Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with severe aortic stenosis (AS). Cardiovascular magnetic resonance imaging (CMR) provides reliable and ...reproducible estimates for assessment of cardiac structure and function after TAVR. The goal of this study was to conduct a systematic review and meta-analysis of the literature to assess left ventricular (LV) volumes, mass and function by CMR after TAVR.
Using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase for studies reporting CMR findings before and at least 1 month after TAVR. Main factors of interest were LV end-diastolic volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass index (LVMi), and left ventricular ejection fraction (LVEF). Standardized mean differences (SMD) were pooled by random effects meta-analytic techniques.
Of 453 screened publications, 10 studies (published between 2012 and 2018) were included. A total of 305 patients completed pre- and post-TAVR follow-up CMR (mean age range 78.6-85.0 years, follow-up range 6-15 months). Random effects analysis showed TAVR resulted in reduced LVEDVi (SMD: -0.25, 95% CI: - 0.43 to - 0.07, P = 0.006), LVESVi (SMD: -0.24, 95% CI: - 0.44 to - 0.05, P = 0.01), LVMi (SMD: -0.82, 95% CI: - 1.0 to - 0.63, P < 0.001) and increased LVEF (SMD: 22, 95% CI: 6 to 38%, P = 0.006). Heterogeneity across studies was low (I
: 0%, P
> 0.05 for all). The median reduction was 4 ml/m
(IQR: 3.1 to 8.2) for LVEDVi, 5 ml/m
(IQR: 3.0 to 6.0) for LVESVi, and 15.1 g/m
(IQR: 11.8 to 18.3) for LVMi. The median increase for LVEF was 3.4% (IQR 1.0 to 4.6%).
CMR demonstrates reverse LV remodeling occurrs within 6-15 months after TAVR, with reductions in LVEDVi, LVESVi and LVMi, and increased LVEF.
To systematically examine discontinuation rates with new US Food and Drug Administration-approved oral anticoagulants (NOACs) in patients with various indications for long-term anticoagulation.
Poor ...adherence to medications is considered a potential and frequent cause of treatment failure. We searched the PubMed, Cochrane Central Register of Controlled Trials, EMBASE, EBSCO, Web of Science, and CINAHL databases for articles published from January 1, 2001, through September 15, 2013. The following Medical Subject Heading terms and/or keywords were used for our database searches: rivaroxaban, dabigatran, apixaban, new oral anticoagulants, oral thrombin inhibitors, and oral factor Xa inhibitors. Articles in English that focused on randomized controlled trials (RCTs) comparing NOACs (apixaban, dabigatran, and rivaroxaban) with conventional therapy or placebo were abstracted. Independent extraction of relevant data was performed by 2 authors. The primary end point of interest was discontinuation due to all causes. Other end points of interest were discontinuation due to adverse events, consent withdrawal, and nonadherence.
Eighteen RCTs including a total of 101,801 patients were included for analysis. Total study drug discontinuation rates were not statistically different with NOACs in comparison to pharmacologically active comparators for treatment of venous thromboembolism/pulmonary embolism (risk ratio RR, 0.91; 95% CI, 0.74-1.13; P=.40) and for NOACs in comparison to warfarin and aspirin for prevention of stroke in patients with atrial fibrillation (RR, 1.01; 95% CI, 0.87-1.17; P=.92). In contrast, in acute coronary syndromes, total study drug discontinuation with NOACs was significantly higher than with placebo (RR, 1.40; 95% CI, 1.07-1.83; P=.01). Overall discontinuations were comparable to those with active comparators.
Study drug discontinuations with NOACs were not significantly different from those with conventional drugs in treatment of venous thromboembolism/pulmonary embolism and prevention of stroke in patients with atrial fibrillation but were worse in acute coronary syndromes as noted in evidence from contemporary RCTs.
Superior vena cava (SVC) syndrome is caused by the obstruction of the SVC and can result in significant morbidity and mortality. In contemporary practice, endovascular therapy (ET) has become the ...standard of care for a majority of these patients. This study is a systematic review and meta-analysis of the available literature to assess technical success, restenosis, and recurrence of SVC syndrome following endovascular intervention.
For this meta-analysis, we conducted a systematic literature review of PubMed, Cochrane Library, and Embase databases from inception to April 14, 2021 for studies on ET for SVC syndrome. Studies included full-length journal articles on the use of ET among adults with SVC syndrome. Case reports or case series with fewer than 20 patients were excluded. We evaluated the endpoints of technical success rate, restenosis rate, and recurrence rates in SVC syndrome patients after endovascular stenting. The results of this study were calculated using random-effects models.
