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  • 1
    Language: English
    In: The New England journal of medicine, 2014-04-10, Vol.370 (15), p.1412-1421
    Description: In patients with severe sepsis, albumin replacement in addition to crystalloid administration conferred no benefit, as compared with crystalloids alone, with respect to mortality at 28 or 90 days. Post hoc analysis suggested a possible benefit in patients with septic shock. For decades, human albumin has been administered to patients to provide adequate oncotic pressure and intravascular volume. 1 In 1998, however, a report from the Cochrane Injuries Group Albumin Reviewers indicated that the administration of albumin may be potentially harmful in critically ill patients, as compared with the administration of crystalloid solutions. 2 Subsequent meta-analyses reported contradictory findings. 3 , 4 To clarify this issue, a large, double-blind, randomized trial (the Saline versus Albumin Fluid Evaluation [SAFE] study) 5 was conducted, in which 4% albumin solution was compared with normal saline as fluid replacement in critically ill patients, with results indicating that albumin administration was . . .
    Subject(s): General aspects ; Infectious diseases ; Bacterial diseases ; Human bacterial diseases ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Intensive care medicine ; Emergency and intensive care: infection, septic shock ; Medical sciences ; Bacterial sepsis ; Humans ; Middle Aged ; Isotonic Solutions - administration & dosage ; Albumins - administration & dosage ; Male ; Survival Rate ; Treatment Outcome ; Shock, Septic - mortality ; Serum Albumin - analysis ; Shock, Septic - therapy ; Sepsis - mortality ; Sepsis - therapy ; Female ; Aged ; Rehydration Solutions - therapeutic use ; Albumin ; Evaluation ; Sepsis ; Septic shock ; Usage ; Care and treatment ; Proteins ; Intensive care units ; Clinical trials ; Blood pressure ; Drug therapy ; Index Medicus ; Abridged Index Medicus
    ISSN: 0028-4793
    E-ISSN: 1533-4406
    Source: Single Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 2
    Language: English
    In: Journal of the American College of Cardiology, 2008, Vol.52 (12), p.997-1003
    Description: Prognostic Value of Changes in N-Terminal Pro-Brain Natriuretic Peptide in Val-HeFT (Valsartan Heart Failure Trial) Serge Masson, Roberto Latini, Inder S. Anand, Simona Barlera, Laura Angelici, Tarcisio Vago, Gianni Tognoni, Jay N. Cohn, for the Val-HeFT Investigators We assessed the prognostic value of repeated determinations of N-terminal pro-brain natriuretic peptide (NT-proBNP) in a large population of patients with stable and chronic heart failure (HF). A single determination of NT-proBNP showed a higher prognostic discrimination during the course of a strict clinical monitoring period than continuous changes of concentrations. Categorical changes across a threshold value predicted outcome independently of a single determination. Serial determinations of NT-proBNP and classification into few categories of changes may be a superior strategy for risk stratification of patients with chronic and stable HF, and may offer an aid in monitoring these patients.
    Subject(s): Cardiovascular ; Internal Medicine ; heart failure ; prognosis ; natriuretic peptide ; Prognosis ; Time Factors ; Humans ; Middle Aged ; Peptide Fragments - blood ; Proportional Hazards Models ; Female ; Male ; Aged ; Heart Failure - diagnosis ; Heart Failure - blood ; Natriuretic Peptide, Brain - blood ; Heart failure ; Natriuretic peptides ; Brain ; Medical colleges ; Index Medicus ; Abridged Index Medicus
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 3
    Language: English
    In: The New England journal of medicine, 2017-07-06, Vol.377 (1), p.41-51
    Description: Data were analyzed from 40,195 patients with heart failure with reduced ejection fraction enrolled in 12 clinical trials in the 1995–2014 period. Sudden-death rates declined substantially over time, a finding consistent with a cumulative effect of evidence-based medical therapy.
