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1.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547102

RESUMO

A 32-year-old doctor, who has a medical history of primary Raynaud's disease and previous scotomas, presented to eye clinic with sudden onset blurring of vision (infero-nasally) with no other associated symptoms. The patient had good visual acuity bilaterally (6/6) and no anterior chamber activity or conjunctival hyperaemia. Findings consistent with a nerve fibre layer infarct were noted in the right eye, with unremarkable examination of the left eye. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images were obtained, which showed an area of capillary shut down in keeping with a nerve fibre layer lesion. Previous literature pertaining to similar symptoms is sparse with symptoms such as migraines, epilepsy and visual loss being stated. This case provides further evidence of Raynaud's associated retinal artery spasm, with complete resolution at 4 weeks. We also demonstrate the accessibility of OCT and more importantly OCTA for investigation of sudden onset visual deficit.


Assuntos
Doença de Raynaud/complicações , Artéria Retiniana , Doenças Retinianas/etiologia , Espasmo/etiologia , Doenças Vasculares/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos
2.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563672

RESUMO

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline-an ergot derivative and dopamine agonist that may induce vasospasm-has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.


Assuntos
Cabergolina/efeitos adversos , Vasoespasmo Coronário/induzido quimicamente , Vasoespasmo Coronário/complicações , Anomalias dos Vasos Coronários/etiologia , Agonistas de Dopamina/efeitos adversos , Doenças Vasculares/congênito , Adulto , Feminino , Humanos , Neoplasia Endócrina Múltipla/tratamento farmacológico , Doenças Vasculares/etiologia
3.
Khirurgiia (Mosk) ; (1): 90-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395518

RESUMO

We report a complex reconstruction of arteriovenous fistula (AVF). Proximal stenosis of cephalic vein was followed by aneurysms of fistulous veins (distal segment of cephalic vein and median cubital vein) complicated by AVF thrombosis. Blood outflow from AVF was retrograde. One week after thrombosis, an aneurysm of median cubital vein containing dense clots was excised. We resected cephalic vein wall and repaired the vessel. Anastomosis with the brachial artery was created distal to the last anastomosis. Proximal cephalic vein repair was performed using resected aneurysm walls. After a year, AVF has been successfully used for hemodialysis.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Diálise Renal , Doenças Vasculares/cirurgia , Veias/cirurgia , Aneurisma/etiologia , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Artéria Braquial/diagnóstico por imagem , Humanos , Resultado do Tratamento , Doenças Vasculares/etiologia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
4.
Int J Mol Sci ; 22(2)2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33445491

RESUMO

Every organism has an intrinsic biological rhythm that orchestrates biological processes in adjusting to daily environmental changes. Circadian rhythms are maintained by networks of molecular clocks throughout the core and peripheral tissues, including immune cells, blood vessels, and perivascular adipose tissues. Recent findings have suggested strong correlations between the circadian clock and cardiovascular diseases. Desynchronization between the circadian rhythm and body metabolism contributes to the development of cardiovascular diseases including arteriosclerosis and thrombosis. Circadian rhythms are involved in controlling inflammatory processes and metabolisms, which can influence the pathology of arteriosclerosis and thrombosis. Circadian clock genes are critical in maintaining the robust relationship between diurnal variation and the cardiovascular system. The circadian machinery in the vascular system may be a novel therapeutic target for the prevention and treatment of cardiovascular diseases. The research on circadian rhythms in cardiovascular diseases is still progressing. In this review, we briefly summarize recent studies on circadian rhythms and cardiovascular homeostasis, focusing on the circadian control of inflammatory processes and metabolisms. Based on the recent findings, we discuss the potential target molecules for future therapeutic strategies against cardiovascular diseases by targeting the circadian clock.


Assuntos
Aterosclerose/etiologia , Ritmo Circadiano , Trombose/etiologia , Animais , Aterosclerose/metabolismo , Aterosclerose/terapia , Biomarcadores , Relógios Circadianos/genética , Ritmo Circadiano/efeitos dos fármacos , Ritmo Circadiano/genética , Ritmo Circadiano/fisiologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Homeostase , Humanos , Terapia de Alvo Molecular , Trombose/metabolismo , Trombose/terapia , Doenças Vasculares/etiologia , Doenças Vasculares/metabolismo , Doenças Vasculares/terapia
5.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452070

