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Clinical pharmacology relevant to older adults with cardiovascular disease

Journal of Geriatric Cardiology 2015年第3期12卷 192-195页

作者： jorge A brenes-salazar Laith Alshawabkeh Kenneth E Schmader Joseph T Hanlon Daniel E Forman Department of Medicine Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA Department of Medicine Division of Cardiovascular Medicine University of lowa Iowa City IA USA Department of Medicine Division of Geriatrics Duke University School of Medicine Durham NC USA Departments of Medicine (Division of Geriatric Medicine) Pharmacy and Epidemiology University of Pittsburgh Geriatric Research Education and Clini- cal Center and Center for Health Equity Research and Promotion VA Pittsburgh Health System Pittsburgh PA USA Department of Medicine (Divisions of Geriatric Medicine and Cardiology) University of Pittsburgh Medical Center Geriatric Research Education and Clinical Center VA Pittsburgh Health System Pittsburgh PA USA

1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usually reluctant to include many senior adults in randomized controlled clinical trials in part due to their high prevalence of multiple comorbidities, frailty, and polypharmacy; and to age-related pharmacokinetic and pharmacodynamic complexities. Consequently, there is often insufficient high quality evidence-based data to inform pharmacologic management of common cardiovascular conditions on older adults. In the absence of data, clinicians often rely on conceptual principles regarding metabolism and drug-drug interactions to minimize adverse drug events, but this is often not well-substantiated or standardized. A related challenge is poor cardiovascular medication adherence among older adults, and its detrimental impact on their health outcomes. In this brief review we highlight some aspects of these topics.

关键词： Metabolism Pharmacokinetics Pharmacodynamics Polypharmacy

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Echocardiography in centenarians： characteristics, utility and follow-up

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Journal of Geriatric Cardiology 2018年第5期15卷 328-333页

作者： jorge A brenes-salazar Jaime de la Fuente Punnaiah Marella Hari Chaliki Christopher Scott Heidi M Connolly Roger L Click Department of Cardiovascular Diseases Mayo Clinic Rochester USA Department of Internal Medicine Mayo Clinic Rochester USA Department of Cardiovascular Diseases Mayo Clinic Arizona USA Division of Biostatistics Mayo Clinic Rochester USA

Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. Methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic ass

关键词： Centenarian Echocardiography Geriatric

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Factors associated with change in frailty scores and long-term outcomes in older adults with coronary artery disease

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Journal of Geriatric Cardiology 2021年第3期18卷 196-203页

作者： S.Michael Gharacholou Joshua P.Slusser Ryan J.Lennon Carolyn R.Flock Leslie T.Cooper Patricia A.Pellikka jorge brenes salazar Mandeep Singh Department of Cardiovascular Medicine Mayo ClinicJacksonvilleFLUSA Department of Cardiology Mayo Health SystemLa CrosseWIUSA Department of Biostatistics Mayo ClinicRochesterMNUSA Department of Cardiovascular Medicine Mayo ClinicRochesterMNUSA

OBJECTIVE Older adults with coronary artery disease(CAD)are at risk for ***,little is known regarding transition in frailty measures over time or its impact on *** sought to determine the association of temporal change in frailty with long-term outcome in older adults with *** We re-assessed for phenotypic frailty using the Fried index(0=not frail;1−2=pre-frail;≥3 frail)in a cohort of CAD patients≥65 years old at 2 time points 5 years *** associated with frailty worsening were assessed with scatterplots and outcomes estimated using the Kaplan-Meier *** models were used to assess the risk of worsening frailty on *** There were 45 subjects that completed both baseline and 5-year Fried frailty *** age was 74.6±5.9 and 30(67%)were *** incidence increased over time:baseline(3%frail,37%pre-frail);5 years(10%frail,40%pre-frail).Baseline factors were not predictors of worsening frailty score,while both slower walk time(r=0.46;P=0.004)and diminishing grip strength(r=−0.39;P=0.01)were associated with worsening frailty *** follow-up(median 5.2 years),long-term major adverse cardiac event(MACE)free survival(P=0.12)or hospitalization(P=0.98)was not different for those with worsening frailty score(referent:improved/unchanged frailty).Frailty worsening had a trend towards increased risk of MACE(HR=1.86;95%CI:0.65−5.27,P=0.25).CONCLUSIONS Frailty transitions,specifically,declines in walk time and grip strength,were strongly associated with worsening frailty score in a cohort of older adults with CAD than were baseline indices,though frailty change status was not independently associated with MACE outcomes.

关键词： coronary unchanged score

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TLR8： the forgotten relative revindicated

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Cellular & Molecular Immunology 2012年第6期9卷 434-438页

作者： jorge L Cervantes Bennett Weinerman Chaitali Basole Juan C salazar Department of Pediatrics Immunology University of Connecticut Health Center Farmington CT USA Division of Pediatric Infectious Diseases Connecticut Children's Medical Center Hartford USA Parmington CT 06030 USA

The endosomal Toll-like receptors （TLRs） TLR3, TLR7, TLR8 and TLR9 are important in sensing foreign nucleic acids encountered by phagocytes. Because TLR8 was initially thought to be non-functional in mice, less is known about TLR8 than the genetically and functionally related TLR7. Originally associated with the recognition of single-stranded RNA of viral origin, there is now evidence that human TLR8 is also able to sense bacterial RNA released within phagosomal vacuoles, inducing the production of both nuclear factor （NF）-κB-dependent cytokines and type I interferons （IFNs）, such as IFN-β. The functions of TLR8 extend beyond the recognition of foreign pathogens and include cross-talk with other endosomal TLRs, a process that may also have a role in the generation of autoimmunity.

关键词： human monocytes TLR8 type I interferon

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Innovative treatments for congenital heart defects

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World Journal of Pediatrics 2023年第1期19卷 1-6页

作者： Antonio F.Corno Taylor S.Koerner jorge D.salazar McGovern Medical School Children's Heart InstituteMemorial Hermann Children's HospitalUniversity of Texas Health Science Center in Houston6410 Fannin StreetMSB 6.274HoustonTX 77030USA

The past few decades have witnessed substantial advances in the treatment of complex congenital heart defects,with most significant advances in surgical treatment strategies and improved outcomes dependent upon well-educated and calculated risk-taking *** the present surgical era,doing nothing for complex congenital heart defects is unacceptable,and pioneering surgeons are willing to under-take and accept the substantial risks of innovative pediatric cardiac surgery[1].

关键词： congenital treatment defects

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Cardiovascular physiology in the older adults

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Journal of Geriatric Cardiology 2015年第3期12卷 196-201页

作者： Xuming Dai Scott L Hummel jorge B salazar George E Taffet Susan Zieman Janice B Schwartz Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA Division of Cardiovascular Medicine Department of Medicine University of Michigan Ann Arbor Ml Ann Arbor Veterans Affairs Health System Ann Arbor M1 USA Division of Cardiology Mayo Clinic Rochester MN USA Division of Geriatrics Geriatrics and Cardiovascular Sciences Houston Methodist Hospital Baylor College of'Medicine Houston TX USA Division of Geriatrics and Clinical Gerontology National Institute of Aging Bethesda ME) USA Divisions of Geriatrics and Clinical Pharmacology Department of Medicine University of California San Francisco CA USA

1 Introduction In an aging society with persistent high prevalence of cardiovascular disease （CVD） in the elderly population, the health care system is facing an increasing challenge to effectively care for these patients. However, due to the under-representation of CVD patients over 75 years of age in clinical trials, assessing safety and efficacy of diagnostic and therapeutic approaches, the evidence for managing elderly CVD patients is especially limited. Physiological changes of aging intertwined with pathophysiology of CVD, and comorbid conditions often complicate clinical management.

