Munckcheng8661

Large clinical trials and meta-analyses have shown that thrombus aspiration (TA) in the setting of ST-T segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) does not improve clinical outcome, whilst it may be associated with an increased risk of stroke. Accordingly, in the most recent European Society of Cardiology guidelines the role of routine TA during PPCI has been downgraded to a class III recommendation with level A of evidence. On the other hand, it has been suggested that in case of high thrombus burden a selective use of TA may still play a role. STEMI due to cardioembolism (CE) definitely represents one of these situations. In the present case of an 81-year-old woman presenting with STEMI due to a cardioembolic obstruction of left main coronary artery, we show that TA succeeded, whereas classical angioplasty failed, in promoting a prompt coronary flow restoration in a life-threatening condition. Further, it allowed us not to upgrade the procedure with stent implantation that would have required a triple antithrombotic therapy, significantly increasing the bleeding risk. Visual examination of thrombi retrieved suggested the diagnosis of CE. Finally, we clearly show which is the mechanism linking TA with the risk of stroke. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.A 69-year-old female Jehovah's Witness was diagnosed with symptomatic severe aortic stenosis (AS). Because the patient, who refused blood transfusion for religious reasons, had multiple comorbidities, such as thrombocytopenia due to liver cirrhosis, esophageal varices, and an old cerebral infarction, a decision to perform transcatheter aortic valve implantation (TAVI) was made. Preprocedural computed tomography showed a small aortic root and severe leaflet calcification, especially at the non-coronary cusp; therefore, the risk of annulus and Valsalva rupture was considered to be high. A 20-mm transcatheter heart valve (Edwards SAPIEN3; Edwards Lifesciences Corporation, Irvine, CA, USA) was successfully implanted using the transfemoral approach. To prevent blood transfusion, erythropoietin and sodium ferrous citrate were prescribed during the periprocedural period. The postprocedural course was uneventful, and the patient was discharged on postoperative day 10. TAVI, which is associated with a significantly lower need for transfusion compared with surgical aortic valve replacement, has recently been performed as a less invasive treatment for high- or intermediate-risk patients with AS. This case highlights the feasibility and safety of TAVI using a 20-mm transcatheter heart valve for a patient with severe AS, a small aortic root, and severe and eccentric leaflet calcification who refused blood transfusion. . © 2019 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.This study identified associations between perceived neighborhood stress and adolescents' perceptions of life satisfaction. African American adolescents aged 13-18 (n=1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.Facilitating mentalization, or the ability to understand mental states and their link to behavior, is increasingly viewed as a common mechanism of action across effective psychotherapies. Here we present an overview of a new set of contemplative psychotherapeutic techniques, Mentalizing Imagery Therapy (MIT), that uses guided imagery and mindfulness practices to facilitate mentalization. MIT aims to reduce negative psychological symptoms by stimulating an understanding of mental states and their links to behavior in self and others, including in challenging interpersonal situations. Case discussions of MIT in personality disordered and depressed patients are used to illustrate theoretical points and the specific practical benefits of MIT. We conclude that there are promising indications that the imagery and mindfulness practices of MIT, that are specifically targeted to facilitate insight in the context of attachment relationship challenges, may help to improve mentalization and reduce symptoms of depression and anxiety. Both in practice and with respect to its articulated goals, MIT promotes a distinct set of capacities from other mindfulness or compassion based therapies. Further research is required to determine the clinical efficacy of MIT in controlled trials.Objectives Mindfulness is effective for reducing anxiety and depression and increasing chronic disease self-management. An accessible, insurance-reimbursable model for implementation in patient-centered medical homes within US healthcare systems has promise for patients with multi-morbid conditions. Clarifying both the dose needed to impact anxiety, depression and self-management, and the design requirements for accessible primary care implementation, is essential. Methods We tested feasibility, acceptability, and effectiveness of Mindfulness Training for Primary Care (MTPC), an 8-week, referral-based, insurance-reimbursable mindfulness program integrated within primary care, compared with a Low-Dose Comparator (LDC), consisting of a 60-minute mindfulness introduction plus referral to community and digital resources. Outcome measures were assessed at baseline and 8 weeks. MTPC is trauma-informed, incorporates mindfulness-oriented behavior change skills, and is designed to target anxiety, depression, stress, and