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2007486 Clinical features of multiple myeloma pa-tients with extramedullary disease: a report of 40 ca-ses from a single center.CHEN Haifei(陈海飞), etal. Dept Hematol, Changzheng Hosp, 2nd Milit MedUniv, Shanghai 200003. Chin J Hematol 2007;28(10):655 -658. Objective To analyze the clinical and laboratory fea-tures and risk factors of multiple myeloma(MM) with ex-tramedullary disease (EM) and its extraosseous localiza-tions at diagnosis and during the course of MM.Meth-ods The clinic… 相似文献
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2005260 Cytomegalovirus infection of myeloma cell line KM3 and its effect on IL-6 mRNA expression in the cells. WEI Guo-qing(魏国庆),et al. Dept Hema-tol, The Affili Hosp, Coll Sci, Zhejiang Univ, Hangzhou 310003. Chin J Hematol 2004;25(10) 596-599. Objectve:To investigate the infection of myeloma cell line KM3 by cytomegalovirus (CMV) as well as its effect on IL-6 mRNA in the cells. Methods: RT-PCR assay was used to detect the mRNA expression 相似文献
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Johnny Chahine Amer N. Kadri Rama D. Gajulapalli Amar Krishnaswamy Stephanie Mick Oscar Perez Hassan Lak Raunak M. Nair Bryce Montane James Tak E. Murat Tuzcu Brian Griffin Lars G. Svensson Serge C. Harb Samir R. Kapadia 《JACC: Cardiovascular Interventions》2019,12(22):2299-2306
ObjectivesThe aim of this study was to compare outcomes after transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS) (i.e., no or trivial associated aortic regurgitation [AR]) with those in patients with AS and mild or more severe AR (i.e., mixed aortic valve disease [MAVD]).BackgroundTAVR is indicated in treating patients with severe AS. Limited data exist regarding the outcomes of TAVR in patients with MAVD.MethodsA total of 1,133 patients who underwent TAVR between January 2014 and December 2017 were included. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests, while Kaplan-Meier analyses were used to compare survival.ResultsA total of 688 patients (61%) had MAVD (median age 83 years , 43% women). Among these, 17% developed mild, 2% moderate, and <1% severe post-TAVR AR. Overall, patients with MAVD had better survival compared with patients with pure AS (p = 0.03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (p = 0.04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (p = 0.11).ConclusionsPatients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR. 相似文献
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Esther Toes-Zoutendijk Monique E. van Leerdam Evelien Dekker Frank van Hees Corine Penning Iris Nagtegaal Miriam P. van der Meulen Anneke J. van Vuuren Ernst J. Kuipers Johannes M.G. Bonfrer Katharina Biermann Maarten G.J. Thomeer Harriët van Veldhuizen Sonja Kroep Marjolein van Ballegooijen Gerrit A. Meijer Harry J. de Koning Manon C.W. Spaander M.A. Blankenstein 《Gastroenterology》2017,152(4):767-775.e2
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Edward Buratto William Y. Shi Rochelle Wynne Chin L. Poh Marco Larobina Michael O’Keefe John Goldblatt James Tatoulis Peter D. Skillington 《Journal of the American College of Cardiology》2018,71(12):1337-1344
Background
It is unclear whether the Ross procedure offers superior survival compared with mechanical aortic valve replacement (AVR).Objectives
This study evaluated experience and compared long-term survival between the Ross procedure and mechanical AVR.Methods
Between 1992 and 2016, a total of 392 Ross procedures were performed. These were compared with 1,928 isolated mechanical AVRs performed during the same time period as identified using the University of Melbourne and Australia and New Zealand Society of Cardiac and Thoracic Surgeons’ Cardiac Surgery Databases. Only patients between 18 and 65 years of age were included. Propensity-score matching was performed for risk adjustment.Results
Ross procedure patients were younger, and had fewer cardiovascular risk factors. The Ross procedure was associated with longer cardiopulmonary bypass and aortic cross-clamp times. Thirty-day mortality was similar (Ross, 0.3%; mechanical, 0.8%; p = 0.5). Ross procedure patients experienced superior unadjusted long-term survival at 20 years (Ross, 95%; mechanical, 68%; p < 0.001). Multivariable analysis showed the Ross procedure to be associated with a reduced risk of late mortality (hazard ratio: 0.34; 95% confidence internal: 0.17 to 0.67; p < 0.001). Among 275 propensity-score matched pairs, Ross procedure patients had superior survival at 20 years (Ross, 94%; mechanical, 84%; p = 0.018).Conclusions
In this Australian, propensity-score matched study, the Ross procedure was associated with better long-term survival compared with mechanical AVR. In younger patients, with a long life expectancy, the Ross procedure should be considered in centers with sufficient expertise. 相似文献12.