    Subject(s): Death, Sudden - epidemiology ; Age Factors ; Follow-Up Studies ; Humans ; Middle Aged ; Heart Failure - physiopathology ; Male ; Risk ; Confounding Factors, Epidemiologic ; Cause of Death ; Incidence ; Randomized Controlled Trials as Topic ; Stroke Volume ; Regression Analysis ; Sex Factors ; Adult ; Female ; Aged ; Heart Failure - mortality ; Heart failure ; Clinical trials ; Care and treatment ; Cardiac output ; Patient outcomes ; Analysis ; Cardiac arrhythmia ; Mortality ; Regression analysis ; Patients ; Defibrillators ; Ischemia ; Peptidyl-dipeptidase A ; Angiotensin ; Death ; Cardiovascular diseases ; Health risk assessment ; Cardiology ; Heart diseases ; Index Medicus ; Abridged Index Medicus ; metaanalysis ; ventricular systolic ; Klinisk medicin ; dysfunction ; candesartan ; randomized controlled-trials ; Clinical Medicine ; myocardial-infarction ; cardiac death ; converting-enzyme inhibitors ; mortality ; General & Internal Medicine ; implantable cardioverter-defibrillator ; prevention
    ISSN: 0028-4793
    E-ISSN: 1533-4406
    Source: Single Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 4
    Language: English
    In: Catheterization and cardiovascular interventions, 2018-06-01, Vol.91 (7), p.1291-1293
    Description: Coronary Sinus Reducer (Neovasc, Inc., Richmond B.C., Canada) has shown to be an effective and safe treatment option for the treatment of refractory angina. Until now, a few number of complications related to its implantation have been reported. Coronary sinus perforation is a rare complication, more often related to cardiac surgery procedures. We report the first case of coronary sinus perforation after a sinus Reducer implantation.
    Subject(s): CORD ; CAD ; IDI ; Angina Pectoris - diagnosis ; Humans ; Middle Aged ; Cardiac Catheterization - adverse effects ; Coronary Sinus - diagnostic imaging ; Male ; Treatment Outcome ; Vascular System Injuries - etiology ; Heart Injuries - therapy ; Angina Pectoris - therapy ; Cardiac Catheterization - instrumentation ; Coronary Sinus - injuries ; Coronary Angiography ; Balloon Occlusion ; Heart Injuries - etiology ; Vascular System Injuries - diagnostic imaging ; Vascular System Injuries - therapy ; Heart Injuries - diagnostic imaging
    ISSN: 1522-1946
    E-ISSN: 1522-726X
    Source: Alma/SFX Local Collection
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  • 5
    Language: English
    In: Intensive care medicine, 2015-01, Vol.41 (1), p.12-20
    Description: Presepsin is a soluble fragment of the cluster-of-differentiation marker protein 14 (CD14) involved in pathogen recognition by innate immunity. We evaluated the relation between its circulating concentration, host response, appropriateness of antibiotic therapy, and mortality in patients with severe sepsis.Plasma presepsin was measured 1, 2, and 7 days after enrollment of 997 patients with severe sepsis or septic shock in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial. They were randomized to albumin or crystalloids. We tested with univariate and adjusted models the association of single measurements of presepsin or changes over time with clinical events, organ dysfunctions, appropriateness of antibiotic therapy, and ICU or 90-day mortality.Presepsin concentration at baseline (946 [492–1,887] ng/L) increased with the SOFA score, the number of prevalent organ dysfunctions or failures, and the incidence of new failures of the respiratory, coagulation, liver, and kidney systems. The concentration decreased in ICU over 7 days in patients with negative blood cultures, and in those with positive blood cultures and appropriate antibiotic therapy; it increased with inappropriate antibiotic therapy (p = 0.0009). Baseline presepsin was independently associated with, and correctly reclassified, the risk of ICU and 90-day mortality. Increasing concentrations of presepsin from day 1 to day 2 predicted higher ICU and 90-day mortality (adjusted p 〈 0.0001 and 0.01, respectively). Albumin had no effect on presepsin concentration.Presepsin is an early predictor of host response and mortality in septic patients. Changes in concentrations over time seem to reflect the appropriateness of antibiotic therapy.
