scholarly journals An integrated method of management for children with cardiovascular pathology

2021 ◽  
Author(s):  
М.А. Бабайкина ◽  
О.Б. Гордеева ◽  
Н.В. Федорова ◽  
Н.Д. Вашакмадзе ◽  
Н.В. Журкова ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Clinical Laboratory ◽  
Beta Blockers ◽  
Antiplatelet Agents ◽  
Individual Sensitivity ◽  
Cardiovascular Pathology ◽  
Integrated Method ◽  
Conduction Disorders ◽  
Depth Study

В последние годы регистрируется все больше случаев кардиоваскулярных заболеваний в детской популяции с длительным бессимптомным течением. При этом манифестация заболевания начинается с тромботических проявлений, которые могут привести к инвалидности и летальному исходу. В настоящее время имеется недостаточно данных о влиянии бета-адреноблокаторов на сосудисто-тромбоцитарное звено гемостаза и контроле эффективности терапии у детей с патологией сердечно-сосудистой системы. Лишь незначительное количество публикаций о влиянии бета-адреноблокаторов на агрегацию тромбоцитов представлено в доступной литературе. Своевременная диагностика и персонифицированный выбор тактики терапии пациентов с различными кардиоваскулярными заболеваниями требуют совершенствования подходов к ведению таких больных, поскольку предрасполагающие факторы – хирургические операции, постельный режим, катетеризация периферических вен и высокий риск развития осложнений основного заболевания, в том числе хроническая сердечная недостаточность, способствуют ранней инвалидизации пациента. Исследование проводилось с целью разработки технологии наблюдения за больными разного возраста с кардиоваскулярной патологией при терапии бета-адреноблокаторами и антиагрегантами для оптимизации фармакотерапевтической стратегии их лечения. В исследование были включены 50 пациентов с кардиомиопатиями, врожденными пороками сердца, клапанной патологией, нарушениями ритма и проводимости, артериальной гипертензией. Все пациенты были обследованы клинически, лабораторно и инструментально. Разработанная и модифицированная в ходе исследования технология наблюдения является пошаговой моделью персонифицированного ведения детей с кардиоваскулярными нарушениями, включает углубленное исследование гемостаза, возможного потенцированного взаимодействия бета-адреноблокаторов и антиагрегантов, методику определения оптимальной индивидуальной чувствительности к препарату. In recent years, more and more cases of cardiovascular diseasesin children have been registered, they often have a long-term asymptomatic course and start with thrombotic manifestations, which can lead to disability and death. Currently, there is insufficient data on the effect of beta-blockers on the vascular-platelet link of hemostasis and monitoring of the effectiveness of therapy in children with cardiovascular diseases. The aim of our study was to develop a technology for monitoring patients with cardiovascular pathologywho receive beta-blockers and antiplatelet agents to optimize the pharmacotherapeutic strategy for their treatment. A complete clinical, laboratory and instrumental examination was performedin 50 patients with suchnosological forms of cardiovascular pathology, as cardiomyopathy, congenital heart disease, valvular pathology, rhythm and conduction disorders, arterial hypertension. The assessment of the platelet aggregation function was emphasized, which revealed changes in aggregation during therapy in 80% of cases.According to the results of the study, platelet aggregation intervals were established, which allow to prescribe appropriate doses of drugs, a model of personalized management of children with cardiovascular disorders was developed, including an in-depth study of hemostasis, a possible potentiated interaction of beta-blockers and antiplatelet agents, and a method for determining the optimal individual sensitivity to the drug.

Enhanced Stability and Controlled Delivery of MOF Encapsulated Vaccines and Their Immunogenic Response In Vivo

2018 ◽  
Author(s):  
Michael Luzuriaga ◽  
Raymond P. Welch ◽  
Madushani Dharmawardana ◽  
Candace Benjamin ◽  
Shaobo Li ◽  
...  
Keyword(s):  
Viral Vector ◽  
Controlled Delivery ◽  
Conformational Structure ◽  
Spectroscopy Analysis ◽  
Zeolitic Imidazolate Framework ◽  
Structural Conformation ◽  
Depth Study ◽  
Viral Nanoparticle

