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INTRODUCTION: This manuscript offers an in-depth comparative examination of the effectiveness of higher-dose (double standard-dose and high-dose) influenza vaccines in contrast to a single standard-dose vaccine when it comes to alleviating major cardiovascular events. STUDY DESIGN: Meta-Analysis. METHODS: To conduct this study, an exhaustive search was carried out in the medical English literature using databases such as PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL until 10 April 2024. The evaluation of associations was achieved through the calculation of pooled relative risks (RRs) accompanied by their corresponding 95% confidence intervals (CIs). RESULTS: A meticulous analysis encompassed a comprehensive cohort of 68,713 patients. Among these participants, 34,430 individuals were randomly assigned to receive a higher-dose influenza vaccination, whereas 34,283 received the standard influenza vaccination. Contrary to initial expectations, a higher-dose influenza vaccine did not manifest elevated efficacy compared to the standard-dose vaccine in terms of mitigating major cardiovascular events. The computed pooled RR stood at 1.0, accompanied by a 95% CI ranging from 0.93 to 1.10. CONCLUSION: While this systematic review and meta-analysis did not find a statistically significant advantage of higher-dose influenza vaccines over a single standard-dose vaccine in preventing major cardiovascular events, the observed trend towards risk reduction warrants continued investigation. These findings contribute to the ongoing dialogue surrounding vaccination strategies and their implications for cardiovascular outcomes.
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Subject(s)
Idiopathic Pulmonary Fibrosis , Lung Diseases, Interstitial , Silicosis , Tuberculosis , Humans , Tuberculosis/epidemiology , Prevalence , Lung Diseases, Interstitial/epidemiology , Silicosis/epidemiology , Idiopathic Pulmonary Fibrosis/epidemiologyABSTRACT
Background: Multi-visceral transplantation (MvTx) usually refers to the transplantation of more than three intra-abdominal organs. A successful MvTx requires strong multidisciplinary teamwork of transplant surgeons, anesthesiologists, and intensivists. Case presentation: We present five cases of MvTx with a history of short bowel syndrome admitted to the Abu-Ali Sina Hospital, Shiraz, Iran from May 2019 to January 2020 and describe anesthetic considerations in MvTx. Subjects were identified (4F/1M) with a mean age of 43 years old (range 35-51). The most frequent cause of intestinal failure was portal vein thrombosis, followed by bowel gangrene and short bowel syndrome. The mean ±SD duration of the operation was 360±60 min. The bleeding volume was approximately 2600±1474 cc, and 4±1 bags of packed red blood cells were transfused. Sepsis was the main cause of death in our series. Conclusion: Careful preoperative planning, vigilant intraoperative anesthetic management, and prevention of postoperative infection are imperative to achieve the best outcomes.
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The objective of this study was to synthesize the mesoporous silicate SBA-15 loaded with glimeperide, a slightly soluble antidiabetic, and to investigate the impact of drug loading on the release of glimepiride from this carrier. SBA-15 mesospheres were synthesized by addition of HCl to the trico-polymer (PEO20PPO70PEO20) until complete dissolution, then by addition of tetraethyl orthosilicate, stirring and drying until mesospheres powder was received. The mesopheres were characterized by thermal gravimetric analysis, powder X-ray diffraction, and Fourier transfer infrared analysis. The morphology was examined under a Scanning Electron Microscope. The surface area of the prepared mesospheres was determined by Brunauer-Emmett-Teller and the compression behavior of the powder was also studied. Then glimepiride was loaded on the mesospheres and percent loading as well as drug release was studied. Results showed successful preparation of the mesospheres with a glimepiride loading of was 40% with significant release improvement of glimepiride dissolution. A proportion of 70% glimepiride was released in the first 10 min compared to 5 % pure drug. It was concluded that the prepared mesospheres highly improve dissolution of glimeperide.
Subject(s)
Drug Carriers , Silicon Dioxide , Calorimetry, Differential Scanning , Drug Delivery Systems , Porosity , Solubility , Spectroscopy, Fourier Transform Infrared , Sulfonylurea Compounds , X-Ray DiffractionABSTRACT
BACKGROUND: Ischemia-reperfusion injury during transplantation can cause post-operative graft dysfunction. OBJECTIVE: To assess the efficacy of N-acetylcysteine in preventing hepatic ischemia-reperfusion injury and post-transplant outcomes. METHODS: In this retrospective study on pediatrics undergoing living-donor (from one of their parents) liver transplantation, N-acetylcysteine was administered to one group (n=20) after induction in the donors until graft harvest, and in the recipients during implantation, which was maintained for 19 hours. The second group (n=20) did not receive NAC. Early allograft dysfunction was determined in the presence of alanine aminotransferase or aspartate aminotransferase ≥2000 IU/L and bilirubin ≥10 mg/dL within the first 7 days, and an international normalized ratio ≥1.6 on day 7. Data were collected from a retrospectively maintained database. RESULTS: The incidence of post-reperfusion syndrome was lower in N-acetylcysteine group compared with the other group (5% vs. 30%, p=0.037). Serum creatinine level was significantly (p=0.04) different in the N-acetylcysteine group during the second post-operative week (0.14 vs. 0.15 mg/dL). There was no significant difference in the incidence of early allograft dysfunction (21% vs. 14%, p=0.327), and the survival rate (p=0.409). CONCLUSION: Peri-operative infusion of N-acetylcysteine in both donor and recipient would effectively prevent post-reperfusion syndrome and renal insufficiency. However, it might not affect the early allograft dysfunction, ICU stay, and mortality. NAC increases the chance of re-operation due to non-surgical bleeding in the first post-operative day.
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Quantum backaction (QBA) of a measurement limits the precision of observation of the motion of a free mass. This profound effect, dubbed the "Heisenberg microscope" in the early days of quantum mechanics, leads to the standard quantum limit (SQL) stemming from the balance between the measurement sensitivity and the QBA. We consider the measurement of motion of a free mass performed in a quantum reference frame with an effective negative mass which is not limited by QBA. As a result, the disturbance on the motion of a free mass can be measured beyond the SQL. QBA-limited detection of motion for a free mass is extremely challenging, but there are devices where this effect is expected to play an essential role, namely, gravitational wave detectors (GWDs) such as LIGO and Virgo. Recent reports on the observations of gravitational waves have opened new horizons in cosmology and astrophysics. We present a general idea and a detailed numerical analysis for QBA-evading measurement of the gravitational wave effect on the GWD mirrors, which can be considered free masses under relevant conditions. The measurement is performed by two entangled beams of light, probing the GWD and an auxiliary atomic spin ensemble, respectively. The latter plays the role of a free negative mass. We show that under realistic conditions the sensitivity of the GWD in m/sqrt[Hz] can be increased by 6 dB over the entire frequency band of interest.
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AIM: To evaluate the importance of exercise testing (ET) parameters and leisure time physical activity in predicting long-term prognosis in middle-aged women hospitalized for acute coronary syndrome (ACS). METHODS AND RESULTS: Women aged <66 years recently hospitalized for ACS in the Greater Stockholm area in Sweden were recruited. All underwent baseline clinical examinations including ET and then were followed up for 9 years. Nonparticipation in ET had a hazard ratio of 4.26 (95% confidence interval 2.02-8.95) for total mortality and 3.03 (1.03-8.91) for cardiovascular mortality. All ET parameters were significantly different between survivors than nonsurvivors, except for chest pain and ST-segment depression during ET. Sedentary lifestyle and ET parameters were related to total mortality and cardiovascular mortality in a multivariate analysis adjusting for potential confounders. Predictors of total mortality were sedentary lifestyle 2.94 (1.31-6.62), exercise time 1.75 (1.07-2.87) and inadequate haemodynamic responses: low increase in pulse rate 2.04 (1.16-3.60) and systolic blood pressure (SBP) 1.88 (1.19-2.95) from rest to peak exercise. Parameters that predicted cardiovascular mortality were sedentary lifestyle 3.15 (1.13-8.74) and poor increase in SBP 2.76 (1.30-5.86) from rest to peak exercise. The relation of sedentary lifestyle to survival was substantially weakened when exercise parameters were added to the multivariate analysis model. CONCLUSION: In female patients <66 years surviving ACS, important independent predictors of long-term all-cause mortality were sedentary lifestyle, low physical fitness and inadequate pulse rate and SBP increase during exercise. Predictors of cardiovascular mortality were sedentary lifestyle and inadequate blood pressure response during exercise.
Subject(s)
Exercise Tolerance , Myocardial Infarction/physiopathology , Physical Fitness/physiology , Adult , Coronary Angiography , Electrocardiography , Exercise Test , Female , Health Surveys , Humans , Hypertension/complications , Middle Aged , Myocardial Infarction/etiology , Prognosis , Proportional Hazards Models , Pulse , Risk Assessment , Statistics, Nonparametric , Survivors , SystoleABSTRACT
OBJECTIVES: Low heart rate variability (HRV) is associated with poor prognosis after acute coronary events in men. In women, the prognostic impact is not well documented. The objective of this study was to assess the long-term predictive power of HRV on mortality amongst middle-aged women with coronary heart disease (CHD). DESIGN, SETTINGS AND SUBJECTS: Consecutive women below 65 years hospitalized for an acute coronary syndrome during a 3-year period in Stockholm were examined for cardiovascular prognostic factors including HRV, and followed for a median of 9 years. An ambulatory 24-h electrocardiograph was recorded during normal activities, 3-6 months after hospitalization. SDNN index (mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording) and the following frequency domain parameters were assessed: total power, high-frequency (HF) power, low-frequency (LF) power, very-low frequency (VLF) power and LF/HF ratio. Using Cox proportional hazards regression, the hazard ratios (HR) for each 25% decrease of the HRV parameters were assessed. RESULTS: After controlling for the independent, significant predictors of mortality amongst the clinical variables, the following HRV parameters were found to be significant predictors of all-cause mortality: SDNN index [HR 1.56, 95% confidence intervals (CI) 1.19-2.05], total power (HR 1.21, 95% CI 1.08-1.35), VLF power (HR 1.22, 95% CI 1.09-1.36), LF power (HR 1.18 95%, CI 1.07-1.30) and HF power (HR 1.18, 95% CI 1.05-1.33). The results were essentially the same when cardiovascular mortality was used as end-points. The HRV parameters were stronger predictors of mortality in the first 5 years following the index event. CONCLUSION: Low HRV is a predictor of long-term mortality amongst middle-aged women with CHD when measured 3-6 months after hospitalization for an acute coronary syndrome, even after controlling for established clinical prognostic markers.
Subject(s)
Coronary Disease/mortality , Heart Rate/physiology , Cohort Studies , Coronary Disease/physiopathology , Electrocardiography, Ambulatory/methods , Female , Heart Function Tests/methods , Humans , Middle Aged , Predictive Value of Tests , Prognosis , Risk Assessment/methods , Risk FactorsABSTRACT
OBJECTIVES: The aim of this study was to evaluate the importance of different clinical parameters predicting long-term cardiac prognosis in younger women with an acute coronary event. DESIGN: The Stockholm Female Coronary Risk Study is a follow-up study in women =65 years. SETTING: Patients were included between 1991 and 1994 from all 10 coronary care or intensive care units in the greater Stockholm area. SUBJECTS: A total of 335 consecutive female patients hospitalized for an acute coronary event. MAIN OUTCOME MEASURES: Cardiac death and nonfatal myocardial infarction (AMI). RESULTS: During the follow-up period of 5 years there were 26 (8%) all cause deaths and 39 (12%) recurrent cardiac events. In the group that participated in the complete study, the following age adjusted parameters were found as strong predictors of adverse outcome: AMI as index event [Hazard Ratio (HR) 9.13, 95% CI 3.09-26.99], diabetes mellitus (HR 4.13, 95% CI 1.68-10.17), left ventricular dysfunction (HR 3.94, 95% CI 1.52-10.17), serum HDL cholesterol <1.0 mmol L-1 (HR 4.01, 95% CI 1.62-6.12), and serum triglycerides >2.0 mmol L-1 (HR 2.46, 95% CI 1.06-5.54). AMI as index event and diabetes mellitus were the most significant predictors in a multivariate statistical model. Diabetes mellitus was the strongest predictor when the analysis was repeated in the total patient cohort, integrating patients that did not participate in the extended investigations. CONCLUSION: Women aged =65-year-old hospitalized for an acute coronary event has a low rate of cardiac events during the following 5-year period. Easily obtained clinical variables such as diabetes mellitus predict adverse prognosis and implicates a need for a more active diagnostic and treatment strategy.
