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Bridging therapy

Sven Persoon, Michael Paulus, Stephan Hirt, Carsten Jungbauer, Alexander Dietl, Andreas Luchner, Christof Schmid, Lars S Maier, Christoph Birner
Implantation of left ventricular assist devices (LVADs) as bridge to transplant in end-stage heart failure allows for analyzing reverse remodeling processes of the supported heart. Whether this therapy influences the cGMP-PKG signaling pathway, which is currently under thorough investigation for developing new heart failure therapeutics, is unknown. In fourteen end-stage heart failure patients (8 with dilated cardiomyopathy, DCM; 6 with ischemic cardiomyopathy, ICM) tissue specimens of left ventricles were collected at LVAD implantation and afterwards at receiver heart explantation, respectively...
March 15, 2018: Heart and Vessels
Anas H Abu-Humaidan, Malin Elvén, Andreas Sonesson, Peter Garred, Ole E Sørensen
The complement system is an ancient part of the innate immune system important for both tissue homeostasis and host defense. However, bacteria like Staphylococcus aureus (SA) possess elaborative mechanisms for evading both the complement system and other parts of the immune system. One of these evasive mechanisms-important in causing chronic and therapy resistant infections-is the intracellular persistence in non-immune cells. The objective of our study was to investigate whether persistent intracellular SA infection of epidermal keratinocytes resulted in complement activation...
2018: Frontiers in Immunology
Susanne Röger, Stefanie L Rosenkaimer, Anna Hohneck, Siegfried Lang, Ibrahim El-Battrawy, Boris Rudic, Erol Tülümen, Ksenija Stach, Jürgen Kuschyk, Ibrahim Akin, Martin Borggrefe
BACKGROUND: The wearable cardioverter-defibrillator (WCD) has emerged as a valuable tool to temporarily protect patients at risk for sudden cardiac death (SCD). The aim of this study was to determine the value of the WCD for therapy optimization of heart failure patients. METHODS: One hundred five consecutive patients that received WCD between 4/2012 and 9/2016 were included in the study. All patients were followed for clinical outcome and echocardiographic parameters during WCD therapy and had continued follow-up after WCD therapy, irrespective of subsequent implantable cardioverter-defibrillator (ICD) implantation...
March 15, 2018: BMC Cardiovascular Disorders
Sanjay Kalra
Insulin is a life saving medicine. Yet, diabetes care professionals encounter many barriers to its use, especially at the patient level. This is even more true in primary care, where patients tend to resist injectable therapy. This article uses the mnemonic,InfoCRIne, to highlight four important barriers to insulin, and proposes bridges to overcome them. The bridges include information, confidence building, resource husbandry and individualization of strategy. These help overcome the barriers of hearsay, perceived inability to use insulin, perceived lack of resources and intrusion into lifestyle...
March 2018: JPMA. the Journal of the Pakistan Medical Association
Z Merhi, E Buyuk, M J Cipolla
STUDY QUESTION: Does vitamin D attenuate the adverse effects of advanced glycation end products (AGEs) on steroidogenesis by human granulosa cells (GCs)? SUMMARY ANSWER: AGEs alter the expression of genes important in steroidogenesis while 1,25-dihydroxyvitamin D3 (vit D3) in vitro attenuates some of the actions of AGEs on steroidogenic gene expression, possibly by downregulating the expression of the pro-inflammatory cell membrane receptor for AGEs (RAGE). WHAT IS KNOWN ALREADY: Vitamin D attenuates the pro-inflammatory effects of AGEs in non-ovarian tissues...
March 12, 2018: Molecular Human Reproduction
Heidi J Reich, Lawrence S C Czer, Danny Ramzy, Francisco Arabia, Jaime Moriguchi, Deborah D Ascheim, Timothy D Henry
The use of stem cell therapy in combination with a left ventricular assist device (LVAD) for patients with advanced heart failure (HF) is an attractive concept with the potential to alter the natural history of HF. Cell therapy trials for HF have demonstrated excellent safety and encouraging results, but current rates of myocardial recovery after LVAD implantation are limited. Early trials combining these 2 therapies to increase the likelihood of recovery and to potentially obviate the need for subsequent transplantation appear promising...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Gretchen Stern, Jessica Rimsans, Arman Qamar, Muthiah Vaduganathan, Deepak L Bhatt
AIMS: Oral antiplatelet therapy may require interruption soon after percutaneous coronary intervention (PCI) or acute coronary syndrome. The optimal parenteral antiplatelet bridge strategy with glycoprotein IIb/IIIa inhibitors or cangrelor, a P2Y12 inhibitor, is unclear. We explore real-world use of cangrelor or eptifibatide for antiplatelet bridging at a large tertiary-care center. METHODS AND RESULTS: Thirty-one patients (9 eptifibatide, 20 cangrelor, and 2 both) received bridge therapy from October 2015 to June 2017...
March 13, 2018: EuroIntervention
Chun Han Nigel Tan, Yue Yu, Yan Rui Nicholas Tan, Boon Leng Kieron Lim, Shridhar Ganpathi Iyer, Krishnakumar Madhavan, Alfred Wei Chieh Kow
Backgrounds/Aims: Liver Transplantation (LT) is a recognized treatment for Hepatocellular Carcinoma (HCC). The role of Bridging Therapies (BT) remains controversial. Methods: From January 2001 to October 2012, 192 patients were referred to the National University Hospital, Singapore for consideration of LT for HCC. Sixty-five patients (33.8%) were found suitable for transplant and were placed on the waitlist. Analysis was performed in these patients. Results: The most common etiology of HCC was Hepatitis B (n=28, 43...
February 2018: Annals of Hepato-Biliary-Pancreatic Surgery
Kay Lash, Rachelle Oppel, Jeanette Hasse
Technology advances have made it possible to prolong life for patients with heart failure who are not transplant candidates or while awaiting transplant. Many different cardiac devices are available that can be used as a bridge to transplant (temporary support) or as a destination therapy (permanent support). Placement of these devices can cause complications that, if not addressed, could negatively impact the nutrition status of patients. Placement of nasointestinal feeding tubes using an electromagnetic sensor-guided enteral access system (EMS-EAS) has been difficult in patients with implantable devices because of the potential for interference with the EMS-EAS and the left ventricular assist device (LVAD)...
March 12, 2018: Nutrition in Clinical Practice
Shawn M Shah, Nicholas R Teman, Eileen Dearth, Leora T Yarboro, John A Kern
Utilization of a left ventricular assist device (LVAD) as a bridge to myocardial recovery is an established therapy for acute systolic heart failure. However, device removal can present a technical challenge with no clear consensus on preferred method. In this case report, we describe a complex patient who underwent successful explantation of an LVAD using an intraoperatively constructed apical plug. This method utilizes inexpensive and easily accessible materials, minimizes ventricular distortion during device removal, and preserves the ventricular sewing ring for future reimplantation...
March 9, 2018: Annals of Thoracic Surgery
Germán L Farfalli, Jose I Albergo, Nicolas S Piuzzi, Miguel A Ayerza, D Luis Muscolo, Lucas E Ritacco, Luis A Aponte-Tinao
BACKGROUND: The treatment of locally aggressive bone tumors is a balance between achieving local tumor control and surgical morbidity. Wide resection decreases the likelihood of local recurrence, although wide resection may result in more complications than would happen after curettage. Navigation-assisted surgery may allow more precise resection, perhaps making it possible to expand the procedure's indications and decrease the likelihood of recurrence; however, to our knowledge, comparative studies have not been performed...
March 2018: Clinical Orthopaedics and related Research
Mandeep R Mehra, Daniel J Goldstein, Nir Uriel, Joseph C Cleveland, Melana Yuzefpolskaya, Christopher Salerno, Mary N Walsh, Carmelo A Milano, Chetan B Patel, Gregory A Ewald, Akinobu Itoh, David Dean, Arun Krishnamoorthy, William G Cotts, Antone J Tatooles, Ulrich P Jorde, Brian A Bruckner, Jerry D Estep, Valluvan Jeevanandam, Gabriel Sayer, Douglas Horstmanshof, James W Long, Sanjeev Gulati, Eric R Skipper, John B O'Connell, Gerald Heatley, Poornima Sood, Yoshifumi Naka
Background In an early analysis of this trial, use of a magnetically levitated centrifugal continuous-flow circulatory pump was found to improve clinical outcomes, as compared with a mechanical-bearing axial continuous-flow pump, at 6 months in patients with advanced heart failure. Methods In a randomized noninferiority and superiority trial, we compared the centrifugal-flow pump with the axial-flow pump in patients with advanced heart failure, irrespective of the intended goal of support (bridge to transplantation or destination therapy)...
March 11, 2018: New England Journal of Medicine
Annemieke Oude Lansink-Hartgring, Dinis Dos Reis Miranda, Dirk W Donker, Jacinta J Maas, Thijs Delnoij, Marijn Kuijpers, Judith van den Brule, Erik Scholten, Hendrik Endeman, Alexander P J Vlaar, Walter M van den Bergh
BACKGROUND: Extracorporeal life support (ECLS) is used to support the cardiorespiratory function in case of severe cardiac and/or respiratory failure in critically ill patients. According to the ELSO guidelines ECLS should be considered when estimated mortality risk approximates 80%. ECLS seems an efficient therapy in terms of survival benefit, but no undisputed evidence is delivered yet. The aim of the study is to assess the health-related quality of life after ECLS treatment and its cost effectiveness...
March 9, 2018: BMC Health Services Research
Mohammad Kamal Shaker, Iman F Montasser, Mohamed Sakr, Mohamed Elgharib, Hany M Dabbous, Hend Ebada, Ahmed El Dorry, Mohamed Bahaa, Mahmoud El Meteini
Background and aim: The number of loco-regional therapies (LRTs) for hepatocellular carcinoma (HCC) has increased dramatically during the past decade, bridging or downstaging patients on the waiting list for liver transplantation. This study aimed to analyze the outcomes of LRTs prior to living donor liver transplantation in patients with HCC. Methods: Sixty-two HCC patients received living donor liver transplantation at Ain Shams Center for Organ Transplantation over a 2-year period...
