Objective
The research is aimed to investigate interactions between cardiovascular signals and to assess contributions of central and local mechanisms to skin blood flow regulation in upper and lower extremities at rest and under orthostasis.
Methods
Heart rate variability, respiration, forearm, and foot skin blood flow were assessed at rest and during postural test in 25 healthy volunteers. Spectral analysis was performed. Phase synchronization degree of analyzed signals was determined by group phase wavelet coherence function.
Results
Skin blood flow was lower on foot at rest and during postural test than on forearm. High‐frequency component of heart rate variability was higher at ~0.3 Hz during postural test versus rest. Blood flow oscillation amplitudes on the foot were lower in frequency range including respiratory interval at rest than on forearm. Postural exposure increased amplitude of foot blood flow oscillations in respiratory interval and decreased amplitudes in cardiac interval versus rest. Orthostasis increased group wavelet phase coherence between foot blood flow and heart rate variability or respiration, as well as between forearm and foot blood flow at 0.3 Hz corresponding to respiration.
Conclusions
The contribution of central mechanisms associated with respiration to blood flow regulation increased in lower extremities during orthostasis.
The article presents the results of the DAPA-HF study - evaluating the efficacy of dapagliflozin, used at a dose of 10 mg once a day, in addition to the standard treatment for patients with chronic heart failure with reduced left ventricular ejection fraction, compared to placebo. An analysis of current clinical recommendations related to this issue was carried out, the results of recent clinical studies and metaanalyses conducted were highlighted. Based on the results of the study, the need is postulated to optimize drug therapy of this category to patients with persistent symptoms of heart failure, despite standard therapy, with the addition of dapagliflozin to reduce the risk of cardiovascular death and hospitalizations for heart failure, improve the course of the disease. Keywords: chronic heart failure, dapagliflozin, low ejection fraction, effects of type 2 sodium-glucose co transporter inhibitors, diabetes mellitus.
666 Background: Targeted therapy with axitinib resulted in a greater objective response rate and prolonged progression-free survival (PFS) compared to sorafenib in patients with previously treated metastatic renal cell carcinoma (mRCC) in AXIS study. 75% of patients had intermediate and poor IMDC prognosis. In this phase 2 study, we assessed the activity of axitinib in mRCC patients with favourable risk and a history of prior VEGFR-directed therapy. Methods: Patients were required to have clear cell mRCC, favourable risk according to IMDC criteria, and to have received first-line treatment with sunitinib or pazopanib. Prior treatment with other agents was not permitted. The primary endpoint of the study was PFS. Additional endpoints included response rate, safety, and overall survival (OS). Results: A total of 21 patients were enrolled, 62% of whom were male. Median age was 59 years. 11 (52%) patients had 2 and more metastatic sites. 67% and 33% of patients received first-line sunitinib or pazopanib with a median PFS of 17 months (95% CI 14-20). After a median follow-up of 16 months, the median PFS and OS was not yet reached. The current study did achieve its primary endpoint based on the 10-month PFS of 71.4%. 3 (14.3%) patients had confirmed partial responses and 14 (66.7%) had stable disease. No grade 3/4 treatment-related adverse events were observed; the most frequent grade 1/2 treatment-related adverse events were hypertension (57.1%), fatigue (57.1%), GI (33%) and skin (19%) toxicity. 7 patients had dose-escalation of axitinib and 1 patient had dose reduction. Conclusions: The encouraging PFS and favorable safety profile observed in FavorAx study support the administration of axitinib in mRCC patients with favourable IMDC risk and a history of prior sunitinib or pazopanib. Clinical trial information: NCT02700568.
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