1) The document discusses cardiovascular disease as the leading cause of death in Mexico and worldwide. Early detection of risk is important as cardiovascular diseases are not incurable if treated early.
2) It proposes establishing centers equipped with portable ultrasound technology to enable early detection of cardiovascular risk in primary care settings. The ultrasound units would be operated by non-specialists and can assess vascular age by measuring intima-media thickness and arterial elasticity in minutes.
3) Studies show this radiofrequency-based ultrasound technology provides accurate markers of preclinical vascular changes and has higher potential than traditional metrics to detect early atherosclerosis, especially in evaluating diabetes patients. Daily physical activity is also found to independently influence vascular stiffness and myocardial performance.
Factors Predicting Neurological Complications Following Percutaneous Coronary Angiography and Interventions in a Large Series of Transfemoral and Transradial Approach.
Factors Predicting Neurological Complications Following Percutaneous Coronary Angiography and Interventions in a Large Series of Transfemoral and Transradial Approach.
Thermal Imaging for the Diagnosis of Early Vascular Dysfunctions: A Case Reportasclepiuspdfs
Diseases of blood vessels (referred in this article as vascular dysfunction) cause more morbidity and mortality, than combined impact of any other major non-communicable disease including cancer. We strongly feel that the development of a therapy system based on the management of disease of the vessel than management of the risk factors will yield better results and provide greater opportunity for individualized therapy. Detection of early vascular changes before clinical manifestations of endothelial dysfunction, hardening of the arteries, increased intima-media thickness, is of great importance for early identification of individuals with increased risk of accelerated atherosclerosis.
Potential directions on coronary artery disease prediction using machine lear...IAESIJAI
Coronary artery disease (CAD) is the most ubiquitous and protuberant cause of fatal death. The hit in mortality rate is because of certain lifestyle variables including unhealthy diet, usage of tobaccos and drugs, physical inactivity, and environmental pollution. Traditional screening tests including computed tomography, angiography, electrocardiography, and magnetic resonance imaging are employed for diagnosis and would necessitate more manpower. Machine learning (ML) has been utilized in healthcare to create early predictions from massive volumes of data. The Scopus, Web of Science databases were exhaustively searched utilizing a search strategy that comprised CAD prediction, cardiac illness detection, and heart disease categorization. After applying the inclusion and exclusion criteria to the 99 articles obtained, the population of the study was composed of 30 articles. This review study offers an organized look at the articles published in ML-based CAD detection and classification models that include clinical variables. The use of ML could produce amazing results in CAD detection, as evidenced by the classifiers random forest, decision tree, and k-nearest-neighbour with accuracy being >90%. The use of ML in CAD diagnosis lowers false-positive, and false-negative errors, and presents a special opportunity by providing patients quick, and affordable diagnostic services.
Detection of myocardial infarction on recent dataset using machine learningIJICTJOURNAL
In developing countries such as India, with a large aging population and limited access to medical facilities, remote and timely diagnosis of myocardial infarction (MI) has the potential to save the life of many. An electrocardiogram is the primary clinical tool utilized in the onset or detection of a previous MI incident. Artificial intelligence has made a great impact on every area of research as well as in medical diagnosis. In medical diagnosis, the hypothesis might be doctors' experience which would be used as input to predict a disease that saves the life of mankind. It is been observed that a properly cleaned and pruned dataset provides far better accuracy than an unclean one with missing values. Selection of suitable techniques for data cleaning alongside proper classification algorithms will cause the event of prediction systems that give enhanced accuracy. In this proposal detection of myocardial infarction using new parameters is proposed with increased accuracy and efficiency of the existing model. Additional parameters are used to predict MI with more accuracy. The proposed model is used to predict an early diagnosis of MI with the help of expertise experiences and data gathered from hospitals.
An Ill-identified Classification to Predict Cardiac Disease Using Data Cluste...ijdmtaiir
The health care industry contains large amount of
health care data with hidden information. This information is
useful for making effective decision. For getting appropriate
result from the hidden information computer based data mining
techniques are used. Previously Neural Network (NN) is
widely used for predicting cardiac disease. In this paper, a
Cardiac Disease Prediction System (CDPS) is developed by
using data clustering. The CDPS system uses 15 parameters to
predict the disease, for example BP, Obesity, cholesterol, etc.
