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1.
Stephan Neidhardt Jens Garbade Fabian Emrich Kristin Klaeske Michael A. Borger Sven Lehmann Khalil Jawad Maja-Theresa Dieterlen 《Journal of cardiac failure》2019,25(3):204-212
Background
Oxidative stress due to reactive oxygen species (ROS) production is a key factor in the development of heart failure (HF). This study investigated the thioredoxin (Trx) system, which plays a major role in antioxidant defense, in patients suffering from ischemic (ICM) or dilated (DCM) cardiomyopathy.Methods and Results
Myocardial tissue from ICM (n?=?13) and DCM (n?=?13) patients, as well as septal tissue of patients with aortic stenosis but without diagnosed hypertrophic cardiomyopathy or subaortic stenosis (control; n?=?12), was analyzed for Trx1, Trx-interacting protein (TXNIP) and E3 ligase ITCH (E3 ubiquitin-protein ligase Itchy homolog) expression. Trx-reductase 1 (TXNRD1) amount and activity, cytosolic cytochrome C content, and apoptosis markers were quantified by means of enzyme-linked immunosorbent assay and multiplexing. Compared with control samples, ITCH and Trx1 expression, TXNRD1 amount and activity were reduced and TXNIP expression was increased in ICM (ITCH: P?=?.013; Trx1: P?=?.028; TXNRD1 amount: P?=?.035; TXNRD1 activity: P?=?.005; TXNIP: P?=?.014) but not in DCM samples. A higher level of the downstream apoptosis marker caspase-9 (ICM: 582 ± 262 MFI [P?=?.995]; DCM: 1251 ± 548 MFI [P?=?.002], control: 561 ± 214 MFI) was detected in DCM tissue. A higher expression of Bcl-2 was found in DCM (P?=?.011).Conclusion
The Trx system was impaired in ICM but not in DCM. ITCH appeared to be responsible for the down-regulation of the Trx system. ROS-induced mitochondrial instability appeared to play a role in DCM. 相似文献2.
Gary P. Wormser Kitae Park Colby Madison Julia Rozenberg Donna McKenna Carol Scavarda Carol Karmen Rhea Dornbush Paul Visintainer 《The American journal of medicine》2019,132(4):519-524
Background
The Beck Depression Inventory (BDI-II) may be used to evaluate individuals for symptoms of depression.Methods
In a 1-year prospective study, 52 adult Lyme disease patients with erythema migrans and 104 matched control subjects were clinically assessed and completed the BDI-II at study entry and approximately 6 and 12 months later following antibiotic treatment.Results
The mean BDI-II score was significantly higher at the baseline visit among Lyme disease patients compared with controls (P?=?.002), but no significant differences between the groups were observed at either the 6- or 12-month study visits. Over the course of the study, the mean BDI-II scores decreased an average of approximately 0.22 points per month (P < .0005) for Lyme disease patients, whereas the mean scores changed very little for controls (mean change?=??0.02 per month, P?=?.50). The total number of somatic symptoms, of the 12 symptoms evaluated, strongly and directly correlated with the BDI-II scores at the baseline visit for the Lyme disease patients.Conclusions
The mean BDI-II scores of patients with early Lyme disease significantly exceeded that of matched controls at study entry, but by 6 months the values did not differ significantly. There was a good-to-excellent direct correlation between the BDI-II score and the total number of symptoms, suggesting that the BDI-II scores were reflecting somatic rather than affective depressive symptoms. When using the BDI-II as an assessment tool of patients with Lyme disease, infection-related somatic symptoms per se need to be considered in the interpretation of the results. 相似文献3.
