Post-catheterisation arterial thrombosis in children – pathophysiology, prevention, and treatment

2014 ◽  
Vol 24 (5) ◽  
pp. 767-773 ◽  
Author(s):  
João Silva Marques ◽  
Cristina Gonçalves
Keyword(s):  
Treatment Strategies ◽  
Current Evidence ◽  
Special Focus ◽  
Limb Ischaemia ◽  
Review Of The Literature ◽  
Access Site ◽  
Arterial Access ◽  
Significant Disability ◽  
Surgical Thrombectomy

AbstractLower limb ischaemia is the most frequent complication of cardiac catheterisation in children. It is often overlooked, but it can cause significant disability and may limit arterial access sites to repeat diagnostic or interventional catheterisations. A narrative review of the literature on arterial access site thrombosis in children was carried out with a special focus on current evidence that supports preventive and treatment strategies. Anticoagulation, thrombolysis, and thrombectomy have been used successfully to treat arterial access site thrombosis. However, it is not completely established which is the role of each treatment modality and what is the most appropriate timing to deliver it. Therefore, diagnostic and therapeutic strategies have to be prospectively investigated, particularly for clarifying the role of new pharmacologic interventions and of percutaneous and surgical thrombectomy in the current era.

scholarly journals Role of the Myokine Irisin on Bone Homeostasis: Review of the Current Evidence

2021 ◽  
Vol 22 (17) ◽  
pp. 9136
Author(s):  
Amanda Kornel ◽  
Danja J. Den Hartogh ◽  
Panagiota Klentrou ◽  
Evangelia Tsiani
Keyword(s):  
Bone Resorption ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Current Evidence ◽  
Signaling Proteins ◽  
Bone Homeostasis ◽  
Menopausal Women ◽  
Post Menopausal

Bone is a highly dynamic tissue that is constantly adapting to micro-changes to facilitate movement. When the balance between bone building and resorption shifts more towards bone resorption, the result is reduced bone density and mineralization, as seen in osteoporosis or osteopenia. Current treatment strategies aimed to improve bone homeostasis and turnover are lacking in efficacy, resulting in the search for new preventative and nutraceutical treatment options. The myokine irisin, since its discovery in 2012, has been shown to play an important role in many tissues including muscle, adipose, and bone. Evidence indicate that irisin is associated with increased bone formation and decreased bone resorption, leading to reduced risk of osteoporosis in post-menopausal women. In addition, low serum irisin levels have been found in individuals with osteoporosis and osteopenia. Irisin targets key signaling proteins, promoting osteoblastogenesis and reducing osteoclastogenesis. The present review summarizes the existing evidence regarding the effects of irisin on bone homeostasis.

scholarly journals Glucocorticoids and the brain after critical illness

Endocrinology ◽  
2021 ◽  
Author(s):  
Alice R Hill ◽  
Joanna L Spencer-Segal
Keyword(s):  
Critical Illness ◽  
Structural Integrity ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Post Traumatic Stress ◽  
Free Cortisol ◽  
Acute Elevation ◽  
Post Traumatic

Abstract Treatment for critical illness typically focuses on a patient’s short-term physical recovery; however, recent work has broadened our understanding of the long-term implications of illness and treatment strategies. In particular, survivors of critical illness have significantly elevated risk of developing lasting cognitive impairment and psychiatric disorders. In this review, we examine the role of endogenous and exogenous glucocorticoids in neuropsychiatric outcomes following critical illness. Illness is marked by acute elevation of free cortisol and adrenocorticotropic hormone (ACTH) suppression, which typically normalize after recovery; however, prolonged dysregulation can sometimes occur. High glucocorticoid levels can cause lasting alterations to the plasticity and structural integrity of the hippocampus and prefrontal cortex, and this mechanism may plausibly contribute to impaired memory and cognition in critical illness survivors, though specific evidence is lacking. Glucocorticoids may also exacerbate inflammation-associated neural damage. Conversely, current evidence indicates that glucocorticoids during illness may protect against the development of post-traumatic stress disorder (PTSD). We propose future directions for research in this field, including determining the role of persistent glucocorticoid elevations after illness in neuropsychiatric outcomes, the role of systemic vs. neuroinflammation, and probing unexplored lines of investigation on the role of mineralocorticoid receptors and the gut-brain axis. Progress toward personalized medicine in this area has the potential to produce tangible improvements to the lives patients after a critical illness, including Coronavirus Disease 2019 (COVID-19).

