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1
Lee, Chi-hang y 李志恆. "Microvascular obstruction following percutaneous coronary interventionfor coronary artery disease". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43278723.
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Bose, Jolly. "Percutaneous transluminal coronary angioplasty (PTCA) in the treatment of coronary artery disease in Hong Kong : procedural success, complications and long-term follow-up /". Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2084282X.
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Waterhouse, Anna. "Bioengineering a coronary stent with covalently immobilised tropoelastin". Thesis, The University of Sydney, 2011. https://hdl.handle.net/2123/28916.
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This thesis describes the characterisation and development of covalently immobilised recombinant human tropoelastin (TE) on a plasma-activated coating (PAC) as a potential stent coating for the treatment of coronary artery disease. A biomimetic approach was used to create a biocompatible coating with an immobilised human protein to enhance biointegration of an implanted stent. A coating that enhanced endothelialisation while displaying low tbrombogenicity was developed and characterised in vitro and in vivo.
Covalent binding of TE to PAC was verified using ELISA and radiolabelled TE. Modulating the gas composition of the PAC, and therefore its mechanical and biological properties, resulted in varying amounts of covalently bound TE. The nitrogen containing PA Cs covalently bound up to 89± 1 % of physisorbed TE. The N2/Ar PAC covalently bound a monolayer of TE and was chosen for further characterisation. The covalent binding capacity of PAC extended for at least a year, retaining 65±1 % of its covalent TE binding capacity. Restoration of the full covalent binding capacity was achieved upon heat treatment of the PAC.
TE was shown to support the attachment and proliferation of endothelial cells (ECs) when physisorbed to tissue culture plastic (TCP). This was comparable to other adhesive extracellular matrix proteins, fibronectin and collagen. The morphology and distribution of ECs cultured on 316L SS, PAC and PAC+TE was investigated using reflective, fluorescence and scanning electron microscopy. PAC+TE supported increased endothelial attachment and proliferation compared to uncoated 3 l 6L SS and PAC. An EC phenotype was confirmed on 316L SS, PAC and PAC+TE by immunofluorescent labelling of endothelial cell specific markers, CD3 I and vWF.
As the thrombogenicity of blood contacting medical devices is crucial, methodology was developed to test the haemocompatibility of metallic surfaces in vitro. In static adhesion assays using whole heparinised blood, PAC was found to confer low thrombogenicity compared to 3 l 6L SS, and nitrogen again modulated this property. PAC and PAC+TE showed lower thrombogenicity than 316L SS after 60 min incubation. A modified Chandler loop was developed to test the tbrombogenicity of metallic surfaces in the presence of flowing blood. PAC and PAC+TE were again found to display low thrombogenicity, resulting in a 3-fold increase in the time to thrombus formation compared to 3 I 6L SS. This effect correlated with a 65±1 % increase in soluble P-selectin, a platelet activation marker on 3 l 6L SS. No significant platelet activation occurred on PAC or PAC+TE. The low thrombogenicity of PAC was retained for between 3 and 7 months. Furthermore, TE coated 3 I 6L SS displayed lower thrombogenicity than uncoated 316L SS, or fibronectin-or collagen-coated 316L SS.
The PAC was translated to a 316L SS laser cut stent for evaluation and in vivo testing. The PAC deposition was altered to coat all surfaces and resisted delamination. In vitro crimping and expansion of the PAC stent showed only the formation of nanocracks, compared to the large scale delamination observed on a commercially available Taxus Liberte stent. The covalent TE binding capacity and non-thrombogenicity of the PAC were maintained on the stent PAC.
The endothelialisation of PAC and PAC+TE stents was evaluated in vivo. This study marks the first comparator analysis of bare metal stents (BMS), PAC and PAC+ TE stents in a well-characterised model of rabbit bilateral iliac stenting. PAC and PAC+ TE stents were well tolerated and showed no gross inflammatory response. Cell coverage of stent struts occurred by 7 days post-implantation with endotheJialisation occurring both between the struts and over the struts in all samples. PAC and PAC+ TE showed no difference in the rate of endothelialisation compared to BMS, the standard corrunerciaJly available stents.
In further work, covalently immobilised TE was found to be susceptible to proteolytic cleavage by the common blood plasma proteases kallikrein and thrombin, which predominantly cleave TE at its arginine 515 residue. A mutant form of TE, R5 I 5A was shown to resist proteolytic cleavage at the 515 residue and thus retained the C-terminus of the protein which is required for cell attachment. This mutant form of TE retained the equivalent level of covalent binding to PAC and would therefore be a suitable candidate for application to a PAC stent for in vivo evaluation.
4
Kärner, Anita. "Patients' and spouses' perspectives on coronary heart disease and its treatment /". Linköping : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5264.
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Kärner, Anita. "Patients’ and Spouses’ Perspectives on Coronary Heart Disease and its Treatment". Doctoral thesis, Linköpings universitet, Hälsa, Aktivitet, Vård (HAV), 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5264.
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Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment. Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework. Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent. Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes. Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes.On the day of the public defence of the doctoral thesis the status of article V was Submitted.
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Baird, Simon Herbert. "Progress in diagnosis and treatment of acute coronary syndromes". Thesis, Queen's University Belfast, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326416.
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Ko, Weng-wah Wendy. "Morphine treatment and acute myocardial ischaemia in rats /". [Hong Kong] : University of Hong Kong, 1988. http://sunzi.lib.hku.hk/hkuto/record.jsp?B12358745.
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Dall'Armellina, Erica. "Applications of 3T CMR in acute coronary syndromes (ACS)". Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589619.
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Introduction There is a pressing clinical need to treat patients with acute coronary syndrome (ACS) timely and efficiently in order to improve their prognosis. Standard tools available in ED, while useful, do not comprehensively characterize ACS for either diagnosis or risk stratification. The role of CMR in ACS is emerging because it allows assessment of both myocardial composition and function. Newer CMR techniques such as: a) T2 W imaging for assessing myocardial oedema and area at risk B) pre contrast T1 mapping techniques for quantitative characterization of the tissue composition, are adding further utility for CMR in ACS. At present the clinical use of these techniques is still limited and further investigations are needed to assess their clinical applicability in ACS patients. Aims The aims of this thesis were several. Firstly we sought to establish a CMR protocol for imaging ACS patients on a 3T CMR scanner. In order to do so, we validated a novel T2 W technique for oedema imaging (T2 prep SSFP) at 3T. Second, we aimed to perform a detailed study of the time course of oedema in ACS patients in order to establish the appropriate imaging time for the assessment of area at risk. Third, by applying T2W acute oedema imaging, we sought to investigate the functional and pathological meaning of complicated remote plaques in patients with multivessel disease. Finally, we aimed to establish whether, in comparison to standard CMR techniques, novel precontrast Tl mapping allows better characterisation of the acutely injured myocardium and whether it can predict long-term functional recovery. Methods The research studies were all performed on a 3T Trio Siemens scanner. In the initial stage of the research, we validated the T2 W technique performing phantom work and scanning both volunteers and patients to assess the uniformity of signal intensity in the myocardium and to establish a threshold based method to post process the images. We then established a CMR protocol for ACS including oedema imaging, T1 mapping imaging, perfusion, functional and late gadolinium enhancement imaging. Patients with acute myocardial infarction (both ST elevation myocardial infarction (STEMI) and non STEMI) were scanned at 4 different time points after the acute event (3 scans within 2 weeks and one at 6 months). All STEMI patients underwent primary percutaneous coronary intervention (PCI) while the non-STEMI patients underwent coronary angiography and for PCI. Results We validated the T2prep SSFP technique at 3T, highlighting its limitations and establishing a threshold of mean ± 2SD to assess myocardial oedema. We found that the optimal imaging window to assess the maximal expression of myocardial oedema was within 1 week from the acute event in patients with ST elevation MI. Also, our results showed a reduction of LGE over time (from acute to chronic) in segments which also showed improvement in contractile function indicating that even segments with transmural LGE assessed in the early hours post event could be viable. By applying these techniques in acute patients with bystander disease undergoing percutaneous coronary intervention, we found that: l) T2W imaging can detect myocardial injury downstream from a vessel identified as "non culprit" 2) in 20% of NSTEMI patients, the angiographic assessment alone failed to identify the culprit vessel. Finally, we found that the diagnostic performance of acute pre-contrast Tl-mapping was at least as good as that ofT2W CMR for detecting myocardial injury. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental Tl values and the likelihood of improvement of segmental function at 6 months decreased progressively as acute Tl values increased. Conclusions In summary, we defined a stable imaging window for the retrospective evaluation of area at risk and we also indicated that acutely detected LGE does not necessarily equate with irreversible injury and may severely underestimate salvaged myocardium. Furthermore, in NSTEMI patients with multivessel disease, by revealing acute myocardial damage in territories pertaining to vessels not treated acutely, we raised the issue of the need for better tools for the correct identification of the culprit vessel and to stratify patients rather than by angiographic assessment alone. Finally, we demonstrated how pre-contrast Tl mapping allows for assessment of the extent of myocardial damage and how Tl mapping might become an important complementary technique to LGE and T2W for the identification of reversible myocardial injury and the prediction of functional recovery in acute MI.