Kathleen A.N. Aithinne Casey W. Cooper Robert A. Lynch David L. Johnson 《American journal of infection control》2019,47(5):515-520
Introduction
Clostridium difficile is the leading cause of health care–associated gastric illness. Environmental contamination with C difficile spores is a risk factor for contact transmission, and toilet flushing causes such contamination. This work explores toilet contamination persistence and environmental contamination produced over a series of flushes after contamination.Methods
A flushometer toilet was seeded with C difficile spores in a sealed chamber. The toilet was flushed 24times, with postflush bowl water samples and settle plates periodically collected for culturing and counting. Air samples were collected after each of 12 flushes using rotating plate impactors.Results
Spores were present in bowl water even after 24 flushes. Large droplet spore deposition accumulated over the 24-flush period. Droplet nuclei spore bioaerosol was produced over at least 12 flushes.Conclusions
Toilets contaminated with C difficile spores are a persistent source of environmental contamination over an extended number of flushes. 相似文献4.
Yue-Nan Ni He Yu Hui Xu Wei-jing Li Bin-miao Liang Ling Yang Zong-An Liang 《The American journal of the medical sciences》2019,357(3):213-222
Background
We aimed to further determine the relationship between the areas of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the ratio of VAT to SAT (VAT/SAT) with the outcomes of acute respiratory distress syndrome (ARDS) patients.Methods
A retrospective study was performed on patients with ARDS in 7 intensive care units (ICU) of West China Hospital, Sichuan University.Results
A total of 169 patients were included in the analysis. Abdominal computed tomography scans of each patient within 24 hours of being admitted to the ICU were assessed by at least 2 investigators. Higher VAT/SAT was related with higher hospital mortality (22% vs. 44%, P?=?0.003; adjusted odds ratio [aOR] 0.699, 95% CI 0.530-0.922 ([P?=?0.011]). On the contrary, higher SAT and VAT were related to lower hospital mortality in ARDS (aOR 1.077, 95% CI 1.037-1.119 [P < 0.001]; aOR 1.017, 95% CI 1.004-1.030 [P?=?0.011], respectively). Patients with higher SAT and VAT had shorter length of ICU stay (ICU LOS) (26.26 vs. 15.83 days, P?=?0.031; 25.16 vs. 14.19 days, P?=?0.007, respectively), while VAT/SAT was not related with ICU LOS. Moreover, we did not find any significant relationship either between VAT/SAT and mechanical ventilation-free days or between SAT and mechanical ventilation-free days.Conclusions
This study suggests that VAT/SAT can contribute to adverse outcomes of patients with ARDS. However, higher SAT and VAT were related to better prognosis of ARDS patients. 相似文献5.
Adelita Tinoco David W. Mortara Xiao Hu Cass Piper Sandoval Michele M. Pelter 《Heart & lung : the journal of critical care》2019,48(2):114-120
Background
Cheyne-Stokes respiration and periodic breathing (CSRPB) have not been studied sufficiently in the intensive care unit setting (ICU).Objectives
To determine whether CSRPB is associated with adverse outcomes in ICU patients.Methods
The ICU group was divided into quartiles by CSRPB (86 patients in quartile 1 had the least CSRPB and 85 patients in quartile 4 had the most CSRPB). Adverse outcomes (emergent intubation, cardiorespiratory arrest, inpatient mortality and the composite of all) were compared between patients with most CSRPB (quartile 4) and those with least CSRPB (quartile 1).Results
ICU patients in quartile 4 had a higher proportion of cardiorespiratory arrests (5% versus 0%, (p=.042), and more adverse events over all (19% versus 8%, p=.041) as compared to patients in quartile 1.Conclusions
CSRPB can be measured in the ICU and it's severity is associated with adverse outcomes in critically ill patients. 相似文献6.
