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  • ISSN: 2378-9344
    Early Online
    Volume 7, Issue 4
    Mini Review
    Takehiko Takayanagi*
    Atherosclerosis is a chronic vascular inflammatory disease characterized by oxidative stress and endothelial dysfunction. Oxidation of low-density lipoprotein (LDL), cholesterol is a key step in the development of atherosclerosis. Pathogenesis of atherosclerosis can begin with shear stress-induced endothelial dysfunction, which can lead to endothelial and platelet activation and adhesion of monocytes to the activated endothelium. These monocytes, upon differentiation into proinflammatory macrophages, can increase the uptake of oxidized LDL (oxLDL), and become foam cells, thereby exacerbating inflammatory signaling. Although the prolonged use of antioxidative components, such as polyphenols and supplemental vitamins C and E, has been proven effective in preventing atherosclerosis in animal models, this has not yet been demonstrated in human clinical trials. The use of multiple antioxidants with different mechanisms of action simultaneously has shown positive effects in the treatment of atherosclerosis. There is some indication that a diet rich in antioxidants may be beneficial in the prevention of cardiovascular events.
    Research Article
    Leah Gober, Allen Bui, and Jean Marie Ruddy*
    Best medical therapy for peripheral artery disease (PAD) includes statin and anti-platelet agents, a combination shown to decrease rates of major cardiovascular events. Despite these findings, many patients remain undertreated and the objective of this project was to investigate the rate of initiating anti-platelet and statin therapy for inpatients newly diagnosed with PAD with a focus on disparities by race and sex.
    A retrospective chart review of inpatients with newly diagnosed PAD was performed between January 1, 2016 to December 31, 2016 at a single institution. Demographics and comorbid conditions were collected. Primary outcomes included antiplatelet and statin prescription at discharge.
    The 44 patients included in this study were predominantly male (59% vs. 41%) and African American (61% vs. 39%). Between admission and discharge, prescriptions rose from 70% to 82% for statin and 82% to 91% for anti-platelet agents. Vascular specialists were more successful than non-vascular specialists at initiating medical therapy, with statin prescriptions increasing 22% and anti-platelet prescriptions climbing 23% for those admitted to a vascular specialist. Interestingly, when the ABI was reported in the normal range, rates of statin initiation were particularly compromised at only 40%. For the total patient sample, those discharged without a statin were more commonly African American (63%) and the majority were female (67%). All patients discharged without an antiplatelet were African American and 50% were females.
    Despite national guidelines, patients with PAD continue to be discharged without optimal medical therapy. This study suggests that obstacles to initiation may include race, sex, admitting service, or presence of a normal ABI. Further investigation is warranted to determine effective avenues for provider education and system-wide initiatives.
    Letter to the Editor
    Kamran A Gaba*, Charles Vincent and Prem Chana
    A novel coronavirus has caused a pandemic, resulting in the deaths of thousands of individuals worldwide. Health systems responded rapidly to this crisis and mobilised resources, maximising the effectiveness of interventions. Lessons can be applied from this experience to improve the safety of carotid interventions.
    Clinical Image
    Joo Miguel de Almeida Silva*, Guilherme Marcos Soares Dias and Andr Luiz Rezende
    A1 segment: Precommunicating Anterior Cerebral Artery; ACA: Anterior Cerebral Arteries; ACoA: Anterior Communicating Artery; DSA: Digital Subtraction Angiograph.
    Review Article
    Klas Norrby*
    Unfractionated heparin (UFH), made from very high-molecular mast cell proteoglycans, has the highest negative charge density of any known biological molecule. It binds to proteins, including many growth factors, facilitating the interaction between growth factors and their receptors. The degradation of native heparin includes continuous heparinase depolymerization. Low-molecular-weight heparins (LMWHs) used as anticoagulants are manufactured from UFH by diverse methods. Tinzaparin is the only LMWH that is produced enzymatically, by heparinase-depolymerization of UFH.
    Data show that Tinzaparin (6.5 kDa) injected s.c. significantly suppresses angiogenesis mediated by VEGF, a key regulator of physiological and pathological angiogenesis. Notably, a 5.0 kDa fraction of Tinzaparin exercises an even more potent angiogenesis-suppressive effect, while UFH (c. 15 kDa) tends to stimulate and 22 kDa heparins significantly stimulate VEGF-mediated angiogenesis, demonstrating fragment-mass-specific effects. The anti-angiogenic effect of the 5 kDa Tinzaparin fraction is shown also in angiogenesis mediated by basic fibroblast growth factor or endotoxin. There is a strong correlation between heparin fragment-mass and angiogenesis-modulating effect (r = 0.97 in the examined range of 2.6, 8, 15 and 22 kDa). Contrarily to Tinzaparin, the LMWH Dalteparin (6 kDa), produced by chemical depolymerization of UFH, stimulates VEGF-mediated angiogenesis demonstrating a non-equivalent angiogenesis-modulating effect among LMWHs.
    A novel hypothesis suggests that there is an in vivo intrinsic heparin-depolymerization angiogenesis-modulating process due to continual heparinase depolymerization of angiogenic high-molecular weight heparins, including those in UFH, into anti-angiogenic low-molecular-weight heparins. Further depolymerization would produce inactive heparin species, as judged by the data.
    Case Report
    Antonio Baule*, Antonello Caddeo, Stefalo Pala, Giuseppe Deiana, and Antonio Manca
    Takayasu arteritis usually affects young women between 10 and 40 years old, while is uncommon diagnosis after 50 years old. Symptoms at onset are often subacute and aspecific and this can be the reason for delay in diagnosis. Less frequently the first manifestation of disease can be a stroke or a transient ischaemic attack. We report here a rare case of a woman with a past medical history of tuberculosis infection, diagnosed with Takayasu arteritis at the age of 61 years old, with a minor stroke as first manifestation of disease. She presented to the emergency department for a sudden onset episode of facial weakness and difficulty with speech regressed in about 10 minutes. She was admitted in Stroke Unit where a Colour Doppler ultrasonography of the sovra-aortic branches was performed and it showed an occlusion from its origin of the right common carotid artery and severe thickening and luminal narrowing of left CCA wall with ipsilateral ICA occlusion from its beginning. Antiplatelet and high dose statin was introduced, she was discharged from Stroke Unit after 3 days and a Rheumatologic consultation and follow up was arranged. Past medical history of the patient was interesting as she referred a pulmonary and cutaneous Mycobacterium tuberculosis infection when she was 12 and 22 years old. Relationship between Tuberculosis infection, both latent and active, and Takayasu arteritis is suggested in many studies but so far no causal relationship between the two conditions could be established. New studies should be done in the future in order to understand mechanisms at the basis of this relationship. At the moment, a practical advice could be tuberculosis infection screening for TAK patients before initiating immunosuppressive therapies, especially in high prevalence TB infection countries.
    Abhishek Chakraborty, D. Byron Holt, Karen Wright and Hitesh Agrawal*
    Cardiac catheterization was done in a patient with Trisomy 18 and atrio-ventricular septal defect, large inlet VSD, and poly-valvular dysplasia prior to consideration of surgical AVSD repair. The patient had severe pulmonary hypertension with severely elevated end diastolic pressures in both ventricles. Pulmonary vascular resistance was found to be 7.5 Woodunits.m2, with poor reactivity to oxygen and nitric oxide. Patient was thus managed conservatively without any surgical interventions.
    Original Article
    Wenyang Pan*, Pascale Kulisa, Xavier Escriva, Benyebka Bou-Sad, Marine Menut, Patrick Lermusiaux, Antoine Millon
    In cardiovascular disease, aortic dissection is relatively unknown and difficult to treat. Endovascular treatment seeks to obliterate the entrances to the false lumen with a stent. The currently available surgical tools for endovascular procedures are selected only from information based on medical imaging techniques. The images are carried out before the intervention and therefore do not consider the deformation of the vascular structure by the implementation of the prosthesis. While many biomechanical studies have been done on the endovascular treatment of aneurysms of the abdominal aorta, there are, however, very few such studies on aortic dissections. This paper aims to present a numerical tool, from the open-source software FOAM-Extend, allowing for Multiphysics numerical simulations performing the fluid-structure coupling between the hemodynamics and the arterial deformation to assist in the planning process. And, in addition using Abaqus software we realize the placement of the surgical tools in a biomecano-faithful model.
    Research Article
    Nazire Belgin Akilli*, Hseyin Mutlu, Yahya Kemal Gnaydin, Ramazan Koylu, Levent Oktar and Basar Cander
    Objective: The rates of out-of-hospital cardiac arrest are increasing day by day in a progressive manner. Despite all the improvements in care after cardiac arrest, the majority of fatalities occur in the first 24-hours following the cardiac arrest. In recent years, the ratio of the peripheral neutrophils to lymphocytes has been accepted as a prognostic marker in many diseases. We also aimed to investigate the correlation of the NLR with mortality in patients with OHCA.
    Methods: The study design was planned by retrospective scanning of all OHCA patients with ROSC. The demographic features and laboratory data were recorded. The survival rates for the 24-hours and 14-days were calculated.
    Results: 91 patients were included out of 191 cases who had returned from OHCA to spontaneous circulation. When the patients who had died and survived in the first 24-hours were compared, significant differences were found between the neutrophil counts, NLR, lactate and arrest rhythms on admission (p<0.05). The survival rates calculated by Kaplan Meier curves were significantly lower in the group with NLR values lower than 3.05 (Log Rank 5.07, p=0.02). With the multivariable Cox-regression model, it was determined that the NLR value being lower than 3.05, is a predictive factor for the 24-hour mortality independent of age, gender, blood lactate and creatinine values and the arrest rhythm on admission (Hazard Ratio: 0.34 (0.15-0.79), p=0.01).
    Conclusion: Among the OHCA patients with ROSC, low NLR levels on admission is an independent predictor of mortality in the first 24-hours.
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