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Lalonde, Lyne. "Health-related quality of life measures in coronary heart disease prevention and treatment". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/NQ44484.pdf.
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Lincoln, White Simon Jonathan. "Cardiac rehabilitation patients' perspectives on coronary heart disease and treatment : a qualitative study". Thesis, University of Nottingham, 2008. http://eprints.nottingham.ac.uk/10608/.
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UK hospital-based Cardiac Rehabilitation (CR) programmes offer eligible Coronary Heart Disease (CHD) patients information on various issues including lifestyle modification and medicines. However, CR patients' perspectives on medicine-taking and lifestyle modification in relation to their perspectives on their risk of experiencing further CHD-related events remains under-researched. This study explored these topics. Following ethical approval, a qualitative approach was taken that drew on the broad principles of grounded theory. In-depth, audiotaped interviews were conducted with sixteen CR patients approximately three months after hospital discharge. Second interviews explored whether heart attack CR patients' perspectives on risk, medicines and lifestyle modification had changed when interviewed again approximately nine months later. The perspectives of a group of CR patients who had not had a heart attack were explored for comparison. Findings suggested that CR patients made sophisticated yet uncertain assessments of their risk. This did not just involve identifying lifestyle factors needing change or attributing the likelihood of experiencing further CHD-related events to chance or heredity alone; patients tended to also consider information about heart damage or current heart function. Heart attack patients commonly feared recurrence, which appeared to heighten short-term perceptions of risk but longer-term perspectives on risk appeared similar to CR patients who had not had a heart attack. CR patients tended to only maintain changes to aspects of lifestyle perceived as causes, rather than viewing lifestyle recommendations as standards to achieve. Some heart attack patients initially changed aspects of lifestyle they did not cite as a cause, which seemed to be associated with heightened risk perceptions, since these changes tended not to be maintained. CR patients reported continuing to take heart-related medicines and viewed them as important to reduce their risk, despite disquiet about medicines causing harm being common. These findings have implications for health professionals' practice and CR programme improvement.
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Lockyer, Lesley Josephine. "The experience of women in the diagnosis and treatment of coronary heart disease". Thesis, Royal Holloway, University of London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343845.
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Bose, Jolly. "Percutaneous transluminal coronary angioplasty (PTCA) in the treatmentof coronary artery disease in Hong Kong: procedural success, complications and long-term follow-up". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31220307.
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盧雅聰. "針灸治療冠心病心絞痛的臨床文獻研究". HKBU Institutional Repository, 2011. https://repository.hkbu.edu.hk/etd_ra/1308.
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Stanton, Susan Baucom Donald H. "Social support and dietary changes in a couples-based treatment for coronary heart disease". Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,744.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Dec. 18, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Psychology." Discipline: Psychology; Department/School: Psychology.
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Fernandez, Ritin. "Development and evaluation of a health-related lifestyle self-management intervention for patients with acute coronary syndrome". Thesis, View thesis, 2007. http://handle.uws.edu.au:8081/1959.7/32587.
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Acute coronary syndrome (ACS), the acute manifestation of coronary heart disease (CHD), is the leading cardiovascular cause of mortality and morbidity globally, and represents one of the most common causes of acute medical admissions to Australian hospitals. Following medical and/or surgical management of ACS, lifestyle modification to reduce the underlying risk factors that contribute to the progression of the disease remains vital. Cardiac rehabilitation (CR) has been widely accepted as an intervention that can reduce mortality and modify risk factors for subsequent coronary events and cardiovascular disease. While the benefits of cardiac rehabilitation programs have been demonstrated, participation and adherence to these programs remain low for various reasons, particularly among patients whose treatment includes revascularisation with percutaneous coronary intervention. This method of revascularisation has become increasingly common due its immediate success, rapid procedural technique, short hospital stay and early return to work for patients of working age. The aim of this study was to develop and test the feasibility of an evidence-based health-related lifestyle management program for risk factor modification in patients with ACS undergoing percutaneous coronary intervention. Four distinct yet interrelated studies were undertaken as part of the Development and evaluation of a Health-related Lifestyle self-Management (HeLM) intervention for patients with ACS Project. Three of these studies informed the development of the HeLM intervention, which was based on the principles of chronic disease self-management and evidence-based practice that included best evidence from the literature, clinical expertise and patient preferences. The first study was a systematic review of the literature to identify the best available evidence of the effect of brief interventions for lifestyle modification in patients with CHD. Findings from the 17 trials included in the systematic review, although inconclusive suggest that brief structured interventions can have beneficial effects on risk factor modification and consequently on progression of CHD.
The second study was a qualitative interview of CR coordinators to identify from their clinical expertise the influence of the Reducing Risk in Heart Disease guidelines on practice: the Implementation of the Cardiac Evidence-Based Reducing Risk in Heart Disease Guidelines (ICEBRG) study. Findings from this study indicated limited implementation of the guidelines due to various barriers relating to health services, CR programs, professional practice and the patient and their families. Despite these barriers, it was evident that CR coordinators were striving to overcome these odds and provide evidence-based care. The third study undertaken to identify patient preferences for CR was the Follow-up After percutaneous Coronary Treatment (FACT) Study. The findings indicated that although the majority of the participants had two or more risk factors, they lacked knowledge of the link between risk factors and CHD, and less than a third had attended CR. The main reasons for nonattendance included timing, distance to travel, length of program, work commitments and lack of motivation to attend the programs. Their suggestions for improvement included telephone follow-up and flexibility of the CR programs. This study also informed the development of a tool that can be used by clinicians to flag patients who are unlikely to attend traditional CR. Identification of these people will allow alternate strategies to reduce risk factors to be tailored to their needs. The findings from these three studies were used to develop the HeLM intervention. The final study was undertaken to assess the feasibility of the HeLM intervention that was based on evidence compared to standard treatment for promoting lifestyle modification. This study was undertaken in 51 participants who were followed up two weeks following the completion of the intervention. The findings demonstrated that patients found the information beneficial and were pleased to receive it in their homes. The telephone support was also extremely well received. The study enabled the program and the process for implementation to be refined and indicated that a large multicentre trial would be feasible.
