A change in the treatment of abdominal aortic aneurysms

OBJECTIVE: One of the most exciting potential applications of percutaneous therapy is the treatment of abdominal aneurysms. METHODS: Of 230 patients treated with a self-expanding polyester-lined stent-graft for different aortic pathologies at our institution, we selected 80 abdominal aneurysm cases undergoing treatment (from May 1997 to December 2002). The stent was introduced through the femoral artery, in the hemodynamic laboratory, with the patient under general anesthesia, with systemic heparinization, and induced hypotension. RESULTS: The procedure was successful in 70 (92.9%) cases; 10 patients with exclusion of abdominal aortic aneurysms were documented immediately within the hemodynamic room and 5 patients persisted with a residual leak. Two surgical conversions were necessary. Additional stent-grafts had to be inserted in 3 (3.7%) cases. In the follow-up, 91.4% of patients were alive at a mean follow-up of 15.8 months. CONCLUSION: We believe that stent-grafts are an important tool in improving the treatment of abdominal aneurysms, and this new policy may change the conventional medical management of these patients.

Terapéutica farmacológica y de pequeñas moléculas en patologías de atesoramiento lisosomal: focalización en las Lipofuscinosis Ceroideas Neuronales. Farmaceutical and small molecules therapy in lysosomal storage diseases: focus on the Neuronal Ceroid Lipofuscinoses.

Introducción: Las Lipofuscinosis Ceroideas Neuronales (LCNs) son un grupo de patologías neurodegenerativas hereditarias de atesoramiento lisosomal (PALs) caracterizadas por el almacenamiento en los lisosomas de materiales complejos pobremente reconocidos. Su curso es muy severo con desenlace fatal, habiendo sido definidos diversos tipos sobre la base del estudio de los fenotipos clínicos, enzimáticos, morfológicos y las mutaciones. Su incidencia es de 1:12.500 nacimientos vivos a nivel mundial. Las intervenciones farmacológicas con moléculas pequeñas han sido exitosas para algunas PALs; sin embargo, debido a que para cada una de las moléculas ha sido asumido un mecanismo de acción, la efectividad puede estar limitada a uno o a pocos desórdenes y no beneficiar a otros. Se han comprobado efectos diversos de una serie de moléculas tales como Miglustat, Chaperonas moleculares diseñadas, Clenbuterol, N-acetilcisteina (Mucomyst), Cisteamina, Gentamicina y PTC124. Los tratamientos farmacológicos/ con moléculas pequeñas podrían resultar exitosos para las LCNs, mereciendo consideración desarrollar terapias para estos desórdenesObjetivo generalo Investigar en un tipo de patologías del sistema nervioso central, las Lipofuscinosis Ceroideas Neuronales, el enfoque terapéutico-farmacológico con pequeñas moléculas aplicado a otras patologías hereditarias.Objetivos específicoso Desarrollar un prototipo de cultivo de fibroblastos de pacientes a nivel hospitalario en Córdoba y mantener cultivos de fibroblastos de pacientes afectados de una LCN de genotipo CLN2, con mutaciones conocidas. o Enriquecer los cultivos con fármacos/ moléculas pequeñas probadas en otras PALs.o Averiguar si se produce incremento de actividad enzimática de la Tripeptidil Peptidasa-I (TPP-I) lisosomal.Materiales y Métodos: cultivo de fibroblastos de pacientes con el agregado de fármacos/pequeñas moléculas. Los donantes serán diagnosticados en CEMECO a través de una estrategia sistematizada para el reconocimiento de las LCNs y se identificarán las mutaciones en el gen CLN2 causales de enfermedad. Se averiguará la actividad enzimática de TPP-I y se marcará la enzima con anticuerpos específicos en corridas electroforéticas por western blot. Resultados esperados: incrementos en la actividad enzimática de TPP-I en los cultivos celulares con agregado de fármacos/ pequeñas moléculas con respecto a los controles. Importancia del proyecto: se trata de una investigación traduccional (traslational research) en la cual la clínica y los servicios a pacientes se vinculan con la investigación científica, desde una perspectiva de integración. Se desarrolla en un Hospital Público, el Hospital de Niños de la Provincia de Córdoba, asiento del Centro de Estudio de las Metabolopatías Congénitas-CEMECO. Se beneficiarán los pacientes, dado que impactará sobre la calidad de los servicios hospitalarios al suministrar diagnósticos bajo los estándares internacionales, en estrecha vinculación con centros referenciales del exterior. Se obtendrán para los genes de las LCNs los datos del espectro de mutaciones y polimorfismos presentes en la región y se aportarán datos sobre posibilidades de las terapias farmacológicas en relación a cada una de las mutaciones.

Estudios in vitro e in vivo de agentes fotosensibilizadores y su aplicación en terapia fotodinámica. In vitro and in vivo studies of photosensitizer agents and its application in photodynamic therapy.

Muchos esfuerzos se están realizando en el diseño de nuevos métodos para la eliminación de las células tumorales y así inhibir el crecimiento neoplásico. Entre los métodos no convencionales se encuentran la Terapia Fotodinámica.La Terapia Fotodinámica (TFD) es un tratamiento experimental de algunos tipos de cáncer, basado en el efecto citotóxico inducido en el tejido tumoral, por la acción combinada de una droga (fotosensibilizador) y la luz visible. El fotosensibilizador posee la propiedad de absorber la luz y reaccionar con el oxígeno molecular, produciendo una forma activa del oxígeno: el oxígeno singlete (1O2) que oxida diversas moléculas biológicas, induciendo un efecto citotóxico que se traduce en la regresión tumoral. Los nuevos avances en la dosimetría de la luz, así como la búsqueda de una segunda generación de nuevos fotosensibilizadores más eficaces que los actualmente utilizados, han permitido incluir protocolos de Terapia Fotodinámica en numerosos centros hospitalarios principalmente para el tratamiento de cánceres de pulmón, vejiga, esófago y piel. Plantas fototóxicas, sus metabolitos fotosensibilizantes y sus posibles usos; En general, dentro de las especies vegetales tóxicas existen aquellas denominadas plantas alergénicas, que son las que pueden producir sus efectos indeseables por vía dérmica. También existen aquellas que pueden producir efectos tóxicos por vía sistémica. Sin embargo, coexiste en la naturaleza otro grupo de plantas tóxicas que desencadenan sus efectos nocivos bajo la acción de la luz, por lo que son llamadas plantas fototóxicas, cuyos principios activos son comúnmente denominados agentes fotosensibilizantes La apoptosis como blanco terapéutico contra el cáncer: Los conocimientos moleculares sobre la apoptosis adquiridos en los últimos años están siendo aplicados al desarrollo de nuevos fármacos que puedan modular selectivamente las señales involucradas en la muerte de las células. Una de las razones que justifica el interés en el estudio de este tipo de moléculas, es que una de las características más tempranas en la transformación de la células neoplásicas esta relacionada con la incapacidad de responder a los estímulos de muerte. Esto lleva a una desregulación del proceso de apoptosis desencadenando una proliferación descontrolada. Los otros eventos que desencadenan el cáncer son, la invasión vascular y la metástasis a distanciaLa adquisición de resistencia a los efectos citotóxicos de los tratamientos anticancerígenos ha emergido como un significante impedimento para el efectivo tratamiento de la enfermedad. Por ello, en el presente proyecto se investigará si la adquisición de resistencia a TFD inducida en la línea celular estudiada es conferida por el aumento de la proteína MDRP1 a través de la vía de señalización PI3K/Akt. Además, se estudiará la correlación entre la posible resistencia a drogas y la inducción de apoptosis, analizando los mecanismos involucrados. Los resultados obtenidos contribuirán a dilucidar y entender los mecanismos moleculares implicados en la resistencia y sensibilidad tumoral a la TFD, y de esta manera mejorar la eficacia de dicha terapia antitumoral para sensibilizar a las células a la apoptosis. OBJETIVOS Estudiar el efecto de agentes fotosensibilizadores de origen sintético (ftalocianinas), comercialmente ya aprobadas por la FDA (Me-ALA), de origen natural (antraquinonas), y obtenidas en procesos nanotecnologicos (nanofibras) respecto a su capacidad de inducir la muerte celular en sistemas experimentales in vivo, para el desarrollo de nuevas drogas de aplicación en Terapia Fotodinámica (PDT). Estudiar las señales de apoptosis que se desencadenan, combinando la PDT con iRNA (antisurvivina) con la finalidad de aumentar la eficiencia de la muerte tumoral. Estudiar los mecanismos de resistencia a la Terapia Fotodinámica en carcinoma de células escamosas con fotosensibilizadores permitidos (Me-ALA).

