Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 96
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
Proc Natl Acad Sci U S A ; 121(17): e2317589121, 2024 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-38630715

RESUMEN

This paper presents quasiexperimental evidence of Covid-19 transmission through casual contact between customers in retail stores. For a large sample of individuals in Denmark, we match card payment data, indicating exactly where and when each individual made purchases, with Covid-19 test data, indicating when each individual was tested and whether the test was positive. The resulting dataset identifies more than 100,000 instances where an infected individual made a purchase in a store and, in each instance, allows us to track the infection dynamics of other individuals who made purchases in the same store around the same time. We estimate transmissions by comparing the infection rate of exposed customers, who made a purchase within 5 min of an infected individual, and nonexposed customers, who made a purchase in the same store 16 to 30 min before. We find that exposure to an infected individual in a store increases the infection rate by around 0.12 percentage points (P < 0.001) between day 3 and day 7 after exposure. The estimates imply that transmissions in stores contributed around 0.04 to the reproduction number for the average infected individual and significantly more in the period where Omicron was the dominant variant.


Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , Comportamiento del Consumidor
2.
Am J Physiol Lung Cell Mol Physiol ; 327(2): L250-L257, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38810241

RESUMEN

In the field of pulmonary hypertension (PH), a well-established protocol to induce severe angioproliferation in rats (SuHx) involves combining the VEGF-R inhibitor Sugen 5416 (SU5416) with 3 wk of hypoxia (Hx). In addition, injecting monocrotaline (MCT) into rats can induce inflammation and shear stress in the pulmonary vasculature, leading to neointima-like remodeling. However, the SuHx protocol in mice is still controversial, with some studies suggesting it yields higher and reversible PH than Hx alone, possibly due to species-dependent hypoxic responses. To establish an alternative rodent model of PH, we hypothesized mice would be more sensitive to hemodynamic changes secondary to shear stress compared with Hx. We attempted to induce severe and irreversible PH in mice by combining SU5416 or monocrotaline pyrrole (MCTP) injection with pneumonectomy (PNx). However, our experiments showed SU5416 administered to mice at various time points after PNx did not result in severe PH. Similarly, mice injected with MCTP after PNx (MPNx) showed no difference in right ventricular systolic pressure or exacerbated pulmonary vascular remodeling compared with PNx alone. These findings collectively demonstrate that C57/B6 mice do not develop severe and persistent PH when PNx is combined with either SU5416 or MCTP.NEW & NOTEWORTHY We attempted to establish a mouse model of severe and irreversible pulmonary hypertension by substituting hypoxia with pulmonary overcirculation. To do so, we treated mice with either SU5416 or monocrotaline pyrrole after pneumonectomy and performed hemodynamic evaluations for PH. Despite this "two-hit" protocol, mice did not exhibit signs of severe pulmonary hypertension or exacerbated pulmonary vascular remodeling compared with PNx alone.


Asunto(s)
Hipertensión Pulmonar , Indoles , Ratones Endogámicos C57BL , Monocrotalina , Neumonectomía , Pirroles , Animales , Monocrotalina/análogos & derivados , Pirroles/farmacología , Hipertensión Pulmonar/patología , Hipertensión Pulmonar/inducido químicamente , Indoles/farmacología , Ratones , Masculino , Modelos Animales de Enfermedad , Hipoxia/patología , Remodelación Vascular/efectos de los fármacos , Pulmón/patología , Pulmón/efectos de los fármacos , Pulmón/metabolismo , Hemodinámica/efectos de los fármacos
3.
BMC Pulm Med ; 24(1): 233, 2024 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-38745282

RESUMEN

BACKGROUND: Acute pulmonary embolism (PE) induces ventilation-perfusion mismatch and hypoxia and increases pulmonary pressure and right ventricular (RV) afterload, entailing potentially fatal RV failure within a short timeframe. Cardiopulmonary factors may respond differently to increased clot burden. We aimed to elucidate immediate cardiopulmonary responses during successive PE episodes in a porcine model. METHODS: This was a randomized, controlled, blinded study of repeated measurements. Twelve pigs were randomly assigned to receive sham procedures or consecutive PEs every 15 min until doubling of mean pulmonary pressure. Cardiopulmonary assessments were conducted at 1, 2, 5, and 13 min after each PE using pressure-volume loops, invasive pressures, and arterial and mixed venous blood gas analyses. ANOVA and mixed-model statistical analyses were applied. RESULTS: Pulmonary pressures increased after the initial PE administration (p < 0.0001), with a higher pulmonary pressure change compared to pressure change observed after the following PEs. Conversely, RV arterial elastance and pulmonary vascular resistance was not increased after the first PE, but after three PEs an increase was observed (p = 0.0103 and p = 0.0015, respectively). RV dilatation occurred following initial PEs, while RV ejection fraction declined after the third PE (p = 0.004). RV coupling exhibited a decreasing trend from the first PE (p = 0.095), despite increased mechanical work (p = 0.003). Ventilatory variables displayed more incremental changes with successive PEs. CONCLUSION: In an experimental model of consecutive PE, RV afterload elevation and dysfunction manifested after the third PE, in contrast to pulmonary pressure that increased after the first PE. Ventilatory variables exhibited a more direct association with clot burden.


