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A Multicenter Experience in the Use of Allomap and Allosure Surveillance Strategies in Multiorgan Heart-Kidney and Heart-Liver Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Cardiac Contractility Modulation Use in Decompensated Heart Failure Requiring Inotropic Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Opioid Sparing Multimodal Analgesia for Transoral Robotic Surgery: Improved Analgesia and Narcotic Use Reduction. OTO Open 2023; 7:e17. [PMID: 36998552 PMCID: PMC10046737 DOI: 10.1002/oto2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/23/2022] [Indexed: 03/15/2023] Open
Abstract
Objective To compare postoperative pain scores and opioid consumption in patients after transoral robotic surgery (TORS). Study Design Single institution retrospective cohort study. Setting TORS was performed at a single academic tertiary care center. Methods This study compared traditional opioid-based and opioid-sparing multimodal analgesia (MMA) regimens in patients with oropharyngeal and supraglottic malignancy after TORS. Data were obtained from the electronic health records from August 2016 to December 2021. The average postoperative pain scores and total opioid consumption in morphine milligram equivalents were calculated for postoperative days (PODs) 0 to 3. The secondary objectives were to quantify and characterize opioid prescriptions upon hospital discharge. Results A total of 114 patients were identified for this study, 58 patients in the non-MMA cohort and 56 in the MMA cohort. Postoperative pain levels in the MMA cohort were statistically lower on POD 0 (p = 0.001), POD 1 (p = 0.001), and POD 3 (p = 0.004). Postoperative opioid consumption decreased significantly in the MMA cohort from 37.7 to 10.8 mg on POD 0 (p = 0.002), 65.9 to 19.9 mg on POD 1 (p < 0.001), 36.0 to 19.3 mg on POD 2 (p = 0.02), and 45.4 to 13.8 mg on POD 3 (p = 0.02). The number of patients discharged from the hospital with a prescription for narcotics was significantly lower in the MMA cohort (71.4%) compared with the non-MMA cohort (98.3%) (p < 0.001). Conclusion Implementation of our MMA pain protocol reduced pain levels and narcotic consumption in the immediate postoperative period.
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Impact of the 2018 UNOS Heart Allocation Policy Change on Post-Transplant Outcomes: Intermediate Term Analysis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Improving Results Management Processes in an Acute Hospital Using a Multi-Faceted Approach. Int J Qual Health Care 2021; 34:6485219. [PMID: 34962273 DOI: 10.1093/intqhc/mzab158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Radiological examinations and laboratory tests are routinely ordered by hospital physicians as part of the care plan to diagnose and treat patients. However, the failure to actively review and follow-up on these results pose a significant problem to patient safety. A study team was formed to mitigate the clinical risks of poor results management, which was identified as a top clinical risk in our organisation, in order to make improvements to the results management process and to ensure the timely review, acknowledgement, and follow-up of test results. METHODS The institutional expectations of results management were set and published as a hospital policy, which was communicated to all clinical departments for compliance. Improvements to the electronic medical records system were made to facilitate the results acknowledgement process, and physicians were engaged to educate them on the importance of results management. RESULTS The study team observed a decrease in unacknowledged results from approximately 16,000 in March 2017 to 2673 in December 2020. The compliance rate for acknowledgement results increased from a monthly average of 83.7% (from March to December 2017) to a monthly average of 99.3% (in 2020). The risk score for results management decreased from 16 to 6.5, and was excluded from the organisation's top clinical risks. CONCLUSION This study showed the importance of both system improvements and culture changes that are required to improve the process of results management, and provides a step forward for the hospital to safeguard patient safety and mitigate clinical risk.
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EP.TU.369Straight to Test (STT) vs. Traditional Colorectal Target Investigations Pathway - A Local Audit. Br J Surg 2021. [PMCID: PMC8574327 DOI: 10.1093/bjs/znab311.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Aims The STT pathway was borne out of the National Cancer Strategy 2015 and faster diagnosis standard to rule in, or out, cancer within 28 days of referral. We aimed to review local target standard of practice, including comparison of STT vs Traditional pathways towards reaching the national standards. Methods The Somerset Database for all target referrals to the department was accessed. We chose October 2019 as a period unaffected by COVID-19. Time to investigation, results and treatment were reviewed. SPSS v.16 was used to perform an unpaired T-test of Traditional vs. STT time to diagnosis. Results 212 patients were referred for target investigations. 53 declined, DNA-ed or were unfit. 159 proceeded to investigations of which 7 cancers were diagnosed: 4 colorectal, 1 gastric and 2 lung. Time to diagnosis averaged 45.8 days and only 47/159 (29.6%) had their definitive diagnosis in 28 days. 52 patients were streamed to STT and 107 traditional pathways. STT patients were diagnosed at 36.3 days (95% CI 28.1-44.6) and traditional patients 50.5 days (95% CI 45.4-55.7) (P = 0.005). Cancer treatment was received median day 59 (range 27-189) and 4/7 received this within 62 days. Conclusion Target investigations have low pick up rates of cancers with ever increasing referrals. Our centre did not meet aspirational national targets of time to treatment or diagnosis, although STT patients were diagnosed significantly faster. With COVID-19, rationalisation of patient contact with maintained diagnosis rates must be strategised. Stricter FIT testing with risk stratification and STT expansion is one strategy.
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EP.WE.577Chest air-leak complications in critically ill COVID-19 Patients: a retrospective single-centre cohort study. Br J Surg 2021. [PMCID: PMC8574365 DOI: 10.1093/bjs/znab308.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction COVID-19 has caused a global pandemic with a proportion of patients admitted to intensive care with viral pneumonia and respiratory failure. Spontaneous air leaks have been reported in patients with COVID-19. We report on a phenomenon of significant chest air-leak manifestations on a cohort of critically unwell intubated COVID-19 patients in our single centre. Methods All patients admitted to our single-centre intensive care unit during the initial outbreak of COVID-19 in the UK were identified. Individual electronic notes and imaging were screened to look for complications of: surgical emphysema, pneumomediastinum and/or pneumothorax. Results 158 patients were admitted to our intensive care and eleven (7.0%) of patients were found to have suffered air leak complications unrelated to line insertion. Five suffered surgical emphysema only, one surgical emphysema with pneumomediastinum and two with the full triad of surgical emphysema, pneumomediastinum & pneumothorax. Two patients had unilateral pneumothoraces and one patient experienced a tension pneumothorax. Four patients were managed conservatively and seven had chest drains inserted. Overall outcomes were: one patient was discharged home, one discharged to ward, two transferred to an outside hospital and seven died. Conclusion Air-leak complications in COVID-19 patients, both spontaneous and ventilation associated are an under-recognised phenomenon. In the critically ill population literature suggests there is a > 5% incidence and risk reduction strategies should be considered. We advocate for early diagnosis and decompressive therapy with chest drains to avoid tamponade in intubated patients. Virus spread from air-leak should also be considered and health-care professionals adequately protected.
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Abstract
Abstract
Aims
Laparoscopic surgery is technically challenging and assessment of competency is necessary to ensure patient safety and guide training. Existing tools of assessment are mostly subjective, with a growing need for objective credentialing. LapPass™ was developed by a UK-based laparoscopic society as an accessible simulation assessment tool. The aim of this study was to report on its development and preliminary findings of usability and validity.
Methods
LapPass™ consists of 4 tasks that test: bimanual dexterity, simulated appendicectomy, dissection and intracorporeal suturing. Participants were prospectively recruited from testing events. Online surveys were sent to assessors and participants to assess the usability, face and content validity of the tool. Options to respond were on a five-point Likert scale with ratings from strongly disagree (1) to strongly agree (5).
Results
LapPass was launched and offered to trainees as free-of-charge assessment tool. 31 participants and 12 assessors took part. The 1st time pass rate for bimanual dexterity was 19/29 (65.5%), appendicectomy 13/23 (56.5%), dissection 20/27 (74.1%) and intracorporeal suturing 6/19 (31.5%). The mean scores for participants’ usability and validity were 3.8 and 4.12 for bimanual dexterity; 3.96 and 4.37 for appendicectomy; 4.5 and 4.16 for dissection and 3.84 and 4.52 for intracorporeal suturing. Assessors' mean score of usability was 4.5 across all tasks. Assessors scored validity of bimanual dexterity 4.35, appendicectomy 4.42, dissection 3.71 and intracorporeal suturing 4.65.
Conclusion
LapPass™ is a an accessible objective assessment tool for laparoscopic basic surgical skills with preliminary data to confirm its usability and face and content validity.
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Microbiome-Specific Statistical Modeling Identifies Interplay Between Gastrointestinal Microbiome and Neurobehavioral Outcomes in Patients With Autism: A Case Control Study. Front Psychiatry 2021; 12:682454. [PMID: 34744810 PMCID: PMC8563626 DOI: 10.3389/fpsyt.2021.682454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/22/2021] [Indexed: 12/20/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with unclear mechanisms of pathogenesis. Gastrointestinal microbiome alterations were found to correlate with ASD core symptoms, but its specific role in ASD pathogenesis has not been determined. In this study, we used a case-control strategy that simultaneously compared the ASD gastrointestinal microbiome with that from age-sex matched controls and first-degree relative controls, using a statistical framework accounting for confounders such as age. Enterobacteriaceae (including Escherichia/Shigella) and Phyllobacterium were significantly enriched in the ASD group, with their relative abundances all following a pattern of ASD > first degree relative control > healthy control, consistent with our hypothesis of living environment and shared microbial and immunological exposures as key drivers of ASD gastrointestinal microbiome dysbiosis. Using multivariable omnibus testing, we identified clinical factors including ADOS scores, dietary habits, and gastrointestinal symptoms that covary with overall microbiome structure within the ASD cohort. A microbiome-specific multivariate modeling approach (MaAsLin2) demonstrated microbial taxa, such as Lachnoclostridium and Tyzzerella, are significantly associated with ASD core symptoms measured by ADOS. Finally, we identified alterations in predicted biological functions, including tryptophan and tyrosine biosynthesis/metabolism potentially relevant to the pathophysiology of the gut-brain-axis. Overall, our results identified gastrointestinal microbiome signature changes in patients with ASD, highlighted associations between gastrointestinal microbiome and clinical characteristics related to the gut-brain axis and identified contributors to the heterogeneity of gastrointestinal microbiome within the ASD population.
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The Effects of Limosilactobacillus reuteri LR-99 Supplementation on Body Mass Index, Social Communication, Fine Motor Function, and Gut Microbiome Composition in Individuals with Prader-Willi Syndrome: a Randomized Double-Blinded Placebo-Controlled Trial. Probiotics Antimicrob Proteins 2021; 13:1508-1520. [PMID: 34115318 PMCID: PMC8578098 DOI: 10.1007/s12602-021-09800-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder associated with developmental delay, obesity, and neuropsychiatric comorbidities. Limosilactobacillus reuteri (Lactobacillus reuteri, Lact. reuteri) has demonstrated anti-obesity and anti-inflammatory effects in previous studies. In the present study, we aim to evaluate the effects of Lact. reuteri supplementation on body mass index (BMI), social behaviors, and gut microbiota in individuals with PWS. We conducted a 12-week, randomized, double-blind, placebo-controlled trial in 71 individuals with PWS aged 6 to 264 months (64.4 ± 51.0 months). Participants were randomly assigned to either receive daily Lact. reuteri LR-99 probiotic (6 × 1010 colony forming units) or a placebo sachet. Groupwise differences were assessed for BMI, ASQ-3, and GARS-3 at baseline, 6 weeks, and 12 weeks into treatment. Gut microbiome data was analyzed with the QIIME2 software package, and predictive functional profiling was conducted with PICRUSt-2. We found a significant reduction in BMI for the probiotic group at both 6 weeks and 12 weeks relative to the baseline (P < 0.05). Furthermore, we observed a significant improvement in social communication and interaction, fine motor function, and total ASQ-3 score in the probiotics group compared to the placebo group (P < 0.05). Altered gut microbiota was observed in the probiotic group to favor weight loss and improve gut health. The findings suggest a novel therapeutic potential for Lact. reuteri LR-99 probiotic to modulate BMI, social behaviors, and gut microbiota in Prader-Willi syndrome patients, although further investigation is warranted.Trial registration Chinese Clinical Trial Registry: ChiCTR1900022646.
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Acute appendicitis and retroperitoneal abscess: rare complications of sigmoid diverticulitis. Radiol Case Rep 2021; 16:1961-1964. [PMID: 34149983 PMCID: PMC8193070 DOI: 10.1016/j.radcr.2021.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Diverticulitis is a common cause of an acute surgical abdomen and computed tomography has become an essential part of work up particularly to identify complications that commonly include intraperitoneal perforation, abscess and fistula formation. We report the case of an 81-year-old male who presented to the emergency department with acute lower abdominal pain and was found to have sigmoid diverticulitis with the rare complications of a diverticular abscess that had formed a sinus tract and perforated into the retroperitoneum and secondary acute appendicitis. Initial management was with intravenous antibiotics, a Hartmann's procedure and appendicectomy. Subsequently the retroperitoneal collection was drained percutaneously. The case was further complicated by the patient's multiple co-morbidities and unfortunately the patient died 6 weeks after admission from sepsis. This case highlights the role of computed tomography in the pre- and post-operative period to identify complications which are often clinically occult and require early surgical and interventional radiology management to optimize outcomes.
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Probiotic and Oxytocin Combination Therapy in Patients with Autism Spectrum Disorder: A Randomized, Double-Blinded, Placebo-Controlled Pilot Trial. Nutrients 2021; 13:1552. [PMID: 34062986 PMCID: PMC8147925 DOI: 10.3390/nu13051552] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorder (ASD) is a rapidly growing neurodevelopmental disorder. Both probiotics and oxytocin were reported to have therapeutic potential; however, the combination therapy has not yet been studied. We conducted a randomized, double-blinded, placebo-controlled, 2-stage pilot trial in 35 individuals with ASD aged 3-20 years (median = 10.30 years). Subjects were randomly assigned to receive daily Lactobacillus plantarum PS128 probiotic (6 × 1010 CFUs) or a placebo for 28 weeks; starting on week 16, both groups received oxytocin. The primary outcomes measure socio-behavioral severity using the Social Responsiveness Scale (SRS) and Aberrant Behavior Checklist (ABC). The secondary outcomes include measures of the Clinical Global Impression (CGI) scale, fecal microbiome, blood serum inflammatory markers, and oxytocin. All outcomes were compared between the two groups at baseline, 16 weeks, and 28 weeks into treatment. We observed improvements in ABC and SRS scores and significant improvements in CGI-improvement between those receiving probiotics and oxytocin combination therapy compared to those receiving placebo (p < 0.05). A significant number of favorable gut microbiome network hubs were also identified after combination therapy (p < 0.05). The favorable social cognition response of the combination regimen is highly correlated with the abundance of the Eubacterium hallii group. Our findings suggest synergic effects between probiotics PS128 and oxytocin in ASD patients, although further investigation is warranted.
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Altered Autonomic Functions and Gut Microbiome in Individuals with Autism Spectrum Disorder (ASD): Implications for Assisting ASD Screening and Diagnosis. J Autism Dev Disord 2021; 51:144-157. [PMID: 32410097 DOI: 10.1007/s10803-020-04524-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurological and developmental disorder, and a growing body of literature suggests the presence of autonomic nervous system (ANS) dysfunction in individuals with ASD. ANS is part of the "gut brain axis", which consists of an intricate interplay between the gut microbiome, mucosal immune system, enteric nervous system, ANS, and central processes receiving input from the vagus nerve. Measurements of the gut microbiome and the autonomic indices can serve as non-invasive markers of the status of the gut-brain axis in ASD. To our knowledge, no previous studies have explored the relationship between ANS and gut microbiome in individuals with ASD. Furthermore, while previous studies investigated the use of autonomic indices and gut microbiome independently as markers of ASD-related comorbidities, such as anxiety, cardiovascular issues, and gastrointestinal dysfunction, the use of combined autonomic indices and gut microbiome factors to classify ASD and control subjects has not been explored. In this study, we characterized autonomic function of a group of individuals with ASD in comparison to their paired, first-degree relative controls. Second, we explored the ASD gut-brain-axis through the relationship between gut microbiome markers and autonomic indices, as well as the correlation between the gut-brain-axis and clinical presentation of ASD. Lastly, this study explores the predictive capability of gut-brain-axis biomarkers (including autonomic and microbiome indices) in subtyping ASD cases, serving as a starting point to investigate the possibility of assisting in ASD screening and diagnosis that still heavily relies on psychological testing, which may be based on highly subjective standards.
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Outcomes in Heart Transplant (HT) in Patients Receiving Inotropes Following UNOS Heart Allocation Policy Changes. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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One-year before and after UNOS Status Change Effect on ECMO as a Bridge to Heart Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Waitlist Outcomes in Patients Supported with Extracorporeal Membrane Oxygenation before and after the UNOS Policy Allocation Change. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The Effects of Probiotic Supplementation on Anthropometric Growth and Gut Microbiota Composition in Patients With Prader-Willi Syndrome: A Randomized Double-Blinded Placebo-Controlled Trial. Front Nutr 2021; 8:587974. [PMID: 33681271 PMCID: PMC7933553 DOI: 10.3389/fnut.2021.587974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/02/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Prader-Willi Syndrome (PWS) is a rare genetic disorder associated with developmental delay, obesity, and neuropsychiatric comorbidities. Bifidobacterium animalis subsp. lactis has demonstrated anti-obesity and anti-inflammatory effects in previous studies. Aim: To evaluate the effects of Bifidobacterium animalis subsp. lactis probiotics supplementation on anthropometric growth, behavioral symptoms, and gut microbiome composition in patients with PWS. Methods: Ethical Approval was issued by the Internal Review Board (IRB) of the Second Affiliated Hospital of Kunming Medical University (Review-YJ-2016-06). We conducted a 12-week, randomized, double-blind, placebo-controlled trial in 68 patients with Prader-Willi syndrome aged 11 months−16 years (mean = 4.2 years old) who were randomly assigned to receive daily B. lactis-11 probiotics (6 × 1010 CFUs) or a placebo sachet. Weight, height, ASQ-3, ABC, SRS-2, and CGI-I were compared between the two groups at baseline and at 6 and 12 weeks into treatment. Gut microbiome data were analyzed with the QIIME 2 software package, and functional gene analysis was conducted with PICRUSt-2. Results: We found a significant increase in height (mean difference = 2.68 cm, P < 0.05) and improvement in CGI-I (P < 0.05) in the probiotics group compared to the placebo group. No significant change in weight or psychological measures were observed. Probiotic treatment altered the microbiome composition to favor weight loss and gut health and increased the abundance of antioxidant production-related genes. Conclusions: The findings suggest a novel therapeutic potential for Bifidobacterium animalis subsp. lactis probiotics in Prader-Willi syndrome patients, although further investigation is warranted.
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Can quantitative 18F-FDG PET/CT and serum cytokine analysis differentiate ARVC from cardiac sarcoidosis? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) and Cardiac Sarcoidosis (CS) may both cause malignant arrhythmia and sudden death, but differentiating the two can be difficult.
Purpose
To investigate the role of quantitative FDG PET/CT at distinguishing ARVC from CS, and explore whether addition of an inflammatory panel correlates with PET uptake, aiding diagnosis.
Methods
10 patients with CS, 10 with ARVC were enrolled. Participants were prospectively studied with PET/CT. LV uptake was quantified using software and a 17-segment model, measuring maximum standardised uptake (SUVmax) and mean myocardial uptake, comparing these to a local normal reference range (21 volunteers) using a z-score. Blood levels of IL-1b, IL-6, IL-8, IL10, IL-12p40, MCP-1, TGFb, GRO, TNFa, IFNy, FGF2, PDGF were measured using ELISA, compared with 10 healthy controls.
Results
There were no significant differences in cytokine levels between CS and ARVC; most cytokine levels were higher in CS, except IL-6, IL-8 and MCP-1 in ARVC (Table 1). Increased PET uptake was noted in 1 segment of 1 ARVC patient, and in 1–2 segments of 5 CS patients (z-scores 2.25 SD; 2.15–2.38 SD). No pattern of uptake distinguished ARVC from CS, qualitatively assessing LV polar maps (Figure 1A, B). SUVmax and mean uptake were higher in CS vs. ARVC (p<0.05; p=0.13). No significant correlation between cytokine levels and PET uptake was detected (Figure 1C, D).
Conclusion
Quantitative PET/CT uptake and a blood inflammatory panel did not have utility in differentiating the two conditions in our population. There was generally more PET and serum inflammatory activity in CS.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): NHS Endowments
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The Evolution of Duplicated Genes of the Cpi-17/Phi-1 ( ppp1r14) Family of Protein Phosphatase 1 Inhibitors in Teleosts. Int J Mol Sci 2020; 21:ijms21165709. [PMID: 32784920 PMCID: PMC7460850 DOI: 10.3390/ijms21165709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022] Open
Abstract
The Cpi-17 (ppp1r14) gene family is an evolutionarily conserved, vertebrate specific group of protein phosphatase 1 (PP1) inhibitors. When phosphorylated, Cpi-17 is a potent inhibitor of myosin phosphatase (MP), a holoenzyme complex of the regulatory subunit Mypt1 and the catalytic subunit PP1. Myosin phosphatase dephosphorylates the regulatory myosin light chain (Mlc2) and promotes actomyosin relaxation, which in turn, regulates numerous cellular processes including smooth muscle contraction, cytokinesis, cell motility, and tumor cell invasion. We analyzed zebrafish homologs of the Cpi-17 family, to better understand the mechanisms of myosin phosphatase regulation. We found single homologs of both Kepi (ppp1r14c) and Gbpi (ppp1r14d) in silico, but we detected no expression of these genes during early embryonic development. Cpi-17 (ppp1r14a) and Phi-1 (ppp1r14b) each had two duplicate paralogs, (ppp1r14aa and ppp1r14ab) and (ppp1r14ba and ppp1r14bb), which were each expressed during early development. The spatial expression pattern of these genes has diverged, with ppp1r14aa and ppp1r14bb expressed primarily in smooth muscle and skeletal muscle, respectively, while ppp1r14ab and ppp1r14ba are primarily expressed in neural tissue. We observed that, in in vitro and heterologous cellular systems, the Cpi-17 paralogs both acted as potent myosin phosphatase inhibitors, and were indistinguishable from one another. In contrast, the two Phi-1 paralogs displayed weak myosin phosphatase inhibitory activity in vitro, and did not alter myosin phosphorylation in cells. Through deletion and chimeric analysis, we identified that the difference in specificity for myosin phosphatase between Cpi-17 and Phi-1 was encoded by the highly conserved PHIN (phosphatase holoenzyme inhibitory) domain, and not the more divergent N- and C- termini. We also showed that either Cpi-17 paralog can rescue the knockdown phenotype, but neither Phi-1 paralog could do so. Thus, we provide new evidence about the biochemical and developmental distinctions of the zebrafish Cpi-17 protein family.
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Utilization of Public Health Service Increased Risk Donors in Heart Transplantation and Outcomes: UNOS Registry Review. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Comparison of Six-Month Outcomes in Restrictive Cardiomyopathy Patients before and after UNOS Allocation System Change. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Comparison of Six-Month Outcomes in Patients with Cardiac Amyloidosis before and after the UNOS Allocation System Change. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Heart Transplant Outcomes for Patients with Myocarditis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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A Multi-Platform Treatment Planning Benchmark Study for Spinal Radiosurgery. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Novel Hydrolyzed Chicken Sternal Cartilage Extract Improves Facial Epidermis and Connective Tissue in Healthy Adult Females: A Randomized, Double-Blind, Placebo-Controlled Trial. Altern Ther Health Med 2019; 25:12-29. [PMID: 31221944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Dietary supplement manufacturers claim cutaneous anti-aging properties for their products; however, research supporting these claims remains sparse. OBJECTIVES The study intended to determine if a correlation existed between the effects of a collagen dietary supplement and changes associated with skin aging. DESIGN The study was a 12-week, double-blind, placebo-controlled trial. SETTING The study took place at a clinical facility specializing in dermatological testing that could perform biophysical, instrumental analysis on the effects of proprietary supplement on human skin. PARTICIPANTS Participants were 128 females, aged 39-59 (50.57 ± 5.55). INTERVENTION Participants were randomly assigned to an intervention or a placebo. The intervention consisted of twice daily oral administration of a supplement containing 500 mg BioCell Collagen, a chicken sternal cartilage derived dietary ingredient composed of a naturally-occurring matrix of hydrolyzed collagen type-II (≥300 mg), chondroitin sulfate (≥100 mg), hyaluronic acid (≥50 mg). OUTCOME MEASURES The primary parameters included transepidermal water loss, viscoelasticity, hydration, (indirect) collagen content, chromophore (melanin) content and hemoglobin level, and photographic analysis. An expert visually graded participants' skin to determine the intervention's efficacy, measuring facial lines and wrinkles, crow's feet lines and wrinkles, skin texture and smoothness, and skin tone. The presence of erythema and/or dryness determined tolerance. Secondary outcome measures were tolerance and incidence of adverse events, and the participant's perception of the supplement's value. RESULTS For the 113 participants completing the study, the dietary supplementation compared to a placebo: (1) significantly reduced facial lines and wrinkles (P = .019) and crow's feet lines and wrinkles (P = .05), (2) increased skin elasticity (P = .008) and cutaneous collagen content (P < .001) by 12%, (3) improved indicators associated with a more youthful skin appearance based on visual grading and wrinkle width (P = .046), and (4) decreased skin dryness and erythema. No difference existed between the supplement and the placebo for skin-surface water content or retention. The supplement was well tolerated, with no reported adverse reactions. CONCLUSIONS Dietary supplementation with chicken, sternal cartilage extract supports the accumulation of types-I/III collagen in skin to promote increased elasticity and reduced skin wrinkling.
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The Effects of Skin Aging Associated with the Use of BioCell Collagen: A Randomized, Double-blind, Placebo-controlled Clinical Trial (P06-122-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz031.p06-122-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The aim of the study intended to correlate the effects of the dietary supplement, BioCell Collagen, with any changes associated with skin aging, since dietary supplements claim cutaneous anti-aging properties for their products; however, research supporting these claims remains sparse.
Methods
A 12-week, randomized, double-blind, placebo-controlled trial of 128 female subjects, aged 39–59 (50.57 ± 5.55) randomly assigned to treatment or placebo. Intervention: Twice daily oral administration of a supplement containing 500 mg of a naturally occurring matrix of collagen type-II peptides, hyaluronic acid, and chondroitin sulfate, derived from chicken sternal cartilage, or placebo. Primary outcome measures: trans-epidermal water loss, viscoelasticity, hydration, collagen content, chromophore (melanin) content and hemoglobin level, and photographic analysis. Expert visual grading for facial lines/wrinkles, crow's feet lines/wrinkles, skin texture/smoothness, and skin tone. Secondary outcomes: Tolerance and incidence of adverse events. Presence of erythema and/or dryness determined tolerance. Participant's perception of the product's value.
Results
Dietary supplementation significantly reduced facial lines and wrinkles (p = 0.019), crow's feet lines/wrinkles (p = 0.05), increased skin elasticity (p = 0.05), cutaneous collagen content (p = 0.001), and improved indicators of youthful skin appearance and wrinkle width (p = 0.046), and decreased skin dryness and erythema, compared to placebo. There was no difference between supplement and placebo for skin surface water content or retention. Supplement was well tolerated with no reported adverse reactions.
Conclusions
Dietary supplementation of this chicken sternal cartilage extract supports the accumulation of types-I/III collagen in skin to promote increased elasticity and reduced skin wrinkling in women 39 to 59 years of age.
Funding Sources
BioCell Technology, LLC.