Inducción sistémica de la biosintesis de metabolitos secundarios en plantas aromáticas mediada por rizobacterias. Systemic induction of secondary metablolites biosynthesis in aromatic plants by rhizobacteria.

El uso de microorganismos como inoculantes para incrementar la disponibilidad y toma de nutrientes por parte de los cultivos, es una nueva tecnología que ha dado buenos resultados, observándose un incremento en la emergencia, vigor, mayor desarrollo en la parte aérea y de raíces, registrándose aumentos considerables de los rendimientos en cultivos de interés comercial. Esto es debido a que los microorganismos PGPR (Plant Growth promoting rhizobacteria) sintetizan ciertas sustancias reguladoras del crecimiento como giberelinas, citoquininas y auxinas; las cuales estimulan la densidad y longitud de los pelos radicales, aumentando así la cantidad y longitud de las raíces de los vegetales. Así, se incrementa la capacidad de absorción de agua y nutrientes, haciendo que las plantas sean más vigorosas, productivas y tolerantes a condiciones climáticas adversas, como sequías o heladas. Otro factor benéfico es que ciertos microorganismos solubilizan nutrientes poco móviles en el suelo como el caso del fósforo, segundo nutriente, después del nitrógeno en importancia para el crecimiento de los cultivos. Estos microorganismos también tienen una función muy importante en el control natural de agentes patógenos, a través de la inducción del sistema de defensa en las plantas, aumentando su resistencia a enfermedades, a través de la producción de compuestos bacterianos como antibióticos y sideróforos. Los variados mecanismos mediante los cuales la acción PGPR se lleva a cabo no son plenamente conocidos y, por lo tanto, es necesario determinar con precisión su efecto particular en la biología de la planta beneficiada. Las plantas aromáticas y medicinales inoculadas con microorganismos (rizobacterias) registran un incremento en varios parámetros de crecimiento vegetal (peso fresco parte aérea, peso seco de raíz, número de hojas, etc) y en el rendimiento de aceite esencial (AE). El aumento de la síntesis, y la variación de los porcentajes relativos de los componentes principales de AE en plantas aromáticas, como efecto de la inoculación, podría considerarse como una respuesta defensiva de la planta frente a la colonización de microorganismos dado que varios AE poseen propiedades antimicrobianas. El incremento de estos metabolitos también se ha registrado como respuesta frente a la herbivoría. En el presente proyecto se propone dilucidar la existencia de una relación entre las defensas inducidas por rizobacterias con la producción de metabolitos secundarios en plantas aromaticas y medicinales. The use of microorganisms as inoculants to increase the availability and nutrient uptake by crops, is a new technology that has been successfully applied, with an increase in the emergence, vigor, greater development in the shoot and roots, recording significant increases in yields of crop with commercial interest. This is because microorganisms PGPR (Plant Growth Promoting rhizobacteria) synthesize certain growth regulating substances such as gibberellins, cytokinins and auxins, which stimulate the density and length of root hairs, increasing the number and length of roots. Thus, increase the capacity of absorbing water and nutrients, make the plants more vigorous, productive and tolerant to adverse climatic conditions such as drought or frost.Another beneficial factor is that some microorganisms solubilize nutrients mobile in the soil as the case of phosphorus, second nutrient after nitrogen important for plant growth. These organisms also have an important role in the natural control of pathogens through the induction of the plants defense system, increasing their resistance to disease through the production of compounds such as antibiotics and bacterial siderophores. The various mechanisms by which PGPR action takes place are not fully known and therefore it is necessary to accurately determine its particular effect on the biology of the specific plant benefit. Aromatic and medicinal plants inoculated with microorganisms (rhizobacteria) recorded an increase in several parameters of plant growth (shoot fresh weight, root dry weight, leaf number, etc) and essential oil yield (AE). The increase in the biosynthesis, and changes in the relative percentages of the main components of AE in aromatic plants inoculated with rizobacterias, could be regarded as a plant defense response against microbial colonization, since several AE have antimicrobial properties. The increase of these metabolites have also been recorded as a response to herbivory.

Evaluación del efecto del láser y magnetoterapia en miopatía experimental valorando biomarcadores de estrés oxidativo, histomorfometría y actividad enzimática mitocondrial. Evaluation of the effect of laser and magnetic therapy in experimental myopathy assessing oxidative stress biomarkers, histomorphometry and mitochondrial enzyme activity

El láser de baja y media energía y la magnetoterapia son utilizados en desórdenes osteomioarticulares por sus efectos analgésico, antiinflamatorio y trófico, entre los más destacados. Sin embargo, son insuficientes las investigaciones sobre su mecanismo de acción y antecedentes científicos que avalen sus efectos. Es por ello, que la determinación de acontecimientos celulares y moleculares que ocurren durante la interacción de estos tipos de energía con el sistema muscular, sería relevante para el conocimiento y optimización de tales terapias en las ciencias biomédicas. En las miopatías inflamatorias idiopáticas, se encuentra afectada la estructura, morfología y bioquímica del tejido muscular. La energía que éste requiere para el normal funcionamiento es generada en la mitocondria. Esta organela también es la responsable de la generación de especies oxidantes provocando estrés oxidativo y el inicio de los procesos de apoptosis. Por lo antes dicho, consideramos que la determinación de los biomarcadores inflamatorios asociados a estrés oxidativo, realizando el análisis histomorfométrico ultraestructural y valorando la actividad de los complejos enzimáticos mitocondriales, permitiría una evaluación de la acción terapéutica del láser y la magnetoterapia en un modelo experimental de miopatía. Para ello se propone evaluar el efecto de la magnetoterapia y del láser de baja energía (He-Ne y As.Ga) en miopatía experimental determinando indicadores inflamatorios asociados a estrés oxidativo, análisis histomorfométrico y valoración de la actividad enzimática mitocondrial. Específicamente: -Determinar indicadores inflamatorios y de estrés oxidativo: Oxido Nítrico, Grupos carbonilos, L-citrulina, Fibrinógeno, Superóxido dismutasa, Glutation peroxidasa y Catalasa por espectrofotometría. -Identificar los cambios anatomopatológicos del músculo esquelético por microscopía óptica (MO): cuantificación del infiltrado inflamatorio; MO de alta resolución (MOAR) y por microscopía electrónica: histomorfometría de la ultraestructura miofibrilar y mitocondrial. -Valorar las actividades enzimáticas de la citrato sintasa y de los complejos: I (NADH-ubiquinona reductasa), II (succinato-ubiquinona-reductasa) III (ubiquinona-citocromo c-reductasa) y IV (citocromo c-oxidasa); en mitocondrias de tejido muscular por espectrofotometría. -Evaluar la actividad apoptótica en las fibras musculares de los diferentes grupos por ténica de T.U.N.E.L. Las mediciones mitocondriales (por ME) y de infiltrado inflamatorio (por MO) se realizarán en un total de 5 fotos de aumentos similares en forma aleatoria por grupo estudiado (n=10). Los cambios estructurales observados se analizarán en el programa Axiovision 4.8, para cuantificar el área total ocupada, número total y grado de alteración de las mitocondrias y el porcentaje de infiltrado inflamatorio determinando el grado de inflamación. Los resultados de los datos cuantitativos se analizarán aplicando ANAVA (test de Fisher para comparaciones múltiples); y para los datos categóricos se utilizará Chi cuadrado (test de Pearson), estableciéndose un nivel de significación de p < 0.05 para todos los casos. Importancia del Proyecto: La salud y el bienestar del hombre son los logros perseguidos por las ciencias de la salud. La obtención de terapias curativas o paliativas con un mínimo de efectos colaterales para el enfermo se incluye en estos logros. Por esto y todo lo anteriormente expuesto es que consideramos de gran importancia poder esclarecer desde las ciencias básicas los efectos celulares y moleculares en modelos experimentales la acción de la terapia con láser y magnetoterapia para una aplicación clínica con base científica en todas las áreas de las Ciencias Médicas. In the idiopathic inflammatory myopathies, is affected the structure, morphology and biochemistry of muscle tissue. The mitochondria is responsible for the generation of oxidizing species leading to oxidative stress and the beginning of the process of apoptosis. As said before, we consider the determination of inflammatory biomarkers related to oxidative stress, by ultrastructural morphometric analysis and assessing the activity of mitochondrial enzyme complexes, permit an evaluation of the therapeutic action of laser and magnetic therapy in an experimental model myopathy. We propose to evaluate the effect of the treatment identifying indicators in experimental inflammatory myopathy associated with oxidative stress, histomorphometric analysis and assessment of mitochondrial enzyme activity. Specifically -determining: Nitric oxide, carbonyl groups, L-citrulline, fibrinogen, superoxide dismutase, glutathione peroxidase and catalase by spectrophotometry. -Identify the pathological changes in skeletal muscle by optical microscopy (OM): quantification of the inflammatory infiltrate, OM high resolution (MOAR) and electron microscopy, histomorphometry of myofibrillar and mitochondrial ultrastructure. -Evaluate the enzymatic activity of citrate synthase and complexes: I, II, III and IV in mitochondria muscle tissue by spectrophotometry. -Evaluate apoptotic activity in muscle fibers by TUNEL technique of Mitochondrial measurements and inflammatory infiltration (by OM) was performed in a total of 5 photos of similar increases in random by the study group (n = 10). The structural changes observed are discussed in the program Axiovision 4.8, to quantify number, degree of alteration of mitochondria and the percentage of inflammatory infiltrate determining the degree of inflammation. The results of the quantitative data were analyzed using ANOVA (Fisher test), and categorical data with Chi-square (Pearson test), establishing a significance level of p <0.05.

Evaluation of Sexual Dimorphism in the Efficacy and Safety of Simvastatin/Atorvastatin Therapy in a Southern Brazilian Cohort

Background: Dyslipidemia is the primary risk factor for cardiovascular disease, and statins have been effective in controlling lipid levels. Sex differences in the pharmacokinetics and pharmacodynamics of statins contribute to interindividual variations in drug efficacy and toxicity. Objective: To evaluate the presence of sexual dimorphism in the efficacy and safety of simvastatin/atorvastatin treatment. Methods: Lipid levels of 495 patients (331 women and 164 men) were measured at baseline and after 6 ± 3 months of simvastatin/atorvastatin treatment to assess the efficacy and safety profiles of both drugs. Results: Women had higher baseline levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) compared with men (p < 0.0001). After treatment, women exhibited a greater decrease in plasma TC and LDL-C levels compared with men. After adjustment for covariates, baseline levels of TC and LDL-C influenced more than 30% of the efficacy of lipid-lowering therapy (p < 0.001), regardless of sex. Myalgia [with or without changes in creatine phosphokinase (CPK) levels] occurred more frequently in women (25.9%; p = 0.002), whereas an increase in CPK and/or abnormal liver function was more frequent in in men (17.9%; p = 0.017). Conclusions: Our results show that baseline TC and LDL-C levels are the main predictors of simvastatin/atorvastatin therapy efficacy, regardless of sex. In addition, they suggest the presence of sexual dimorphism in the safety of simvastatin/atorvastatin. The effect of sex differences on receptors, transporter proteins, and gene expression pathways needs to be better evaluated and characterized to confirm these observations.

Combination Therapy for the Cardiovascular Effects of Perinatal Lead Exposure in Young and Adult Rats

Background: Combination therapy can play a significant role in the amelioration of several toxic effects of lead (Pb) and recovery from associated cardiovascular changes. Objective: To investigate the effects of combination therapy on the cardiovascular effects of perinatal lead exposure in young and adult rats Methods: Female Wistar rats received drinking water with or without 500 ppm of Pb during pregnancy and lactation. Twenty-two- and 70-day-old rat offspring who were or were not exposed to Pb in the perinatal period received meso-dimercaptosuccinic acid (DMSA), L-arginine, or enalapril and a combination of these compounds for 30 additional days. Noradrenaline response curves were plotted for intact and denuded aortas from 23-, 52-, 70-, and 100-day-old rats stratified by perinatal Pb exposure (exposed/unexposed) and treatment received (treated/untreated). Results: Systolic blood pressure was evaluated and shown to be higher in the 23-, 52-, 70-, and 100-day age groups with Pb exposure than in the corresponding control age groups: 117.8 ± 3.9*, 135.2 ± 1.3*, 139.6 ± 1.6*, and 131.7 ± 2.8*, respectively and 107.1 ± 1.8, 118.8 ± 2.1, 126.1 ± 1.1, and 120.5 ± 2.2, respectively (p < 0.05). Increased reactivity to noradrenaline was observed in intact, but not denuded, aortas from 52-, 70-, and 100-day-old exposed rats, and the maximum responses (g of tension) in the respective Pb-exposed and control age groups were as follows: 3.43 ± 0.16*, 4.32 ± 0.18*, and 4.21 ± 0.23*, respectively and 2.38 ± 0.33, 3.37 ± 0.13, and 3.22 ± 0.21, respectively (p < 0.05). Conclusions: All treatments reversed the changes in vascular reactivity to noradrenaline in rats perinatally exposed to Pb. The combination therapy resulted in an earlier restoration of blood pressure in Pb-exposed rats compared with the monotherapies, except for enalapril therapy in young rats. These findings represent a new approach to the development of therapeutic protocols for the treatment of Pb-induced hypertension.

Role Of MMP-2 and MMP-9 in Resistance to Drug Therapy in Patients with Resistant Hypertension

AbstractBackground:Despite the increased evidence of the important role of matrix metalloproteinases (MMP-9 and MMP‑2) in the pathophysiology of hypertension, the profile of these molecules in resistant hypertension (RHTN) remains unknown.Objectives:To compare the plasma levels of MMP-9 and MMP-2 and of their tissue inhibitors (TIMP-1 and TIMP-2, respectively), as well as their MMP-9/TIMP-1 and MMP-2/TIMP-2 ratios, between patients with controlled RHTN (CRHTN, n=41) and uncontrolled RHTN (UCRHTN, n=35). In addition, the association of those parameters with clinical characteristics, office blood pressure (BP) and arterial stiffness (determined by pulse wave velocity) was evaluate in those subgroups.Methods:This study included 76 individuals diagnosed with RHTN and submitted to physical examination, electrocardiogram, and laboratory tests to assess biochemical parameters.Results:Similar values of MMP-9, MMP-2, TIMP-1, TIMP-2, and MMP-9/TIMP-1 and MMP-2/TIMP-2 ratios were found in the UCRHTN and CRHTN subgroups (P>0.05). A significant correlation was found between diastolic BP (DBP) and MMP-9/TIMP-1 ratio (r=0.37; P=0.02) and DPB and MMP-2 (r=-0.40; P=0.02) in the UCRHTN subgroup. On the other hand, no correlation was observed in the CRHTN subgroup. Logistic regression models demonstrated that MMP-9, MMP-2, TIMP-1, TIMP-2 and their ratios were not associated with the lack of BP control.Conclusion:These findings suggest that neither MMP-2 nor MMP-9 affect BP control in RHTN subjects.

Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab

AbstractIntroduction:Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.Objectives:The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.Methods:Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.Results:Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).Conclusion:Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

Data mining in diagnostic charts and treatment outcome prediction for vision restoration therapy

Data Mining, Vision Restoration, Treatment outcome prediction, Self-Organising-Map

Reverse Auction: A Potential Strategy for Reduction of Pharmacological Therapy Cost

Background:Polypharmacy is a significant economic burden.Objective:We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients.Methods:We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost.Results:The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively.Conclusion:RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.

Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy

AbstractBackground:30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes.Objective:This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT).Methods:Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves.Results:The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping.Conclusion:We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.

Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy

Abstract Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.

Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

Abstract Background: The use of aortic counterpulsation therapy in advanced heart failure is controversial. Objectives: To evaluate the hemodynamic and metabolic effects of intra-aortic balloon pump (IABP) and its impact on 30-day mortality in patients with heart failure. Methods: Historical prospective, unicentric study to evaluate all patients treated with IABP betwen August/2008 and July/2013, included in an institutional registry named TBRIDGE (The Brazilian Registry of Intra-aortic balloon pump in Decompensated heart failure - Global Evaluation). We analyzed changes in oxygen central venous saturation (ScvO2), arterial lactate, and use of vasoactive drugs at 48 hours after IABP insertion. The 30-day mortality was estimated by the Kaplan-Meier method and diferences in subgroups were evaluated by the Log-rank test. Results: A total of 223 patients (mean age 49 ± 14 years) were included. Mean left ventricle ejection fraction was 24 ± 10%, and 30% of patients had Chagas disease. Compared with pre-IABP insertion, we observed an increase in ScvO2 (50.5% vs. 65.5%, p < 0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and a decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and use of vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion. Thirty-day survival was 69%, with lower mortality in Chagas disease patients compared without the disease (p = 0.008). Conclusion: After 48 hours of use, IABP promoted changes in the use of vasoactive drugs, improved tissue perfusion. Chagas etiology was associated with lower 30-day mortality. Aortic counterpulsation therapy is an effective method of circulatory support for patients waiting for heart transplantation.

Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe

Abstract Background: The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. Objective: To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. Methods: Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. Results: The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. Conclusion: The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.