Madeline R. Sterling Deanna Jannat-Khah Joanna Bryan Samprit Banerjee Leslie A. McClure Virginia G. Wadley Frederick W. Unverzagt Emily B. Levitan Parag Goyal Janey C. Peterson Jennifer J. Manly Deborah A. Levine Monika M. Safford 《Journal of cardiac failure》2019,25(2):130-136
Background
Cognitive impairment (CI) is estimated to be present in 25%–80% of heart failure (HF) patients, but its prevalence at diagnosis is unclear. To improve our understanding of cognition in HF, we determined the prevalence of CI among adults with incident HF in the REGARDS study.Methods and Results
REGARDS is a longitudinal cohort study of adults ≥45 years of age recruited in the years 2003–2007. Incident HF was expert adjudicated. Cognitive function was assessed with the Six-Item Screener. The prevalence of CI among those with incident HF was compared with the prevalence of CI among an age-, sex-, and race-matched cohort without HF. The 436 participants with incident HF had a mean age of 70.3 years (SD 8.9), 47% were female, and 39% were black. Old age, black race, female sex, less education, and anticoagulation use were associated with CI. The prevalence of CI among participants with incident HF (14.9% [95% CI 11.7%–18.6%]) was similar to the non-HF matched cohort (13.4% [11.6%–15.4%]; P < .43).Conclusions
A total of 14.9% of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. Increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted. 相似文献7.
Stefanos Despotopoulos Anastasios Roumeliotis Nicholas G. Kounis Grigorios Tsigkas George Hahalis Periklis Davlouros 《Heart & lung : the journal of critical care》2019,48(2):138-140
Background
Kounis syndrome is a systemic complication following an allergic reaction, presenting with coronary artery spasm or thrombosis and occasionally with stent thrombosis that can have fatal outcome.Objectives
Heparins can induce allergic reactions via tissue antigenicity, heparin induced thrombocytopenia and contact system-activating effects of contaminants but allergy bivalirudin has not been reported so far.Methods
Herein, we describe a patient with fatal acute coronary in-stent thrombosis following an allergic reaction soon after an intra-arterial heparin dose and intravenous administration of bivalirudin during angioplasty.Results
The patient received intense myocardial infarction protocol treatment including angioplasty and defibillation together with antiallergic therapy but despite all of these efforts and measures, he succumbed 2 h later.Conclusions
Significant suspicion should be raised that life saving drugs such as heparin and bivalirudin could join forces with concurrent medication acting as antigens and induce fulminant and fatal stent thrombosis as a manifestation of Kounis syndrome 相似文献8.
Hester Groenewegen Wouter F.W. Bierman Konstantina Delli Pieter U. Dijkstra Willem Nesse Arjan Vissink Frederik K.L. Spijkervet 《The Journal of infection》2019,78(3):171-177
Objective
To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis.Design
cross-sectional controlled study.Methods
We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires.Results
Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p?=?0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists.Conclusions
Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients. 相似文献9.
Ravinder Kang Samuel T. Kunkel Jesse A. Columbo Philip P. Goodney Sandra L. Wong 《The American journal of medicine》2019,132(4):530-534.e1
Background
Employee satisfaction is thought to impact performance. However, which aspects of employee satisfaction matter most is unknown. We utilized data from the Veterans Affairs Medical Centers(VAMC) via their Strategic Analytics for Improvement and Learning program to examine the association between organizational satisfaction as well as job-specific satisfaction with measures of patient safety, patient satisfaction, and hospital rating.Methods
The correlation between employee satisfaction with their organization and with their specific job were examined across indicators of patient care using Pearson and Spearman's correlation. Employee satisfaction data were obtained from the All Employee Survey.Results
We found that employee job-specific satisfaction does not correlate with patient outcomes, whereas higher satisfaction with the organization is associated with improved patient safety (ρ?=??0.19, P < .05) and correlates with all aspects of patient satisfaction (“top box” ratings of hospital [r?=?0.30, P < 0.005], primary care [r?=?0.25, P < 0.005], and specialty care [r?=?0.14, P < 0.005]). Further, employees are more satisfied with their job and organization when they work at a VAMC with a higher Star rating.Conclusion
Employee organizational satisfaction and job-specific satisfaction are distinct metrics, and it is higher organizational satisfaction that is associated with improved patient care. 相似文献10.
Anna M. Nordenskjöld Bo Lagerqvist Tomasz Baron Tomas Jernberg Nermin Hadziosmanovic Harmony R. Reynolds Per Tornvall Bertil Lindahl 《The American journal of medicine》2019,132(3):335-346
Background
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.Methods
In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.Results
The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P?=?.54).Conclusions
About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD. 相似文献11.
