scholarly journals Treatment of Acute Pulmonary Embolism: Update on Newer Pharmacologic and Interventional Strategies

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Francesco Pelliccia ◽  
Michele Schiariti ◽  
Claudio Terzano ◽  
Abdul M. Keylani ◽  
Darrin C. D'Agostino ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Evidence ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Common Complication ◽  
Treatment Paradigm ◽  
Institutional Experience

Acute pulmonary embolism (PE) is a common complication in hospitalized patients, spanning multiple patient populations and crossing various therapeutic disciplines. Current treatment paradigm in patients with massive PE mandates prompt risk stratification with aggressive therapeutic strategies. With the advent of endovascular technologies, various catheter-based thrombectomy and thrombolytic devices are available to treat patients with massive or submassive PE. In this paper, a variety of newer treatment strategies for PE are analyzed, with special emphasis on various interventional treatment strategies. Clinical evidence for utilizing endovascular treatment modalities, based on our institutional experience as well as a literature review, is provided.

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.

scholarly journals Post pulmonary embolism syndrome: a common, underdiagnosed complication that is not well recognised

2019 ◽  
Vol 12 (2) ◽  
pp. e226674 ◽  
Author(s):  
Alexander Sanders ◽  
Max Matonhodze
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Treatment Options ◽  
Common Complication ◽  
Embolism Syndrome ◽  
Acute Pe

A 56-year-old man developed chronic breathlessness which persisted for years after he suffered acute pulmonary embolism (PE) despite all investigations being subsequently normal. This case illustrates a very common complication which occurs in up to half of all patients after an acute PE which has been labelled ‘post pulmonary embolism syndrome’, yet it is not well recognised and at present there is not much research into the prevention or even possible treatment options for patients who develop these symptoms.

scholarly journals Circulating MicroRNAs for Diagnosis of Acute Pulmonary Embolism: Still a Long Way to Go

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Matteo Sobrero ◽  
Fabrizio Montecucco ◽  
Federico Carbone
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Application ◽  
Acute Pulmonary Embolism ◽  
Clinical Evidence ◽  
Negative Impact ◽  
Small Sample Size ◽  
Cost Benefit ◽  
Small Sample ◽  
Development Organization

Venous thromboembolism (VTE) represents the third most frequent cause of acute cardiovascular syndrome. Among VTE, acute pulmonary embolism (APE) is the most life-threatening complication. Due to the low specificity of symptoms clinical diagnosis of APE may be sometimes very difficult. Accordingly, the latest European guidelines only suggest clinical prediction tests for diagnosis of APE, eventually associated with D-dimer, a biomarker burdened by a very low specificity. A growing body of evidence is highlighting the role of miRNAs in hemostasis and thrombosis. Due to their partial inheritance and susceptibility to the environmental factors, miRNAs are increasingly described as active modifiers of the classical Virchow’s triad. Clinical evidence on deep venous thrombosis reported specific miRNA signatures associated to thrombosis development, organization, recanalization, and resolution. Conversely, data of miRNA profiling as a predictor/diagnostic marker of APE are still preliminary. Here, we have summarized clinical evidence on the potential role of miRNA in diagnosis of APE. Despite some intriguing insight, miRNA assay is still far from any potential clinical application. Especially, the small sample size of cohorts likely represents the major limitation of published studies, so that extensive analysis of miRNA profiles with a machine learning approach are warranted in the next future. In addition, the cost-benefit ratio of miRNA assay still has a negative impact on their clinical application and routinely test.

scholarly journals GCT-23. MULTI-INSTITUTIONAL ANALYSIS OF TREATMENT MODALITIES IN BASAL GANGLIA AND THALAMIC GERMINOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii332-iii332
Author(s):  
Richard T Graham ◽  
Mohammad H Abu-Arja ◽  
Joseph Stanek ◽  
Ute Bartels ◽  
Andrea Cappellano ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Institutional Analysis ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Event Free Survival ◽  
Free Survival ◽  
Combine Chemotherapy ◽  
Imaging Characteristics ◽  
Significant Difference