2018: Journal of Hepatocellular Carcinoma
Gianfranco Varetto, Alessandra Trevisan, Giovanni Barile, Lorenzo Gibello, Flavia Spalla, Edoardo Frola, Daniele Pennica, Pietro Rispoli PhD
BACKGROUND: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare and potentially life-threatening complication, with an incidence lower than 1%. Most of the cases described report PAs after carotid patch angioplasty and are associated with infection, often caused by Staphylococci. The management of PAs can be surgical, endovascular, or hybrid. METHODS: We herein present the case of an infected carotid PA 27 days after an eversion CEA. We performed a common to internal carotid bypass with the interposition of great saphenous vein (GSV) associated with specific polyantibiotic therapy for 4 weeks...
January 1, 2018: Vascular and Endovascular Surgery
Julia Chalaye, Charlotte E Costentin, Alain Luciani, Giuliana Amaddeo, Nathalie Ganne-Carrié, Laurence Baranes, Manon Allaire, Julien Calderaro, Daniel Azoulay, Pierre Nahon, Olivier Seror, Ariane Mallat, Michael Soussan, Christophe Duvoux, Emmanuel Itti, Jean Charles Nault
BACKGROUND: Hepatocellular carcinoma (HCC) staging according to the BCLC classification is based on conventional imaging. The aim of our study was to assess the impact of dual-tracer 18F-fluorocholine and 18F-FDG PET/CT on tumor staging and treatment allocation. METHODS: 192 dual-tracer PET/CT (18F-fluorocholine and 18F-FDG PET/CT) were performed in 177 patients with HCC. BCLC staging and treatment proposal based on conventional imaging were retrospectively collected, along with any new lesions detected, changes in BCLC classification or treatment allocation based on dual-tracer PET/CT...
March 5, 2018: Journal of Hepatology
Gabriele Dell'Era, Matteo Ziacchi, Eleonora Prenna, Igor Diemberger, Marco Varalda, Cristian Martignani, Federico Guerra, Mauro Biffi, Eraldo Occhetta
BACKGROUND: The management of patients explanted for implantable defibrillator (ICD) infections may be complex when anti-bradycardia pacing and tachyarrhythmia protection are needed. We aimed to test the efficacy and safety of a conventional ICD externally connected to a transvenous dual-coil lead as bridging therapy before the re-implantation. METHODS AND RESULTS: We enrolled seven patients explanted for ICD infections and needing prolonged antibiotic therapy in two high-volume hospitals in Italy and treated them with a passive can external ICD for a mean of 13 (4-30) days before re-implant...
March 8, 2018: Pacing and Clinical Electrophysiology: PACE
Stephanie Ruf, Holger Hebart, Lisa Lyngsie Hjalgrim, Edita Kabickova, Peter Lang, Daniel Steinbach, Georg C Schwabe, Wilhelm Woessmann
Vinblastine and targeted therapies induce remissions in patients with relapsed or progressive anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL). Central nervous system (CNS) prophylaxis often is not included during re-induction in CNS-negative relapse patients. We report on five patients with progressive or early relapsed ALK-positive ALCL who developed CNS progression during re-induction with vinblastine, crizotinib, or brentuximab vedotin given for bridging to allogeneic blood stem cell transplantation...
March 7, 2018: Pediatric Blood & Cancer
Frank J Wolters, M Arfan Ikram
Dementia is among the leading causes of death and disability. Due to the ageing population, its prevalence is expected to nearly triple worldwide by 2050, urging the development of preventive and curative interventions. Various modifiable risk factors have been identified in community-based cohort studies, but insight into the underlying pathophysiological mechanisms is lacking. Clinical trials have thus far failed in the development of disease-modifying therapy in patients with dementia, thereby triggering a shift of focus toward the presymptomatic phase of disease...
2018: Methods in Molecular Biology
Woo Hyun Paik, Sang Hyub Lee, Dong Won Ahn, Ji Bong Jeong, Jin Woo Kang, Jun Hyuk Son, Ji Kon Ryu, Yong-Tae Kim
BACKGROUND: One major adverse event of endoscopic sphincterotomy (EST) is bleeding, which could be more common and severe in patients receiving anticoagulant therapy. However, the cessation of anticoagulants for long periods could lead to thromboembolic events. We aimed to evaluate the optimal timing of resumption of anticoagulants after EST in patients at risk for thromboembolism. MATERIALS AND METHODS: From January 2010 through October 2017, a retrospective cohort at risk for thromboembolism who had taken warfarin and bridging therapy with heparin around EST from three tertiary hospitals in South Korea was investigated...
March 6, 2018: Surgical Endoscopy
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