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1.
Medicine (Baltimore) ; 99(5): e18701, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000374

RESUMO

INTRODUCTION: Programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors have been increasingly used in the treatment of cancer. Immunosuppressive therapy can control the cancer well and is suitable for the moderate to severe diseases. However, according to clinical observation, immune-related cardiac adverse events against PD-1or/and PD-L1 are inevitable, but generally reversible. Understanding the cardiac adverse events of PD-1 or/and PD-L1 inhibitors is crucial to improve the anti-cancer efficacy and ensure the life safety of patients. The variability of cardiac adverse events between different immunosuppressants and different cancers is not clear. METHODS AND ANALYSIS: This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will search the following electronic bibliographic databases: PubMed, Cochrane Library, EMBASE databases and ClinicalTrials.gov from their inception to December 2019. We will use a combination of Medical Subject Heading, and free-text terms with various synonyms to search based on the Eligibility criteria. We will include RCTs on PD-1 or/and PD-L1 inhibitors therapy to analyze. In addition, our study will include some clinical trials. All relevant RCTs will be included, such as early phase I/II, phase III experimental trials, prospective and retrospective observational studies. According to the inclusion and exclusion criteria outlined above, the full texts of each eligible study will be retrieved for further identification by one reviewer. Two authors will screen the titles and abstracts of all records retrieved in above electronic databases independently to find potentially eligible reviews. Data will be extracted by 2 reviewers independently using a pre-designed data extraction form. The other reviewer will validate data. I-square (I) test, substantial heterogeneity, sensitivity analysis and publication bias assessment will be performed accordingly. For our network meta-analysis, we will use Stata 15.0 and WinBUGS 1.4.3. ETHICS AND DISSEMINATION: Ethics approval and patient consent would be not required because the data of this network meta-analysis mainly are obtained from existing resources. This network meta-analysis will be published in a peer-reviewed journal. PROSPERO NUMBER: CRD42019142865.


Assuntos
Antineoplásicos/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Cardiopatias/induzido quimicamente , Neoplasias/tratamento farmacológico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Humanos , Metanálise como Assunto , Revisão Sistemática como Assunto
2.
Adv Exp Med Biol ; 1216: 131-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894553

RESUMO

Comprehensive cardiac rehabilitation programmes include multifactorial components to optimise cardiovascular risk reduction, promote healthy behaviours and an active lifestyle, reduce disability and improve health and wellbeing. There is compelling evidence that older people with certain cardiovascular conditions, such as heart failure, can benefit both physically and mentally from cardiac rehabilitation. This chapter discusses the evolution of cardiac rehabilitation, frailty assessment in cardiac rehabilitation and guideline recommendations in the context of ageing populations. Contemporary cardiac rehabilitation service models are presented along with potential solutions to meeting older people's preferences and improving access to effective treatment for those with frailty. Innovations in catheter-based surgical interventions mean that more people with frailty are undergoing cardiovascular surgery than ever before. Although traditionally, cardiac rehabilitation has been associated with secondary prevention after cardiac diagnoses, events and interventions, new models of preconditioning rehabilitation or 'prehab' are being offered to frail older people before surgery to improve functional outcomes and reduce hospital stay. Individual tailoring of cardiac rehabilitation programme components is a cornerstone of high-quality care. Importantly, participation in core components, such as exercise and nutritional interventions, can impact on both cardiac vascular disease and frailty, providing the potential to change the trajectory of both conditions.


Assuntos
Reabilitação Cardíaca , Idoso Fragilizado , Cardiopatias/reabilitação , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/reabilitação , Humanos
3.
Khirurgiia (Mosk) ; (1): 85-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994505

RESUMO

Mini-thoracotomy is one of the most popular minimally invasive approaches. This approach is used in the treatment of congenital and acquired heart diseases and characterized less surgical trauma, intraoperative blood loss, pain syndrome severity, risk of infectious complications and better cosmetic results. Successful correction of atrial septal defect (ASD) through right-sided mini-thoracotomy is reported in the article.


Assuntos
Comunicação Interatrial/cirurgia , Veias Pulmonares/cirurgia , Toracotomia/métodos , Cardiopatias/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Veias Pulmonares/anormalidades , Resultado do Tratamento
4.
J Zoo Wildl Med ; 50(4): 822-836, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926512

RESUMO

Cardiovascular disease (CVD) has been identified as a major cause of mortality in all four great ape taxa in zoologic institutions. In an effort to better understand and treat CVD in captive great apes, a program called the Great Ape Heart Project (GAHP), based at Zoo Atlanta, collects and maintains a database of echocardiograms and other relevant medical information relating to the cardiac health status of great apes. Cardiac health assessments have become standard practice among North American zoos that house great apes and are recommended by all four great ape Species Survival Plans (SSP) for the assessment of CVD in captive great apes. As of December 31, 2017, more than 70 ape-holding institutions have submitted approximately 1,100 cardiac examinations of great apes to the GAHP, information from which is stored in the GAHP database. Transthoracic echocardiography is one of the most practical and cost-effective diagnostic imaging techniques for the evaluation of cardiac function in great apes. Standardization of echocardiographic measurements is critical for maximizing the diagnostic value of an echocardiographic exam and for utilization of stored information in comparative studies within and between the great ape taxa. The following manuscript offers suggestions for standardization of nomenclature, imaging technique, echocardiographic measurements, data storage, and reporting of cardiac exams for submission into the GAHP database with the goal of promoting consistency and quality in data collection.


Assuntos
Doenças dos Símios Antropoides/diagnóstico por imagem , Ecocardiografia/veterinária , Cardiopatias/veterinária , Hominidae , Guias de Prática Clínica como Assunto , Animais , Animais de Zoológico , Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem
6.
BMJ ; 368: l6794, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941657

RESUMO

OBJECTIVE: To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treatments and preserve long term health, on serious cardiac outcomes among adult survivors of childhood cancer. DESIGN: Retrospective cohort study. SETTING: 27 institutions participating in the Childhood Cancer Survivor Study. PARTICIPANTS: 23 462 five year survivors (6193 (26.4%) treated in the 1970s, 9363 (39.9%) treated in the 1980s, and 7906 (33.6%) treated in the 1990s) of leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, renal tumors, neuroblastoma, soft tissue sarcomas, and bone sarcomas diagnosed prior to age 21 years between 1 January 1970 and 31 December 1999. Median age at diagnosis was 6.1 years (range 0-20.9) and 27.7 years (8.2-58.3) at last follow-up. A comparison group of 5057 siblings of cancer survivors were also included. MAIN OUTCOME MEASURES: Cumulative incidence and 95% confidence intervals of reported heart failure, coronary artery disease, valvular heart disease, pericardial disease, and arrhythmias by treatment decade. Events were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Multivariable subdistribution hazard models were used to estimate hazard ratios by decade, and mediation analysis examined risks with and without exposure to cardiotoxic treatments. RESULTS: The 20 year cumulative incidence of heart failure (0.69% for those treated in the 1970s, 0.74% for those treated in the 1980s, 0.54% for those treated in the 1990s) and coronary artery disease (0.38%, 0.24%, 0.19%, respectively), decreased in more recent eras (P<0.01), though not for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%), or arrhythmias (0.08%, 0.09%, 0.13%). Compared with survivors with a diagnosis in the 1970s, the risk of heart failure, coronary artery disease, and valvular heart disease decreased in the 1980s and 1990s but only significantly for coronary artery disease (hazard ratio 0.65, 95% confidence interval 0.45 to 0.92 and 0.53, 0.36 to 0.77, respectively). The overall risk of coronary artery disease was attenuated by adjustment for cardiac radiation (0.90, 0.78 to 1.05), particularly among survivors of Hodgkin lymphoma (unadjusted for radiation: 0.77, 0.66 to 0.89; adjusted for radiation: 0.87, 0.69 to 1.10). CONCLUSIONS: Historical reductions in exposure to cardiac radiation have been associated with a reduced risk of coronary artery disease among adult survivors of childhood cancer. Additional follow-up is needed to investigate risk reductions for other cardiac outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01120353.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Sobreviventes de Câncer/estatística & dados numéricos , Cardiopatias , Neoplasias , Radioterapia , Risco Ajustado , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cardiotoxicidade , Criança , Estudos de Coortes , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/classificação , Cardiopatias/epidemiologia , Humanos , Incidência , Masculino , Neoplasias/classificação , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/radioterapia , Modelos de Riscos Proporcionais , Radioterapia/efeitos adversos , Radioterapia/métodos , Estudos Retrospectivos , Risco Ajustado/métodos , Risco Ajustado/tendências , Estados Unidos/epidemiologia
7.
Anaesthesia ; 75 Suppl 1: e165-e173, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903570

RESUMO

Peri-operative risk estimation has traditionally focused on assessing the likelihood of postoperative morbidity and mortality using pre-operative functional assessment. Although this strategy is currently recommended by most major society guidelines, contemporary evidence suggests that cardiac biomarker measurement has important advantages over pre-operative functional assessment. These advantages include superior predictive discrimination and inclusion of the postoperative course in risk estimation. In this review, we provide an overview of the evidence supporting the peri-operative utilisation, compare risk estimation methods and discuss which patients may benefit most from cardiac biomarker screening. We also discuss protocols for biomarker screening and management of patients with abnormal results.


Assuntos
Cardiopatias/diagnóstico , Assistência Perioperatória/métodos , Biomarcadores , Humanos
10.
Mymensingh Med J ; 29(1): 43-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915334

RESUMO

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.


Assuntos
Pressão Sanguínea/fisiologia , Diabetes Mellitus/epidemiologia , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Adulto , Bangladesh/epidemiologia , Comorbidade , Feminino , Humanos , Hipertensão/diagnóstico , Isquemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , Classe Social , População Urbana/estatística & dados numéricos , Adulto Jovem
12.
Br J Anaesth ; 124(1): 25-34, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31668348

RESUMO

BACKGROUND: Iron deficiency is frequent in patients undergoing cardiac surgery. The relevance of iron deficiency, however, is ill defined. Therefore, our study aimed to investigate the impact of iron deficiency (ferritin <100 µg L-1) with or without concomitant anaemia on clinical outcome after cardiac surgery. METHODS: In this prospective observational study, 730 patients undergoing elective cardiac surgery were assigned into four groups according to their iron status and anaemia. Mortality, serious adverse events (SAEs), major cardiac and cerebrovascular events (MACCEs), allogenic blood transfusion requirements, and length of hospital stay were assessed during a 90-day follow-up period. The effect of iron deficiency on these outcomes was first calculated in models adjusting for anaemia only, followed by two multivariate models adjusting for anaemia and either the EuroSCORE II or any possible confounders. RESULTS: The presence of iron deficiency (ferritin <100 µg L-1) was associated with an increase in 90-day mortality from 2% to 5% in patients without anaemia, and from 4% to 14% in patients with anaemia. Logistic regression resulted in an odds ratio of 3.5 (95% confidence interval: 1.5-8.4); P=0.004. The effect persisted in both multivariate models. Moreover, iron deficiency was associated with an increased incidence of SAEs, MACCEs, transfusion, and prolonged hospital stay. CONCLUSIONS: Preoperative iron deficiency (ferritin <100 µg L-1) was independently associated with increased mortality, more SAEs, and prolonged hospital stay after cardiac surgery. These findings underline the importance of preoperative iron deficiency screening in the context of a comprehensive patient blood management programme, and highlight its importance as a research topic in cardiac surgery. CLINICAL TRIAL REGISTRATION: NCT02031289.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Ferro/deficiência , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/complicações , Anemia Ferropriva/mortalidade , Transfusão de Sangue/estatística & dados numéricos , Transtornos Cerebrovasculares/mortalidade , Feminino , Ferritinas/sangue , Cardiopatias/mortalidade , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Resultado do Tratamento
14.
Toxicol Lett ; 318: 1-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31618665

RESUMO

Triptolide (TP), a principal bioactive component extracted from traditional Chinese medicine Tripterygium wilfordii Hook. F. (TWHF), has attracted wide attention of its therapeutic effects on inflammation and autoimmune diseases. However, the therapeutic application of TP is hindered by severe cardiomyocyte toxicity and narrow therapeutic window. We previously identified that the p53 was an indispensable contributor in TP-induced myocardial injury. p53 has an inhibitory effect on IKKß-NF-κB pathway that regulates glucose transporters (GLUT) expression. Based on these evidences, we speculate that p53 mediates TP-disturbed glucose uptake by blocking IKKß-NF-κB signaling. This study focused on the effect of TP on cardiac glucose uptake and the role of p53 in glucose metabolism in cardiomyocytes, and p53 -/- mice. TP treatment depressed glucose consumption and ATP production resulting in myocardial damage. Incubation with ATP (5 mM) remarkably decreased the cellular damage. Immunoblotting and immunofluorescence identified that TP suppressed glucose uptake by restricting IKKß-NF-κB signaling activation, GLUT1 and GLUT4 expression. p53 inhibition alleviated the cell damage and the compromise of glucose uptake. Mechanistically, p53 antagonist PFTα abolished TP-induced the inhibition of IKKß, IκBα phosphorylation, p65 nuclear translocation, and GLUT1, GLUT4 expression. Consistently, in acute heart injury models, p53 deficiency upregulated IKKß-NF-κB activation and GLUT1, GLUT4 protein levels which was also indicated as amelioration of heart histological injury after 1.2 mg kg-1 TP administration. The present findings indicate that TP-induced p53 overactivation suppresses glucose uptake by inhibiting IKKß-NF-κB pathway and downregulating NF-κB-dependent GLUT1 and GLUT4 expression.


Assuntos
Diterpenos/toxicidade , Glucose/metabolismo , Cardiopatias/induzido quimicamente , Quinase I-kappa B/metabolismo , Miócitos Cardíacos/efeitos dos fármacos , NF-kappa B/metabolismo , Fenantrenos/toxicidade , Proteína Supressora de Tumor p53/metabolismo , Animais , Apoptose/efeitos dos fármacos , Cardiotoxicidade , Linhagem Celular , Metabolismo Energético/efeitos dos fármacos , Compostos de Epóxi/toxicidade , Transportador de Glucose Tipo 1/genética , Transportador de Glucose Tipo 1/metabolismo , Transportador de Glucose Tipo 4/genética , Transportador de Glucose Tipo 4/metabolismo , Cardiopatias/genética , Cardiopatias/metabolismo , Cardiopatias/patologia , Camundongos Knockout , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Proteína Supressora de Tumor p53/deficiência , Proteína Supressora de Tumor p53/genética
15.
Radiol Clin North Am ; 58(1): 133-150, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731897

RESUMO

Imaging plays a central role in the evaluation of patients following cardiothoracic surgery, both for monitoring in the early postoperative period and for assessing for suspected complications. Patients with postsurgical complications can develop a range of signs and symptoms, from hypotension and tachycardia, as the result of severe bleeding, to fever and leukocytosis because of infection. The radiologist is an important member of the care team in the postoperative period, helping identify and manage complications of cardiothoracic surgery. This article reviews the common complications of cardiothoracic surgery focusing on the role of imaging and clues to diagnosis.


Assuntos
Cardiopatias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Doenças Respiratórias/diagnóstico por imagem , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Doenças Vasculares/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias/etiologia , Humanos , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Doenças Respiratórias/etiologia , Doenças Vasculares/etiologia
16.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731905

RESUMO

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Assuntos
Meios de Contraste , Cardiopatias/diagnóstico por imagem , Pacientes Internados , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Coração/diagnóstico por imagem , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Radiografia Torácica/métodos
19.
Int Heart J ; 60(6): 1448, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31787633

RESUMO

We are pleased to announce that the following 3 articles have been selected for the UEDA Heart Awards for the Year 2019. FIRST PLACEA Novel Truncating LMNA Mutation in Patients with Cardiac Conduction Disorders and Dilated CardiomyopathyHiroshi Kawakami, Akiyoshi Ogimoto, Naohito Tokunaga, Kazuhisa Nishimura, Hideo Kawakami, Haruhiko Higashi, Chiharuko Iio, Tamami Kono, Jun Aono, Teruyoshi Uetani, Takayuki Nagai, Katsuji Inoue, Jun Suzuki, Shuntaro Ikeda, Takafumi Okura, Yasumasa Ohyagi, Yasuharu Tabara, Jitsuo HigakiInt Heart J 2018; 59 (3): 531-541. SECOND PLACEAssociation Between the Presence or Severity of Coronary Artery Disease and Pericardial Fat, Paracardial Fat, Epicardial Fat, Visceral Fat, and Subcutaneous Fat as Assessed by Multi-Detector Row Computed TomographyYoko Ueda, Yuhei Shiga, Yoshiaki Idemoto, Kohei Tashiro, Kota Motozato, Rie Koyoshi, Takashi Kuwano, Kanta Fujimi, Masahiro Ogawa, Keijiro Saku, Shin-ichiro MiuraInt Heart J 2018; 59 (4): 695-704. THIRD PLACECatecholamine-Induced Senescence of Endothelial Cells and Bone Marrow Cells Promotes Cardiac Dysfunction in MiceGoro Katsuumi, Ippei Shimizu, Yohko Yoshida, Yuka Hayashi, Ryutaro Ikegami, Masayoshi Suda, Takayuki Wakasugi, Masaaki Nakao, Tohru MinaminoInt Heart J 2018; 59 (4): 837-844. November 2019International Heart Journal Association.


Assuntos
Distinções e Prêmios , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Animais , Modelos Animais de Doenças , Humanos , Camundongos
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