Abstract BACKGROUND Central nervous system (CNS) germinomas are radiotherapy (RT)-sensitive tumors with excellent survival. Current treatment strategies combine chemotherapy with RT to reduce the field and dose of RT. There is no standard treatment for germinomas originating in the basal ganglia/thalami (BGTG) given their rarity and poorly-defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have been previously utilized; however, the optimal strategy remains unclear. METHODS Retrospective multi-institutional analysis was conducted across 18 institutions in four countries. RESULTS For 46 cases with non-metastatic BGTG, the event-free survival (EFS) was 86.9% at both 5 and 10 years, while overall survival (OS) was 100%, and 95.7% respectively at 5 and 10 years. Median RT dose and range for the various treatment volumes were as follows: CSI (n=10): 2340 cGy (1980–3060 cGy), WBI (n=8): 2340 (1800–3000 cGy), WVI (n=14): 2340 cGy (1800–2550 cGy), focal (n=9): 3600 cGy (3060–5400 cGy). There was no statistically significant difference in the EFS based on RT modality (p=0.57), but EFS for subjects with CSI and WBI were both 100%. The three subjects who received chemotherapy alone had significantly lower EFS than those who received chemotherapy and RT (p=0.001), but were salvageable with RT. CONCLUSION In the largest study to date for BGTG, there were no significant differences in outcomes between patients who received CSI, WBI, WVI or focal RT. This group of patients should be included in future prospective clinical trials, and a more limited RT field may be considered.

scholarly journals Contemporary clinical management of acute pulmonary embolism: the COPE study

2022 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli ◽  
Aldo Pietro Maggioni ◽  
Francesco Dentali ◽  
Andrea Fabbri ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Low Risk ◽  
Contemporary Management ◽  
Secondary Study ◽  
European Society Of Cardiology ◽  
Acute Pe

Abstract Background New management, risk stratification and treatment strategies have become available over the last years for patients with acute pulmonary embolism (PE), potentially leading to changes in clinical practice and improvement of patients’ outcome. Methods The COntemporary management of Pulmonary Embolism (COPE) is a prospective, non-interventional, multicentre study in patients with acute PE evaluated at internal medicine, cardiology and emergency departments in Italy. The aim of the COPE study is to assess contemporary management strategies in patients with acute, symptomatic, objectively confirmed PE concerning diagnosis, risk stratification, hospitalization and treatment and to assess rates and predictors of in-hospital and 30-day mortality. The composite of death (either overall or PE-related) or clinical deterioration at 30 days from the diagnosis of PE, major bleeding occurring in hospital and up to 30 days from the diagnosis of PE and adherence to guidelines of the European Society of Cardiology (ESC) are secondary study outcomes. Participation in controlled trials on the management of acute PE is the only exclusion criteria. Expecting a 10–15%, 3% and 0.5% incidence of death for patients with high, intermediate or low-risk PE, respectively, it is estimated that 400 patients with high, 2100 patients with intermediate and 2500 with low-risk PE should be included in the study. This will allow to have about 100 deaths in study patients and will empower assessment of independent predictors of death. Conclusions COPE will provide contemporary data on in-hospital and 30-day mortality of patients with documented PE as well as information on guidelines adherence and its impact on clinical outcomes. Trail registration NCT number: NCT03631810.

CD70 as a critical mediator of tumor progression and immunosuppression in gliomas.

2017 ◽  
Vol 35 (7_suppl) ◽  
pp. 18-18
Author(s):  
Changlin Yang ◽  
Haitao Ge ◽  
Linchun Jin ◽  
Qiong J. Wang ◽  
James C. Yang ◽  
...  
Keyword(s):  
Tumor Progression ◽  
T Regulatory Cells ◽  
Malignant Gliomas ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Specific Cell ◽  
Low Grade ◽  
Chemokine Production ◽  
Poor Survival Outcome

18 Background: For malignant gliomas, current treatment modalities are rarely curative, necessitating development of novel therapies. Cancer immunotherapy has represented one of the most promising new treatment strategies for patients with gliomas based on the evidence that patients with brain tumors are able to mount immune responses against the autologous tumors. However, very few tumor specific targets have been discovered in this malignancy. Thus, identifying clinical useful targets for immunotherapeutic approaches is desperately needed. Methods: CD70 expression was tested from primary GBM and low grade gliomas patient tissues. CD70 gene expression and clinical outcomes were culled from TCGA datasets. CD70 inducing CD8 T cells death was performed by flowcytometry. Results: We demonstrate that CD70, a member of the TNF ligand family, was constitutively overexpressed by primary IDH-wild-type LGG and GBMs with mesenchymal gene signatures. Elevated CD70 expression was also found in recurrent tumors and correlated with tumor progression and poor survival outcome in LGGs and GBMs. CD70 was shown to be directly involved in tumor-chemokine production and associated with sustained T regulatory cells in tumor. Importantly, CD70 played a role inducing CD8+T- specific cell death via engagement of the EREG-EGFR axis in glioma. Conclusions: CD70 is a multi-pronged modulator of immunosuppression in gliomas and enhances tumor progression.

