This study evaluated a novel transcatheter interatrial shunt device for treating heart failure with preserved ejection fraction (HFPEF). 64 patients underwent successful implantation of the device. At 6 months follow up, 71% of patients had a reduction in pulmonary capillary wedge pressure at rest or during exercise compared to baseline. The procedure was well tolerated with no safety issues. The results suggest the device may help reduce left atrial pressure and improve functional status for patients with HFPEF, though the study had limitations as an open-label single-arm trial with short follow up.
STICH (Surgical Treatment for Ischemic Heart Failure)theheart.org
- Population and treatment:
1212 patients with coronary artery disease amenable to coronary artery bypass graft (CABG) with LVEF <35%
Randomized to CABG or standard medical therapy alone
- Primary outcome:
All-cause death
STICH myocardial viability substudy:
- A substudy designed to determine whether substantial viable myocardium evident at baseline (visualized by SPECT imaging or dobutamine echo) affects all-cause mortality over five years or influences the relative effectiveness of the selected treatment strategy
See the article at http://www.theheart.org/article/1204899.do
STICH (Surgical Treatment for Ischemic Heart Failure)theheart.org
- Population and treatment:
1212 patients with coronary artery disease amenable to coronary artery bypass graft (CABG) with LVEF <35%
Randomized to CABG or standard medical therapy alone
- Primary outcome:
All-cause death
STICH myocardial viability substudy:
- A substudy designed to determine whether substantial viable myocardium evident at baseline (visualized by SPECT imaging or dobutamine echo) affects all-cause mortality over five years or influences the relative effectiveness of the selected treatment strategy
See the article at http://www.theheart.org/article/1204899.do
Coronary artery perforation during percutaneous coronaryRamachandra Barik
Percutaneous coronary intervention (PCI) has considerable
efficacy in the treatment of coronary artery disease, but it is
associated with some complications.[1‑4] One of the uncommon
complications of PCI is a coronary artery perforation, with an
incidence rate of 0.2%–0.6%, which may lead to pericardial
effusion and may consequently progress to cardiac tamponade,
myocardial infarction, and death.[1‑8] We herein present a case
of a right coronary artery (RCA) perforation during PCI.
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
OBJECTIVES:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac sur-
gery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG)-
http://www.theheart.org/web_slides/1416535.do
A trial to compare Fractional Flow Reserve versus Angiography for Guiding PCI in Patients with Multivessel Coronary Artery Disease II
Ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction (MI).
Bimodal peak
Range: few hours 2 weeks
Average time to rupture
2-8 days
Time course may be accelerated by thrombolysis, possible related to intramyocardial hemorrhage
Coronary artery perforation during percutaneous coronaryRamachandra Barik
Percutaneous coronary intervention (PCI) has considerable
efficacy in the treatment of coronary artery disease, but it is
associated with some complications.[1‑4] One of the uncommon
complications of PCI is a coronary artery perforation, with an
incidence rate of 0.2%–0.6%, which may lead to pericardial
effusion and may consequently progress to cardiac tamponade,
myocardial infarction, and death.[1‑8] We herein present a case
of a right coronary artery (RCA) perforation during PCI.
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
OBJECTIVES:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac sur-
gery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG)-
http://www.theheart.org/web_slides/1416535.do
A trial to compare Fractional Flow Reserve versus Angiography for Guiding PCI in Patients with Multivessel Coronary Artery Disease II
Ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction (MI).
Bimodal peak
Range: few hours 2 weeks
Average time to rupture
2-8 days
Time course may be accelerated by thrombolysis, possible related to intramyocardial hemorrhage
Pre hospital reduced-dose fibrinolysis followed by pciVishwanath Hesarur
Extensive investigations of treatment strategies for patients with STEMIs have led to many improvements in care.
Yet optimal treatment strategies for patients aged ≥75 years with STEMIs are much less clear, and many knowledge gaps remain.
Age ≥75 years is an independent predictor of 30-day mortality in STEMI.
Although this higher mortality risk generally would dictate more aggressive treatments, recent data have shown, for example, that <1/2 of patients aged ≥80 years with STEMIs are treated with any reperfusion therapies at all.
Effect of restrictive versus liberal transfusion strategies on outcomes in pa...Mohd Saif Khan
Restrictive red cell transfusion policies are recommended as safe for most hospital patients with anaemia. Uncertainty exists for patients with cardiovascular disease, whose hearts may be more susceptible to limited coronary oxygen supply.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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
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.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
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
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.
2. Incidence of HFPEF is rising worldwide.
– Improved recognition,
– an ageing population,
– increased prevalence of co-morbid diseases such
as hypertension, chronic kidney disease, and
diabetes,
3. • HFPEF is characterised by complex cardiovascular
pathophysiology.
• Originally, attention focused on the role of diastolic
dysfunction as a cause of a rapid rise in left ventricular
diastolic and left atrial pressure during exertion.
• The underlying myocardial biology of HFPEF is
controversial.
• It has been ascribed to myocardial fibrosis, myocyte
hypertrophy, and changed post translation modification
of myocardial proteins such as titin.
• Many other factors contribute to the clinical profile of
patients with HFPEF, including hypertension, myocardial
and systemic microvascular dysfunction, in addition to
extra-cardiac comorbidities such as renal insufficiency,
anaemia, obesity, and sleep apnoea.
4. • Pharmacological treatment has improved
symptoms and reduced morbidity and
mortality for patients with HFREF.
• discovery of an effective treatment for
patients with the disorder has proved elusive
5. • The hallmark of HFPEF is effort intolerance, which
is associated with a profound and rapid increase
in left atrial pressure during exercise indicating
impaired left ventricular diastolic reserve,with
consequent pulmonary congestion.
• This disproportionate rise in left atrial pressure is
thought to provoke symptoms and contribute to
increased morbidity and mortality in HFPEF
6. • Patients with Lutembacher’s syndrome might
have fewer symptoms and better outcomes
than those with pure mitral stenosis,
• Closure of their atrial septal defect can trigger
a rise in pulmonary artery pressure and
pulmonary oedema in some patients.
An iatrogenic left-to-rightatrial shuntis therefore a
potentially attractive interventionthatmight
have therapeutic value.
7. • A novel device-based therapy targeting a
common patho-physiological feature of HFPEF
might succeed where pharmacological therapies
have failed.
• The REDUCe Elevated Left Atrial Pressure in
Patients with Heart Failure (REDUCE LAP-HF)
study was designed to assess the device
performance and safety of a transcatheter,
transvenous interatrial shunt device in
symptomatic patients with HFPEF.
9. Study design and participants
• The REDUCE LAP-HF study was a multicentre,
prospective, non-randomised, open-label, single-
arm study designed to investigate the safety and
performance of a transcatheter, transvenous
interatrial shunt device (IASD system II, Corvia
Medical Inc [Tewkesbury, MA, USA]
10. ELIGIBILITY
• Patients with known HFPEF enrolled from
hospital outpatient departments or via referring
physicians were eligible for study inclusion if they
were
– adults (aged >40 years)
– had evidence of chronic symptomatic heart failure
(New York Heart Association [NYHA] functional class
II–IV),
– a left ventricular ejection fraction higher than 40%,
– and an increased pulmonary capillary wedge pressure
at rest (>15 mm Hg) or during exercise (>25 mm Hg)
measured by right heart catheterisation.
11. EXCLUSION
• Patients with substantial right ventricular
dysfunction including a central venous pressure
higher than 14 mm Hg and tricuspid annular plane
systolic excursion below 14 mm were excluded.
• Recent (<3 months)
– myocardial infarction,
– Coronary artery bypass graft, or
– percutaneous coronary intervention.
• Non-ambulatory NYHA IV heart failure;
• Infiltrative or hypertrophic cardiomyopathy; and
• Moderate or greater aortic stenosis or mitral
regurgitation.
12. Procedures
• All enrolled patients underwent right heart catheterisation with
assessment of cardiac output and central haemodynamics (right
atrial pressure, pulmonary artery pressure, and pulmonary
capillary wedge pressure) at rest and during supine bicycle
exercise, both at baseline and 6 months after device
implantation.
• Following baseline haemodynamic measurements, symptom-
limited supine bicycle exercise commenced at 20 watts (W) with
20-W increments every 3 min until the patient achieved
maximum eff ort (as defi ned by symptom limiting dyspnoea or
fatigue).
• Blood samples were collected from the pulmonary artery and
vena cavae at baseline and at 6 months’ follow-up to measure
oxygen saturation and to assess left-to-right shunting as
indicated by the pulmonary to systemic blood flow ratio.
13. • Device insertion was done within 45 days of screening.
• Implantation was performed percutaneously via the femoral vein on
a separate occasion to the screening.
• Standard trans-septal puncture of the interatrial septum was done
using the operator’s preferred technique, including fluoroscopy and
transoesophageal or intracardiac echocardiography, and the device
was positioned through the use of an over-the-wire technique.
• Patients not taking oral anticoagulants were treated with aspirin (75–
325 mg daily) indefinitely, and clopidogrel (75 mg daily) for 6
months.
• Patients treated with oral anticoagulants continued on their existing
oral anticoagulants after the procedure.
• Endocarditis prophylaxis was advised for a minimum of 6 months
post-implantation.
14. Outcomes
• The primary objectives of the study were to assess device
performance and safety.
• The primary device performance endpoints
– were defined as the proportion of patients with successful
device implantation,
– the percentage of patients with a reduction in pulmonary
capillary wedge pressure at 6 months either at rest or during
exercise compared with baseline,
– and the presence of persistent left-to-right transdevice blood
flow at 6 months.
