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National Heart (national + heart)
Selected AbstractsImpact of substance use on the physical health of patients with bipolar disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010M. P. Garcia-Portilla Garcia-Portilla MP, Saiz PA, Benabarre A, Florez G, Bascaran MT, Díaz EM, Bousoño M, Bobes J. Impact of substance use on the physical health of patients with bipolar disorder. Objective:, To describe the impact of tobacco, alcohol and cannabis on metabolic profile and cardiovascular risk in bipolar patients. Method:, Naturalistic, cross-sectional, multicenter Spanish study. Current use of tobacco, alcohol and cannabis was determined based on patient self-reports. Metabolic syndrome was defined using the National Health and Nutrition Examination Survey 1999,2000 and the American Heart Association/National Heart, Lung and Blood Institute criteria, and cardiovascular risk using the Framingham and the Systematic Coronary Risk Evaluation functions. Results:, Mean age was 46.6 years, 49% were male. Substance use: 51% tobacco, 13% alcohol and 12.5% cannabis. Patients who reported consuming any substance were significantly younger and a higher proportion was male. After controlling for confounding factors, tobacco was a risk factor for coronary heart disease (CHD) (unstandardized linear regression coefficient 3.47, 95% confidence interval 1.85,5.10). Conclusion:, Substance use, mainly tobacco, was common in bipolar patients. Tobacco use negatively impacted CHD risk. [source] Testing the Biobehavioral Family Model in Pediatric Asthma: Pathways of EffectFAMILY PROCESS, Issue 1 2008BEATRICE L. WOOD PH.D. This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n=199; aged 7,17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (,2[1]=.11, p=.74, NFI=.99, RMSEA=.00). Observed NFEC predicted child depression (,=.19, p<.01), which predicted asthma disease severity (,=.23, p<.01). Relational security inversely predicted depressive symptoms (,=,.40, p<.001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms. RESUMEN Prueba del Biobehavioral Family Model (Modelo familiar de biocomportamiento) en asma pediátrica: Factores desencadenantes Objetivo: Este estudio utiliza un método de laboratorio con varios informantes y distintos enfoques para probar la hipótesis de que un ambiente familiar negativo agrava la enfermedad del asma a través de síntomas de depresión infantil, y que la inseguridad en la relación entre padres e hijos influye en su efecto. Sujetos y métodos: Una serie de niños que padecen asma (n=199; edades entre 7 y 17; 55% varones) informaron sobre conflictos de pareja de sus padres, la seguridad en la relación con sus padres y síntomas de depresión. Los padres, por su parte, aportaron datos demográficos, antecedentes de asma e información acerca de los síntomas. El diagnóstico de asma fue confirmado por examen clínico y pruebas de pulmón, y un experto en asma determinó la gravedad de la enfermedad de acuerdo con las pautas del NHLBI (National Heart, Lung, and Blood Institute). La interacción en familia fue simulada mediante el método Family Process Assessment Protocol (protocolo de evaluación de dinámicas familiares) y estimada mediante el Iowa Family Interaction Rating Scales (escala Iowa de interacciones familiares). Resultados: El análisis de camino demostró que los datos encajaron bien con el modelo de la hipótesis (,2[1]=.11, p=.74, NFI=.99, RMSEA=.00). En las familias en las que se observó un ambiente emocional negativo se predijo la depresión del niño o de la niña (,=.19, p<.01), lo que, a su vez, predijo un agravamiento del asma (,=.23, p<.01). Por otra parte, las relaciones positivas predijeron síntomas de depresión de manera inversa (,=.40, p<.001), y no resultaron ser un mediador, como se había predicho, sino un contribuidor independiente. Conclusión: Las averiguaciones coinciden con el Biobehavioral Family Model (modelo familiar de biocomportamiento), que sugiere la existencia de una influencia psicobiológica de procesos de relaciones familiares específicos en la gravedad de la enfermedad del asma a través de síntomas de depresión infantil. [source] Hemocompatibility, biocompatibility, inflammatory and in vivo studies of primary reference materials low-density polyethylene and polydimethylsiloxane: A reviewJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 5 2001Claire Bélanger, Marie Abstract In 1984, low-density polyethylene (LDPE) and polymethylsiloxane (PDMS), two primary reference materials (PRM), were made available by the National Heart, Lung, and Blood Institute (NHLBI) as discriminatory tools for the validation of standardized and novel in vitro and in vivo tests in the evaluation of biomaterials. This article reviews the results and conclusions obtained by