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Myocardial Infarction/mortality , Adult , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Prognosis , Proportional Hazards Models , Recurrence , Risk Factors , Survival Rate , Sweden/epidemiologyABSTRACT
METHODS: Morphologic characteristics of coronary arteries in eight women with myocardial infarction and angiographically normal or not significantly stenosed vessels were investigated with intracoronary ultrasound. The infarct-related vessel was assessed by three-dimensional volumetric analysis and compared with a control vessel from a noninfarcted area. RESULTS: Atherosclerosis was found in all infarct-related arteries. The plaques were predominantly soft, eccentric, poorly calcified, and with little lipid pools or none at all. Although the average area and thickness of plaques and cross-sectional narrowing of the infarct-related arteries were greater than those of control arteries, there were no pathognomonic characteristics of plaques in the infarct-related vessels. CONCLUSION: The possibility that atherosclerosis is the main etiologic factor for myocardial infarction can not be excluded even for women without an angiographically obvious coronary stenosis in the infarct-related vessels.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Myocardial Infarction/diagnostic imaging , Aged , Coronary Angiography , Coronary Artery Disease/complications , Female , Humans , Middle Aged , Myocardial Infarction/etiology , Ultrasonography, InterventionalSubject(s)
Angina, Unstable/diagnosis , Exercise Test , Myocardial Infarction/diagnosis , Cohort Studies , Female , Humans , Middle Aged , Prognosis , Proportional Hazards Models , Sweden , SyndromeABSTRACT
BACKGROUND: The objectives of this study were to investigate the relation between coronary risk factors, exercise testing parameters, and the presence of angiographically significant coronary artery disease (CAD) (> or =50% luminal stenosis) in female patients previously hospitalized for an acute CAD event. METHODS AND RESULTS: All women younger than age 66 years in the greater Stockholm area in Sweden who were hospitalized for acute coronary syndromes during a 3-year period were recruited. Besides collection of clinical parameters, coronary angiography and a symptom-limited exercise test were performed in 228 patients 3 to 6 months after the index hospitalization. The mean age was 56 +/- 7 years. Angiographically nonsignificant CAD (stenosis <50%) was verified in 37% of the patients; significant CAD was found in 63%. The clinical parameters that showed the strongest relation with the presence of significant CAD after adjusting for age were history of myocardial infarction (odds ratio [OR] 4.91, 95% confidence interval [CI] 2.35 to 7.49), history of diabetes mellitus (OR 3.83, 95% CI 1.63 to 14.31), serum high-density lipoprotein cholesterol <1.4 mmol/L (OR 2.11, 95% CI 1. 20 to 3.72), and waist-to-hip ratio >0.85 (OR 1.78, 95% CI 1.02 to 3. 10). A low exercise capacity and associated low change of rate-pressure product from rest to peak exercise were the only exercise testing parameters that were significantly related to angiographically verified significant CAD (<90% of the predicted maximal work capacity adjusted for age and weight, OR 1.91, 95% CI 1. 04 to 3.50). CONCLUSIONS: In female patients recovering from unstable CAD, exercise capacity was the only exercise testing parameter of value in the prediction of significant CAD. The consideration of certain clinical characteristics and coronary risk factors offer better or complementary information when deciding on further coronary assessment.
Subject(s)
Angina, Unstable/diagnosis , Exercise Test , Myocardial Infarction/diagnosis , Adult , Aged , Angina, Unstable/blood , Angina, Unstable/physiopathology , Blood Pressure , Body Constitution , Cholesterol, HDL/blood , Coronary Angiography , Electrocardiography , Female , Heart Rate , Humans , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/physiopathology , Odds Ratio , Prognosis , Retrospective Studies , Risk Factors , Sensitivity and Specificity , SwedenSubject(s)
Coronary Disease/prevention & control , Estrogen Replacement Therapy , Hormone Replacement Therapy , Aged , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/mortality , Cardiovascular Diseases/prevention & control , Contraindications , Coronary Disease/drug therapy , Estrogen Replacement Therapy/adverse effects , Female , Humans , Middle Aged , Postmenopause , Progestins/administration & dosage , Progestins/adverse effects , Thrombosis/chemically inducedABSTRACT
BACKGROUND: A variety of vascular effects have been ascribed to 17 beta-oestradiol. These effects may partially explain the reduced incidence of cardiovascular disease found in post-menopausal women on oestrogen replacement therapy. OBJECTIVES: To evaluate the effects of 2 mg sublingual 17 beta-oestradiol on exercise capacity, exercise-induced myocardial ischaemia and circulating levels of endothelin-1 in post-menopausal women with stable coronary artery disease. METHODS: Twelve post-menopausal women, mean age 61 (range 52-72) years, with angiographically verified significant coronary artery disease, were randomly assigned to 2 mg of sublingual 17 beta-oestradiol, 2.5 mg of buccal nitroglycerine and to placebo in a double-blind cross-over study design with at least 2 days between each of the study arms. Antianginal medications, with the exception of beta-blockers, were discontinued before investigation. All study patients underwent a maximal bicycle exercise test 30 min after drug intake. Blood was withdrawn immediately before and up to 8 h after medication for analyses of circulating levels of oestradiol and endothelin-1. RESULTS: The mean serum levels of oestradiol increased from a control level of 72 +/- 28 pmol.l-1 to 3557 +/- 1731 pmol.l-1 after 30 min and to 5028 +/- 3971 pmol.l-1 after 60 min with a gradual decline thereafter. Sublingual 17 beta-oestradiol did not induce any improvement in exercise duration when compared with nitroglycerin and placebo (500 +/- 112 s, 505 +/- 107 s, 498 +/- 157 s), and did not influence time to onset of ST-segment depression (358 +/- 89 s, 436 +/- 93 s, 384 +/- 116 s). The plasma levels of endothelin-1 did not change after administration of 17 beta-oestradiol, nitroglycerin or placebo. CONCLUSIONS: No effects of exercise capacity, exercise-induced acute ischaemia, or plasma levels of endothelin-1 were found after a single dose of 2 mg 17 beta-oestradiol in post-menopausal women with documented coronary artery disease.
Subject(s)
Coronary Disease/drug therapy , Electrocardiography/drug effects , Estradiol/administration & dosage , Estrogen Replacement Therapy , Exercise Test/drug effects , Myocardial Ischemia/drug therapy , Postmenopause/drug effects , Administration, Sublingual , Coronary Disease/diagnosis , Cross-Over Studies , Double-Blind Method , Endothelin-1/blood , Female , Humans , Middle Aged , Myocardial Ischemia/diagnosis , Nitroglycerin/administration & dosage , Treatment OutcomeABSTRACT
Estrogen replacement protects against cardiovascular morbidity and mortality in postmenopausal women. Conjugated estrogen is the main hormone used in these studies. However, the vascular effects of this type of estrogen are, to a large extent, unexplored. The objective of this study was to evaluate short-term endothelium-dependent vascular effects of intravenously conjugated estrogen at 2 dose levels. Eleven postmenopausal women were included. Each study subject was given 2.5 and 5 mg of conjugated estrogen or placebo in random order with at least 1 week between each investigation in a double-blind study design. The vascular reactivity of the brachial artery was studied using the duplex technique before and 30 minutes after the intravenous administration of study drug. Reactive hyperemia was used to study the flow-mediated vasodilation. Serum estradiol increased significantly and dose dependently 5 minutes after conjugated estrogen infusion. The flow-mediated vasodilation at baseline before drug administration was 1.8 +/- 2.0% (mean +/- SD) after an average 400% increase in local blood flow. Conjugated estrogen at a dose of 2.5 mg caused an increase in flow-mediated vasodilation from 1.8 +/- 2.1% at baseline to 5.4 +/- 2.8% after infusion (p <0.05 vs placebo), whereas 5 mg caused an increase from 1.9 +/- 1.5% at baseline to 7.0 +/- 3.3% after infusion (p <0.05 vs placebo). Intravenous injection of conjugated estrogen significantly improves the peripheral vascular reactivity in postmenopausal women.
Subject(s)
Estrogen Replacement Therapy , Estrogens, Conjugated (USP)/blood , Estrogens, Conjugated (USP)/therapeutic use , Postmenopause , Vasodilation/drug effects , Aged , Brachial Artery/diagnostic imaging , Cross-Over Studies , Double-Blind Method , Female , Humans , Middle Aged , Sweden , Ultrasonography , Women's HealthABSTRACT
Subcutaneous injection of diluted formalin (0.25 microliter of 0.5%) caused a biphasic pain response in mice. The first phase of pain was observed during the first 5 min., while the second phase occurred 10-30 min. after formalin administration. With the formalin test, it was found that the antinociception produced by the GABA-A antagonist, picrotoxin, and the GABA-B antagonist, phaclofen, was abolished when employed in combination. The opioid antagonist naloxone and antimuscarinic atropine also decreased the picrotoxin response. However, sulpiride, SCH 23390, phenoxybenzamine and propranolol did not alter the picrotoxin response. Administration of naloxone, sulpiride and propranolol showed a pain response. The data indicate that dopaminergic and adrenergic mechanisms may not be involved in the picrotoxin antinociceptive effect. However, postsynaptic GABA-A and GABA-B may be involved in the drug effect, and involvement of opioid or cholinergic systems can not be excluded.
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Formaldehyde/toxicity , Pain Measurement/drug effects , Pain Threshold/drug effects , Pain/drug therapy , Picrotoxin/pharmacology , Animals , GABA Antagonists/pharmacology , Male , MiceABSTRACT
An 83-year-old man was found unconscious and was successfully resuscitated. Progressive cardiac failure developed. After 42 hours of observation echocardiography revealed cardiac tamponade and a discontinuity in the left atrial wall. Exploration showed a laceration of the left atrium at the junction of the left pulmonary veins, which was closed with a direct suture on cardiopulmonary bypass. The postoperative course was uneventful.
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Heart Atria/surgery , Heart Massage/adverse effects , Heart Rupture/etiology , Heart Rupture/surgery , Aged , Aged, 80 and over , Cardiac Tamponade/etiology , Cardiac Tamponade/surgery , Cardiopulmonary Bypass , Echocardiography , Heart Atria/diagnostic imaging , Heart Rupture/diagnosis , Humans , MaleABSTRACT
The effects of dichloroglyoxime (DCG) on isolated rings of aorta, main pulmonary artery, trachea and spontaneously-beating atrium of guines-pig were studied. DCG caused concentration- dependent relaxation of the epinephrine-contracted aortic and pulmonary artery rings and of the tone of tracheal rings. Propranolol caused a slight shift to the right in the concentration-effect curves of DCG on these preparations. Quinacrine, an inhibitor of the release of arachidonic acid and its metabolites, caused a significant shift to the right in the concentration-effect curves of DCG on the three preparations. Low concentrations of DCG increased the beating rate of the atrium, an effect which was blocked by propranolol but not by quinacrine whereas large concentrations decreased the beating rate, an effect which was not significantly affected by propranolol or by quinacrine. DCG also caused a concentration-dependent decrease in the contractility of the atrium and this effect was only slightly affected by propranolol or quinacrine. These observations suggest that the relaxant effect of dichloroglyoxime on the smooth muscle may not be mediated by the stimulation of beta adrenoceptors specifically although a nonspecific interaction with these receptors or with the contractile machinery of the cell cannot be excluded. Data with quinacrine suggest that the effects may be mediated by the release of an inhibitory metabolite of arachidonic acid. The results further suggest that in the atrium the effects of DCG may not be specific and they may be partially mediated by the release of catecholamines from the nerve endings.