1,801 research outputs found
Cementless Total Hip Arthroplasty with Medial Wall Osteotomy for the Sequelae of Septic Arthritis of the Hip
Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)
Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes.
Methods Data were analyzed from the βRecurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillationβ (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0β2 favorable outcome, 3β6 unfavorable outcome).
Results: Of the 1029 patients enrolled, 561 were women (54.5%) (pβ<β0.001) and younger (pβ<β0.001) compared to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke (pβ=β0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, pβ=β0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4βΒ±β11.7 days for men versus 6.5βΒ±β12.4 days for women, pβ=β0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2βΒ±β6.9 versus 8.1βΒ±β7.5, pβ<β0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men (pβ=β0.28 and pβ=β0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men (pβ<β0.001). Multivariate analysis did not confirm this significance.
Conclusions: Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes
Comparison of Transaxial Source Images and 3-Plane, Thin-Slab Maximal Intensity Projection Images for the Diagnosis of Coronary Artery Stenosis with Using ECG-Gated Cardiac CT
Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study
Background and PurposesβThis study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.
MethodsβThe derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00β1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08β2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (β€1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30β1.00). We assigned to age β₯80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632β0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493β0.678; P=0.10) for major bleedings.
ResultsβThe validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529β0.763; P=0.009) for ischemic outcome events and 0.407 (0.275β0.540; P=0.14) for hemorrhagic outcome events.
ConclusionsβIn acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings
C-reactive protein in degenerative aortic valve stenosis
Degenerative aortic valve stenosis includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar to atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum C-reactive protein, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression
Aortic stiffness as a marker of cardiac function and myocardial strain in patients undergoing aortic valve replacement
Background: Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the
stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic
stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative
myocardial strain in aortic valve replacement (AVR).
Methods: Patients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for
inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was
analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type
natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB).
NYHA class, leg edema, and LV function were recorded at follow-up (409 Β± 159 days).
Results: Fifty-six patients (16 females) with a mean age of 71 Β± 8.4 years were included, with 50 (89%) patients
completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both
pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of
NYHA class pre- and post-operatively (OR 8.3, 95%CI [2.27,33.33] and OR 14.44, 95%CI [1.49,139.31] respectively). No
significant relationship was observed between PWV and either LV function or plasma BNP.
Conclusion: In patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative
NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a
non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain
such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in
order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further
validation is required in the form of larger prospective studies specifically designed to assess the relationship between
PWV and these functional clinical outcomes
RNAcontext: A New Method for Learning the Sequence and Structure Binding Preferences of RNA-Binding Proteins
Metazoan genomes encode hundreds of RNA-binding proteins (RBPs). These proteins regulate post-transcriptional gene expression and have critical roles in numerous cellular processes including mRNA splicing, export, stability and translation. Despite their ubiquity and importance, the binding preferences for most RBPs are not well characterized. In vitro and in vivo studies, using affinity selection-based approaches, have successfully identified RNA sequence associated with specific RBPs; however, it is difficult to infer RBP sequence and structural preferences without specifically designed motif finding methods. In this study, we introduce a new motif-finding method, RNAcontext, designed to elucidate RBP-specific sequence and structural preferences with greater accuracy than existing approaches. We evaluated RNAcontext on recently published in vitro and in vivo RNA affinity selected data and demonstrate that RNAcontext identifies known binding preferences for several control proteins including HuR, PTB, and Vts1p and predicts new RNA structure preferences for SF2/ASF, RBM4, FUSIP1 and SLM2. The predicted preferences for SF2/ASF are consistent with its recently reported in vivo binding sites. RNAcontext is an accurate and efficient motif finding method ideally suited for using large-scale RNA-binding affinity datasets to determine the relative binding preferences of RBPs for a wide range of RNA sequences and structures
Tlr2 deficiency does not limit the development of left ventricular hypertrophy in a model of transverse aortic constriction induced pressure overload
Natriuretic Peptides and Assessment of Cardiovascular Disease Risk in Asymptomatic Persons
Current tools for cardiovascular disease (CVD) risk assessment in asymptomatic individuals are imperfect. Preventive measures aimed only at individuals deemed high risk by current algorithms neglect large numbers of low-risk and intermediate-risk individuals who are destined to develop CVD and who would benefit from early and aggressive treatment. Natriuretic peptides have the potential both to identify individuals at risk for future cardiovascular events and to help detect subclinical CVD. Choosing the appropriate subpopulation to target for natriuretic peptide testing will help maximize the performance and the cost effectiveness. The combined use of multiple risk markers, including biomarkers, genetic testing, and imaging or other noninvasive measures of risk, offers promise for further refining risk assessment algorithms. Recent studies have highlighted the utility of natriuretic peptides for preoperative risk stratification; however, cost effectiveness and outcomes studies are needed to affirm this and other uses of natriuretic peptides for cardiovascular risk assessment in asymptomatic individuals
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