EXTENSION OF THE FUNCTIONAL CLASS OF DEGREE MODIFIERS IN MODERN ENGLISH

Pulmonary arterial hypertension is a progressive disease of the pulmonary vasculature, ultimately leading to right heart failure and death. Current treatment is aimed at targeting three different pathways: the prostacyclin, endothelin and nitric oxide pathways. These therapies improve functional class, increase exercise capacity and improve haemodynamics. In addition, data from a meta-analysis provide compelling evidence of improved survival. Despite these treatments, the outcome is still grim and the cause of death is inevitable – right ventricular failure. One explanation for this paradox of haemodynamic benefit and still worse outcome is that the right ventricle does not benefit from a modest reduction in pulmonary vascular resistance. This article describes the physiological concepts that might underlie this paradox. Based on these concepts, we argue that not only a significant reduction in pulmonary vascular resistance, but also a significant reduction in pulmonary artery pressure is required to save the right ventricle. Haemodynamic data from clinical trials hold the promise that these haemodynamic requirements might be met if upfront combination therapy is used.

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STEVIA PLANT - ALTERNATIVE SWEETNER IN FOOD TECHNOLOGY

Knowledge International Journal ◽

10.35120/kij28041213j ◽

2018 ◽

Vol 28 (4) ◽

pp. 1213-1217

Author(s):

Jovana Džoljić ◽

Ljiljana Đorđević

Keyword(s):

Food Additives ◽

Functional Class ◽

World Health ◽

Food Technology ◽

Food Standards ◽

Safety Studies ◽

Negative Side Effects ◽

Health Organization ◽

Almost All ◽

Agricultural Organization

Food and Agricultural Organization as a “sweeteners” consider products used for sweetening derived from sugar crops, cereals, fruits or milk, or that are produced by insects. Sweeteners, as an additive, have important role for technological functions of food, especially in providing texture, bulk and color, and also as preservative agents. Regardless the numerous sweeteners, alternative sweeteners to sucrose are in main focus for implementation in food industry. Nowadays Food and Agricultural Organization and World Health Organization Food standards, Codex Alimentarius Commission (2018) accepted list of 27 food additives that have the functional class “sweetener”. Nowadays, alternative sweeteners and their application in food technology are in main focus of scientist. Stevia plant stands for one of the most important natural intense sweetener, since stevia glycosides are almost 400 times sweeter than sucrose. Extracts of stevia represents a powerful tool for reducing sugars in food and beverages, which can be acceptable substitutes to full sugar versions of this products. Regarding the data of Euromonitor international, new food products containing stevia grew 10% from 2016 to 2017. The biggest increment in stevia use was noticed in categories of snacks, juice drinks, dairy, carbonated soft drinks and confectionery. Barriocanal et al. (2008) highlighted that safety studies reported no negative side effects of stevia use. Can be expected that in recent future use of S. rebaudiana as sweetener would be extended to almost all the world’s countries, regarding all discovered beneficial health effects.

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Dissociation Between Improvement in Left Ventricular Performance and Functional Class in Patients With Chronic Heart Failure

Journal of Cardiovascular Pharmacology ◽

10.1097/01.fjc.0000175235.33949.c4 ◽

2005 ◽

Vol 46 (3) ◽

pp. 262-268 ◽

Cited By ~ 5

Author(s):

Pierre V Ennezat ◽

Caroline A Ennezat ◽

Pugazhendhi Vijayaraman ◽

Justine Lachmann ◽

Philippe Asseman ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Performance ◽

Ventricular Performance

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Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1716324 ◽

2020 ◽

Author(s):

Julia Götte ◽

Armin Zittermann ◽

Kavous Hakim-Meibodi ◽

Masatoshi Hata ◽

Rene Schramm ◽

...

Keyword(s):

Mitral Valve ◽

General Population ◽

Elderly Patients ◽

Cox Regression ◽

Functional Class ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

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Adolescents and adults with Fontan circulation: insights from the PREpArE-Fontan registry

Cardiology in the Young ◽

10.1017/s1047951121002791 ◽

2021 ◽

pp. 1-9

Author(s):

Lars Søndergaard ◽

Jamil Aboulhosn ◽

Yves d’Udekem ◽

Céline Faure ◽

Wayne J Franklin ◽

...

Keyword(s):

Creatinine Clearance ◽

Receptor Antagonist ◽

Functional Class ◽

Fontan Circulation ◽

Endothelin Receptor Antagonist ◽

Endothelin Receptor ◽

Converting Enzyme Inhibitors ◽

Nyha Functional Class ◽

Lateral Tunnel ◽

Adolescents And Adults

Abstract The Patient Registry for Adolescents and Adults with Stable Fontan Circulation aims to describe a contemporary cohort of Fontan patients who could be eligible for a clinical trial investigating macitentan, an endothelin receptor antagonist. This international, non-interventional, multicentre, cross-sectional, observational registry enrolled patients with “stable” Fontan circulation ≥10 years following extra-cardiac conduit or lateral tunnel procedure. Main exclusion criteria were NYHA functional class IV, reoperation of Fontan circulation, or signs of disease worsening. Patient characteristics at enrolment are described; available data were collected during a single registration visit. Of the 266 screened patients, 254 were included in this analysis. At enrolment, median (interquartile range) age was 24 (20;30) years, 37%/63% of patients were from the USA/Europe, 54% were male, 54%/47% had undergone extra-cardiac conduit/lateral tunnel procedures, and 95% were in NYHA functional class I or II. History of arrhythmia was more common in older patients and patients with lateral tunnel; overall prevalence was 19%. Most laboratory values were within the normal range but mean creatinine clearance was abnormally low (87.7 ml/min). Angiotensin-converting enzyme inhibitors were used by 48% of patients and their use was associated with creatinine clearance <90 ml/min (p = 0.007), as was Fontan completion at an older age (p = 0.007). 53.4% of patients had clinical characteristics that could potentially meet an endothelin receptor antagonist trial’s eligibility criteria. The PREpArE-Fontan registry describes a cohort of patients who could potentially participate in an endothelin receptor antagonist trial and identified early subtle signs of Fontan failure, even in “stable” patients.

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