This 15 attributes like sex, age, weight are given as the input.
In this paper by using the patient’s medical record, an illdefined classification is used at the early stage of the patient to
diagnose the cardiac disease. Based on the result the patients
are advised to keep the sensor to predict them.
Keunikan anatomi small vessel of the brain dan neurovascular unit, kontroversi peran stganasi vena dalam patofisiologi, klasifikasi small vessel disease, variasi kriteria diagnostik, pitfall dalam neuroimaging, pilihan antiplatelet untuk prevensi sekundar, dampaknya bagi outcome pasien, hubungannya dengan gangguan fungsi kognitif.
Hmm, apa lagi nih yang baru?
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. Principales Causa de Mortalidad (Nacional)
Orden Causas CIE-10 Defunciones
Tasa
(1)
%
1
Enfermedades del corazón I00-I51 (excepto I46 paro
cardíaco sólo para
mortalidad) 92,679 86.9 17.2
- Enfermedades isquémicas del corazón I20-I25 59,801 56.1 11.1
2 Diabetes mellitus E10-E14 75,637 70.9 14.0
3 Tumores malignos C00-C97 67,048 62.9 12.4
4 Accidentes V01-X59, Y40-Y86 38,875 36.4 7.2
5 Enfermedades del hígado K70-K76 31,528 29.6 5.8
- Enfermedad alcohólica del hígado K70 13,361 12.5 2.5
6 Enfermedades cerebrovasculares I60-I69 30,246 28.4 5.6
7
Enfermedades pulmonares obstructivas crónicas, excepto
bronquitis, bronquiectasia, enfisema y asma J44 16,540 15.5 3.1
8 Ciertas afecciones originadas en el período perinatal A33, P00-P96 14,768 13.8 2.7
- Hipoxia intrauterina, asfixia y otros trastornos
respiratorios originados en el período perinatal P20-P28 8,172 7.7 1.5
9 Agresiones (homicidios) X85-Y09 14,006 13.1 2.6
10 Neumonía e influenza J09-J18 13,456 12.6 2.5
Paro cardíaco
Síntomas signos y hallazgos anormales clínicos y de
laboratorio no clasificados en otra parte R00-R99 521 26.7 1.8
(1) Tasa por 100,000 nacimientos estimados de CONAPO.
Fuente:INEGI/Secretaría de Salud.DGIS, 2008. Elaborado a partir de base de datos de
defunciones 2008 y CONAPO, 2006. Proyecciones de Población de México 2005-2050.
4. Antecedentes
Las enfermedades del corazón constituyen la
primera causa de muerte en todo el mundo.
Y la primera en Mexico
Fuente: ENSALUD 2006
4
5. Antecedentes (cont)
• Según la Secretaría de la Salud, en México esta patología produce,
por sí sola, más muertes que la suma de los decesos producidos por
los tumores, las enfermedades transmisibles, los accidentes, y los
asesinatos.
• A diferencia de otras enfermedades, que son incurables, las
enfermedades cardiovasculares NO son incurables sino que, si
son tratadas a tiempo, ni siquiera dejan secuelas en el paciente.
5
7. Ahora bien, si el síntoma es evidente (dolor
precordial) y la enfermedad curable...por qué
es la causa de muerte #1 en el mundo?
8. Principales Causas (según encuesta a pacientes y familiares)
• FALTA DE CONCIENTIZACIÓN DE LOS CIUDADANOS
• REQUIERE DE MEDICOS ESPECIALISTAS
• FALTA DE TECNOLOGÍA PARA UN INMEDIATO DIAGNÓSTICO
CARDIOLÓGICO
8
9. Retos existentes
• Falta de conciencia PREVENTIVA.
• Infraestructura de salud dependiente de medicina especializada.
• Serias limitaciones en el número de doctores y de personal médico.
“La NO ACCION simplemente empeora el problema”
9
11. Plan de Prevención CON TECNOLOGIA!!!
• En el primer nivel se contaría con una detección muy temprana del
riesgo cardio-vascular.
• Esta tecnología es altamente sensible y no requiere de medico
especialista.
• Requiere muy poco tiempo para su realización y el resultado es
individualizado al paciente.
