The notion of self-branding has drawn myriad academic responses over the last decade. First popularised in a provocative piece published in Fast Company, self-branding has been criticised by some on ...theoretical, practical and ethical grounds, while others have endorsed and propelled the idea. This article considers how and why the concept of self-branding has become so prevalent. We contend that it parallels the growth of digital technology (particularly social media) embedded in the current political climate: neoliberal individualism. Another objective here is to imbue the concept of self-branding with a marketing perspective and show how the 'celebrities' of self-branding manifest at a marketing media nexus distinct to the opening decades of the twenty-first century. Building on literature from mostly media and cultural studies, this critique sees self-branding as a distortion of key branding principles that has obvious implications for its practitioners and advocates. The article shows that, despite inherent tensions and problematic ironies, self-branding persists through the rise of Social Media Influencers; we consider three of these whose fame and following was achieved via the practices and phenomena under consideration.
Chronic Thromboembolic Pulmonary Hypertension Mahmud, Ehtisham; Madani, Michael M.; Kim, Nick H. ...
Journal of the American College of Cardiology,
05/2018, Letnik:
71, Številka:
21
Journal Article
Recenzirano
Odprti dostop
Chronic thromboembolic pulmonary hypertension (CTEPH), a rare consequence of an acute pulmonary embolism, is a disease that is underdiagnosed, and surgical pulmonary thromboendarterectomy (PTE) ...remains the preferred therapy. However, determination of operability is multifactorial and can be challenging. There is growing excitement for the percutaneous treatment of inoperable CTEPH with data from multiple centers around the world showing the clinical feasibility of balloon pulmonary angioplasty. Riociguat remains the only approved medical therapy for CTEPH patients deemed inoperable or with persistent pulmonary hypertension after PTE. We recommend that expert multidisciplinary CTEPH teams be developed at individual institutions. Additionally, optimal and standardized techniques for balloon pulmonary angioplasty need to be developed along with dedicated interventional equipment and appropriate training standards. In the meantime, the percutaneous revascularization option is appropriate for patients deemed inoperable in combination with targeted medical therapy, or those who have failed to benefit from surgery.
Display omitted
Balloon pulmonary angioplasty (BPA) is an emerging treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who have inoperable, segmental/subsegmental disease, or ...residual disease after pulmonary endarterectomy. In the past decade, advances in the techniques for BPA have led to better clinical outcomes with improvements in hemodynamics, pulmonary perfusion, exercise tolerance, functional capacity, and quality of life. We present the experience with BPA at our university, the largest CTEPH center in the world, followed by reviewing the published data regarding the efficacy and safety of BPA in patients with CTEPH. There is increasing evidence to support that the initial hemodynamic improvement is sustained for ≥3 years after the procedure. Although infrequent, complications observed with BPA are associated with pulmonary vascular injury or rarely reperfusion pulmonary edema. As the technique for percutaneous pulmonary artery revascularization has improved, the procedural risk and complications have continued to decrease. This promising technique continues to develop, and future research is required to demonstrate the long-term benefits of BPA, standardize the technique, and define a uniform institutional infrastructure for providing BPA as a part of the treatment of CTEPH.
Objectives
To assess the long‐term safety and efficacy of robotic percutaneous coronary revascularization for use in complex coronary lesions.
Background
Robotically assisted percutaneous coronary ...intervention (PCI) is safe and feasible in simple coronary lesions and has excellent short‐term procedural and clinical outcomes for complex lesions; however, long‐term safety and efficacy outcomes are unknown.
Methods
A total of 103 consecutive patients underwent a total of 108 robotic (R)‐PCI procedures (age 68.1; 78.3% male) over 18 months, and 210 patients underwent a total of 226 manual (M)‐PCI procedures (age 67.5; 78.1% male) during the same period. Patients were subsequently followed and both 6‐month and 12‐month major adverse cardiovascular events (MACE), comprised of any death, stroke, myocardial infarction, or target vessel revascularization, are reported and compared.
Results
There was no difference between the two groups with regard to overall MACE at 6 months (R‐PCI 5.8% vs. M‐PCI 3.3%, P = 0.51) or at 12 months (R‐PCI 7.8% vs. M‐PCI 8.1%, P = 0.92). There was no difference between the individual components of the primary combined endpoint at either time point. No access site complications occurred in either cohort that met BARC III or higher criteria.
Conclusions
At the 6‐ and 12‐month time points following R‐PCI, no difference in clinical outcomes or safety measures was observed as compared to M‐PCI.
Chronic thromboembolic pulmonary hypertension is a form of precapillary pulmonary hypertension resulting from the incomplete resolution of pulmonary thromboemboli and formation of chronic, fibrotic, ...flow-limiting obstructions within the pulmonary vasculature. The progression of chronic thromboembolic disease is associated with the development of pulmonary hypertension, right heart failure, and diminished patient function. Surgical pulmonary thromboendarterectomy to extract thromboembolic disease is curative and the primary treatment option for chronic thromboembolic pulmonary hypertension. For patients who are not surgical candidates, balloon pulmonary angioplasty (BPA) is a percutaneous treatment option that uses angioplasty techniques to dilate diseased pulmonary arteries, disrupt organized flow-limiting obstructions, revascularize underperfused lung regions, improve pulmonary vascular hemodynamics, and restore patient function. BPA has undergone refinement and worldwide adoption since its inception, leading to advancements in the equipment used, technical approach, and complication management for each procedure. The approach to modern BPA, its attendant complications, and contemporary treatment outcomes are discussed in this state-of-the-art review.
Abstract Objectives The aim of this study was to evaluate the diagnostic utility of plasma metabolomic biomarkers for in-stent restenosis (ISR). Background ISR remains an issue for patients after ...percutaneous coronary intervention. Identification of biomarkers to predict ISR could be invaluable for patient care. Methods Next-generation metabolomic profiling was performed in the discovery phase from the plasma of 400 patients undergoing percutaneous coronary intervention. In the validation phase, targeted analysis was conducted using stable isotope dilution–multiple reaction monitoring mass spectrometry in another independent group of 500 participants. Results A set of 6 plasma metabolites was discovered and validated for the diagnosis of ISR as early as 1 month after percutaneous coronary intervention. This biomarker panel classified patients with ISR and control subjects with sensitivity of 91% and specificity of 90% in the discovery phase. The diagnostic accuracy in the independent validation phase was 90% (95% confidence interval: 87% to 100%). The defined 6 metabolites all belong to sphingolipid and phospholipid metabolism, including phosphatidylcholine diacyl C36:0, phosphatidylcholine diacyl C34:2, phosphatidylinositol diacyl C36:4, phosphatidic acid C34:1, ceramide, and sphingomyelin diacyl 18:1/20:1. These biomarkers play essential roles in cell signaling that regulates the proliferation and migration of vascular smooth muscle cells. Conclusions Next-generation metabolomics demonstrates powerful diagnostic value in estimating ISR-related metabolic disturbance. The defined plasma biomarkers provide better early diagnostic value compared with conventional imaging techniques.
Robotic technology has been utilized in cardiovascular medicine for over a decade, and over that period, its use has been expanded to percutaneous coronary and peripheral vascular interventions. The ...safety and feasibility of robotically assisted percutaneous cardiovascular interventions has been demonstrated in studies including simple to complex coronary lesions, and both iliac and femoropopliteal lesions. These reports have shown that robotically assisted PCI significantly reduces operator exposure to harmful ionizing radiation without a detrimental effect on procedural success or clinical efficacy. Additionally, the use of robotics has the intuitive benefit of alleviating the risk of orthopedic injuries faced by interventional operators. In addition to the interventional operator benefits, robotically assisted intervention has the potential for patient level benefit by allowing more accurate lesion length measurement, precise stent placement, and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits.
Elevated Serum Fibrinogen Ang, Lawrence, MD; Mahmud, Ehtisham, MD
Journal of the American College of Cardiology,
04/2015, Letnik:
65, Številka:
16
Journal Article
Recenzirano
Odprti dostop
After this observation, the following remained unclear: 1) whether elevated fibrinogen in diabetic patients is simply a marker of greater systemic inflammation or actively facilitates increased ...platelet cross-linking as measured by in vitro platelet aggregation testing, and 2) with an elevated fibrinogen level, is it impaired on-treatment PI or DM most closely associated with the occurrence of major adverse cardiac events (MACE) after PCI?
PDF