Rushi V. Parikh Kiran Khush Vedant S. Pargaonkar Helen Luikart David Grimm Michelle Yu Kozo Okada Yasuhiro Honda Alan C. Yeung Hannah Valantine William F. Fearon 《Journal of cardiac failure》2019,25(2):97-104
Background
Endothelin-1 (ET-1) has been implicated in the development of post–heart transplantation (HT) cardiac allograft vasculopathy (CAV), but has not been well studied in humans.Methods and Results
In 90 HT patients, plasma ET-1 was measured within 8 weeks after HT (baseline) via a competitive enzyme-linked immunosorbent assay. Three-dimensional volumetric intravascular ultrasound of the left anterior descending artery was performed at baseline and at 1 year. Accelerated CAV (lumen volume loss) was defined with the 75th percentile as a cutoff. Patients were followed beyond the first year after HT for late death or retransplantation. A receiver operating characteristic (ROC) curve demonstrated that a baseline ET-1 concentration of 1.75 pg/mL provided the best accuracy for diagnosis of accelerated CAV at 1 year (area under the ROC curve 0.69, 95% confidence interval [CI] 0.57–0.82; P?=?.007). In multivariate logistic regression, a higher baseline ET-1 concentration was independently associated with accelerated CAV (odds ratio [OR] 2.13, 95% CI 1.15–3.94; P?=?.01); this relationship persisted when ET-1 was dichotomized at 1.75 pg/mL (OR 4.88, 95% CI 1.69–14.10; P?=?.003). Eighteen deaths occurred during a median follow-up period of 3.99 (interquartile range 2.51–9.95) years. Treated as a continuous variable, baseline ET-1 was not associated with late mortality in multivariate Cox regression (hazard ratio [HR] 1.22, 95% CI 0.72–2.05; P?=?.44). However, ET-1 >1.75 pg/mL conferred a significantly lower cumulative event-free survival on Kaplan-Meier analysis (P?=?.047) and was independently associated with late mortality (HR 2.94, 95% CI 1.12–7.72; P?=?.02).Conclusions
Elevated ET-1 early after HT is an independent predictor of accelerated CAV and late mortality, suggesting that ET-1 has durable prognostic value in the HT arena. 相似文献12.
Sakthi Sundararajan Michael S. Kiernan Gregory S. Couper Jenica N. Upshaw David DeNofrio Amanda R. Vest 《Journal of cardiac failure》2019,25(3):188-194
Background:
Systolic heart failure (HF) is a low-grade systemic inflammatory state. Neutrophil-lymphocyte ratio (NLR) is a nonspecific inflammatory marker with prognostic value in HF. We aimed to determine the relationship between NLR and mortality during left ventricular assist device (LVAD) support.Methods and Results:
We retrospectively reviewed LVAD recipients implanted in the years 2010–2018. NLR was recorded before LVAD implantation and at intervals during LVAD support; pre-LVAD and 90-day LVAD NLRs were compared. Cox proportional hazard models were constructed to study the impact of NLR, both before LVAD implantation and at 90 days with LVAD, on mortality during subsequent LVAD support. Among 301 subjects, the median pre-LVAD NLR was 4.7 (interquartile range 3.0–8.0). Higher pre-LVAD NLR was independently associated with increased mortality during a median 324 days of LVAD support (adjusted hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01–1.06; P?=?.012, adjusted for pre-LVAD age, HF etiology, white blood count, hemoglobin, blood urea nitrogen, and sodium). After LVAD implantation, the NLR rose initially and then plateaued lower by day 90. Despite the mean decrease, higher 90-day LVAD NLR remained independently associated with increased mortality (adjusted HR 1.06, 95% CI 1.01–1.13; P?=?.033, stratified by early infection events).Conclusions:
Higher pre-LVAD NLR is independently associated with mortality during LVAD support. NLR improves during LVAD support, but even accounting for early infections, a higher NLR at day 90 remains associated with subsequent mortality. 相似文献13.