• The primary safety endpoints were
– peri-procedural and 6-month major adverse cardiac and
cerebrovascular events, defined as death, stroke, myocardial
infarction, or a systemic embolic event (excluding pulmonary
thromboembolism),
– or need for cardiac surgical device removal within 6 months
15. Secondary outcomes
• The incidence of major adverse events,
• Admission to hospital for heart failure during the
entire study, and
• changes in
– echocardiographic parameters,
– functional capacity (6-min walk test),
– natriuretic peptides,
– and qualityof-life assessments (the Minnesota Living
with Heart Failure [MLWHF] questionnaire).
17. • Between Feb 8, 2014, and June 10, 2015, 102 patients
were enrolled from 21 centres, of whom 68 met the
inclusion and exclusion criteria.
• Two patients withdrew after enrolment (personal
preference).
• Of the remaining 66 patients, implantation of the IASD
system was abandoned in two (in one patient because
of a trans-septal puncture complication without further
sequelae, and in another because of perceived
unsuitable atrial septal anatomy) and was successful in
64 patients.
18. BASELINE CHARACTERISTICS
Consistent with the HFPEF phenotype, the
mean pulmonary capillary wedge pressure
increased during exercise from 17 mm Hg
to 35 mm Hg (p<0·0001), the mean
pulmonary pressure rose
from 25 mm Hg to 44 mm Hg
(p<0·0001),and the mean right atrial
pressure increased from 9 mm Hg to 18
mm Hg (p<0·0001).
The mean cardiac output rose from 5·6
L/min to 8·4 L/min (p<0·0001).
The mean exercise time during
haemodynamic testing was 7·3 min at a
mean workload of 43 W
19. • No patient had a peri-procedural or major adverse cardiac
or cerebrovascular event, including death, stroke,
myocardial infarction, pulmonary or systemic embolism, or
need for cardiac surgical intervention for device-related
complications, during 6 months of follow-up.
• One patient declined a final clinical follow-up because of
non-cardiovascular illness.
• In three patients the initial device was removed because of
unsuitable position (n=2) or a suspected small mobile
thrombus in the right atrium (n=1); however, a second
device was deployed in all three patients without incident.
• 60 patients underwent right heart catheterisation for
haemodynamic assessment at 6 months, and exercise
haemodynamic responses were analysed in 59 patients.
20. • At 6 months’ follow-up, 42 (71%) of 59 patients met the
primary device performance endpoint definition of a
reduction in pulmonary capillary wedge pressure either
at rest or during exertion compared with their baseline
values.
• 31 (52%) of 60 patients had a reduction in pulmonary
capillary wedge pressure at rest, 34 (58%) of 59 had a
lower pulmonary capillary wedge pressure during
exertion, and 23 (39%) of 59 fulfi lled both these
criteria.
• All patients with adequate echocardiographic image
quality (n=50) had evidence of left-to-right flow through
the device by colour flow Doppler flow at 6 months.
• Right-to-left flow by colour flow Doppler was not
observed.
25. • Compared with baseline, a small reduction in mean
bodyweight was recorded at 6 months (from 90·1 kg at
baseline to 88·4 kg at 6 months; p=0·008).
• Neither N-terminal pro b-type natriuretic peptide level
(median 377 pg/Ml [IQR 222–925] at baseline vs 382
pg/mL [170–1075] at 6 months) nor mean estimated
glomerular filtration rate (62 mL/min/m² at baseline vs
61 mL/min/m² at 6 months) changed during the study.
• In the 6 months before trial participation, 13 (20%) of
64 of patients had to be admitted to hospital for heart
failure, compared with nine (14%) of 63 in the 6
months following enrolment.
26. Summary of results
• In this open-label study of a novel transcatheter
interatrial shunt device, which was developed for
the management of patients with HFPEF,
reductions in left atrial pressure during exercise
with improvements in functional capacity and
quality of life 6 months after implantation, were
recorded.
• The procedure was well tolerated, and
echocardiographic and oximetric studies showed
the presence of continuing device patency and
left-to-right shunting at 6 months.
27. limitations
• Open label , non randomized … placebo effect
cant be excluded.
• Small sample size / short observation period-
reduce the reliability.
• BNP levels and E/e’ did not decrease
significantly- ? Placebo effect
28. CONCLUSION
• Overall, the results of this open-label non-
randomised study show that transcatheter
transvenous placement of an interatrial shunt
device is feasible and might be associated with
improvements in exercise haemodynamics,
functional capacity, and quality of life.
• These findings require validation in a
randomised controlled masked trial.
Editor's Notes
Existing guidelines for the diagnosis of HFPEF include
evidence of raised levels of natriuretic peptides and
echocardiographic measures of increased fi lling
pressures, as indicated by the mitral peak velocity of early
fi lling (E) to early diastolic mitral annular velocity (e´)
ratio.28 In this study, device implantation was not
accompanied by a decrease in either of these noninvasive
measurements. This fi nding could be explained
by the fact that these measures were taken at rest or by
the quite modest overall reduction in filling pressures.