关键词： Aging Cardiovascular disease Left ventricular

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Openwork Walls and Their Solar Applicability Range jorge Hernan salazar Trujillo

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Journal of Civil Engineering and Architecture 2015年第4期9卷 373-383页

作者： jorge Hernan salazar Trujillo Faculty of Architecture Universidad Nacional de Colombia (National University of Colombia) Medellin Colombia

The environmental potential of perforated surfaces in the tropics is noticeable. They allow obtaining higher attenuation and spatial dispersion of both direct and diffuse lighting in indoor spaces, whereas in outdoor areas, the openwork elements reduce surfaces temperature and mitigate the characteristic glare of smooth surfaces when exposed to sunlight. Openwork walls have an immense sustainability potential in modern tropical buildings： they limit the solar rays＇ admission, as well as provide an advantageous use of natural light and cross ventilation, but the research on their solar behavior is scarce. In order to obtain suitable levels of solar gain, relationships among shape, proportion, thickness and partitions composing openwork elements must be studied. This research evaluates solar gain in perforated surfaces by defining the ＂solar applicability range＂, a property useful to identify intervals of guidance where a perforated pattern shape will present a definite solar gain, giving valuable input in the geometric design of openwork elements and introducing shade performance in the design of openwork walls. Results give geometric guidelines that allow to widen the solar applicability range of a perforation pattern and to define two perforation features that have impact on the solar performance of perforated surfaces： focalization and solar performance shift.

关键词： Openwork bricks openwork walls solar performance shadow tropic architecture.

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Nitrification inhibitor nitrapyrin does not affect yield-scaled nitrous oxide emissions in a tropical grassland

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Pedosphere 2021年第2期31卷 265-278页

作者： Ana Gabriela PÉREZ-CASTILLO Cristina CHINCHILLA-SOTO jorge Alberto ELIZONDO-salazar Ronny BARBOZA Dong-Gill KIM Christoph MÜLLER Alberto SANZ-COBENA Azam BORZOUEI Khadim DAWAR Mohammad ZAMAN Environmental Pollution Research Center(CICA) University of Costa RicaMontes de Oca 11501(Costa Rica) Alfredo Volio Mata Experimental Station University of Costa RicaOchomogo 30304(Costa Rica) Wondo Genet College of Forestry and Natural Resources Hawassa UniversityP.O.Box 128Shashemene(Ethiopia) Institute of Plant Ecology Justus Liebig University GiessenHeinrich-Buff Ring 26Giessen 35392(Germany) School of Biology and Environmental Science University College DublinBelfieldDublin 4(Ireland) Research Center for the Management of Environmental and Agricultural Risks(CEIGRAM) Department of Chemistry and Food Technology(ETSIAAB)Universidad Politécnica de MadridMadrid 28040(Spain) Nuclear Agriculture Research School Nuclear Science and Technology Research Institute(NSTRI)Karaj 31465-1498(Iran) Department of Soil and Environmental Sciences The University of AgriculturePeshawar 25000(Pakistan) Soil and Water Management&Crop Nutrition Section Joint Food and Agriculture Organization(FAO)/International Atomic Energy Agency(IAEA)Division of Nuclear Techniques in Food and AgricultureDepartment of Nuclear Sciences and ApplicationsIAEAVienna International CentreP.O.Box 100Vienna 1400(Austria)

Urea is the most common nitrogen(N)fertilizer used in the tropics but it has the risk of high gaseous nitrogen(N)*** of nitrification inhibitor has been suggested as a potential mitigation measure for gaseous N losses in N fertilizer-applied *** a field trial on a tropical Andosol pastureland in Costa Rica,gaseous emissions of ammonia(NH_(3))and nitrous oxide(N_(2)O)and grass yield were quantified from plots treated with urea(U;41.7 kg N ha^(-1)application^(-1))and urea plus the nitrification inhibitor nitrapyrin(U+NI;41.7 kg N ha^(-1)application^(-1)and 350 g of nitrapyrin for each 100 kg of N applied)and control plots(without U and NI)over a six-month period(rainy season).Volatilization of NH_(3)(August to November)in U(7.4%±1.3%of N applied)and U+NI(8.1%±0.9%of N applied)were not significantly different(P>0.05).Emissions of N_(2)O in U and U+NI from June to November were significantly different(P<0.05)only in October,when N_(2)O emission in U+NI was higher than that in *** and crude protein production of grass were significantly higher(P<0.05)in U and U+NI than in the control plots,but they were not significantly different between U and U+*** was no significant difference in yield-scaled N_(2)O emission between U(0.31±0.10 g N kg^(-1)dry matter)and U+NI(0.47±0.10 g N kg^(-1)dry matter).The results suggest that nitrapyrin is not a viable mitigation option for gaseous N losses under typical N fertilizer application practices of pasturelands at the study site.

