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1.
Conscious Cogn ; 96: 103219, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34749157

RESUMO

Research on the sense of agency has proliferated a range of explicit and implicit measures. However, the relation of different measures is poorly understood with especially mixed findings on the correlation between explicit judgments of agency and the implicit perceptual bias of temporal binding. Here, we add to the conundrum by showing that the two sub-components of temporal binding - action-binding and effect-binding, respectively - are not correlated across participants either, suggesting independent processes for both components. Research on inter-individual differences regarding the sense of agency is thus well-advised to rely on other implicit measures until the phenomenon of temporal binding is better understood.


Assuntos
Individualidade , Julgamento , Humanos
2.
J Clin Monit Comput ; 35(2): 229-243, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32458170

RESUMO

The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.


Assuntos
Ecocardiografia , Hemodinâmica , Anestesiologistas , Coração , Humanos , Monitorização Fisiológica
3.
Anaesthesist ; 70(9): 772-784, 2021 09.
Artigo em Alemão | MEDLINE | ID: mdl-33660043

RESUMO

BACKGROUND: The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DO2) in this patient population, a timely assessment of cardiac function and the underlying pathophysiological causes of hemodynamic instability is essential for the anesthesiologist. A variety of hemodynamic monitoring procedures are available for this purpose; however, due to method-immanent limitations they are often not able to directly identify the underlying cause of cardiovascular impairment. OBJECTIVE: To present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography. METHODS AND RESULTS: Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves. CONCLUSION: Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.


Assuntos
Ecocardiografia Transesofagiana , Ecocardiografia , Anestesiologistas , Coração , Hemodinâmica , Humanos
4.
Conscious Cogn ; 75: 102807, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31494358

RESUMO

The sense of agency, i.e., the feeling of control over one's own actions and their consequences in the environment, is a crucial part of action taking. In experimental studies, agency is most commonly measured either directly via explicit agency ratings or indirectly via implicit measures, e.g., temporal binding. In order to aid our interpretation of previous and future results, several studies have focused on relating implicit and explicit measures of agency to one another. However, possibly due to different methodological issues, results have been far from conclusive. In the present study, we therefore contribute to this discussion by further characterizing temporal binding and explicit agency ratings in their response to action choice as an experimental manipulation in a high-powered design, and by studying how temporal binding and agency ratings are related in different experimental conditions. Furthermore, we discuss the possible influence of the specific agency question regarding the participants' ratings.


Assuntos
Percepção Auditiva/fisiologia , Comportamento de Escolha/fisiologia , Atividade Motora/fisiologia , Desempenho Psicomotor/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reconhecimento Visual de Modelos/fisiologia , Fatores de Tempo , Adulto Jovem
5.
Nutr Metab Cardiovasc Dis ; 29(7): 692-700, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31079869

RESUMO

BACKGROUND AND AIM: Obesity is a recognized risk factor for new-onset atrial fibrillation (AF). The association between body fat distribution, which is measured by body mass index (BMI) and waist-hip ratio (WHR), its changes, and new-onset AF is conflicting. METHODS AND RESULTS: Participants of the European Prospective Investigation into Cancer and Nutrition in Norfolk cohort study were included, with exclusion criteria of prevalent AF, rheumatic heart disease, and cancer. AF was confirmed by the International Classification of Diseases-10 hospital discharge code I48. Adjusted sex-specific Cox proportional hazards models were used to quantify the AF risk per 1 standard deviation increase and for quintiles of adiposity indices. A total of 10,885 men and 12,857 women were followed up for a median of 19 years, yielding 451,098 person-years. New-onset AF was diagnosed in 1408 (12.9%) men and 1102 (8.6%) women. Multivariable analyses showed that BMI predicted new-onset AF in all, while WHR predicted only in men. New-onset AF risk gradually increased across the range of adiposity indices: for men in the highest BMI quintile, HR: 1.59 (CI 1.32-1.91, p for trend<0.001), whereas for women in the highest BMI quintile, HR: 1.52 (CI 1.23-1.88, p for trend<0.001). Further, for men in the highest WHR quintile, HR: 1.31 (CI 1.09-1.57, p for trend: 0.01), whereas for women in the highest WHR quintile, HR: 1.12 (CI 0.90-1.41, p for trend: 0.17). The change in BMI and WHR was similar in participants with or without new-onset AF. CONCLUSIONS: An increased body mass, as measured by BMI, is associated with an increased risk of developing new-onset AF. More abdominal fat distribution, as measured by WHR, is associated with an increased risk of developing new-onset AF in men but not in women.


