- Study of Angiographic Relationship between Peripheral Arterial Diseases with the Involvement of Specific Coronary Artery Lesion. [Journal Article]
- MMMymensingh Med J 2018; 27(1):126-129
- The purpose of this study was to investigate magnitude, pattern and involvement of previously unheralded coronary artery disease in patients suffering from clinically significant peripheral artery di...
The purpose of this study was to investigate magnitude, pattern and involvement of previously unheralded coronary artery disease in patients suffering from clinically significant peripheral artery disease of lower limbs. This cross sectional study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2014 to February 2015. Total 58 patients with clinically diagnosed peripheral arterial disease of lower limb undergoing angiographic evaluation. Selective CAG in addition to peripheral arteriography was performed in all the study population as per ACC/AHA guidelines for CAG (class IIa recommendation).In this study, it was documented that the proportion of coronary arterial disease was highest in LAD (63.9%) followed by LCX (55.6%), RCA (52.8%), and lowest LM (11.1%) in lesion with aorto-iliac segment. But the proportion of coronary arterial disease was highest in LCX (41.9%) followed by LAD (38.7%), RCA (35.5%), and lowest LM (12.9%) in lesion with femero-popliteal blood vessels. Similarly, the proportion of coronary arterial disease was highest in LCX (36.4%) followed by RCA (27.3%) and equal percentage in LAD and lowest in LM (9.1%) in tibioperoneal segment. Patients of peripheral arterial disease (PAD) having no symptoms of coronary artery disease (CAD) are more likely to have severe coronary artery involvement. Coronary angiogram should be done in patient with PAD to detect previously undetected CAD and pattern of PAD reflects the severity and involvement of coronary arteries.
- Evolutionary Origin, Gradual Accumulation and Functional Divergence ofHeat Shock FactorGene Family with Plant Evolution. [Journal Article]
- FPFront Plant Sci 2018; 9:71
- Plants, as sessile organisms, evolved a complex and functionally diverseheat shock factor(HSF) gene family to cope with various environmental stresses. However, the limited evolution studies of theHS...
Plants, as sessile organisms, evolved a complex and functionally diverseheat shock factor(HSF) gene family to cope with various environmental stresses. However, the limited evolution studies of theHSFgene family have hindered our understanding of environmental adaptations in plants. In this study, a comprehensive evolution analysis on theHSFgene family was performed in 51 representative plant species. Our results demonstrated that the HSFB group which lacks a typical AHA activation domain, was the most ancient, and is under stronger purifying selection pressure in the subsequent evolutionary processes. While, dramatic gene expansion and functional divergence occurred at evolution timescales corresponding to plant land inhabit, which contribute to the emergence and diversification of the HSFA and HSFC groups in land plants. During the plant evolution, the ancestral functions of HSFs were maintained by strong purifying pressure that acted on the DNA binding domain, while the variable oligomerization domain and motif organization of HSFs underwent functional divergence and generated novel subfamilies. At the same time, variations were further accumulated with plant evolution, and this resulted in remarkable functional diversification among higher plant lineages, including distinct HSF numbers and selection pressures of several HSF subfamilies between monocots and eudicots, highlighting the fundamental differences in different plant lineages in response to environmental stresses. Taken together, our study provides novel insights into the evolutionary origin, pattern and selection pressure of plant HSFs and delineates critical clues that aid our understanding of the adaptation processes of plants to terrestrial environments.
- Confronting system barriers for ST- elevation MI in low and middle income countries with a focus on India. [Journal Article]
- IHIndian Heart J 2018 Jan - Feb; 70(1):185-190
- Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organ...
Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by the entire group of submitting authors. We expect these recommendations to be utilitarian in improving STEMI care in developing countries.
- Analysis of transactivation potential of rice (Oryza sativa L.) heat shock factors. [Journal Article]
- PPlanta 2018 Feb 16
- CONCLUSIONS: Based on yeast one-hybrid assays, we show that the presence of C-terminal AHA motifs is not a prerequisite for transactivation potential in rice heat shock factors. Transcriptional activation or transactivation (TA) of heat stress responsive genes takes place by binding of heat shock factors (Hsfs) to heat shock elements. Analysis of TA potential of thirteen rice (Oryza sativa L.) Hsfs (OsHsfs) carried out in this study by yeast one-hybrid assay showed that OsHsfsA3 possesses strong TA potential while OsHsfs A1a, A2a, A2b, A4a, A4d, A5, A7b, B1, B2a, B2b, B2c and B4d lack TA potential. From a near complete picture of TA potential of the OsHsf family (comprising of 25 members) emerging from this study and an earlier report from our group (Mittal et al. in FEBS J 278(17):3076-3085, 2011), it is concluded that (1) overall, six OsHsfs, namely A3, A6a, A6b, A8, C1a and C1b possess TA potential; (2) four class A OsHsfs, namely A3, A6a, A6b and A8 have TA potential out of which A6a and A6b contain AHA motifs while A3 and A8 lack AHA motifs; (3) nine class A OsHsfs, namely A1a, A2a, A2b, A2e, A4a, A4d, A5, A7a and A7b containing AHA motif(s) lack TA function in the yeast assay system; (4) all class B OsHsfs lack AHA motifs and TA potential (B4a not analyzed) and (5) though all class C OsHsf members lack AHA motifs, two members C1a and C1b possess TA function, while one member C2a lacks TA potential (C2b not analyzed). Thus, the presence or absence of AHA motif is possibly not the only factor determining TA potential of OsHsfs. Our findings will help to identify the transcriptional activators of rice heat shock response.
- Translation of an evidence-based therapeutic exercise program for patients with peripheral artery disease. [Journal Article]
- JVJ Vasc Nurs 2018; 36(1):23-33
- The purpose of this study was to implement and evaluate quality outcomes including referral, enrollment, and completion rates of a new peripheral artery disease (PAD)-specific supervised exercise the...
The purpose of this study was to implement and evaluate quality outcomes including referral, enrollment, and completion rates of a new peripheral artery disease (PAD)-specific supervised exercise therapy (SET) program within a preexisting clinical exercise wellness program and to evaluate the clinical effectiveness and patient-centered outcomes derived from 12 weeks of PAD-specific SET. Recruited participants completed an individualized, minimally supervised, PAD-specific SET program based on the AHA-ACC guidelines. Exercise workloads (metabolic equivalents of task [METs]) were tracked and evaluated throughout the program. Short Physical Performance Battery, 6-minute walk test (6MWT) Walking Impairment Questionnaire, Short-Form 36 (SF-36), and Peripheral Artery Disease Quality of Life Questionnaire (PADQOL) were assessed before and after the program. Paired t-tests were used to examine differences between baseline and follow-up outcome variables. On average, participants (n = 46) attended 23 (standard deviation [SD] 12.9) out of the possible 36 training sessions, for a 64% attendance rate. Among participants who used treadmill walking as the primary mode of exercise (n = 40), the overall mean MET level just prior to program completion was 3.79 (SD 1.49), which represented an increase of 0.92 (34%) METs compared to baseline (P < .001). Total distance on the 6MWT increased 115 (11%) feet (P = .011), which is considered a clinically meaningful improvement. Significant improvements were noted in the PADQOL: symptoms and limitations in physical functioning (P = .007). This study demonstrates that a minimally staffed PAD-specific SET program can improve functional performance in patients with claudication due to PAD and serves as a foundation to help build a clinically effective, Centers for Medicare and Medicaid reimbursed PAD-specific rehabilitation program.
- Status of Hypertension in China: Results from the China Hypertension Survey, 2012-2015. [Journal Article]
- CircCirculation 2018 Feb 15
- Background -Although the prevalence of hypertension (HTN) continues to increase in developing countries including China, recent data are lacking. A national wide survey was condu...
Background -Although the prevalence of hypertension (HTN) continues to increase in developing countries including China, recent data are lacking. A national wide survey was conducted from October 2012 to December 2015 to assess the prevalence of HTN in China. Methods -A stratified multistage random sampling method was used to obtain a nationally representative sample of 451,755 residents aged ≥18 years from 31 provinces in mainland China from October 2012 to December 2015. Blood pressure (BP) was measured after resting for 5 minutes by trained staff, using a validated oscillometric BP monitor. HTN was defined as systolic BP (SBP) ≥140 mmHg and/or /diastolic BP (DBP) ≥90 mmHg and/or use of antihypertensive medication within two weeks. Pre-HTN was defined as SBP 120-139 mmHg and DBP 80-89 mmHg without antihypertensive medication. HTN control was defined as SBP <140 mmHg and DBP<90 mm Hg. In addition, the prevalence of HTN (SBP≥130 or DBP≥80 mmHg) and control rate (SBP<130 and DBP<80 mmHg) of HTN were also estimated according to the 2017 American College of Cardiology (ACC) /American Heart Association (AHA) High Blood Pressure Guideline. Results -Overall, 23.2% (estimated 244.5 million) of the Chinese adult population aged ≥18 years had HTN, and another 41.3% (estimated 435.3 million) had pre-HTN according to the Chinese guideline. There were no significant differences of HTN prevalence between urban and rural residents (23.4% vs. 23.1%,P=0.819). Among individuals with HTN, 46.9% were aware of their condition, 40.7% were taking prescribed antihypertensive medications, and 15.3% had controlled HTN. Calcium channel blockers were the most commonly used antihypertensive medication (46.5%) as monotherapy; and 31.7% of treated hypertensive patients used two or more medications. The prevalence of HTN based on the 2017 ACC/AHA guideline was twice as high as that based on 2010 Chinese guideline (46.4%), while the control rate fell to 3.0%. Conclusions -In China, there is a high prevalence of HTN and pre-HTN; awareness, treatment and control of HTN were low. Management of medical therapy for HTN needs to improve.
- Comprehensive electrocardiogram-to-device time for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: A report from the American Heart Association mission: Lifeline program. [Journal Article]
- AHAm Heart J 2018; 197:9-17
- CONCLUSIONS: Comprehensive ECG-to-device time provides an integrated hospital-related network-level assessment of reperfusion timing metrics for primary PCI, regardless of the location for STEMI identification; further validation will delineate how this metric can be used to facilitate STEMI care improvements.
- CPR in medical TV shows: non-health care student perspective. [Journal Article]
- AMAdv Med Educ Pract 2018; 9:85-91
- CONCLUSIONS: The findings of this study show that high percentage of nonmedical college students are influenced significantly by medical shows. One particular influence is the false belief about when a shock using the automated external defibrillator (AED) is appropriate as it is portrayed falsely in most medical shows. This finding raises a concern about how these shows portray basic life support, especially when not following American Heart Association (AHA) guidelines. We recommend the medical advisors in these shows to use AHA guidelines and AHA to expand its expenditures to include medical shows to educate the public on the appropriate action to rescue an out-of-hospital cardiac arrest patient.
- Cardiovascular Risk Prediction Functions Underestimate Risk in HIV Infection. [Journal Article]
- CircCirculation 2018 Feb 14
- Background -Cardiovascular disease (CVD) risk is elevated in HIV-infected individuals, with contributions from both traditional and non-traditional risk factors. The accuracy of ...
Background -Cardiovascular disease (CVD) risk is elevated in HIV-infected individuals, with contributions from both traditional and non-traditional risk factors. The accuracy of established CVD risk prediction functions in HIV is uncertain. We sought to assess the performance of three established CVD risk prediction functions in a longitudinal cohort of HIV-infected men. Methods -Framingham Heart Study (Framingham) functions for hard coronary heart disease (Framingham CHD) and atherosclerotic CVD (Framingham ASCVD) and the American College of Cardiology/American Heart Association (ACC/AHA ASCVD) function were applied to the Partners HIV cohort. Risk scores were calculated between 1/1/2006 and 12/31/2008. Outcomes included CHD (myocardial infarction [MI] or coronary death) for the Framingham CHD function and ASCVD (MI, stroke or coronary death) for the Framingham ASCVD and ACC/AHA ASCVD functions. We investigated the accuracy of CVD risk prediction for each function when applied to the HIV cohort using comparison of Cox regression coefficients, discrimination, and calibration. Results -The HIV cohort was comprised of 1280 men followed for a median of 4.4 years. There were 80 (6.3%) ASCVD events; 5-year incidence rate was 16.7 per 1000 person years. Discrimination was moderate to poor as indicated by lowcstatistic (0.68 for Framingham CHD, 0.65 for ACC/AHA, and 0.67 for Framingham ASCVD). Observed CVD risk exceeded predicted risk for each of the functions in most deciles of predicted risk. Calibration, or goodness-of-fit of the models, was consistently poor, with significant chi-square p values for all functions. Recalibration did not significantly improve model fit. Conclusions -Cardiovascular risk prediction functions developed for use in the general population are inaccurate in HIV infection and systematically underestimate risk in a cohort of HIV-infected men. Development of tailored CVD risk prediction functions incorporating traditional CVD risk factors and HIV-specific factors is likely to result in more accurate risk estimation to guide preventative CVD care.
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- Palatal prolapse as a signature of expiratory flow limitation and inspiratory palatal collapse in patients with obstructive sleep apnoea. [Journal Article]
- EREur Respir J 2018; 51(2)
- In some individuals with obstructive sleep apnoea (OSA), the palate prolapses into the velopharynx during expiration, limiting airflow through the nose or shunting it out of the mouth. We hypothesise...
In some individuals with obstructive sleep apnoea (OSA), the palate prolapses into the velopharynx during expiration, limiting airflow through the nose or shunting it out of the mouth. We hypothesised that this phenomenon causes expiratory flow limitation (EFL) and is associated with inspiratory "isolated" palatal collapse. We also wanted to provide a robust noninvasive means to identify this mechanism of obstruction.Using natural sleep endoscopy, 1211 breaths from 22 OSA patients were scored as having or not having palatal prolapse. The patient-level site of collapse (tongue-related, isolated palate, pharyngeal lateral walls and epiglottis) was also characterised. EFL was quantified using expiratory resistance at maximal epiglottic pressure. A noninvasive EFL index (EFLI) was developed to detect the presence of palatal prolapse and EFL using the flow signal alone. In addition, the validity of using nasal pressure was assessed.A cut-off value of EFLI >0.8 detected the presence of palatal prolapse and EFL with an accuracy of >95% and 82%, respectively. The proportion of breaths with palatal prolapse predicted isolated inspiratory palatal collapse with 90% accuracy.This study demonstrates that expiratory palatal prolapse can be quantified noninvasively, is associated with EFL and predicts the presence of inspiratory isolated palatal collapse.