several studies investigating the hemocompatibility, in vitro biocompatibility, inflammatory response, and in vivo tissue reactions of these two reference materials. Variable results obtained with LDPE and PDMS in ex vivo hemocompatibility studies were attributed to the type of animal model used, the flow velocity of the circulating blood, the time of exposure, and the methodology used to measure blood cell adhesion or activation at the surface of the materials. In contrast, both the LDPE and PDMS appeared to be suitable reference materials when used in in vitro biocompatibility, inflammatory response, and in vivo studies. However, caution must be taken when interpreting the results, because gamma sterilization of these two materials as well as their origin (for example PDMS) are two critically important factors. In conclusion, we see a definite need for standardized hemocompatible parameters and better high-quality hemocompatibility studies on PRM. This review also suggests other materials as potential PRM candidates, namely, Biomer® and IntramedicÔ polyethylene. © 2001 John Wiley & Sons, Inc. J Biomed Mater Res (Appl Biomater) 58: 467,477, 2001 [source] Roundtable Discussion: Problems in the Management of HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 3 2002Marvin Moser MD Following a symposium on hypertension sponsored by the National Heart, Lung, and Blood Institute in Chicago, IL on October 3, 2001, a panel was convened to discuss various aspects of hypertension treatment. Moderating the panel was Dr. Marvin Moser, Clinical Professor of Medicine at The Yale University School of Medicine. Panel members included Dr. George Bakris, Professor of Preventive Medicine and Director, Hypertension/Clinical Research Center at the Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois and Dr. Henry Black, Professor of Medicine, Associate Vice President for Research, and Chairman of the Department of Preventive Medicine at Rush-Presbyterian. [source] Marked Improvements in Outcomes of Contemporary Percutaneous Coronary Intervention in Patients with Diabetes MellitusJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2006ANDREW M. FREEMAN M.D. We sought to determine if advances in percutaneous coronary intervention (PCI) are associated with better outcomes among patients with diabetes mellitus (DM). Patients with DM enrolled in the National Heart, Lung, and Blood Institute (NHLBI) early PTCA Registry (1985,1986) were compared to those in the subsequent contemporary Dynamic Registry (1999,2002) for in-hospital and one-year cardiovascular outcomes. The study population included 945 adults with DM, 325 from the PTCA Registry and 620 from the Dynamic Registry. Multivariable Cox regression models were built to estimate the risk of clinical events. Dynamic Registry patients were older, had more noncardiac comorbidities, and a lower mean ejection fraction (50.5% vs 57.8%, P , 0.001) compared to the PTCA Registry patients. The incidence of in-hospital mortality (1.9% vs 4.3%, P , 0.05), myocardial infarction (MI) (1.0% vs 7.4%, P , 0.001), and coronary artery bypass grafting (CABG) (0.8% vs 6.2%, P , 0.001) were all significantly lower and independent of the use of stents. One-year adverse events including MI (4.9% vs 11.0%, P , 0.001), CABG (6.4% vs 15.0%, P , 0.001), and need for repeat revascularization (18.7% vs 33.3%, P , 0.001) were all lower in the Dynamic Registry. The relative risk of death at 1 year was significantly less for patients in the Dynamic Registry (RR 0.56, 0.34; 0.92, P = 0.02). Although Dynamic Registry patients with diabetes had more advanced coronary disease, in-hospital and late adverse events were lower. A combination of the use of stents and an increase in adjunctive medical therapy are likely responsible for the observed improvements in outcomes in contemporary PCI. [source] Clinical and laboratory diagnosis of von Willebrand disease: A synopsis of the 2008 NHLBI/NIH guidelines,AMERICAN JOURNAL OF HEMATOLOGY, Issue 6 2009William L. Nichols Von Willebrand factor (VWF) mediates blood platelet adhesion and accumulation at sites of blood vessel injury, and also carries coagulation factor VIII (FVIII) that is important for generating procoagulant activity. Von Willebrand disease (VWD), the most common inherited bleeding disorder, affects males and females, and reflects deficiency or defects of VWF that may also cause decreased FVIII. It may also occur less commonly as an acquired disorder (acquired von Willebrand syndrome). This article briefly summarizes selected features of the March 2008 evidence-based clinical and laboratory diagnostic recommendations from the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel for assessment for VWD or other bleeding disorders or risks. Management of VWD is also addressed in the NHLBI guidelines, but is not summarized here. The VWD guidelines are available at the NHLBI Web site (http://www.nhlbi.nih.gov/guidelines/vwd). Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Animal Model Development for the Penn State Pediatric Ventricular Assist DeviceARTIFICIAL ORGANS, Issue 11 2009Elizabeth L. Carney Abstract:, In March 2004, the National Heart, Lung, and Blood Institute awarded five contracts to develop devices providing circulatory support for infants and small children with congenital and acquired cardiac disease. Since 2004, the team at Penn State College of Medicine has developed a pneumatically actuated ventricular assist device (VAD) with mechanical tilting disk valves. To date, hemodynamic performance, thrombogenesis, and hemolysis have been chronically evaluated in 16 animals, including 4 pygmy goats and 12 sheep. Major complications, mainly respiratory failure, have been encountered and resolved by a multi-disciplinary team. Multi-modal analgesia, appropriate antibiotic therapy, and attentive animal care have contributed to successful outcomes. Time after implant has ranged from 0 to 40 days. Most recently, a sheep implanted with Version 3 Infant VAD was electively terminated at 35 days postimplant, with no major adverse events. This report describes a successful in vivo model for evaluating a pediatric VAD. [source] The PediPump: A Versatile, Implantable Pediatric Ventricular Assist Device,Update IVARTIFICIAL ORGANS, Issue 11 2009Brian W. Duncan Abstract Cleveland Clinic's PediPump (Cleveland, OH, USA) is a ventricular assist device designed for the support of pediatric patients. The PediPump is a mixed-flow ventricular assist device with a magnetically suspended impeller measuring 10.5 mm in diameter by 64.5 mm in length. Progress and achievements for the PediPump program are considered according to the development project's three primary objectives: Basic engineering: along with size reductions, substantial design improvements have been incorporated in each design iteration including the motor, magnetic bearings, axial touch points, and heat transfer path; Anatomic modeling and device fitting studies: Techniques based on computed tomography and magnetic resonance imaging have been developed to create three-dimensional anatomic-modeling and device-fitting tools to facilitate device implantation and to assist in preoperative planning. For in vivo testing, to date, six acute (6-h duration) and nine chronic (30-day target duration) implantations have been performed in sheep; the implantation of the PediPump appears to be relatively easy with excellent hemodynamic performance and minimal hemolysis during support. Cleveland Clinic's PediPump program supported by the National Heart, Lung and Blood Institute's Pediatric Circulatory Support Program has led to the development of a pediatric ventricular assist device that has satisfactory performance in preclinical evaluation and appears to be ready to support a program of clinical testing. [source] Risks and benefits of continued aggressive statin therapyCLINICAL CARDIOLOGY, Issue S3 2003Antonio M. Gotto Jr. M.D., D.PHIL Abstract The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, are a well-tolerated, effective class of medications for the reduction of low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels. Extensive data from clinical trials demonstrate that these agents reduce fatal and nonfatal cardiovascular risk in primary and secondary prevention patients, including women and the elderly. A threshold value for LDL-C reduction below which there is no further clinical benefit has not yet been identified. In the Heart Protection Study (HPS), significant relative risk reduction occurred even among patients with LDL-C levels < 2.6 mmol/l (100 mg/dl). Statin therapy also produced reductions in cardiovascular disease in a wide range of high-risk patients regardless of baseline cholesterol levels. Rhabdomyolysis, typically defined as muscle pain or weakness associated with creatine kinase levels higher than 10 times the upper limit of normal and the presence of myoglobulinuria, is a rare but potentially serious complication of statins. Although dose-dependent transaminase elevations occur in 0.5 to 2% of cases, it has not been determined whether these elevations qualify as true drug-related hepatotoxicity. Management of myopathy and elevated transaminases is addressed in a joint publication from the American College of Cardiology (ACC), the American Heart Association (AHA), and the National Heart, Lung, and Blood Institute (NHLBI). Because statins have significant potential benefits and a low risk for serious adverse effects, aggressive therapy should be considered in patients at high risk for coronary heart disease. [source] | ||||||||||