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1.
Int J Angiol ; 31(3): 179-187, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36157101

RESUMEN

Pulmonary embolism is the third most common cardiovascular syndrome with an estimated up to 25% of patients presenting with sudden death. For those who survive, a mainstay of management for patients with hemodynamic stability is anticoagulation; however, recommendations and options are rapidly changing for patients with submassive or massive pulmonary embolism with hemodynamic instability. Catheter-based and surgical approaches offer efficacious management options for unstable patients or patients with contraindications to anticoagulation; however, both approaches have inherent benefits and risk. This article seeks to offer a brief review on the recommendations and options for management of pulmonary embolism from both surgical and catheter-based perspectives.

2.
World J Pediatr Congenit Heart Surg ; 13(6): 759-769, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36300262

RESUMEN

OBJECTIVE: This study aims to perform a meta-analysis of early and late outcomes of the Ross/Ross-Konno procedures in neonates/infants. METHODS: A meta-analysis was performed in accordance with PRISMA guidelines. We used Ovid versions of MEDLINE/PubMed for relevant studies and included those that reported Ross/Ross-Konno operations in neonates/infants and at least one of the predetermined clinical outcomes. I2 and double arcsine methods assessed the heterogeneity between pooled estimates. We used a random-effect model to account for heterogeneity with MetaXL. We calculated point estimates of a pooled estimates along with its 95% CI. RESULTS: 587 neonate/infant patients were included with median age of 87.5 days old. The follow-up range was five days to 23 years. Early mortality reported in 25 studies with pooled estimates of 18.3% (95% CI: 13.6%-23.5%). Estimates ranged from 0% to 50% with relatively substantial heterogeneity (P = .01, I2 = 48.6%). Late mortality reported in 22 studies with pooled incidence of 9.7% (95% CI: 5.9%-14.3%). Estimates ranged from 0% to 53% with relatively substantial heterogeneity (P = .01, I2 = 46.1%). Autograft reintervention reported in 18 studies with pooled estimate of 19.2% (95% CI: 7.3%-34.5%). Estimates ranged from 0% to 81.8% with high heterogeneity (P < .001, I2 = 90.5%). Right ventricle-to-pulmonary artery conduit reintervention reported in 16 studies with pooled estimates of 32.0% (95% CI: 20.9%-44.12%). Estimates ranged from 0% to 92.3% with high heterogeneity (P < .001, I2 = 75.9%). CONCLUSIONS: The data suggest that the Ross/Ross-Konno procedure in neonates/infants still carries significant risk of early/late mortality and autograft/conduit reintervention. The high variability of results among centers confirms the need for surgical expertise and good patient selection. Prospective multicenter studies are warranted to investigate the rate of autograft reintervention and the impact on long-term survival in this specific population.


Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Válvula Pulmonar , Lactante , Recién Nacido , Humanos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Estudios Prospectivos , Resultado del Tratamiento , Trasplante Autólogo , Arteria Pulmonar/cirugía , Válvula Aórtica/cirugía , Estudios Retrospectivos , Estenosis de la Válvula Aórtica/cirugía , Reoperación , Válvula Pulmonar/cirugía
3.
Int J Gen Med ; 14: 2637-2644, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34177272

RESUMEN

BACKGROUND: Venous thromboembolism is a common cause of morbidity and mortality in hospital patients, especially that of the lower extremities. Risk factors and diagnostic elements of upper-extremity deep-vein thrombosis (UEDVT) are poorly understood compared to those of the lower extremities. The primary objectives of this study were to identify predictive risk factors of secondary UEDVT. METHODS: This retrospective study included all nonpregnant patients aged >18 years who had undergone upper-extremity duplex scans to check for the presence of secondary UEDVT at Richmond University Medical Center from January 2014 to March 2020. Patients were stratified by presence or absence of UEDVT. Collected data points included patient demographics, comorbidities, central-line use, platelet count at time of scan, length of stay, and overall mortality. IBM 27.0 was used for all statistical analysis, with p<0.05 considered significant. RESULTS: A total of 1,009 upper extremity venous duplex studies were included. There were no significant differences in age, sex, race, or mean platelet levels between patients diagnosed with DVT and those without (p<0.05). After multinomial regression analysis, central venous catheter (CVC; 26.8% versus 78.5%, aOR 1.770, 95% CI 1.150-2.725; p<0.002), peripherally inserted central catheter (PICC) line (17.5% versus 82.5%, aOR3.254, 95% CI 1.997-5.304; p<0.001), hypertension (67.8% versus 28.8%, aOR 1.641, 95% CI 1.136-2.369; p<0.001), chronic kidney disease (CKD; 34.5% versus 65.5%, aOR 1.743, 95% CI 1.201-2.531; p<0.001), and malignancy (27.1% versus 74.6%, aOR 1.475, 95% CI 0.994-2.190; p<0.053) were found to be independent predictors of UEDVT. CONCLUSION: Use of CVC or PICC line, preexisting diagnosis of hypertension, malignancy, and CKD were independent risk factors of UEDVT, while there was no significant correlation between increased platelet levels and UEDVT.

4.
Am J Stem Cells ; 5(3): 99-106, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27853631

RESUMEN

The successful generation of the first iPSCs about ten years ago has provided deeper insight into previously unknown disease mechanisms and therapeutic opportunities for many diseases. In particular, iPSCs are becoming an important tool in advancing modeling and therapeutic intervention for Alzheimer's disease. In this manuscript, we assess the research climate surrounding the application of iPSCs to familial and sporadic Alzheimer's disease, including the generation and isolation of individualized neural stem cells, the introduction of neural stem cell transplants using iPSCs, and an estimation of the potential use of iPSCs as research models for Alzheimer's treatments and therapies. The clinical application of stem cells in the treatment of Alzheimer's disease appears promising, but much of the recent experimentation has been conducted using animal models or embryonic stem cells. As induced pluripotent stem cell research advances, iPSCs will likely provide investigators with a more applicable tool to progress advances in research and treatment for Alzheimer's and other neurodegenerative diseases.

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