ABSTRACT
Gated positron emission testing with computed tomography (PET-CT) yields left ventricular (LV) volume analysis along with perfusion analysis. The correlation between PET-CT volumes and cardiac magnetic resonance imaging (CMR) volumes remains unknown. Understanding of the accuracy of these volumes and ejection fractions (EF) by PET is clinically relevant, particularly in the sarcoid population where patients receive initial diagnostic CMR and then are followed by PET for inflammation. 89 patients undergoing cardiac sarcoidosis evaluation with both rest PET-CT and CMR within approximately 1 year were identified at Cleveland Clinic from 2011 to 2021. LV volumes and EF were collected. Linear regression and Bland-Altman analyses were performed. Mean PET-CT derived left ventricular ejection fraction (LVEF) was 46 ± 16% with mean LV end diastolic volume (LVEDV) of 127 ± 60â mL and mean LV end systolic volume (LVESV) of 75 ± 54â mL. Mean CMR-derived LVEF was 47 ± 15% with mean LVEDV of 189 ± 61â mL and mean LVESV of 106 ± 60â mL. Pearson correlation coefficient with standard measurements was 0.85 for EF, 0.80 for LVEDV, and 0.86 for LVESV. In our cohort, there is an excellent correlation of LVEF between PET-CT and CMR with a mean difference of 1.1% and a good correlation of volumes between these two imaging modalities. This has potential clinical implications when judging LVEF qualifications for medical and device therapies although future larger validation cohorts are warranted.
ABSTRACT
Cardiovascular disease remains one of the most prevalent and preventable chronic conditions worldwide. Diet modification is the foundation of cardiovascular disease prevention. Several dietary approaches have emerged to promote better cardiovascular health. The rapid dissemination of anecdotal and observational data through the internet and social media has caused confusion amongst providers and patients. The aim of this comprehensive review is to present objective insights into 2 of today's most popular fad diets: ketogenic diet and intermittent fasting. We will evaluate the performance of these diets based on their impact on cardiovascular risk factors.
Subject(s)
Cardiovascular Diseases/prevention & control , Diet, Ketogenic/methods , Dyslipidemias/metabolism , Fasting , Atrial Fibrillation , Blood Glucose/metabolism , Blood Pressure , Cholesterol, HDL/metabolism , Cholesterol, LDL/metabolism , Diabetes Mellitus, Type 2/diet therapy , Diabetes Mellitus, Type 2/prevention & control , Diet Fads , Humans , Insulin Resistance , Lipid Metabolism , Obesity/metabolism , Risk Reduction Behavior , Triglycerides/metabolism , Weight LossABSTRACT
Dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, have been shown to improve cardiac health. Intermittent fasting is another type of popular dietary pattern that is based on timed periods of fasting. Two different regimens are alternative day fasting and time-restricted eating. Although there are no large, randomized control trials examining the relationship between intermittent fasting and cardiovascular outcomes, current human studies that suggest this diet could reduce the risk for cardiovascular disease with improvement in weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting may exert its effects through multiple pathways, including reducing oxidative stress, optimization of circadian rhythms, and ketogenesis. This review evaluates current literature regarding the potential cardiovascular benefits of intermittent fasting and proposes directions for future research.
Subject(s)
Cardiovascular Diseases/metabolism , Circadian Rhythm/physiology , Diabetes Mellitus/metabolism , Dyslipidemias/metabolism , Fasting/metabolism , Hypertension/metabolism , Obesity/metabolism , Diabetes Mellitus/diet therapy , Diet, Ketogenic , Dyslipidemias/diet therapy , Fasting/physiology , Humans , Hypertension/physiopathology , Ketone Bodies/metabolism , Obesity/diet therapy , Oxidative Stress/physiology , Risk Factors , Risk Reduction BehaviorABSTRACT
Background Educational attainment is an indicator of socioeconomic status and is inversely associated with coronary artery disease risk. Whether educational attainment level (EAL) among patients with coronary artery disease influences outcomes remains understudied. Methods and Results Patients undergoing cardiac catheterization had their highest EAL assessed using options of elementary/middle school, high school, college, or graduate education. Primary outcome was all-cause mortality and secondary outcomes were a composite of cardiovascular death/non-fatal myocardial infarction and non-fatal myocardial infarction during follow-up. Cox models adjusted for clinically relevant confounders were used to analyze the association of EAL with outcomes. Among 6318 patients (63.5 years, 63% men, 23% black) enrolled, 16%, 42%, 38%, and 4% had received graduate or higher, college, high school, and elementary/middle school education, respectively. During 4.2 median years of follow-up, there were 1066 all-cause deaths, 812 cardiovascular deaths/non-fatal myocardial infarction, and 276 non-fatal myocardial infarction. Compared with patients with graduate education, those in lower EAL categories (elementary/middle school, high school, or college education) had a higher risk of all-cause mortality (hazard ratios 1.52 [95% CI 1.11-2.09]; 1.43 [95% CI 1.17-1.73]; and 95% CI 1.26 [1.03-1.53], respectively). Similar findings were observed for secondary outcomes. Conclusions Low educational attainment is an independent predictor of adverse outcomes in patients undergoing angiographic coronary artery disease evaluation. The utility of incorporating EAL into risk assessment algorithms and the causal link between low EAL and adverse outcomes in this high-risk patient population need further investigation.
