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| 1 | Cardiac toxicity of trastuzumab in elderly patients with breast cancer显示文摘乳癌(BC ) 在 ≥ 被诊断;65 个岁女人在关于盒子的一半。专家们当前建议,那全身的治疗基于他们的全面条件和预期寿命与 BC 被提供给老病人,好处将超过治疗的风险,这能相当被期望。为年轻题目,相似对人的表皮的生长因素 receptor-2 (HER-2 ) 的 monoclonal 抗体, trastuzumab,代表一种有效治疗学的选择什么时候 BC 在表示上这受体。不幸地, trastuzumab 的管理与左室的机能障碍和长期的心失败(CHF ) 的出现被联系,因为有 homeostatic 的干扰,可能在心 HER-2 工作。基于登记的、回顾的分析在在没为 BC 给任何治疗的那些与 10%-15% 相比收到 trastuzumab 的老女人在 25% 附近报导了 CHF 的发生,并且 CHF 的风险被估计了在 > 更高双重;60-65 岁 trastuzumab 用户对非用户。极其先进的年龄和先存在的心脏病被显示了预先安排到 trastuzumab cardiotoxicity。因此,为有 trastuzumab 的治疗的更老的病人的选择应该主要基于他们的一般地位和 comorbidities 的存在;特别与 anthracyclines,以前的化疗应该也被考虑。一旦治疗开始了,努力应该被作保证常规心脏的监视。选择 biomarkers 的角色,例如心脏的 troponin,或新成像技术(三尺寸,织物 Doppler echocardiography,磁性的回声成像) 是有希望的,但是必须进一步在特别被调查老。而且,另外的研究被需要以便更好理解 trastuzumab 由影响旧心的机制。 | Andrea Denegri Tiziano Moccetti Marco Moccetti Paolo Spallarossa Claudio Brunelli Pietro Ameri | 2016 | Journal of Geriatric Cardiology2016，13，4： | 10 |
| 2 | Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure显示文摘AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers(BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.RESULTS A total of 903 patients were evaluated(mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms(New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia(23% vs 37%), coronary artery disease(28% vs 52%) and left bundle branch block(9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology(50% vs 24%), a history of valve surgery(13% vs 4%) and received overall more devices implantation(31% vs 21%). The use of disease-modifying medications(i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF(72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics(87% vs 69%) and digoxin(51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm(SR)(45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of allcause mortality, the univariate relationship between AF and death(HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant(HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy.CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis. | Lorenzo Gigli Pietro Ameri Gianmarco Secco Gabriele De Blasi Roberta Miceli Alessandra Lorenzoni Francesco Torre Francesco Chiarella Claudio Brunelli Marco Canepa | 2016 | World Journal of Cardiology2016，8，11： | 4 |
| 3 | Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement:Report of a case显示文摘We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors. | Gian Marco Rosa Antonello Parodi Ulrico Dorighi Federico Carbone Franois Mach Alessandra Quercioli Fabrizio Montecucco Nicolas Vuilleumier Manrico Balbi Claudio Brunelli | 2014 | World Journal of Clinical Cases2014，2，1： | 2 |
| 4 | Prostate cancer volume associates with preoperative plasma levels of testosterone that independently predicts high grade tumours which show low densities(quotient testosterone/tumour volume)显示文摘Objective:To investigate potential associations of preoperative total testosterone(TT)with tumor volume(TV)and grade of prostate cancer(PCa).Methods:Patients who were under medications impacting on the hypothalamic-pituitaryadrenal-testis-prostate axis were excluded.TT was measured preoperatively at least 1 month after biopsies and TV was calculated on the removed prostate specimen.Other continuous variables included total prostate specific antigen(PSA),percentage of positive cores(Pt)and weight(W)of the removed prostate.Patients were categorized according to the pathologic Gleason score(pGS)in 3 groups(pGS 6,7 and>7).Invasion of the seminal vesicles was coded as seminal vesicle invasion(SVI).Results:The median levels of TT were significantly and increasingly higher from pGS 6(14.7 nmol/L)to pGS 7(15.0 nmol/L)and pGS>7(18.8 nmol/L).The median values of TV were also detected significantly and increasingly higher from pGS 6(5.6 mL)to pGS 7(8.1 mL)and pGS>7(14.8 mL).The median preoperative levels of PSA were also increasing from pGS 6(5.9 μg/L)to pGS 7(6.2 μg/L)and pGS>7(7.7 μg/L).There was a significant and positive correlation of TV to PSA,TT and Pt.Multiple linear regression analysis showed that TV was significantly and independently predicted by TT,PSA and Pt.High grade PCa(pGS>7)independently associated with TV,TT,Pt and SVI.The median density values of TT relative to TV(quotient TT/TV)significantly decreased from pGS 6(2.6 nmol/L/mL)to pGS 7(1.9 nmol/L/mL)and pGS>7(1.4 nmol/L/mL).The median density values of PSA relative to TV(quotient PSA/TV)also significantly decreased from pGS(1.1 μg/L/mL)to pGS 7(0.7 μg/L/mL)and pGS>7(0.6 μg/L/mL).Conclusion:The investigation shows that TT relates to volume and grade of PCa;moreover,the density of TT relative to TV inversely associates with rate of increase of cancer that depends on the grade of the tumour. | Antonio B.Porcaro Aldo Petrozziello Matteo Brunelli Filippo Migliorini Giovanni Cacciamani Davide De Marchia Nicolo’de Luyk Irene Tamanini Beatrice Caruso Maria A.Cerruto Claudio Ghimenton Walter Artibani | 2016 | Asian Journal of Urology2016，3，1： | 0 |
| 5 | Treatment with neurohormonal inhibitors and prognostic outcome in pulmonary arterial hypertension with risk factors for left heart disease显示文摘BACKGROUND Despite major advances in pharmacologic treatment,patients with pulmonary arterial hypertension(PAH)still have a considerably reduced life expectancy.In this context,chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH,thus providing novel insights on the role of neurohormonal blockade as a potential therapeutic target.AIM To evaluate the application and prognostic effect of neurohormonal inhibitors(NEUi)in a single-center sample of patients with idiopathic PAH and risk factors for left heart disease.METHODS We analyzed data retrospectively collected from our register of right heart catheterizations performed consecutively from January 1,2005 to October 31,2018.Patients on beta-blocker,angiotensin-converting enzyme inhibitor,angiotensin receptor blocker or mineralocorticoid receptor antagonist at the time of right heart catheterization were classified as NEUi users and compared to NEUi nonrecipients.RESULTS Complete data were available for 57 PAH subjects:27 of those(47.4%)were taking at least one NEUi at the time of right heart catheterization and were compared with the remaining 36 NEUi non-recipients.NEUi users were older and had a higher cardiovascular risk profile compared to non-recipients.Additionally,NEUi non-users had a higher probability of dying during the course of follow-up than NEUi recipients(56.7%vs 25.9%,log-rank P=0.020).CONCLUSION The above data highlighted a subgroup of patients with PAH and comorbidities for left heart disease in which NEUi use has shown to be associated with improved survival.Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population. | Riccardo Scagliola Claudio Brunelli Manrico Balbi | 2022 | World Journal of Critical Care Medicine2022，11，2： | 0 |
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