11
12. Equipamiento de Unidades Médicas
• Se pretende dotar de Equipo de una unidad de Ultrasonido
Vascular.
• Esta unidad portátil de bajo costo y operada con baterías podrá ser
utilizada como herramienta de discriminación en pacientes.
• Contara con programas dedicados que determinaran la edad
vascular del paciente, basado en la elasticidad y grosor de la zona
vascular periférica.
• Este estudio no invasivo que se puede llevar a cabo en minutos, por
personal NO-especializado y entrenado.
12
13. Unidades de Ultrasonido Vascular MYLAB ONE
13
• Sistema de Ultrasonido
Vascular dedicado.
• Operación a corriente y
batería recargable.
• Pantalla a color LCD de 12”
sensible al tacto.
• Almacenamiento en disco
duro interno y en dispositivos
USB.
• Comunicación inalámbrica
WiFi.
• Compatibilidad en Plataforma
comercial Windows XP.
14. Prestaciones del MyLab ONE
• Operación con menus en pantalla sensible al tacto, con orientación
automática.
• Programa Automático dedicado para evaluación de la edad vascular
de la Intima Media.
• Programa Automático dedicado para evaluación de la elasticidad
vascular.
14
15. Tecnología utilizada
Ademaás de mediciones tradicionales de factores de riesgo (Framingham), utiliza
indicadores predictivos basados en: El grosor de la pared arterial (QIMT) y
Elasticidad de la pared arterial (QAS)
16. Algun datos adicionales
16
RADIOFREQUENCY-BASED ESTIMATES OF LOCAL COMMON CAROTID STIFFNESS AND INTIMA-
MEDIA THICKNESS: IMPLICATIONS FOR DETECTING EARLY VASCULAR INVOLVEMENT IN
HYPERTENSION AND DIABETES
C. Palombo1, M. Kozakova1, G. Bini1, C. Morizzo1, R. Miccoli2, G. Dell' Omo3, R. Pedrinelli3, V. Di Bello3, N. Guraschi4, A. Balbarini3
(1) Department of Internal Medicine, University of Pisa, Pisa, Italy (2) Department of Endocrinology and Metabolism, Pisa, Italy
(3) Cardiothoracic Department, University of Pisa, Pisa, Italy (4) ESAOTE SpA, Genoa, Italy
Intima-media thickness (IMT) of common
carotid artery (CCA) and carotid-femoral
pulse wave velocity (CF-PWV) are established
markers of preclinical vascular disease,
implemented in European guidelines for
cardiovascular (CV) risk prediction.
However, both are influenced mostly by age
and blood pressure (BP), and their value as
forerunner of atherosclerosis remains elusive.
New US techniques improve accuracy of IMT
measurements and provide estimates of local
stiffness in the clinical setting.
Background
was to evaluate the
association of high-resolution,
radiofrequency-based (RF) US
measurements of CCA IMT
(QIMT) and local carotid
stiffness (QAS) as well as
CF-PWV with age, BP and
early disease state.
Aim of this study
64 middle-age subjects free of
clinical CV disease
19 healthy volunteers (NL, 9 men)
19 subjects with BP from high normal to
mild hypertension (HT, 13 men)
26 patients with recently diagnosed, well
controlled, type 2 diabetes (DM2, 20 men)
Study Population
CCA far-wall IMT (QIMT®, Fig. 1),
diameter and distension (QAS®, Fig. 2) were
measured by a RF-based, fully automatic
algorithm implemented in a US system
(MyLab 70, Esaote, Genova,Italy), 1.0 cm
below the flow divider.
The indices of CCA stiffness were calculated
after calibration for BP .
Carotid–femoral pulse wave velocity (CF-PWV,
Complior, Alam, France), was used as an
estimate of aortic stiffness (Fig. 3).
Methods
Fig. 3
Fig. 1 Fig. 2
NL HT DM2 p
Q-IMT
(µm)
540±72 597±50 724±110* * p<0.001 vs NL and HT
CCA B
Index
7.7±2.1 10.1±3.1t 12.6±3.5*
* p<0.001 vs NL
t p<0.05 vs NL
CF-PWV
(m/s)
8.5±1.3 9.7±1.5 10.8±2.4* * p<0.001 vs NL
Age
(years)
44±8 53±9* 61±7t
* p<0.001 vs NL
t p<0.01 vs NL and HT
BP
(mmHg)
107±12/74±8 130±13/86±8* 117±29/77±6 * p<0.001 vs NL and DM2
PP
(mmHg)
34±9 44±10* 46±12* * p<0.01 vs NL
• QIMT,CCA Beta Index, CF-PWV age, systolic BP and
pulse pressure (PP) in NL, HT and DM2 are reported in
Table 1.
• In the overall population, CF-PWV, QIMT and Beta
stiffness index were directly related each other and
increased with age as well as with systolic BP and pulse
pressure (Table 2).
• In a multivariate model adjusted for age and sex,
DM2 status resulted independent predictor of QIMT,
while variability of CF-PWV and CCA Beta stiffness
index was accounted mostly by age (Table 3).
Results
New advanced US systems provide
accurate markers of preclinical vascular
involvement. An increased local CCA
stiffness shows high sensitivity to detect
vascular ageing, while QIMT seems to
have an higher potential to discriminate
early atherosclerosis, particularly in the
evaluation of the diabetic disease
Conclusions
QIMT CCA BI CF-PWV AGE SBP PP
_
0.488 0.362 0.697 0.437 0.413
QIMT
_ 0.527 0.669 0.346 0.360
CCA BI
_ 0.569 0.438 0.492
CF PWV
_ 0.332 0.382
AGE
_ __
SBP
_
PP
Tab. 1
SE p
QIMT
Age 0.44 0.12 <0.005
Diagnosis DM2 0.38 0.14 <0.01
Cumulative R2 0.57 <0.0001
Beta index
Age 0.67 0.09 <0.0001
Cumulative R2 0.45 <0.0001
CF-PWV
Age 0.45 0.11 <0.0005
PPc 0.33 0.11 <0.001
Cumulative R2 0.41 <0.0001
PP
PWV CF 0.39 0.13 <0.01
Diagnosis HBP 0.27 0.12 <0.05
Cumulative R2 0.32 <0.0005
Multivariate Model
Tab. 2
Tab. 3
17. Algun datos adicionales (cont)
17
AVERAGE DAILY PHYSICAL ACTIVITY IS AN INDEPENDENT DETERMINANT OF
LOCAL CAROTID STIFFNESS AND MYOCARDIAL PERFORMANCE
M. Kozakova1, C. Palombo1, C. Morizzo1, E. Muscelli1, N. Guraschi2, S. Pedri2, E. Ferrannini1, B. Balkau3
(1) Department of Internal Medicine, University of Pisa, Pisa, Italy (2) ESAOTE SpA, Genoa, Italy
(3) Center for Research in Epidemiology and Public Health, Villejuif, France
It has been recently reported that vigorous physical
activity (PA) attenuates age-related increase in
common carotid artery (CCA) stiffness in young
subjects and that light PA is associated with lower
aortic stiffness in elderly subjects. The hypothesis
could be raised that a PA-induced reduction in the
stiffness of large arteries could favorably influence
LV myocardial performance.
BACKGROUND
was to evaluate, in healthy middle-age
subjects, the impact of objectively
measured daily PA on CCA and aortic
stiffness and LV myocardial performance.
AIM OF THIS STUDY
47apparently healthy subjects
• age 30-60 years (mean 43±/8 years)
• not involved in endurance exercise training
• normal glucose tolerance
• normal LV geometry (LV mass, RWT)
• normal LV global and regional function (EF and kinesis)
• free of carotid plaques
STUDY POPULATION
• Interview (family history, drugs, smoking)
• Metabolic profile, insulin sensitivity by a gold-standard
euglycemic hyperinsulinemic clamp
• LV mass, Doppler-derived stroke volume and TDI-
derived longitudinal myocardial velocities by cardiac
ultrasound (MyLab, Esaote, Italy);
• Right CCA diameter and distension by a high resolution,
radio-frequency based vascular US (QAS®, Esaote,
Italy) : Fig. 1
• Carotid-femoral pulse wave velocity used as an estimate
of aortic stiffness (PWV, Complior, Alam, France): Fig. 2
• A monitoring of daily PA (single-axis accelerometer,
Computer Science Manufacturing Technology, FL, USA;
mean monitoring time 5.6±1.2 day)
STUDY PROTOCOL
• Average intensity of daily PA was expressed as an
average number of accelerometer counts per min of
monitoring time (314±106 counts/min) and was directly
related to peak systolic myocardial longitudinal velocity and
inversely to heart rate and CCA Beta stiffness index, but
not to PWV, LV mass and diastolic longitudinal myocardial
velocities (Tab. 1).
