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  • ISSN: 2378-9344
    Volume 1, Issue 1
    Editorial
    Walmor C De Mello*
    The role of potassium current on the regulation of resting potential and tone of vascular resistance vessels was discussed.The finding that intracellular administration of angiotensin II (Ang II) into arterial myocytes from mesenteric arteries increases the potassium current and hyperpolarizes the cell, indicates that the internalization or local synthesis of the peptide counteracts the effect of extracellular Ang II on the regulation of vascular tone and peripheral resistance. Implications for hypertension are discussed.
    Review Article
    Tadashi Yoshida*, Maho Yamashita, and Matsuhiko Hayashi
    Abstract: Krüppel-like factor 4 (KLF4) is a zinc-finger transcription factor implicated in cellular differentiation and proliferation in multiple cell types. Results of recent studies have shown that KLF4 is expressed in the heart and the vasculature, and it plays a key role in the development and progression of cardiovascular diseases. For example, KLF4 inhibits cardiac hypertrophy in multiple murine models. Loss of endothelial Klf4 in mice results in enhanced atherosclerotic lesion formation. Moreover, deletion of the Klf4 gene accelerates neointimal formation following vascular injury. This article succinctly reviews the functions of KLF4 in cardiovascular diseases.
    Review Article
    Sumeet Kumar Reddy*, Manar Khashram and Richard Evans
    Abstract:
    Introduction: In keeping with established international guidelines our institute follows an "all-autogenous" approach with regard to hemodialysis access. Upper arm transposition fistulas can allow for access options when forearm autogenous options are not suitable. We evaluate our experience with a single staged brachio-basilic arteriovenous fistulas (BBAVF) to assess efficacy and patency.
    Methods: We retrospectively reviewed all patients who underwent a BBAVF formation from January 2005 to December 2011.
    Results: 30 fistulas were created on 30 patients.Median age is 50 years old, 16 (53%) patients are male. Renal failure was associated with diabetes in 11 (37%) patients and 22 (73%) patients were already receiving hemodialysis prior to fistula formation. For eight (26%) patients BBAVF was the first attempt at upper extremity access. Median basilic vein diameter was 4.5 mm (range of 2.8- 6.7 mm).
    Median length of follow up was 15 months. Primary patency rates at 6 months, 1 year, and 2 year were 79%, 65 %, and 59 % respectively. Primary assisted patency rates were 86%, 81 %, 67% and secondary patency rates were 93%, 93%, 93 % respectively. No patients went on to have a prosthetic graft placement. A total of 20 secondary procedures were required to maintain patency, 15 surgical revisions were performed on 9 patients and 5 endovascular procedures on 3 patients.
    Discussion: In our experience a single stage BBAVF provides an excellent option for maintaining autogenous hemodialysis access with good long term patency.
    Alexander Egbe*
    Abstract:
    More women with complex congenital heart disease are now surviving into childbearing age. Most of these women have residual hemodynamic lesions that may impair cardiovascularadaptation to pregnancy related physiologic changes. The second and third trimesters of pregnancyare associated with significant increase in preload, and heart rate with slight decrease in afterload. Labor is associated with abrupt increase in cardiac output mostly due to increase in heart rate and contractility in the first stage and increase in preload in the second stage of labor. These physiologic changes are tolerated differently based on the type and complexity of cardiac lesions. Antenatal cardiovascular assessment is necessary to determine lesion-specific risk for the mother and the fetus. Multi-disciplinary approach is required at all stages of pregnancy in patients with significant risk of cardiovascular complications.
    Research Article
    JL Clua-Espuny1*, Moises Garces-Redondo2, Jorgina Lucas-Noll3, Anna Panisello-Tafalla4, LLuisa Queralt-Tomas5, Antonia Gonzalez-Henares6, Rosa Vicente-Ripolles7 and Carlos Lopez-Pablo8
    Abstract:
    Introduction: The epidemology and results on survival and disability are described from the begining of the Ictus code in a mediterranean population according to the modified Malgrem criteria. We want identify the main priorities in the quality policies about the Stroke Code.
    Materials and methods: Ebrictus Project is a study based on a cohort population from incident cases on the first stroke episode (included those patients with transient ischemic attack (TIA), recurrent strokes, and those treated with thrombolysis) from 01/04/2006 to 31/12/2013 participated by Primary care and neurological service referent.
    Results: The standardized population incidence is 11.7/104(CI95% 10.3-13.2) in women and 11.5/104 /year (CI95% 9.8-13.1) in men .The epidemiology is similar between men and women until they are 75-84 years old in which the incident cases per year increase as it is duplicated (15,67 vs 28,65) between women. In the 32.5% from the Ictus episodes, the Ictus code is activated (CI95% 24.3-43.4). According to the non-treated ischemic strokes and the ones that are from hemorrhage in the group treated with thrombolysis (8.6%) was the one that presented mayor clinical severity but better results in mortality RRR 39.8% RRA 18%, and NNT 5, and in functional RRR de 46.3% RRA de 9.4% y NNT 10 to a moderate dependency (Barthel <60). The risk of mortality among men is IR=3.2 (CI95% 1.2-8.0) in difference to women. After the stroke episode it is reduced in the half the number of individuals with initial dependency, with a meaningful loss (p 0.023) superior in women rather than men in the Barthel index (83.18 vs 75.8). Not giving secondary cardiovascular prevention after the ictus, it increases 7 times the risk of mortality.
    Conclusions: The standardized incidence on the Ictus is inferior to similar studies. The treatment with thrombolysis reduces the mortality and disability after an stroke episode, especially among women and with the secondary cardiovascular prevention it reduces 7 times the risk of mortality.
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