RESUMO

A 65-year-old man, a smoker, presented to the emergency department with progressive digital ischaemia, fever and weight loss. The clinical examination revealed generalised lymphadenopathy and ischaemic changes of the right distal phalanges of the second, third and fourth fingers. He had an ultrasound-guided biopsy of the cervical lymph node, which showed histopathological findings of classic Hodgkin's lymphoma. Paraneoplastic acral vascular syndrome (PAVS) is a rare phenomenon and seen more in solid malignancies. There are very few reported cases of PAVS in haematological malignancies, including Hodgkin's lymphoma. This case highlights the idea that the presence of acral vascular syndrome-especially in older patients-should alert physicians to search for an underlying malignancy as part of the medical evaluation. Also, it shows that medical treatment may slow the progress of the digital ischaemia until the culprit tumour has been identified and treated.


Assuntos
Doença de Hodgkin/complicações , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Doenças Vasculares/etiologia , Doenças Vasculares/patologia , Idoso , Dedos/irrigação sanguínea , Doença de Hodgkin/diagnóstico , Humanos , Masculino
6.
Microvasc Res ; 133: 104071, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32949574

RESUMO

OBJECTIVE: Increasing evidence points to endothelial dysfunction as a key pathophysiological factor in coronavirus disease-2019 (COVID-19). No specific methods have been identified to predict, detect and quantify the microvascular alterations during COVID-19. Our aim was to assess microvasculature through nailfold videocapillaroscopy (NVC) in COVID-19 patients. METHODS: We performed NVC in patients with a confirmed diagnosis of COVID-19 pneumonia. Elementary alterations were reported for each finger according to a semi-quantitative score. Capillary density, number of enlarged and giant capillaries, number of micro-hemorrhages and micro-thrombosis (NEMO score) were registered. RESULTS: We enrolled 82 patients (mean age 58.8 ± 13.2 years, male 68.3%) of whom 28 during the hospitalization and 54 after recovery and hospital discharge. At NVC examination we found abnormalities classifiable as non-specific pattern in 53 patients (64.6%). Common abnormalities were pericapillary edema (80.5%), enlarged capillaries (61.0%), sludge flow (53.7%), meandering capillaries and reduced capillary density (50.0%). No pictures suggestive of scleroderma pattern have been observed. Acute COVID-19 patients, compared to recovered patients, showed a higher prevalence of hemosiderin deposits as a result of micro-hemorrhages (P = .027) and micro-thrombosis (P < .016), sludge flow (P = .001), and pericapillary edema (P < .001), while recovered patients showed a higher prevalence of enlarged capillaries (P < .001), loss of capillaries (P = .002), meandering capillaries (P < .001), and empty dermal papillae (P = .006). CONCLUSION: COVID-19 patients present microvascular abnormalities at NVC. Currently ill and recovered subjects are characterized by a different distribution of elementary capillaroscopic alterations, resembling acute and post-acute microvascular damage. Further studies are needed to assess the clinical relevance of NVC in COVID-19.


Assuntos
/complicações , Capilares/patologia , Angioscopia Microscópica , Unhas/irrigação sanguínea , Doenças Vasculares/patologia , Idoso , /terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doenças Vasculares/etiologia
7.
Int J Mol Sci ; 21(24)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33348552

RESUMO

Ischemic stroke is a major cause of death among patients with systemic hypertension. The narrowing of the lumen of the brain vasculature contributes to the increased incidence of stroke. While hyalinosis represents the major pathological lesions contributing to vascular lumen narrowing and stroke, the pathogenic mechanism of brain vascular hyalinosis has not been well characterized. Thus, the present study examined the postmortem brain vasculature of human patients who died of ischemic stroke due to systemic hypertension. Hematoxylin and eosin staining and immunohistochemistry showed the occurrence of brain vascular hyalinosis with infiltrated plasma proteins along with the narrowing of the vasa vasorum and oxidative stress. Transmission electron microscopy revealed endothelial cell bulge protrusion into the vasa vasorum lumen and the occurrence of endocytosis in the vasa vasorum endothelium. The treatment of cultured microvascular endothelial cells with adrenaline also promoted the formation of the bulge as well as endocytic vesicles. The siRNA knockdown of sortin nexin-9 (a mediator of clathrin-mediated endocytosis) inhibited adrenaline-induced endothelial cell bulge formation. Adrenaline promoted protein-protein interactions between sortin nexin-9 and neural Wiskott-Aldrich syndrome protein (a regulator of actin polymerization). Spontaneously hypertensive stroke-prone rats also exhibited lesions indicative of brain vascular hyalinosis, the endothelial cell protrusion into the lumen of the vasa vasorum, and endocytosis in vasa vasorum endothelial cells. We propose that endocytosis-dependent endothelial cell bulge protrusion narrows the vasa vasorum, resulting in ischemic oxidative damage to cerebral vessels, the formation of hyalinosis, the occurrence of ischemic stroke, and death in systemic hypertension patients.