Assuntos
Adiposidade , Fibrilação Atrial/epidemiologia , Índice de Massa Corporal , Obesidade/epidemiologia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Relação Cintura-Quadril
6.
Herz ; 44(2): 175-188, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30847511

RESUMO

Recent advances in the medical oncological treatment options for cancer have led to a clear improvement in the survival rate worldwide; however, many of the recently developed new drugs are directly or indirectly associated with cardiovascular side effects. Cardiovascular diseases are already the most frequent non-cancerous cause of death in tumor patients. Prevention, early detection of these complications, correct management and timely initiation of specific cardiac medical treatment are the key for an improvement of the cardiovascular prognosis. This article provides an overview and comprehensive summary of the possible cardiotoxic side effects of important oncological therapies and offers possible practical strategies with respect to risk stratification, cardiological follow-up care and management approaches for chemotherapy-induced left ventricular dysfunction.


Assuntos
Antineoplásicos , Cardiotoxicidade , Neoplasias , Cardiotoxicidade/prevenção & controle , Detecção Precoce de Câncer , Humanos , Oncologia , Neoplasias/terapia
7.
Herz ; 44(7): 596-601, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31372675

RESUMO

Functional mitral regurgitation (FMR) is characterized by a dilatation of the mitral valve annulus resulting in an insufficient adaptation of the anterior and posterior mitral valve leaflets and/or severe tethering of the leaflets due to dilatation of the left ventricle. The Cardioband® system was introduced in 2015 and is a catheter-based direct mitral valve annuloplasty procedure for treatment of FMR. In the European CE approval study 60 patients with moderate or severe FMR were analyzed per protocol. There were no device or procedure-related deaths. The technical success rate of the procedure, defined as successful implantation and tightening was 97%. At 1 year, the overall survival and survival free of hospital readmission for heart failure were 87% and 66%, respectively. Currently, various interventional treatment procedures are available, such as the edge-to-edge technique as well as direct and indirect annuloplasty. In summary, patients with FMR as a result of a dilatation of the mitral valve annulus appear to be suitable for direct annuloplasty with the Cardioband® system.


Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Ventrículos do Coração , Humanos , Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
8.
Herz ; 44(6): 491-501, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312873

RESUMO

Pulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients with left-sided heart disease, including valvular heart disease. In this context, elevated left atrial pressure primarily leads to the development of post-capillary PH. Despite the fact that repair of left-sided valvular heart disease by surgical or interventional approaches will improve PH, recent studies have highlighted that PH (pre- or post-interventional) remains an important predictor of long-term outcome. Here, we review the current knowledge on PH in valvular heart disease taking into account new hemodynamic PH definitions, and the distinction between post- and pre-capillary components of PH. A specific focus is on the precise characterization of hemodynamics and cardiopulmonary interaction, and on potential strategies for the management of residual PH after mitral or aortic valve interventions. In addition, we highlight the clinical significance of tricuspid regurgitation, which may occur as a primary condition or as a consequence of PH and right heart dilatation (functional). In this context, proper patient selection for potential tricuspid valve interventions is crucial. Finally, the article highlights gaps in evidence, and points toward future perspectives.


Assuntos
Doenças das Valvas Cardíacas , Hipertensão Pulmonar , Insuficiência da Valva Tricúspide , Doenças das Valvas Cardíacas/complicações , Hemodinâmica , Humanos , Hipertensão Pulmonar/complicações , Valva Tricúspide , Insuficiência da Valva Tricúspide/complicações
9.
BMC Med Ethics ; 20(1): 74, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640670

RESUMO

BACKGROUND: Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability (intensive care versus comfort care) are influenced by the way information on incurred risks is given or received. METHODS: This is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our sample included 102 healthcare professionals. RESULTS: Forty-nine responders (48%) were students (response rate of 33.1%), 32 (31%) paediatricians (response rate of 91.4%) and 21 (20%) nurses in NICU (response rate of 50%). The received risk tended to be more severe in both groups compared to the graphically presented facts and current guidelines, although optimistic representation favoured the perception of "survival without disability" at 23 to 25 weeks. Therapeutic attitudes did not differ between groups, but healthcare professionals with children were more restrained and students more aggressive at very low gestational ages. CONCLUSION: Written information on mortality and morbidity given to healthcare professionals in graphic form encourages them to overestimate the risk. However, perception in healthcare staff may not be directly transferable to parental perception during counselling as the later are usually naïve to the data received. This parental information are always communicated in ways that subtly shape the decisions that follow.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Recém-Nascido Prematuro , Educação de Pacientes como Assunto/métodos , Assistência Perinatal/organização & administração , Ressuscitação/psicologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Otimismo , Pediatras/psicologia , Assistência Perinatal/normas , Pessimismo , Estudos Prospectivos , Estudantes de Medicina/psicologia
10.
Internist (Berl) ; 60(1): 86-89, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30194482

