Exercise stress echocardiography in patients with aortic stenosis: impact of baseline diastolic dysfunction and functional capacity on mortality and aortic valve replacement
Authors: Andrew N. Rassi, Wael AlJaroudi, Sahar Naderi, M Chadi Alraies, Venu Menon, Leonardo Rodriguez, Richard Grimm, Brian Griffin, Wael A. Jaber
http://www.thecdt.org/article/view/2855
Echocardiography was performed using contrast for all studies. The contrast agent used was a commercially available sulfur hexafluoride microbubble preparation, SonoVue (Bracco Imaging SpA). This agent was administered in 0.3-mL bolus doses intravenously for each image acquisition followed by 1 to 2 mL of saline flush. After acquisition of resting images to exclude significant valvular disease, intravenous dobutamine was infused at a starting dose of 10 µg·kg–1·min–1 followed by increasing doses of 20 µg·kg–1·min–1, 30 µg·kg–1·min–1, up to a maximum of 40 µg·kg–1·min–1 in 3-minute stages. Intravenous atropine was administered in 300-μg boluses up to a maximum of 1200 μg for those patients not achieving 85% of the predicted maximal heart rate. Images were taken in the apical 2-chamber, 3-chamber, 4-chamber, and parasternal short-axis views at baseline, low-dose stress, high-dose stress, and recovery
Echocardiography was performed using contrast for all studies. The contrast agent used was a commercially available sulfur hexafluoride microbubble preparation, SonoVue (Bracco Imaging SpA). This agent was administered in 0.3-mL bolus doses intravenously for each image acquisition followed by 1 to 2 mL of saline flush. After acquisition of resting images to exclude significant valvular disease, intravenous dobutamine was infused at a starting dose of 10 µg·kg–1·min–1 followed by increasing doses of 20 µg·kg–1·min–1, 30 µg·kg–1·min–1, up to a maximum of 40 µg·kg–1·min–1 in 3-minute stages. Intravenous atropine was administered in 300-μg boluses up to a maximum of 1200 μg for those patients not achieving 85% of the predicted maximal heart rate. Images were taken in the apical 2-chamber, 3-chamber, 4-chamber, and parasternal short-axis views at baseline, low-dose stress, high-dose stress, and recovery
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
A Speckle Tracking Echocardiographic Study for Correlation Between Global Lef...Premier Publishers
Global longitudinal strain (GLS) measured by Two-dimensional speckle tracking imaging (2D-STI) has been shown to be useful for assessing subtle changes in the left ventricular function with increasing severity of aortic stenosis (AS) in patients with preserved left ventricular ejection fraction (LVEF). To evaluate the relation between the severity of valve stenosis and GLS measured by 2D-STI in AS patients with normal LVEF. We studied 65 subjects (age, 53_75 years) with normal LVEF (≥50%) but without overt coronary artery disease. Patients were stratified into four groups (control, mild, moderate and severe AS), the clinical characteristics and echocardiographic findings were compared among the groups. Using dedicated software, we measured GLS in the apical four, two and three -chamber views. LVEF was not significantly different among the four groups. However, GLS showed significant differences among the four groups (controls;18.9±1.4, mild: 18.8±1.3, moderate: 15.35±1.6and severe: 12.42±1.4, ANOVA P = 0.001), GLS was significantly correlated with AVA, mean PG and LV mass index. Despite unchanged LVEF, GLS gradually decreased as severity of AS increases. GLS measured by 2D-STI is useful to assess subtle changes in LV function in AS patients.
Role of Left Ventricular Mass Index Versus Left Ventricular Relative Wall Thi...Premier Publishers
In non-cardioembolic stroke patients, the cardiac manifestations of elevated blood pressure are of particular interest. The value of LV geometry in the prediction of cardiovascular risk is controversial. Many reports detected that left ventricular hypertrophy is independently associated with risk of ischemic stroke. The primary objective of this study was to identify the frequency of different patterns of altered left ventricular geometry in patients with non cardioembolic stroke, and to assess whether a significant number of patients will miss the diagnosis of LV remodeling if the left ventricular relative wall thickness(RWT) is not evaluated or reported. 100 patients were referred within 48 hours after an acute non cardioembolic ischemic stroke for a transthoracic echocardiogram. The echocardiographic findings were analyzed. Mean age was 61.86 ± 12.59 years, 45 % men. Concentric remodeling carried the highest frequency (43%), followed by normal pattern (27%), concentric hypertrophy (22%), and eccentric hypertrophy (8%). The frequency of abnormal left ventricular RWT (61.4%) was significantly higher than that of abnormal LVMI.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
Coronary heart disease is best addressed by a comprehensive approach aimed at halting atherosclerotic disease and reducing the risk of thrombosis. Unfortunately, our success in optimal risk factor modification in patients with stable CHD remains poor: only 41% of patients achieved all basic goals in the recent ISCHEMIA trial, with success rates likely even lower outside the rigorous clinical trial context. A greater focus on achieving prevention goals in patients with CHD will have a substantial impact on patient outcome and rates of hospitalization and more resources and incentives should be allocated for improved secondary prevention.