The HeLM may be a strategy that could reach patients who have thus far eluded traditional CR programs and support them to make the necessary lifestyle changes. It may also be an adjunct to traditional CR and have a synergistic effect in facilitating health-promoting behaviours in CHD patients. Studies of interventions for risk factor modification in participants with CHD require longer term follow-up to assess the effect of the intervention in the sustainability of behaviour modification. Further research is necessary to evaluate the long-term effects as well as the cost effectiveness of the intervention.
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Fong, Ho-fai Daniel y 方晧暉. "Platelet function test and bleeding risk in patients with coronary artery disease : a case-control study". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193754.
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Background
Management of coronary heart disease remains a challenge even with modern advances. New anti-platelet agents which reduce thromboembolic events in patients with coronary heart disease were introduced. However, there are concerns about an increased in bleeding risk for patients taking these new anti-platelet agents. Platelet function test, such as VerifyNow, claimed to be able to predict bleeding risk. However, the evidence was limited, especially among the Asian population. This study aimed to evaluate the use of VerifyNow to assess bleeding risk. Subjects with low residual platelet reactivity, i.e. low PRU value, were hypothesized to have an increased bleeding risk.
Methods
This was a case control study performed in the Princess Margaret Hospital of Hong Kong. A total of 120 subjects who were taking a P2Y12 inhibitor and had a VerifyNow test were recruited. The cases were defined as subjects with a PRU value of less than or equal to 95, a threshold for increased bleeding risk as recommended by Western studies. The controls were age matched to the cases. The primary outcome was the increase in bleeding risk associated with a low PRU value at 30 days. The secondary outcome was the increase in bleeding risk associated with a low PRU value at 1 year. The use of the percentage of platelet inhibition was also evaluated as a secondary outcome. Multivariable logistic regression was used to obtain the odds ratio of the low PRU group.
Results
Bleeding events occurred more frequently in the low PRU group. At 30 days, 31.7% of subjects among the case had a bleeding event while 43.3% of the cases had a bleeding event at 1 year. The majority of these bleeding events were minor bleeding, such as easy bruising. After adjusting for confounders, there was no statistically significant increase in bleeding risk among those in the low PRU group at 30 days or 1 year. Subjects with a high percentage of platelet inhibition (>50%) was also not associated with a statistically significant increase in bleeding risk.
Conclusion
A low PRU value was not associated with an increased bleeding risk at 30 days. Thus the VerifyNow test was not shown to be useful in assessing the bleeding risk of patients in an Asian population, contrary to the findings from Western literature. A possible explanation was that the VerifyNow threshold for predicting bleeding might be higher among the Asian population. The definition for low residual platelet reactivity might be different in our locality. A larger sample size might also be needed. Further studies are needed to evaluate whether a different cut off is more optimal for the Asian population.published_or_final_version
Public Health
Master
Master of Public Health
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Yi, Xiaoqin. "Total ginsenosides of Asian ginseng increase coronary artery perfusion flow of the ischemia-reperfusion injury rat heart in Langendorff system through activation of Akt-eNOS signaling and cardiac energy-associate protein expression". HKBU Institutional Repository, 2010. http://repository.hkbu.edu.hk/etd_ra/1195.
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高榮華 y Weng-wah Wendy Ko. "Morphine treatment and acute myocardial ischaemia in rats". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1988. http://hub.hku.hk/bib/B31231172.
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Veroni, Margherita. "The use of pharmacotherapies in the secondary prevention of coronary heart disease". University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0029.
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[Truncated abstract] Background: This thesis examines pharmacotherapy use in the secondary prevention of coronary heart disease. It includes antiplatelet agents, beta-blockers, statins and ACE inhibitors, all shown in landmark clinical trials and meta-analyses to reduce the risk of cardiac events in patients with known coronary disease. Underuse of effective preventive therapies represents a lost opportunity to reduce mortality and morbidity. Overseas studies have shown significant underuse of effective therapies at the time of hospital discharge following an acute event and later in ambulatory care. Australian data on prescribing practices following an acute coronary event and, ongoing use in ambulatory care are sparse. Aims: The aim of this thesis was to quantify the prescription of known effective therapies at the time of hospital discharge following an acute coronary event and ongoing use in ambulatory care. A secondary aim was to identify barriers to optimal secondary prevention thus providing an evidential basis to recommend change. Methods: This was an observational study of a cohort of post-MI patients admitted to a tertiary and affiliate hospital in Perth, Western Australia. The continuum of care from the treatment plan at discharge through to the treatment regimen and risk factor management 12 months post-MI was examined. The intermediate step, communication about the treatment plan with the patient and the primary health care provider was also examined. The study involved a review of hospital medical records and follow-up questionnaires to patients and their general practitioners at 3 and 12 months post-MI. All post-myocardial patients were included in the analysis of prescriptions at discharge. The follow-up study included patients 80 years and younger with no terminal conditions. Patient interviews at 3 months and interviews and focus groups with key hospital staff provided qualitative data to inform the quantitative data.
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Dholakia, Ronak Jashwant. "Numerical modeling of Hemodynamics in the thoracic aorta and alterations by Dacron patch treatment of Aortic Coarctation". [Milwaukee, Wis.] : e-Publications@Marquette, 2009. http://epublications.marquette.edu/theses_open/9.
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黃一偉 y Yat-wai Patrick Wong. "Review on the effect of Salviae Miltiorrhizae Bunge (Danshen) in the management of coronary heart diseases". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31969860.
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Rosell, Johan. "Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer". Doctoral thesis, Linköpings universitet, Avdelningen för kliniska vetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-112085.
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The aims of this thesis were to investigate the long-term effects of adjuvant tamoxifen treatment on breast cancer recurrence and mortality, cardiovascular disease, and the incidence of secondary cancer. Between 1982 and 1992, postmenopausal patients with early stage breast cancer were included in a randomized clinical study of 2 or 5 years of postoperative tamoxifen therapy. The trial was planned by the Swedish Breast Cancer Group, and it included 4610 patients. Follow-up on causes of death, hospitalizations and secondary cancers were obtained from national population-based registries. All-cause mortality, breast cancer-specific mortality and mortality from coronary heart disease were decreased in the 5-year group, but the incidence of endometrial cancer was increased (Paper I). The incidence and mortality of cerebrovascular diseases were increased during the active treatment phase, and reduced after the active treatment (Paper II). Similar results were seen for subgroups of cerebrovascular diseases such as stroke and ischemic stroke. In the 5-year group, the morbidity from coronary heart disease was reduced during treatment but not after treatment was stopped (Paper III). This was the case also for heart failure and for atrial fibrillation/flutter. For secondary cancers the lung cancer risk was reduced, as well as the lung cancer mortality (Paper IV). An increased risk was observed for endometrial cancer, but appeared to decrease over time. The risk of contralateral breast cancer was reduced, with most of the reduction after treatment was stopped. For distance recurrences the risk was reduced both during treatment and a few years after treatment was stopped. The breast cancer mortality was also reduced, especially during the post-treatment phase.
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Mannan, Haider Rashid. "Development and use of a Monte Carlo-Markov cycle tree model for coronary heart disease incidence-mortality and health service usage with explicit recognition of coronary artery revascularization procedures (CARPs)". University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0101.
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[Truncated abstract] The main objective of this study was to develop and validate a demographic/epidemiologic Markov model for population modelling/forecasting of CARPs as well as CHD deaths and incidence in Western Australia using population, linked hospital morbidity and mortality data for WA over the period 1980 to 2000. A key feature of the model was the ability to count events as individuals moved from one state to another and an important aspect of model development and implementation was the method for estimation of model transition probabilities from available population data. The model was validated through comparison of model predictions with actual event numbers and through demonstration of its use in producing forecasts under standard extrapolation methods for transition probabilities as well as improving the forecasts by taking into account various possible changes to the management of CHD via surgical treatment changes. The final major objective was to demonstrate the use of model for performing sensitivity analysis of some scenarios. In particular, to explore the possible impact on future numbers of CARPs due to improvements in surgical procedures, particularly the introduction of drug eluting stents, and to explore the possible impact of change in trend of CHD incidence as might be caused by the obesity epidemic. ... When the effectiveness of PCI due to introduction of DES was increased by reducing Pr(CABG given PCI) and Pr(a repeat PCI), there was a small decline in the requirements for PCIs and the effect seemed to have a lag. Finally, in addition to these changes when other changes were incorporated which captured that a PCI was used more than a CABG due to a change in health policy after the introduction of DES, there was a small increase in the requirements for PCIs with a lag in the effect. Four incidence scenarios were developed for assessing the effect of change in secular trends of CHD incidence as might be caused by the obesity epidemic in such a way that they gradually represented an increasing effect of obesity epidemic (assuming that other risk factors changed favourably) on CHD incidence. The strategy adopted for developing the scenarios was that based on past trends the most dominant component of CHD incidence was first gradually altered and finally the remaining components were altered. iv The results showed that if the most dominant component of CHD incidence, eg, Pr(CHD - no history of CHD) levelled off and the trends in all other transition probabilities continued into future, then the projected numbers of CABGs and PCIs for 2001-2005 were insensitive to these changes. Even increasing this probability by as much as 20 percent did not alter the results much. These results implied that the short-term effect on projected numbers of CARPs caused by an increase in the most dominant component of CHD incidence, possibly due to an ?obesity epidemic, is small. In the final incidence scenario, two of the remaining CHD incidence components-Pr(CABG - no history of CHD) and Pr(CHD death - no CHD and no history of CHD) were projected to level off over 2001-2005 because these probabilities were declining over the baseline period of 1998-2000. The projected numbers of CABGs were more sensitive (compared to the previous scenarios) to these changes but PCIs were not.
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Lam, Lap-fung y 林立峰. "Flow cytometric analysis of intra-platelet VASP for evaluation of clopidogrel resistance in ischemic heart disease patients undergoingpercutaneous coronary intervention". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48421200.
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Ischemic heart disease (IHD) is the most common cause of death around the world. The underlying cause of IHD is myocardial ischemia as a result of progressive narrowing of coronary arteries due to atherosclerosis with potential thrombotic complications mediated by platelets. In addition to the role in hemostasis, platelets are increasingly recognized as an important mediator in this atherothrombotic disease. Basic management of IHD lies on medical therapy and coronary revascularization procedures. Percutaneous coronary intervention (PCI) is a commonly used revascularization procedure in the treatment of IHD especially for relief and reduction of symptoms. On the other hand, antiplatelet therapy is often administrated to patients undergoing PCI in an attempt to prevent major adverse cardiac events (MACE) following the procedures. However not all patients respond to the same degree of the antiplatelet therapy and some still develop MACE or stent thrombosis in the presence of the treatment with antiplatelet drugs.
Recently a flow cytometric-based assay has been developed to monitor the effect of the antiplatelet drug, particularly the P2Y12 receptor antagonist, in patients treated with this kind of drug. This assay measures the activity of platelets as platelet reactivity index (PRI) based on the phosphorylation state of an intracellular platelet protein called vasodilator stimulated phosphoprotein (VASP). The measured value of PRI is inversely related to the response of patient to the antiplatelet drug.
In this study, the response of patients to the P2Y12 receptor antagonist Clopidogrel was investigated following PCI. The PRI of patients was found to be significantly lower than normal subjects without taking this drug, indicating the therapeutic effect of this drug on the patients. However nearly one-third of patients (17 out of 59) studied were found to be non-responsive to clopidogrel treatment based on a cut-off established in this study for classifying patients into responders or non-responders. Furthermore, significant difference between the two types of stents used in PCI procedure, namely bare metal stent (BMS) and drug eluting stent (DES), was observed in the study. Patients receiving DES had nearly three times higher percentage of being non-responsive to clopidogrel than the BMS counterpart (45% vs. 16%, p<0.028). This study provides evidence that DES may be implicated in the non-responsiveness or drug resistance of clopidogrel in patient undergoing PCI.published_or_final_version
Pathology
Master
Master of Medical Sciences
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Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche y Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106354.
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Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany.
Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications.
Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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Pischke, Claudia Ruth [Verfasser]. "The role of comprehensive lifestyle changes in the prevention and treatment of coronary heart disease / Claudia Ruth Pischke". Berlin : Freie Universität Berlin, 2008. http://d-nb.info/1023233622/34.
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Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche y Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany". Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26666.
Texto completoResumen
Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany.
Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications.
Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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Ho, Sheau-Yan. "The impact of depression on treatment adherence and cardiorespiratory fitness in cardiac rehabilitation". ScholarWorks @ UVM, 2017. http://scholarworks.uvm.edu/graddis/789.
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Major depression and coronary heart disease are two strongly linked, major causes of death and disability. After an acute coronary event, many patients are referred to cardiac rehabilitation (CR), a medically supervised exercise intervention and lifestyle training program. Depression may partially account for poor CR adherence and resulting cardiovascular problems in patients with a history of heart disease; however, underlying mechanisms through which depression impacts cardiac functioning are not well understood. The current project tests a theoretical model in which CR adherence (i.e., number of CR sessions attended) mediates the relation between baseline depression and cardiorespiratory fitness after CR. A community sample of 858 older adults initiating CR after hospitalization for a coronary event completed a symptom-limited exercise stress test before and after the 12-week program. Cardiorespiratory fitness was measured via VO2max, peak MET, and total duration of the stress test. Depression was measured at baseline using the Patient Health Questionnaire Depression Scale. CR adherence did not mediate the relation between baseline depression scores and fitness outcomes. Path analyses revealed that higher baseline depression severity predicted lower likelihood of CR completion (i.e., completion of all 36 sessions, or fewer if limited by insurance or terminated early for good prognosis) in the full sample. Higher levels of depression predicted poorer CR adherence in a subsample of 74 patients with moderate to severe depression. These findings lend support to depression as a predictor of treatment nonadherence in CR. Screening for depression in the context of coronary heart disease and implementing evidence-based depression interventions in secondary prevention settings can help alleviate a massive public health burden.
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Dhar, Lipi. "Perceptions of global coronary heart disease risk, and adherence to antihypertensive treatment among low income urban women in Delhi, India". Thesis, Curtin University, 2016. http://hdl.handle.net/20.500.11937/728.
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This study examined perceived coronary heart disease (CHD) risks and adherence to antihypertensive treatment among women in a low-income area in Delhi, India. A mixed-methods design comprising a structured survey and semi-structured interviews was used. Among findings, most participants inaccurately perceived their CHD risks, with poor adherence to antihypertensive treatment. The findings can help inform the design of interventions to improve women’s accuracy of their perceived CHD risk and medication adherence to prevent CHD.
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Sousa, Flávia de Oliveira. "Prevalência de Periodontite Apical em pacientes com Diabetes Mellitus e Doenças Cardiovasculares". Master's thesis, [s.n.], 2014. http://hdl.handle.net/10284/4359.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaA Periodontite Apical é uma resposta inflamatória aguda ou crónica, desencadeada por uma infeção bacteriana, que atinge o tecido pulpar do dente. O diagnóstico desta patologia é feito através do exame clínico e podem ser necessários meios auxiliares de diagnóstico. O Tratamento Endodôntico Não Cirúrgico tem como objetivo o restabelecimento dos tecidos periapicais mantendo a integridade do dente. A Diabetes Mellitus é uma patologia metabólica que se carateriza por um estado de hiperglicemia devido a defeitos na produção de insulina ou na sua ação. Sistema imunitário comprometido e atraso na cicatrização são aspetos importantes a considerar. Vários estudos indicam o aumento da prevalência de lesões periapicais em pacientes diabéticos e uma diminuição do sucesso do Tratamento Endodôntico Não Cirúrgico, nestes pacientes. A Periodontite Apical pode também levar ao descontrolo glicémico, podendo descompensar um quadro de Diabetes Mellitus controlada. A Hipertensão Arterial é uma patologia crónica em que os níveis de pressão sanguínea são elevados. Esta patologia é o principal fator de risco para o desenvolvimento de doenças cardiovasculares. Nem toda a população está consciente do seu estado de saúde arterial. Alguns estudos determinaram uma associação relativa entre pacientes hipertensos e a presença de Periodontite Apical. A Doença Cardíaca Coronária é uma patologia desencadeada pela aterosclerose, e com a posterior consequência de redução do fluxo sanguíneo. A obesidade é o principal fator de risco para desenvolver aterosclerose. Vários estudos demonstraram uma associação significativa entre a Doença Cardíaca Coronária e a presença de Periodontite Apical. Esta monografia teve como objetivo realizar uma revisão narrativa tendo por base vários estudos que tiveram como propósito estudar a prevalência de Periodontite Apical em pacientes com Diabetes Mellitus e Doenças Cardiovasculares. Foi realizada uma pesquisa bibliográfica entre Janeiro a Maio de 2014 com as seguintes palavras-chave: Diabetes Mellitus; Coronary Heart Disease; Hypertension; Apical Periodontitis; Root Canal Treatment e selecionou-se os artigos científicos que estavam em concordância com o tema. Concluiu-se que, a partir da pesquisa efetuada, tanto a Diabetes Mellitus como a Doença Cardíaca Coronária apresentaram uma associação significativa com a Periodontite Apical. Já a Hipertensão Arterial não mostrou ter associação significativa com o desenvolvimento de Periodontite Apical. Apical Periodontitis is an inflammatory response acute or chronic, developed by an infection caused by bacteria, which attack teeth’s pulp tissue. The diagnosis for this pathology is made through a clinical exam and there might necessary auxiliary means of diagnosis. The main aim of Nonsurgical Endodontic Treatment is to restablish the periapical tissues keeping the teeth’s integrity. Diabetes Mellitus is a metabolic pathology that is characterized by a hyperglycemic state due to defects on insulin production and on its action. A compromised immune system and delayed healing are important aspects to consider. Several studies indicate a raise in the prevalence of periapical lesions on diabetic patients and a decrease of the Nonsurgical Endodontic Treatment’s success, in these patients. Apical Periodontitis may also lead to uncontrolled glycemic and may decompensate a framework of controlled Diabetes Mellitus. Arterial Hypertension is a chronic pathology which the levels of blood pressure are high. This pathology is the main responsible for developing cardiovascular diseases. Not everyone is aware of their health’s condition. Some studies have determined a link between hypertensive patients and Apical Periodontitis. The Coronary Heart Disease is a pathology unchained by atherosclerosis, and a consequent reduction in the blood flux. Obesity is the main risk factor to develop atherosclerosis. Several studies have shown a link between Coronary Heart Disease and the occurrence of Apical Periodontitis. This monograph had main aim a narrative review based on several studies which had aim to study the prevalence of Apical Periodontitis in patients with Diabetes Mellitus and Cardiovascular Diseases. Was performed a literature search from January to May 2014 with the following keywords: Diabetes Mellitus; Coronary Heart Disease; Hypertension; Apical Periodontitis; Root Canal Treatment and was selected scientific articles which were in agreement with the topic. It was concluded, from the research, which Diabetes Mellitus and Coronary Heart Disease showed a significant association with Apical Periodontitis. Arterial Hypertension showed no significant association with the development of Apical Periodontitis.
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Conradie, Suzanne Louise. "The role of calcium and calcium antagonists in the reperfusion injury of the heart". Thesis, Stellenbosch : Stellenbosch University, 2005. http://hdl.handle.net/10019.1/50518.
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Thesis (PhD)--Stellenbosch University, 2005.ENGLISH ABSTRACT: The reperfusion injury after myocardial ischemia is relevant in the clinical setting, after cardiopulmonary bypass for cardiac surgery, after PTCA and stenting and after cardiopulmonary resuscitation. The components of the reperfusion injury considered in this study were myocardial stunning and reperfusion arrhythmias. Calcium antagonists have been shown to be beneficial in attenuating the myocardial reperfusion injury in the in vitro and in vivo laboratory setting (Lamping, Gross 1985, Przyklenk and Kloner 1988, Taylor 1990, Ehring 1992, Gross and Piper 1992). However systemic administration of a dose of calcium antagonist, large enough to attenuate the myocardial reperfusion injury in the clinical setting, would inevitably lead to unwanted systemic side effects of the drug. The aim of this study was to investigate the hypothesis that an adequate dose of verapamil administered timeously, directly into the ischemic myocardium, would attenuate the reperfusion injury, either when administered from the onset of ischemia, or from 3 minutes before reperfusion. The anesthetized open chest porcine model of myocardial ischemia (15 min total LAD occlusion) and reperfusion was employed in this study. A low dose of verapamil (0.5 mg/8mt or 0.0625mg/mt), a high dose of verapamil (2mg/8m or O.25mg/ml), or vehicle (saline) (8ml) was infused over 8 minutes, directly into the LAD coronary artery supplying the ischemic segment. The infusion was started either at the onset of ischemia, or from 3 minutes before reperfusion. The time taken for the various parameters to return to pre ischemic values was compared between the different groups. The results showed that the high dose of verapamil (2mg) attenuated the reperfusion injury both when administered from the onset of ischemia, and when administered from 3 minutes before reperfusion, compared to either the low dose of verapamil, or the saline infusions. The high dose of verapamil groups had a faster recovery of both systolic contractile function and diastolic function and a lower incidence of ventricular fibrillation on reperfusion. There were no systemic effects of verapamil infusion in any of the groups. The clinical setting of cardiac surgery expressly lends itself to the clinical application of this finding. There is direct access to the coronary arteries both before ischemia and before reperfusion. A small dose of calcium channel blocking drug, with no systemic effect can be administered into the aortic root at the onset of ischemia, just prior to cardioplegia (when the heart is still warm), and after rewarming a few minutes prior to removal of the aortic cross clamp.