Asunto(s)
Modelos Animales de Enfermedad , Embolia Pulmonar , Resistencia Vascular , Animales , Embolia Pulmonar/fisiopatología , Porcinos , Resistencia Vascular/fisiología , Distribución Aleatoria , Análisis de los Gases de la Sangre , Función Ventricular Derecha/fisiología , Disfunción Ventricular Derecha/fisiopatología , Femenino , Masculino
4.
Eur Heart J ; 44(29): 2659-2671, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-37470202

RESUMEN

The current treatment algorithm for chronic thromboembolic pulmonary hypertension (CTEPH) as depicted in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnosis and treatment of pulmonary hypertension (PH) includes a multimodal approach of combinations of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapies to target major vessel pulmonary vascular lesions, and microvasculopathy. Today, BPA of >1700 patients has been reported in the literature from centers in Asia, the US, and also Europe; many more patients have been treated outside literature reports. As BPA becomes part of routine care of patients with CTEPH, benchmarks for safe and effective care delivery become increasingly important. In light of this development, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function has decided to publish a document that helps standardize BPA to meet the need of uniformity in patient selection, procedural planning, technical approach, materials and devices, treatment goals, complications including their management, and patient follow-up, thus complementing the guidelines. Delphi methodology was utilized for statements that were not evidence based. First, an anatomical nomenclature and a description of vascular lesions are provided. Second, treatment goals and definitions of complete BPA are outlined. Third, definitions of complications are presented which may be the basis for a standardized reporting in studies involving BPA. The document is intended to serve as a companion to the official ESC/ERS guidelines.


Asunto(s)
Angioplastia de Balón , Cardiología , Hipertensión Pulmonar , Embolia Pulmonar , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/terapia , Hipertensión Pulmonar/diagnóstico , Embolia Pulmonar/complicaciones , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Circulación Pulmonar , Función Ventricular Derecha , Angioplastia de Balón/métodos , Arteria Pulmonar/cirugía , Enfermedad Crónica
5.
Exp Physiol ; 108(5): 762-771, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36892095

RESUMEN

NEW FINDINGS: What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy and pericardiotomy affect cardiopulmonary variables? What is the main finding and its importance? Opening of the thorax decreased mean systemic and pulmonary pressures. Left ventricular function improved, but no changes were observed in right ventricular systolic measures. No consensus or recommendation exists regarding instrumentation. Methodological differences risk compromising rigour and reproducibility in preclinical research. ABSTRACT: Animal models of cardiovascular disease are often evaluated by invasive instrumentation for phenotyping. As no consensus exists, both open- and closed-chest approaches are used, which might compromise rigour and reproducibility in preclinical research. We aimed to quantify the cardiopulmonary changes induced by sternotomy and pericardiotomy in a large animal model. Seven pigs were anaesthetized, mechanically ventilated and evaluated by right heart catheterization and bi-ventricular pressure-volume loop recordings at baseline and after sternotomy and pericardiotomy. Data were compared by ANOVA or the Friedmann test where appropriate, with post-hoc analyses to control for multiple comparisons. Sternotomy and pericardiotomy caused reductions in mean systemic (-12 ± 11 mmHg, P = 0.027) and pulmonary pressures (-4 ± 3 mmHg, P = 0.006) and airway pressures. Cardiac output decreased non-significantly (-1329 ± 1762 ml/min, P = 0.052). Left ventricular afterload decreased, with an increase in ejection fraction (+9 ± 7%, P = 0.027) and coupling. No changes were observed in right ventricular systolic function or arterial blood gases. In conclusion, open- versus closed-chest approaches to invasive cardiovascular phenotyping cause a systematic difference in key haemodynamic variables. Researchers should adopt the most appropriate approach to ensure rigour and reproducibility in preclinical cardiovascular research.


