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1.
BMJ ; 367: l6055, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748235

RESUMO

OBJECTIVE: To determine the relation between age and troponin level and its prognostic implication. DESIGN: Retrospective cohort study. SETTING: Five cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC). PARTICIPANTS: 257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: 257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient's hospital stay. Troponin levels were standardised as a multiple of each laboratory's 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively. CONCLUSIONS: A positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks. STUDY REGISTRATION: ClinicalTrials.gov NCT03507309.


Assuntos
Envelhecimento/sangue , Doenças Cardiovasculares , Troponina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Estudos de Coortes , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Reino Unido/epidemiologia
3.
Int Heart J ; 60(4): 854-861, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257335

RESUMO

The aim of this single-arm pilot study was to determine the effects of whole-body vibration training (WBVT) on endothelial function in elderly patients with cardiovascular diseases, as well as its safety. A total of 20 elderly patients with stable cardiovascular diseases underwent WBVT, which consisted of five static resistance training exercises (squats, wide stance squats, toe-stands, squats + band, and front lunges). The parameters of WBVT included vertical vibrations, 30 Hz frequency, and a 3-mm peak-to-peak amplitude. Each vibration session lasted 30 seconds, with 120 seconds of rest between sessions. Before and after WBVT, the reactive hyperemia peripheral arterial tonometry index (RH-PAT index) and transcutaneous oxygen pressure (tcPO2) were recorded as a measure of endothelial function and peripheral blood circulation. Systolic blood pressure, diastolic blood pressure, heart rate, and arterial oxygen saturation of pulse oximetry (SpO2) were measured at each rest interval as well as before and after WBVT. All patients completed our WBVT protocol without adverse events. The RH-PAT index significantly increased following WBVT (1.42 to 2.06, P < 0.001). There were no significant changes in heart rate (P = 0.777), systolic blood pressure (P = 0.183), diastolic blood pressure (P = 0.925), or SpO2 (P = 0.248) during WBVT. In conclusion, we demonstrated the acute effects of WBVT on endothelial function, with no reports of adverse events. These findings support the need for further randomized controlled studies to investigate the long-term effects of WBVT.


Assuntos
Artérias/fisiopatologia , Doenças Cardiovasculares/terapia , Endotélio Vascular/fisiopatologia , Modalidades de Fisioterapia/instrumentação , Vasodilatação/fisiologia , Idoso , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Força Muscular/fisiologia , Projetos Piloto , Pletismografia , Estudos Retrospectivos , Resultado do Tratamento , Vibração
4.
Soins ; 64(837): 18-21, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31345302

RESUMO

Therapeutic patient education (TPE) for those suffering from cardiovascular disease forms an important part of the management of risk factors. It must be continued throughout the course of the disease. The creation of a health network focused on TPE facilitates the emergence of healthier lifestyle habits and improves the care management of these patients.


Assuntos
Doenças Cardiovasculares/terapia , Educação de Pacientes como Assunto/organização & administração , Humanos , Fatores de Risco
5.
Expert Rev Med Devices ; 16(8): 675-682, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31306049

RESUMO

Introduction: Cardiovascular diseases are accompanied by autonomic nervous system (ANS) imbalance which is characterized by decreased vagal tone. Preclinical and clinical studies have revealed that increasing vagal activity via vagus nerve stimulation (VNS) could protect the heart. Based on these studies, VNS has emerged as a potential non-pharmaceutical treatment strategy. Although it's still difficult to find the optimal stimulus parameters, however, in arrhythmia model, it is reported that low-level VNS (LL-VNS) exacts paradoxical effects from the high-level VNS. Thus, the concept of LL-VNS is introduced. Areas covered: Animal and human studies have discussed the safety and efficacy of VNS and LL-VNS, and this review will discuss the research data in cardiovascular diseases, including atrial arrhythmia, ventricular arrhythmia, ischemia/reperfusion injury, heart failure, and hypertension. Expert opinion: In this regard, various clinical studies have been performed to verify the safety and efficacy of VNS. It is shown that VNS is well-tolerated and safe, but the results of its efficacy are conflicting, which may well block the translational process of VNS. The appearance of LL-VNS brings new idea and inspiration, suggesting an important role of subthreshold stimulation. A better understanding of the LL-VNS will contribute to translational research of VNS.