AFRIKAANSE OPSOMMING: Die reperfusie besering na miokardiale isgemie is klinies relevant na kardiopulmonêre omleiding vir hart chirurgie, na kardiologiese PTKA en stut prosedures en na kardiopulmonale ressussitasie. Die komponente van die reperfusie besering wat in hierdie studie oorweeg is, is miokardiale tydelike omkeerbare onderdrukking (stunning) en reperfusie arritmieë. Kalsium antagoniste is gewys om effektief te wees in beperking van die reperfusie besering in beide in vitro en in vivo laboratorium eksperimente (Lamping, Gross 1985, Przyklenk en Kloner 1988, Taylor 1990, Ehring 1992, Gross en Piper 1992). Sistemiese toediening van 'n dosis kalsium kanaal blokker, voldoende om die miokardiale reperfusie besering in die pasiënt te beperk, lei egter tot ongewenste sistemiese newe effekte van die middel. Die doel van die studie was om die hipotese te ondersoek dat 'n voldoende dosis verapamil, wat betyds direk toegedien is aan die isgemiese miokardium, die reperfusie besering sal beperk, ongeag of dit toegedien is vanaf die begin van isgemie, of van 3 minute voor reperfusie. Die vark model van miokardiale isgemie en reperfusie is aangewend in die studie. Die varke was tydens die eksperiment onder narkose, met die borskas oop, en 15 minute totale LAD okklusie is toegepas. 'n Lae dosis verapamil (0.5mg/8ml of 0.0625 mg/mt), of hoë dosis veraparnil (2mg/8mt of 0.25mg/mt), of saline (8mt) is oor 8 minute toegedien direk in die LAD arterie wat die isgemiese segment voorsien. Die infuus is begin direk na die aanvang van isgemie, of 3 minute voor die aanvang van reperfusie. Die tyd geneem vir terugvoer van parameters na pre isgemiese waardes is tussen die groepe vergelyk. Die resultate toon dat die hoë dosis veraparnil die reperfusie besering beperk in vergelyking met die lae dosis veraparnil of saline infusies, ongeag of dit van die begin van isgemie, of van 3 minute voor reperfusie toegedien word. Die groepe wat die hoë dosis veraparnil ontvang het, het vinniger herstel van sistoliese en diastoliese funksie getoon en het'n laer insidensie van reperfusie disritmieë, gewys. Geen sistemiese effekte van veraparnail infuus is waargeneem nie. Die kliniese toepassing van hierdie bevinding is by uitstek geskik vir toepassing tydens kardiopulmonale omleiding by kardiale chirurgie. Daar is direkte toegang tot koronêre arteries voor isgemie en voor reperfusie. 'n Klein dosis kalsium antagonis, met weglaatbare sistemiese effekte, kan toegedien word in die aorta wortel met die aanvang van isgemie, net voor kardioplegie toediening (hart steeds warm), en na verwarming, 'n paar minute voor verwydering van die aorta kruis klem.
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黃卓睿 y Cheuk-yui Max Wong. "Role of k-opioid receptor in cardioprotection against stress with coldexposure and restraint or against morphine". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971283.
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Tse, Hung-fat y 謝鴻發. "Bone marrow cell transplantation for therapeutic angiogenesis in ischemic myocardium: from bench to bedside". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39557972.
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Cheng, Xi y 程曦. "Prevalence, profile, predictors, and natural history of aspirin resistance measured by the ultegra rapid platelet function assay-asain patients with coronary artery disease". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B33708708.
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Pfäffli, Daniel. "Molsidomine, a new drug for the treatment of coronary heart disease enhances PGI2 and PGE2 and inhibits thromoxane synthesis of cultured human skin fibroblasts /". [S.l : s.n.], 1985. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Dunder, Kristina. "Clinical Manifestations of Coronary Heart Disease and the Metabolic Syndrome : A Population-based Study in Middle-aged Men in Uppsala". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4280.
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Odendaal, Louise. "The effect of dietary Red Palm Oil on the functional recovery and the PKB/Akt pathway in the ischaemic/reperfused isolated rat heart". Thesis, Stellenbosch : Stellenbosch University, 2007. http://hdl.handle.net/10019.1/21745.
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Thesis (MSc)--University of Stellenbosch, 2007.ENGLISH ABSTRACT: Introduction Cardiovascular disease is one of the leading causes of death in the world. Formation of harmful reactive oxygen species (ROS) is associated with several pathological conditions, and contributes to ischaemia/reperfusion injury. Antioxidants can be added to the diet in an attempt to decrease the prevalence of cardiovascular disease by decreasing the harmful effects of ischaemia/reperfusion injury. Red Palm Oil (RPO) consists of saturated, monounsaturated and polyunsaturated fatty acids and is rich in antioxidants such as -carotene, tocopherols and tocotrienols. It has previously been shown that RPO-supplementation improved reperfusion mechanical function. In these studies it was found that RPO might exert its beneficial effects during reperfusion through increased PKB/Akt pathway activity, which may lead to inhibition of apoptosis and improved mechanical function. Aims The aims of this study were: 1) to determine whether RPO-supplementation protected against ischaemia/reperfusion injury in the isolated perfused rat heart, 2) to confirm RPO-supplementation’s effect on the PKB/Akt pathway activity and, 3) to elucidate the regulators in the PKB/Akt pathway that RPOsupplementation influenced. Methods Male Wistar rats were divided into 4 groups, 2 control groups and 2 experimental groups. The 2 control groups were fed a standard rat chow (SRC) for 4 weeks. The two experimental groups received SRC and RPOsupplementation for 4 weeks. Hearts were excised and transferred to a Langendorff perfusion apparatus and perfused with Krebs-Henseleit buffer. Mechanical functional recovery was measured after 25 min of total global noflow ischaemia. The following parameters were also measured during various time points in the protocol: left ventricular develop pressure, heart rate, coronary flow, rate pressure product. Hearts were also freeze-clamped for biochemical analysis at 10 min during reperfusion. The biochemical analysis was aimed at determining PKB/Akt involvement. In a second protocol, hearts were subjected to the same perfusion protocol, but wortmannin was also added to the perfusion fluid, in order to inhibit PI3- kinase. Results Hearts from the RPO-supplemented rats showed an improved RPP recovery (92.26 ± 5.89 % vs 63.86 ± 7.74 %) after 10 min of reperfusion. This finding corroborated the findings of previous studies. Hearts of the RPOsupplemented rats perfused with wortmannin, showed increased RPP recoveries at several time points. Biochemical results showed that wortmannin did indeed inhibit PI3-K phosphorylation in the RPO-supplemented group, as was expected. The RPO-supplemented group that was perfused with wortmannin had an increased PKB/Akt (Ser473) phosphoyrylation, when compared to the wortmannin control group. It was also found that the combination of RPO and wortmannin had prosurvival effects. Discussion This study showed that RPO-supplementation offered protection against ischaemia/reperfusion injury in the Langendorff-perfusion apparatus at 10 min into reperfusion. Thereafter the significance of the protection was lost. This protection has been confirmed in several previous studies and several mechanisms have been proposed for this protection. Since no conclusive evidence exists on the precise mechanism of protection, our investigation focused on the regulators of the pro-survival PKB/Akt pathway. An improved functional recovery was also seen in the RPO-supplemented group that was perfused with wortmannin. This was an unexpected finding, because Wortmannin is a known PI3-kinase inhibitor (as was confirmed by our biochemical data). PI3-kinase phosphorylation leads to PKB/Akt phosphorylation and therefore, activation of a pro-survival pathway. It would be expected that wortmannin would inhibit PKB/Akt and thus decrease the survival of the cells. The RPO-supplementation thus reversed wortmannin’s detrimental effect to such an extent that the functional recovery was far better than RPO-supplementation alone. In the RPO + wortmannin group, PKB/Akt (Ser473) phosphorylation was increased, contrary to previous findings. This is an indication that RPO may have the ability to override wortmannin’s inhibitory effect on PI3-kinase, or that PKB/Akt (Ser473) may be phosphorylated independently of PI3-kinase.
AFRIKAANSE OPSOMMING: Inleiding Kardiovaskulêre siektes is een van die hoof oorsake van sterftes in die wêreld. Die vorming van skadelike reaktiewe suurstof spesies word geassosieer met verskeie patologiese kondisies en dra ook by tot isgemie/reperfusie skade. ‘n Moontlike manier om die voorkoms van isgemie/herperfusie skade asook kardiovaskulêre siektes te voorkom, is om antioksidante by die dieet te voeg. Rooi Palm Olie (RPO) bevat versadigde, mono-onversadigde en polionversadigde vetsure. RPO bevat ook ‘n oorvloed van antioksidante soos β- karoteen en tokoferole en tokotriënole. Dit is bewys in vorige studies dat RPO-aanvulling verbeter funksionele herstel. Hierdie voordelige effekte mag dalk wees agv verhoogde PKB/Akt pad aktiwiteit. Die PKB/Akt pad word geassosieer met die inhibisie van apoptose en verhoogde meganiese funksie. Doelwitte Die doelwitte van hierdie studie was om te bepaal of 1) RPO-aanvulling beskermende effekte teen isgemie/herperfusie skade in die geisoleerde rotharte het, 2) Bevestig of RPO-aanvulling wel die PKB/Akt pad beïnvloed 3). om die effekte wat RPO-aanvulling het op die reguleerders van die PKB/Akt pad te onthul. Metodes Manlike Wistar rotte is in 4 groepe verdeel. 2 Groepe kontrole rotte is ‘n standaard rotkosmengsel gevoer vir 4 weke. Die 2 eksperimentele groepe het ook ‘n standaard rotkosmengsel gekry plus ‘n RPO-aanvulling vir 4 weke. Harte is uitgesny en op ‘n Langendorff perfusie sisteem gemonteer en met Krebs-Henseleit buffer geperfuseer. Meganiese funksie herstel is gemeet na 25 min totale globale geen-vloei isgemie. Linker ventrikulêre ontwikkelde druk, harttempo, koronêre vloei en tempo druk produk is gemeet by verskillende tydpunte. Sommige harte is na 10 min herperfusie vir biochemiese analiese gevriesklamp. Die biochemiese analisiese was beoog om die PKB/Akt pad betrokkenheid te bepaal. ‘n Tweede stel harte is aan dieselfde perfusie protokol blootgestel, maar wortmannin (PI3-kinase inhibitor) is ook bygevoeg by die perfusie vloeistof. Resultate Die groep wat met RPO aangevul is, het na 10 min herperfusie, ‘n verbeterde tempo druk produk herstel getoon (92.26 ± 5.89 % vs 63.86 ± 7.74. Hierdie bevinding is ook met ander studies bevestig. ‘n Interessante bevinding was dat die groep wat met RPO aangevul is en met wortmannin geperfuseer is, ‘n verbeterde meganiese funksionele herstel getoon het. Biochemiese resultate het getoon dat wortmannin wel PI3-K fosforilering geinhibeer het. Die harte van die rotte in die groep wat aangevul is met RPO en daarna met wortmannin geperfuseer is, het ‘n toename in PKB/Akt (Ser473) fosforilering getoon, relatief tot die wortmannin geperfuseerde harte van die rotte in die kontrole groep. Hierdie groep (RPO-aanvulling en wortmannin perfusie) het beskermende effekte getoon. Bespreking Hierdie studie het getoon dat RPO-aanvulling beskerming gebied het teen isgemie/herperfusie skade in die Langendorff geperfuseerde rothart na 10 min herperfusie. Daarna is die beduidenheid van die beskerming verloor. Hierdie bevindings ondersteun die resultate van vorige studies. Verskeie moontlike meganismes is voorgestel vir die beskerming, maar die presiese meganisme is nog nie duidelik nie. In hierdie studie is daar gekyk na die reguleerders van die PKB/Akt pad. Geen vorige studies het al gefokus op RPO-aanvulling en sy effek op die reguleerders van die PKB/Akt pad nie. ‘n Onverwagte bevinding is dat harte van die rotte in die RPO + wortmannin groep ‘n verbeterde funksionele herstel getoon het. Wortmannin is ‘n PI3- kinase inhibitor. PI3-K fosforilering lei tot PKB/Akt fosforilering, wat tot sel beskerming lei. Dus, aangesien wortmannin PI3-K inhibeer, sou dit verwag word dat wortmannin sel beskerming sal verminder. Die RPO het egter die wortmannin se nadelige effekte tot so ‘n mate oorskrei dat die funksionele herstel baie beter was as die RPO-aanvulling alleen. Die verhoogde PKB/Akt (Ser473) fosforilering, wat gesien is in die RPO + wortmannin groep kan toegeskryf word aan RPO se vermoë om wortmannin se nadelige effekte te oorskrei. ‘n Moontlike verduideliking vir hierdie bevinding mag wees dat rooi palm olie PKB/Akt (Ser473) op ‘n PI3-K onafhanklike manier fosforileer.
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Cilliers, Willie. "Cost-effective cardiology in the new national health system in South Africa : a proposal". Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/987.
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Thesis (MBA (Business Management))--University of Stellenbosch, 2009.ENGLISH ABSTRACT: South Africa is on the verge of major changes in the private medical sector. The government’s planned National Health Insurance has far reaching implications for all role players in the industry, as well as for the general public. This paper looks at the changes that have been made since the ANC government came to power in 1994 and then continues to look at possible models for the new National Health Insurance plan. A proposal on practicing cost-effective cardiology within this new system is made. The data of a pilot project between a private service provider and a managed healthcare company is analysed as a basis of this discussion.
AFRIKAANSE OPSOMMING: Suid-Afrika se mediese bedryf staan op die vooraand van groot veranderinge. Die regering se beplande Nasionale Gesondheidsplan het verreikende implikasies vir alle rolspelers in die bedryf, sowel as die algemene man op straat. Die dokument kyk oorsigtelik na die veranderinge wat ondergaan is sedert die ANC regering aan bewind gekom het in 1994 en gaan daarna voort om na moontlike opsies te kyk hoe die nuwe gesondheidsmodel daarna gaan uitsien. Voorstelle word gemaak oor hoe privaat kardiologie in die nuwe sisteem koste-effektief beoefen kan word. ‘n Lootsprojek van ‘n privaat diensverskaffer en ‘n bestuurde gesongheidsorg maatskappy se data word ontleed as basis vir die bespreking.
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陳烈. "探討化痰袪瘀方藥治療冠心病的臨床應用價值". HKBU Institutional Repository, 2006. http://repository.hkbu.edu.hk/etd_ra/739.
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Böhler, Steffen, Hubert Scharnagl, F. Freisinger, T. Stojakovic, Heide Glaesmer, Jens Klotsche, Lars Pieper et al. "Unmet needs in the diagnosis and treatment of dyslipidemia in the primary care setting in Germany". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-108711.
