Pentoxifylline for heart failure: A systematic review

Background. Recent trials have indicated a beneficial effect of pentoxifylline on measures of inflammation and markers of cardiac dysfunction in people with heart failure. However, it is uncertain whether pentoxifylline should be used routinely in the management of heart failure. Objective. To determine the effectiveness of pentoxifylline in heart failure. Design. Systematic review of randomised controlled trials. Methods. We searched MEDLINE (1 January 1966 - 20 November 2004), the Cochrane Controlled Trials Register (issue 4, 2004), and reference lists of related papers, for randomised controlled trials of pentoxifylline in the treatment of heart failure. Prospective, randomised, double-blind controlled trials were sought for inclusion in the study. The two reviewers independently assessed trial quality and extracted data, which were analysed using RevMan statistical software. The following outcome measures were evaluated: (i) New York Heart Association (NYHA) functional class; (ii) left ventricular ejection fraction (LVEF); (iii) frequency of hospitalisation; and (iv) death from all causes. Results. Four studies with a total of 144 participants met the inclusion criteria. Statistical pooling (or meta-analysis) was not performed owing to the significant clinical heterogeneity and differences in reporting of the outcomes in the included studies; instead, the trials were analysed separately for the outcomes of interest. The four studies tested the use of pentoxifylline versus placebo in patients with heart failure of varying aetiology (idiopathic dilated cardiomyopathy, 3 studies; ischaemic cardiomyopathy, 1 study). In 2 of the idiopathic dilated cardiomyopathy studies, patients were classified as NYHA class II or III, while the study population in another idiopathic cardiomyopathy study was in NYHA class IV. The trial of patients with ischaemic cardiomyopathy included patients in NYHA functional classes I - IV. The use of pentoxifylline was associated with significant improvement in symptoms (i.e. NYHA functional class) and cardiac function (i.e. LVEF) in 3 out of 4 studies. The beneficial effect on symptoms of heart failure and cardiac function was seen in all grades of severity of heart failure and in patients with ischaemic and idiopathic dilated cardiomyopathy. All 4 studies showed a trend towards reduction of mortality, but this effect was not statistically significant. The effect of pentoxifylline on the frequency of hospitalisation has not been tested in randomised controlled trials. Interpretation. Pentoxifylline may have a beneficial effect on NYHA functional class, ejection fraction and mortality in heart failure, but published trials are too small to provide conclusive evidence. There is a need for large, placebocontrolled trials of pentoxifylline in heart failure, involving a diverse group of patients with regard to cause and severity of heart failure

Waterborne Autonomous VEhicle

This project designed and realized the Waterborne Autonomous VEhicle (WAVE), a submersible modular robotic platform to enable research on underwater technologies at WPI at minimal cost. WAVE’s primary design objectives were modularity and expandability while adhering to the regulations for the international competition held by the Association for Unmanned Vehicle Systems International. WAVE’s core features include a six degree-of-freedom chassis, a modular electronic infrastructure, and an easily configurable software framework

Self-reported health impacts of do-it-yourself air cleaner use in a smoke-impacted community

Background: Smoke exposure from wildfires or residential wood burning for heat is a public health problem for many communities. Do-It-Yourself (DIY) portable air cleaners (PACs) are promoted as affordable alternatives to commercial PACs, but evidence of their effect on health outcomes is limited. Objective: Pilot test an evaluation of the effect of DIY PAC usage on self-reported symptoms, and investigate barriers and facilitators of PAC use, among members of a tribal community that routinely experiences elevated concentrations of fine particulate matter (PM2.5) from smoke. Methods: We conducted studies in Fall 2021 (“wildfire study”; N = 10) and Winter 2022 (“wood stove study”; N = 17). Each study included four sequential one-to-two-week phases: 1) initial, 2) DIY PAC usage ≥8 h/day, 3) commercial PAC usage ≥8 h/day, and 4) air sensor with visual display and optional PAC use. We continuously monitored PAC usage and indoor/outdoor PM2.5 concentrations in homes. Concluding each phase, we conducted phone surveys about participants’ symptoms, perceptions, and behaviors. We analyzed symptoms associated with PAC usage and conducted an analysis of indoor PM2.5 concentrations as a mediating pathway using mixed effects multivariate linear regression. We categorized perceptions related to PACs into barriers and facilitators of use. Results: No association was observed between PAC usage and symptoms, and the mediation analysis did not indicate that small observed trends were attributable to changes in indoor PM2.5 concentrations. Small sample sizes hindered the ability to draw conclusions regarding the presence or absence of causal associations. DIY PAC usage was low; loud operating noise was a barrier to use. Discussion: This research is novel in studying health effects of DIY PACs during wildfire and wood smoke exposures. Such research is needed to inform public health guidance. Recommendations for future studies on PAC use during smoke exposure include building flexibility of intervention timing into the study design

Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialtie

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries