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Clinica E Investigacion En... Jul 2019One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment....
One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation.
Topics: Arteriosclerosis; Cardiovascular Diseases; Global Health; Humans; Risk Factors; Risk Management; Societies, Medical; Spain
PubMed: 30981542
DOI: 10.1016/j.arteri.2019.03.004 -
Frontiers in Behavioral Neuroscience 2022Clinical and animal studies have shown that transcutaneous auricular vagus nerve stimulation (ta-VNS) exerts neuroprotection following cerebral ischemia. Studies have...
BACKGROUND
Clinical and animal studies have shown that transcutaneous auricular vagus nerve stimulation (ta-VNS) exerts neuroprotection following cerebral ischemia. Studies have revealed that white matter damage after ischemia is related to swallowing defects, and the degree of white matter damage is related to the severity of dysphagia. However, the effect of ta-VNS on dysphagia symptoms and white matter damage in dysphagic animals after an ischemic stroke has not been investigated.
METHODS
Middle cerebral artery occlusion (MCAO) rats were randomly divided into the sham, control and vagus nerve stimulation (VNS) group, which subsequently received ta-VNS for 3 weeks. The swallowing reflex was measured once weekly by electromyography (EMG). White matter remyelination, volume, angiogenesis and the inflammatory response in the white matter were assessed by electron microscopy, immunohistochemistry, stereology, enzyme-linked immunosorbent assay (ELISA) and Western blotting.
RESULTS
ta-VNS significantly increased the number of swallows within 20 s and reduced the onset latency to the first swallow. ta-VNS significantly improved remyelination but did not alleviate white matter shrinkage after MCAO. Stereology revealed that ta-VNS significantly increased the density of capillaries and increased vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (FGF2) expression in the white matter. ta-VNS significantly alleviated the increase inTLR4, MyD88, phosphorylated MAPK and NF-κB protein levels and suppressed the expression of the proinflammatory factors IL-1β and TNF-α.
CONCLUSION
These results indicated ta-VNS slightly improved dysphagia symptoms after ischemic stroke, possibly by increasing remyelination, inducing angiogenesis, and inhibiting the inflammatory response in the white matter of cerebral ischaemia model rats, implying that ta-VNS may be an effective therapeutic strategy for the treatment of dysphagia after ischemic stroke.
PubMed: 35493949
DOI: 10.3389/fnbeh.2022.811419 -
Pilot and Feasibility Studies Apr 2023Cancer-related fatigue (CRF) is defined as a "distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to...
Effect of transcutaneous auricular vagal nerve stimulation on the fatigue syndrome in patients with gastrointestinal cancers - FATIVA: a randomized, placebo-controlled pilot study protocol.
BACKGROUND
Cancer-related fatigue (CRF) is defined as a "distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning." CRF is frequently observed in cancer patients even before the initiation of tumor therapy. Its cause is not clear, but in addition to primary effects of therapy, a tumor-induced elevated level of inflammatory cytokines may play a role. Transcutaneous auricular vagal nerve stimulation (taVNS) is a noninvasive way to activate central nervous pathways and modulate pain perception and the immune system. It has positive effects on autoimmune conditions and can also improve fatigue associated with Sjogren's syndrome. It is the main purpose of this feasibility study to investigate the feasibility of daily taVNS against CRF. Therefore, the stimulation protocol of the newly introduced smartphone app of the manufacturer is evaluated. Additionally, the effect taVNS on CRF and quality of life (QoL) shall be evaluated.
METHODS
Thirty adult patients with gastrointestinal tumors during or after treatment, relevant CRF (Hornheide questionnaire) and life expectancy > 1 year, are enrolled. Patients are randomized to treatment or sham arm and be informed that they will either feel the stimulation or not. Treatment group will receive left-sided tragus above-threshold stimulation with 25 Hz, 250 µs pulse width, and 28-s/32-s on/off paradigm for 4 h throughout the day for 4 weeks. Sham group will receive no stimulation via a nonfunctional electrode. A daily stimulation protocol with time and average intensity is automatically created by a smartphone app connected to the stimulator via Bluetooth®. Multidimensional Fatigue Inventory-20, Short-Form 36 and Beck Depression Inventory questionnaires will be filled out before and after 4 weeks of stimulation.
DISCUSSION
Primarily, the patients' daily stimulation time and intensity will be evaluated through the electronic protocol after 4 weeks. Secondarily, the effect of taVNS on cancer-related fatigue and QoL will be measured through the questionnaires. As taVNS seems to modulate inflammatory cytokines, this noninvasive method may - if accepted by the patients - be a promising adjunct in the treatment of cancer-related fatigue.
