The link between vascular calcification (VC) and increased mortality is now well established. Over time, as clinical importance of this phenomenon has begun to be fully considered, scientists have highlighted more and more physiopathological mechanisms and signaling pathways that underlie VC. Several conditions such as diabetes, dyslipidemia and renal diseases are undoubtedly identified as predisposing factors. But even if the process is better understood, many questions still remain unanswered. This review briefly develops the various theories that attempt to explain mineralization genesis. Nonetheless, the main purpose of the article is to provide a profile of the various existing biomarkers of VC. Indeed, in the past years, a lot of inhibitors and promoters, which form a dense and interconnected network, were identified. Given importance to assess and control mineralization process, a focusing on accumulated knowledge of each marker seemed to be necessary. Therefore, we tried to define their respective role in the physiopathology and how they can contribute to calcification risk assessment. Among these, Klotho/fibroblast growth factor-23, fetuin-A, Matrix Gla protein, Bone morphogenetic protein-2, osteoprotegerin, osteopontin, osteonectin, osteocalcin, pyrophosphate and sclerostin are specifically discussed.
Purpose: To describe the results of a left ventricular assist device (LVAD) survey conducted through the patient website "mylvad.com". Methods: An online questionnaire consisting of 6 multiple choice questions and 4 open ended questions which asked respondents to describe dressing practices and experiences, was offered to all patients and caregivers who were registered with mylvad.com, a website funded by unrestricted educational grants from industry, that was created by LVAD professionals. The questionnaire was preceded by a statement outlining that de-identified responses might be used for future publication. Results: We received 187 responses (110 LVAD patients and 77 caregivers) from across North America between August 20th and 24th, 2015. Implanted devices were: HeartMate II (n= 146, 78%), HeartWare HVAD (n= 26, 14%) or others (n= 15, 8%). One hundred and forty four (77%) patients had lived with the LVAD for more than 1 year. Half of the respondents (n= 93) changed their dressing 2-3 times per week, and a further 47 (25%) changed it weekly. Most patients and caregivers found the dressing change procedure easy to learn (n= 143, 76%) and perform (n= 149, 80%). Of the 32 patients who reported experiencing skin irritation, 23 (71%) reported modifying their dressing protocol vs. 53/155 (30%) patients who had no irritation (p = 0.000). Cost was mentioned as an issue when breaches in dressing change protocol occurred in 13 (7%) cases. Some common themes emerged in the comments received from both patients and caregivers. 1. Concerns about fatigue "after 5 years, it wears on youhelp!". 2. Creativity "We have created a little procedure to follow which seems to work...". 3. Difficulties with showering "shower protectors are pretty much worthless". Conclusion:Although there is some variation in dressing techniques taught by implanting centers, actual practice by patients and families in the outpatient setting varies considerably. These variations are due to skin irritation, convenience and cost. Comments received from patients clearly indicated that dressing procedures need to be individualized and better solutions to minimize skin irritation and enable stress-free bathing for LVAD patients need to be found.
Purpose: Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients to provide cardiac and/or respiratory support. Despite improvement in technology, experience, and management, the survival rate remains low. In the Extracorporeal Life Support Organization (ELSO) registry only 43% of adult ECMO patients survived to discharge, though readmission rates and reasons for readmission are not captured. These data are valuable to determine discharge planning and education for ECMO patients. This study retrospectively assessed readmission rates, reason for readmission, and outcomes within the first year of hospital discharge for survivors of ECMO therapy at an urban medical center. Methods: A retrospective chart review from patients who survived ECMO to discharge between January 2009 and July 2014 was conducted. ECMO duration, type (Veno-Arterial (VA)/ Veno-Venous (VV)), date of discharge, rate and reason for readmission, and mortality were recorded. Descriptive statistics were used for data analysis. Results: Complete data were available for 48 patients; 32 were recipients of VA ECMO, 13 of VV ECMO, and 3 were converted from VA to VV. Seventy-one percent (n= 34) of patients were readmitted within the first year of discharge (mean number of readmissions: 2.7; range 1-8). Eighty percent of readmissions were unplanned, and the majority of patients were readmitted with pulmonary illness (37%). Fifty-four percent (n= 26) of patients had an unplanned first readmission, mean number of days to readmission post-discharge was 84.59 (range 1-342 days). Eighty-one percent (n= 39) of patients survived one year post-discharge. Four patients died between discharge and 3 months; 1 patient died between 3 and 6 months; and 4 patients died between 6 and 12 months post-discharge. Conclusion: Eighty-one percent of the patients in our cohort who survived ECMO to discharge were still alive one year post-discharge. Several patients had unplanned readmissions within the first year. Findings suggest the need for careful monitoring and follow up post-discharge, particularly regarding pulmonary illness, due to increased risk for morbidity and readmission. Discharge education provided to patients and their families should highlight the increased risk for development of illness post-discharge, and the need for efficient follow up, should symptoms occur.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.