scholarly journals Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

2021 ◽  
Vol 8 ◽  
Author(s):  
Le Li ◽  
Zhao Hu ◽  
Yulong Xiong ◽  
Yan Yao
Keyword(s):  
Cardiovascular Diseases ◽  
Sympathetic Nerve ◽  
Large Scale ◽  
Clinical Evidence ◽  
Ventricular Remodeling ◽  
Therapeutic Option ◽  
Vascular Endothelial ◽  
Randomized Controlled ◽  
Novel Approaches ◽  
Nerve Regulation

Sympathetic overactivation plays an important role in promoting a variety of pathophysiological processes in cardiovascular diseases (CVDs), including ventricular remodeling, vascular endothelial injury and atherosclerotic plaque progression. Device-based sympathetic nerve (SN) regulation offers a new therapeutic option for some CVDs. Renal denervation (RDN) is the most well-documented method of device-based SN regulation in clinical studies, and several large-scale randomized controlled trials have confirmed its value in patients with resistant hypertension, and some studies have also found RDN to be effective in the control of heart failure and arrhythmias. Pulmonary artery denervation (PADN) has been clinically shown to be effective in controlling pulmonary hypertension. Hepatic artery denervation (HADN) and splenic artery denervation (SADN) are relatively novel approaches that hold promise for a role in cardiovascular metabolic and inflammatory-immune related diseases, and their first-in-man studies are ongoing. In addition, baroreflex activation, spinal cord stimulation and other device-based therapies also show favorable outcomes. This review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for some CVDs.

Role of Biologics in Chronic Rhinosinusitis With Nasal Polyposis: State of the Art Review

2020 ◽  
pp. 019459982093996 ◽  
Author(s):  
Christine Kim ◽  
Joseph Han ◽  
Tara Wu ◽  
Claus Bachert ◽  
Wytske Fokkens ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Large Scale ◽  
Nasal Polyposis ◽  
Therapeutic Option ◽  
Cochrane Review ◽  
Clinical Problem ◽  
Randomized Controlled ◽  
Systemic Treatments

Objective To review the current literature regarding the role of biologics in the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). Data Sources PubMed/MEDLINE, EMBASE, Cochrane Review, ClinicalTrials.gov Review Methods We conducted a comprehensive review of the literature on clinical studies investigating the efficacy of emerging biologics in CRSwNP, with a focus on randomized controlled trials. Conclusions There appears to be promising evidence to support the safety and efficacy of biologics in CRSwNP with and without asthma for select patients. However, additional large-scale randomized studies with longer follow-up are necessary to determine which patients would benefit the most from these novel systemic treatments. Implications for Practice Chronic rhinosinusitis with nasal polyposis refractory to medical and surgical therapy remains a challenging clinical problem for otolaryngologists. However, emerging biologic therapies may offer a new therapeutic option for such patients with recalcitrant disease.

Relationship between total plasma homocysteine and the risk of aneurysms – a meta-analysis

VASA ◽  
2020 ◽  
pp. 1-6
Author(s):  
Hanji Zhang ◽  
Dexin Yin ◽  
Yue Zhao ◽  
Yezhou Li ◽  
Dejiang Yao ◽  
...  
Keyword(s):  
Large Scale ◽  
Meta Analysis ◽  
Single Species ◽  
Total Plasma ◽  
Control Groups ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
The Difference ◽  
The Relationship ◽  
Healthy Participants

Summary: Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.

Should all Hypertensive Patients be Screened for Primary Aldosteronism?

2019 ◽  
Vol 15 (1) ◽  
pp. 54-56
Author(s):  
Stelina Alkagiet ◽  
Konstantinos Tziomalos
Keyword(s):  
Resistant Hypertension ◽  
Primary Aldosteronism ◽  
Large Scale ◽  
Controlled Trial ◽  
The Other ◽  
Limited Data ◽  
Hypertensive Patients ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Prospective Randomized Controlled Trial

Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover, PA is associated with increased cardiovascular risk, which is disproportionate to BP levels. In addition, timely diagnosis of PA and prompt initiation of treatment attenuate this increased risk. On the other hand, there are limited data regarding the usefulness of screening for PA in all asymptomatic or normokalemic hypertensive patients. More importantly, until now, no well-organized, large-scale, prospective, randomized controlled trial has proved the effectiveness of screening for PA for improving clinical outcome. Accordingly, until more relevant data are available, screening for PA should be considered in hypertensive patients with spontaneous or diuretic-induced hypokalemia as well as in those with resistant hypertension. However, screening for PA in all hypertensive patients cannot be currently recommended.

