scholarly journals Biomarkers of Carotid Stenosis

2021 ◽  
Vol 3 (1) ◽  
pp. 104-130
Author(s):  
Sergey G. Sсherbak ◽  
Tatyana A. Kamilova ◽  
Svetlana V. Lebedeva ◽  
Dmitry A. Vologzhanin ◽  
Alexander S. Golota ◽  
...  
Keyword(s):  
Matrix Metalloproteinases ◽  
Carotid Stenosis ◽  
Plaque Rupture ◽  
Early Recognition ◽  
Clinical Problem ◽  
Vascular Wall ◽  
Inflammatory Factors ◽  
Atherosclerotic Lesions ◽  
Important Clinical Problem ◽  
Definition Of

Early recognition of rupture-prone atherosclerotic lesions in patients with high-graded carotid stenosis is an important clinical problem for preventing ischemic stroke. Various pathophysiological mechanisms are responsible for the progression and instability of plaques, such as changes in lipid composition, infiltration by immunoinflammatory cells and degradation of the extracellular matrix of the vascular wall by matrix metalloproteinases, enhanced inflammatory response and plaque neovascularization. These features are the main cause of plaque rupture and, as a consequence, neurologic symptoms. Therefore, matrix metalloproteinases and inflammatory factors can serve as possible markers for patients with severe unstable stenosis of carotid arteries. Due to the heterogeneity of atherosclerotic lesions, only one biomarker is not enough to reliably predict the development of a stroke. The use of a combination of biomarkers is better correlated with clinical data and, therefore, exceeds the analysis of individual factors. To increase the overall sensitivity and specificity and more reliable diagnosis of stroke in patients with symptomatic and asymptomatic carotid stenosis, the biomarker panel should include independent biomarkers. Further preclinical experiments and clinical trials are needed to assess the significance and precise definition of the threshold levels of such biomarkers before they can be used in clinical practice.

Recent Advances in the Management of Cardiogenic Shock

2021 ◽  
Author(s):  
Christine M. Gasperetti
Keyword(s):  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Case Studies ◽  
Mechanical Circulatory Support ◽  
Early Recognition ◽  
Dynamic State ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Recent Advances ◽  
Definition Of

For decades, the cardiogenic shock has remained one of the cardiac illnesses with the highest mortality, as high as 50%. Recent advances have lowered this mortality rate by use of early recognition of shock as well as an increased understanding of both advanced mechanical support and the hemodynamics of myocardial support. Included are the new definition of shock, results of a study of inotropic medications in shock, description, and case studies of mechanical circulatory support, all providing a framework for the overall goal in the management of cardiogenic shock as one to recognize shock, follow its dynamic state, and maximize support to patients toward recovery.

Abstract P563: Prognosis Driven Definition of Carotid Near-Occlusion With Full Collapse

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Charith Cooray ◽  
Thomas Gu ◽  
Allan J Fox ◽  
Elias Johansson
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Risk Markers ◽  
Inclusion Criteria ◽  
Short Term ◽  
Residual Stenosis ◽  
Kaplan Meier ◽  
Near Occlusion ◽  
Definition Of ◽  
Distal Artery

Introduction: Carotid near-occlusion is a severe carotid stenosis causing distal artery collapse of varying degree. Near-occlusion is often divided into a “full collapse” group with a threadlike distal lumen, and the often overlooked “without full collapse” group with a normal-appearing, albeit small, distal lumen. By this division by appearance, symptomatic near-occlusion with full collapse has been reported to have worse short-term prognosis than those without full collapse, no other division has been assessed for prognosis. The aim of this study was to assess if a measurement based definition of full collapse might improve prognostic discrimination. Methods: 99 consecutive patients with symptomatic near-occlusion diagnosed on CT-angiography were included. The risk of preoperative recurrent ipsilateral ischemic stroke within 28 days of presenting event was assessed with Kaplan-Meier analysis, censoring at revascularization. We assessed residual stenosis diameter, distal ICA diameter, ICA-ratio (side-to-side), and ICA-ECA ratio as risk markers. Results: By appearance, the 28-day risk of stroke tended to be higher for full collapse (27%, 11/42) than without full collapse (11%, 6/57), p=0.054 (figure). The best new definition of full collapse was distal ICA diameter ≤2.0 mm and/or ICA ratio ≤0.47. 10 patients were reclassified by this new definition compared to appearance definition, 5 in each direction. By the new definition, 28-day risk of stroke was higher in full collapse (34%, 14/42) than without full collapse (5%, 3/57), p<0.001 (fig 1B). Conclusions: Compared to the appearance based definition, our new definition of separating near-occlusions into with and without full collapse yields similar groups sizes but better prognostic discrimination. This new definition could be used as inclusion criteria in future treatment trials.

scholarly journals Late Protective Effect of Netrin-1 in the Murine Acetaminophen Hepatotoxicity Model

2020 ◽  
Vol 175 (2) ◽  
pp. 168-181 ◽  
Author(s):  
Luqi Duan ◽  
Benjamin L Woolbright ◽  
Hartmut Jaeschke ◽  
Anup Ramachandran
Keyword(s):  
Liver Injury ◽  
Alanine Aminotransferase ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Clinical Problem ◽  
The United States ◽  
Therapeutic Window ◽  
Protective Effects ◽  
Apap Overdose ◽  
Important Clinical Problem

