Bullardbroussard7252

We investigated changes in alcohol consumption following the COVID-19 lockdown among French-speaking Belgian individuals at risk for severe alcohol use disorder. Participants (N = 299) at risk for alcohol use disorder (AUD, i.e., score higher than 19 at the Alcohol Use Disorder Identification Test), and 299 moderate drinkers (MOD, i.e., score lower than 8) individually matched for age, gender and education provided self-reports of alcohol consumption changes (i.e., number of alcohol units consumed during a typical week before and during lockdown). AUD were more likely (91.31%) than MOD (71.57%) to modify their consumption following lockdown (p less then 0.0001). They were more likely to decrease (65.89% vs. 35.12%, p less then 0.0001) and less likely to increase (25.42% vs. 36.45%, p = 0.004) their consumption than MOD. Analyses of post-pre lockdown differences in alcohol consumption showed that AUD presented a stronger decrease than MOD (-13.97 units/week vs. -0.07, p less then 0.0001). Among individuals who decreased consumption, AUD decreased more (-27.92 vs. -2.74, p less then 0.0001) than MOD. Among those who increased consumption, AUD increased more (17.32 vs. 2.44, p less then 0.0001) than MOD. We thus observed sharp consumption increases or conversely abrupt decreases in individuals at high risk of alcohol use disorder, underscoring the need to develop prophylactic interventions for this population during such sanitary crises, to avoid brutal changes of the alcohol consumption pattern. Efforts should be made to mitigate consumption increases but also to favor progressive rather than sudden decreases in order to prevent damaging withdrawal symptoms.Lower limb peripheral artery disease is a leading cause of cardiovascular disease morbidity and mortality. Endovascular revascularization is often indicated to improve walking function and to prevent limb loss but restenosis in the treated vessel segment remains a concern that limits the overall effectiveness of the treatment. The most promising technique to prevent restenosis is the use of drug-coated devices, and the most common drug used to coat lower limb balloon angioplasty balloons and stents is paclitaxel. A systematic review and meta-analysis in 2018 reported a possible increase in late mortality attributable to paclitaxel-coated devices. Since then, their use has been brought into question. Here, we present an update of data focusing on the efficacy and safety of paclitaxel-coated devices in lower limb treatment applications. While paclitaxel-coated devices appear to reduce restenosis rates it is still unclear how these surrogate marker improvements translate to direct patient benefits and uncertainty remains as to whether paclitaxel-coated devices confer an increased risk of long-term mortality. Available randomized clinical data is hampered by trial heterogeneity, insufficient power, potential attrition bias and the lack of a plausible mechanistic explanation. An important step forward is that the ongoing trials that were temporarily halted due to the Katsanos et al. report have now both commenced recruitment and may ultimately resolve this clinical dilemma by virtue of their larger sample sizes. Other possible ways forward are the ongoing investigation of alternative anti-proliferative coating agents and use of new sophisticated vascular imaging techniques to more clearly identify patients at risk of restenosis already in the preoperative setting.Despite the availability of safe and effective antihypertensive drugs, blood pressure (BP) control to guideline-recommended target values is poor. Several device-based therapies have been introduced to lower BP. The most extensively investigated approach is catheter-based renal sympathetic denervation (RDN), which aims to interrupt the activity of afferent and efferent renal sympathetic nerves by applying radiofrequency energy, ultrasound energy, or injection of alcohol in the perivascular space. The second generation of placebo-controlled trials have provided solid evidence for the BP-lowering efficacy of radiofrequency- and ultrasound-based RDN in patients with and without concomitant pharmacological therapy. In addition, the safety profile of RDN appears to be excellent in all registries and clinical trials. However, there remain unsolved issues to be addressed. This review summarizes the rationale as well as the current evidence and discusses open questions and possible future indications of catheter-based RDN.Interventional cardiologists who treat malfunctioning hemodialysis accesses play an important role in the life of patients with end-stage kidney disease (ESKD). By collaborating with interventional nephrologists who currently perform the bulk of routine access angiographic procedures, interventional cardiologists can fill an important gap in the care of ESKD patients by performing urgent or emergent procedures that fall outside the schedule of an outpatient interventional nephrology laboratory to ensure that hemodialysis patients will not miss a hemodialysis session or get a temporary catheter. This paper reviews the pathophysiology of dialysis access failure and illustrates the catheter-based approaches used by interventional cardiologists to treat malfunctioning dialysis accesses.The diagnosis and treatment of acute limb ischemia (ALI) has long been a fierce adversary that has evolved over the last several decades with scientific advancements in endovascular therapy. History and physical examination remain the mainstay of diagnosis enhanced by detailed imaging to guide therapy. Many endovascular tools are available for prompt restoration of flow that compliment traditional surgical options. These devices incorporate the mechanical removal of thrombus and the chemical dissolution of thrombus . check details Medical decision-making for ALI patients must take into account the patient characteristics, anatomic variables, mechanism of ischemia, degree of ischemia, and operator skill to employ the right strategy for the right patient. This moving target challenges scientific study, making the therapeutic bedside decision making an artform. We present an overview of the field, supportive data, and a treatment algorithm that hopefully captures this delicate balance.