Clinical factors predicting blood pressure reduction after catheter-based renal denervation

Introduction: Renal denervation (RD) can lead to a significant and sustained decrease in mean values of arterial blood pressure (BP). However, there is still a subset of patients without a significant BP drop after RD (non-responders). Aim: To compare characteristics of RD responders to RD non-responders and to identify the clinical predictors of BP reduction. Material and methods: Thirty-one patients with diagnosed resistant hypertension underwent RD. Three years after RD the analysis of BP reduction was performed in regard to the baseline patient characteristics. Results: After 3 years’ follow-up a 10% or more reduction of systolic baseline BP was observed in 74% of patients. Ten percent or more reduction of diastolic baseline BP was observed in 71% of patients. Among responders we observed the following risk factors: hypercholesterolemia in 70%, body mass index (BMI) > 30 kg/m2 in 55%, diabetes mellitus in 35%, current smoking in 5%. Comorbidity included coronary artery disease (CAD) in 30%, cardiomyopathy in 10%, chronic obstructive pulmonary disease (COPD) in 10%, renal insufficiency in 10%, and ventricular arrhythmia in 5%. Among non-responders we observed the following risk factors: hypercholesterolemia in 38%, diabetes mellitus type 2 in 38% and BMI > 30 kg/m2 in 86%. Comorbidity included CAD in 50% and cardiomyopathy in 13% of patients. Conclusions: A 10% reduction of systolic baseline BP was observed in 74% of patients 3 years after renal denervation. Clinical factors like COPD, chronic kidney disease 3a, female sex and hypercholesterolemia increase the chances of effective reduction of BP

Renal artery sympathetic nerve radiofrequency denervation

Background: Arterial hypertension is one of the most common chronic diseases in the western world, affecting more than 25% of the adult population. Aim: The aim of this study was to assess changes in arterial blood pressure (BP) levels in hypertensive patients, after ablation of nerve terminals in renal arteries, using radiofrequency energy during 24 months of follow-up. Methods: Thirty-two patients with diagnosed resistant hypertension (20 men and 12 women) underwent percutaneous catheter-based renal denervation of nerve terminals in renal artery walls. Mean BP value before ablation was [mm Hg]: systolic 174.92, diastolic 99.73 and pulse pressure 75.19. After procedure reduction value of BP was reported [mm Hg]: systolic 146.78; diastolic 87.14, pulse pressure 59.64 at 24-month follow-up (p < 0.05 for all). Results: 30% of patients had systolic BP ≤ 140 mm Hg, 67% had diastolic BP ≤ 90 mm Hg, and optimum BP values ≤ 140/90 mm Hg were observed in 30% of patients. Conclusions: In our cohort of patients, percutaneous renal artery ablation procedure effectively reduces systolic, diastolic BP and pulse pressure. No adverse events during 24 months of follow-up were noted. These results were comparable with available data from SIMPLICITY I and II trials.Wstęp: Nadciśnienie tętnicze jest jedną z najbardziej powszechnych chorób przewlekłych w krajach zachodnich i dotyczy więcej niż 25% dorosłej populacji. Cel: Celem pracy była ocena zmian ciśnienia tętniczego (BP) u pacjentów z nadciśnieniem tętniczym po ablacji zakończeń nerwowych w tętnicach nerkowych z zastosowaniem prądu o wysokiej częstotliwości w 24-miesięcznej obserwacji. Metody: Trzydziestu dwóch pacjentów z rozpoznanym nadciśnieniem opornym (20 mężczyzn i 12 kobiet) poddano przezskórnej denerwacji zakończeń nerwowych w ścianie tętnic nerkowych. Średnia wartość ciśnienia krwi przed ablacją wynosiła [mm Hg]: 174,92 (skurczowe), 99,73 (rozkurczowe), a ciśnienie tętna — 75,19. Po 24 miesiącach obserwacji stwierdzono zmniejszenie wartości ciśnienia tętniczego [mm Hg]: skurczowe — 146,78; rozkurczowe — 87,14, ciśnienie tętna — 59,64. Wyniki: Wszystkie wyniki były statystycznie znamienne. U 30% pacjentów zanotowano wartość skurczowego BP ≤ 140 mm Hg, u 67% osób rozkurczowe BP wynosiło ≤ 90 mm Hg, natomiast optymalne wartości ciśnienia krwi (≤ 140/90 mm Hg) stwierdzono u 30% pacjentów po 24 miesiącach od ablacji tętnic nerkowych. Wnioski: W grupie badanych chorych przezskórna ablacja tętnicy nerkowej skutecznie obniżyła skurczowe i rozkurczowe BP oraz ciśnienia tętna. Nie stwierdzono istotnych zdarzeń niepożądanych w ciągu 24-miesięcznej obserwacji. Wyniki badań polskiej grupy pacjentów nie odbiegają w żaden sposób od wyników uzyskanymi w badaniach SIMPLICITY I i II

Percutaneous management of long and diffused coronary lesions using newer generation drug-eluting stents in routine clinical practice : long-term outcomes and complication predictors