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Sean M. Davidson Péter Ferdinandy Ioanna Andreadou Hans Erik Bøtker Gerd Heusch Borja Ibáñez Michel Ovize Rainer Schulz Derek M. Yellon Derek J. Hausenloy David Garcia-Dorado 《Journal of the American College of Cardiology》2019,73(1):89-99
Many treatments have been identified that confer robust cardioprotection in experimental animal models of acute ischemia and reperfusion injury. However, translation of these cardioprotective therapies into the clinical setting of acute myocardial infarction (AMI) for patient benefit has been disappointing. One important reason might be that AMI is multifactorial, causing cardiomyocyte death via multiple mechanisms, as well as affecting other cell types, including platelets, fibroblasts, endothelial and smooth muscle cells, and immune cells. Many cardioprotective strategies act through common end-effectors and may be suboptimal in patients with comorbidities. In this regard, emerging data suggest that optimal cardioprotection may require the combination of additive or synergistic multitarget therapies. This review will present an overview of the state of cardioprotection today and provide a roadmap for how we might progress towards successful clinical use of cardioprotective therapies following AMI, focusing on the rational combination of judiciously selected, multitarget therapies. This paper emerged as part of the discussions of the European Union (EU)-CARDIOPROTECTION Cooperation in Science and Technology (COST) Action, CA16225. 相似文献
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Pamela E. Scott Ellis F. Unger Marjorie R. Jenkins Mary Ross Southworth Tzu-Yun McDowell Ruth J. Geller Merina Elahi Robert J. Temple Janet Woodcock 《Journal of the American College of Cardiology》2018,71(18):1960-1969
Background
Concerns exist that women are underrepresented in trials of cardiovascular medications.Objectives
The authors sought to examine women’s participation and the reported safety and efficacy by gender for pivotal cardiovascular disease (CVD) trials submitted to the U.S. Food and Drug Administration (FDA) supporting marketing applications.Methods
On the basis of publicly available FDA reviews, the authors assessed enrollment of women in trials supporting 36 drug approvals from 2005 to 2015. Prevalence-corrected estimates for the participation of women were calculated as the percentage of women among trial participants divided by the percentage of women in the disease population (participation to prevalence ratio [PPR]), with a range between 0.8 and 1.2 reflecting similar representation of women in the trial and disease population. Sex differences in efficacy and safety were assessed.Results
The proportion of women enrolled ranged from 22% to 81% (mean 46%). The calculated PPR by disease area was within or above the desirable range for atrial fibrillation (0.8 to 1.1), hypertension (0.9), and pulmonary arterial hypertension (1.4); PPR was <0.8 for heart failure (0.5 to 0.6), coronary artery disease (0.6), and acute coronary syndrome/myocardial infarction (0.6). The authors found little indication of clinically meaningful gender differences in efficacy or safety. Gender differences in efficacy or safety were described in labeling for 4 drugs.Conclusions
Women were well represented in trials of drugs for hypertension and atrial fibrillation, and overrepresented for pulmonary arterial hypertension. Representation of women fell below a PPR of 0.8 for trials in heart failure, coronary artery disease, and acute coronary syndrome. Minimal gender differences in drug efficacy and safety profiles were observed. 相似文献15.
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Guillain-Barré syndrome is a rare complication in the setting of hematopoietic stem cell transplantation. We report three children with T cell lymphoma/leukemia in whom this syndrome developed soon after they received unrelated donor transplants. The rapid onset of symptoms raises the concern that the bone marrow transplant conditioning regimen (ie, total body irradiation, cyclophosphamide and cytosine arabinoside) might have precipitated the clinical syndrome of ascending polyneuropathy. Although central nervous system toxicity has been well described with high-dose cytosine arabinoside therapy, peripheral neuropathy of the Guillain-Barré type has been reported only infrequently. We review possible factors contributing to the development of this syndrome in these three patients. 相似文献
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Iosif Xenogiannis Peter Tajti Allison B. Hall Khaldoon Alaswad Stéphane Rinfret William Nicholson Dimitri Karmpaliotis Kambis Mashayekhi Sergey Furkalo João L. Cavalcante M. Nicholas Burke Emmanouil S. Brilakis 《JACC: Cardiovascular Interventions》2019,12(17):1635-1649
Patients who undergo coronary bypass graft surgery often require subsequent cardiac catheterization and repeat coronary revascularization. Saphenous vein graft lesions have high rates for distal embolization that can be reduced with use of embolic protection devices. They also have high restenosis rates, which are similar with drug-eluting and bare-metal stents. Percutaneous coronary interventions of native coronary arteries is generally preferred over saphenous vein graft interventions, but can often be complex, requiring expertise and specialized equipment. Prolonged dual-antiplatelet therapy and close monitoring can help optimize subsequent clinical outcomes. 相似文献