Abstract Acetaminophen (APAP) overdose-induced acute liver failure is an important clinical problem in the United States and the current antidote N-acetylcysteine, has a short early therapeutic window. Since most patients present late to the clinic, there is need for novel late-acting therapeutic options. Though the neuronal guidance cue netrin-1, has been shown to promote hepatic repair and regeneration during liver ischemia/reperfusion injury, its effect in APAP-induced hepatotoxicity is unknown. In the quest for a late-acting therapeutic intervention in APAP-induced liver injury, we examined the role of netrin-1 in a mouse model of APAP overdose. Male C57BL/6J mice were cotreated with exogenous netrin-1 or vehicle control, along with 300 mg/kg APAP and euthanized at 6, 12, and 24 h. Significant elevations in alanine aminotransferase indicative of liver injury were seen in control mice at 6 h and this was not affected by netrin-1 administration. Also, netrin-1 treatment did not influence mitochondrial translocation of phospho-JNK, or peroxynitrite formation indicating that there was no interference with APAP-induced injury processes. Interestingly however, netrin-1 administration attenuated liver injury at 24 h, as seen by alanine aminotransferase levels and histology, at which time significant elevations in the netrin-1 receptor, adenosine A2B receptor (A2BAR) as well as macrophage infiltration was evident. Removal of resident macrophages with clodronate liposomes or treatment with the A2BAR antagonist PSB1115 blocked the protective effects of netrin-1. Thus, our data indicate a previously unrecognized role for netrin-1 in attenuation of APAP hepatotoxicity by enhancing recovery and regeneration, which is mediated through the A2BAR and involves resident liver macrophages.

scholarly journals Nitric oxide function in atherosclerosis

1997 ◽  
Vol 6 (1) ◽  
pp. 3-21 ◽  
Author(s):  
K. E. Matthys ◽  
H. Bult
Keyword(s):  
Nitric Oxide ◽  
Leukocyte Adhesion ◽  
Atherosclerotic Lesion ◽  
Vascular Wall ◽  
Early Event ◽  
No Production ◽  
Oxygen Intermediates ◽  
Atherosclerotic Lesions ◽  
Oxide Synthase ◽  
Endothelial Nitric Oxide

Atherosclerosis is a chronic inflammatory process in the intima of conduit arteries, which disturbs the endothelium-dependent regulation of the vascular tone by the labile liposoluble radical nitric oxide (NO) formed by the constitutive endothelial nitric oxide synthase (eNOS). This defect predisposes to coronary vasospasm and cardiac ischaemia, with anginal pain as the typical clinical manifestation. It is now appreciated that endothelial dysfunction is an early event in atherogenesis and that it may also involve the microcirculation, in which atherosclerotic lesions do not develop. On the other hand, the inflammatory environment in atherosclerotic plaques may result in the expression of the inducible NO synthase (iNOS) isozyme. Whether the dysfunction in endothelial NO production is causal to, or the result of, atherosclerotic lesion formation is still highly debated. Most evidence supports the hypothesis that constitutive endothelial NO release protects against atherogenesis e.g. by preventing smooth muscle cell proliferation and leukocyte adhesion. Nitric oxide generated by the inducible isozyme may be beneficial by replacing the failing endothelial production but excessive release may damage the vascular wall cells, especially in combination with reactive oxygen intermediates.

Current consideration and management of disseminated intravascular coagulation

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 286-291 ◽  
Author(s):  
Cheng Hock Toh ◽  
Yasir Alhamdi
Keyword(s):  
Conceptual Understanding ◽  
Disseminated Intravascular Coagulation ◽  
Cell Injury ◽  
Early Recognition ◽  
Clinical Care ◽  
Clinical Problem ◽  
Intravascular Coagulation ◽  
Central Tenet ◽  
Functional Consequences

Abstract Disseminated intravascular coagulation (DIC) is a devastating clinical condition that is characterized by the loss of normal hemostatic control in response to sustained and systemic cell injury. The inciting injury may be from infection, trauma, or malignancy, but the consequent pathophysiology is multifactorial involving intertwined feedback loops between the coagulant, immune, and inflammatory pathways. Central to this is thrombin generation, but the ubiquitous nature of its in vivo functional consequences can make it difficult to dissect away the separate but overlapping components to the clinical problem. Therefore, early recognition and resolution of the precipitating events leading to DIC remains the central tenet to clinical care. This article refreshes our conceptual understanding of DIC pathogenesis and draws in recent advances in the cycle of cell death caused by extracellular nuclear proteins. It also aims to delineate recognition of response pathways that can be predominantly procoagulant or profibrinolytic to enable a more personalized and evidence-based approach to be delivered to the patient with DIC.

