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Frailty and acute coronary syndrome: does gender matter?

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Journal of Geriatric Cardiology 2019年第2期16卷 138-144页

作者： Lourdes Vicent Manuel Martinez-Selles servicio de cardiologia Hospital General Universitario Gregorio MaraiionCIBERCVMadridSpain Universidad Europea Universidad ComplutenseMadridSpain

There are important sex-related differences in elderly patients with acute coronary syndrome(ACS).Women are older,more frequently frail,and present more comorbidities than *** symptoms at presentation are also more common in female patients,they are leaded to a delayed diagnosis and *** angiography and subsequent revascularization are frequently underused in elderly women and they tend to receive less guidelines-recommended *** prognosis in elderly frail women with ACS is poor,and it is with high mortality and readmissions *** is recurrent ischemic events in which it is more frequent in women than in *** time might be long,and a multidisciplinary approach is desirable to improve prognosis and quality of *** studies are needed in order to clarify the benefit of the different therapies in the group of frail women,and this is particularly true for revascularization,as scientific evidence in this group is very scarce.

关键词： Acute coronary syndrome Frailty The elderly Women

Transcatheter mitral valve repair in nonagenarians

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Journal of Geriatric Cardiology 2022年第1期19卷 90-94页

作者： Pedro Luis Cepas-Guillén Isaac Pascual Eulogio Garcia Pilar Jimenez-Quevedo Alfonso Jurado-Roman Tomás Benito-González Rodrigo Estevez-Loureiro Pedro Li Dabit Arzamendi Bruno Melica Eduardo Infante de oliveira Pedro Martín Lorenzo Felipe Fernández-Vázquez Guillermo Galeote Luis Nombela-Franco Leire Unzue Pablo Avanzas Manel Sabate Xavier Freixa Cardiology department Cardiovascular Institute(ICCV)Hospital ClinicIDIBAPSUniversity of BarcelonaBarcelonaSpain Interventional Cardiology Unit Hospital Universitario Central de AsturiasDepartment of MedicineUniversity of OviedoOviedoSpain servicio de Hemodinámica y Cardiología Intervencionista HM CIEC-Centro Integral de Enfermedades CardiovascularesHospital Universitario HM MontepríncipeHM HospitalesMadridSpain Facultad de Medicina Universidad CEU San PabloMadridSpain Cardiology department Cardiovascular InstituteHospital Clínico San CarlosIdISSCMadridSpain Division of Interventional Cardiology University Hospital La PazIdiPAZCIBER-CVMadridSpain department of Cardiology University Hospital of LeónLeónSpain Interventional Cardiology Unit HospitalÁlvaro CunqueiroVigoSpain Interventional Cardiology Unit Hospital Sant Pau i Santa CreuBarcelonaSpain serviço de cardiologia Centro Hospitalar de Vila Nova de Gaia/Espinho-EPEVila Nova de GaiaPortugal serviço de cardiologia Hospital de Santa MariaCentro Hospitalar Lisboa NorteCentro Académico Médico de LisboaLisboaPortugal servicio de Cardiología Hospital Universitario de Gran Canaria Dr.NegrínLas Palmas de Gran CanariaSpain

Given the increase in life expectancy indeveloped countries,nonagenarian population will become clinically and numerically relevant in our daily routine practice in the near *** has been observed to exert a profound influence on the prevalence of severe mitral regurgitation (MR) in the population.[1]Mitral valve surgery remains the gold standard of care for patients with symptomatic severe MR.

关键词： mitral routine surgery

Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

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World Journal of Hepatology 2019年第4期11卷 402-408页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge Luiz Gustavo Guedes Diaz Milla Carolina Costa Lafeta Araujo Gabriela de Campos Araujo Amanda de Castro Machado department of Liver Transplantation Instituto de Cardiologia do Distrito Federal Curso de Medicina Universidade Catolica de Brasilia

BACKGRoUND Infection by the hepatitis C virus(HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver *** SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid *** biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1 A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the *** This case highlights the difficulties of diagnosing skin lesions caused by HCVinfection in immunosuppressed patients.

关键词： Hepatitis C Liver transplantation Leukocytoclastic vasculitis Immunosuppression Direct-acting antivirals Case report

Thrombosis in ST-elevation myocardial infarction:Insights from thrombi retrieved by aspiration thrombectomy

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World Journal of Cardiology 2016年第6期8卷 362-367页

作者： Daniel Rios P Ribeiro Eduardo Cambruzzi Marcia Moura Schmidt Alexandre S Quadros Instituto de cardiologia/Fundacao Universitária de cardiologia(IC/FUC)

In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy(AT), andto discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.

关键词： Myocardial infarct Aspiration Mechanical Thrombectomy Thrombus Immunohistocytochemistry

Transmission of cryptococcosis by liver transplantation:A case report and review of literature

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World Journal of Hepatology 2020年第5期12卷 253-261页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge Carolina de Fatima Couto Priscila Brizolla de Campos Gabriel oliveira Nunes Caja department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70673900Brazil

BACKGRoUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans(***)species *** fungi are ubiquitous in soil and bird droppings,and infection by them is an important global health concern,particularly in immunosuppressed patients,such as organ transplant recipients and those infected by the human immunodeficiency *** fungus usually enters the body through the respiratory tract,but extremely rare cases of infection acquired by transplantation of solid organs have been *** SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient,diagnosed 2 wk after the *** patient initially presented with fever,hyponatremia and elevated transaminase levels,manifesting intense headache after a few *** cultures were positive for *** biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous *** resonance imaging of the brain showed multiple small lesions with low signal in T2,peripheric enhancement and edematous halo,diffuse through the parenchyma but more concentrated in the subcortical *** with amphotericin B for 3 wk,followed by maintenance therapy with fluconazole,led to complete resolution of the *** recipients of both kidneys from the same donor also developed disseminated cryptococcosis,confirming the transplant as the source of *** organ donor lived in a rural area,surrounded by tropical rainforest,and had negative blood cultures prior to organ *** This case highlights the risk of transmission of fungal diseases,specifically of ***,through liver graft during liver transplantation.

关键词： Cryptococcosis Liver transplantation Cryptococcus neoformans Case report Immunosuppression Fungal infection

Anticoagulation in elderly patients at high risk of atrial fibrillation without documented arrhythmias

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Journal of Geriatric Cardiology 2017年第3期14卷 166-168页

作者： Manuel Martinez-Selles Eusebio Garcia-Izquierdo Jaen Ignacio Fernandez Lozano servicio de cardiologia Hospital General Universitario Gregorio Maranon Universidad Complutense CIBERCV Madrid Spain servieio de cardiologia Hospital Universitario Puerta de Hierro Majadahonda Madrid Spain

Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age ≥ 75 years （doubled）, Diabetes, Stroke （doubled）, Vascular disease, Age 65-74 years, Sex category （female sex）] thromboembolic complications occurred irrespective of the presence of atrial fibrillation （AF） and anticoagulant therapy may be initiated irrespective of documented AF.

关键词： Anticoagulation Atrial fibrillation Interatrial block Prognosis

Management of portopulmonary hypertension:New perspectives

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World Journal of Gastroenterology 2013年第45期19卷 8252-8257页

作者： Luigi Mancuso Francesca Scordato Michela Pieri Eliana Valerio Andrea Mancuso department of cardiologia Ospedale Cervello90100 Palermo Italy cardiologia Clinica Candela 90100 Palermo Italy Epatologia e Gastroenterologia Ospedale Niguarda Cà Granda Milano 20162 Milano Italy Medicina Interna 1 ARNAS Civico 90100 Palermo Italy

Portopulmonary hypertension(PPHTN)is a known complication of ***-to-severe PPHTN implies an extremely poor *** occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic *** with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was ***,new perspectives in the management of patients with portopulmonary hypertension are *** fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary *** drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular ***,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent *** there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.

关键词： Portopulmonary hypertension Cirrhosis Liver transplantation Management Epoprostenol

Tako-tsubo syndrome after administration of intravenous adrenaline during atrioventricular block

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open Journal of Emergency Medicine 2013年第2期1卷 8-10页

作者： Manuel Calvo-Taracido Manuel Almendro-delia Juan C. Garcia-Rubira Unidad de Gestion de cardiologia Hospital Universitario Virgen Macarena Sevilla Spain

We describe the clinical case of a 70-year-old woman with complete atrioventricular block that after administration of intravenous adrenaline, developed electrocardiographic changes suggestive of acute coronary syndrome, together with apical dyskinesia of the left ventricle. After ruling out the existence of coronary lesions, and after total recovery of the echocardiographic alterations in segmental contractility, she was diagnosed as Tako-tsubo syndrome induced by administration of adrenaline. This is the first report of this syndrome in the scenario of atrioventricular block treated with adrenaline infusion.

关键词： Adrenaline Asystole Atrioventricular Block Tako-Tsubo Syndrome

ISCHEMIA trial:How to apply the results to clinical practice

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World Journal of Cardiology 2021年第8期13卷 237-242页

作者： Rafael Vidal-Perez Alberto Bouzas-Mosquera Jesus Peteiro Jose Manuel Vazquez-Rodriguez servicio de cardiologia Unidad de Imagen y Funcion CardiacaComplexo Hospitalario Universitario A Coruna(CHUAC)Centro de Investigacion Biomedica en Red(CIBERCV)-Instituto de Salud Carlos IIIA Coruna 15006Spain servicio de Cardiología Complexo Hospitalario Universitario A CoruñaA Coruña 15006Spain

During the last years two questions have been continuously asked in chronic coronary syndromes:(1)Do revascularization procedures(coronary artery bypass grafting or percutaneous coronary intervention)really improve symptoms of angina?and(2)Do these techniques improve outcomes,*** they prevent new myocardial infarction events and cardiovascular death?Therefore,there was a need for a large definitive *** study was the ISCHEMIA trial,a large,multicentric trial sponsored by the National Heart,Lung,and Blood *** main trial compared coronary revascularization and optimal medical treatment(oMT)vs oMT alone in 5179 patients enrolled after a stress *** a median 3.2-year follow-up,318 primary outcome events occurred;the adjusted hazard ratio for the invasive strategy as compared with the conservative strategy was 0.93(95%confidence interval 0.80-1.08,P=0.34).The ISCHEMIA trial deeply disrupted many of our prior attitudes regarding management strategies for patients with stable coronary artery *** findings underscore the benefits of disease-modifying oMT for stable coronary artery disease *** main purposes of ischemia assessment before this trial were:Diagnostic purposes,assessment of outcome,and adding to decision-making ***,this changed after the trial *** results of ISCHEMIA might challenge the current diagnostic approach for stable angina patients recommended in the last European Society of Cardiology guidelines on chronic coronary disease that were based on studies published before the ISCHEMIA *** this editorial we propose our approach based on the ISCHEMIA study and the pretest probability for a positive test in patients with chronic coronary syndromes.

关键词： Stable angina Chronic coronary syndrome ISCHEMIA Stress testing Therapy Diagnosis