Assuntos
Isquemia Encefálica/etiologia , Isquemia Encefálica/mortalidade , Diarreia/etiologia , Diarreia/patologia , Oftalmopatias Hereditárias/etiologia , Oftalmopatias Hereditárias/patologia , Hipertensão/complicações , Enteropatias/etiologia , Enteropatias/patologia , /mortalidade , Anormalidades da Pele/etiologia , Anormalidades da Pele/patologia , Vasa Vasorum/patologia , Doenças Vasculares/etiologia , Doenças Vasculares/patologia , Idoso , Idoso de 80 Anos ou mais , Animais , Autopsia , Encéfalo/patologia , Isquemia Encefálica/patologia , Células Cultivadas , Endocitose/genética , Células Endoteliais/metabolismo , Feminino , Técnicas de Silenciamento de Genes , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/genética , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Nexinas de Classificação/genética , Transfecção
10.
Medicine (Baltimore) ; 99(46): e23299, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181720

RESUMO

Calcific tendinitis (CT) of the shoulder is a painful disorder usually identified in individuals aged 40 and 60 years. The estimated global prevalence of CT is 2.7% to 36%. We examined the association of hyperlipidemia and sex with CT of the shoulder using Taiwan Biobank (TWB) and the National Health Insurance Research Database (NHIRD).Data were available for 9903 TWB participants who were recruited between 2008 and 2015. We used multiple logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) for CT of the shoulder.Overall, 1564 women, and 1491 men were identified with hyperlipidemia. Women, compared to men, had higher odds of CT of the shoulder (OR, 1.53; 95% CI, 1.08-2.16). Hyperlipidemia, compared to no hyperlipidemia, was associated with an increased risk of CT (OR, 1.40; 95% CI, 1.02-1.93). The test for interaction was significant for sex and hyperlipidemia (P = .006). After stratification, the odds ratio for CT was 1.95 (95% CI, 1.30-2.92) in women and 0.82 (95% CI, 0.48-1.39) in men, respectively. Compared to men with no hyperlipidemia, the odds ratio was 0.86 (95% CI, 0.53-1.38) for men with hyperlipidemia and 2.00 (95% CI, 1.29-3.10) for women with hyperlipidemia.Importantly, our findings indicated that the risk for CT of the shoulder was higher among Taiwanese women with hyperlipidemia. However, CT risk among their male counterparts with hyperlipidemia was not significant.


Assuntos
Calcinose/etiologia , Hiperlipidemias/complicações , Artropatias/etiologia , Fatores Sexuais , Ombro/anormalidades , Tendinopatia/etiologia , Doenças Vasculares/etiologia , Adulto , Idoso , Calcinose/epidemiologia , Calcinose/fisiopatologia , Feminino , Humanos , Hiperlipidemias/epidemiologia , Hiperlipidemias/fisiopatologia , Artropatias/epidemiologia , Artropatias/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Ombro/fisiopatologia , Taiwan/epidemiologia , Tendinopatia/epidemiologia , Tendinopatia/fisiopatologia , Doenças Vasculares/epidemiologia , Doenças Vasculares/fisiopatologia
11.
Rev Cardiovasc Med ; 21(3): 315-319, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33070537