Asunto(s)
Pericardiectomía , Esternotomía , Porcinos , Animales , Reproducibilidad de los Resultados , Hemodinámica , Modelos Animales
6.
Echocardiography ; 40(9): 925-931, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37477341

RESUMEN

OBJECTIVES: In acute pulmonary embolism (PE), the right ventricle (RV) may dilate compromising left ventricular (LV) size, thereby increasing RV/LV ratio. End-diastolic RV/LV ratio is often used in PE risk stratification, though the cause of death is RV systolic failure. We aimed to confirm our pre-clinical observations of higher RV/LV ratio in systole compared to diastole in human patients with PE. METHODS: We blinded and independently analyzed echocardiograms from 606 patients with PE, evaluated by a Pulmonary Embolism Response Team. We measured RV/LV ratios in end-systole and end-diastole and fractional area change (FAC). Our primary outcome was a composite of 7-day clinical deterioration, treatment escalation or death. Secondary outcomes were 7-day and 30-day all-cause mortality. RESULTS: RV/LV ratio was higher in systole compared to diastole (median 1.010 [.812-1.256] vs. .975 [.843-1.149], p < .0001). RV/LV in systole and diastole were correlated (slope = 1.30 [95% CI 1.25-1.35], p < .0001 vs. slope = 1). RV/LV ratios in both systole and diastole were associated with the primary composite outcome but not with all-cause mortality. CONCLUSION: The RV/LV ratio is higher when measured in systole versus in diastole in patients with acute PE. The two approaches had similar associations with clinical outcomes, that is, it appears reasonable to measure RV/LV ratio in diastole.


Asunto(s)
Insuficiencia Cardíaca , Embolia Pulmonar , Humanos , Ventrículos Cardíacos/diagnóstico por imagen , Diástole , Sístole , Embolia Pulmonar/diagnóstico por imagen , Ecocardiografía , Enfermedad Aguda
7.
Proc Natl Acad Sci U S A ; 117(34): 20468-20473, 2020 08 25.
Artículo en Inglés | MEDLINE | ID: mdl-32747573

RESUMEN

This paper uses real-time transaction data from a large bank in Scandinavia to estimate the effect of social distancing laws on consumer spending in the coronavirus 2019 (COVID-19) pandemic. The analysis exploits a natural experiment to disentangle the effects of the virus and the laws aiming to contain it: Denmark and Sweden were similarly exposed to the pandemic but only Denmark imposed significant restrictions on social and economic activities. We estimate that aggregate spending dropped by around 25% (95% CI: 24 to 26%) in Sweden and, as a result of the shutdown, by 4 additional percentage points (95% CI: 3 to 5 percentage points [p.p.]) in Denmark. This suggests that most of the economic contraction is caused by the virus itself and occurs regardless of social distancing laws. The age gradient in the estimates suggests that social distancing reinforces the virus-induced drop in spending for low-health-risk individuals but attenuates it for high-risk individuals by lowering the overall prevalence of the virus in the society.


Asunto(s)
Control de Enfermedades Transmisibles/economía , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Comportamiento del Consumidor/economía , Infecciones por Coronavirus/economía , Pandemias/economía , Neumonía Viral/economía , Aislamiento Social , Betacoronavirus , COVID-19 , Dinamarca , Política de Salud/legislación & jurisprudencia , Humanos , SARS-CoV-2 , Suecia
8.
Catheter Cardiovasc Interv ; 99(5): 1551-1557, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34773685

RESUMEN

OBJECTIVES: To describe the occurrence of postprocedural atrial fibrillation (AF) among patients with cryptogenic stroke undergoing patent foramen ovale (PFO) closure in the REDUCE clinical study and analyze for potential risk factors for the development of postprocedural AF. BACKGROUND: AF is an adverse event that might potentially counterbalance the stroke prevention benefit from PFO closure. Data on AF after transcatheter PFO closure are sparse. METHODS: We evaluated data from patients having PFO closure (Gore HELEX or Gore Cardioform Septal Occluder) in the REDUCE clinical trial (n = 408) in at post hoc explorative analysis. Median follow-up was 5.0 years. RESULTS: AF occurred in 30 patients (7.4%) after PFO closure with a total of 34 AF events. Most were reported as non-serious (68%), detected within 45 days post-procedure (79%), and resolved within 2 weeks of onset (63%). One subject with AF had recurrent stroke. Postprocedural AF occurred more frequently among subjects with higher age and large device sizes. Male sex was the only independent predictor of postprocedural AF. We found no association between the type of occluder (HELEX or Gore Cardioform Septal Occluder) or PFO anatomical characteristics and post-procedural AF. CONCLUSION: In the REDUCE clinical study, postprocedural atrial fibrillation was mostly early onset, transient and with no later recurrence. Postprocedural AF occurred more frequently among patients with higher age and larger devices. Male sex was the only independent predictor of postprocedural AF.