Interventional Reperfusion Strategies for Acute Pulmonary Embolism

Praxis ◽  
2021 ◽  
Vol 110 (13) ◽  
pp. 743-751
Author(s):  
Dominik F. Draxler ◽  
Stefan Stortecky
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Stroke Risk ◽  
Interventional Treatment ◽  
Therapeutic Approaches ◽  
Early Reperfusion ◽  
The Third ◽  
Catheter Directed Thrombolysis ◽  
Life Threatening ◽  
Reperfusion Strategy

Abstract. Acute pulmonary embolism (APE) is a common, potentially life-threatening cardiovascular emergency, and represents the third leading cause of cardiovascular mortality after myocardial infarction and stroke. Risk stratification is important to guide the management of APE, as an early reperfusion strategy is associated with improved clinical outcomes in specific high-risk conditions. Pulmonary artery reperfusion is commonly achieved by systemic intravenous administration of thrombolytic drugs, but catheter-directed thrombolysis (CDThr) and interventional techniques of catheter-based embolectomy provide novel therapeutic approaches with an improved risk-benefit ratio. Future trials will help to determine when to use these different devices in massive or sub-massive APE, and which patient population is likely to benefit from interventional treatment.

scholarly journals Immune Dysfunction and Multiple Treatment Modalities for the SARS-CoV-2 Pandemic: Races of Uncontrolled Running Sweat?

Biology ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 243
Author(s):  
Ashish Kothari ◽  
Vanya Singh ◽  
Uttam Kumar Nath ◽  
Sandeep Kumar ◽  
Vineeta Rai ◽  
...  
Keyword(s):  
Clinical Trials ◽  
High Performance ◽  
Immune Cell ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Antigen Receptors ◽  
Multiple Treatment ◽  
Global Pandemic ◽  
Treatment Plans

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic threat with more than 11.8 million confirmed cases and more than 0.5 million deaths as of 3 July 2020. Given the lack of definitive pharmaceutical interventions against SARS-CoV-2, multiple therapeutic strategies and personal protective applications are being used to reduce the risk of high mortality and community spread of this infection. Currently, more than a hundred vaccines and/or alternative therapeutic regimens are in clinical trials, and some of them have shown promising results in improving the immune cell environment and controlling the infection. In this review, we discussed high-performance multi-directory strategies describing the uncontrolled deregulation of the host immune landscape associated with coronavirus disease (COVID-19) and treatment strategies using an anti-neoplastic regimen. We also followed selected current treatment plans and the most important on-going clinical trials and their respective outcomes for blocking SARS-CoV-2 pathogenesis through regenerative medicine, such as stem cell therapy, chimeric antigen receptors, natural killer (NK) cells, extracellular vesicular-based therapy, and others including immunomodulatory regimens, anti-neoplastic therapy, and current clinical vaccine therapy.

scholarly journals Perinatal Hypoxic-Ischemic Damage: Review of the Current Treatment Possibilities

2021 ◽  
pp. S379-S401
Author(s):  
A FRAJEWICKI ◽  
Z LAŠTŮVKA ◽  
V BORBÉLYOVÁ ◽  
S KHAN ◽  
K JANDOVÁ ◽  
...  
Keyword(s):  
Muscle Tone ◽  
Research Effort ◽  
Treatment Strategies ◽  
Perinatal Period ◽  
Current Treatment ◽  
Hypoxic Ischemic Encephalopathy ◽  
Treatment Modalities ◽  
Motor Disabilities ◽  
Promising Treatment ◽  
Ischemic Encephalopathy

Neonatal hypoxic-ischemic encephalopathy is a disorder with heterogeneous manifestation due to asphyxia during perinatal period. It affects approximately 3-12 children per 1000 live births and cause death of 1 million neonates worldwide per year. Besides, motor disabilities, seizures, impaired muscle tone and epilepsy are few of the consequences of hypoxic-ischemic encephalopathy. Despite an extensive research effort regarding various treatment strategies, therapeutic hypothermia with intensive care unit supportive treatment remains the only approved method for neonates who have suffered from moderate to severe hypoxic-ischemic encephalopathy. However, these protocols are only partially effective given that many infants still suffer from severe brain damage. Thus, further research to systematically test promising neuroprotective treatments in combination with hypothermia is essential. In this review, we discussed the pathophysiology of hypoxic-ischemic encephalopathy and delved into different promising treatment modalities, such as melatonin and erythropoietin. However, preclinical studies and clinical trials are still needed to further elucidate the mechanisms of action of these modalities.

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