RESUMO

Great attention has been paid to endothelial dysfunction (ED) in coronavirus disease 2019 (COVID-19). There is growing evidence to suggest that the angiotensin converting enzyme 2 receptor (ACE2 receptor) is expressed on endothelial cells (ECs) in the lung, heart, kidney, and intestine, particularly in systemic vessels (small and large arteries, veins, venules, and capillaries). Upon viral infection of ECs by severe acute respiratory syndrome coronarvirus 2 (SARS-CoV-2), ECs become activated and dysfunctional. As a result of endothelial activation and ED, the levels of pro-inflammatory cytokines (interleukin -1, interleukin-6 (IL-6), and tumor necrosis factor-α), chemokines (monocyte chemoattractant protein-1), von Willebrand factor (vWF) antigen, vWF activity, and factor VIII are elevated. Higher levels of acute phase reactants (IL-6, C-reactive protein, and D-dimer) are also associated with SARS-CoV-2 infection. Therefore, it is reasonable to assume that ED contributes to COVID-19-associated vascular inflammation, particularly endotheliitis, in the lung, heart, and kidney, as well as COVID-19-associated coagulopathy, particularly pulmonary fibrinous microthrombi in the alveolar capillaries. Here we present an update on ED-relevant vasculopathy in COVID-19. Further research for ED in COVID-19 patients is warranted to understand therapeutic opportunities.


Assuntos
Betacoronavirus , Transtornos da Coagulação Sanguínea/etiologia , Infecções por Coronavirus/complicações , Endotélio Vascular/fisiopatologia , Pneumonia Viral/complicações , Doenças Vasculares/etiologia , Vasodilatação/fisiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Infecções por Coronavirus/epidemiologia , Humanos , Inflamação/etiologia , Inflamação/fisiopatologia , Pandemias , Pneumonia Viral/epidemiologia , Doenças Vasculares/fisiopatologia
12.
Angiol. (Barcelona) ; 72(n.extr.1): 1-30, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-199277

RESUMO

Presentamos la adaptación para España de la actualización de las Guías Europeas de Prevención Vascular. En esta actualización se hace mayor énfasis en el abordaje poblacional, especialmente en la promoción de la actividad física y de una dieta saludable mediante políticas alimentarias y de ocio y transporte activo en España. Para estimar el riesgo vascular, se destaca la importancia de recalibrar las tablas que se utilicen, adaptándolas a los cambios poblaciones en la prevalencia de los factores de riesgo y en la incidencia de enfermedades vasculares, con particular atención al papel de la enfermedad renal crónica. A nivel individual resulta clave el apoyo personalizado para el cambio de conducta, la adherencia a la medicación en los individuos de alto riesgo y pacientes con enfermedad vascular, la promoción de la actividad física y el abandono del tabaquismo. Además, se revisan los ensayos clínicos recientes con inhibidores de PCKS9, la necesidad de simplificar el tratamiento farmacológico de la hipertensión arterial para mejorar su control y la adherencia al tratamiento. En los pacientes con diabetes mellitus 2 y enfermedad vascular o riesgo vascular alto, cuando los cambios de estilo de vida y la metformina resultan insuficientes, deben priorizarse los fármacos con demostrado beneficio vascular. Por último, se incluyen pautas sobre enfermedad arterial periférica y otras enfermedades específicas y se recomienda no prescribir antiagregantes en prevención primaria. El objetivo del presente trabajo es realizar una revisión actualizada de la literatura con el propósito de ayudar a mejorar el conocimiento de esta patología


We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalized support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritized. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention. The objective of the present work is to carry out an updated review of the literature in order to help improve the knowledge of this pathology


Assuntos
Humanos , Masculino , Feminino , Doenças Vasculares/prevenção & controle , Doenças Vasculares/etiologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Fatores Sexuais , Fatores Etários , Promoção da Saúde , Espanha , Exercício Físico , Dieta Saudável
13.
Clín. investig. arterioscler. (Ed. impr.) ; 32(5): 200-205, sept.-oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196743

RESUMO

ANTECEDENTES: La esteatosis hepática es un problema de salud pública de incidencia y prevalencia crecientes en nuestra sociedad. OBJETIVO: Determinar si la esteatosis hepática, medida mediante el Fatty Liver Index (FLI), se relaciona con el riesgo metabólico y vascular y, de ser así, identificar qué factor clínico-metabólico explica el mayor riesgo vascular de estos pacientes. MÉTODOS: Estudio transversal que incluye una muestra de 531 varones que acudieron a la unidad de chequeos de la Clínica Universitaria de Navarra. Se determinó el grado de esteatosis mediante el FLI. El riesgo metabólico fue evaluado mediante una escala basada en determinaciones de HDL, LDL, triglicéridos, glucemia, HOMA-IR, índice neutrófilo/linfocitario y presión sistólica; el riesgo vascular, mediante la presencia de placas ateromatosas en carótidas y/o femorales. La asociación dosis-respuesta entre el FLI y ambos riesgos se analizó mediante modelos no paramétricos (splines) y regresión logística. RESULTADOS: La muestra estudiada presenta una edad media de 52,70años, con el 49,3% de ellos presentando un FLI≥60, el 33,6% con síndrome metabólico y el 43,9% con placas ateromatosas en carótidas o femorales. La relación entre el FLI y el riesgo metabólico y vascular fue lineal (metabólico: valor de p no lineal=0,097; valor de p lineal <0,001; vascular: valor de p no lineal=1,000; valor de p lineal=0,028). Por cada 10unidades de incremento del FLI la odds de presentar placas de ateroma aumentaba en un 9,7% (OR=1,097; intervalo de confianza al 95%: 1,010-1,191). Al ajustar por trigliceridemia la asociación desaparecía (OR=1,001). CONCLUSIONES: Los pacientes con esteatosis hepática presentan un mayor riesgo metabólico y vascular. El mayor riesgo vascular está asociado con el nivel de triglicéridos. A nivel clínico, este estudio sugiere que estos pacientes podrían beneficiarse del tratamiento de la hipertrigliceridemia


BACKGROUND: Hepatic steatosis is a public health problem with increased incidence and prevalence. OBJECTIVE: To determine whether the liver steatosis, as measured by the Fatty Liver Index (FLI), is related to metabolic risk and vascular factors and, if so, to identify the clinical-metabolic factor that explains the higher vascular risk. METHODS: Cross-sectional study including a sample of 531 men who came to the University of Navarra Clinic Check-up Unit. The degree of steatosis was determined by the FLI. The metabolic risk was assessed using a scale based on determinations of HDL, LDL, triglycerides, blood glucose, HOMA-IR, neutrophil/lymphocyte index, and systolic blood pressure. The vascular risk was assessed by the presence of carotid and/or femoral atheromatous plaques. The dose-response association between FLI and both risks was analysed using non-parametric models (splines) and logistic regression. RESULTS: The sample studied had a mean age of 52.70years, with 49.3% having an FLI ≥60, as well as 33.6% with metabolic syndrome, and 43.9% with carotid and/or femoral atheromatous plaques. The relationship between FLI and metabolic risk and vascular was linear (metabolic: non-linear P=.097; linear P<.001; vascular: non-linear P=1.000; linear P=.028). For every 10 units of increase in FLI, the odds of presenting with atheroma plaques increased by 9.7% (OR=1.097; 95% confidence interval 1.010-1.191). When adjusting for triglyceridaemia, the association disappeared (OR=1.001). CONCLUSIONS: Patients with fatty liver disease had an increased metabolic and vascular risk. The increased vascular risk is associated with the triglyceride level. On a clinical level, this study suggests that these patients could benefit from treatment of hypertriglyceridaemia


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Hepatopatia Gordurosa não Alcoólica/complicações , Doenças Vasculares/etiologia , Fatores de Risco , Estudos Transversais , Hipertrigliceridemia/terapia , Triglicerídeos/análise , Indicadores Básicos de Saúde , Medição de Risco , Modelos Logísticos
14.
J Vasc Interv Radiol ; 31(10): 1654-1660.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32951972

RESUMO

PURPOSE: To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA). MATERIALS AND METHODS: Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction. RESULTS: Central venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra- or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6-70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2-25.5) minutes. CONCLUSIONS: The Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.


Assuntos
Veias Braquiocefálicas , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Veias Jugulares , Diálise Renal , Veia Subclávia , Doenças Vasculares , Veia Cava Superior , Adulto , Idoso , Idoso de 80 Anos ou mais , Veias Braquiocefálicas/diagnóstico por imagem , Cateterismo Venoso Central/efeitos adversos , Constrição Patológica , Desenho de Equipamento , Europa (Continente) , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , América do Sul , Veia Subclávia/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia , Veia Cava Superior/diagnóstico por imagem
15.
Ann Emerg Med ; 76(3S): S12-S20, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928457

RESUMO

STUDY OBJECTIVE: This was a prospective, pre-post, 13-year observational study documenting the multiyear implementation of an observation unit sickle cell pathway for patients with uncomplicated vaso-occlusive events. METHODS: The sickle cell pathway begins with rapid triage to identify patients with uncomplicated vaso-occlusive events for immediate transfer to the observation unit and initiation of patient-controlled analgesia followed by repeated evaluations of pain and identification of other complications. Data were abstracted from the electronic medical record or observation unit database. The sickle cell pathway was initiated in April 2006. Major revisions of it were carried out in June 2009 (physician evaluation occurs in sickle cell pathway and only patient-controlled analgesia administration of medications) and October 2010 (multidisciplinary management and individual dosing). RESULTS: Annual ED visits ranged between 287 and 528. The preimplementation hospital admission rate was 33% (123/368), 3-day return rate 16% (60/368), and 30-day return rate 67% (248/368). Refinements to the sickle cell pathway have resulted in a decrease in admission rate to 20% (258/1276); 3-day return rate, to 3.6% (46/1,276); and 30-day return rate, to 41% (525/1,276) for the past 3 years. CONCLUSION: The use of a sickle cell pathway for the treatment of uncomplicated vaso-occlusive events has been effective in providing rapid treatment and reducing hospital admissions. However, it was not only the intervention and its refinement that made the sickle cell pathway successful. With the Consolidated Framework for Implementation Research, it was discerned that outer setting factors of organizational commitment to the care of patients with SCD, inner setting factors of learning climate and leadership engagement, individuals, and process contributed to the success of the sickle cell pathway.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Anemia Falciforme/terapia , Unidades de Observação Clínica , Serviço Hospitalar de Emergência , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Adolescente , Adulto , Idoso , Anemia Falciforme/complicações , Estudos Controlados Antes e Depois , Procedimentos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Prospectivos , Triagem , Doenças Vasculares/etiologia , Adulto Jovem
16.
Life Sci ; 260: 118398, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32920004

RESUMO

AIMS: We investigate the effect of nobiletin on vascular and renal alterations and possible mechanisms involved in high-fat diet (HFD)-fed rats. MAIN METHODS: Male Sprague-Dawley rats were fed a HFD with fructose 15% in drinking water for 16 weeks. HFD-fed rats were treated with nobiletin (20 or 40 mg/kg/day) or vehicle for the last 4 weeks. KEY FINDINGS: HFD-fed rats treated with nobiletin was significantly reduced obesity, hypertension, dyslipidemia and hyperinsulinemia. Nobiletin improved vascular endothelial function, restored creatinine clearance, and reduced plasma urea and creatinine levels, as well as urinary protein excretion. Nobiletin markedly alleviated vascular medial cross-sectional area (CSA) and collagen deposition, glomerular extracellular matrix (ECM) accumulation, and renal fibrosis. Nobiletin significantly elevated plasma adiponectin levels, together with upregulated adiponectin receptor 1 (AdipoR1) and suppressed transforming growth factor-ß1 (TGF-ß1) expression in kidney. In addition, an increase of plasma tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) was significantly attenuated after nobiletin treatment. SIGNIFICANCE: Our results suggest that nobiletin attenuates HFD-induced vascular and renal alterations in rats, which is possibly related to the modulation of AdipoR1 and TGF-ß1expression, and suppression of inflammation.


Assuntos
Dieta Hiperlipídica/efeitos adversos , Flavonas/farmacologia , Inflamação/prevenção & controle , Nefropatias/tratamento farmacológico , Receptores de Adiponectina/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Doenças Vasculares/tratamento farmacológico , Animais , Antioxidantes/farmacologia , Regulação da Expressão Gênica , Inflamação/etiologia , Inflamação/metabolismo , Inflamação/patologia , Nefropatias/etiologia , Nefropatias/metabolismo , Nefropatias/patologia , Masculino , Ratos , Ratos Sprague-Dawley , Receptores de Adiponectina/genética , Fator de Crescimento Transformador beta1/genética , Doenças Vasculares/etiologia , Doenças Vasculares/metabolismo , Doenças Vasculares/patologia
19.
Arterioscler Thromb Vasc Biol ; 40(10): 2548-2556, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32847389

RESUMO

OBJECTIVE: Preterm birth has been associated with changes in arterial structure and function. Association with complications occurring during the neonatal period, including bronchopulmonary dysplasia, on vascular outcomes in adulthood is unknown. Approach and Results: We evaluated a cohort of 86 adults born preterm (below 30 weeks of gestation), compared to 85 adults born term, at a mean age of 23 years. We performed ultrasonographic assessment of the dimensions of the ascending aorta, carotid and brachial arteries, and estimated flow-mediated dilation, carotid-femoral pulse wave velocity, augmentation index corrected for heart rate, and carotid intima-media thickness. All analyses were performed with and without adjustment for potential confounding variables, including height, sex, and body mass index. Ascending aorta diameter in diastole was smaller in the preterm group, but carotid and brachial arteries were similar. Carotid and brachial strain, a marker of arterial distensibility, was smaller in the preterm group, while carotid-femoral pulse wave velocity, was similar between groups, indicating similar aortic stiffness. Carotid intima-media thickness, endothelial function flow-mediated dilation, blood nitrite, and nitrate levels were similar between groups. Individuals with bronchopulmonary dysplasia had lower brachial artery strain suggesting long-term association of this neonatal complication with vascular structure. Diastolic blood pressure was higher in the preterm group and was associated with decreased brachial and carotid distensibility. CONCLUSIONS: Young adults born preterm display alterations in arterial distensibility that are associated with a history of bronchopulmonary dysplasia.


Assuntos
Aorta/fisiopatologia , Artéria Braquial/fisiopatologia , Displasia Broncopulmonar/complicações , Artérias Carótidas/fisiopatologia , Recém-Nascido Prematuro , Doenças Vasculares/etiologia , Rigidez Vascular , Adolescente , Adulto , Fatores Etários , Aorta/diagnóstico por imagem , Pressão Arterial , Artéria Braquial/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/fisiopatologia , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Estudos Transversais , Feminino , Idade Gestacional , Frequência Cardíaca , Humanos , Recém-Nascido , Masculino , Fatores de Risco , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Adulto Jovem
20.
Vasc Endovascular Surg ; 54(7): 565-572, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32677549

RESUMO

OBJECTIVES: To investigate the safety and efficacy of a stent combined with a linear strand of 125I seeds to treat malignant cancer-associated venous obstruction. METHODS: We retrospectively analyzed the data of 57 patients with malignant cancer-associated venous obstruction. Nineteen patients underwent the placement of a stent combined with a linear strand of 125I seeds (group A), and 38 patients underwent the placement of a bare stent (group B). The following parameters were compared between the 2 groups of patients: symptom relief rate, duration of venous patency, survival time, quality of life, and adverse events. RESULTS: A total of 34 stents and 527 seeds were implanted in group A, while a total of 57 stents were implanted in group B. The surgery success rate was 96.5%, and no serious complication related to the surgery was reported. Symptoms of venous obstruction improved significantly after surgery. The score of group A decreased from 14.74 ± 0.562 points before surgery to 2.79 ± 1.357 points after surgery(P < .001), and the score of group B decreased from 13.79 ± 1.398 points before surgery to 5.55 ± 3.674 points after surgery (P < .001). The patency rate of group A was significantly higher than that of group B at 1 to 6 months after surgery (100%, 84.2%, 68.4%, 63.2%, 36.8%, 21.1% vs 68.4%, 23.7%, 18.4%, 7.9%, 5.3%, 2.6%, respectively; P < .05). Before treatment, there was no statistically significant difference in the Karnofsky Performance Status (KPS) score between the groups (P = .791). After 1 to 6 months of treatment, the KPS score was significantly higher in group A than in group B (P = .013). The median patency duration in groups A and B was 125 days (95% CI: 80.018-169.982) and 35 days (95% CI: 20.501-49.499), respectively (P < .001). The median survival time of group A was 155 days (95% CI: 110.406-199.594), and that of group B was 98 days (95% CI: 55.712-140.288; P = .325). Multivariate analysis showed that the implantation of a stent combined with a linear strand of 125I seeds and the KPS score (≥80 points) were independent factors of long-term patency after stent placement. CONCLUSIONS: The placement of a stent combined with a linear strand of 125I seeds is a safe and effective treatment for venous obstruction caused by malignant tumors. This treatment provides prolonged patency compared with the placement of bare stent, and while it does not significantly improve the survival time of patients, it can improve their quality of life.


Assuntos
Procedimentos Endovasculares/instrumentação , Radioisótopos do Iodo/administração & dosagem , Neoplasias/terapia , Células Neoplásicas Circulantes/patologia , Compostos Radiofarmacêuticos/administração & dosagem , Stents , Doenças Vasculares/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/mortalidade , Neoplasias/patologia , Desenho de Prótese , Qualidade de Vida , Compostos Radiofarmacêuticos/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/etiologia , Doenças Vasculares/mortalidade , Doenças Vasculares/patologia , Grau de Desobstrução Vascular
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