    Subject(s): Pediatrics ; Pain Medicine ; Presepsin ; Emergency Medicine ; Pneumology/Respiratory System ; Prognosis ; Medicine & Public Health ; Severe sepsis ; Intensive / Critical Care Medicine ; Septic shock ; Clinical trial ; Anesthesiology ; Intensive Care Units ; Isotonic Solutions - therapeutic use ; Humans ; Middle Aged ; Male ; Treatment Outcome ; Biomarkers - blood ; Shock, Septic - mortality ; Shock, Septic - therapy ; Lipopolysaccharide Receptors - blood ; Sepsis - mortality ; Albumins - therapeutic use ; Anti-Bacterial Agents - therapeutic use ; Sepsis - therapy ; Shock, Septic - blood ; Peptide Fragments - blood ; Female ; Italy - epidemiology ; Aged ; Sepsis - blood ; Antigens ; Medical research ; Immune response ; Physiological aspects ; Medicine, Experimental ; Sepsis ; Research ; Properties ; Index Medicus
    ISSN: 0342-4642
    E-ISSN: 1432-1238
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 6
    Language: English
    In: JAMA : the journal of the American Medical Association, 2009-11-11, Vol.302 (18), p.1977-1984
    Description: CONTEXT Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS). OBJECTIVE To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS. DESIGN, SETTING, AND PATIENTS The Prone-Supine II Study, a multicenter, unblinded, randomized controlled trial conducted in 23 centers in Italy and 2 in Spain. Patients were 342 adults with ARDS receiving mechanical ventilation, enrolled from February 2004 through June 2008 and prospectively stratified into subgroups with moderate (n = 192) and severe (n = 150) hypoxemia. INTERVENTIONS Patients were randomized to undergo supine (n = 174) or prone (20 hours per day; n = 168) positioning during ventilation. MAIN OUTCOME MEASURES The primary outcome was 28-day all-cause mortality. Secondary outcomes were 6-month mortality and mortality at intensive care unit discharge, organ dysfunctions, and the complication rate related to prone positioning. RESULTS Prone and supine patients from the entire study population had similar 28-day (31.0% vs 32.8%; relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P = .72) and 6-month (47.0% vs 52.3%; RR, 0.90; 95% CI, 0.73-1.11; P = .33) mortality rates, despite significantly higher complication rates in the prone group. Outcomes were also similar for patients with moderate hypoxemia in the prone and supine groups at 28 days (25.5% vs 22.5%; RR, 1.04; 95% CI, 0.89-1.22; P = .62) and at 6 months (42.6% vs 43.9%; RR, 0.98; 95% CI, 0.76-1.25; P = .85). The 28-day mortality of patients with severe hypoxemia was 37.8% in the prone and 46.1% in the supine group (RR, 0.87; 95% CI, 0.66-1.14; P = .31), while their 6-month mortality was 52.7% and 63.2%, respectively (RR, 0.78; 95% CI, 0.53-1.14; P = .19). CONCLUSION Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00159939
    Subject(s): General aspects ; Viral diseases of the respiratory system and ent viral diseases ; Infectious diseases ; Viral diseases ; Biological and medical sciences ; Medical sciences ; Human viral diseases ; Prone Position ; Humans ; Middle Aged ; Kaplan-Meier Estimate ; Adult ; Female ; Male ; Aged ; Respiratory Distress Syndrome, Adult - mortality ; Hypoxia - therapy ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult - therapy ; Index Medicus ; Abridged Index Medicus
    ISSN: 0098-7484
    E-ISSN: 1538-3598
    Source: American Medical Association Journals Backfile (through 1997)
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 7
    Language: English
    In: The Journal of clinical investigation, 2009-03, Vol.119 (3), p.524-530
    Description: The renin-angiotensin system plays a role in the etiology of hypertension and the pathophysiology of cardiac and renal diseases in humans. Ang II is the central product of this system and is involved in regulating immune responses, inflammation, cell growth, and proliferation by acting through Ang II type 1 receptors (AT1 and AT2). Here, we show that targeted disruption of the Agtr1a gene that encodes AT1A results in marked prolongation of life span in mice. Agtr1a-/- mice developed less cardiac and vascular injury, and multiple organs from these mice displayed less oxidative damage than wild-type mice. The longevity phenotype was associated with an increased number of mitochondria and upregulation of the prosurvival genes nicotinamide phosphoribosyltransferase (Nampt) and sirtuin 3 (Sirt3) in the kidney. In cultured tubular epithelial cells, Ang II downregulated Sirt3 mRNA, and this effect was inhibited by an AT1 antagonist. These results demonstrate that disruption of AT1 promotes longevity in mice, possibly through the attenuation of oxidative stress and overexpression of prosurvival genes, and suggests that the Ang II/AT1 pathway may be targeted to influence life span in mammals.