TRIAL REGISTRATION
The study was approved by local ethics committee (21-7395) and registered at the DRKS database (DRKS00027481).
PubMed: 37087481
DOI: 10.1186/s40814-023-01289-z -
Veterinary Anaesthesia and Analgesia Sep 2021To use American College of Veterinary Internal Medicine (ACVIM) criteria to evaluate a high-definition oscillometric (HDO) blood pressure monitoring device versus...
Agreement between invasive and oscillometric arterial blood pressure measurement using a high-definition oscillometric device in normotensive New Zealand White rabbits using two different anaesthetic protocols.
OBJECTIVE
To use American College of Veterinary Internal Medicine (ACVIM) criteria to evaluate a high-definition oscillometric (HDO) blood pressure monitoring device versus invasive blood pressure (IBP) measurement in normotensive rabbits anaesthetized with two different anaesthetic protocols.
STUDY DESIGN
Prospective experimental study.
ANIMALS
A group of 20 healthy adult New Zealand White rabbits weighing 4.36 ± 0.37 kg (mean ± standard deviation).
MATERIALS AND METHODS
Rabbits were premedicated with butorphanol 0.5 mg kg and midazolam 0.5 mg kg subcutaneously (SC, group BMA) or ketamine 25 mg kg and medetomidine 0.4 mg kg SC (group KM). Anaesthesia was induced with alfaxalone administered intravenously (group BMA) or isoflurane by face mask (group KM) and maintained with isoflurane in oxygen. IBP was measured from the central auricular artery. The cuff for the HDO monitor was placed distal to the left elbow and distal to the left tarsus. Agreement between invasive and HDO measurements was evaluated using Bland-Altman method.
RESULTS
In group KM there was better agreement between the HDO device and IBP when the cuff was placed on the thoracic limb, with 100% and 91% of the readings for mean (MAP) and diastolic arterial pressure (DAP), respectively, within 10 mmHg of the IBP measurements. The agreement, although worse, also met the ACVIM criteria for systolic arterial pressure (SAP; 53% of the readings within 10 mmHg). In group BMA, the device met the criteria with the cuff on the thoracic limb only, and only for MAP and DAP (73% and 75% of the measurements within 10 mmHg of the IBP, respectively) but not for SAP (12%).
CONCLUSION AND CLINICAL RELEVANCE
The HDO device met most of the ACVIM criteria for noninvasive blood pressure measurement in anaesthetized rabbits, specifically when the cuff was placed distal to the elbow and the anaesthetic protocol included ketamine and medetomidine.
Topics: Anesthetics; Animals; Arterial Pressure; Arteries; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitors; Prospective Studies; Rabbits
PubMed: 34364790
DOI: 10.1016/j.vaa.2021.03.016 -
ESC Heart Failure Dec 2022Our previous study proved that low-level tragus nerve stimulation (LL-TS) could improve left ventricular remodelling by cardiac down-stream mechanisms. However, the...
AIMS
Our previous study proved that low-level tragus nerve stimulation (LL-TS) could improve left ventricular remodelling by cardiac down-stream mechanisms. However, the cardiac up-stream mechanisms remain unknown.
METHODS AND RESULTS
Twenty-eight adult beagle dogs were randomly divided into an MI group (myocardial infarction was induced by permanent ligation of the left coronary artery, n = 10), an LL-TS group (MI plus intermittent LL-TS treatment, n = 10), and a control group (sham ligation with the same stimulation as the LL-TS group, n = 8). Auricular tragus nerve was bilaterally delivered to the tragus via ear-clips connected to a custom-made stimulator. The voltage slowing sinus rate was used as the threshold to set the LL-TS 80% below this level. At the end of 4 weeks post-MI, LL-TS could significantly increase atrial ganglion plex (GP) activity, decreased left stellate ganglion (LSG) activity, reduced LV dilation, and improved ventricular functions. Chronic intermittent LL-TS treatment significantly attenuated left ventricular remodelling via the up-regulation of α7nAChR expression and the down-regulation of MMP-9 level in post-MI LV tissue. The elevated protein and mRNA of MMP-9 levels in remote areas were significantly ameliorated by LL-TS treatment.
CONCLUSIONS
Chronic LL-TS increased GP neural activity and improved ventricular remodelling possibly via α7nAChR/MMP-9 axis.
Topics: Animals; Dogs; alpha7 Nicotinic Acetylcholine Receptor; Heart Atria; Matrix Metalloproteinase 9; Myocardial Infarction; Ventricular Remodeling
PubMed: 36085552
DOI: 10.1002/ehf2.14146 -
Frontiers in Veterinary Science 2023Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the...