<div><div><div><p>Vaccines have an innate tendency to lose their structural conformation upon environmental and chemical stressors. A loss in conformation reduces the therapeutic ability to prevent the spread of a pathogen. Herein, we report an in-depth study of zeolitic imidazolate framework-8 (ZIF-8) and its ability to provide protection for a model viral vector against dena- turing conditions. The immunoassay and spectroscopy analysis together demonstrate enhanced thermal and chemical stability to the conformational structure of the encapsulated viral nanoparticle. The long-term biological activity of this virus-ZIF composite was investigated in animal models to further elucidate the integrity of the encapsulated virus, the bio-safety, and immunogenicity of the overall composite. Additionally, histological analysis found no observable tissue damage in the skin or vital organs in mice, following multiple subcutaneous administrations. This study shows that ZIF-based protein composites are strong candidates for improved preservation of proteinaceous drugs, are biocompatible, and capable of controlling the release and adsorption of drugs in vivo.</p></div></div></div>

Research on the Economic Vitality of the Northeast China

2020 ◽  
Vol 3 (3) ◽  
Author(s):  
Jiayue Jiao
Keyword(s):  
Northeast China ◽  
Practical Significance ◽  
Economic Policies ◽  
Regional Competitiveness ◽  
Regional Economic ◽  
Important Indicator ◽  
Depth Study ◽  
Long Term Impact ◽  
Economic Vitality

 Economic vitality is an important indicator of regional competitiveness. The demand for talents and the vitality of enterprises in different regions are obvious to all and have practical significance. Therefore, it is necessary to establish a survey data model and conduct in-depth study on improving regional economic vitality from the perspective of policy.Based on a variety of forecasting methods, this paper analyzes the short-term and long-term impact of economic policies in Northeast China, and finally puts forward the factors that affect the economic vitality of northeast policies. Finally, the paper puts forward the feasibility and targeted suggestions of strengthening regional economic vitality, obtaining long-term development and building a more competitive city in the new era. 

scholarly journals Diagnostic Challenges on the Laboratory Detection of Lupus Anticoagulant

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 844
Author(s):  
Armando Tripodi
Keyword(s):  
Lupus Anticoagulant ◽  
Clinical Laboratory ◽  
External Quality Assessment ◽  
State Of The Art ◽  
Diagnostic Procedures ◽  
External Quality ◽  
Glycoprotein I ◽  
Current State ◽  
Clinical Laboratories

Lupus anticoagulant (LA) is one of the three laboratory parameters (the others being antibodies to either cardiolipin or β2-glycoprotein I) which defines the rare but potentially devastating condition known as antiphospholipid syndrome (APS). Testing for LA is a challenging task for the clinical laboratory because specific tests for its detection are not available. However, proper LA detection is paramount for patients’ management, as its persistent positivity in the presence of (previous or current) thrombotic events, candidate for long term anticoagulation. Guidelines for LA detection have been established and updated over the last two decades. Implementation of these guidelines across laboratories and participation to external quality assessment schemes are required to help standardize the diagnostic procedures and help clinicians for appropriate management of APS. This article aims to review the current state of the art and the challenges that clinical laboratories incur in the detection of LA.

scholarly journals Differing effects of beta-blockers on long-term clinical outcomes following percutaneous coronary intervention between patients with mid-range and reduced left ventricular ejection fraction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Shitara ◽  
Ryo Naito ◽  
Takatoshi Kasai ◽  
Hirohisa Endo ◽  
Hideki Wada ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background The aim of this study was to determine the difference in effects of beta-blockers on long-term clinical outcomes between ischemic heart disease (IHD) patients with mid-range ejection fraction (mrEF) and those with reduced ejection fraction (rEF). Methods Data were assessed of 3508 consecutive IHD patients who underwent percutaneous coronary intervention (PCI) between 1997 and 2011. Among them, 316 patients with mrEF (EF = 40–49%) and 201 patients with rEF (EF < 40%) were identified. They were assigned to groups according to users and non-users of beta-blockers and effects of beta-blockers were assessed between mrEF and rEF patients, separately. The primary outcome was a composite of all-cause death and non-fatal acute coronary syndrome. Results The median follow-up period was 5.5 years in mrEF patients and 4.3 years in rEF patients. Cumulative event-free survival was significantly lower in the group with beta-blockers than in the group without beta-blockers in rEF (p = 0.003), whereas no difference was observed in mrEF (p = 0.137) between those with and without beta-blockers. In the multivariate analysis, use of beta-blockers was associated with reduction in clinical outcomes in patients with rEF (hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.36–0.97; p = 0.036), whereas no association was observed among those with mrEF (HR 0.74; 95% CI 0.49–1.10; p = 0.137). Conclusions Our observational study showed that use of beta-blockers was not associated with long-term clinical outcomes in IHD patients with mrEF, whereas a significant association was observed in those with rEF.