• In multivariate analyses (Tab. 2), after adjustment for
sex, smoking and stroke volume (taken as an index of
preload), average habitual PA remained independently
related to CCA Beta stiffness index (together with age and
fasting insulin) and to systolic longitudinal myocardial
velocity (together with PWV).
RESULTS
In healthy untrained middle-age subjects, the
average PA has an independent favorable
impact on local CCA stiffness but not on
carotid-femoral PWV, that represents an
independent determinant of systolic longitudinal
myocardial performance. Average intensity of
daily PA, however, seems to influence
myocardial performance independently of load.
CONCLUSIONSCCA Beta Index PSV Longitudinal
Sex p=0.71 Sex p=0.19
Age p<0.005 CF PWV p<0.01
CCA IMT p=0.87 Average PA p<0.05
Insulin p<0.005 Smoking p=0.27
M/I p=0.92
Average PA p=0.01
Smoking p=0.57
R2= 0.66 p<0.0001 R2= 0.34 p<0.01
Avg PA HR CCA BI CF PWV LV mass PSV long PEV long
_ -0.30 -0.32 n.s. n.s. 0.46 n.s. Avg PA
_ n.s. n.s. n.s. n.s. n.s. HR
_ 0.31 0.50 n.s. -0.51 CCA BI
_ n.s. -0.41 -0.47 CF PWV
_ n.s. -0.44 LV mass
_ 0.65 PSV long
_ PEV long
Fig. 2
Fig. 1
Multivariate Analyses
Tab. 1
Tab. 2
18. Algun datos adicionales
(cont)
18
INCREASED CAROTID IMT IN EARLY HYPERTENSION REPRESENTS
AN ADAPTIVE MECHANISM TO INCREASED PULSATILE LOAD
C. PALOMBO (1), M. KOZAKOVA (2), C. MORIZZO (3), G. BINI (3), A. CORCIU (4),
AM SIRONI (5), G. DELL'OMO (4), R. PEDRINELLI (4)
(1) UNIVERSITY of PISA, DEPARTMENT of SURGERY, PISA-ITALY, (2) ESAOTE SpA, GENOVA-ITALY,
(3) DEPARTMENT OF INTERNAL MEDICINE, UNIVERSITY OF PISA, PISA-ITALY, (4) UNIVERSITY of PISA,
CARDIAC and THORACIC DEPARTMENT, PISA-ITALY, (5) CNR, INSTITUTE OF CLINICAL PHYSIOLOGY, PISA-ITALY
Background
An increased intima-media thickness (IMT) of
common carotid artery (CCA) has been reported in
early hypertension as a marker of subclinical
atherosclerosis (1).
However, large artery wall thickening was also
supposed to be an adaptive response to the
increased pressure load (2).
References:
1. Raiko JR et al, Eur J Cardiovasc Prev Rehabil; 2010: 17:549
2. Bots ML et al, Stroke 1997; 28: 2442
Aim of the study
To verify the presence and
predictors of subclinical large
artery involvement in early
hypertension as compared to
normotensive subjects.
Design and Methods
Thirty-eight never treated, non diabetic subjects free of clinical
cardiovascular disease were recruited so far in a prospective study, 18
with “optimal” casual BP (NL), and 20 with high-normal or mildly
elevated BP (pre-HT) (Tab. 1), according to JNC7 Report (individuals
with a systolic BP of 120 to 139 mmHg or a diastolic BP of 80 to 89
mmHg should be considered as prehypertensive and require health-
promoting lifestyle modifications to prevent CVD)
Right CCA IMT and local stiffness were assessed by radio-frequency
(RF) based,real-time, automatic tracking of arterial wall [Q-IMT (Fig.