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Stephen G. Ellis Tommaso Gori Patrick W. Serruys Holger Nef Giuseppe Steffenino Salvatore Brugaletta Thomas Munzel Cordula Feliz Götz Schmidt Manel Sabaté Yoshinobu Onuma R.J. van Geuns Run-Lin Gao Maurizio Menichelli Dean J. Kereiakes Gregg W. Stone Luca Testa Takeshi Kimura Alexandre Abizaid 《JACC: Cardiovascular Interventions》2018,11(7):638-644
Objectives
The aim of this study was to identify independent correlates of very late scaffold thrombosis (VLST) from an analysis of consecutively treated patients from 15 multicenter studies.Background
Recent analyses suggest an increased risk for VLST with the Absorb Bioresorbable Vascular Scaffold compared with drug-eluting stents, but insights as to correlates of risk are limited.Methods
A total of 55 patients were identified with scaffold thrombosis. They were matched 2:1 with control subjects selected randomly from patients without thrombosis from the same study. Quantitative coronary angiography was available for 96.4% of patients. Multiple logistic and Cox regression analysis were used to identify significant independent outcome correlates from 6 pre-specified characteristics.Results
Patients had scaffold thrombosis at a median of 20 months (interquartile range: 17 to 27 months). Control subjects were followed for 36 months (interquartile range: 24 to 38 months). For the combined groups, reference vessel diameter (RVD) was 2.84 ± 0.50 mm, scaffold length was 26 ± 16 mm, and post-dilatation was performed in 56%. Univariate correlates of thrombosis were smaller nominal scaffold/RVD ratio (linear p = 0.001; ratio <1.18:1; odds ratio: 7.5; p = 0.002) and larger RVD (linear p = 0.001; >2.72 mm; odds ratio: 3.4; p = 0.001). Post-dilatation at ≥16 atm, post-dilatation balloon/scaffold ratio, final percentage stenosis, and dual antiplatelet therapy were not correlated with VLST. Only scaffold/RVD ratio remained a significant independent correlate of VLST (p = 0.001), as smaller ratio was correlated with RVD (p < 0.001). Post hoc analysis of 8 other potential covariates revealed no other correlates of outcome.Conclusions
In the present analysis, the largest to date of its type, relative scaffold undersizing was the strongest determinant of VLST. Given current understanding of “scaffold dismantling,” this finding likely has ramifications for all bioresorbable scaffolds. 相似文献19.
Wieneke Vlastra Jaya Chandrasekhar Jeroen Vendrik Enrique Gutierrez-Ibanes Didier Tchétché Fabio S. de Brito Marco Barbanti Ran Kornowski Azeem Latib Augusto D’Onofrio Flavio Ribichini Jan Baan Jan G.P. Tijssen Manuel Pan Nicolas Dumonteil José A. Mangione Samantha Sartori Paola D’Errigo Ronak Delewi 《JACC: Cardiovascular Interventions》2019,12(10):911-920
ObjectivesThis study aimed to compare differences in patient characteristics and clinical outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) versus patients younger than 90 years of age and to test the predictive accuracy of the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), the EuroSCORE II, and the STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) for mortality after TAVR in nonagenarians.BackgroundThe prevalence of severe aortic valve stenosis is increasing due to the rising life expectancy. However, there are limited data evaluating outcomes in patients older than 90 years of age. Moreover, the predictive accuracy of risk scores for mortality has not been evaluated in nonagenarian patients undergoing transfemoral TAVR.MethodsThe CENTER (Cerebrovascular EveNts in Patients Undergoing TranscathetER Aortic Valve Implantation) collaboration (N = 12,381) is an international collaboration consisting of 3 national registries, 6 local or multicenter registries, and 1 prospective clinical study, selected through a systematic online search. The primary endpoint of this study was the difference in 30-day all-cause mortality and stroke after TAVR in nonagenarians versus patients younger than 90 years of age. Secondary endpoints included differences in baseline characteristics, in-hospital outcomes, and the differences in predictive accuracy of the logistic EuroSCORE, the EuroSCORE II, and STS-PROM.ResultsA total of 882 nonagenarians and 11,499 patients younger than 90 years of age undergoing transfemoral TAVR between 2007 and 2018 were included. Nonagenarians had considerably fewer comorbidities than their counterparts. Nevertheless, rates of 30-day mortality (9.9% vs. 5.4%; relative risk [RR]: 1.8; 95% confidence interval [CI]: 1.4 to 2.3; p = 0.001), in-hospital stroke (3.0% vs. 1.9%; RR: 1.5; 95% CI: 1.0 to 2.3; p = 0.04), major or life-threatening bleeding (8.1% vs. 5.5%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.004), and new-onset atrial fibrillation (7.9% vs. 5.2%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.01) were higher in nonagenarians. The STS-PROM adequately estimated mortality in nonagenarians, with an observed-expected mortality ratio of 1.0.ConclusionsIn this large, global, patient-level analysis, mortality after transfemoral TAVR was 2-fold higher in nonagenarians compared with patients younger than 90 years of age, despite the lower prevalence of baseline comorbidities. Moreover, nonagenarians had a higher risk of in-hospital stroke, major or life-threatening bleeding, and new-onset atrial fibrillation. The STS-PROM was the only surgical risk score that accurately predicted the risk of mortality in nonagenarians. 相似文献
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Antonios Douros Laurent Azoulay Hui Yin Samy Suissa Christel Renoux 《Journal of the American College of Cardiology》2018,71(10):1105-1113