Futility Disputes: A Review of the Literature and Proposed Model for Dispute Navigation Through Trust Building

2016 ◽  
Vol 32 (9) ◽  
pp. 523-527 ◽  
Author(s):  
Brian D. Leland ◽  
Alexia M. Torke ◽  
Lucia D. Wocial ◽  
Paul R. Helft
Keyword(s):  
Medical Decision Making ◽  
Intensive Care Unit Setting ◽  
Medical Decision ◽  
Current Evidence ◽  
Trust Building ◽  
Review Of The Literature ◽  
The Past ◽  
Proposed Model ◽  
Significant Attention

Futility disputes in the intensive care unit setting have received significant attention in the literature over the past several years. Although the idea of improving communication in an attempt to resolve these challenging situations has been regularly discussed, the concept and role of trust building as the means by which communication improves and disputes are best navigated is largely absent. We take this opportunity to review the current literature on futility disputes and argue the important role of broken trust in these encounters, highlighting current evidence establishing the necessity and utility of trust in both medical decision-making and effective communication. Finally, we propose a futility dispute navigation model built upon improved communication through trust building.

scholarly journals A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

2016 ◽  
Vol 7 (4) ◽  
pp. 188-196 ◽  
Author(s):  
Charla R. Fischer ◽  
Gregory Hanson ◽  
Melinda Eller ◽  
Ronald A. Lehman
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Treatment Strategies ◽  
Pedicle Screws ◽  
Spine Fusion ◽  
Current Evidence ◽  
Review Of The Literature ◽  
Degenerative Lumbar Spine ◽  
Lumbar Spine Fusion

Purpose: To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis. Methods: A systematic review of the literature from 1950 to 2015. Results: The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws. Conclusion: There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.

scholarly journals Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?

2018 ◽  
Vol 35 (05) ◽  
pp. 427-434 ◽  
Author(s):  
Raghuram Posham ◽  
Lindsay Young ◽  
Robert Lookstein ◽  
Constantino Pena ◽  
Rahul Patel ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Unmet Needs ◽  
Arterial Disease ◽  
Review Of The Literature ◽  
Access Site ◽  
Arterial Access ◽  
Radial Access ◽  
Effective Interventions ◽  
Peripheral Arterial

AbstractThe benefits of transradial arterial access (TRA) versus transfemoral arterial access (TFA) have been extensively described in the literature; however, TFA remains the predominant access site choice in the management of peripheral arterial disease (PAD). There are still significant unmet needs for operators wishing to provide the same effective interventions for lower extremity PAD via TRA as with TFA. This article provides an up-to-date review of the literature and devices currently available for operators wishing to treat lower extremity PAD via TRA and the limitations they may face.

scholarly journals M4 Muscarinic Receptors and Locomotor Activity Regulation

2017 ◽  
pp. S443-S455 ◽  
Author(s):  
J. MYSLIVECEK ◽  
V. FARAR ◽  
P. VALUSKOVA
Keyword(s):  
Locomotor Activity ◽  
Muscarinic Receptors ◽  
Current Evidence ◽  
Special Focus ◽  
Activity Regulation ◽  
Brain Areas ◽  
Hypothalamic Area ◽  
Males And Females ◽  
G Protein Coupled

M4 muscarinic receptors (M4 MR) represent a subfamily of G-protein coupled receptors serving a substantial role in spontaneous locomotor activity regulation, cognition and modulation of cholinergic system. With increasing body of literature discussing the role of M4 MR some controversies arose. Thus, we try here to summarize the current evidence regarding the M4 MR, with the special focus on their role in locomotor activity control. We review the molecular function of M4 MR in specific brain areas implicated in locomotor regulation, and shortly in other CNS processes that could be connected to locomotor activity. We also focus on brain areas implicated in locomotor activity biorhythm changes like suprachiasmatic nucleus, subparaventricular zone posterior hypothalamic area, striatum and thalamus. Gender-related aspects and differences in locomotor activity in males and females are discussed further.

scholarly journals Mediatization of Power: Corporate CEOs in Flexible Capitalism

2014 ◽  
Vol 35 (2) ◽  
pp. 29-41 ◽  
Author(s):  
Anu Kantola
Keyword(s):  
Community Formation ◽  
Special Focus ◽  
Corporate Management ◽  
Review Of The Literature ◽  
Corporate Power ◽  
Corporate Leaders ◽  
Institutional Structures ◽  
The Media ◽  
And Control

