scholarly journals Μελέτη κλινικών, εργαστηριακών και περιεπεμβατικών παραμέτρων που επηρεάζουν τη βραχυπρόθεσμη και μακροπρόθεσμη έκβαση των διαδερμικά εμφυτευμένων αορτικών βαλβιδών

2018 ◽  
Author(s):  
Μαρία Καριώρη
Keyword(s):  
Medtronic Corevalve

Εισαγωγή: Οι ιδανικές τιμές για το βάθος εμφύτευσης για την αυτοεκπτυσσόμενη βαλβίδα τύπου Medtronic CoreValve/Evolut R κατά τη διάρκεια της διακαθετηριακής εμφύτευσης αορτικής βαλβίδας (ΔΕΑΒ) κυμαίνεται από 4 έως και 12 mm. Αν τιμή μικρότερη των 4 mm για το βάθος εμφύτευσης μπορεί να επηρεάσει την επέμβαση δεν έχει αποδειχτεί ακόμα. Στόχος: Στόχος της παρούσας μελέτης είναι η αξιολόγηση της επίδρασης του βάθους εμφύτευσης όταν η τιμή του είναι μικρότερη των 4 mm τόσο στην άμεση όσο και στην μακροπρόθεσμη λειτουργικότητα της αυτοεκπτυσσόμενης αορτικής βιοπρόσθεσης.Μεθοδολογία: Διαδοχικοί ασθενείς που υπεβλήθησαν σε διακαθετηριακή εμφύτευση αορτικής βαλβίδας αξιολογήθηκαν και χωρίστηκαν σε 2 ομάδες σύμφωνα με το αν η τιμή του βάθους εμφύτευσης ήταν μικρότερη των 4 mm. Το βάθος εμφύτευσης ορίστηκε ως η απόσταση είτε από τη μη- είτε από την αριστερή στεφανιαία πτυχή μέχρι το πιο άπω τμήμα του άκρου της πλήρως εκπτυγμένης βιοπροσθετικής στην αριστερή κοιλία. Το βάθος εμφύτευσης μετρήθηκε με τη χρήση της τελικής αορτογραφίας μετά την εμφύτευση της βιοπροσθετικής. Η Ομάδα I περιελάμβανε όλους τους ασθενείς με βάθος εμφύτευσης >4 mm και η Ομάδα II περιελάμβανε όλους τους ασθενείς με βάθος εμφύτευσης ≤ 4 mm. Οι εργαστηριακές καθώς και περιεπεμβατικές παράμετροι καταγράφηκαν πριν και μετά την τοποθέτηση της βιοπροσθετικής βαλβίδας. Η παρακολούθηση των ασθενών πραγματοποιήθηκε στο μήνα και στο χρόνο είτε μέσω τηλεφωνικού follow-up είτε και με εκτίμηση από τον κλινικό καρδιολόγο. Αποτελέσματα: Εκατόν ενενήντα οκτώ ασθενείς (80±5.5 ετών, 107 άρρενες (54%)) στους οποίους πραγματοποιήθηκε ΔΕΑΒ με τη χρήση των βιοπροσθετικών βαλβίδων CoreValve/Evolut R καταγράφηκαν. Στην Ομάδα I παρατηρήθηκαν μεγαλύτερες τιμές τόσο για τη μέγιστη διαβαλβιδική κλίση πίεσης (17±6.5 vs. 14±5.5 mmHg, p=0.02) όσο και τη μέγιστη ταχύτητα στην αορτή (Vmax) (2±0.4 vs. 1.84±0.38 m/s, p=0.02) συγκριτικά με την Ομάδα ΙΙ, κατά την υπερηχογραφική παρακολούθηση των ασθενών ένα χρόνο μετά τη ΔΕΑΒ. Η παραβαλβιδική ανεπάρκεια όπως επίσης και το κλάσμα εξώθησης της αριστερής κοιλίας αποδείχτηκαν ανεξάρτητοι προγνωστικοί παράγοντες της θνητότητας κάθε αιτιολογίας στον 1 χρόνο όταν έγινε η προσαρμογή για τους συμπαράγοντες.Συμπέρασμα: Οι τιμές βάθους εμφύτευσης που είναι μικρότερες από 4mm επιδρούν θετικά στη μακροχρόνια λειτουργικότητα της αυτοεκπτυσσόμενης βιοπρόσθεσης

