Acute coronary syndrome in the older adults

Coronary heart disease remains the leading cause of death in the developed world. Advanced age is the single strongest risk factor for coronary artery disease (CAD) and independent predictor for poor outcomes following an acute coronary syndrome (ACS). ACS refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction due to various degrees of reduction in coronary blood flow as a result of plaque rupture/erosion and thrombosis formation or supply and demand mismatch. Unstable angina and non-ST segment elevation myocardial infarction are often continuous and clinically indistinguishable, collectively referred as non-ST elevation ACS (NSTE-ACS). An abrupt total occlusion of a coronary artery causing transmural myocardial ischemia/necrosis and displaying ST segment elevation or new left bundle branch block on a12-lead ECG leads to the diagnosis of ST segment elevation myocardial infarction (STEMI). NSTE-ACS and STEMI require acute cardiac care. Professional societies have established guidelines for high quality contemporary care for ACS patients, i.e., American Heart Association/American College of Cardiology guidelines for STEMI and NSTE-ACS, European Society of Cardiology guidelines for STEMI and NSTE-ACS, and the United Kingdom National Institute for Health and Care Excellence guidelines for STEMI and NSTE-ACS.[1]–[6] Implementation of evidence-based therapies has significantly decreased mortality and morbidities of ACS.[3],[7],[8] However, these advancements in ACS management have not equally improved outcomes for older adults. Vulnerable older patients continue to be at high risk of poor outcomes, are less likely to receive evidence based care, and have high mortality rates regardless of treatments given.[9],[10] These disparities and challenges in caring for ACS in older adults are well recognized.[11]–[13] This review summarizes the increasing burden and persistent unfavorable outcome of ACS in older adults, and discusses the clinical presentation, diagnosis and strategies for medical and invasive therapy

Endothelial Nitric Oxide Synthase Deficiency Causes Collateral Vessel Rarefaction and Impairs Activation of a Cell Cycle Gene Network During Arteriogenesis

The collateral circulation is tissue- and life-saving in obstructive arterial disease. Disappointing outcomes in clinical trials aimed at augmenting collateral growth highlight the need for greater understanding of collateral biology

Stable ischemic heart disease in the older adults

Ischemic heart disease is caused by atherosclerotic and/or thrombotic obstruction of coronary arteries. Clinical spectrum of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syndromes (ACS) including unstable angina, acute myocardial infarction (non-ST elevation myocardial infarction and ST elevation myocardial infarction). Stable ischemic heart disease (SIHD) refers to patients with known or suspected SIHD who have no recent or acute changes in their symptomatic status, suggesting no active thrombotic process is underway. These patients include those with (1) recent-onset or stable angina or ischemic equivalent symptoms, such as dyspnea or arm pain with exertion; (2) post-ACS stabilized after revascularization or medical therapy; and (3) asymptomatic SIHD diagnosed by abnormal stress tests or imaging studies. This review summarizes clinical features and management of SIHD in the older adult. ACS in older adults is not considered in this review

Named Entity Recognition Using BERT BiLSTM CRF for Chinese Electronic Health Records

As the generation and accumulation of massive electronic health records (EHR), how to effectively extract the valuable medical information from EHR has been a popular research topic. During the medical information extraction, named entity recognition (NER) is an essential natural language processing (NLP) task. This paper presents our efforts using neural network approaches for this task. Based on the Chinese EHR offered by CCKS 2019 and the Second Affiliated Hospital of Soochow University (SAHSU), several neural models for NER, including BiLSTM, have been compared, along with two pre-trained language models, word2vec and BERT. We have found that the BERT-BiLSTM-CRF model can achieve approximately 75% F1 score, which outperformed all other models during the tests

Automatic Generation of Electronic Medical Record Based on GPT2 Model

Writing Electronic Medical Records (EMR) as one of daily major tasks of doctors, consumes a lot of time and effort from doctors. This paper reports our efforts to generate electronic medical records using the language model. Through the training of massive real-world EMR data, the CMedGPT2 model provided by us can achieve the ideal Chinese electronic medical record generation. The experimental results prove that the generated electronic medical record text can be applied to the auxiliary medical record work to reduce the burden on the compose and provide a fast and accurate reference for composing work

An Word2vec based on Chinese Medical Knowledge

Introducing a large amount of external prior domain knowledge will effectively improve the performance of the word embedded language model in downstream NLP tasks. Based on this assumption, we collect and collate a medical corpus data with about 36M (Million) characters and use the data of CCKS2019 as the test set to carry out multiple classifications and named entity recognition (NER) tasks with the generated word and character vectors. Compared with the results of BERT, our models obtained the ideal performance and efficiency results