Subject(s)
Coronary Artery Disease/epidemiology , Coronary Artery Disease/therapy , Educational Status , Myocardial Revascularization , Social Determinants of Health , Aged , Cause of Death , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Female , Georgia/epidemiology , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Myocardial Revascularization/adverse effects , Myocardial Revascularization/mortality , Prospective Studies , Registries , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To review the clinical presentation, histology, staging, treatment modalities, and survival for pediatric head and neck rhabdomyosarcoma (non-orbital). STUDY DESIGN: Retrospective chart review at a tertiary pediatric hospital of children treated over 18 years (1996-2014) for primary head and neck non-orbital rhabdomyosarcoma. METHODS: Medical charts were examined for clinical presentation, staging, histology, genetic abnormalities, treatment modalities, recurrence and complications from treatment. RESULTS: Our cohort was 17 children (7 male, 10 female) with rhabdomyosarcoma with a median age of 6.3 years (range <1-19). The majority of tumors were of parameningeal location (13/17) with embryonal histology (11/17). Twenty-nine percent (5/17) demonstrated advanced metastatic disease at initial referral. Fifty-three percent (9/17) had skull base erosion and/or cranial nerve deficits. PET CT scan was performed in 4 patients. The overall survival was 75% for the duration of the study. Primary surgical excision was performed in all 4 patients with nonparameningeal tumors as compared to only 1 patient with a parameningeal tumor. All received chemotherapy and radiotherapy, as none had completely resectable disease. CONCLUSION: Pediatric non-orbital primary rhabdomyosarcoma of the head and neck usually has a rapid onset and presents with advanced disease. Our analysis found that the majority of patients in our series had a cranial neuropathy at presentation, which highlights how advanced the disease is in these patients at presentation. The first mode of surgical intervention should be directed toward biopsy in junction with a metastatic work-up. Primary excision with negative microscopic margins for nonparameningeal rhabdomyosarcoma is ideal to spare radiotherapy but was not achievable in our cohort. The benefits of second-look biopsy after chemotherapy and radiation are still unproven; however, we believe that it was beneficial in two patients in our review for further resection thus decreasing subsequent radiation. Fluorodeoxy-d-glucose positron emission tomography (PET) to evaluate disease post treatment may further define the role for second look surgery.
Subject(s)
Head and Neck Neoplasms , Rhabdomyosarcoma , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy, Adjuvant , Child , Child, Preschool , Cranial Nerve Diseases/etiology , Female , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/therapy , Humans , Infant , Male , Neoplasm Recurrence, Local/therapy , Positron-Emission Tomography , Retrospective Studies , Rhabdomyosarcoma/complications , Rhabdomyosarcoma/secondary , Rhabdomyosarcoma/therapy , Survival Rate , Tomography, X-Ray Computed , Young AdultABSTRACT
To minimize premature release of drugs from their carriers during circulation in the blood stream, we have recently developed reversible disulfide cross-linked micelles (DCMs) that can be triggered to release drug at the tumor site or in cancer cells. We designed and synthesized thiolated linear-dendritic polymers (telodendrimers) by introducing cysteines to the dendritic oligo-lysine backbone of our previously reported telodendrimers comprised of linear polyethylene glycol (PEG) and a dendritic cluster of cholic acids. Reversibly cross-linked micelles were then prepared by the oxidization of thiol groups to disulfide bond in the core of micelles after the self-assembly of thiolated telodendrimers. The DCMs were spherical with a uniform size of 28 nm, and were able to load paclitaxel (PTX) in the core with superior loading capacity up to 35.5% (w/w, drug/micelle). Cross-linking of the micelles within the core reduced their apparent critical micelle concentration and greatly enhanced their stability in non-reductive physiological conditions as well as severe micelle-disrupting conditions. The release of PTX from the DCMs was significantly slower than that from non-cross-linked micelles (NCMs), but can be gradually facilitated by increasing the concentration of reducing agent (glutathione) to an intracellular reductive level. The DCMs demonstrated a longer in vivo blood circulation time, less hemolytic activities, and superior toxicity profiles in nude mice, when compared to NCMs. DCMs were found to be able to preferentially accumulate at the tumor site in nude mice bearing SKOV-3 ovarian cancer xenograft. We also demonstrated that the disulfide cross-linked micellar formulation of PTX (PTX-DCMs) was more efficacious than both free drug and the non-cross-linked formulation of PTX at equivalent doses of PTX in the ovarian cancer xenograft mouse model. The anti-tumor effect of PTX-DCMs can be further enhanced by triggering the release of PTX on-demand by the administration of the FDA approved reducing agent, N-acetylcysteine, after PTX-DCMs have reached the tumor site.