Asunto(s)
Fibrilación Atrial , Cateterismo Cardíaco , Foramen Oval Permeable , Fibrilación Atrial/epidemiología , Cateterismo Cardíaco/efectos adversos , Foramen Oval Permeable/terapia , Humanos , Masculino , Dispositivo Oclusor Septal , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
9.
J Thromb Thrombolysis ; 53(2): 506-513, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34370168

RESUMEN

Pulmonary embolism response teams (PERT) aim to improve treatment of acute pulmonary embolism (PE). PERT focus on intermediate- and high-risk PE patients, but recent multicenter studies show that low-risk PE patients compose one in five of all PERT cases. Conversely, not all intermediate- and high-risk PE patients elicit a PERT activation. The factors leading to PERT activations remain unknown. This study aims to describe the patient characteristics associated with PERT activation for low-risk PE patients and characteristics precluding PERT activation for intermediate/high-risk PE patients. We analysed data from all patients with confirmed PE diagnosed in the Massachusetts General Hospital Emergency Department from August 2013 to February 2017 and cross-referred these data with patients who received a PERT activation and patients who did not. Patients were stratified into low-risk or intermediate/high-risk PE. Univariate analyses were performed within each risk group comparing patients with a PERT activation and patients without. Fifteen percent (56/374) of low-risk PE patients triggered a PERT activation. Patient characteristics associated with PERT activation were: (1) vascular disease, (2) pulmonary diseases, (3) thrombophilia, (4) current use of anticoagulants, (5) central PE and (6) concurrent DVT. Thirty-five percent (110/283) of intermediate/high-risk PE patients did not elicit a PERT activation. Patient characteristics precluding a PERT activation were: (1) vascular disease, (2) malignancies and (3) asymptomatic presentation. Low-risk PE patients with PERT activations had more extensive clot burden, complex comorbidities, or had failed anticoagulation treatment. Intermediate/high-risk PE patients without PERT activations tended to have malignancies or vascular disease.


Asunto(s)
Grupo de Atención al Paciente , Embolia Pulmonar , Anticoagulantes , Humanos , Massachusetts/epidemiología , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Factores de Riesgo
10.
J Strength Cond Res ; 36(3): 796-804, 2022 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-35180191

RESUMEN

ABSTRACT: Bláfoss, R, Rikardo, J, Andersen, AØ, Hvid, LG, Andersen, LL, Jensen, K, Christensen, PM, Kvorning, T, and Aagaard, P. Effects of resistance training cessation on cycling performance in well-trained cyclists: an exploratory study. J Strength Cond Res 36(3): 796-804, 2022-Supplementary (i.e., concurrent) resistance training can enhance cycling performance among competitive cyclists. However, a lack of knowledge exists about the retention (decay profile) in mechanical muscle function and cycling performance after concurrent resistance and endurance training. The present exploratory intervention study investigated the effect of 6 weeks of resistance training cessation when preceded by 8 weeks of concurrent resistance and endurance training on mechanical muscle function and cycling performance in 9 male well-trained competitive cyclists (V̇o2max = 66 ± 7 ml·min-1·kg-1). Cyclists performed periodized resistance training targeting leg and core muscles for 8 weeks as a supplement to their normal endurance (cycling) training. This was followed by 6 weeks of endurance training only (retention period) leading up to the start of the competitive season. Maximal leg extensor power, isometric leg extensor strength (maximal voluntary contraction [MVC]), rate of force development (RFD), and long-term cycling performance (2-hour submaximal cycling at 55% of Wmax), followed by 5-minute max cycling were evaluated. After 8 weeks of concurrent resistance and endurance training, leg extensor power, MVC, and RFD increased by 12, 15, and 17%, respectively while mean power output (W) during 5-minute max cycling increased by 7% (p < 0.05). Training-induced gains in MVC and 5-minute max cycling power were retained after 6-week cessation of resistance training (p < 0.05). These findings indicate that competitive cyclists can focus on cycling training alone for at least 6 weeks leading up to competition without losing attained gains in maximal muscle strength and cycling performance achieved by preceding periods of concurrent resistance training.


Asunto(s)
Rendimiento Atlético , Entrenamiento de Fuerza , Rendimiento Atlético/fisiología , Ciclismo/fisiología , Humanos , Masculino , Fuerza Muscular/fisiología , Consumo de Oxígeno/fisiología , Resistencia Física/fisiología
11.
Am J Respir Cell Mol Biol ; 64(3): 331-343, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33264068

RESUMEN

Monoamine oxidases (MAOs), a class of enzymes bound to the outer mitochondrial membrane, are important sources of reactive oxygen species. Increased MAO-A activity in endothelial cells and cardiomyocytes contributes to vascular dysfunction and progression of left heart failure. We hypothesized that inhibition of MAO-A can be used to treat pulmonary arterial hypertension (PAH) and right ventricular (RV) failure. MAO-A levels in lung and RV samples from patients with PAH were compared with levels in samples from donors without PAH. Experimental PAH was induced in male Sprague-Dawley rats by using Sugen 5416 and hypoxia (SuHx), and RV failure was induced in male Wistar rats by using pulmonary trunk banding (PTB). Animals were randomized to receive either saline or the MAO-A inhibitor clorgyline at 10 mg/kg. Echocardiography and RV catheterization were performed, and heart and lung tissues were collected for further analysis. We found increased MAO-A expression in the pulmonary vasculature of patients with PAH and in experimental experimental PAH induced by SuHx. Cardiac MAO-A expression and activity was increased in SuHx- and PTB-induced RV failure. Clorgyline treatment reduced RV afterload and pulmonary vascular remodeling in SuHx rats through reduced pulmonary vascular proliferation and oxidative stress. Moreover, clorgyline improved RV stiffness and relaxation and reversed RV hypertrophy in SuHx rats. In PTB rats, clorgyline had no direct clorgyline had no direct effect on the right ventricle effect. Our study reveals the role of MAO-A in the progression of PAH. Collectively, these findings indicated that MAO-A may be involved in pulmonary vascular remodeling and consecutive RV failure.


