{"title":"Venous Thromboembolism Risk Assessment and Thromboprophylaxis Practice in Hospitalized Medical Patients: The Experience of a Singapore Teaching Hospital.","authors":"Sin Yin Lee, Chaozer Er","doi":"10.1055/s-0044-1791506","DOIUrl":"10.1055/s-0044-1791506","url":null,"abstract":"<p><p>Despite the availability of institutional guidelines, the practice of venous thromboembolism (VTE) risk assessment and thromboprophylaxis remains inadequate in Singapore. With hospital-associated VTE (HA-VTE) being a common cause of preventable mortality for medical patients, it is vital for prompt, appropriate prescription of thromboprophylaxis after VTE risk assessment. This study aimed to (1) assess the local practice of VTE risk assessment and prophylaxis according to institutional guidelines, (2) study the risk factors of potential preventable HA-VTE among hospitalized medical patients, and (3) improve the quality of care with respect to early prevention of HA-VTE. An audit was performed on daily new admissions to two general medical wards in a teaching hospital in Singapore (total capacity of 76 beds) over 2 weeks. Each new admission's medical records were reviewed to examine whether (1) VTE risk assessment was performed by the managing medical teams, (2) thromboprophylaxis was prescribed during admission in high VTE risk patients, and (3) any contraindications to pharmacological thromboprophylaxis for cases with high VTE risk but no pharmacological thromboprophylaxis prescribed was present. Only 1 out of 52 cases had VTE risk assessment performed. Thirty-one cases (59.1%) were identified to have high VTE risk using the Padua Prediction Score. However, only 1 out of the 31 cases (3.2%) had VTE prophylaxis prescribed. Adherence to local institutional guidelines remains poor despite increasing awareness of the importance of VTE risk assessment and prophylaxis in the prevention of associated morbidity and mortality. Certain patient profiles should prompt clinicians to perform VTE risk assessment.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"34 1","pages":"75-77"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Year in Cardiology-Practice Changing Trials from European Society of Cardiology Congress 2023.","authors":"Akshyaya Pradhan, Umesh Tripathi, Abhishek Singh","doi":"10.1055/s-0044-1788893","DOIUrl":"10.1055/s-0044-1788893","url":null,"abstract":"<p><p>The European Society of Cardiology annual congress is the premier global platform for dissemination and unraveling major scientific advances in the field of cardiology. Each year a myriad number of scientific ideas are exchanged at this meeting and many major path-breaking clinical trials are presented that have the potential to alter our practice. Last year was not different and more than 30 clinical trials spanning various facets of cardiology were unveiled and discussed-heart failure, lipid lowering, coronary intervention, intracoronary imaging, cardiomyopathies, anticoagulation, atrial fibrillation, antiplatelet therapy, etc. We present a brief summary of 10 major trials which in the view of authors have the potential for impacting daily cardiology practice. In each study, we also attempt to provide a contemporary perspective and the way forward. We aim to provide a glimpse on the major advances in the field of cardiology in the past year.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"34 1","pages":"1-9"},"PeriodicalIF":0.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11813610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Grayscale Inversion to aid Diagnosis of Acute Occlusive and Chronic Pulmonary Embolism on CT.","authors":"Achala Donuru, Drew A Torigian, Arun C Nachiappan","doi":"10.1055/s-0044-1786745","DOIUrl":"10.1055/s-0044-1786745","url":null,"abstract":"","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 2","pages":"132-133"},"PeriodicalIF":0.5,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew J Gorton, Suresh Keshavamurthy, Sibu P Saha
{"title":"Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms.","authors":"Andrew J Gorton, Suresh Keshavamurthy, Sibu P Saha","doi":"10.1055/s-0044-1787304","DOIUrl":"10.1055/s-0044-1787304","url":null,"abstract":"<p><p>The thoracic aorta is a dynamic structure composed of the aortic root, ascending aorta, aortic arch, and descending aorta. It is subject to the pressure and volume of the cardiac cycle and susceptible to atherosclerotic and aneurysmal changes. With these changes, the risk for acute aortic syndromes increases, thus creating the impetus for earlier interventions. The previous standard of open surgical repair has undergone a transition in recent years toward endovascular repair being favored in the descending and abdominal aortas with ongoing investigation into approaches for the ascending and aortic arch. These therapies have been shown to improve early mortality and morbidity outcomes with the caveat of more interventions compared with open surgery. We undertook this review to analyze the current data available regarding long-term outcomes in patients undergoing endovascular repair for thoracic aortic disease. The data support long-term benefit of endovascular repair for thoracic aortic disease. The primary indications identified for reintervention are endoleak and further aneurysmal degeneration. As the devices available for endovascular repair evolve, ongoing review of these outcomes will be necessary. It will also be important to trend the results as further techniques become available for endovascular repair of the ascending aorta and aortic arch.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 4","pages":"237-249"},"PeriodicalIF":0.5,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raul Del Toro Mijares, Adrian Rojas Murguia, Mateo Porres-Aguilar, Debabrata Mukherjee
{"title":"Anticoagulation in the Management of Acute Pulmonary Embolism-A Review.","authors":"Raul Del Toro Mijares, Adrian Rojas Murguia, Mateo Porres-Aguilar, Debabrata Mukherjee","doi":"10.1055/s-0044-1782537","DOIUrl":"10.1055/s-0044-1782537","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is a very frequent cardiovascular entity that encompasses deep vein thrombosis and pulmonary embolism (PE). This last entity represents a major cause of cardiovascular morbidity and mortality. The incidence of PE and the rate of PE-related morbidity significantly increase with age, race, and underlying medical conditions, such as malignancy. Given the recent advances in diagnostic strategies and algorithms, patients can be risk assessed and treated promptly to avoid disease progression. Anticoagulation is the mainstay of treatment for acute PE that is not hemodynamically unstable. Direct oral anticoagulants, such as apixaban, rivaroxaban, or edoxaban, are currently the preferred agents for the treatment of patients who present with acute PE or for long-term treatment. Treatment duration should be continued for at least 3 months, and all patients should be assessed for extended duration of therapy based on the precipitating factors that led to the development of the VTE. Novel anticoagulant agents targeting factor XI/XIa are currently being investigated in phases 2 and 3 clinical trials, representing an attractive option in anticoagulation therapies in patients with VTE. For hemodynamically unstable patients, systemic thrombolysis is the treatment of choice, and it may also be of benefit-in reduced dose-for patients with intermediate to high risk who are at risk of hemodynamic collapse.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 2","pages":"95-100"},"PeriodicalIF":0.5,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pericardial Decompression Syndrome: A Comprehensive Review of a Controversial Entity.","authors":"Karan Sarode, Amar Patel, Kedzie Arrington, Rakhee Makhija, Debabrata Mukherjee","doi":"10.1055/s-0044-1780536","DOIUrl":"10.1055/s-0044-1780536","url":null,"abstract":"<p><p>Pericardial decompression syndrome is an ambiguous clinical entity which has generated controversy regarding its existence. Following pericardial decompression, patients experienced clinical deterioration ranging in complications from pulmonary edema to death that could not be attributed to any other distinct clinical pathology. Multiple theories have suggested the pathophysiology behind pericardial decompression syndrome is related to preload-afterload mismatch following pericardial decompression, coronary microvascular ischemia, and stress from high adrenergic state. Our review aims to describe this syndrome by analyzing demographics, etiology of pericardial effusion, method of drainage, volume of pericardial fluid removed, time to decompensation, and clinical outcomes. A systematic review of MEDLINE/PubMed and Google Scholar literature databases were queried for case reports, case series, review articles, and abstracts published in English journals between 1983 and December 2022. Each author's interpretation of echocardiographic and/or pulmonary arterial catheterization data provided in the case reports was used to characterize ventricular dysfunction. Based on our inclusion criteria, 72 cases of pericardial decompression syndrome were included in our review. Our results showed that phenotypic heterogeneity was present based on echocardiographic findings of right/left or biventricular failure with similar proportions in each type of ventricular dysfunction. Time to decompensation was similar between immediate, subacute, and acute cases with presentation varying between hypoxic respiratory failure and shock. This review article highlights theories behind the pathophysiology, clinical outcomes, and therapeutic options in this high mortality condition.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 3","pages":"139-147"},"PeriodicalIF":0.5,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnostic Strategies in Pulmonary Embolism.","authors":"Margaret Mary Glazier, James J Glazier","doi":"10.1055/s-0044-1779661","DOIUrl":"10.1055/s-0044-1779661","url":null,"abstract":"<p><p>Key to the diagnosis of pulmonary embolism (PE) is a careful bedside evaluation. After this, there are three further diagnostic steps. In all patients, estimation of the clinical probability of PE is performed. The other two steps are measurement of D-dimer when indicated and chest imaging when indicated. The clinical probability of PE is estimated at low, moderate, or high. The prevalence of PE is less than 15% among patients with low clinical probability, 15 to 40% with moderate clinical probability, and >40% in patients with high clinical probability. Clinical gestalt has been found to be very useful in estimating probability of PE. However, clinical prediction rules, such as Wells criteria, the modified Geneva score, and the PE rule out criteria have been advocated as adjuncts. In patients with high clinical probability, the high prevalence of PE can lower the D-dimer negative predictive value, which could increase the risk of diagnostic failure. Consequently, patients with high probability for PE need to proceed directly to chest imaging, without prior measurement of D-dimer level. Key studies in determining which low to moderate probability patients require chest imaging are the Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism (ADJUST-PE), the Simplified diagnostic management of suspected pulmonary embolism (YEARS), and the Pulmonary Embolism Graduated D-Dimer trials. In patients with low clinical probability, PE can be excluded without imaging studies if D-dimer is less than 1,000 ng/mL. In patients in whom there is not a low likelihood for PE, this can be excluded without imaging studies if the D-dimer is below the age-adjusted threshold.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 2","pages":"89-94"},"PeriodicalIF":0.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postoperative Intimal Hyperplasia: Review from My Research.","authors":"Mitsuhiro Yamamura","doi":"10.1055/s-0044-1779300","DOIUrl":"10.1055/s-0044-1779300","url":null,"abstract":"<p><p>Postoperative intimal hyperplasia is the major cause of the vein graft occlusion. It is very important to establish an animal model for the start of research. After my vascular surgery residency in Japan, I started my research work on postoperative intimal hyperplasia at the University of Wisconsin-Madison. My research showed that endothelial injury and monocyte infiltration is the key for postoperative intimal hyperplasia, which is very similar to Ross' pathogenesis of atherosclerosis as an inflammatory disease. Focusing on postoperative intimal hyperplasia as an inflammatory disease, especially on tumor necrosis factor-α, FR-167653 (tumor necrosis factor-α suppressive agent, inhibitor of <i>p</i> 38 mitogen-activated protein kinase; Fujisawa Pharmaceutical Co., Ltd., Japan) is found to suppress postoperative intimal hyperplasia in a rat model by reducing serum monocyte chemoattractant protein-1 levels. However, FR-167653 is not commercially available today. Because endothelial injury is the first step of postoperative intimal hyperplasia, I investigated whether the free radical scavenger, edaravone (Radicut, Mitsubishi Tanabe Pharma Co., Japan), which alleviates the endothelial injury <i>in vitro</i> , can also suppress postoperative intimal hyperplasia. Moreover, the free radical scavenger edaravone (Radicut®, Mitsubishi Tanabe Pharma Co.) is also found to suppress postoperative intimal hyperplasia, by alleviating endothelial injury. In clinical settings, it is very important to detect postoperative intimal hyperplasia before its establishment. Hepatocyte growth factor is not only a hepatic growth factor but also a vascular endothelial growth factor. Recently, serum hepatocyte growth factor level was found to be a candidate biomarker for postoperative intimal hyperplasia in our rat model.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 3","pages":"135-138"},"PeriodicalIF":0.5,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jee Min Kim, Claudia C Carcamo, Sina Jazani, Zepei Xie, Xinyu A Feng, Maryam Yamadi, Matthew Poyton, Katie L Holland, Jonathan B Grimm, Luke D Lavis, Taekjip Ha, Carl Wu
{"title":"Dynamic 1D Search and Processive Nucleosome Translocations by RSC and ISW2 Chromatin Remodelers.","authors":"Jee Min Kim, Claudia C Carcamo, Sina Jazani, Zepei Xie, Xinyu A Feng, Maryam Yamadi, Matthew Poyton, Katie L Holland, Jonathan B Grimm, Luke D Lavis, Taekjip Ha, Carl Wu","doi":"10.1101/2023.06.13.544671","DOIUrl":"10.1101/2023.06.13.544671","url":null,"abstract":"<p><p>Eukaryotic gene expression is linked to chromatin structure and nucleosome positioning by ATP-dependent chromatin remodelers that establish and maintain nucleosome-depleted regions (NDRs) near transcription start-sites. Conserved yeast RSC and ISW2 remodelers exert antagonistic effects on nucleosomes flanking NDRs, but the temporal dynamics of remodeler search, engagement and directional nucleosome mobilization for promoter accessibility are unknown. Using optical tweezers and 2-color single-particle imaging, we investigated the Brownian diffusion of RSC and ISW2 on free DNA and sparse nucleosome arrays. RSC and ISW2 rapidly scan DNA by one-dimensional hopping and sliding respectively, with dynamic collisions between remodelers followed by recoil or apparent co-diffusion. Static nucleosomes block remodeler diffusion resulting in remodeler recoil or sequestration. Remarkably, both RSC and ISW2 use ATP hydrolysis to translocate mono-nucleosomes processively at ~30 bp/sec on extended linear DNA under tension. Processivity and opposing push-pull directionalities of nucleosome translocation shown by RSC and ISW2 shape the distinctive landscape of promoter chromatin.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10827135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79996848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schraepen Cédric, van der Laan Lijckle, Smet Nick, Meulenbroek Anne, Fourneau Inge
{"title":"Chronic Limb-Threatening Ischemia does not Enclose a Homogenous Population: Time for a More Detailed Classification","authors":"Schraepen Cédric, van der Laan Lijckle, Smet Nick, Meulenbroek Anne, Fourneau Inge","doi":"10.1055/s-0043-1777414","DOIUrl":"https://doi.org/10.1055/s-0043-1777414","url":null,"abstract":"Abstract Objective Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality. Classification methods differentiate into patients with rest pain or with ischemic ulcers. No distinction is made between the presence or absence of rest pain in patients with ischemic ulcers. Our aim is to determine any differences in outcome between these subdivisions so we can improve preoperative counseling and risk assessment. Methods This multicenter retrospective cohort study included all patients revascularized for a first episode of CLTI between 2013 and 2018. The cohort was divided in three groups: patients with solely rest pain (RP), solely ischemic ulcers (IU), and patients with both rest pain and ischemic ulcers (RP + IU). Baseline characteristics, morbidity, and mortality were analyzed. Results A total of 624 limbs in 599 patients were included: 225 (36.1%) in the rest pain group, 169 (27.1%) in the ischemic ulcers group, and 230 (36.2%) in combined group. Amputation rates were higher in the combined group at 6 months. Mortality rates were significantly higher in the ischemic ulcers group and the combined group at 6 months and 1 year. Conclusions Patients with solely rest pain have significantly lower mortality rates in comparison to patients with ischemic ulcers. Rest pain did not affect mortality rates in patients with ulcers. There was a higher amputation rate in patients with combined rest pain and ischemic ulcers because the presence of rest pain CLTI patients had a significant negative effect on amputation risk. A separate subdivision for patients with combined ulcers and rest pain is indicated.","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":"33 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}