Abstract 13349: Long Term (4 Years) Clinical and Echocardiographic Results of Transcatheter Self-expanding Medtronic Corevalve Device in Patients With Aortic Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vassilis Voudris ◽  
Sofia Thomopoulou ◽  
Manolis Vavuranakis ◽  
Maria Kariori ◽  
Christos Stefopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
The Self ◽  
Paravalvular Leak ◽  
Categorical Variables ◽  
Aortic Valve Area ◽  
Medtronic Corevalve

Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients (pts) with severe aortic stenosis considered inoperable or at high operative risk. However, little is known about long-term outcomes following TAVI. In this study we assessed the 4-year clinical and echocardiographic outcomes of pts undergoing TAVI with the self expanding Medtronic CoreValve prosthesis. Methods: The 4-year outcomes following successful TAVI with the self-expanding aortic valve device (Medtronic CoreValve) were evaluated in 60 pts (mean age 79+6 years, male 47 %, Logistic Euroscore 28.43+10.93%). Principal outcome measures were death from any cause. An echocardiograpic examination was performed at prespecified intervals of 6 and 12 months, and every year afterwards. Categorical variables were compared using X2 test, and continuous variables using t test. Survival curves were also constructed. Results: All cause mortality at 1, 2, 3, and 4 years was 16.7%, 28.3%, 30%, and 40% respectively. Mean aortic valve gradient decreased from 50.96+18.6 mm Hg pre to 9.22+ 4.6 mm Hg after TAVI (P<0.001) and remained at 15.69+6.3 mm Hg at 4 years (p for post-TAVI trend <0.01). Mean aortic valve area increased from 0.66+ 0.14 cm2 pre to 1.87+0.33 cm2 after TAVI (p<0.001) and remained at 1.23+ 0.25 cm2 at 4 years (p for post-TAVI trend <0.01). Paravalvular leak (minimal to moderate) was observed in 61% of pts post-TAVI; however, there was no case of progression to severe regurgitation at 4 years follow-up. Conclusions: TAVI with the Medtronic CoreValve prosthesis is associated with sustained clinical and functional cardiovascular benefits in inoperable or high-risk patients with symptomatic aortic stenosis up to 4-year follow-up.

scholarly journals Pharmacodynamic Effect of Clopidogrel in Patients Undergoing Transcatheter Aortic Valve Implantation

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Petr Tousek ◽  
Viktor Kocka ◽  
Jakub Sulzenko ◽  
Frantisek Bednar ◽  
Hana Linkova ◽  
...  
Keyword(s):  
Platelet Reactivity ◽  
Point Of Care ◽  
Bolus Administration ◽  
Antiplatelet Treatment ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Medtronic Corevalve ◽  
Valve Implantation ◽  
Dual Antiplatelet Treatment

The aim of this study was to analyze periprocedural and mid-term effect of clopidogrel on platelet function using the VerifyNow P2Y12point-of-care assay in patients undergoing TAVI. Platelet reactivity was measured at the beginning of the procedure after 300 mg clopidogrel bolus administration and during the follow-up (at 1 month after the procedure) in 52 patients undergoing TAVI using the Medtronic CoreValve prosthesis (Medtronic CoreValve). A cutoff value of 240 PRU was used to identify nonresponders to clopidogrel treatment with high residual platelet reactivity (HRPR). Baseline HRPR was identified in 80% of patients and in 72% of patients during 6-month follow-up. There was no significant difference in the pharmacodynamic effects of clopidogrel on platelet reactivity from baseline to 6-months follow-up (297±57vs.275±62;P=0.058). Ischemic event occurred only in 3 patients (5.8%) from the study group. In conclusion, majority of patients undergoing TAVI had high residual platelet reactivity after pretreatment with 300 mg of clopidogrel and during the 6-month follow-up at dual antiplatelet treatment. The noneffectiveness of clopidogrel in the TAVI population raises the question of the routine use of dual antiplatelet treatment in this setting.

A clinical protocol for analysis of the structural integrity of the Medtronic CoreValve System® frame and its application in patients with 1-year minimum follow-up

2010 ◽  
Vol 5 (6) ◽  
pp. 680-686 ◽  
Author(s):  
Nicolo Piazza ◽  
Eberhard Grube ◽  
Ulrich Gerckens ◽  
Gerhard Schuler ◽  
Axel Linke ◽  
...  
Keyword(s):  
Structural Integrity ◽  
Clinical Protocol ◽  
Medtronic Corevalve

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Brief summary of Kleť photographic search programme for minor planets

1999 ◽  
Vol 173 ◽  
pp. 189-192
Author(s):  
J. Tichá ◽  
M. Tichý ◽  
Z. Moravec
Keyword(s):  
Ccd Camera ◽  
Minor Planet ◽  
Minor Planets ◽  
Main Belt