Quan M. Bui Oscar O. Braun Michela Brambatti Yan K. Gernhofer Holly Hernandez Victor Pretorius Eric Adler 《Heart & lung : the journal of critical care》2019,48(2):85-89
Background
The Stanford integrated psychosocial assessment for transplantation (SIPAT) is a validated psychosocial evaluation tool in the transplant population.Objective
We evaluated SIPAT in predicting post-left ventricular assist device (LVAD) outcomes, including cumulative re-admissions, driveline infections, pump malfunction, pump thrombosis, gastrointestinal bleeding, major bleeding, stroke and right ventricular failure.Methods
This retrospective study included 50 LVAD patients at an academic institution in the United States who had a pre-implant SIPAT score during the years 2015-2017. Patients were split into two groups based on SIPAT score, separating a “excellent”/“good” from a “minimally acceptable”/“poor” candidate. Poisson regression, using SIPAT as both a categorical and continuous variable, was used to compare the incidence rates of the primary outcome of cumulative re-admissions and secondary outcomes of LVAD complications.Results
The patient cohort was predominantly male 93.5% vs 89.4% (p = 0.629) with a median age of 67.0 vs 58.0 years (p = 0.037), planned destination therapy 48.4% vs 68.4% (p = 0.242) and median LVAD follow-up time of 241 vs 379 days (p = 0.10) in the low- and high- SIPAT groups, respectively. SIPAT was not a significant predictor for cumulative re-admissions, but there was an association between higher SIPAT scores and major bleeding.Conclusion
In this single-center retrospective study, SIPAT did not predict cumulative re-admissions. Further study is required to validate SIPAT before clinical implementation. 相似文献14.
Jonathan H Soslow Meng Xu James C. Slaughter Kimberly Crum Joshua D. Chew W. Bryan Burnette Yan Ru Su Kelsey Tomasek David A. Parra Larry W. Markham 《Journal of cardiac failure》2019,25(4):259-267
Background
Cardiomyopathy is the leading cause of death in Duchenne muscular dystrophy (DMD). Standard cardiac biomarkers are poor indicators of DMD cardiovascular disease. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) regulate collagen turnover. Given the cardiac fibrosis seen in DMD, we hypothesized that MMPs and TIMPs correlate with severity of DMD cardiomyopathy.Methods and Results
Prospectively enrolled DMD subjects (n?=?42) underwent cardiac magnetic resonance imaging for function and late gadolinium enhancement (LGE), including LGE severity from 0 (no LGE) to 4 (severe). Serum from DMD and healthy male control subjects (n?=?15) analyzed for MMPs 1, 2, 3, 7, 9, and 10 and TIMPs 1–4. MMP1, MMP7, and MMP10 were higher in DMD than in control (respectively, median 5080 pg/mL vs 2120 pg/mL [P?=?.007], 2170 pg/mL vs 1420 pg/mL [P < .001], and 216 pg/mL vs 140pg/mL [P?=?.040]); TIMP4 was lower in DMD (124 pg/mL vs 263 pg/mL; P?=?.046). Within DMD, MMP7 correlated inversely with left ventricular ejection fraction (r?=??0.40; P?=?.012) and directly with strain (r?=?0.54; P?=?.001) and LGE severity (r?=?0.47; P?=?.003). MMP7 was higher in DMD patients with LGE compared with those without LGE and control subjects (P < .001).Conclusions
Multiple MMPs are elevated in DMD compared with control subjects. MMP7 is related to DMD cardiac dysfunction and myocardial fibrosis, possibly through remodeling of the extracellular matrix. 相似文献15.