Asunto(s)
Progresión de la Enfermedad , Monoaminooxidasa/metabolismo , Hipertensión Arterial Pulmonar/enzimología , Animales , Clorgilina/farmacología , Clorgilina/uso terapéutico , Modelos Animales de Enfermedad , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/enzimología , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Derecha/complicaciones , Hipertrofia Ventricular Derecha/fisiopatología , Indoles , Estrés Oxidativo/efectos de los fármacos , Hipertensión Arterial Pulmonar/inducido químicamente , Hipertensión Arterial Pulmonar/tratamiento farmacológico , Hipertensión Arterial Pulmonar/fisiopatología , Arteria Pulmonar/efectos de los fármacos , Arteria Pulmonar/enzimología , Arteria Pulmonar/patología , Arteria Pulmonar/fisiopatología , Pirroles , Ratas , Remodelación Vascular/efectos de los fármacos , Rigidez Vascular/efectos de los fármacos , Vasodilatación/efectos de los fármacos
12.
Crit Care Med ; 49(9): e891-e901, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-33870917

RESUMEN

OBJECTIVES: To investigate if oxygen could unload the right ventricle and improve right ventricle function in a porcine model mimicking intermediate-high risk acute pulmonary embolism. DESIGN: Controlled, blinded, animal study. SETTING: Tertiary university hospital, animal research laboratory. SUBJECTS: Female, Danish pigs (n = 16, approximately 60 kg). INTERVENTIONS: Acute autologous pulmonary embolism was induced until doubling of baseline mean pulmonary arterial pressure. Group 1 animals (n = 8) received increasing Fio2 (40%, 60%, and 100%) for time intervals of 15 minutes returning to atmospheric air between each level of Fio2. In group 2 (n = 8), the effects of Fio2 40% maintained over 75 minutes were studied. In both groups, pulmonary vasodilatation from inhaled nitric oxide (40 parts per million) was used as a positive control. MEASUREMENTS AND MAIN RESULTS: Effects were evaluated by biventricular pressure-volume loop recordings, right heart catheterization, and arterial and mixed venous blood gasses. Pulmonary embolism increased mean pulmonary arterial pressure from 15 ± 4 to 33 ± 6 mm Hg (p = 0.0002) and caused right ventricle dysfunction (p < 0.05) with troponin release (p < 0.0001). In group 1, increasing Fio2 lowered mean pulmonary arterial pressure (p < 0.0001) and pulmonary vascular resistance (p = 0.0056) and decreased right ventricle volumes (p = 0.0018) and right ventricle mechanical work (p = 0.034). Oxygenation was improved and pulmonary shunt was lowered (p < 0.0001). Maximal hemodynamic effects were seen at Fio2 40% with no additional benefit from higher fractions of oxygen. In group 2, the effects of Fio2 40% were persistent over 75 minutes. Supplemental oxygen showed the same pulmonary vasodilator efficacy as inhaled nitric oxide (40 parts per million). No adverse effects were observed. CONCLUSIONS: In a porcine model mimicking intermediate-high risk pulmonary embolism, oxygen therapy reduced right ventricle afterload and lowered right ventricle mechanical work. The effects were immediately present and persistent and were similar to inhaled nitric oxide. The intervention is easy and safe. The study motivates extended clinical evaluation of supplemental oxygen in acute pulmonary embolism.


Asunto(s)
Terapia por Inhalación de Oxígeno/normas , Embolia Pulmonar/fisiopatología , Función Ventricular Derecha/efectos de los fármacos , Animales , Dinamarca , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Embolia Pulmonar/tratamiento farmacológico , Porcinos
13.
Scand Cardiovasc J ; 55(5): 315-325, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34470566