AbstractA long-term photographic search programme for minor planets was begun at the Kleť Observatory at the end of seventies using a 0.63-m Maksutov telescope, but with insufficient respect for long-arc follow-up astrometry. More than two thousand provisional designations were given to new Kleť discoveries. Since 1993 targeted follow-up astrometry of Kleť candidates has been performed with a 0.57-m reflector equipped with a CCD camera, and reliable orbits for many previous Kleť discoveries have been determined. The photographic programme results in more than 350 numbered minor planets credited to Kleť, one of the world's most prolific discovery sites. Nearly 50 per cent of them were numbered as a consequence of CCD follow-up observations since 1994.This brief summary describes the results of this Kleť photographic minor planet survey between 1977 and 1996. The majority of the Kleť photographic discoveries are main belt asteroids, but two Amor type asteroids and one Trojan have been found.

Intranuclear Crystals in Regenerating Canine Kidneys

1973 ◽  
Vol 31 ◽  
pp. 412-413
Author(s):  
D.G. Osborne ◽  
L.J. McCormack ◽  
M.O. Magnusson ◽  
W.S. Kiser
Keyword(s):  
Epithelial Cell ◽  
Epithelial Cells ◽  
Tubular Epithelial Cell ◽  
Tubular Epithelial Cells ◽  
Cell Nuclei ◽  
Crystalline Structures ◽  
Small Crystals ◽  
Membrane Bound

During a project in which regenerative changes were studied in autotransplanted canine kidneys, intranuclear crystals were seen in a small number of tubular epithelial cells. These crystalline structures were seen in the control specimens and also in regenerating specimens; the main differences being in size and number of them. The control specimens showed a few tubular epithelial cell nuclei almost completely occupied by large crystals that were not membrane bound. Subsequent follow-up biopsies of the same kidneys contained similar intranuclear crystals but of a much smaller size. Some of these nuclei contained several small crystals. The small crystals occurred at one week following transplantation and were seen even four weeks following transplantation. As time passed, the small crystals appeared to fuse to form larger crystals.

Electron Microscopy of Human Gallstones

1971 ◽  
Vol 29 ◽  
pp. 296-297
Author(s):  
C. Wolpers ◽  
R. Blaschke
Keyword(s):  
Electron Microscopy ◽  
Room Temperature ◽  
Bile Pigment ◽  
X Ray Diffraction ◽  
Triclinic Crystal System ◽  
X Ray ◽  
Follow Up Study ◽  
Infra Red ◽  
Main Components

Scanning microscopy was used to study the surface of human gallstones and the surface of fractures. The specimens were obtained by operation, washed with water, dried at room temperature and shadowcasted with carbon and aluminum. Most of the specimens belong to patients from a series of X-ray follow-up study, examined during the last twenty years. So it was possible to evaluate approximately the age of these gallstones and to get information on the intensity of growing and solving.Cholesterol, a group of bile pigment substances and different salts of calcium, are the main components of human gallstones. By X-ray diffraction technique, infra-red spectroscopy and by chemical analysis it was demonstrated that all three components can be found in any gallstone. In the presence of water cholesterol crystallizes in pane-like plates of the triclinic crystal system.

Articulatory Intervention for the Visually Impaired

1979 ◽  
Vol 10 (3) ◽  
pp. 139-144
Author(s):  
Cheri L. Florance ◽  
Judith O’Keefe
Keyword(s):  
High School ◽  
High School Students ◽  
Behavior Change ◽  
Visually Impaired ◽  
School Students ◽  
Handicapped Children ◽  
Paired Stimuli ◽  
Visually Handicapped ◽  
Parent Program

A modification of the Paired-Stimuli Parent Program (Florance, 1977) was adapted for the treatment of articulatory errors of visually handicapped children. Blind high school students served as clinical aides. A discussion of treatment methodology, and the results of administrating the program to 32 children, including a two-year follow-up evaluation to measure permanence of behavior change, is presented.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

2019 ◽  
Vol 28 (3) ◽  
pp. 1039-1052
Author(s):  
Reva M. Zimmerman ◽  
JoAnn P. Silkes ◽  
Diane L. Kendall ◽  
Irene Minkina
Keyword(s):  
Short Term Memory ◽  
Controlled Trial ◽  
Treatment Success ◽  
Linear Regression Models ◽  
Language Performance ◽  
Short Term ◽  
Term Memory ◽  
Treatment Gains ◽  
Post Hoc

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

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