scholarly journals Long-Term Follow-Up of Denosumab Discontinuers with Multiple Vertebral Fractures in the Real-World: A Case Series

2021 ◽  
Author(s):  
Liana Tripto-Shkolnik ◽  
Yair Liel ◽  
Naama Yekutiel ◽  
Inbal Goldshtein
Keyword(s):  
Real World ◽  
Vertebral Fractures ◽  
Clinical Laboratory ◽  
Case Series ◽  
High Risk Group ◽  
Imaging Data ◽  
Long Term Follow Up ◽  
Multiple Vertebral Fractures

AbstractDenosumab discontinuation is associated with rapid reversal of bone turnover suppression and with a considerable increase in fracture risk, including a risk for multiple vertebral fractures (MVF). Long-term follow-up of patients who sustained MVF after denosumab discontinuation has not been reported. This case-series was aimed to provide a long-term follow-up on the management and outcome of denosumab discontinuers who initially presented with multiple vertebral fractures. Denosumab discontinuers were identified from a computerized database of a large healthcare provider. Baseline and follow-up clinical, laboratory, and imaging data were obtained from the computerized database and electronic medical records. The post-denosumab discontinuers MVF patients consisted of 12 women aged 71±12. Osteoporotic fractures were prevalent before denosumab discontinuation in 6 of the patients. The majority received bisphosphonates before denosumab. MVF occurred 134±76 days after denosumab discontinuation. The patients were followed for a median of 36.5 (IQR 28.2, 42.5) months after MVF. Two patients passed-away. Two patients suffered recurrent vertebral fractures. Following MVF, patients were treated inconsistently with denosumab, teriparatide, oral, and intravenous bisphosphonates, in various sequences. Two patients underwent vertebroplasty/kyphoplasty. This long-term follow-up of real-world patients with MVF following denosumab discontinuation reveals that management is inconsistent, and recurrent fractures are not uncommon. It calls for clear management guidelines for patients with MVF after denosumab discontinuation and for special attention to this high-risk group.

scholarly journals Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Laura W van Buul ◽  
Jenny T van der Steen ◽  
Sarah MMM Doncker ◽  
Wilco P Achterberg ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Long Term Care ◽  
Antibiotic Prescribing ◽  
Term Care ◽  
Factors Influencing ◽  
Care Facilities ◽  
Depth Study

scholarly journals Diagnosis and Multimodality Management of Cushing’s Disease: A Practical Review

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Gabriel Zada
Keyword(s):  
Pituitary Adenoma ◽  
Cushing’S Disease ◽  
Patient Survival ◽  
Clinical Laboratory ◽  
Management Strategies ◽  
Serum Cortisol ◽  
Cushing's Disease ◽  
First Line ◽  
Stepwise Approach

Cushing’s Disease is caused by oversecretion of ACTH from a pituitary adenoma and results in subsequent elevations of systemic cortisol, ultimately contributing to reduced patient survival. The diagnosis of Cushing’s Disease frequently involves a stepwise approach including clinical, laboratory, neuroimaging, and sometimes interventional radiology techniques, often mandating multidisciplinary collaboration from numerous specialty practitioners. Pituitary microadenomas that do not appear on designated pituitary MRI or dynamic contrast protocols may pose a particularly challenging subset of this disease. The treatment of Cushing’s Disease typically involves transsphenoidal surgical resection of the pituitary adenoma as a first-line option, yet may require the addition of adjunctive measures such as stereotactic radiosurgery or medical management to achieve normalization of serum cortisol levels. Vigilant long-term serial endocrine monitoring of patients is imperative in order to detect any recurrence that may occur, even years following initial remission. In this paper, a stepwise approach to the diagnosis, and various management strategies and associated outcomes in patients with Cushing’s Disease are discussed.

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