RESUMEN

OBJECTIVES: Several cardiovascular, structural, and functional abnormalities have been considered as potential causes of cardioembolic ischemic strokes. Beyond atrial fibrillation, other sources of embolism clearly exist and may warrant urgent action, but they are only a minor part of the many stroke mechanisms and strokes that seem to be of embolic origin remain without a determined source. The associations between stroke and findings like atrial fibrillation, valve calcification, or heart failure are confounded by co-existing risk factors for atherosclerosis and vascular disease. In addition, a patent foramen ovale which is a common abnormality in the general population is mostly an innocent bystander in patients with ischemic stroke. For these reasons, experts from the national Danish societies of cardiology, neurology, stroke, and neuroradiology sought to develop a consensus document to provide national recommendations on how to manage patients with a suspected cardioembolic stroke. Design: Comprehensive literature search and analyses were done by a panel of experts and presented at a consensus meeting. Evidence supporting each subject was vetted by open discussion and statements were adjusted thereafter. Results: The most common sources of embolic stroke were identified, and the statement provides advise on how neurologist can identify cases that need referral, and what is expected by the cardiologist. Conclusions: A primary neurological and neuroradiological assessment is mandatory and neurovascular specialists should manage the initiation of secondary prophylactic treatment. If a cardioembolic stroke is suspected, a dedicated cardiologist experienced in the management of cardioembolism should provide a tailored clinical and echocardiographic assessment.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Embólico , Isquemia Encefálica/diagnóstico , Consenso , Ecocardiografía , Accidente Cerebrovascular Embólico/diagnóstico , Humanos
14.
BMC Pulm Med ; 21(1): 72, 2021 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-33639897

RESUMEN

BACKGROUND: To investigate if acute pulmonary vasodilation by sildenafil improves right ventricular function in patients with acute intermediate-high risk pulmonary embolism (PE). METHODS: Single center, explorative trial. Patients with PE were randomized to a single oral dose of sildenafil 50 mg (n = 10) or placebo (n = 10) as add-on to conventional therapy. The time from hospital admission to study inclusion was 2.3 ± 0.7 days. Right ventricular function was evaluated immediately before and shortly after (0.5-1.5 h) randomization by right heart catheterization (RHC), trans-thoracic echocardiography (TTE), and cardiac magnetic resonance (CMR). The primary efficacy endpoint was cardiac index measured by CMR. RESULTS: Patients had acute intermediate-high risk PE verified by computed tomography pulmonary angiography, systolic blood pressure of 135 ± 18 (mean ± SD) mmHg, increased right ventricular/left ventricular ratio 1.1 ± 0.09 and increased troponin T 167 ± 144 ng/L. Sildenafil treatment did not improve cardiac index compared to baseline (0.02 ± 0.36 l/min/m2, p = 0.89) and neither did placebo (0.00 ± 0.34 l/min/m2, p = 0.97). Sildenafil lowered mean arterial blood pressure (- 19 ± 10 mmHg, p < 0.001) which was not observed in the placebo group (0 ± 9 mmHg, p = 0.97). CONCLUSION: A single oral dose of sildenafil 50 mg did not improve cardiac index but lowered systemic blood pressure in patients with acute intermediate-high risk PE. The time from PE to intervention, a small patient sample size and low pulmonary vascular resistance are limitations of this study that should be considered when interpreting the results. TRIAL REGISTRATION: The trial was retrospectively registered at www.clinicaltrials.gov (NCT04283240) February 2nd 2020, https://clinicaltrials.gov/ct2/show/NCT04283240?term=NCT04283240&draw=2&rank=1 .


Asunto(s)
Presión Arterial/efectos de los fármacos , Ventrículos Cardíacos/efectos de los fármacos , Embolia Pulmonar/tratamiento farmacológico , Citrato de Sildenafil/uso terapéutico , Vasodilatación/efectos de los fármacos , Administración Oral , Anciano , Anciano de 80 o más Años , Cateterismo Cardíaco , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Citrato de Sildenafil/farmacología , Resultado del Tratamiento , Resistencia Vascular/efectos de los fármacos
15.
Crit Care Med ; 48(12): e1306-e1312, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33060507