RESUMO

A 47-year-old man presented with angina pectoris complaints in the chest pain unit. Due to psoriasis and psoriatic arthritis he had been systemically treated for 4 years. Because of an increased cardiovascular risk profile, coronary heart disease (CHD) was suspected and an invasive coronary diagnosis was performed. In the cardiac catheterization, CHD could be detected and treated in the same session. The risk of CHD in patients with psoriasis is increased due to a higher incidence of risk factors but also the disease itself. Patients with psoriasis should regularly undergo cardiovascular risk screening.


Assuntos
Angina Pectoris/etiologia , Artrite Psoriásica/complicações , Cateterismo Cardíaco/métodos , Dor no Peito/etiologia , Doença das Coronárias/diagnóstico , Angina Pectoris/diagnóstico , Doença das Coronárias/complicações , Doença das Coronárias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Esportes , Resultado do Tratamento
11.
Acta Paediatr ; 107(7): 1240-1246, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29461646

RESUMO

AIM: Epidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored. METHODS: This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs. Multivariate analysis of the associated risk factors was performed. RESULTS: We analysed 1300 PIVC in 695 paediatric patients with a median age of 1.5 years. The overall extravasation incidence was 17.6% for all patients and 11.7% for PIVC. The overall incidence rate of PIVC extravasation was 4.5 per 100 catheters days, and the risk was highest in the 201 neonates, at 28.4%. The incidence rate four days after insertion of the PIVC was around three times higher than on day one. Neonates and the in situ duration of PIVCs were associated risk factors (p < 0.001). CONCLUSION: Extravasation was frequent and neonates were particularly at risk. Younger age and longer in situ PIVC duration were independent risk factors for extravasation.


Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Dispositivos de Acesso Vascular/efeitos adversos , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia
12.
Anaesthesist ; 67(5): 343-350, 2018 05.
Artigo em Alemão | MEDLINE | ID: mdl-29666925

RESUMO

BACKGROUND: Mortality in patients with out-of-hospital cardiac arrest (OHCA) remains very high despite advances in resuscitation algorithms. Most of these patients die at the scene and do not reach hospital. It is currently the subject of discussion whether transport to hospital with ongoing cardiopulmonary resuscitation (CPR) improves survival and neurological outcome in patients with OHCA. OBJECTIVE: The aim of this study was to identify predictors of survival and good neurological outcome in patients after OHCA who were transported to hospital with ongoing CPR. PATIENTS AND METHODS: A total of 70 consecutive patients with refractory OHCA (mean age 54.7 ± 15 years) transported to hospital with ongoing CPR were retrospectively analyzed. Neurological outcome was assessed after 30 days based on the Glasgow-Pittsburgh cerebral performance category (CPC). RESULTS: After 30 days 82.9% of the patients enrolled in the trial died (CPC score of 5), 8 patients (11.4%) showed a good neurological recovery with CPC scores of 1-2 and 4 patients (5.7%) had a poor neurological outcome with CPC scores of 3-4. Predictors of good neurological outcome were witnessed arrest, initial defibrillatable rhythm and serum lactate levels on admission. In all patients with good outcome, the index event for OHCA was from cardiac causes. CONCLUSION: Selected patient collectives can benefit from transport to hospital with ongoing cardiopulmonary resuscitation (CPR).


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Transporte de Pacientes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/instrumentação , Feminino , Alemanha/epidemiologia , Escala de Resultado de Glasgow , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
13.
Anaesthesist ; 67(8): 607-616, 2018 08.
Artigo em Alemão | MEDLINE | ID: mdl-30014276

RESUMO

Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Algoritmos , Consenso , Oxigenação por Membrana Extracorpórea/métodos , Humanos
14.
Herz ; 42(7): 644-650, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-28791435

RESUMO

Tricuspid valve regurgitation is frequently found as a result of right ventricular remodeling due to advanced left heart diseases. Drug treatment is limited to diuretics and the cardiac or pulmonary comorbidities. Due to the high risk only a small percentage of patients are amenable to surgical treatment of tricuspid regurgitation in those who undergo left-sided surgery for other reasons. Catheter-based procedures are an attractive treatment alternative, particularly since the strong prognostic impact of tricuspid regurgitation suggests an unmet need of treatment, independent of the underlying heart disease. A vast amount of clinical experience exists for the MitraClip system for treatment of mitral regurgitation. A first case series shows that the application for treatment of tricuspid regurgitation is technically feasible, seems to be safe and the degree of valve regurgitation can be reduced. In this review the background of tricuspid regurgitation treatment is summarized and first experiences and perspectives with the MitraClip system are assessed.