Edward R. McClellan Andrew Hover Mehana Moore Justin Spaleny Seema Singh Ludrena Rodriguez Michael B. Lustik Donald J. Gloeb 《American journal of infection control》2019,47(5):558-564
Background
Objective
Obstetric-related infections are a major cause of maternal morbidity and mortality worldwide. Our team implemented an evidence-based infection control bundle aimed at reducing obstetric-related infections at our facility.Methods
A multidisciplinary team at Tripler Army Medical Center developed, implemented, and evaluated an evidence-based maternal safety infection control bundle (MSICB) on labor and delivery aimed at reducing the incidence of surgical site infections (SSI) and chorioamnionitis. Adenosine triphosphate testing of patient care–related surfaces was performed while behavioral and environmental interventions were implemented. Incidence rates for chorioamnionitis, SSI, and endometritis were compared between pre- and during-MSICB implementation using Fisher exact test and Poisson regression, adjusting for year and quarter. The decision science analysts at US Army Medical Command, Fort Sam Houston, Texas responsible for our facility utilized diagnosis-related group and ICD-10 Procedure Coding to determine infection-related costs.Results
Prior to implementation of the MSICB, the rates of chorioamnionitis, SSI, and endometritis in the first half of 2016 were 6.3%, 3.4%, and 0.4%, respectively. After implementation of the MSICB, in the first 6 months of 2017, the rates of chorioamnionitis and SSI decreased to 1.7% and 1.0%, respectively, with no change in the rate of endometritis. The rate was significantly lower after implementation for chorioamnionitis (P < .001), and there was a statistically nonsignificant decrease for SSI (P?=?.060) and no difference for postpartum endometritis (P?=?1.00). These reductions resulted in an estimated net cost savings of $671,218.Conclusions
A multidisciplinary approach with evidence-based strategies resulted in a significant decrease (P < .001) in chorioamnionitis and a statistically nonsignificant decrease (P?=?.060) in the SSI rate, which resulted in a significant cost savings for the hospital. There was no change in our postpartum endometritis rate. 相似文献16.
Noelle V. Pavlovic Tania Randell Tim Madeira Steven Hsu Radoslav Zinoviev Martha Abshire 《Heart & lung : the journal of critical care》2019,48(2):90-104
Background
Left ventricular assist devices (LVADs) improve quality of life in end-stage heart failure but can cause serious complications such as infections with driveline infection causing significant morbidity and mortality.Objectives
The purpose of this systematic literature review is to synthesize the literature to determine variables associated with driveline infection and seek opportunities to improve nursing management of LVAD drivelines.Methods
A systematic literature review was performed. The evidence was synthesized using the Johns Hopkins Nursing Evidence-Based Practice tools and the Chain of Infection epidemiological framework.Results
Thirty-four studies focused on vulnerable host, portal of entry, and causative organism aspects of the Chain of Infection. Increased BMI, younger age, exposed driveline velour showed increased risk of infection and driveline dressing protocol change showed lower risk of infection.Conclusions
Although some risk factors for infection were identified, evidence is still limited. Nurses are uniquely positioned to improve driveline management, disrupting the chain of infection. 相似文献17.
Xiao-Wei Liu Hong-Feng Jin Chang-Qing Du Li-Jiang Tang 《The American journal of the medical sciences》2019,357(4):323-332
Background
This study assessed the effect of ibandronate (IBN), a farnesyl pyrophosphate synthase (FPPS) inhibitor, on vascular remodeling in diabetic rats.Methods
A rat model of diabetes was induced by a high-fat and high-sugar diet combined with a small dose of streptozotocin. The diabetic rats received 5 µg/kg of ibandronate solution or normal saline subcutaneously every morning for 16 weeks. The morphology of the thoracic aorta was assessed by hematoxylin and eosin and Masson's trichrome staining techniques. Gene expression levels of connective tissue growth factor (CTGF) and FPPS were assessed by quantitative real-time polymerase chain reaction (qRT-PCR) analysis. CTGF and FPPS protein levels were determined by Western blotting analysis.Results
Rats with diabetes mellitus showed moderate hyperglycemia, insulin resistance, hyperlipidemia and thoracic aortic fibrosis. FPPS was significantly upregulated in the thoracic aorta from diabetic animals. Interestingly, IBN treatment for 16 weeks alleviated the diabetes-induced histopathologic changes in the thoracic aortic wall and reduced CTGF protein and mRNA levels.Conclusions
These findings provided evidence that FPPS is involved in thoracic aortic fibrosis in diabetic rats. Meanwhile, IBN could alleviate vascular remodeling in diabetic animals. 相似文献18.