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Book Review: Ambulatory Anesthesia & Perioperative Analgesia. Anaesth Intensive Care 2019. [DOI: 10.1177/0310057x0503300526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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2061. Does Robotic TME Offer Better Oncological Outcome For Rectal Cancer? Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Impact of Contemporary Ventricular Assist Device Therapy on Renal Outcomes in End Stage Heart Failure. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Acute Reduction in Pulmonary Artery Pressures with Sacubitril-Valsartan Measured by the CardioMEMS HF Device. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Maintenance Intravenous Fluid and Electrolyte Prescription for Surgical Patients: Comparison to NICE CG174 Guidance. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Predicting Outcomes in Patients Requiring Extracorporeal Membrane Oxygenation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Developmental neuroscience and stunting: A strong case for action in the
first 1000 days. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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35
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Malnutrition in Lao PDR: Does maternal health knowledge buffer the
negative effects of environmental risk factors on child stunting? Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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A randomized controlled trial to determine the efficacy of a high carbohydrate and high protein ready-to-eat food product for weight loss. Clin Obes 2016; 6:108-16. [PMID: 26781700 DOI: 10.1111/cob.12137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/04/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Incorporating meal replacements has been shown to produce a significantly greater weight loss than a conventional reduced calorie diet. Ready-to-eat conventional foods may also be effective in this role and provide additional benefit because of their palatability, acceptance and enjoyment and thus increase dietary compliance. This trial investigated the efficacy of a ready-to-eat food product (Vita-Weat biscuit) that is both high in carbohydrate and high in protein as part of a diet prescription for weight loss in an overweight and obese population group. A total of 76 participants were randomized to a 6-week weight loss intervention including the ready-to-eat food product (intervention group) or advice on the 'Australian Guide to Healthy Eating' (control group). Both groups lost approximately 2 kg weight which equated to a reduction in body mass index of 0.70 kg m(-2) . There was no significant difference in percentage weight loss from screening to 6 weeks between the two groups; mean difference for the intervention vs. CONTROL GROUP -0.20% (95% confidence interval: -0.96, 1.36); P = 0.73. Both diets were nutritionally matched and well-accepted over the 6-week period. This study shows that the inclusion of a ready-to-eat food product can be included as part of a dietary programme to achieve a clinically significant weight loss over a short period. This may have benefit when incorporated into an individual's meal plan intermittently to assist weight control. It also provides support for current public health nutritional guidelines as the participants in this study following such advice were also successful in achieving a clinically meaningful weight loss.
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EP-1180: VMAT makes it possible to treat more advanced stages of NSCLC compared to 3D-CRT. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reverse vs. total shoulder arthroplasty: X-ray, range of motion and strength. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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39
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A-52 * Cognitive Function in Older Patients with Lymphoma and Leukemia Prior to Hematopoietic Stem Cell Transplant. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Monte Carlo calculation of dose distributions in oligometastatic patients planned for spine stereotactic ablative radiotherapy. Phys Med Biol 2013; 58:7107-16. [DOI: 10.1088/0031-9155/58/20/7107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Piloting the CANRISK tool in Vancouver Coastal Health. CHRONIC DISEASES AND INJURIES IN CANADA 2011; 32:12-18. [PMID: 22153172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Vancouver Coastal Health Authority's Healthy Living Program implemented this pilot study to test and validate the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) developed by the Public Health Agency of Canada as a screening tool for undiagnosed type 2 diabetes mellitus (DM) and prediabetes. Key objectives were to test the feasibility and acceptability of screening urban ethnic groups using the CANRISK, increase awareness of risk factors for DM and preDM and develop resources for lifestyle change. METHODS The study recruited participants through community groups and churches, intraorganizational emails, primary care clinics and word of mouth. They completed the CANRISK and an oral glucose tolerance test (OGTT) either individually or as part of a group. Groups received a brief diabetes prevention information session. Documents to support lifestyle change were distributed to all participants. RESULTS Participants (n = 556) were recruited among East Asian, Caucasian, South Asian and Latin American ethnic groups. Of these, 17% had OGTT results in the preDM range and 3% in the DM range. Over 90% of participants reported that the CANRISK wording was clear and that they had received useful information about lowering their diabetes risk. CONCLUSION The benefit of using an OGTT was in identifying 11% of the sample of participants who had impaired glucose tolerance (IGT) and did not show abnormal fasting plasma glucose (FPG) results. All participants with abnormal laboratory results were provided with follow-up educational interventions in their own language.
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National Survey of Health Care Providers' Views on the Risk of Inadvertent Exposure of Pregnant Patients to Ionizing Radiation in Canadian Radiotherapy Departments. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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2049 POSTER Is RapidArc Superior to 3D Conformal Radiotherapy for Radical Radiation of Primary Esophageal Carcinoma – A Dosimetric Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Book Review: Pre-hospital Anaesthesia Handbook. Anaesth Intensive Care 2011. [DOI: 10.1177/0310057x1103900331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Species dependent differences in the actions of sympathetic nerves and noradrenaline in the internal anal sphincter. Neurogastroenterol Motil 2007; 19:937-45. [PMID: 17973631 DOI: 10.1111/j.1365-2982.2007.00982.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Excitatory motor innervation to the internal anal sphincter (IAS) of the monkey, the rabbit and mouse were compared. Contractile responses to electrical field stimulation of nerves (EFS, atropine 1 micromol L(-1) and N(omega)-nitro-L-arginine 100 micromol L(-1) present throughout) were examined in isolated strips of IAS. In the monkey IAS, EFS caused frequency dependent (1-30 Hz) contractions which were abolished by guanethidine (10 micromol L(-1)) or phentolamine (3 micromol L(-1)). The sympathetic neurotransmitter noradrenaline (NA) also caused concentration-dependent (10 nmol L(-1)-100 micromol L(-1)) contractions which were abolished by phentolamine revealing a small relaxation that was abolished by propranolol (3 micromol L(-1)). In contrast, EFS caused only relaxation of the mouse and rabbit IAS which was not affected by guanethidine. Furthermore, NA relaxed these muscles and relaxation was nearly abolished by combined addition of phentolamine and propranolol. In conclusion, the monkey IAS is functionally innervated by sympathetic nerves that contract the muscle via excitatory alpha-adrenergic receptors. In contrast, no significant motor function could be identified for sympathetic nerves in the rabbit or mouse IAS although adrenergic receptors linked to muscle inhibition are present. These data reveal species dependent differences in sympathetic motor innervation and suggest that some species are more appropriate than others as models for motor innervation to the human IAS.
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Changes in Excitability of the Cortical Projections to the Human Tibialis Anterior After Paired Associative Stimulation. J Neurophysiol 2007; 97:1951-8. [PMID: 17202240 DOI: 10.1152/jn.01176.2006] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Paired associative stimulation (PAS) based on Hebb's law of association can induce plastic changes in the intact human. The optimal interstimulus interval (ISI) between the peripheral nerve and transcranial magnetic stimulus is not known for muscles of the lower leg. The aims of this study were to investigate the effect of PAS for a variety of ISIs and to explore the efficacy of PAS when applied during dynamic activation of the target muscle. PAS was applied at 0.2 Hz for 30 min with the tibialis anterior (TA) at rest. The ISI was varied randomly in seven sessions ( n = 5). Subsequently, PAS was applied ( n = 14, ISI = 55 ms) with the TA relaxed or dorsi-flexing. Finally, an optimized ISI based on the subject somatosensory evoked potential (SEP) latency plus a central processing delay (6 ms) was used ( n = 13). Motor-evoked potentials (MEPs) were elicited in the TA before and after the intervention, and the size of the TA MEP was extracted. ISIs of 45, 50, and 55 ms increased and 40 ms decreased TA MEP significantly ( P = 0.01). PAS during dorsi-flexion increased TA MEP size by 92% ( P = 0.001). PAS delivered at rest resulted in a nonsignificant increase; however, when the ISI was optimized from SEP latency recordings, all subjects showed significant increases ( P = 0.002). No changes in MEP size occurred in the antagonist. Results confirm that the excitability of the corticospinal projections to the TA but not the antagonist can be increased after PAS. This is strongly dependent on the individualized ISI and on the activation state of the muscle.
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Fluid deficits and hypotension during colonoscopy. Anaesth Intensive Care 2006; 34:305-6. [PMID: 16802481 DOI: 10.1177/0310057x0603400318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Interplay between inhibition of adenosine uptake and phosphodiesterase type 3 on cardiac function by cilostazol, an agent to treat intermittent claudication. J Cardiovasc Pharmacol 2001; 38:775-83. [PMID: 11602824 DOI: 10.1097/00005344-200111000-00014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors have recently shown that cilostazol, a type 3 cyclic nucleotide phosphodiesterase (PDE3) inhibitor, has a much weaker positive inotropic effect than milrinone, a PDE3 inhibitor of similar potency. They have also shown that cilostazol inhibits adenosine uptake, whereas milrinone has no such effect. This study investigated the possible cardiac functional significance of cilostazol on adenosine uptake inhibition. In isolated rabbit hearts, 10 microM of cilostazol elevated adenosine concentration in interstitial dialysate (0.16 +/- 0.01 microM, or approximately 0.81 microM in the interstitial space when adjusted for recovery rate of microdialysis) and coronary effluent (0.69 +/- 0.03 microM ). The values are significantly higher than those for 10 microM of milrinone (0.11 +/- 0.1 microM in interstitial dialysate and 0.2 +/- 0.04 microM in coronary effluent). Although cilostazol increased contractility, heart rate, and coronary flow in isolated rabbit hearts, the effect on contractility and heart rate was significantly augmented in the presence of an adenosine A 1 receptor antagonist. Conversely, an adenosine A 1 receptor agonist or an adenosine uptake inhibitor attenuated the positive inotropic effect of milrinone. These results indicate that adenosine uptake inhibition by cilostazol increases interstitial and circulatory adenosine concentration, and antagonizes PDE3 inhibition-induced contractility and heart rate increases through an adenosine A 1 receptor-mediated mechanism.
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Which should be inserted first--giving set or airway? Anaesth Intensive Care 2001; 29:305-6. [PMID: 11439809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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