scholarly journals A STUDY ON ADVERSE DRUG REACTIONS IN PATIENTS ON ANTIRETROVIRAL THERAPY IN A TERTIARY CARE HOSPITAL AT JAIPUR, RAJASTHAN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Vishnu Gupta ◽  
Abhishek Agarwal
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Early Recognition ◽  
Tertiary Care ◽  
Hiv Treatment ◽  
Research Review ◽  
Care Hospital ◽  
Medical College ◽  
The Status ◽  
Definition Of

Background: The present study was conducted to know the status of ADRs caused due to the first line ART in the ART center of SMS Hospital Jaipur, Rajasthan. This study would be beneficial to the HIV infected patients, with the ultimate goal of improving the tolerability and effectiveness of HIV treatment by promoting the early recognition of potentially serious adverse effects. Methods: Hospital based Prospective, Observational study conducted after approval by research review board and ethics committee SMS Medical College Jaipur (Rajasthan). WHO definition of ADR was used (any response to a medicine which is noxious and unintended and which occurs at doses normally used in man). The detail of ADRs collected including suspected drug involved, treatment given for ADRs and outcome. Results: Majority of ADRs were related to central and peripheral nervous system related 55 (47%) followed by gastro intestinal 28 (23.9%), dermatological 15 (12.8%), musculoskeletal 9 (7.7%) and metabolic 5 (4.3%). Conclusion: Majority of ADRs were related to central and peripheral nervous system related followed by gastro intestinal. Keywords: ADRs, HIV, WHO.

scholarly journals Pathophysiological justification of the use of photodynamic therapy in the initial stage of squamous cell skin cancer

2021 ◽  
Vol 67 (1) ◽  
pp. 77-84
Author(s):  
Vladimir Masljakov ◽  
Dmitry Grebnev ◽  
Larisa Kim
Keyword(s):  
Photodynamic Therapy ◽  
Surgical Treatment ◽  
Skin Cancer ◽  
Matrix Metalloproteinases ◽  
Squamous Cell ◽  
Therapy Group ◽  
Combined Treatment ◽  
Vascular Wall ◽  
Comprehensive Treatment ◽  
Initial Stage

The work is based on an analysis of the course of the disease in 185 patients with squamous cell skin cancer. The study program included studies in three major groups. The first included 74 (40%) patients who underwent combined treatment: an operation involving widespread excision of a tumor under intravenous anesthesia + photodynamic therapy (group 1). The second group was 111 (60%) patients with squamous cell carcinoma of the skin who received only operative treatment. To control and compare the obtained laboratory indicators, a second group was created, which included patients without established pathology. This group included 17 people who voluntarily agreed to conduct the study. The study traced the dynamics of changes in hemostasis scores and metalloproteinases in the two groups being compared. In the group of patients with squamous cell skin cancer, there was a statistically significant decrease in the metalloproteinase-1 inhibitor index, which led to an increase in all metalloproteinase-2, -7 and -9 indicators. Performing surgical treatment did not lead to correction of these indicators, both in the near and distant periods after treatment. The mechanism of influence of photodynamic therapy in squamous cell skin cancer can be characterized as follows: there is a decrease in the inhibitor of metalloproteinase-1, which leads to an increase in matrix metalloproteinases-2, -7 and -9 in the blood, as a result of damage to the endothelium of the vascular wall, which is confirmed by an increase in endothelin, this, in turn, led to the development of vasoconstriction and increased procoagulant activity The use of photodynamic therapy restores the index of metalloproteinase-1 inhibitor, this leads to the restoration of matrix metalloproteinases-2, -7 and -9 in the blood and the prevention of damage to the vascular wall. Comprehensive treatment of patients with squamous cell skin cancer in the initial stage of the disease should include photodynamic therapy with simultaneous intravenous blood irradiation, laser tumor training, and then surgical treatment, consisting in excision of the tumor with observance of oncological principles.

scholarly journals Potential drug-drug interactions in the psychiatric hospital: Frequency analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Oleg O. Kirilochev ◽  
Inna P. Dorfman ◽  
Adelya R. Umerova ◽  
Svetlana E. Bataeva
Keyword(s):  
Drug Interactions ◽  
Clinical Significance ◽  
Psychiatric Hospital ◽  
Psychiatric Inpatient ◽  
Clinical Problem ◽  
Drug Combinations ◽  
Drug Prescriptions ◽  
Inpatient Setting ◽  
Potential Drug ◽  
Important Clinical Problem

Introduction: Drug-drug interactions are an important clinical problem in pharmacotherapy. This study is focused on different types of drugs used in a psychiatric hospital. Materials and methods: The pharmacoepidemiological study included the analysis of medical records of 500 psychiatric inpatients. The patients were divided into 2 groups: under 65 and over 65 years of age. All the drug prescriptions were analyzed to identify the combinations of drugs that can induce drug-drug interactions and determine their clinical significance. Results and discussion: Over 77% of hospitalized patients were administered drug combinations that could induce drug-drug interactions, most of which were of moderate clinical significance. A reliable association was found between the patient’s age, the clinical significance of drug-drug interactions, and the pharmacotherapy structure. The most common irrational drug combinations were identified. Conclusion: Timely analysis of drug prescriptions for potential drug-drug interactions can enhance the safety of pharmacotherapy and decrease the risk of adverse drug reactions in the psychiatric inpatient setting.

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