Assuntos
Cateterismo Cardíaco/instrumentação , Anuloplastia da Valva Cardíaca/instrumentação , Instrumentos Cirúrgicos , Insuficiência da Valva Tricúspide/cirurgia , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Prognóstico , Insuficiência da Valva Tricúspide/classificação , Insuficiência da Valva Tricúspide/diagnóstico
15.
Internist (Berl) ; 58(9): 908-915, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28765983

RESUMO

Circulatory insufficiency is often understood as symptomatic hypotension due to various causes. The clinical result of circulatory dysregulation is arterial hypotension. The manifestation of hypotension is often divided into chronic and acute forms. Chronic hypotension can be distinguished etiopathogenetically into primary and secondary hypotension. Acute hypotension is usually equated to circulatory shock. While patients with chronic hypotension should be seen primarily by their general practitioner, patients with acute hypotension and a frequently severe clinical manifestation should be evaluated in the emergency department or, if there is a specific cause, directly in the acute clinic. Standardization of diagnostic and therapeutic pathways in both out- and inpatient care-not only for the management of circulatory weakness-would be an improvement not only in regards to patient care, but also with respect to healthcare economics.


Assuntos
Assistência Ambulatorial , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/terapia , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/terapia , Admissão do Paciente , Doença Aguda , Pressão Sanguínea , Doença Crônica , Diagnóstico Diferencial , Humanos , Hipotensão Ortostática/etiologia , Comunicação Interdisciplinar , Colaboração Intersetorial , Hipotonia Muscular/etiologia , Fatores de Risco , Choque/diagnóstico , Choque/etiologia , Choque/terapia
16.
Nutr Metab Cardiovasc Dis ; 26(8): 722-34, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27052923

RESUMO

BACKGROUND: We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association. METHODS AND RESULTS: We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01). CONCLUSIONS: Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.


Assuntos
Doces , Chocolate , Comportamento Alimentar , Insuficiência Cardíaca/epidemiologia , Idoso , Doces/efeitos adversos , Chocolate/efeitos adversos , Inglaterra/epidemiologia , Feminino , Voluntários Saudáveis , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/prevenção & controle , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
17.
Herz ; 40(7): 959-65, 2015 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-26525523

RESUMO

Sympathovagal imbalance plays an important role in the progression of heart failure with reduced ejection fraction. Baroreflex activation therapy (BAT), i. e. electrical stimulation of baroreceptors located at the carotid sinus, can reduce sympathetic and enhance parasympathetic tone. Large animal studies on BAT demonstrated improvements in cardiac function, arrhythmogenic risk and a survival benefit compared to untreated controls. The recently published Neo Randomized Heart Failure Study, the first multicenter, randomized and controlled trial of optimal medical and device therapy alone or plus BAT in patients with a left ventricular ejection fraction ≤ 35 %, demonstrated a reasonable safety profile of BAT in this severely ill patient population and no relevant interactions with other devices. The study found significant improvements in the New York Heart Association (NYHA) class of heart failure, quality of life as well as 6 min walking distance and data pointed to a reduction in hospitalization rates. Moreover, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly reduced. This review gives an overview on BAT for the treatment of heart failure with reduced ejection fraction, from the rationale and animal experiments to the most recent clinical data and future perspectives.


Assuntos
Barorreflexo , Terapia por Estimulação Elétrica/métodos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/prevenção & controle , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/prevenção & controle , Doença Crônica , Medicina Baseada em Evidências , Insuficiência Cardíaca/diagnóstico , Humanos , Pressorreceptores , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico
18.
Int J Sports Med ; 36(8): 615-23, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25875316

RESUMO

Essential hypertension (EH) is a widespread disease and might be prevalent in apnea divers and master athletes. Little is known about the influence of EH and the antihypertensive drugs (AHD) on cardiovascular reactions to combined breath hold (BH) and exercise. In this pilot study, healthy divers (HCON) were compared with treated hypertensive divers with regard to heart rate (HR) and mean blood-pressure (MAP) responses to BH, exercise and the combination of both. Ten subjects with EH and ten healthy divers were tested. 3 different 20 s stimuli were applied: BH combined with 30 W or 150 W and 150 W without BH. The time-charts during the stress intervals and during recovery were compared. Subjects treated with an angiotensin-converting enzyme (ACE) inhibitor showed higher changes for MAP values if breath hold was performed. HR responses were obviously changed if a ß-blocker was part of the medication. One subject showed extreme MAP responses to all stimuli and conspicuous HR if BH was involved. The modulation of HR-/MAP-response in EH subjects depends on the mechanisms of antihypertensive agents. The combination of an ACE inhibitor and a ß-blocker may give the best protection. It is recommended to include short apnea tests in the fitness-to-dive examination to individually predict potential endangerment.


Assuntos
Pressão Sanguínea/fisiologia , Suspensão da Respiração , Mergulho/fisiologia , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Hipertensão/fisiopatologia , Antagonistas Adrenérgicos beta/farmacologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Estudos de Casos e Controles , Hipertensão Essencial , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Projetos Piloto
19.
Mol Vis ; 20: 593-605, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24826067

RESUMO

PURPOSE: In an earlier study, we showed that human antigen R (HuR) and ß-actin expression levels were downregulated in fibroblasts isolated from human keratoconus stroma compared to normal corneal stroma. To further extend the finding, we determined whether HuR expression affects ß-actin gene expression and in turn affects corneal fibroblast migration and wound healing. METHODS: Stromal keratocytes from normal human corneas were cultured in the presence of serum. Cells were transfected with siRNA specific for ß-actin or HuR. SiRNAs specific for GAPDH or a scrambled sequence were used as positive and negative controls (siCTR) for transfection, respectively. The effects of gene silencing were analyzed at the transcriptional and translational levels. Specific proteins were immunohistochemically localized using confocal imaging. The effects of gene silencing on cell migration and cell proliferation were analyzed using a modified Boyden chamber and with a wound healing assay, respectively. RESULTS: Reverse-transcription PCR (RT-PCR) and western blot analyses showed that when the HuR gene was silenced, ß-actin expression was significantly downregulated. This was further confirmed at the translational level with immunohistochemical-confocal analysis. However, when the ß-actin gene was silenced, its expression was significantly decreased but showed no effect on HuR gene expression. When the ß-actin or HuR gene was individually silenced, the motility and proliferation of corneal fibroblasts were significantly reduced. CONCLUSIONS: The results show that downregulation of the HuR gene results in decreased ß-actin gene expression, which in turn results in decreased motility and proliferation of corneal fibroblasts. We conclude that decreased ß-actin expression in normal corneal stroma clearly disrupts the cytoskeletal structure and functions, including keratocyte motility and wound healing.


Assuntos
Actinas/genética , Movimento Celular/genética , Córnea/citologia , Regulação para Baixo/genética , Proteínas ELAV/genética , Fibroblastos/citologia , Fibroblastos/metabolismo , Actinas/metabolismo , Movimento Celular/efeitos dos fármacos , Substância Própria/citologia , Regulação para Baixo/efeitos dos fármacos , Proteínas ELAV/metabolismo , Proteína Semelhante a ELAV 1 , Fibroblastos/efeitos dos fármacos , Técnicas de Silenciamento de Genes , Inativação Gênica/efeitos dos fármacos , Humanos , Imuno-Histoquímica , Fosfatidilinositol 3-Quinases/metabolismo , Inibidores de Fosfoinositídeo-3 Quinase , Biossíntese de Proteínas/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacologia , Transporte Proteico/efeitos dos fármacos , Transcrição Gênica/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Cicatrização/genética
20.
Anaesthesist ; 62(12): 1023-33, 2013 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-24292123

RESUMO

Restless legs syndrome (RLS) is one of the most common neurological disorders. The key feature is the urge to move, especially in the legs. New onset RLS can develop perioperatively or an existing RLS can be exacerbated. Severe insomnia, forced immobilization and acute iron deficiency are common trigger factors. Medicinal treatment can also be an important triggering or exacerbating factor. Drugs with dopamine antagonistic, serotonergic and opioid antagonistic effects should be avoided. The long-term medicinal treatment should be terminated as quickly as possible and if necessary bridged non-orally. For diseases which can be associated with secondary RLS a provocation or an exacerbation of RLS should be taken into consideration. This is particularly true for Parkinson's disease, diabetes mellitus, terminal renal insufficiency, spinal cord lesions and pregnancy. So far, there is not sufficient evidence that any form of anesthesia has a negative influence on RLS.


Assuntos
Assistência Perioperatória/métodos , Síndrome das Pernas Inquietas/terapia , Anestesia/efeitos adversos , Anestésicos/efeitos adversos , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/tratamento farmacológico , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/fisiopatologia
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