RESUMEN

OBJECTIVES: To compare the hemodynamic effects of increased versus decreased preload in a porcine model of acute intermediate-risk pulmonary embolism. DESIGN: Randomized, controlled animal study. SETTING: Tertiary medical center, animal research laboratory. SUBJECTS: Female, Danish slaughter pigs (n = 22, ~ 60 kg). INTERVENTIONS: Acute pulmonary embolism was induced by large emboli made from clotting of autologous blood. Sixteen animals were randomized to either fluid loading (n = 8, isotonic saline, 1 L/hr for 2 hr) or diuretic treatment (n = 8, furosemide, 40 mg every 30 min, total 160 mg) and compared with a vehicle group (n = 6, no treatment). MEASUREMENTS AND MAIN RESULTS: Hemodynamics were evaluated at baseline, after pulmonary embolism and after each dose by biventricular pressure-volume loops, invasive pressures, diuretic output, respiratory variables, and blood analysis. Pulmonary embolism increased mean pulmonary arterial pressure (p < 0.0001), pulmonary vascular resistance (p = 0.008), right ventricular arterial elastance (p = 0.003), and right ventricular end-systolic volume (p = 0.020) while right ventricular stroke volume and right ventricular ejection fraction were decreased (p = 0.047 and p = 0.0003, respectively) compared with baseline. Fluid loading increased right ventricular end-diastolic volume (+31 ± 13 mL; p = 0.004), right ventricular stroke volume (+23 ± 10 mL; p = 0.009), cardiac output (+2,021 ± 956 mL; p = 0.002), and right ventricular ejection fraction (+7.6% ± 1.5%; p = 0.032), whereas pulmonary vascular resistance decreased (-202 ± 65 dynes; p = 0.020) compared with vehicle. Diuretic treatment decreased right ventricular end-diastolic volume (-84 ± 11 mL; p < 0.001), right ventricular stroke volume (-40 ± 6 mL; p = 0.001), cardiac output (-3,327 ± 451 mL; p = 0.005), and mean pulmonary arterial pressure (-7 ± 1 mm Hg; p < 0.001) and increased right ventricular end-systolic elastance (+0.72 ± 0.2 mm Hg/mL; p < 0.001) and systemic vascular resistance (+1,812 ± 767 dynes; p < 0.001) with no effects on mean arterial pressure. CONCLUSIONS: In a porcine model of acute intermediate-risk pulmonary embolism, fluid loading increased right ventricular preload and right ventricular stroke volume, whereas diuretics decreased right ventricular preload and right ventricular stroke volume without affecting mean arterial pressure.


Asunto(s)
Hemodinámica , Embolia Pulmonar/fisiopatología , Función Ventricular Derecha , Animales , Presión Sanguínea/fisiología , Femenino , Hemodinámica/fisiología , Porcinos , Resistencia Vascular/fisiología , Función Ventricular Derecha/fisiología
16.
Crit Care Med ; 48(4): e308-e315, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32205621

RESUMEN

OBJECTIVES: We investigated whether the vasopressin-analog, terlipressin induces systemic vasoconstriction and pulmonary vasodilation in a porcine model of acute pulmonary embolism. DESIGN: Controlled, animal study. SETTING: Tertiary medical center research laboratory. SUBJECTS: Female pigs (n = 12, Cross of Land Race, Duroc, and Yorkshire ~ 60 kg). INTERVENTIONS: Acute pulmonary embolism was induced by administration of three large autologous emboli. Animals then received four increasing doses of either terlipressin (n = 6) or vehicle (n = 6). MEASUREMENTS AND MAIN RESULTS: Effects were evaluated in vivo at baseline, after pulmonary embolism and after each dose by invasive hemodynamic measures, transesophageal echocardiography, and blood analysis. Isolated pulmonary arteries were evaluated ex vivo in a myograph. Pulmonary embolism caused a four-fold increase in pulmonary vascular resistance (p < 0.0001) and a two-fold increase in mean pulmonary arterial pressure (p < 0.0001) compared with baseline. Terlipressin increased mean systemic blood pressure (28 ± 5 mm Hg; p < 0.0001) and systemic vascular resistance (1,320 ± 143 dynes; p < 0.0001) compared with vehicle. In the pulmonary circulation, terlipressin decreased mean pulmonary arterial pressure (-6.5 ± 1.8 mm Hg; p = 0.005) and tended to decrease pulmonary vascular resistance (-83 ± 33 dynes; p = 0.07). Terlipressin decreased cardiac output (-2.5 ± 0.5 L/min; p < 0.0001) and increased plasma lactate (2.7 ± 0.2 mmol/L; p < 0.0001), possibly indicating systemic hypoperfusion. A biomarker of cerebral ischemia, S100b, remained unchanged, suggesting preserved cerebral perfusion (0.17 ± 0.11 µg/L; p = 0.51). Ex vivo, terlipressin relaxed pulmonary and constricted mesenteric arteries. CONCLUSIONS: Terlipressin caused systemic vasoconstriction and pulmonary vasodilation in a porcine in vivo model of acute pulmonary embolism and vasorelaxation in isolated pulmonary arteries. Despite positive vascular effects, cardiac output declined and plasma lactate increased probably due to a predominantly systemic vasoconstrictor effect of terlipressin. These findings should warrant careful translation to the clinical setting and does not suggest routine use in acute pulmonary embolism.


Asunto(s)
Presión Arterial/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Embolia Pulmonar/tratamiento farmacológico , Resistencia Vascular/efectos de los fármacos , Vasoconstrictores/efectos adversos , Animales , Presión Sanguínea/efectos de los fármacos , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Masculino , Arteria Pulmonar/fisiopatología , Embolia Pulmonar/embriología , Embolia Pulmonar/fisiopatología , Porcinos , Vasoconstrictores/administración & dosificación
17.
Psychol Sci ; 31(11): 1351-1362, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33021885

RESUMEN

In this study, we monitored 470 university students' smartphone usage continuously over 2 years to assess the relationship between in-class smartphone use and academic performance. We used a novel data set in which smartphone use and grades were recorded across multiple courses, allowing us to examine this relationship at the student level and the student-in-course level. In accordance with the existing literature, our results showed that students' in-class smartphone use was negatively associated with their grades, even when we controlled for a broad range of observed student characteristics. However, the magnitude of the association decreased substantially in a fixed-effects model, which leveraged the panel structure of the data to control for all stable student and course characteristics, including those not observed by researchers. This suggests that the size of the effect of smartphone usage on academic performance has been overestimated in studies that controlled for only observed student characteristics.