The ISCHEMIA trial suggests that even selected, high-risk patients with extensive ischemic burden do not benefit from revascularization barring unacceptable angina despite OMT. As ISCHEMIA excluded patients with unacceptable angina, advanced heart failure, and those with unprotected left main disease, our evaluation may be geared to identify such patients for consideration of revascularization alongside an initial strategy of OMT.
Atherosclerosis is a systemic disease of the arterial circulation, with focal areas of more severe manifestation. From an imaging standpoint, the paradigm of ischemia testing may have come to an end. Recent evidence from COURAGE, PROMISE, SCOT-HEART, and ISCHEMIA has demonstrated that functional testing for inducible myocardial ischemia is inferior to anatomic assessment for risk stratifying and managing patients with suspected or known CHD. Consistent with a large body of evidence, risk from CHD is mediated by the extent of atherosclerotic disease burden and not by the extent of inducible ischemia. Given that 55% of patients had nonobstructive CHD by CT in PROMISE, which was associated with 77% of cardiovascular deaths and myocardial infarctions at follow-up, there is immense opportunity to impact the disease at an earlier stage in a very large population of patients with occult CHD.
Does Type of Dialysis Affect BNP in Fluid Overload Patients?Premier Publishers
Brain Natriuretic Peptide (BNP) levels are important as predictors of heart failure in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD). Twenty-four HD patients and 35 PD patients were included in the study. Each patient underwent an echocardiographic examination besides the determination of BNP, high-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy). BNP, left ventricular mass (LVM), left ventricular mass index (LVMI) and Hcy levels were significantly higher in HD group (p<0.05); hs-CRP levels were significantly higher in PD group (p=0.029). Predialysis BNP was significantly higher than the postdialysis BNP (p=0.003). There was a significant correlation between LVMI and BNP in PD (r=0.527, p=0.009) and predialysis BNP in HD (r=0.417, p=0.043) groups. In conclusion, BNP levels were found to be significantly correlated with LVMI in HD and PD patients. Hemodialysis patients had higher BNP and LVMI levels. This may be due to the hemodynamic changes which occur with the hemodialysis.
At SciArt Center, we think artists and scientists seek answers to the same fundamental questions: who are we, why are we here, and where are we going? Both art and science build models of human experience in order to extend the boundaries of human capacity. Despite this common ground, artists and scientists are too often separate in their endeavors. As a community-based arts organization, we provide support and promote cross-disciplinary approaches and interactions.
SciArt Center offers a variety of online resources for our members and also hosts an assortment of pop-up events around New York City open to the public. In creating a virtual space for our members to interact and share their work, we seek to connect scientists and artists online and explore the potentials of those connections. Paired with our partner publication SciArt in America, we publish the fruits of these cross-disciplinary interactions, bolstering the science-art community at large. Our science and art themed pop-up events including film screenings, book club meetings, art shows, panel talks, and social mixers, serve to physically bring together scientists and artists for a common creative and intellectual cause.
With the pursuit of scientific and artistic understanding within the larger paradigm of intellectual unity, SciArt Center encourages the connectivity and transdisciplinary approaches needed for the 21st century.
For more information, please visit: http://www.sciartcenter.org.
Aims: Post-mortem pathological studies have shown that a “vulnerable” plaque is the dominant patho-physiological mechanism responsible for acute coronary syndromes (ACS). One way to improve our understanding of these plaques in vivo is by using histological “surrogates” created by intravascular ultrasound derived virtual histology (IVUS-VH). Our aim in this analysis was to determine the relationship between site-specific differences in individual plaque areas between ACS plaques and stable plaques (SP), with a focus on remodelling index and the pattern of calcifying necrosis.
Methods and results: IVUS-VH was performed before percutaneous intervention in both ACS culprit plaques (CP) n=70 and stable disease (SP) n=35. A total of 210 plaque sites were examined in 105 lesions at the minimum lumen area (MLA) and the maximum necrotic core site (MAX NC). Each plaque site had multiple measurements made including some novel calculations to ascertain the plaque calcification equipoise (PCE) and the calcified interface area (CIA). CP has greater amounts of positive remodelling at the MLA (RI@MLA): 1.1 (±0.17) vs. 0.95 (±0.14) (P<0.001);><0.001)>1.12; RI @ MAX NC >1.22; PCE @ MLA <47.1%;><47.3%;>2.6; CIA @ MAX NC >3.1.