Assuntos
Doenças Cardiovasculares/terapia , Estimulação do Nervo Vago/métodos , Animais , Encéfalo/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Coração/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Nervo Vago/fisiopatologia
6.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 306-313, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1023176

RESUMO

A doença arterial coronariana (DAC) é umas das doenças cardiovasculares que mais mata no Brasil e no mundo. É uma doença multifatorial, associada a fatores de risco modificáveis. Além dos tratamentos convencionais, é recomendado que pacientes com DAC também incluam modificações no estilo de vida e programas de reabilitação cardiovascular com ênfase no exercício físico (RCEE) em seu tratamento. Sabidamente, o exercício físico regular somado às mudanças no estilo de vida contribui para a diminuição do avanço da doença aterosclerótica e da mortalidade dos pacientes com DAC. Além disso, o exercício físico tem impacto benéfico na capacidade funcional e qualidade de vida. Um programa de RCEE é uma estratégia eficaz, segura e com excelente razão de custo-benefício para o tratamento da DAC. Contudo, mesmo sendo uma terapia recomendada pelos principais órgãos de saúde, no Brasil as políticas públicas de saúde são extremamente escassas e a quantidade de centros especializados que oferecem a RCEE também é baixa. Problemas de adesão, participação e motivação são evidentes quando os programas são avaliados. Esta revisão mostra os principais estudos que, ao longo das últimas décadas, deram base para as recomendações da RCEE e faz uma análise crítica do cenário atual, deixando claro que novas estratégias de atuação e monitoramento devem ser exploradas e incentivadas para que os programas de RCEE sejam incluídos efetivamente no tratamento dos pacientes com DAC


Coronary artery disease (CAD) is one of the most lethal cardiovascular diseases both in Brazil and worldwide. It is a multifactorial disease associated with modifiable risk factors. In addition to conventional treatments, it is recommended that patients with CAD also include lifestyle changes and exercise-based cardiovascular rehabilitation (CR) programs in their treatment. It is well known that regular physical exercise combined with lifestyle changes contributes to a reduction in the progression of atherosclerosis and in mortality in patients with CAD. Moreover, physical exercise has a beneficial impact on functional capacity and quality of life. A CR program is an effective, safe strategy for the treatment of CAD with an excellent cost-benefit ratio. However, even though it is a therapy recommended by the main health agencies, public health policies in Brazil are extremely scarce and the number of specialized centers that offer CR is low. Problems of adherence, participation, and motivation are evident when these programs are evaluated. This review looks at the main studies that have been the basis for the recommendations of CR over last decades and critically analyzes the current scenario, making it clear that new strategies for action and monitoring should be explored and encouraged such that CR programs will be included effectively in the treatment of patients with CAD


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença da Artéria Coronariana , Exercício , Reabilitação Cardíaca/métodos , Qualidade de Vida , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Doença Crônica/mortalidade , Fatores de Risco , Placa Aterosclerótica , Frequência Cardíaca
7.
BMC Health Serv Res ; 19(1): 452, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277649

RESUMO

BACKGROUND: High utilizers (HUs) are a small group of patients who impose a disproportionately high burden on the healthcare system due to their elevated resource use. Identification of persistent HUs is pertinent as interventions have not been effective due to regression to the mean in majority of patients. This study will use cost and utilization metrics to segment a hospital-based patient population into HU groups. METHODS: The index visit for each adult patient to an Academic Medical Centre in Singapore during 2006 to 2012 was identified. Cost, length of stay (LOS) and number of specialist outpatient clinic (SOC) visits within 1 year following the index visit were extracted and aggregated. Patients were HUs if they exceeded the 90th percentile of any metric, and Non-HU otherwise. Seven different HU groups and a Non-HU group were constructed. The groups were described in terms of cost and utilization patterns, socio-demographic information, multi-morbidity scores and medical history. Logistic regression compared the groups' persistence as a HU in any group into the subsequent year, adjusting for socio-demographic information and diagnosis history. RESULTS: A total of 388,162 patients above the age of 21 were included in the study. Cost-LOS-SOC HUs had the highest multi-morbidity and persistence into the second year. Common conditions among Cost-LOS and Cost-LOS-SOC HUs were cardiovascular disease, acute cerebrovascular disease and pneumonia, while most LOS and LOS-SOC HUs were diagnosed with at least one mental health condition. Regression analyses revealed that HUs across all groups were more likely to persist compared to Non-HUs, with stronger relationships seen in groups with high SOC utilization. Similar trends remained after further adjustment. CONCLUSION: HUs of healthcare services are a diverse group and can be further segmented into different subgroups based on cost and utilization patterns. Segmentation by these metrics revealed differences in socio-demographic characteristics, disease profile and persistence. Most HUs did not persist in their high utilization, and high SOC users should be prioritized for further longitudinal analyses. Segmentation will enable policy makers to better identify the diverse needs of patients, detect gaps in current care and focus their efforts in delivering care relevant and tailored to each segment.


Assuntos
Doenças Cardiovasculares/terapia , Transtornos Cerebrovasculares/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Singapura/epidemiologia
9.
Molecules ; 24(11)2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31159153

RESUMO

Cardiovascular diseases are the most common causes of morbidity and mortality worldwide. Redox dysregulation and a dyshomeostasis of inflammation arise from, and result in, cellular aberrations and pathological conditions, which lead to cardiovascular diseases. Despite years of intensive research, there is still no safe and effective method for their prevention and treatment. Recently, molecular hydrogen has been investigated in preclinical and clinical studies on various diseases associated with oxidative and inflammatory stress such as radiation-induced heart disease, ischemia-reperfusion injury, myocardial and brain infarction, storage of the heart, heart transplantation, etc. Hydrogen is primarily administered via inhalation, drinking hydrogen-rich water, or injection of hydrogen-rich saline. It favorably modulates signal transduction and gene expression resulting in suppression of proinflammatory cytokines, excess ROS production, and in the activation of the Nrf2 antioxidant transcription factor. Although H2 appears to be an important biological molecule with anti-oxidant, anti-inflammatory, and anti-apoptotic effects, the exact mechanisms of action remain elusive. There is no reported clinical toxicity; however, some data suggests that H2 has a mild hormetic-like effect, which likely mediate some of its benefits. The mechanistic data, coupled with the pre-clinical and clinical studies, suggest that H2 may be useful for ROS/inflammation-induced cardiotoxicity and other conditions.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Animais , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Terapia Combinada , Humanos , Hidrogênio/metabolismo , Hidrogênio/farmacologia , Oxirredução/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Lesões por Radiação/complicações , Espécies Reativas de Oxigênio/metabolismo , Resultado do Tratamento
10.
Clin Interv Aging ; 14: 969-975, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31239651

RESUMO

Purpose: Left ventricle (LV)-only pacing is non-inferior to biventricular pacing but permanent fusion pacing is needed to ensure cardiac resynchronization therapy (CRT) responsiveness. The role of systematic exercise testing (ET) in these patients has not been established. This study was designed to assess clinical and therapeutic implications (device programming/drugs) of systematic ET in patients requiring fusion-pacing CRT without an right ventricle (RV) lead. Methods: Consecutive patients with a right atrium/LV-only dual-chamber (DDD) pacing system were included. Prospective data were obtained: device interrogation, ET, and echocardiography at every 6-month follow-up visit. CRT assessment during ET included maximal heart rate, beat-to-beat echocardiography analysis of LV fusion pacing, LV loss of capture, and improvement in exercise capacity. If LV loss of capture or unsatisfactory LV fusion pacing occurred, reprogramming was individualized for each patient and ET redone. Results: A total of 55 patients (29 male) aged 62±11 years were included. During follow-up (39±18 months), a total of 235 ETs were performed, with mean exercise load 6.4±1.3 metabolic equivalents of task (118±35 W, maximal heart rate 119±17 beats/min). Twenty patients (36%) had inadequate pacing or loss of LV capture during ET, due to exceeding the maximum tracking rate (11%), chronotropic incompetence (7%), and LV pacing outside the fusion-pacing band (18%), caused by physiological shortening of the PR interval or exagerated LV preexcitation during maximum exercise. Post-ET CRT-device optimization included reprogramming of rate-adaptive atrioventricular interval (total decrease 23±8 ms), individualized programming of maximum tracking rate, or rate-response function. Drug optimization was performed in 32% of patients, and ET redone in 36%. Conclusion: In one of three ETs, an intervention in device and medication optimization was done to ensure a better outcome. Routine ET should be a standard approach to maximize fusion-pacing CRT response during follow-up.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Doenças Cardiovasculares/terapia , Teste de Esforço/métodos , Exercício/fisiologia , Átrios do Coração/fisiopatologia , Ventrículos do Coração/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
11.
BMJ ; 365: l2191, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208954

RESUMO

Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.


Assuntos
Reabilitação Cardíaca/economia , Doença Crônica/economia , Doença Crônica/reabilitação , Custos de Cuidados de Saúde , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Humanos , Doença Pulmonar Obstrutiva Crônica/economia , Melhoria de Qualidade , Estados Unidos
12.
Cell Mol Life Sci ; 76(20): 3969-3985, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31218451

RESUMO

Cardiovascular diseases represent one of the most important health problems of developed countries. One of the main actors involved in the onset and development of cardiovascular diseases is the increased production of reactive oxygen species that, through lipid peroxidation, protein oxidation and DNA damage, induce oxidative stress and cell death. Basic and clinical research are ongoing to better understand the endogenous antioxidant mechanisms that counteract oxidative stress, which may allow to identify a possible therapeutic targeting/application in the field of stress-dependent cardiovascular pathologies. In this context, increasing attention is paid to the glutathione/glutathione-peroxidase and to the thioredoxin/thioredoxin-reductase systems, among the most potent endogenous antioxidative systems. These key enzymes, belonging to the selenoprotein family, have a well-established function in the regulation of the oxidative cell balance. The aim of the present review was to highlight the role of selenoproteins in cardiovascular diseases, introducing the emerging cardioprotective role of endoplasmic reticulum-resident members and in particular one of them, namely selenoprotein T or SELENOT. Accumulating evidence indicates that the dysfunction of different selenoproteins is involved in the susceptibility to oxidative stress and its associated cardiovascular alterations, such as congestive heart failure, coronary diseases, impaired cardiac structure and function. Some of them are under investigation as useful pathological biomarkers. In addition, SELENOT exhibited intriguing cardioprotective effects by reducing the cardiac ischemic damage, in terms of infarct size and performance. In conclusion, selenoproteins could represent valuable targets to treat and diagnose cardiovascular diseases secondary to oxidative stress, opening a new avenue in the field of related therapeutic strategies.


Assuntos
Cardiotônicos/uso terapêutico , Doenças Cardiovasculares/genética , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Peptídeos/uso terapêutico , Selenocisteína/metabolismo , Selenoproteínas/genética , Animais , Antioxidantes/metabolismo , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/terapia , Regulação da Expressão Gênica , Glutationa Peroxidase/metabolismo , Humanos , Terapia de Alvo Molecular/métodos , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Estresse Oxidativo/efeitos dos fármacos , Isoformas de Proteínas/agonistas , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Espécies Reativas de Oxigênio/antagonistas & inibidores , Espécies Reativas de Oxigênio/metabolismo , Selenoproteínas/agonistas , Selenoproteínas/metabolismo , Tiorredoxina Dissulfeto Redutase/metabolismo
13.
Hypertension ; 74(2): 331-340, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230539

RESUMO

The association between systolic blood pressure, cardiovascular disease, and chronic kidney disease remains unclear. This study aimed to evaluate these relationships. A population-based cohort of 267 469 adult patients with hypertension but without diabetes mellitus, cardiovascular disease, or chronic kidney disease were identified. Using baseline and repeated systolic blood pressure (average of all systolic blood pressure measurements in the past 5 years), the risks of cardiovascular disease and chronic kidney disease associated with systolic blood pressure were evaluated by Cox regression. Subgroup analyses were conducted by baseline characteristics. Over 1.4 million person-years follow-up (median 6 years), 29 500 cardiovascular disease and 30 993 chronic kidney disease events diagnosed. A J-shape association between baseline systolic blood pressure and risks of cardiovascular disease and chronic kidney disease was observed. Using repeated systolic blood pressure, a positive and log-linear association was identified. There was no evidence of a threshold down to the repeated systolic blood pressure of 120 mm Hg. Increases of 10 mm Hg of repeated systolic blood pressure was associated with a 16% (hazard ratio, 1.15; [95% CI, 1.13-1.16]), 11% (1.11; [1.08-1.13]), and 22% (1.22; [1.20-1.24]) higher risk of composite of cardiovascular disease and chronic kidney disease, individual cardiovascular disease and chronic kidney disease, respectively. Strength of the associations was similar across different subpopulations. This study showed that hypertensive patients with elevated repeated systolic blood pressure are at increased risk of cardiovascular disease or chronic kidney disease, irrespective of different characteristics. Very low single measurement of systolic blood pressure may be a potential indicator for poor health, but there seems to be no threshold for usual systolic blood pressure.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Distribuição por Idade , Idoso , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Doenças Cardiovasculares/terapia , Estudos de Coortes , Comorbidade , Feminino , Hong Kong , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Taxa de Sobrevida
14.
J Nippon Med Sch ; 86(2): 70-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31130568

RESUMO

Electroconvulsive therapy (ECT) is the safe application of electricity to the scalp of a patient, using brief-pulse stimulation techniques under general anesthesia and muscle paralysis, inducing a series of generalized epileptic seizures. Principal indications for ECT are major depression (unipolar or bipolar) with a lack of response to medications, intolerance to medications due to side effects or coexisting conditions, the need for a rapid response because of other conditions such as catatonia, psychosis, suicidality, or clinically significant dehydration or malnutrition, mania, and schizophreniform disorder or schizoaffective disorder, and, medical disorders such as Parkinson's disease, neuroleptic malignant syndrome, and chronic pain. Anesthesia management of special patient populations undergoing ECT has been described in textbooks and guidelines, but some descriptions may be antiquated. Therefore, this review describes recent knowledge on anesthesia management of patients who require ECT, such as those with neurologic disorders, cardiovascular disorders, pregnancy, and other concurrent medical illness. Based on the findings of a recent paper, ECT may be safer than is widely reported. According to the American Psychiatric Association, ECT has no absolute contraindications; however, some conditions pose a relatively high risk, and there are many other kinds of complications associated with ECT that can lead to death. Understanding such complications and their management strategies can avoid unnecessary discontinuation of treatment due to manageable complications of ECT and, furthermore, ECT clinicians must also consider the risk-benefit ratio when treating high-risk patients.


Assuntos
Anestesia Geral/métodos , Doenças Cardiovasculares/terapia , Eletroconvulsoterapia , Doenças do Sistema Nervoso/terapia , Eletroconvulsoterapia/efeitos adversos , Feminino , Humanos , Masculino , Gravidez , Risco , Medição de Risco
15.
J Nanobiotechnology ; 17(1): 72, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133024

RESUMO

BACKGROUND: Nano-sized vesicles, so called extracellular vesicles (EVs), from regenerative cardiac cells represent a promising new therapeutic approach to treat cardiovascular diseases. However, it is not yet sufficiently understood how cardiac-derived EVs facilitate their protective effects. Therefore, we investigated the immune modulating capabilities of EVs from human cardiac-derived adherent proliferating (CardAP) cells, which are a unique cell type with proven cardioprotective features. RESULTS: Differential centrifugation was used to isolate EVs from conditioned medium of unstimulated or cytokine-stimulated (IFNγ, TNFα, IL-1ß) CardAP cells. The derived EVs exhibited typical EV-enriched proteins, such as tetraspanins, and diameters mostly of exosomes (< 100 nm). The cytokine stimulation caused CardAP cells to release smaller EVs with a lower integrin ß1 surface expression, while the concentration between both CardAP-EV variants was unaffected. An exposure of either CardAP-EV variant to unstimulated human peripheral blood mononuclear cells (PBMCs) did not induce any T cell proliferation, which indicates a general low immunogenicity. In order to evaluate immune modulating properties, PBMC cultures were stimulated with either Phytohemagglutin or anti-CD3. The treatment of those PBMC cultures with either CardAP-EV variant led to a significant reduction of T cell proliferation, pro-inflammatory cytokine release (IFNγ, TNFα) and increased levels of active TGFß. Further investigations identified CD14+ cells as major recipient cell subset of CardAP-EVs. This interaction caused a significant lower surface expression of HLA-DR, CD86, and increased expression levels of CD206 and PD-L1. Additionally, EV-primed CD14+ cells released significantly more IL-1RA. Notably, CardAP-EVs failed to modulate anti-CD3 triggered T cell proliferation and pro-inflammatory cytokine release in monocultures of purified CD3+ T cells. Subsequently, the immunosuppressive feature of CardAP-EVs was restored when anti-CD3 stimulated purified CD3+ T cells were co-cultured with EV-primed CD14+ cells. Beside attenuated T cell proliferation, those cultures also exhibited a significant increased proportion of regulatory T cells. CONCLUSIONS: CardAP-EVs have useful characteristics that could contribute to enhanced regeneration in damaged cardiac tissue by limiting unwanted inflammatory processes. It was shown that the priming of CD14+ immune cells by CardAP-EVs towards a regulatory type is an essential step to attenuate significantly T cell proliferation and pro-inflammatory cytokine release in vitro.


Assuntos
Doenças Cardiovasculares/terapia , Vesículas Extracelulares/imunologia , Monócitos/imunologia , Miócitos Cardíacos/imunologia , Doenças Cardiovasculares/imunologia , Linhagem Celular , Proliferação de Células , Técnicas de Cocultura , Citocinas/metabolismo , Vesículas Extracelulares/metabolismo , Humanos , Imunomodulação , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/imunologia , Monócitos/citologia , Miócitos Cardíacos/citologia , Regeneração , Linfócitos T/citologia , Linfócitos T/imunologia
18.
Int J Mol Sci ; 20(10)2019 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-31109146

RESUMO

Cardiovascular diseases are the leading cause of mortality worldwide. It is widely known that non-resolving inflammation results in atherosclerotic conditions, which are responsible for a host of downstream pathologies including thrombosis, myocardial infarction (MI), and neurovascular events. Macrophages, as part of the innate immune response, are among the most important cell types in every stage of atherosclerosis. In this review we discuss the principles governing macrophage function in the healthy and infarcted heart. More specifically, how cardiac macrophages participate in myocardial infarction as well as cardiac repair and remodeling. The intricate balance between phenotypically heterogeneous populations of macrophages in the heart have profound and highly orchestrated effects during different phases of myocardial infarction. In the early "inflammatory" stage of MI, resident cardiac macrophages are replaced by classically activated macrophages derived from the bone marrow and spleen. And while the macrophage population shifts towards an alternatively activated phenotype, the inflammatory response subsides giving way to the "reparative/proliferative" phase. Lastly, we describe the therapeutic potential of cardiac macrophages in the context of cell-mediated cardio-protection. Promising results demonstrate innovative concepts; one employing a subset of yolk sac-derived, cardiac macrophages that have complete restorative capacity in the injured myocardium of neonatal mice, and in another example, post-conditioning of cardiac macrophages with cardiosphere-derived cells significantly improved patient's post-MI diagnoses.


Assuntos
Doenças Cardiovasculares/imunologia , Imunidade Inata , Macrófagos/imunologia , Miocárdio/imunologia , Animais , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Coração/fisiopatologia , Humanos , Macrófagos/patologia , Infarto do Miocárdio/imunologia , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Miocárdio/citologia , Miocárdio/patologia , Fatores de Proteção , Remodelação Ventricular
19.
Medicine (Baltimore) ; 98(19): e15490, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083185

RESUMO

BACKGROUND: Lead-related complication is an important drawback of trans-venous implantable cardioverter-defibrillators (TV-ICD). The subcutaneous ICD (S-ICD) was developed to overcome ICD lead associated complications; however, whether the S-ICD confers enhanced clinical benefits compared with TV-ICD remains unclear. The present systematic review and meta-analysis aimed to assess TV-ICD and S-ICD for safety, efficacy, and in-hospital outcomes in the prevention of sudden cardiac death (SCD) in patients not requiring pacing. METHODS: The Medline, PubMed, EmBase, and Cochrane Library databases were searched for studies comparing TV-ICD and S-ICD. RESULTS: A total of 9 eligible studies, including 5 propensity-matched case-control, 3 retrospective, and 1 cross-sectional studies were identified, assessing 7361 patients in all. Pool analyses demonstrated that SICD were associated with lower lead-related complication rates [odds ratio (OR) = 0.13; 95% confidence interval [CI] 0.05-0.33; I = 0%], and S-ICD was more beneficial in terms of reducing ICD shocks [OR = 0.48; 95% CI 0.32-0.72, I = 4%]. In addition, the patients administered S-ICD tend to have shorter length of hospital stay after implantation (SMD = -0.06; 95% CI -0.11 to 0.00, I = 0%) and reduce total complication rates (OR = 0.72; 95% CI 0.50-1.03; I = 18%), non-decreased quality of life (QoL). Moreover, both devices appeared to perform equally well with respect to infection rate and death. CONCLUSIONS: Available overall data suggested that S-ICD is associated with reducing lead-related complications, ICD shocks. In addition, S-ICD has tendency to shorten hospitalization and reduce total complications, although the difference is no significant. Equivalent death rate, infection, and QoL were found between 2 groups. Therefore, S-ICD could be considered an alternative approach to TV-ICD in appropriate patients for SCD prevention.


Assuntos
Doenças Cardiovasculares/terapia , Desfibriladores Implantáveis , Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento , Humanos , Complicações Pós-Operatórias
20.
Medicine (Baltimore) ; 98(20): e15484, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096447

RESUMO

INTRODUCTION: The purpose of this study protocol is to provide the methodology for a review to compare the effect of statins vs physical exercise interventions and the effect of different types of physical exercise, on reducing arterial stiffness associated with cardiovascular diseases and mortality. METHODS AND ANALYSIS: The literature search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception until July 31, 2019. We will include randomized controlled trials, nonrandomized experimental studies, and controlled pre-post studies assessing the effect in the general population of statins and physical exercise interventions on arterial stiffness measured by pulse wave velocity. The Cochrane Collaboration's tool and the Quality Assessment Tool for Quantitative Studies will be used to assess the risk of bias for studies included in the systematic review. A Bayesian network meta-analysis will be carried out to determine the comparative effect of the different physical exercise interventions and/or statin intervention. ETHICS AND DISSEMINATION: This study will generate evidence about the effectiveness of both statins and exercise on reducing arterial stiffness that potentially can be transferred to patients and practitioners. Moreover, in light of the importance of reducing arterial stiffness for preventing cardiovascular disease, the evidence provided by this study will be potentially suitable to be included in cardiovascular clinical practice guidelines. STRENGTHS AND LIMITATIONS: This protocol describes the methods of a study examining, using network meta-analysis strategies, the efficacy of statins and different types of exercise on improving arterial stiffness, which is an early marker of atherosclerosis. The results of this study could immediately help clinicians to recommend the best evidence-based intervention to their patients to reduce arterial stiffness and, as a consequence, prevent major complications, such as heart failure, stroke, or myocardial infarction. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019123120.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Exercício/fisiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Rigidez Vascular/efeitos dos fármacos , Doenças Cardiovasculares/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Meta-Análise em Rede , Ensaios Clínicos Controlados não Aleatórios como Assunto , Avaliação de Resultados (Cuidados de Saúde) , Análise de Onda de Pulso/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Rigidez Vascular/fisiologia
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