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Objectives and methods: DETECT is a cross-sectional study of 55,518 unselected consecutive patients in 3188 representative primary care offices in Germany. In a random subset of 7519 patients, an extensive standardized laboratory program was undertaken. The study investigated the prevalence of cardiovascular disease, known risk factors (such as diabetes, hypertension and dyslipidemia and their co-morbid manifestation), as well as treatment patterns. The present analysis of the DETECT laboratory dataset focused on the prevalence and treatment of dyslipidemia in primary medical care in Germany. Coronary artery disease (CAD), risk categories and LDL-C target achievement rates were determined in the subset of 6815 patients according to the National Cholesterol Education Program (NCEP) ATP III Guidelines.
Results: Of all patients, 54.3% had dyslipidemia. Only 54.4% of the NCEP-classified dyslipidemic patients were diagnosed as ‘dyslipidemic’ by their physicians. Only 27% of all dyslipidemic patients (and 40.7% of the recognized dyslipidemic patients) were treated with lipid-lowering medications, and 11.1% of all dyslipidemic patients (41.4% of the patients treated with lipid-lowering drugs) achieved their LDL-C treatment goals. In conclusion, 80.3% of patients in the sample with dyslipidemia went undiagnosed, un-treated or under-treated.
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Böhler, Steffen, Hubert Scharnagl, F. Freisinger, T. Stojakovic, Heide Glaesmer, Jens Klotsche, Lars Pieper et al. "Unmet needs in the diagnosis and treatment of dyslipidemia in the primary care setting in Germany". Technische Universität Dresden, 2007. https://tud.qucosa.de/id/qucosa%3A26766.
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Objectives and methods: DETECT is a cross-sectional study of 55,518 unselected consecutive patients in 3188 representative primary care offices in Germany. In a random subset of 7519 patients, an extensive standardized laboratory program was undertaken. The study investigated the prevalence of cardiovascular disease, known risk factors (such as diabetes, hypertension and dyslipidemia and their co-morbid manifestation), as well as treatment patterns. The present analysis of the DETECT laboratory dataset focused on the prevalence and treatment of dyslipidemia in primary medical care in Germany. Coronary artery disease (CAD), risk categories and LDL-C target achievement rates were determined in the subset of 6815 patients according to the National Cholesterol Education Program (NCEP) ATP III Guidelines.
Results: Of all patients, 54.3% had dyslipidemia. Only 54.4% of the NCEP-classified dyslipidemic patients were diagnosed as ‘dyslipidemic’ by their physicians. Only 27% of all dyslipidemic patients (and 40.7% of the recognized dyslipidemic patients) were treated with lipid-lowering medications, and 11.1% of all dyslipidemic patients (41.4% of the patients treated with lipid-lowering drugs) achieved their LDL-C treatment goals. In conclusion, 80.3% of patients in the sample with dyslipidemia went undiagnosed, un-treated or under-treated.
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Brouilette, Scott Wayne. "Telomeres and coronary heart disease". Thesis, University of Leicester, 2004. http://hdl.handle.net/2381/29899.
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Using mean telomere length as a marker of biological age, I show that: 1. Subjects with premature myocardial infarction (MI) have significantly shorter telomeres than age-sex matched, healthy, controls. The mean telomere length in MI subjects was similar to controls almost 11 years older. 2. Healthy young adult children of families with a strong history of premature MI have shorter telomeres than age matched children of families without such a history. 3. Shorter telomere lengths are associated with increase risk of subsequent CHD events in a prospective study. This analysis was carried out on samples collected in the West of Scotland Coronary Prevention Study (WOSCOPS). This randomised blinded trial was designated to examine the benefits of statin treatment on preventing CHD and showed a 30% reduction of events in those treated with pravastatin. Interestingly, my analysis showed that this benefit of statin is only seen in those subjects at higher risk of CHD based on their telomere length.;As the final part of the thesis I carried out a quantitative linkage trait (QTL) analysis in sib-pairs in an attempt to identify genetic loci regulating telomere length. I report the mapping of a major QTL on chromosome 12 that determines almost 50% of the inter-individual variation in mean telomere length.;These findings support a novel "telomere" hypothesis of CHD. They indicate that telomere biology is intimately linked to the genetic aetiology and pathogenesis of CHD. Specifically, the findings suggest that (i) those individuals born with shorter telomeres may be at increased risk of CHD (ii) rather than individual genes, a more global structural property of the genetic material may explain the familial basis of CHD (iii) variation in telomere length may explain, in part, the variable age of onset of CHD. The findings provide several new avenues for future research.
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Lee, Chi-hang. "Microvascular obstruction following percutaneous coronary intervention for coronary artery disease". Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43278723.
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Danesh, John. "Chronic infection and coronary heart disease". Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326020.
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Kounali, Daphne. "Early growth and coronary heart disease". Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436926.
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Heiser, Claire Anne. "Personality predictors of coronary heart disease". Thesis, Virginia Polytechnic Institute and State University, 1985. http://hdl.handle.net/10919/50027.
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Fifty percent of the diagnosed cases of coronary heart disease in the United States are of unknown etiology. This study proposed that five personality traits— achievement, dominance, aggression, succorance and Critical Parent—differentiate individuals with coronary heart disease manifestations. The ultimate goal of this research was to formulate a predictive profile of at-risk individuals of developing coronary heart disease.
Cardiac rehabilitation units' participants from across the United States were recruited as subjects. Randomly selected cardiac rehabilitation units were sent an initial letter inquiring whether their staff would be willing to participate in the study by administering the instruments to their participants. Eight units from each of the 50 states were contacted. A total of fourteen units agreed to participate. One hundred sixty-nine subjects completed the Demographic Data Questionnaire and the Adjective Check List.
Five scale scores, representing the five personality differentials, were analyzed. Comparison of the male subject population (n=135) and the male normative population (n=198) revealed no significant differences in terms of the five traits. Comparison of diagnostic subgroups of the subject population also revealed no significant differences.
It was concluded that the subject population did not differ significantly from the normative population in terms of the five traits assess by the instrument used. The goal of a predictive profile was not realized due to this lack of findings.Master of Science
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Zapanta, Laurence (Laurence F. ). "Heart rate variability in mice with coronary heart disease". Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/34118.
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Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2005.Includes bibliographical references (leaves 69-71).
Heart rate variability (HRV), the beat-to-beat fluctuation of the heart rate, is a non-invasive test that measures the autonomic regulation of the heart. Assessment of HRV has been shown to predict the risk of mortality in patients after an acute myocardial infarction. Recently, the Krieger lab at MIT developed genetically engineered double knockout (dKO) mice that develop coronary artery disease accompanied by spontaneous myocardial infarctions and die at a very young age. This thesis investigated whether HRV could function as a prognostic indicator in the dKO mouse. A novel method for estimating physiological state of the mouse from the electrocardiogram using an innovative activity index was developed in order to compare HRV variables at different times while controlling for physiologic state. Traditional time and frequency domain variables were used to assess the prognostic power of HRV. Results have shown that none of the HRV variables were helpful in predicting mortality in the dKO mice. Mean heart rate showed some prognostic power, but it was not consistent in all the dKO mice. Finally, the activity index developed in this thesis provided a reliable metric for activity in mice as validated by a camera with motion detection.
by Laurence Zapanta.
S.M.
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Rose, Edward Leslie. "Coronary heart disease in patients with peripheral vascular disease". Thesis, University of Oxford, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305544.
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Bagés, Nuri. "Psychosocial risk factors and coronary heart disease". [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2000. http://arno.unimaas.nl/show.cgi?fid=6899.
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Chandola, Tarani. "Social inequality in coronary heart disease outcomes". Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285007.
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