    Subject(s): Mice, Knockout - genetics ; Up-Regulation ; Vascular Diseases - prevention & control ; Body Weight ; Down-Regulation ; Oxidative Stress - genetics ; Vascular Diseases - genetics ; Blood Glucose ; Heart Diseases - prevention & control ; Mitochondrial Proteins - genetics ; Longevity - genetics ; Energy Intake ; Nicotinamide Phosphoribosyltransferase - genetics ; Phenotype ; Rotarod Performance Test ; Animals ; Sirtuin 3 ; Adaptor Proteins, Signal Transducing - genetics ; Mice ; Sirtuins - genetics ; Cytokines - genetics ; Heart Diseases - genetics ; Hypertension ; Complications and side effects ; Causes of ; Genetic aspects ; Research ; Longevity ; Renin-angiotensin system ; Health aspects ; Index Medicus ; Abridged Index Medicus
    ISSN: 0021-9738
    E-ISSN: 1558-8238
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 8
    Language: English
    In: American journal of respiratory and critical care medicine, 2019-09-01, Vol.200 (5), p.582-589
    Description: Hyperlactatemia in sepsis may derive from a prevalent impairment of oxygen supply/demand and/or oxygen use. Discriminating between these two mechanisms may be relevant for the early fluid resuscitation strategy. To understand the relationship among central venous oxygen saturation (Scv ), lactate, and base excess to better determine the origin of lactate. This was a analysis of baseline variables of 1,741 patients with sepsis enrolled in the multicenter trial ALBIOS (Albumin Italian Outcome Sepsis). Variables were analyzed as a function of sextiles of lactate concentration and sextiles of Scv . We defined the "alactic base excess," as the sum of lactate and standard base excess. Organ dysfunction severity scores, physiologic variables of hepatic, metabolic, cardiac, and renal function, and 90-day mortality were measured. Scv was lower than 70% only in 35% of patients. Mortality, organ dysfunction scores, and lactate were highest in the first and sixth sextiles of Scv . Although lactate level related strongly to mortality, it was associated with acidemia only when kidney function was impaired (creatinine 〉2 mg/dl), as rapidly detected by a negative alactic base excess. In contrast, positive values of alactic base excess were associated with a relative reduction of fluid balance. Hyperlactatemia is powerfully correlated with severity of sepsis and, in established sepsis, is caused more frequently by impaired tissue oxygen use, rather than by impaired oxygen transport. Concomitant acidemia was only observed in the presence of renal dysfunction, as rapidly detected by alactic base excess. The current strategy of fluid resuscitation could be modified according to the origin of excess lactate.