Conclusions: Determining the stage of calcifying necrosis, along with the remodelling index can discriminate between stable and ACS related plaques. These findings could be applied in the future to help detect plaques that have a vulnerable phenotype.
Echocardiographic guidance is critical for procedural success of paravalvular leak closure. Transesophageal echocardiography (TEE) and particularly three-dimensional echocardiography represent the gold standards. Fusion imaging provides real-time integration of three-dimensional echocardiography and X-ray fluoroscopy and can further facilitate spatial orientation, wire placement and device deployment. Intracardiac echocardiography (ICE) is a secondary approach possibly beneficial in selected cases.
Prosthetic paravalvular leaks (PVL) is an uncommon but serious complication after surgical valve replacement. Although surgery has been the traditional treatment of choice in hemodinamically significant PVL, percutaneous transcatheter closure is emerging as a novel and less invasive option for patients with high operative risk. Cardiac imaging, especially two- and three-dimensional transoesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. The aim of this manuscript is to review the role of cardiac imaging techniques in the interventional management of patients with symptomatic PVL.
Background: Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan.
Methods: Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or implantable cardiac defibrillator (ICD). A descriptive statistical analysis was performed.
Results: Thirty-two patients with myocarditis were included in the study. The mean age was 42.6±21.2 years and 81.2% were male. In a mean follow up of 30.4±17.8 months, the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or ICD was 15.6% (n=5). Two patients had heart failure (one of them underwent heart transplant), one patient needed ICD because of ventricular tachycardia and two other patients were re-hospitalized, for recurrent chest pain and for recurrent myocarditis respectively.
Conclusions: In our series of acute myocarditis diagnosed by CMR we found a low rate of cardiovascular events without mortality. These findings might oppose data from recently published myocarditis trials.
Abstract
Objective: The objective of this study is to determine the normal value of 3D left ventricular (LV) twist in subendocardial, mid-wall and subepicardial layers, as well as to study the effects of aging on 3D LV twist by tagged MR motion tracking techniques. Three dimensional motion detection based on 3D tagged MR images is robust to out-of-plane motion error; while 2D motion detection is inherently unable to analyze the 3D cardiac motion and may lead to inaccurate results.
Methods: The 3D LV volumetric images were acquired in 52 normal adult subjects (aged 21-82) and were analyzed by using 3D HARmonic phase (HARP) technique. HARP technique provided the 3D displacement fields and the displacements were utilized to compute the rotational values. LV twist was defined as apical rotation relative to the basal rotation, in the 3D coordinates. The LV twist values of subendocardial, midwall and subepicardial layers were analyzed separately. The measured parameters in this study were: peak apical rotation, peak basal rotation, and peak LV twist.
Result: Looking at the apex, the normal LV maintains a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal rotation values increase during the aging process, leading to an increased value of LV twist. Peak epicardial LV twist is (10.4±2.6 degrees) which is lower than the mid-wall LV twist (11.3±2.2 degrees) and endocardial LV twist (12.1±2.6 degrees) in the young group (21-35 years old). Also, peak epicardial LV twist is (12.2±2.6 degrees) which is lower than the mid-wall LV twist (14.4±2.8 degrees) and endocardial LV twist (14.7±2.5 degrees) in the middle aged group (21-35 years old). In a similar way, peak epicardial LV twist is (14.8±2.9 degrees) which is lower than the mid-wall LV twist (15.7±3.6 degrees) and endocardial LV twist (16.7±3.0 degrees) in the old group (50-65 years old). Regarding the older group (more than 65 years old), peak epicardial LV twist is (15.9±3.1 degrees) which is lower than the mid-wall LV twist (16.2±3.4 degrees) and endocardial LV twist (18.3±3.0 degrees).
Conclusions: It is feasible to measure the subepicardial, mid-wall and subendocardial twist in tagged MR images. The twist value gradually increases in the aging process. Outside layers have greater twist values compared to the inside layers.
Abstract
This issue of ‘Cardiovascular Diagnosis and Therapy (CDT)’ has a special focus on application and development of magnetic resonance imaging (MRI) in cardiovascular diseases. The challenges associated with imaging of the heart and the huge disease burden associated with cardiovascular diseases has been one of the major motivations in the last few years for the development of new MRI techniques. A realm of new pulse sequences, either focusing on ‘freezing’ motion or on providing improved endogenous contrast mechanisms were developed in this context and are now being evaluated in clinical and preclinical research efforts focusing on the heart and vascular circulation.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
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
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.