Asunto(s)
Rendimiento Académico , Teléfono Inteligente , Humanos , Estudiantes
19.
Int J Mol Sci ; 19(12)2018 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-30486375

RESUMEN

In pulmonary arterial hypertension (PAH), lung-angioproliferation leads to increased pulmonary vascular resistance, while simultaneous myocardial microvessel loss contributes to right ventricular (RV) failure. Endothelial colony forming cells (ECFC) are highly proliferative, angiogenic cells that may contribute to either pulmonary vascular obstruction or to RV microvascular adaptation. We hypothesize ECFC phenotypes (outgrowth, proliferation, tube formation) are related to markers of disease severity in a prospective cohort-study of 33 PAH and 30 healthy subjects. ECFC were transplanted in pulmonary trunk banded rats with RV failure. The presence of ECFC outgrowth in PAH patients was associated with low RV ejection fraction, low central venous saturation and a shorter time to clinical worsening (5.4 months (0.6⁻29.2) vs. 36.5 months (7.4⁻63.4), p = 0.032). Functionally, PAH ECFC had higher proliferative rates compared to control in vitro, although inter-patient variability was high. ECFC proliferation was inversely related to RV end diastolic volume (R² = 0.39, p = 0.018), but not pulmonary vascular resistance. Tube formation-ability was similar among donors. Normal and highly proliferative PAH ECFC were transplanted in pulmonary trunk banded rats. While no effect on hemodynamic measurements was observed, RV vascular density was restored. In conclusion, we found that ECFC outgrowth associates with high clinical severity in PAH, suggesting recruitment. Transplantation of highly proliferative ECFC restored myocardial vascular density in pulmonary trunk banded rats, while RV functional improvements were not observed.


Asunto(s)
Biomarcadores , Células Progenitoras Endoteliales/metabolismo , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/metabolismo , Arteria Pulmonar/fisiopatología , Adulto , Anciano , Animales , Proliferación Celular , Modelos Animales de Enfermedad , Células Progenitoras Endoteliales/trasplante , Femenino , Hemodinámica , Humanos , Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Neovascularización Fisiológica , Pronóstico , Ratas , Índice de Severidad de la Enfermedad , Trasplante de Células Madre , Resistencia Vascular , Disfunción Ventricular Derecha
20.
J Cardiovasc Pharmacol ; 69(1): 1-12, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27652910

RESUMEN

BACKGROUND: Prostacyclin mimetics are vasodilatory agents used in the treatment of pulmonary arterial hypertension. The direct effects of prostanoids on right-ventricular (RV) function are unknown. We aimed to investigate the direct effects of prostacyclin mimetics on RV function in hearts with and without RV hypertrophy and failure. METHODS: Wistar rats were subjected to pulmonary trunk banding to induce compensated RV hypertrophy (n = 32) or manifest RV failure (n = 32). Rats without banding served as healthy controls (n = 30). The hearts were excised and perfused in a Langendorff system and subjected to iloprost, treprostinil, epoprostenol, or MRE-269 in increasing concentrations. The effect on RV function was evaluated using a balloon-tipped catheter inserted into the right ventricle. RESULTS: In control hearts, iloprost, treprostinil, and MRE-269 improved RV function. The effect was, however, absent in hearts with RV hypertrophy and failure. Treprostinil and MRE-269 even impaired RV function in hearts with manifest RV failure. CONCLUSIONS: Iloprost, treprostinil, and MRE-269 improved RV function in the healthy rat heart. RV hypertrophy abolished the positive inotropic effect, and in the failing right ventricle, MRE-269 and treprostinil impaired RV function. This may be related to changes in prostanoid receptor expression and reduced coronary flow reserve in the hypertrophic and failing right ventricle.


Asunto(s)
Cardiotónicos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hipertrofia Ventricular Derecha/tratamiento farmacológico , Prostaglandinas I/uso terapéutico , Función Ventricular Derecha/efectos de los fármacos , Animales , Cardiotónicos/farmacología , Insuficiencia Cardíaca/fisiopatología , Hipertrofia Ventricular Derecha/fisiopatología , Masculino , Técnicas de Cultivo de Órganos , Prostaglandinas I/farmacología , Ratas , Ratas Wistar , Resultado del Tratamiento , Vasodilatadores/farmacología , Vasodilatadores/uso terapéutico , Función Ventricular Derecha/fisiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA