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JAMA Network Open Dec 2023Preclinical studies suggest a potential role for aspirin in slowing abdominal aortic aneurysm (AAA) progression and preventing rupture. Evidence on the clinical benefit...
IMPORTANCE
Preclinical studies suggest a potential role for aspirin in slowing abdominal aortic aneurysm (AAA) progression and preventing rupture. Evidence on the clinical benefit of aspirin in AAA from human studies is lacking.
OBJECTIVE
To investigate the association of aspirin use with aneurysm progression and long-term clinical outcomes in patients with AAA.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective, single-center cohort study. Adult patients with at least 2 available vascular ultrasounds at the Cleveland Clinic were included, and patients with history of aneurysm repair, dissection, or rupture were excluded. All patients were followed up for 10 years. Data were analyzed from May 2022 to July 2023.
MAIN OUTCOMES AND MEASURES
Clinical outcomes were time-to-first occurrence of all-cause mortality, major bleeding, or composite of dissection, rupture, and repair. Multivariable-adjusted Cox proportional-hazard regression was used to estimate hazard ratios (HR) for all-cause mortality, and subhazard ratios competing-risk regression using Fine and Gray proportional subhazards regression was used for major bleeding and composite outcome. Aneurysm progression was assessed by comparing the mean annualized change of aneurysm diameter using multivariable-adjusted linear regression and comparing the odds of having rapid progression (annual diameter change >0.5 cm per year) using logistic regression.
RESULTS
A total of 3435 patients (mean [SD] age 73.7 [9.0] years; 2672 male patients [77.5%]; 120 Asian, Hispanic, American Indian, or Pacific Islander patients [3.4%]; 255 Black patients [7.4%]; 3060 White patients [89.0%]; and median [IQR] follow-up, 4.9 [2.5-7.5] years) were included in the final analyses, of which 2150 (63%) were verified to be taking aspirin by prescription. Patients taking aspirin had a slower mean (SD) annualized change in aneurysm diameter (2.8 [3.0] vs 3.8 [4.2] mm per year; P = .001) and lower odds of having rapid aneurysm progression compared with patients not taking aspirin (adjusted odds ratio, 0.64; 95% CI, 0.49-0.89; P = .002). Aspirin use was not associated with risk of all-cause mortality (adjusted HR [aHR], 0.92; 95% CI, 0.79-1.07; P = .32), nor was aspirin use associated with major bleeding (aHR, 0.88; 95% CI, 0.76-1.03; P = .12), or composite outcome (aHR, 1.16; 95% CI, 0.93-1.45; P = .09) at 10 years.
CONCLUSIONS
In this retrospective study of a clinical cohort of 3435 patients with objectively measured changes in aortic aneurysm growth, aspirin use was significantly associated with slower progression of AAA with a favorable safety profile.
Topics: Adult; Humans; Male; Aged; Retrospective Studies; Platelet Aggregation Inhibitors; Cohort Studies; Endovascular Procedures; Aortic Aneurysm, Abdominal; Aspirin; Hemorrhage
PubMed: 38085542
DOI: 10.1001/jamanetworkopen.2023.47296 -
Frontiers in Neurology 2023Intravenous infusion of human alpha calcitonin gene-related peptide (h-α-CGRP) has been applied to explore migraine pathogenesis and cerebral hemodynamics during the... (Review)
Review
Intravenous infusion of human alpha calcitonin gene-related peptide (h-α-CGRP) has been applied to explore migraine pathogenesis and cerebral hemodynamics during the past three decades. Cumulative data implicate h-α-CGRP in regulating the vascular tone. In this systematic review, we searched PubMed and EMBASE for clinical studies investigating the vascular changes upon intravenous infusion of h-α-CGRP in humans. A total of 386 studies were screened by title and abstract. Of these, 11 studies with 61 healthy participants and 177 participants diagnosed with migraine were included. Several studies reported hemodynamic effects including flushing, palpitation, warm sensation, heart rate (HR), mean arterial blood pressure (MABP), mean blood flow velocity of middle cerebral artery (mean V), and diameter of superficial temporal artery (STA). Upon the start of h-α-CGRP infusion, 163 of 165 (99%) participants had flushing, 98 of 155 (63%) participants reported palpitation, and 160 of 165 (97%) participants reported warm sensation. HR increased with 14%-58% and MABP decreased with 7%-12%. The mean V was decreased with 9.5%-21%, and the diameter of the STA was dilated with 41%-43%. The vascular changes lasted from 20 to >120 min. Intravenous infusion of h-α-CGRP caused a universal vasodilation without any serious adverse events. The involvement of CGRP in the systemic hemodynamic raises concerns regarding long-term blockade of CGRP in migraine patients with and without cardiovascular complications.
PubMed: 37483452
DOI: 10.3389/fneur.2023.1204734 -
Journal of Neurology Aug 2023In malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate.... (Clinical Trial)
Clinical Trial
INTRODUCTION
In malignant cerebral infarction decompressive hemicraniectomy has demonstrated beneficial effects, but the optimum size of hemicraniectomy is still a matter of debate. Some surgeons prefer a large-sized hemicraniectomy with a diameter of more than 14 cm (HC > 14). We investigated whether this approach is associated with reduced mortality and an improved long-term functional outcome compared to a standard hemicraniectomy with a diameter of less than 14 cm (HC ≤ 14).
METHODS
Patients from the DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY) registry who received hemicraniectomy were dichotomized according to the hemicraniectomy diameter (HC ≤ 14 cm vs. HC > 14 cm). The primary outcome was modified Rankin scale (mRS) score ≤ 4 after 12 months. Secondary outcomes were in-hospital mortality, mRS ≤ 3 and mortality after 12 months, and the rate of hemicraniectomy-related complications. The diameter of the hemicraniectomy was examined as an independent predictor of functional outcome in multivariable analyses.
RESULTS
Among 130 patients (32.3% female, mean (SD) age 55 (11) years), the mean hemicraniectomy diameter was 13.6 cm. 42 patients (32.3%) had HC > 14. There were no significant differences in the primary outcome and mortality by size of hemicraniectomy. Rate of complications did not differ (HC ≤ 14 27.6% vs. HC > 14 36.6%, p = 0.302). Age and infarct volume but not hemicraniectomy diameter were associated with outcome in multivariable analyses.
CONCLUSION
In this post-hoc analysis, large hemicraniectomy was not associated with an improved outcome or lower mortality in unselected patients with malignant middle cerebral artery infarction. Randomized trials should further examine whether individual patients could benefit from a large-sized hemicraniectomy.
CLINICAL TRIAL REGISTRATION INFORMATION
German Clinical Trials Register (URL: https://www.drks.de ; Unique Identifier: DRKS00000624).
Topics: Female; Humans; Male; Middle Aged; Decompressive Craniectomy; Hospital Mortality; Infarction, Middle Cerebral Artery; Severity of Illness Index; Treatment Outcome
PubMed: 37162579
DOI: 10.1007/s00415-023-11766-3 -
Pharmaceutics Mar 2024In this work, polyvinylpyrrolidone (PVP)- and β-cyclodextrin (β-CD)-based composite powders containing curcumin (CURC) were obtained through the supercritical...
In this work, polyvinylpyrrolidone (PVP)- and β-cyclodextrin (β-CD)-based composite powders containing curcumin (CURC) were obtained through the supercritical antisolvent (SAS) technique. Pressure, total concentration of CURC/carrier in dimethylsulfoxide, and CURC/carrier ratio effects on the morphology and size of the precipitated powders were investigated. Using PVP as the carrier, spherical particles with a mean diameter of 1.72 μm were obtained at 12.0 MPa, 20 mg/mL, and a CURC/PVP molar ratio equal to 1/2 mol/mol; using β-CD as the carrier, the optimal operating conditions were 9.0 MPa and 200 mg/mL; well-defined micrometric particles with mean diameters equal to 2.98 and 3.69 μm were obtained at molar ratios of 1/2 and 1/1 mol/mol, respectively. FT-IR spectra of CURC/ β-CD inclusion complexes and coprecipitated CURC/PVP powders revealed the presence of some peaks of the active compounds. The stoichiometry of the complexes evaluated through the Job method revealed that β-CD formed inclusion complexes with CURC at a molar ratio equal to 1/1. Dissolution profiles revealed that in comparison with the curve of the pure ingredient, the SAS-processed powders obtained using both PVP and β-CD have an improved release rate.
PubMed: 38543246
DOI: 10.3390/pharmaceutics16030352 -
International Journal of Cardiology Nov 2023The athlete's heart is a well-known phenomenon characterized by a harmonic remodelling that affects the cardiac chambers. However, whether mild-to-moderate aortic...
BACKGROUND
The athlete's heart is a well-known phenomenon characterized by a harmonic remodelling that affects the cardiac chambers. However, whether mild-to-moderate aortic dilatation can be considered normal in athletes is debated. This study aimed to evaluate the ratio between left ventricular (LV) size and aortic dimensions, reporting the normal values of the ratio between the aortic root diameters at the level of the sinuses of Valsalva and LV diameters (AoD/LVEDD ratio) in a wide cohort of competitive athletes.
MATERIALS AND METHODS
Competitive athletes were compared with sedentary subjects and patients with aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26 ± 7 years), 410 sedentary (74.1% males, mean age 29 ± 11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56 ± 7 years).
RESULTS
Patients with aortic dilatation had both an absolute (39.2 ± 2.4 mm) and indexed (19.4 ± 2.2 mm/m2) aortic diameter larger than athletes (30.6 ± 3.2 mm; 16.1 ± 1.5 mm/m, p < 0.05) and sedentary subjects (30.5 ± 3.1 mm; 16.5 ± 1.6 mm/m, p < 0.05), with no differences between athletes and sedentary subjects. The AoD/LVEDD ratio was lower in athletes (0.59 ± 0.06) compared to controls (0.65 ± 0.05, p < 0.05) and patients with aortic dilatation (0.81 ± 0.06, p < 0.05). The patients with aortopathy had the lowest LVEDD/AoD ratio, while competitive athletes had the highest, with values of 1.71 ± 0.16 in the latter (overall p value<0.001).
CONCLUSIONS
In this study, we reported the AoD/LVEDD and LVEDD/AoD ratio values in a cohort of healthy athletes, additional parameters that could help confirm the harmonic remodelling in the athlete's heart.
Topics: Male; Humans; Young Adult; Adult; Adolescent; Middle Aged; Female; Aorta, Thoracic; Retrospective Studies; Heart Ventricles; Heart; Athletes; Aortic Diseases
PubMed: 37480998
DOI: 10.1016/j.ijcard.2023.131202 -
Plants (Basel, Switzerland) Aug 2023Unlike the culm hollow structure of most bamboo species, has a unique solid or semi-solid culm, which may endow it with superior mechanical performance. In this study,...
Unlike the culm hollow structure of most bamboo species, has a unique solid or semi-solid culm, which may endow it with superior mechanical performance. In this study, the variation in fiber morphology and micro-mechanical properties across the radial regions of bamboo culm was examined by optical microscopy, scanning electron microscopy, X-ray diffraction, and nanoindentation. Results showed that the mean values of vascular bundle frequency and fiber tissue proportion were 1.76 pcs/mm2 and 21.04%, respectively, both of which increased gradually from inner to outer. The mean length, diameter, and length-diameter ratio of the fiber were 2.10 mm, 21.54 μm, and 101.41 respectively. The mean indentation modulus of elasticity (IMOE) and hardness were 21.34 GPa and 545.88 MPa. The IMOE exhibited a significant increase from the inner to the middle region, and little change was observed from the middle to the outer region. There were slight fluctuations in hardness along the radial direction. The mean crystallinity and microfibril angle(MFA) of the fibers was 68.12% and 11.26 degrees, respectively. There is a positive correlation between cellulose crystallinity and the IMOE and hardness, while there is a negative correlation between the MFA and the IMOE and the hardness.