chronic illness selfmanagement. Participants schedule a PCP visit to co-create a self-management action plan during week 6. Results Primary care providers (PCP) referred 344 patients over 14 months. Eighty-one participants with DSM-V anxiety disorders, depressive disorders, trauma- and stress-related disorders participated in this pilot randomized-controlled comparative effectiveness trial [MTPC (n=54); LDC (n=27)]. These data suggest that MTPC was more effective than LDC for reducing anxiety (p=0.01), enhancing mindfulness (p=0.02) and self-compassion (p=0.001), and for catalyzing selfmanagement behavior change through action plan initiation (OR=4.34, p=0.03). Conclusions MTPC was successfully integrated into a health system, was billed to insurance, and was acceptable to a diverse primary care population. Replication with a larger study and further accessibility adaptations are needed to confirm and expand these pilot results.Context Metabolic inflexibility is a characteristic of insulin resistance, limiting the ability to transiently regulate oxidative metabolism and gene expression in response to nutrient availability. Little is known of the flexibility of post-transcriptional regulation, including circulatory miRNAs (c-miRNAs). Design The abundances of targeted c-miRNAs, with reported functions in metabolic regulation, were analysed in response to a high-carbohydrate meal in healthy weight insulin-sensitive (IS) and overweight insulin-resistant (IR) women. Participants Age-matched healthy weight IS (n = 20, BMI = 24.3 ± 0.70) and overweight IR (n = 20, BMI = 28.6 ± 0.67) women. Methods An abundance of c-miRNAs was quantified prior to and following a high-carbohydrate breakfast meal (2500 kJ; 50% carbohydrate, 20% fat and 27% protein). Target genes of the differentially regulated c-miRNA were measured in RNA extracted from circulatory peripheral blood mononuclear cells (PBMCs). Results In healthy weight IS women, both miR-15a-5p (p = 0.03) and miR-17-5p (p  less then  0.01) levels were halved at 4 h post-meal. These miRNA remained unaltered following the same meal in the overweight IR women. Furthermore, amongst genes targeted by these miRNA, CPT1A (p = 0.01) and IL8 (p = 0.03) had also reduced expression 4 h post-meal only in the healthy weight IS women. Conclusions The study findings provide preliminary evidence for a possible extension of metabolic inflexibility to include c-miRNAs. Trial registration The clinical trial is registered with Australian New Zealand Clinical Trials Registry under Trial registration ANZCTR ACTRN12615001108505. Registered on 21 October 2015. © The Author(s) 2020.It is currently challenging to eradicate cancer. In the case of solid tumors, the dense and aberrant extracellular matrix (ECM) is a major contributor to the heterogeneous distribution of small molecule drugs and nano-formulations, which makes certain areas of the tumor difficult to treat. Vismodegib As such, much research is devoted to characterizing this matrix and devising strategies to modify its properties as a means to facilitate the improved penetration of drugs and their nano-formulations. This contribution presents the current state of knowledge on the composition of normal ECM and changes to ECM that occur during the pathological progression of cancer. It also includes discussion of strategies designed to modify the composition/properties of the ECM as a means to enhance the penetration and transport of drugs and nano-formulations within solid tumors. Moreover, a discussion of approaches to image the ECM, as well as ways to monitor changes in the ECM as a function of time are presented, as these are important for the implementation of ECM-modifying strategies within therapeutic interventions. Overall, considering the complexity of the ECM, its variability within different tissues, and the multiple pathways by which homeostasis is maintained (both in normal and malignant tissues), the available literature - while promising - suggests that improved monitoring of ECM remodeling in vivo is needed to harness the described strategies to their full potential, and match them with an appropriate chemotherapy regimen. © The author(s).Rationale The blood-brain barrier (BBB) is a major obstacle for drug delivery to the brain. Sonopermeation, which relies on the combination of ultrasound and microbubbles, has emerged as a powerful tool to permeate the BBB, enabling the extravasation of drugs and drug delivery systems (DDS) to and into the central nervous system (CNS). When aiming to improve the treatment of high medical need brain disorders, it is important to systematically study nanomedicine translocation across the sonopermeated BBB. To this end, we here employed multimodal and multiscale optical imaging to investigate the impact of DDS size on brain accumulation, extravasation and penetration upon sonopermeation. Methods Two prototypic DDS, i.e. 10 nm-sized pHPMA polymers and 100 nm-sized PEGylated liposomes, were labeled with fluorophores and intravenously injected in healthy CD-1 nude mice. Upon sonopermeation, computed tomography-fluorescence molecular tomography, fluorescence reflectance imaging, fluorescence microscopy, confocal microscopy and stimulated emission depletion nanoscopy were used to study the effect of DDS size on their translocation across the BBB.