Long and diffuse coronary lesions (LDCLs) are routinely subjected to percutaneous management, but long‑term clinical outcomes and complication predictors with the use of contemporary stents and techniques remain undetermined. Long and diffuse coronary lesion was defined as a lesion requiring an implantation of 30 mm or longer total stent(s) length (TSL) into one coronary artery (bailouts excluded). There were 290 LDCL interventions with the use of newer generation drug‑eluting stents (DESs cobalt chromium everolimus- or zotarolimus-eluting stents) performed between January 2013 and January 2016. The mean (SD) TSL was 55.5 (16.8) mm. The use of intravascular ultrasound / optical coherence tomography was 17.1%, rotablation, 6.9%, and noncompliant balloon, 88.9%. The median (range) follow‑up duration was 831 (390-1373) days. All‑cause mortality and cardiac death rates were 11.7% and 6.9%, respectively. The myocardial infarction (MI) rate was 6.6%, including target‑vessel MI in 4.1%. The rate of clinically‑driven repeat revascularization was 13.8%, and of definite or probable LDCL stent thrombosis, 7.2%. Overall patient‑oriented adverse event rate (any death, MI, or repeat revascularization) was 25.5%, and device‑oriented rate (cardiac death, target vessel‑MI, or target lesion restenosis), 13.4%. Adverse outcome predictors were chronic kidney disease, acute coronary syndrome as an indication for the procedure, chronic heart failure with reduced left ventricular ejection fraction, multivessel disease, and coexisting peripheral artery disease, but not lesion‑related factors, such as bifurcation, calcification, chronic total occlusion, or TSL. Adverse outcomes following contemporary LDCL management using newer generation DESs in routine clinical practice are associated with clinical patient characteristics rather than lesion characteristics or TSL. We identified high‑risk patient cohorts that may benefit from enhanced surveillance

Satisfaction and discontent of Polish patients with biological therapy of rheumatic diseases : results of a multi-center questionnaire study

Objectives: Biologics are medications widely applied in the management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is relatively expensive, and in Poland, it is carried out in specialized centers. The study was designed to evaluate various aspects of satisfaction and dissatisfaction of Polish patients treated with biologics. Material and methods: An anonymous questionnaire was distributed in 23 Polish rheumatological centers involved in the treatment; 1212 returned questionnaires were used for analysis. Responses were received from 606 patients with rheumatoid arthritis, 427 with ankylosing spondylitis, 117 psoriatic arthritis, and 62 adult patients with juvenile idiopathic arthritis (in whom administration of the drugs had been introduced before they were 18 years old). The investigated group constituted about one-fifth of all rheumatic patients on biologics in Poland. Results: A beneficial or very beneficial influence of the medication on the state of physical health was found mostly in patients with rheumatoid arthritis (51.3 and 30.5%) and ankylosing spondylitis (51.0 and 36.8%). Family life was improved by the treatment especially in patients with ankylosing spondylitis (40.7 and 35.6% beneficial and very beneficial, respectively), sleep quality and sexual life mostly in those with ankylosing spondylitis (beneficial/very beneficial influence 41.5/38.4, and 38.7/23.9, respectively). There was a rather small influence of biological treatment on the financial situation of the patients. In general, satisfaction with the treatment was evaluated as positive or very positive in 88% of all investigated patients. In a significant part of the patients, transportation to the medical center was considered as a disadvantage of the treatment. About one-third of the patients considered laboratory and imaging tests to be done before initiation of the medication as a difficulty, and for about 40% waiting time for qualification for the medication was a significant disadvantage. The route of drug administration was without importance for 4/5 of the patients. Conclusions: Summing up, the results were similar in the patients suffering from various diseases although those with psoriatic arthritis felt the highest satisfaction (possibly due to the positive aesthetic effect), and those with ankylosing spondylitis had significant improvement in sexual life (probably due to younger age). Relatively low satisfaction was found in patients with juvenile idiopathic arthritis. There was a small influence of medication on financial status of the patients. Application of biologics has few disadvantages and most of them are associated with the organization of health services (waiting time for the tests, transportation to the medical centers)

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ABBREVIATED TITLE: Bayesian algorithm for multicamera surveillance Visual surveillance in wide areas (e.g. airports) relies on sparsely distributed cameras, that is, cameras that observe non-overlapping scenes. In this setup, multi-object tracking requires re-identification of an object when it leaves one field of view, and later appears at some other. Although similar association problems are common for multi-object tracking scenarios, in the distributed case one has to cope with asynchronous observations and cannot assume smooth motion of the objects. In this paper, we propose a method for human indoor tracking. The method is based on a Dynamic Bayes Network (DBN) as a probabilistic model for the observations. The edges of the network define the correspondences between observations of the same object. Accordingly, we derive an approximate EM-like method for selecting the most likely structure of DBN and learning model parameters. The presented algorithm is tested on a collection of real-world observations gathered by a system of cameras in an office building. Keywords: Multiple-target tracking; Wide-area video surveillance; Data association; Bayes networks; Probabilistic learning