PubMed: 37631198
DOI: 10.3390/plants12162987 -
Journal of Dental Anesthesia and Pain... Oct 2023Accessory infraorbital foramen (AIOF) can change the normal course of emerging branches of the infraorbital nerve and blood vessels exiting the infraorbital foramen...
BACKGROUND
Accessory infraorbital foramen (AIOF) can change the normal course of emerging branches of the infraorbital nerve and blood vessels exiting the infraorbital foramen (IOF). This study aimed to examine the AIOF, number of foramina, and their position in relation to IOF using cone-beam computed tomography (CBCT).
METHODS
We performed a retrospective CBCT assessment of hospital records between January 2018 and August 2022. The CBCT of 507 patients were examined to extract information on the prevalence, number, position, linear distance from the IOF, and diameter of AIOF in relation to demographic factors. Descriptive statistics were used to evaluate the prevalence of AIOF. Mean and standard deviation were used to calculate the linear distance and diameter of the AIOF, respectively. The AIOFs, its distribution, and number were compared between sexes and sides using the chi-square test. The independent t-test and Mann-Mann-Whitney test were used to compare the mean difference between the sexes and sides. Statistical significance was set at P < 0.05.
RESULTS
In this current study, the prevalence of AIOF was 7.1% (36 of the 507 patients). Additionally, the current study examined the number of foramina using a single foramen on each side and double foramina located bilaterally at a distance from the AIOF to the IOF. The mean AIOF diameter was also studied, and the AIOF position with respect to the IOF on CBCT was superomedial or inferomedial. There were no statistically significant associations between any of the parameters assessed in this study when comparing sex and sides.
CONCLUSIONS
A greater number of patients with AIOF presented with a single foramen and unilateral occurrence, without a statistically significant difference. The AIOF was most commonly located superomedial to the IOF.
PubMed: 37841517
DOI: 10.17245/jdapm.2023.23.5.257 -
Platelets Dec 2023Arterial tonometry and vascular calcification measures are useful in cardiovascular disease (CVD) risk assessment. Prior studies found associations between tonometry...
Arterial tonometry and vascular calcification measures are useful in cardiovascular disease (CVD) risk assessment. Prior studies found associations between tonometry measures, arterial calcium, and CVD risk. Activated platelets release angiopoietin-1 and other factors, which may connect vascular structure and platelet function. We analyzed arterial tonometry, platelet function, aortic, thoracic and coronary calcium, and thoracic and abdominal aorta diameters measured in the Framingham Heart Study Gen3/NOS/OMNI-2 cohorts ( = 3,429, 53.7% women, mean age 54.4 years ±9.3). Platelet reactivity in whole blood or platelet-rich plasma was assessed using 5 assays and 7 agonists. We analyzed linear mixed effects models with platelet reactivity phenotypes as outcomes, adjusting for CVD risk factors and family structure. Higher arterial calcium trended with higher platelet reactivity, whereas larger aortic diameters trended with lower platelet reactivity. Characteristic impedance (Zc) and central pulse pressure positively trended with various platelet traits, while pulse wave velocity and Zc negatively trended with collagen, ADP, and epinephrine traits. All results did not pass a stringent multiple test correction threshold ( < 2.22e-04). The diameter trends were consistent with lower shear environments invoking less platelet reactivity. The vessel calcium trends were consistent with subclinical atherosclerosis and platelet activation being inter-related.
Topics: Female; Male; Humans; Calcium; Pulse Wave Analysis; Blood Pressure; Platelet Activation; Atherosclerosis
PubMed: 37609998
DOI: 10.1080/09537104.2023.2238835