2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

Acute stress in parents of patients admitted to the pediatric intensive care unit: A two-center cross-sectional observational study

Objective: To examine medical and psychosocial risk factors associated with the development of acute stress in parents of patients unexpectedly admitted to the PICU.Design: Cross-sectional observational study.Setting: Two tertiary care children\u27s hospitals with mixed medical/surgical/cardiac PICU.Patients: Parents of patients unexpectedly admitted to the PICU.Intervention: None.Measurements and main results: 265 parents of 188 children were enrolled of whom 49 parents (18%) met ASD qualification and 108 (41%) parents developed ASD symptoms as determined by the ASDS-5 scale. Risk factors making parents likely to meet ASD qualification include parents from area served by Penn State (p \u3c 0.001), prior psychiatric illness (p \u3c 0.01), and female gender (p \u3c 0.05), while graduating college was protective (p \u3c 0.05). In the multivariate analysis, parents from area served by Penn State (OR 3.00 (1.49-6.05) p \u3c 0.01) and parents with prior psychiatric illness (OR 2.16 (1.03-4.52) p \u3c 0.05) were associated with ASD qualification. Parents who graduated college or had prior medical problems were not significant.Risk factors making parents more likely to develop ASD symptoms (significant symptoms that do not meet ASD qualification) include patients with higher PRISM-III scores (p \u3c 0.01), patients receiving cardiovascular support (p \u3c 0.05), parents with a history of prior physical/sexual abuse (p \u3c 0.01), parental involvement in the past with a major disaster/accident (p \u3c 0.01), a family member admitted to an ICU in the past (p \u3c 0.05) and preexisting parental psychiatric/medical disorders (p \u3c 0.001). In a multivariate analysis, prior parental psychiatric disorder (OR 4.11 (1.80-6.42) p \u3c 0.001), history of parental abuse (OR 3.11 (1.14-5.08) p \u3c 0.05), and parental prior medical problem (OR 2.03 (1.01-3.05) p \u3c 0.05) were associated with the development of ASD symptoms. However, PRISM-III score and prior involvement in major disaster were not significant.Conclusions: A combination of psychosocial parental risk factors and patient factors were associated with acute stress in parents. Further studies evaluating targeted hospital interventions towards parents most at-risk are needed

MicroRNA as Potential Biomarkers of Platelet Function on Antiplatelet Therapy: A Review

MicroRNAs (miRNAs) are small, non-coding RNAs, able to regulate cellular functions by specific gene modifications. Platelets are the major source for circulating miRNAs, with significant regulatory potential on cardiovascular pathophysiology. MiRNAs have been shown to modify the expression of platelet proteins influencing platelet reactivity. Circulating miRNAs can be determined from plasma, serum, or whole blood, and they can be used as diagnostic and prognostic biomarkers of platelet reactivity during antiplatelet therapy as well as novel therapeutic targets in cardiovascular diseases (CVDs). Herein, we review diagnostic and prognostic value of miRNAs levels related to platelet reactivity based on human studies, presenting its interindividual variability as well as the substantial role of genetics. Furthermore, we discuss antiplatelet treatment in the context of miRNAs alterations related to pathways associated with drug response

The role of miRNAs in regulation of platelet activity and related diseases - a bioinformatic analysis

MicroRNAs (miRNAs) are small, non-coding RNAs, able to regulate cellular functions by induction of mRNA degradation and post-transcriptional repression of gene expression. Platelets are the major source of circulating miRNAs, with significant regulatory potential on cardiovascular pathophysiology and other diseases. MiRNAs have been shown to modify the expression of platelet proteins, which influence the platelets reactivity. Circulating miRNAs can be determined from plasma, serum, or whole blood, and they can be used as diagnostic and prognostic biomarkers as well as therapeutic targets including cardiovascular diseases (CVDs). Herein, we present original results from bioinformatic analyses, which identified top 22 platelet-related miRNAs including hsa-miR-320a, hsa-miR-16-5p, hsa-miR-106a-5p, hsa-miR-320b, hsa-miR-15a-5p, hsa-miR-15b-5p, hsa-miR-195-5p, hsa-miR-92a-3p as widely involved in platelet reactivity and associated diseases, including CVDs, Alzheimer’s and cerebrovascular diseases, cancer and hypertension. Analysis focused on the identification of the highly regulatory targets shared between those miRNAs identified 43 of them. Best ranked genes associated with overall platelet activity and most susceptible for noncoding regulation were PTEN, PIK3R1, CREB1, APP, and MAPK1. Top targets also strongly associated with CVDs were VEGFA, IGF1, ESR1, BDNF, and PPARG. Top targets associated with other platelet-related diseases including cancer identified in our study were TP53, KRAS, and CCND1. The most affected pathways by top miRNAs and top targets included diseases of signal transduction by Growth Factor Receptors (GDFRs) and second messengers, platelet activation, signaling, and aggregation, signaling by VEGF, MAPK family signaling cascades, and signaling by Interleukins. Terms specific only for platelet-related miRNAs included coronary artery disease, platelet degranulation, and neutrophil degranulation, while for the top platelet-related genes it was Estrogen Signaling Receptor (ESR) mediated signaling, extra-nuclear estrogen signaling, and endometriosis. Our results show the novel features of platelet physiology and may provide a basis for further clinical studies focused on platelet reactivity. They also show in which aspects miRNAs can be promising biomarkers of platelet-related pathological processes

Pediatric critical care–associated parental traumatic stress: Beyond the first year*

Objectives: Perform a longitudinal analysis of parental traumatic stress up to 30 months after PICU discharge. Design: Prospective observational cohort study. Setting: Two tertiary care children\u27s hospitals with mixed medical/surgical/cardiac PICUs. Subjects: Parents of patients unexpectedly admitted to the PICU. Interventions: None. Measurements and main results: Two hundred sixty-five parents of 188 children were enrolled. Of the 195 parents who completed the 3-9-month assessments, 29 (14.8%) met posttraumatic stress disorder (PTSD) qualification on the PTSD Symptom Scale Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Multivariable analysis showed parents who met acute stress disorder (ASD) qualification (odds ratio [OR] 8.01; 95% CI 2.64-24.3), parents of children with Pediatric Overall Performance Category score of severe or coma at discharge (OR 5.21; 95% CI 1.65-16.4), parents who had concerns for their child\u27s permanent injury (OR 1.82; 95% CI 1.36-2.43), and parents who reported increased knowledge of child illness during admission (OR 1.82; 95% CI 1.13-2.93) had increased odds of developing parental PTSD. Of the 175 parents (66%) who completed the 18-30-month assessments, 22 (12.5%) met PTSD qualification. Multivariable analysis showed parents who met ASD qualification (OR 4.19; 95% CI 1.12-15.7), parents who had a history of a family member or themselves being admitted to ICU (OR 6.51; 95% CI 1.43-29.6), and parents who had concerns of child\u27s susceptibility to death post discharge (OR 1.58; 95% CI 1.19-2.09) had increased odds of developing parental PTSD. At 18-30 months post discharge, parents who met the PTSD qualification were more likely to report a decrease in household income following discharge (OR 9.23; 95% CI 1.71-49.9

Diálogo Regional de Política de América Latina y el Caribe: Retos y oportunidades en adaptación al cambio climático en materia de agua: Elementos para una agenda regional

El presente documento representa un esfuerzo coordinado entre varias instituciones y organizaciones de la región de América Latina y el Caribe por plasmar los resultados de una reflexión conjunta sobre el tema de la adaptación al cambio climático en la comunidad hídrica y en el marco de un Diálogo Regional de Política. El propósito principal de este Diálogo es el de dar a conocer una serie de mensajes claves y recomendaciones que permitan definir de manera informada las políticas públicas pertinentes y sus acciones correspondientes al cambio climático. Los resultados del Diálogo hasta el día de hoy se han plasmado en la presente versión del documento, que se presentará en el marco de los Diálogos por el Agua y el Cambio Climático, un evento asociado a la COP16 en Cancún, México.Cambio climático, Gestión de recursos hídricos, Administración pública y definición de políticas, cambio climático, COP-16, agua