Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence ...of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.
The enteric nervous system (ENS) consists of glial cells (EGCs) and neurons derived from neural crest precursors. EGCs retain capacity for large-scale neurogenesis in culture, and in vivo lineage ...tracing has identified neurons derived from glial cells in response to inflammation. We thus hypothesize that EGCs possess a chromatin structure poised for neurogenesis. We use single-cell multiome sequencing to simultaneously assess transcription and chromatin accessibility in EGCs undergoing spontaneous neurogenesis in culture, as well as small intestine myenteric plexus EGCs. Cultured EGCs maintain open chromatin at genomic loci accessible in neurons, and neurogenesis from EGCs involves dynamic chromatin rearrangements with a net decrease in accessible chromatin. A subset of in vivo EGCs, highly enriched within the myenteric ganglia and that persist into adulthood, have a gene expression program and chromatin state consistent with neurogenic potential. These results clarify the mechanisms underlying EGC potential for neuronal fate transition.
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•Single-cell RNA and chromatin accessibility profiling of enteric glial cells•Enteric glial cells undergo dynamic chromatin remodeling during neurogenesis•Intraganglionic enteric glial cells have distinct RNA and ATAC profiles•Intraganglionic enteric glia maintain chromatin poised for neurogenesis
By performing comprehensive single-cell transcriptomic and chromatin accessibility profiling of enteric glial cells both in culture and freshly isolated from mouse small intestine, Guyer et al. identify intraganglionic glia as a distinct subpopulation of enteric glial cells that are epigenetically poised for neurogenesis.
Using standardized methodology, the clinical scenarios (indications) in this document were developed by a diverse writing group to represent patient presentations encountered in everyday practice and ...were evaluated and rated by a separate, independent rating panel. Because there is significant clinical overlap between structural and valvular heart disease, separating the indications in the 2 AUC documents is somewhat arbitrary. ...the following radiation safety principles should be applied to all testing involving ionizing radiation: a.Clinical benefit should be As High As Reasonably Achievable, embracing the guiding principle that testing should be performed on cohorts that are most likely to experience a net benefit. b.Radiation exposure should be As Low As Reasonably Achievable (ALARA). Because a given modality may address diverse disease states, indications previously compiled in a single document may be spread over several AUC documents. ...suspected pulmonary arterial hypertension (including the evaluation of right ventricular function) is evaluated in patients at risk for developing pulmonary hypertension (22).
Multimodality Imaging of Thoracic Aortic Diseases in Adults Bhave, Nicole M.; Nienaber, Christoph A.; Clough, Rachel E. ...
JACC. Cardiovascular imaging,
June 2018, 2018-Jun, 2018-06-00, 20180601, Letnik:
11, Številka:
6
Journal Article
Recenzirano
Odprti dostop
In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay modalities for thoracic aortic ...imaging are echocardiography, computed tomographic angiography, and magnetic resonance angiography. For any given clinical scenario, the imaging modality and protocol chosen will have a significant impact on sensitivity and specificity for the aortic diagnosis of concern. Imaging can also provide important ancillary information regarding myocardial performance, aortic valve morphology and function, and end-organ perfusion. Surveillance of patients following thoracic aortic surgery with serial imaging studies can identify complications that may require reintervention, and imaging has played an integral role in development of new surgical and interventional methods. Emerging techniques in thoracic aortic imaging include positron emission tomography, which addresses vessel wall inflammation, and 4-dimensional magnetic resonance angiography, which illustrates flow dynamics.
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