1,720,973 research outputs found
Atherosclerotic Renal Artery Stenosis in the Post-CORAL Trial Era. A Narrative Review
Full text linkAtherosclerotic renal artery stenosis (ARAS) represents a common manifestation of systemic atherosclerosis and remains an underrecognized cause of secondary hypertension, chronic kidney disease, and cardiovascular morbidity. Although often clinically silent, progressive narrowing of the renal artery may result in renovascular hypertension, ischemic nephropathy, or cardiac destabilization syndromes such as recurrent pulmonary edema. The pathophysiology of ARAS extends beyond simple flow limitation, involving renin-angiotensin-aldosterone system activation, oxidative stress, microvascular rarefaction, and parenchymal fibrosis, thereby explaining the limited reversibility of renal damage after revascularization. Over the past decades, management strategies have evolved considerably. While initial enthusiasm for surgical or endovascular revascularization was supported by observational reports of improved blood pressure and renal function, randomized controlled trials-including ASTRAL and CORAL-failed to demonstrate a consistent benefit of stenting over optimal medical therapy in unselected patients. These findings have shifted current practice toward medical therapy as the cornerstone of management, integrating renin-angiotensin system inhibitors, statins, antiplatelet agents, and, more recently, SGLT2 inhibitors. Nevertheless, accumulating evidence indicates that specific high-risk subsets-patients with resistant hypertension, recurrent pulmonary edema, or progressive ischemic nephropathy-may derive meaningful clinical benefit from timely revascularization. In the post-CORAL era, the central challenge is therefore accurate patient selection to identify the small group in whom revascularization remains appropriate, leveraging advanced imaging, physiological indices, and risk stratification
Lipoprotein remnants and dense LDL are associated with features of unstable carotid plaque: A flag for non-HDL-C
Full text linkOBJECTIVE: We investigated the association between cholesterol across the LDL density range and in the VLDL and IDL particles with the prevalence of inflammatory cells in plaques of patients with severe carotid artery stenosis.
METHODS: Forty-five patients undergoing carotid endarterectomy were studied. Plaque specimens were analyzed for cellular composition by immunocytochemistry using monoclonal antibodies. Lipoprotein subclasses were separated by gradient ultracentrifugation.
RESULTS: We found no correlations between LDL-C, HDL-C and plasma triglyceride levels with plaque cellular composition. On the other hand, macrophage content was significantly related to cholesterol in the dense LDL subclasses (r = 0.30, p < 0.01) and in the triglyceride-rich lipoprotein remnants, namely dense VLDL and IDL particles (r = 0.46, p < 0.01). HDL subclasses were not correlated with plaque cellular composition. In a mirror manner, smooth muscle cells were inversely associated with cholesterol levels of the dense LDL subclasses (r = -0.32, p < 0.01 fraction 10; r = -0.26, p < 0.05 fraction 11) while only a non-significant trend was observed with the cholesterol in the VLDL-IDL fractions. These results provide the pathophysiological background to account for the relevance of non-HDL-C as the only lipid parameter, aside LDL density, significantly associated (β = 0.351, p = 0.021) with carotid plaque macrophage content.
CONCLUSIONS: We provide evidence that lipoprotein subclasses, specifically cholesterol in the dense LDL fractions and in the triglyceride-rich lipoprotein remnants, significantly affect carotid plaque cellular composition, in particular macrophages content
OS 10-06 THE IMPACT OF WELL CONTROLLED BLOOD PRESSURE LEVELS ON ARTERIAL PROPERTIES IN ESSENTIAL HYPERTENSIVES
No full textOBJECTIVE:
The aim of this study was to evaluate the impact of well controlled blood pressure (BP) levels on structural and functional properties of arteries in essential hypertensives.
DESIGN AND METHOD:
We studied 80 young hypertensives (mean age 49 yo) allocated either to pharmacological treatment (55 of 80) or to lifestyle modifications (25 of 80) for at least 12 months (mean 38 months) to maintain target BP. Follow-up visits were scheduled every 6 months. Office BP was taken three times by the same doctor at the time of the study. We assessed the B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum IMT (M-MAX) in each carotid artery segment (common, bulb, internal), bilaterally. Endothelial function was evaluated by post-occlusion flow mediated dilation (FMD) of the brachial artery using high-sensitivity ultrasonography. Arterial elastic properties were evaluated by assessing carotid distensibility (DC) and compliance (CC). Forty normotensive subjects paired for age and sex served as controls.
RESULTS:
Throughout the study, BP levels were well controlled in hypertensives (mean BP levels: 131/79 mmHg). The IMT (mean-IMT 0.65 mm, M-MAX 0.79 mm) was significantly higher in hypertensives than in controls (mean-IMT 0.60 mm, M-MAX 0.70 mm). FMD was impaired in hypertensives (5.7%) compared to controls (9.2%). IMT parameters correlated only to age, while LDL-cholesterol was the only factor related to FMD. Compared to controls, arterial elasticity was significantly impaired in hypertensives (DC 25.6 vs 52.4 10/kPa, and CC 0.97 vs 1.40 mm/kPa).
CONCLUSIONS:
In essential hypertensives, despite long-term well controlled BP, the pro-atherogenic remodelling was still present. IMT was mainly dependent upon age, while FMD was mainly related to cholesterol levels. Moreover, carotid elasticity was impaired. The "pseudo-normalization" of BP levels does not result in normalization of structural and functional properties of the arterial wall
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
[PP.09.19] LONG-TERM WELL-CONTROLLED BLOOD PRESSURE LEVELS AND CAROTID ELASTICITY IN YOUNG HYPERTENSIVE SUBJECTS
No full textVascular remodelling in well-controlled hypertensive patients: the challenge of residual risk management
No full textResidual cardiovascular risk (RCVR) is an emerging issue in the clinical and therapeutic management of patients affected by hypertension. In fact, a number of clinical studies showed that even in case of optimal blood pressure (BP) control, the hypertensive patients still carry a sizeable increase in the CV risk as compared to normotensive individuals
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