1,721,027 research outputs found
A Placebo-Controlled Trial of PCI for Stable Angina
No full textIn the editorial accompanying the article by Rajkumar and colleagues (Dec. 21 issue)1 on the results of the ORBITA-2 trial involving the use of percutaneous coronary intervention (PCI) in patients with stable angina, White2 begins with a flawed premise: “The primary aim of treating patients with stable angina is to decrease symptoms and improve quality of life.” That is not the primary aim of treating these patients. Relieving angina is important, but the real priority in the management of stable angina is the provision of appropriate medical therapy to reduce the risk of myocardial infarction and sudden death. Thus, we continue our orbit around PCI. Many patients undergo stent implantation at the same time that we have not made the systematic changes that are necessary to ensure that every patient receives appropriate medical therapy. That is what must be changed.
The follow-up of the ORBITA-2 trial lasted only 12 weeks, and the between-group differences in the frequency of angina were modest. Five years into the COURAGE trial,3 74% of patients in the PCI group and 72% of those in the medical-therapy group were free from angina. The new orbit? Appropriate medical therapy first, followed by PCI if angina is not sufficiently relieved
“Neuromonitoring as an alternative to awake intubation in uncooperative patients at risk for cervical spine injury”
No full textSystemic and Cardiac Microvascular Dysfunction in Hypertension
Full text linkHypertension exerts a profound impact on the microcirculation, causing both structural and functional alterations that contribute to systemic and organ-specific vascular damage. The microcirculation, comprising arterioles, capillaries, and venules with diameters smaller than 20 μm, plays a fundamental role in oxygen delivery, nutrient exchange, and maintaining tissue homeostasis. In the context of hypertension, microvascular remodeling and rarefaction result in reduced vessel density and elasticity, increasing vascular resistance and driving end-organ damage. The pathophysiological mechanisms underlying hypertensive microvascular dysfunction include endothelial dysfunction, oxidative stress, and excessive collagen deposition. These changes impair nitric oxide (NO) bioavailability, increase reactive oxygen species (ROS) production, and promote inflammation and fibrosis. These processes lead to progressive vascular stiffening and dysfunction, with significant implications for multiple organs, including the heart, kidneys, brain, and retina. This review underscores the pivotal role of microvascular dysfunction in hypertension-related complications and highlights the importance of early detection and therapeutic interventions. Strategies aimed at optimizing blood pressure control, improving endothelial function, and targeting oxidative stress and vascular remodeling are critical to mitigating the systemic consequences of hypertensive microvascular damage and reducing the burden of related cardiovascular and renal diseases
Randomized evidence of mortality reduction not confirmed in most recent works: a methodological problem
No full text
Intravenous Amino-acid Infusion to Prevent Acute Kidney Injury after Cardiac Surgery: A Review of the Evidence
No full textBackground: Acute kidney injury (AKI) is a frequent and important complication of cardiac surgery. Decreased perfusion is a key mechanism. This decreased perfusion may be attenuated by intravenous amino acids (AAs) through recruitment of renal functional reserve. Methods: The study investigators performed a PubMed search of all articles published from 1980 to August 30, 2024, with combined search criteria of “renal functional reserve,” “amino acids,” “cardiac surgery,” and “cardiopulmonary bypass” by using MEDLINE (PubMed), Embase, and the Cochrane Central Register of Clinical Trials. Included were studies describing the effect of AAs on renal functional reserve and studies of adult cardiac surgery patients with information on renal function. A narrative review was developed. Results: Multiple experimental and human studies over >40 years have recurrently and consistently shown that the administration of an oral protein load or intravenous AAs increase renal blood flow and glomerular filtration rate by >30%. Moreover, several pilot investigations in cardiac surgery with cardiopulmonary bypass consistently showed renal benefits with intravenous AAs. Finally, a pivotal trial of 3511 cardiac surgery patients (the PROTECTION trial) recently confirmed such beneficial effects in a double-blind multicenter international setting. Conclusions: Intravenous AAs consistently recruit renal functional reserve and improve kidney function in cardiac surgery patients. These findings have been confirmed by the PROTECTION (Intravenous Amino Acid Therapy for Kidney Protection in Cardiac Surgery) trial. Intravenous AA therapy is the only proven treatment to prevent and/or attenuate the severity of cardiac surgery−associated AKI
Amino Acid Infusion and Renal Protection: Beyond Hemodynamic Optimization in Cardiac Surgery
No full textAmino acids and the kidney; friends or foes?
No full textPurpose of review Acute kidney injury (AKI) is common in hospitalized patients and is independently associated with morbidity and mortality. Moreover, AKI increases the risk of chronic kidney disease, which is a major healthcare problem. Currently, no single therapy has been proven to be effective in preventing AKI. The role of amino acids in the context of kidney function and AKI prevention has been controversial and most of the evidence is available from nutritional studies. However, knowledge of amino acids in recruiting renal functional reserve and their potential role to protect renal function under stress has recently expanded. Recent findings The nephroprotective effects of amino acids were first postulated in 1973. Recently, this strategy gained renewed interest and has been more extensively studied, reintroducing their use in clinical situations characterized by a high incidence of AKI. Intravenous amino acids administration for kidney protection is now supported by a large multinational randomized double-blind controlled trial in cardiac surgery and by experimental and observational data. All such data support the rationale for a biologically and clinically important nephroprotective effect. Summary The infusion of amino acids was recently found to reduce the incidence of AKI in cardiac surgery patients and surgical patients. This strategy for the protection of renal function is supported by a multicenter, international, double-blind randomized trial, with a huge potential for additional application in several clinical fields. Several mechanisms of action support the robustness of these findings and are summarized in this manuscript
- …