BACKGROUND
Measurement of arterial blood pressure is recommended in anaesthetized animals to guide perioperative treatment. Invasive blood pressure measurement is considered the gold standard, however it is also technically challenging, requires specialised equipment and carries certain risks. For these reasons, non-invasive blood pressure measurement devices are commonly used and are expected to provide accurate and reliable results. This requirement is particularly true for rabbits, in whom peri-anaesthetic hypotension is commonly observed and in whom perioperative mortality remains disproportionally high. Several authors have compared different non-invasive devices with invasive measurements in rabbits and have reported contrasting results. However, to date no comparison between invasive measurements and the PetMAP device, that has been designed specifically for veterinary medicine, has been reported.
AIM AND HYPOTHESIS
The aim of the study was the comparison of invasive blood pressure measurement with PetMAP in rabbits. We hypothesised that PetMAP would show acceptable agreement with the invasive measurements according to the American College of Veterinary Internal Medicine guidelines.
MATERIALS AND METHODS
Sixteen client-owned rabbits presenting for various surgical interventions were included in the study. Invasive measurements were performed by cannulation of an auricular artery. The PetMAP cuff was applied distal to the elbow according to the manufacturer's guidelines. For each measurement with PetMAP, three invasive blood pressure values were recorded. The mean of the three invasive values was compared with one value measured with PetMAP.
RESULTS
Data collected from 16 rabbits were used for statistical analysis. In the clinical setting, the PetMAP device showed significant overestimation of systolic, diastolic and mean arterial pressure, which were measured in the auricular artery. In addition, the bias was not constant, implying that the device poorly predicted changes in blood pressure.
CONCLUSION
The PetMAP device did not meet any of the American College of Veterinary Internal Medicine recommendations.
PubMed: 37492435
DOI: 10.3389/fvets.2023.1141480 -
Medicina 2023A 33-year-old woman with a history of high blood pressure since she was 8 years old, hypothyroidism, polycystic ovary syndrome, metabolic syndrome, multiple nevi, and a...
A 33-year-old woman with a history of high blood pressure since she was 8 years old, hypothyroidism, polycystic ovary syndrome, metabolic syndrome, multiple nevi, and a maternal family history of death at age 50 due to malignant high blood pressure and heart failure. Cushing's syndrome secondary to a secretory pituitary microadenoma was diagnosed, being the cause of secondary arterial hypertension, and ruling out other causes such as renal stenosis and coarctation of the aorta. A transthoracic and transesophageal echocardiogram was performed, which detected a left atrial myxoma. Given the presence of an atrial myxoma, Cushing's syndrome and polycystic ovary syndrome, a diagnosis of Carney Complex was made due to the presence of positive Stratakis criteria. The cardiac tumor was resected, and pathology confirmed that it was an atrial myxoma. She evolved clinically stable in outpatient controls in a 6-month follow-up. Resection of the pituitary microadenoma is planned as a curative treatment for Cushing's syndrome and arterial hypertension.
Topics: Female; Humans; Middle Aged; Adult; Child; Carney Complex; Cushing Syndrome; Polycystic Ovary Syndrome; Atrial Fibrillation; Myxoma; Heart Neoplasms; Pituitary Neoplasms; Hypertension
PubMed: 36774606
DOI: No ID Found -
Journal of Veterinary Internal Medicine Mar 2023Cats with hypertrophic cardiomyopathy (HCM) are at risk of cardiogenic arterial thromboembolism (CATE). Neutrophil extracellular traps (NETs) may be a potential...
BACKGROUND
Cats with hypertrophic cardiomyopathy (HCM) are at risk of cardiogenic arterial thromboembolism (CATE). Neutrophil extracellular traps (NETs) may be a potential biomarker and therapeutic target for cardiomyopathy in cats.
HYPOTHESIS/OBJECTIVES
Characterize NETs in cats with HCM or CATE. We hypothesized that circulating NETs assessed in the form of cell-free DNA (cfDNA) and citrullinated histone H3 (citH3) are increased in cats with HCM and CATE and associated with reported predisposing factors for thrombus formation.
ANIMALS
Eighty-five cats including client-owned cats with HCM and CATE and staff- and student-owned clinically healthy cats without HCM.
METHODS
After echocardiographic evaluations, NETs were measured as cfDNA and citH3.
RESULTS
Cats with CATE had significant increases in cfDNA (11.2 ng/μL; interquartile range [IQR], 8.1 to 29.6) compared to those without HCM (8.2 ng/μL; IQR, 5.7 to 11.7 μL; P = .01) and were responsible for 75% to 83% of cases with cfDNA fragments sized 100 to 2000 base pairs. Citrullinated histone 3, detected in 52% of cats with HCM (31.1 ng/mL; IQR, 16.9 to 29.8), was significantly lower than in those with CATE (48.2 ng/mL; IQR, 34.2 to 60.2; P = .007). The citH3 concentrations correlated significantly with reported risk factors of CATE, such as left atrial auricular velocity.