Abstract The present article analyses the mediatization of corporate power with a special focus on the work of the CEO. A review of the literature on the role of the media in corporate management, especially in the work of corporate leaders, shows how the techniques of power in corporate management have become mediatized. Different media have become increasingly important for the work of corporate leaders. More importantly, media have become tools of power. In flexible and soft capitalism, corporate power is exercised using performative and affective techniques aimed at identity and community formation. Consequently, different media are utilized as tools of corporate management and control. With regard to the mediatization of power, the case of corporate management suggests that one should look into the societal and institutional structures of power rather than into the power of the media.

scholarly journals Understanding the complex pathophysiology of idiopathic intracranial hypertension and the evolving role of venous sinus stenting: a comprehensive review of the literature

2018 ◽  
Vol 45 (1) ◽  
pp. E10 ◽  
Author(s):  
Nisha Giridharan ◽  
Smruti K. Patel ◽  
Amanda Ojugbeli ◽  
Aria Nouri ◽  
Peyman Shirani ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Venous Sinus ◽  
Review Of The Literature ◽  
Optic Nerve Sheath Fenestration ◽  
Standard Management ◽  
Definition Of

Idiopathic intracranial hypertension (IIH) is a disease defined by elevated intracranial pressure without established etiology. Although there is now consensus on the definition of the disorder, its complex pathophysiology remains elusive. The most common clinical symptoms of IIH include headache and visual complaints. Many current theories regarding the etiology of IIH focus on increased secretion or decreased absorption of cerebrospinal fluid (CSF) and on cerebral venous outflow obstruction due to venous sinus stenosis. In addition, it has been postulated that obesity plays a role, given its prevalence in this population of patients. Several treatments, including optic nerve sheath fenestration, CSF diversion with ventriculoperitoneal or lumboperitoneal shunts, and more recently venous sinus stenting, have been described for medically refractory IIH. Despite the availability of these treatments, no guidelines or standard management algorithms exist for the treatment of this disorder. In this paper, the authors provide a review of the literature on IIH, its clinical presentation, pathophysiology, and evidence supporting treatment strategies, with a specific focus on the role of venous sinus stenting.

Current concepts of the interventional treatment of proximal supraaortic vessel stenosis

VASA ◽  
2012 ◽  
Vol 41 (5) ◽  
pp. 313-318 ◽  
Author(s):  
Ernemann ◽  
Bender ◽  
Melms ◽  
Brechtel ◽  
Kobba ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Carotid Bifurcation ◽  
Current Treatment ◽  
Long Term Results ◽  
Clinical Indication ◽  
Interventional Treatment ◽  
Special Focus ◽  
Brachiocephalic Artery ◽  
Treatment Concepts ◽  
Angioplasty And Stenting

Interventional therapies using angioplasty and stenting of symptomatic stenosis of the proximal supraaortic vessels have evolved as safe and effective treatment strategies. The aim of this paper is to summarize the current treatment concepts for stenosis in the subclavian and brachiocephalic artery with regard to clinical indication, interventional technique including selection of the appropriate vascular approach and type of stent, angiographic and clinical short-term and long-term results and follow-up. The role of hybrid interventions for tandem stenoses of the carotid bifurcation and brachiocephalic artery is analysed. A systematic review of data for angioplasty and stenting of symptomatic extracranial vertebral artery stenosis is discussed with a special focus on restenosis rate.

Social Representations and Commitment

2018 ◽  
Vol 23 (3) ◽  
pp. 233-249 ◽  
Author(s):  
Eric Bonetto ◽  
Fabien Girandola ◽  
Grégory Lo Monaco
Keyword(s):  
Social Representations ◽  
Social Representation ◽  
Second Line ◽  
Review Of The Literature ◽  
First Line ◽  
Research Perspectives ◽  
The Social ◽  
Bibliographic Search ◽  
English Articles

Abstract. This contribution consists of a critical review of the literature about the articulation of two traditionally separated theoretical fields: social representations and commitment. Besides consulting various works and communications, a bibliographic search was carried out (between February and December, 2016) on various databases using the keywords “commitment” and “social representation,” in the singular and in the plural, in French and in English. Articles published in English or in French, that explicitly made reference to both terms, were included. The relations between commitment and social representations are approached according to two approaches or complementary lines. The first line follows the role of commitment in the representational dynamics: how can commitment transform the representations? This articulation gathers most of the work on the topic. The second line envisages the social representations as determinants of commitment procedures: how can these representations influence the effects of commitment procedures? This literature review will identify unexploited tracks, as well as research perspectives for both areas of research.

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