关键词： ammonia volatilization Andosol Costa Rica field trial gaseous N loss greenhouse gas emission urea

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Clinical Profiles at the Time of Diagnosis of SARS-CoV-2 Infection in Costa Rica During the Pre-vaccination Period Using a Machine Learning Approach

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Phenomics 2022年第5期2卷 312-322页

作者： Jose Arturo Molina-Mora Alejandra González Sergio Jiménez-Morgan Estela Cordero-Laurent Hebleen brenes Claudio Soto-Garita jorge Sequeira-Soto Francisco Duarte-Martínez Centro de Investigación en Enfermedades Tropicales(CIET)and Facultad de Microbiología Universidad de Costa RicaSan José2060Costa Rica Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud(INCIENSA) Tres Ríos 30301Costa Rica Escuela de Medicina Universidad de Costa RicaSan José2060Costa Rica

The clinical manifestations of COVID-19,caused by the SARS-CoV-2,define a large spectrum of symptoms that are mainly dependent on the human host *** Costa Rica,more than 169,000 cases and 2185 deaths were reported during the year 2020,the pre-vaccination *** describe the clinical presentations at the time of diagnosis of SARS-CoV-2 infection in Costa Rica during the pre-vaccination period,we implemented a symptom-based clustering using machine learning to identify clusters or clinical profiles at the population level among 18,974 records of positive *** were compared based on symptoms,risk factors,viral load,and genomic features of the SARS-CoV-2 sequence.A total of 18 symptoms at time of diagnosis of SARS-CoV-2 infection were reported with a frequency>1%,and those were used to identify seven clinical profiles with a specific composition of clinical *** the comparison between clusters,a lower viral load was found for the asymptomatic group,while the risk factors and the SARS-CoV-2 genomic features were distributed among all the *** other distribution patterns were found for age,sex,vital status,and *** conclusion,during the pre-vaccination time in Costa Rica,the symptoms at the time of diagnosis of SARS-CoV-2 infection were described in clinical *** host co-morbidities and the SARS-CoV-2 genotypes are not specific of a particular profile,rather they are present in all the groups,including asymptomatic *** addition,this information can be used for decision-making by the local healthcare institutions(first point of contact with health professionals,case definition,or infrastructure).In further analyses,these results will be compared against the profiles of cases during the vaccination period.

关键词： COVID-19 Costa Rica Machine learning Diagnosis SARS-CoV-2 Clinical profiles

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角膜纤维形状

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英语沙龙（初级版） 2009年第8期 116-117页

作者： jorge salazar

在美国有几百万人患有散光，它可导致视线模糊．这种症状源于角膜造型不佳（角膜在各个方向的弯曲度不一致）。角膜是眼睛上清澈透明的覆盖物，它可以使射入瞳孔的光聚集。“地球天空”与在英国加的夫大学领导角膜研究的凯斯·米克进行... 详细信息

在美国有几百万人患有散光，它可导致视线模糊．这种症状源于角膜造型不佳（角膜在各个方向的弯曲度不一致）。角膜是眼睛上清澈透明的覆盖物，它可以使射入瞳孔的光聚集。“地球天空”与在英国加的夫大学领导角膜研究的凯斯·米克进行了对话。

关键词：角膜形状纤维大学领导弯曲度视线

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