Joseph's Hospital of Atlanta, Georgia 30342, USA
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