CONCLUSIONS AND CLINICAL IMPORTANCE
Neutrophil extracellualr traps, especially citH3, are increased in cats with HCM and CATE. They may serve as a novel therapeutic target and biomarker of thrombosis in cats with HCM.
Topics: Cats; Animals; Extracellular Traps; Neutrophils; Histones; Biomarkers; Cardiomyopathy, Hypertrophic; Thromboembolism; Cat Diseases
PubMed: 36951591
DOI: 10.1111/jvim.16676 -
Frontiers in Physiology 2022SARS-CoV-2 is a highly contagious virus that was identified as the cause of COVID-19 disease in early 2020. The infection is clinically similar to interstitial...
SARS-CoV-2 is a highly contagious virus that was identified as the cause of COVID-19 disease in early 2020. The infection is clinically similar to interstitial pneumonia and acute respiratory distress syndrome (ARDS) and often shows cardiovascular damage. Patients with cardiovascular risk factors are more prone to COVID-19 disease and their sequelae. Due to the anti-inflammatory effect and the improvement in pulmonary function, auricular vagus nerve stimulation (aVNS) therapy might alleviate a COVID-19 infection. A high-risk patient with cardiovascular diseases and Implantable Cardioverter Defibrillator (ICD), type 2 diabetes and peripheral arterial disease IV, according to Rutherford`s classification, became infected with COVID-19. The patient underwent wound surgery because of an infected necrosis with a methicillin-resistant (MRSA) of his small toe and was already on aVNS therapy to relieve his leg pain and improve microcirculation. AVNS was performed with the AuriStim device (Multisana GmbH, Austria), which stimulates vagally innervated regions of the auricle by administering electrical stimulation percutaneous electrodes for 6 weeks. The multimorbid high-risk patient, who was expected to go through a severe course of the COVID-19 disease, showed hardly any symptoms during ongoing aVNS therapy, while other family members, being much younger and healthy suffered from a more serious course with headache, pneumonia and general weakness. The auricular vagus nerve stimulation is a clinically tested and safe procedure and might represent an alternative and effective way of treating COVID-19 disease. Nevertheless, due to several limitations of this case report, randomized controlled studies are needed to evaluate the efficacy of aVNS therapy on COVID-19 disease.
PubMed: 36714322
DOI: 10.3389/fphys.2022.1000194 -
Frontiers in Neuroanatomy 2020Therapeutic applications of auricular vagus nerve stimulation (VNS) have drawn recent attention. Since the targeted stimulation process and parameters depend on the...
Therapeutic applications of auricular vagus nerve stimulation (VNS) have drawn recent attention. Since the targeted stimulation process and parameters depend on the electrode-tissue interaction, the lack of structural anatomical information on innervation and vascularization of the auricle restrain the current optimization of stimulation paradigms. For the first time, we employed high-resolution episcopic imaging (HREM) to generate histologic volume data from donated human cadaver ears. Optimal parameters for specimen preparation were evaluated. Anatomical 3D vascular and nerve structures were reconstructed in one sample of an auricular cymba conchae (CC). The feasibility of HREM to visualize anatomical structures was assessed in that diameters, occupied areas, volumes, and mutual distances between auricular arteries, nerves, and veins were registered. The selected region of CC (3 × 5.5 mm) showed in its cross-sections 21.7 ± 2.7 (mean ± standard deviation) arteries and 14.66 ± 2.74 nerve fibers. Identified nerve diameters were 33.66 ± 21.71 μm, and arteries had diameters in the range of 71.58 ± 80.70 μm. The respective occupied area showed a share of, on average, 2.71% and 0.3% for arteries and nerves, respectively, and similar volume occupancy for arteries and nerves. Inter-centroid minimum distance between arteries and nerves was 274 ± 222 μm. The density of vessels and nerves around a point within CC on a given grid was assessed, showing that 50% of all vessels and nerves were found in a radial distance of 1.6-1.8 mm from any of these points, which is strategically relevant when using stimulation needles in the auricle for excitation of nerves. HREM seems suitable for anatomical studies of the human ear. A 3D model of CC was established in the micrometer scale, which forms the basis for future optimization of the auricular VNS. Obviously, the presented single cadaver study needs to be validated by additional anatomical data on the innervation and vascularization of the auricle.
PubMed: 32477074
DOI: 10.3389/fnana.2020.00022