Microvascular angina refers to chest pain associated with coronary microvascular dysfunction (CMD).A new paradigm in cardiology was entrenched when the WISE studies demonstrated that angina may be present in patients with non-obstructive coronary artery disease (NOCAD).Statistically, there is a higher number of cases in women.The prevalence of NOCAD has been perceived in recent years reaching up to 20-30% of all coronary artery disease CAD.60% of the patients with angina symptoms may not present any sign of obstructive coronary artery disease (OCAD).In 2015, the COVADIS group established diagnostic criteria for microvascular angina.Recent studies used these criteria to design randomized clinical trials to elucidate the prevalence, diagnosis, treatment and prognosis of this entity.Conventional invasive angiography suggests that up to two-thirds of patients with NOCAD may have CMD, however this test does not allow direct visualization of the microcirculation.Non-invasive imaging modalities such as Positron Emission Tomography (PET) enable a direct and accurate assessment of coronary microvascular function.Thus, PET is becoming an indispensable tool in the evaluation of suspected CMD.
In Europe the organization of work varies from country to country depending on whether liberal, regulated or with salary.Organization depends on the system of payment of medical services, the way of running general practice, the availability of
Endogenous clocks determine almost all circadian rhythms in physiology.Circadian rhythms are patterns of physiology and behavior that follow a 24-hour cycle.They are autonomous and consist of self-sustained oscillations in biological processes driven or stimulated by environmental processes, the most important being light.Examples are, to name a few, sleep-wake cycle, learning, memory, daily variations in blood pressure, temperature, mood, heart rate, exercise capacity, ventilation, and coagulation, and it is now realized that the time at which our immune system is triggered (by infection, vaccination, surgery), appears to be critical to the way we respond to these insults.Also, circadian clocks give physiological systems the ability to anticipate daily changes.The complex network consists of a master pacemaker in the central nervous system and peripheral molecular clocks neurologically or hormonally connected and trained by the central node.These peripheral clocks govern a vast panel of cellular and molecular processes at virtually every level of regulation, maintaining the stability of the internal environment and anticipating disturbances.The objective of this work is to review the molecular biology of the system, to understand how it can be impacted, negatively or positively, and to review its dysfunction in respiratory diseases.It is also discussed how the understanding of circadian rhythms in respiratory medicine can have significance in the treatment optimization.At the end, some future recommendations for research on this topic are made.
PET Myocardial Perfusion Imaging is one of the most useful tools for clinicians when assessing coronary artery disease, due to its increasing availability, it is of superb importance to recognize the physiological basis and the basic principles for its interpretation.The most common protocols make use of Rubidium or Ammonia as radiotracers to evaluate myocardial perfusion and these agents have different characteristics, one caveat of Ammonia is that an on-site cyclotron is needed due to its short half-life.PET-MPI exhibits abnormalities not only on epicardial arteries but also in the microcirculation, as well as other parameters such as left ventricle ejection fraction and coronary flow reserve.Hybrid studies combine a functional with an anatomical study (i.e.PET-MPI and coronary computed tomography, respectively) and allows for a more complete evaluation of patients and to predict outcomes with great quality..
Background: Coronary flow reserve (CFR) is an index of coronary microcirculation.No previous reports exist on the association between testosterone levels and CFR.Therefore, the aim of the present study is to explore the association between testosterone and CFR in a group of men from the general population. Material and Methods:The study consisted of 66 men with no history of cardiovascular disease (CVD).Clinical data included age, body mass index (BMI), smoking, alcohol consumption, family history of CVD, and systolic blood pressure (SBP) were collected.Serum levels of testosterone and HbA1c were measured, and ApoB-to-ApoA-1 ratio was calculated.CFR was assessed using transthoracic colour Doppler echocardiography.CFR was calculated as the ratio between mean hyperemic coronary flow velocity (CFV) to mean baseline CFV.The men were classified into 3 groups based on CFR : G1 (CFR ≤3), G2 (CFR = 3.1-4.0),and G3 (CFR >4).Results: Men in G1 had significantly lower testosterone levels compared to men in G3 (12nmol/L vs. 17nmol/L; p=0.021).On the other hand, no statistically significant differences were found between men in G1 and those in G2 (12nmol/L vs. 15nmol/L; p=0.299), as well as between men in G2 and G3 (15nmol/L vs. 17nmol/L; p=0.493).Age, BMI, smoking, alcohol consumption, family history of CVD, SBP, ApoB-to-ApoA-1 ratio, and HbA1c did not differ significantly between groups.In multivariate regression analysis adjusted for the age of subjects, BMI, smoking, alcohol consumption, family history of CVD, SBP, ApoB-to-ApoA-1 ratio, HbA1c; a significant positive association was found between testosterone and CFR (β=0.035;95% CI=0.011, 0.069; p=0.04). Conclusions:In men without symptomatic cardiovascular disease, there was a significant positive association between testosterone and CFR, which may indicate that testosterone levels could play a role for coronary microcirculation.
Background:The sacrum is an infrequent localization of tumours.Despite the modern spinal surgical techniques, sacral tumours still are an important challenge for surgeons.This study aimed to describe the clinical course and prognosis of surgically treated patients with sacral tumours. Material and methods:A retrospective analysis from patients with sacral tumours seen from 2011 to 2017 at the National Cancer Institute, Mexico is presented.Multiple clinical variables were evaluated.Results: A total of 13 patients were included in the study.The most common primary histologic type was chordoma, followed by chondrosarcoma and giant cell tumours..The mean followup time was 51.4 months, mean progression-free survival was 31.6 months, 54% of the patients had complications related to surgery.At the end of the study, 54% of patients were still alive, with a mean overall survival of 51.3 months. Conclusion:Sacral tumours are a complex disease with a high surgical complication rate, elevated recurrence, and frequent neurologic and functional sequelae.We present a case series of 13 patients surgically treated with a 54% complication rate.
Background: Craniofacial fibrous dysplasia, is a rare disease with aesthetic and neurological alterations, sometimes requiring complex surgical treatment.The aim of this study is to describe the clinical course and treatment in fibrous dysplasia patients at one of the highest-demanding cancer centres in Latin America. Methods:Retrospective case series study from 1984 to 20019.Demographic, epidemiological, and clinical variables were analysed.Two representative cases were described. Results:In a thirty-five years period, nine patients were included.The mean age at diagnosis was 25.3 9.34 years, 55.5% were female.The most common affected was the frontal bone in 88.8%, skull base was involved in 77.7%.The mean follow-up time was 17.5 (±11.43)years, trigeminal nerve was the most commonly involved.Karnofsky of 95.5±7.2.At the end of the study, Karnofsky score was on average 91.1±13.6. Conclusion:There is a diverse clinical course, sometimes with high morbidity and many patients require multiple surgical interventions during the evolution of this condition.Close monitoring allows appropriate behaviours to be taken to avoid permanent neurological deficits or unwanted cosmetic defects by patients.
Background: Peripherally inserted central catheters (PICC) are increasingly used in the treatment of several conditions, including cancer. Use of PICCs may lead to complications, and various potential factors have been associated to their occurrence. Still, quantitative data on the issue are limited. Objective: Main aims of this study are to provide information on the durability of PICC in oncological patients and to identify which factors are associated to complications leading to PICC removal. Interventions/Methods: This is an observational, retrospective study of adult patients with onco-haematological diseases. An expert venous access team managed the full pathway of PICC use. Complications were continuously recorded according to hospital protocol. PICC survival was analysed using Kaplan-Meier curves and through multivariate hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: A total of 3700 patients were included during 2010-2018, for over 450,000 PICC-days. The HRs of PICC removal were 1.006 (95%CI, 1.001-1.011) for each 1-year increase in patient age, 1.35 (95%CI, 1.08-1.70) for referral to the oncology vs. surgery ward, 1.62 (95%CI, 1.32-1.99) for use of PICC for parenteral nutrition vs. chemotherapy administration, and 3.01 (95%CI, 2.58-3.50) for use of open-tip vs. closed-tip PICC. Conclusions: This Real-World analysis provided new quantitative evidence showing overall long survival times of PICCs in oncological patients. Both patient-related and treatment-related features were associated to PICC complications. Implications for Practice: PICCs were confirmed as a secure and long-lasting venous access device for cancer patients undergoing chemotherapy. In this oncological population, closed-tip PICCs showed overall better performances than open-tip PICCs.
Although measles, mumps, rubella, and varicella (MMRV) are vaccine-preventable diseases common in childhood, the incidence of these viral infections has recently increased in the adult Japanese population. For prevention against infections in medical facilities, it is important to assess the immunity against these viruses and to achieve immunocompetence by vaccination. The purpose of this study was to determine the need for MMRV vaccinations in Japanese students of co-medical fields by means of a seroprevalence survey for these viral infectious diseases and to recommend vaccination. Status of the students attending to International University of health and welfare, Otawara, Tochigi, Japan were surveyed in 2008 to 2011 academic year for vaccination and past medical history by self-administered questionnaire and the serum antibody prevalence for enrollment concerning measles, rubella, varicella and mumps. Majority of the students in all years had immunity for measles, rubella and varicella but not for mumps by EIA assy. Although positive rates of measles antibody had risen since 2009, which of rubella was extremely low in the year of 2011. Serum antibody titers of rubella were lower than those of measles in all years. Freshman of 2008 showed highest antibody titers against measles and rubella. A high prevalence rate for the varicella antibody was observed in subjects of 2010 and 2011. The prevalence rate for the mumps antibody was lower in subjects of 2010 and 2011. Vaccinations in Japan are not enforced and like the United States for final vaccination activities entrusted to guardians and personal perceptions and judgment, limits in encouraging vaccination for legal status. The results of this study suggest that the forth stage of measles and rubella mixed regular vaccination targeted since 2008 in Japan was effective. Also determined what should be done the encouraging vaccination based on specific past medical history, vaccination histories (including dates and times) about encouraging vaccination, appropriate for the individual.
a Equally contributed to the work ReviewAdaptive designs in oncology drug investigation, especially in the clinical trials of anti-cancer agents, have become more and more popular with the advantages of high efficiency and cost-effectiveness.However, potential success of the adaptive trial relies on the thorough understanding of adaptive design, exhaustive preprotocols backup, proficient statistical skills and support from local regulators.Here We reviewed the definitions of adaptive design trial (ADT) from previous publications, listed the advantages and drawbacks of different ADT approaches compared to traditional RCTs.Next, we collected all the clinical trials with adaptive design, exhibited a landscape of registered ADTs yearly and policies/instructions aiming to accelerate drug approval and commercialization across the world to date.Furthermore, we focus on the utilization of master protocol design in the field of solid tumor and analyzed the pros and cons of multiple key ADT studies around the world.Finally, we proposed an optimal PLATFORM study protocol with adaptive master protocol design based on all the elements we listed above and concluded the importance and potential future applications of adaptive trial design.