1) and Q-AS (Fig. 2), respectively, MyLab70, Esaote, Italy]. CCA IMT
was also measured off-line in digitized B-mode images (Fig. 3). Carotid–
femoral pulse wave velocity (CF-PWV, Complior, Alam, France) was used
as an estimate of aortic stiffness (Fig. 4).
Study population
NL PRE-HT p
AGE (years) 47±7 50±7 p=ns
BMI (Kg/m2) 27±6 26±3 p=ns
SEX (M/F) 10/8 13/7 p=ns
SBP (mmHg) 122±14 145±18 p<0.005
DBP (mmHg) 75±9 86±9 p<0.001
PP (mmHg) 46±8 59±13 p<0.005
Fig. 4
NL PRE-HT p
Q-IMT (µm) 560±97 643±85 p<0.01
Q-AS CCA distension (µm) 352±98 368±77 p=ns
CCA Diameter (mm) 7.22±0.55 7.94±0.84 p<0.01
IMT 2D derived (µm) 694±116 746±76 p=ns
Β stiffness index 8.2±1.89 10.7±4 p<0.05
RWT 0.15±0.02 0.16±0.02 p=ns
CCA tensile stress (kPa) 109±18 118±16 p=ns
CF-PWV (m/s) 8.7±1.5 9.5±1.2 p=ns
Fig. 1 Fig. 2
Fig. 3
Results
Pre-HT had significantly higher systolic and diastolic
BP, pulse pressure (Tab. 1), Q-IMT, CCA diameter and
Beta stiffness index (Tab. 2).
No significant differences between the groups were
found for Q-AS CCA distension, relative wall thickness
(RWT: Q-IMT/Vessel Radius), CCA tensile stress, 2D
derived IMT, CF-PWV (Tab. 2), fasting glucose and
lipide profile.
In the entire population, significant direct correlations
were found for Q-IMT with age (r=0.48, p<0.005), SBP
(r=0.55, p<0.001), PP (r=0.57, p<0.001), and CCA
diameter (r=0.66, p<0.0001) (Figg. 5-8). Beta index was
directly related to Q-IMT (r=0.36, p<0.05) and age
(r=0.60, p<0.001) (Figg. 9-10).
In multivariate analysis, adjusted for diagnosis, sex
and smoking habit, independent predictors of Q-IMT
were CCA diameter and PP (R square 0.66, p<0.0001);
the only independent predictor of Beta index was age (R
square 0.39, p<0.001).
Conclusions
RF-based high resolution US system (Q-IMT and Q-AS) is capable to
detect subtle changes in carotid structure and function in absence of an
increase in aortic stiffness. In subjects with early hypertension,
increased Q-IMT appears an adaptive response to increased hemodynamic
load, mainly pulsatile presssure, and is associated with an increased local
stiffness
Tab. 1
Tab. 2
r=0.48, p<0.005
400
500
600
700
800
900
QIMTRight(µm)
30 40 50 60 70
AGE (years)
Fig. 5
400
500
600
700
800
900
QIMTDx(µm)
5 6 7 8 9 10
Right CCA Diameter (mm)
r=0.66, p<0.001
Fig. 8
400
500
600
700
800
900
QIMTRight(µm)
30 50 70 90 110
Pulse Pressure (mmHg)
r=0.57, p<0.001
Fig. 7
r=0.55, p<0.001
400
500
600
700
800
900
QIMTDx(µm)
80 100 120 140 160 180 200
Systolic Blood Pressure (mmHg)
Fig. 6
r=0.60, p<0.001
4
8
12
16
20
24
30 40 50 60 70
AGE (years)
BetaindexRight
Fig. 10
4
8
12
16
20
24
BetaindexRight
400 500 600 700 800 900
QIMT Right (µm)
r=0.36, p<0.05
Fig. 9
19. Conclusiones
• Las enfermedades del corazón SI son curables si son
tratadas a tiempo.
• Se puede educar a la población para la prevención y la
reacción inmediata ante la presencia de estas patologías.
• Los recursos humanos pueden ser entrenados para estas
emergencias.
• La tecnología de apoyo existe y su costo es mínimo
comparado con los beneficios que produce.
19
20. T&C Equipos Médicos y Científicos SA de CV
Barranca del Muerto 329, Desp.
Col. San José Insurgentes
México D.F. 03900
Tel: +52 (55) 3600-3600
ventas@tcmed.com.mx