The role of the right ventricle in pulmonary arterial hypertension

Although changes in the pulmonary vasculature are the primary cause of pulmonary arterial hypertension (PAH), severity of symptoms and survival are strongly associated with right ventricular function, and right heart failure is the main cause of death in patients with PAH. Echocardiography and cardiac magnetic resonance imaging allow noninvasive evaluation of right ventricular function and structure, and a number of indices have been shown to have potential prognostic value in PAH. Given the importance of the right ventricle in PAH, preservation and improvement of its function should be important aspects of therapy; however, there are currently few data specifically related to this aspect of treatment response. Simple, reproducible, noninvasive measures of right ventricular function would help to improve the management of patients with PAH, and to provide tools with which to help establish the optimal therapeutic approach to manage not only the effects of the disease on the pulmonary vasculature, but also to support and improve right ventricular function

Pulmonary arterial hypertension: from the kingdom of the near-dead to multiple clinical trial meta-analyses

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Industrial Design Structure: a straightforward organizational integration of DFSS and QFD in a new industry and market reality

Purpose: The aim of this research is to enlighten the methodology model of Industrial Design Structure (IDeS) that integrates the internal and external customer feedback embodied both in methods of quality function deployment (QFD) and as basis of design for six sigma (DFSS) steps to systematically bring the information across the entire organization, saving overall product development time and resources. Design/methodology/approach: The paper describes the state of the art enlightened to establish the disadvantages and challenges of other methods taken into consideration in the study like QFD and DFSS that, together with the need of companies to react fast to changes they need to straightforwardly implement product development information across all departments, leading to a mass customization infrastructure. Several application trials of this methodology have been cited. Findings: The IDeS method has established to been able to integrate other well-known methodologies to gather technical specifications starting from voice of customers (VOCs) like QFD that served to canalize the generalist approach of define, measure, analyze, design and verify (DMADV) of DFSS in order to reach into a larger share of the organization and englobe by following the overall product design steps of an industrial project. Research limitations/implications: The research approach chosen for this document presents the concept of a methodology ought to operate most internal branches in a company driven by product design requirements and guidelines. Therefore, researchers are encouraged to develop further studies on the IDeS method are required in order to adapt this methodology to specific management tools that would help to ease information gathering for immediate analysis and modification. Practical implications: The paper implicates that a need to interchange information systematically across all subdivisions in the organization, as brisk response to VOC reactions is needed to thrive in the market nowadays, leading to a fast product customization scene. However, the industry is heading into adopting an individual customer-centered product conceptualization ought to be driven by design as a key for individualizing an object. Afterward by taking this concept broadly and adopting it would lead to implement a company organization that would be directly affected by the customer's input. Social implications: The methodology described aims to enable organizations to portray fast and accurate product prototyping, by exploiting technologies from Industry 4.0. Originality/value: This concept proposes a method to canalize the implementation of DFSS by using the DMADV approach, whilst assessing the challenges of adaptation and keeping up with cultural pace that impacts the behavior of buying and consumption and moreover implementing a seamless communication within all departments in the organization to share the development progress and change requests by using similar information technology tools. This would imply important savings in resources, whilst delivering quality products to the society

Transcriptomic analysis of a 3D blood-brain barrier model exposed to disturbed fluid flow.

Cerebral aneurysms are more likely to form at bifurcations in the vasculature, where disturbed fluid is prevalent due to flow separation at sufficiently high Reynolds numbers. While previous studies have demonstrated that altered shear stress exerted by disturbed flow disrupts endothelial tight junctions, less is known about how these flow regimes alter gene expression in endothelial cells lining the blood-brain barrier. Specifically, the effect of disturbed flow on expression of genes associated with cell-cell and cell-matrix interaction, which likely mediate aneurysm formation, remains unclear. RNA sequencing of immortalized cerebral endothelial cells isolated from the lumen of a 3D blood-brain barrier model reveals distinct transcriptional changes in vessels exposed to fully developed and disturbed flow profiles applied by both steady and physiological waveforms. Differential gene expression, validated by qRT-PCR and western blotting, reveals that lumican, a small leucine-rich proteoglycan, is the most significantly downregulated gene in endothelial cells exposed to steady, disturbed flow. Knocking down lumican expression reduces barrier function in the presence of steady, fully developed flow. Moreover, adding purified lumican into the hydrogel of the 3D blood-brain barrier model recovers barrier function in the region exposed to fully developed flow. Overall, these findings emphasize the importance of flow regimes exhibiting spatial and temporal heterogeneous shear stress profiles on cell-matrix interaction in endothelial cells lining the blood-brain barrier, while also identifying lumican as a contributor to the formation and maintenance of an intact barrier

Early invasive strategy (< 24 hours) in patients with acute coronary syndromes: Weighing the evidence

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Anticoagulant treatment in patients with pulmonary arterial hypertension associated with systemic sclerosis: More shadows than lights

Pulmonary arterial hypertension is a chronic and progressive disease characterized by elevated pulmonary artery pressure and pulmonary vascular resistance leading to heart failure and premature death. Pulmonary arterial hypertension is characterized by proliferative and obstructive lesions in the distal pulmonary arteries and some descriptions include also thrombotic lesions. Despite this, in an era when multiple effective pulmonary arterial hypertension therapies are available, the role of anticoagulation in the treatment of pulmonary arterial hypertension remains uncertain. In particular, anticoagulant treatment in pulmonary arterial hypertension associated with connective tissue disease seems to be associated with unfavorable risk to benefit ratio due to an increased rate of bleeding from the gastrointestinal tract. However, anticoagulation may be required in conditions with increased thrombophilia like in the presence of lupus anticoagulant phenomenon or in the presence of anticardiolipin antibodies

Antibiotic use in departments of internal medicine of Lazio

Antimicrobial therapy is inappropriate in 9 to 64% of the patients hospitalized. We evaluated the antibiotic use in Internal Medicine wards of an Italian region (Lazio) by a prospective multicenter, observational study. One thousand and nine patients were evaluated. Patients under antimicrobial treatment (PUAT) were 588 (58.2%), patients without treatment (PWT) 421 (41.8%). Infections were classified as community acquired (47.8%), hospital acquired (10.3%) or healthcare-associated (11.4%); the remaining 30.5% of infections did not receive any epidemiological classification. Samples for microbiological examination were collected in 41.6% of PUAT. The antibiotic choice was empiric in 94.8% of the cases and protected penicillins were selected in 48% of the cases. The mean duration of treatment was 9.5±6 standard deviation (SD) days. Only 6% of the patients switched from intravenous to oral therapy. Age, length of hospital stay and mortality were higher for PUAT than for PWT (mean age: 75.9±15 SD vs 74.2±15 SD years, P&lt;0.02; length of hospital stay: 13.7±10.4 SD vs 10±8.4 SD days, P&lt;0.01; mortality: 15.9% vs 3.1%). Antibiotic stewardship needs to be implemented all over the hospitals of Lazio region

Subacute pericardial abscess after aortic valve replacement: a case report

BACKGROUND: Purulent pericarditis is an infectious disease, frequently caused by gram-positive bacteria, that is rarely observed in healthy individuals, and is often associated with predisposing conditions. CASE PRESENTATION: Here, we present the case of an Escherichia coli post-surgical localized purulent pericarditis complicated by transient constrictive pericarditis and its diagnostic and therapeutic management. CONCLUSIONS: Our case report focuses on the importance of imaging-guided treatment of purulent pericardial diseases, in particular on the emerging role of 18\u2009F-labelled 2-fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in pericardial diseases and on the management of transient constrictive pericarditis, often seen after thoracic surgery