Effects of Dingchuan Decoction on Lung Function and Clinical Effectiveness Rate in Children with Asthma: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Sheng-Nan Wang ◽  
Jia-Li Yan ◽  
Shao-Xing Wu ◽  
Lei Wu ◽  
Yan-Chan Zheng ◽  
...  
Keyword(s):  
Lung Function ◽  
Randomized Controlled Trials ◽  
Large Scale ◽  
Clinical Effectiveness ◽  
Controlled Trials ◽  
Improvement Rate ◽  
Randomized Controlled ◽  
Conventional Medication ◽  
Effectiveness Rate ◽  
Children With Asthma

Dingchuan decoction (DCD) is a traditional Chinese prescription for asthma that remains popular today. To systematically evaluate the effect of DCD on lung function, clinical effectiveness rate, and safety in children with asthma, significant databases were searched for randomized controlled trials from their inception to September 9, 2019. Randomized controlled trials assessing the effect of DCD on lung function and clinical effectiveness rate in children with asthma were included in this meta-analysis. The methodological quality of the included trials was assessed using the Cochrane risk of bias tool. RevMan 5.3 was used for data analysis. Fourteen studies with 1,384 children were reviewed. FEV<sub>1</sub> improvement rate (mean difference [MD] 12.50, 95% confidence interval [CI] 8.72–16.29), PEF improvement rate (MD 14.28, 95% CI 11.08–17.49), and clinical effectiveness rate (relative risk 1.19, 95% CI 1.14–1.25) significantly increased in the DCD group when compared to simple conventional medication. Four trials suggest that DCD is safe for children. In conclusion, the use of DCD combined with conventional medication improves lung function and clinical effectiveness rate better than simple conventional medication. However, the selected trials lack blinding and large-scale studies. Therefore, to better manage DCD in clinical practice, more randomized controlled trials and large-scale studies are required for further evaluation.

scholarly journals Early anti IL-1 treatment replaces steroids in refractory Kawasaki disease: clinical experience from two case reports

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110025
Author(s):  
Maria Vincenza Mastrolia ◽  
Giulia Abbati ◽  
Claudia Signorino ◽  
Ilaria Maccora ◽  
Edoardo Marrani ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Evidence ◽  
Case Reports ◽  
Therapeutic Option ◽  
Intravenous Immunoglobulins ◽  
Second Line Therapy ◽  
Coronary Artery Aneurysms ◽  
Coronary Arteritis ◽  
Line Therapy ◽  
Prior Use

Refractory Kawasaki disease (KD) is related to a major risk of coronary arteries abnormalities and its treatment is not standardized. In this regard, anakinra (ANA), an interleukin (IL)-1 receptor antagonist, represents an emerging therapeutic option. We report two cases of children, diagnosed with KD, nonresponsive to two doses of intravenous immunoglobulins, successfully treated with ANA, without a prior use of steroids. Patient 2 developed a coronary dilatation, that improved significantly after ANA therapy. Our experience highlights IL-1 blockade effectiveness in reducing KD inflammation and suggests ANA adoption as second-line therapy, with a timesaving and steroid-sparing strategy. Our results, combined with the evidence of the IL-1 key role in KD and coronary arteritis pathogenesis and to the recent clinical evidence reported by the KAWAKINRA trial, encourage an earlier recourse to ANA in patients with refractory KD, in order to fight inflammation, and to treat and prevent the development of coronary artery aneurysms. Further studies are needed to better define the place of IL-1 blockade in KD step-up treatment.

scholarly journals Personalized medicine for reconstruction of critical-size bone defects – a translational approach with customizable vascularized bone tissue

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Annika Kengelbach-Weigand ◽  
Carolina Thielen ◽  
Tobias Bäuerle ◽  
Rebekka Götzl ◽  
Thomas Gerber ◽  
...  
Keyword(s):  
Personalized Medicine ◽  
Large Scale ◽  
Critical Size ◽  
Therapeutic Option ◽  
Living Organism ◽  
Bone Defects ◽  
Sheep Model ◽  
Simple Alternative ◽  
Translational Approach ◽  
Near Future

AbstractTissue engineering principles allow the generation of functional tissues for biomedical applications. Reconstruction of large-scale bone defects with tissue-engineered bone has still not entered the clinical routine. In the present study, a bone substitute in combination with mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) with or without growth factors BMP-2 and VEGF-A was prevascularized by an arteriovenous (AV) loop and transplanted into a critical-size tibia defect in the sheep model. With 3D imaging and immunohistochemistry, we could show that this approach is a feasible and simple alternative to the current clinical therapeutic option. This study serves as proof of concept for using large-scale transplantable, vascularized, and customizable bone, generated in a living organism for the reconstruction of load-bearing bone defects, individually tailored to the patient’s needs. With this approach in personalized medicine for the reconstruction of critical-size bone defects, regeneration of parts of the human body will become possible in the near future.

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