    Subject(s): Humans ; Middle Aged ; Biomarkers - analysis ; Male ; Acidosis, Lactic - physiopathology ; Biomarkers - blood ; Sepsis - physiopathology ; Acidosis, Lactic - therapy ; Oxygen Consumption - physiology ; Fluid Therapy - methods ; Sepsis - therapy ; Aged, 80 and over ; Adult ; Female ; Italy ; Aged ; Intensive care ; Mortality ; Critical care ; Emergency medical care ; Metabolism ; Patients ; Variables ; Fluids ; Acids ; Consent ; Sepsis ; Hypoxia ; Anesthesiology ; Acidosis ; Index Medicus ; Abridged Index Medicus
    ISSN: 1073-449X
    E-ISSN: 1535-4970
    Source: ProQuest Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 9
    Language: English
    In: The Journal of clinical investigation, 2009-11, Vol.119 (11), p.3356-3372
    Description: Tumor growth and progression rely upon angiogenesis, which is regulated by pro- and antiangiogenic factors, including members of the semaphorin family. By analyzing 3 different mouse models of multistep carcinogenesis, we show here that during angiogenesis, semaphorin 3A (Sema3A) is expressed in ECs, where it serves as an endogenous inhibitor of angiogenesis that is present in premalignant lesions and lost during tumor progression. Pharmacologic inhibition of endogenous Sema3A during the angiogenic switch, the point when pretumoral lesions initiate an angiogenic phase that persists throughout tumor growth, enhanced angiogenesis and accelerated tumor progression. By contrast, when, during the later stages of carcinogenesis following endogenous Sema3A downmodulation, Sema3A was ectopically reintroduced into islet cell tumors by somatic gene transfer, successive waves of apoptosis ensued, first in ECs and then in tumor cells, resulting in reduced vascular density and branching and inhibition of tumor growth and substantially extended survival. Further, long-term reexpression of Sema3A markedly improved pericyte coverage of tumor blood vessels, something that is thought to be a key property of tumor vessel normalization, and restored tissue normoxia. We conclude, therefore, that Sema3A is an endogenous and effective antiangiogenic agent that stably normalizes the tumor vasculature.
    Subject(s): Uterine Cervical Neoplasms - blood supply ; Humans ; Mice, Inbred C57BL ; Adenoma, Islet Cell - blood supply ; Gene Expression Regulation, Neoplastic ; Mice, Transgenic ; Neoplasms - blood supply ; Uterine Cervical Neoplasms - physiopathology ; Semaphorin-3A - metabolism ; Cell Hypoxia ; Integrin beta1 - metabolism ; Adenoma, Islet Cell - physiopathology ; Angiogenesis Inhibitors - metabolism ; Animals ; Female ; Mice ; Neovascularization, Pathologic - metabolism ; Neoplasms - physiopathology ; Cell Movement ; Disease Models, Animal ; Semaphorin-3A - genetics ; Usage ; Control ; Growth ; Models ; Angiogenesis inhibitors ; Research ; Gene therapy ; Health aspects ; Tumors
    ISSN: 0021-9738
    E-ISSN: 1558-8238
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 10
    Language: English
    In: Scientific reports, 2021-01-15, Vol.11 (1), p.1518-1518
    Description: Ischaemic heart disease is the world's leading cause of mortality. Survival rates from acute myocardial infarction (MI) have improved in recent years; however, this has led to an increase in the prevalence of heart failure (HF) due to chronic remodelling of the infarcted myocardium, for which treatment options remain poor. We have previously shown that inhibition of isoform 4 of the plasma membrane calcium ATPase (PMCA4) prevents chronic remodelling and HF development during pressure overload, through fibroblast mediated Wnt signalling modulation. Given that Wnt signalling also plays a prominent role during remodelling of the infarcted heart, this study investigated the effect of genetic and functional loss of PMCA4 on cardiac outcomes following MI. Neither genetic deletion nor pharmacological inhibition of PMCA4 affected chronic remodelling of the post-MI myocardium. This was the case when PMCA4 was deleted globally, or specifically from cardiomyocytes or fibroblasts. PMCA4-ablated hearts were however less prone to acute arrhythmic events, which may offer a slight survival benefit. Overall, this study demonstrates that PMCA4 inhibition does not affect chronic outcomes following MI.
    Subject(s): Myocardial infarction ; Heart attacks ; Arrhythmia ; Wnt protein ; Calcium ; Fibroblasts ; Myocardium ; Cardiomyocytes ; Survival ; Heart diseases ; Coronary artery disease ; Ca2+-transporting ATPase ; Index Medicus
    E-ISSN: 2045-2322
    Source: Nature Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: Directory of Open Access Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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