We identified 6,012 reports, of which 39 studies met our inclusion criteria and were included for analysis. A total of 2200 patients received ET for SVC syndrome. The weighted technical success rate was 98.8% (95% CI 98.2–99.3) with low heterogeneity (I2=17.4%, p = 0.185), restenosis rate was 10.5% (95% CI 8.4–12.6) with moderate heterogeneity (I2=53.5%, p<0.001), and recurrence rate was 10.8% (95% CI 8.1–13.5) with high heterogeneity (I2=75.8%, p<0.001). Total complication rate was 8.6% (95% CI 7.3%-9.9%) with a mean complication rate of 7.5% (95% CI 4.7%-10.3%).
Our systematic review revealed high technical success, low restenosis, and low recurrence rates following ET. Collectively, these results support the paradigm of ET as an effective and safe treatment for patients with SVC syndrome.
None.
Synthesis and characterization of new ferrocenyl diphopshine chelated iron telluride cluster, Fe3(μ3-YTe)2(CO)8PPh2(Fc)PPh2} {Y = S (8), Se (9), Te(10)} have been carried out at room temperature ...reaction condition, while low temperature reaction study revealed the mechanistic aspects of the cluster formation and result in the isolation of intermediate cluster compounds (5–7). The reactivity study of 7 with metal carbonyl showed their ability to form hetero-metallic cluster compounds, Fe3Te2(CO)n(η2-dppf)W(CO)5 (n = 8, 9). Molecular structure of cluster 10 was confirmed using single crystal X-ray diffraction technique. Antibacterial and BSA protein interaction studies have been carried out with compound 10 which showed promising inhibition activity and protein binding ability.
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•Synthesis of new ferrocenyl diphopshine chelated iron telluride clusters and their reactivity study with metal carbonyl.•Structural characterization of chelated iron telluride cluster using single crystal X-ray crystallography.•Promising antibacterial and protein binding properties of ferrocenyl diphosphine chelated triiron ditelluride cluster.
Background
The urgent demand for innovative theranostic strategies to combat bacterial resistance to antibiotics is evident, with substantial implications for global health. Rapid diagnosis of ...life-threatening infections can expedite treatment, improving patient outcomes. Leveraging diagnostic modalities i.e., positron emission tomography (PET) and single photon emission computed tomography (SPECT) for detecting focal infections has yielded promising results. Augmenting the sensitivity of current PET and SPECT tracers could enable effective imaging of pathogenic bacteria, including drug-resistant strains.UBI (29–41), an antimicrobial peptide (AMP) fragment recognizes the
S. aureus
membrane through electrostatic binding. Radiolabeled UBI (29–41) is a promising SPECT and PET-based tracer for detecting focal infections. 2-APBA (2-acetyl-phenyl-boronic acid), a non-natural amino acid, specifically targets lysyl-phosphatidyl-glycerol (lysyl-PG) on the
S. aureus
membranes, particularly in AMP-resistant strains. We propose that combining UBI with 2-APBA could enhance the diagnostic potential of radiolabeled UBI.
Results
Present work aimed to compare the diagnostic potential of two radiolabeled peptides, namely UBI (29–41) and 2-APBA modified UBI (29–41), referred to as UBI and UBI-APBA. APBA modification imparted antibacterial activity to the initially non-bactericidal UBI against
S. aureus
by inducing a loss of membrane potential. The antibacterial activity demonstrated by UBI-APBA can be ascribed to the synergistic interaction of both UBI and UBI-APBA on the bacterial membrane. To enable PET imaging, we attached the chelator 1,4,7-triazacyclononane 1-glutaric acid 4,7-acetic acid (NODAGA) to the peptides for complexation with the positron emitter Gallium-68 (
68
Ga). Both NODAGA conjugates were radiolabeled with
68
Ga with high radiochemical purity. The resultant
68
Ga complexes were stable in phosphate-buffered saline and human serum. Uptake of these complexes was observed in
S. aureus
but not in mice splenocytes, indicating the selective nature of their interaction. Additionally, the APBA conjugate exhibited superior uptake in
S. aureus
while preserving the selectivity of the parent peptide. Furthermore,
68
GaGa-UBI-APBA demonstrated accumulation at the site of infection in rats, with an improved target-to-non-target ratio, as evidenced by ex-vivo biodistribution and PET imaging.
Conclusions
Our findings suggest that linking UBI, as well as AMPs in general, with APBA shows promise as a strategy to augment the theranostic potential of these molecules.
Cymantrenyl Schiff base compounds (CO)3Mn{(η5-C5H4)C(CH3)N–N(H)C(O)R} (4–7) (R = C6H4–OH, C5H4N-p, C6H5, C5H4N-o) have been synthesized by room temperature reaction and their structural ...characterization was performed by single crystal X-ray diffraction studies. Room temperature reaction of mono- and di-acetyl ferrocene with salicyloyl and isonicotinyl hydrazides led to the formation of the some organometallic Schiff base compounds containing monosubstituted, disubstituted and unsymmetrically substituted ferrocenyl fragments, (η5-C5H5)Fe{(η5-C5H4)C(CH3)N–N(H)C(O)–R} (8, 9), Fe{(η5-C5H4)C(CH3)NN(H)C(O)R}2 (10, 12) (R = C6H4–OH, C5H4N), {(η5-C5H4)COCH3}Fe{(η5-C5H4)C(CH3)NN(H)C(O)(C5H4N)} (11) and Fe{(η5-C5H4)C(CH3)N–N(H)C(O)(C5H4N)}{(η5-C5H4)C(CH3)NN(H)C(O)C6H4–OH} (13) respectively. Antibacterial studies and electrochemical analysis were carried out for some of the compounds. Molecular structure determination was performed for compounds 4, 5, 8 and 9 by single crystal X-ray diffraction technique.
Cymantrenyl and ferrocenyl Schiff base organometallic compounds have been synthesized by the reaction between respective acetylated organometallic fragments and hydrazide compounds. Compounds 4, 5, 8 and 9 have been structurally characterized by single crystal X-ray diffraction studies. Antibacterial studies and electrochemical analysis were performed for some of the ferrocenyl and cymantrenyl compounds. Display omitted
► Synthesis and reactivity of ferrocenyl and cymantrenyl compounds. ► Electrochemical properties study of ferrocenyl Schiff base compounds. ► Antimicrobial study with the synthesized organometallic compounds.
Dabigatran is a novel oral anticoagulant and may be useful during atrial fibrillation (AF) ablation for prevention of thromboembolic events. However, the benefits and adverse effects of ...periprocedural dabigatran therapy have not been thoroughly evaluated. A meta-analysis was performed to evaluate the efficacy and safety of dabigatran for anticoagulation in AF ablation. PubMed, The Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched from January 01, 2001 through July 30, 2013. Two reviewers reviewed the studies for inclusion and extracted data from studies comparing dabigatran with warfarin for AF ablation. A total of 5,513 patients undergoing catheter ablation were included in 17 observational studies and 1 randomized trial. Fourteen events of stroke or transient ischemic attacks were reported in the dabigatran group and 4 in the warfarin group (Peto's odds ratio 3.94, 95% confidence interval CI 1.54 to 10.08, number needed to harm = 284 patients). The risk of all thromboembolic complications was also higher in the dabigatran group compared with the warfarin group (Peto's odds ratio 2.81, 95% CI 1.23 to 6.45). No major differences were observed for the risk of major bleeding (odds ratio 0.99, 95% CI 0.55 to 1.78), pericardial tamponade, and groin hematoma. A lower risk of minor bleeding was observed with dabigatran (odds ratio 0.60, 95% CI 0.41 to 0.87). In conclusion, periprocedural use of dabigatran for AF ablation was related to a higher risk of thromboembolic complications including stroke and transient ischemic attack.
Abstract Background Remote ischemic preconditioning (RIPC) has been associated with reduced risk of myocardial injury in patients undergoing cardiovascular surgery, but uncertainty about clinical ...outcomes remains, particularly in the light of 2 recent large randomized clinical trials (RCTs) which were neutral. We performed a meta-analysis to evaluate the efficacy of RIPC on clinically relevant outcomes in patients undergoing cardiovascular surgery. Methods We searched PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through November 30, 2015. RCTs that compared the effects of RIPC vs. control in patients undergoing cardiac and/or vascular surgery were selected. We calculated summary random-effect odds ratios (OR) and 95% confidence intervals (CI). Results The analysis included 5652 patients from 27 RCTs. RIPC reduced the risk of myocardial infarction (MI) (OR 0.72, 95% CI, 0.52 to 1.00; p = 0.05; number needed to treat (NNT) = 42), acute renal failure (OR 0.73, 95% CI, 0.53 to 1.00; p = 0.05; NNT = 44) as well as the composite of all cause mortality, MI, stroke or acute renal failure (OR 0.60, 95% CI, 0.39 to 0.90; p = 0.01; NNT = 25). No significant difference between RIPC and the control groups was observed for the outcome of all-cause mortality (OR 1.10, 95% CI, 0.81 to 1.51). Randomization to RIPC group was also associated with significantly shorter hospital stay (weighted mean difference − 0.15 days; 95% CI − 0.27 to − 0.03 days). Conclusions RIPC did not decrease overall mortality, but was associated with less MI and acute renal failure and shorter hospitalizations in patients undergoing cardiac or vascular surgery.
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