Daniel Modin Morten Sengeløv Peter Godsk Jørgensen Flemming Javier Olsen Niels Eske Bruun Thomas Fritz-Hansen Ditte Madsen Andersen Jan Skov Jensen Tor Biering-Sørensen 《Journal of cardiac failure》2019,25(2):87-96
Background
The prognostic value of LA functional measures in heart failure patients with reduced ejection fraction (HFrEF) is unclear. Therefore, this study investigated the prognostic value of left atrial (LA) functional measures such as the left atrial emptying fraction (LAEF) and the minimal LA volume compared with left atrial volume index (LAVI) in HFrEF patients.Methods and Results
A total of 818 HFrEF patients with left ventricular ejection fractions <45% underwent echocardiography. LA volumes were determined by the area-length method from the apical 2-chamber and apical 4-chamber views. LAEF, minimal LA volume indexed to body surface area (MinLAVI), and LAVI were calculated. The end point was all-cause mortality. During a median follow-up of 3.3 years (interquartile range 1.8–4.6 years), 121 patients died (14.8%). Follow-up was 100%. In a final multivariable model adjusting for clinical and echocardiographic parameters, LAEF, but not MinLAVI or LAVI, was an independent predictor of all-cause mortality in HFrEF patients: LAEF: hazard ratio (HR) 1.11 (P?=?.033) per 5% decrease; MinLAVI: HR 1.03 (P?=?.57) per 5 mL/m2 increase; LAVI: HR 1.06 (P?=?.16) per 5 mL/m2 increase.Conclusions
LAEF is an independent predictor of all-cause mortality in HFrEF patients after multivariable adjustment. LAEF provides incremental prognostic value over LAVI in risk stratification of HFrEF patients. 相似文献19.
Juan Jiang Chengping Hu Yuanyuan Li Pinhua Pan Xiaoli Su Pengbo Deng Junpu Wang Xiaoying Wu 《The American journal of the medical sciences》2019,357(4):289-295
Background
Severe pneumonia is responsible for great mortality and morbidity worldwide, and early-applied effective anti-infective therapy can improve the prognosis of patients. However, identification of infectious agents in severe pneumonia remains a major challenge so far. In this study, the potential utility of transmission electron microscopy (TEM) in detecting nonbacterial pathogens in patients with severe pneumonia was retrospectively evaluated.Materials and Methods
A total of 106 patients diagnosed with severe pneumonia at our hospital from September 2015 to December 2017 were included, and their baseline clinical characteristics were collected. Nonbacterial infectious agents detected by TEM in bronchoalveolar lavage fluid (BALF) and serological tests were summarized. The detection rates were further compared between TEM and serological tests.Results
BALF examination under the transmission electron microscope revealed 24 viruses, 16 mycoplasmas, 18 chlamydia, 2 fungi and 74 bacteria in 99 samples, among which 61 samples were mixed infections. The combined use of serological tests and TEM significantly improved the detection rate of nonbacterial infectious agents in patients with severe pneumonia.Conclusions
Our data support that implementation of TEM could improve the sensitivity for detecting viruses, atypical pathogens and mixed infections in BALF from patient of severe pneumonia. Therefore, TEM may be used as an auxiliary diagnostic method of other microbiological tests in severe pneumonia. 相似文献20.
Vaughn A. Eyvazian Jonathan S. Gordin Eric H. Yang Olcay Aksoy Henry M. Honda Ronald W. Busuttil Vatche G. Agopian Gabriel Vorobiof 《Journal of cardiac failure》2019,25(3):166-172