Disease Diagnosis Prediction of EMR Based on BiGRL-Att-CapsNetwork Model

Electronic Medical Records (EMR) carry a large number of diseases characteristics, history and other specific details of patients, which has great value for medical diagnosis. These data with diagnostic labels can help automated diagnostic assistant to predict disease diagnosis and provide a rapid diagnostic reference for doctors. In this study, we designed a BiGRU-Att-CapsNetwork model based on our proposed CMedBERT Chinese medical domain pre-trained language model to predict disease diagnosis in Chinese EMR. In the wide-ranging comparative experiments involving a real EMR dataset (SAHSU) and an academic evaluation task dataset (CCKS 2019), our model obtained competitive performance

A Joint Model of Clinical Domain Classification and Slot Filling Based on RCNN and BiGRU-CRF

The task of the Intent Classification & Slot Filling serves as a key joint task in the voice assistant, which also plays the role of the pre-work in the construction of the medical consultation assistant system. How to distribute a doctor-patient conversation into a formatted electronic medical record to an accurate department (Intent Classification) to extract the key named entities or mentions (Slot Filling) through a specialized domain knowledge recognizer is one of the key steps of the entire system. In real cases, the medical vocabulary and clinical entities in different departments of the hospital often differ to some extent. Therefore, we propose a comprehensive model based on CMed-BERT, RCNN and BiGRU-CRF for a joint task of department identification and slot filling of the specific domain. Experimental results confirmed the competitiveness of our model

The Significance of the Bifunctional Kinase/Phosphatase Activities of Diphosphoinositol Pentakisphosphate Kinases (PPIP5Ks) for Coupling Inositol Pyrophosphate Cell Signaling to Cellular Phosphate Homeostasis

Proteins responsible for Pi homeostasis are critical for all life. In Saccharomyces cerevisiae, extracellular [Pi] is “sensed” by the inositol-hexakisphosphate kinase (IP6K) that synthesizes the intracellular inositol pyrophosphate 5-diphosphoinositol 1,2,3,4,6-pentakisphosphate (5-InsP7) as follows: during a period of Pi starvation, there is a decline in cellular [ATP]; the unusually low affinity of IP6Ks for ATP compels 5-InsP7 levels to fall in parallel (Azevedo, C., and Saiardi, A. (2017) Trends. Biochem. Sci. 42, 219–231. Hitherto, such Pi sensing has not been documented in metazoans. Here, using a human intestinal epithelial cell line (HCT116), we show that levels of both 5-InsP7 and ATP decrease upon [Pi] starvation and subsequently recover during Pi replenishment. However, a separate inositol pyrophosphate, 1,5-bisdiphosphoinositol 2,3,4,6-tetrakisphosphate (InsP8), reacts more dramatically (i.e. with a wider dynamic range and greater sensitivity). To understand this novel InsP8 response, we characterized kinetic properties of the bifunctional 5-InsP7 kinase/InsP8 phosphatase activities of full-length diphosphoinositol pentakisphosphate kinases (PPIP5Ks). These data fulfil previously published criteria for any bifunctional kinase/phosphatase to exhibit concentration robustness, permitting levels of the kinase product (InsP8 in this case) to fluctuate independently of varying precursor (i.e. 5-InsP7) pool size. Moreover, we report that InsP8 phosphatase activities of PPIP5Ks are strongly inhibited by Pi (40–90% within the 0–1 mm range). For PPIP5K2, Pi sensing by InsP8 is amplified by a 2-fold activation of 5-InsP7 kinase activity by Pi within the 0–5 mm range. Overall, our data reveal mechanisms that can contribute to specificity in inositol pyrophosphate signaling, regulating InsP8 turnover independently of 5-InsP7, in response to fluctuations in extracellular supply of a key nutrient

Intravascular forward-looking ultrasound transducers for microbubble-mediated sonothrombolysis

Effective removal or dissolution of large blood clots remains a challenge in clinical treatment of acute thrombo-occlusive diseases. Here we report the development of an intravascular microbubble-mediated sonothrombolysis device for improving thrombolytic rate and thus minimizing the required dose of thrombolytic drugs. We hypothesize that a sub-megahertz, forward-looking ultrasound transducer with an integrated microbubble injection tube is more advantageous for efficient thrombolysis by enhancing cavitation-induced microstreaming than the conventional high-frequency, side-looking, catheter-mounted transducers. We developed custom miniaturized transducers and demonstrated that these transducers are able to generate sufficient pressure to induce cavitation of lipid-shelled microbubble contrast agents. Our technology demonstrates a thrombolysis rate of 0.7 ± 0.15 percent mass loss/min in vitro without any use of thrombolytic drugs