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Buszman P.P.,Skirball Center for Cardiovascular Research | Tellez A.,Skirball Center for Cardiovascular Research | Afari M.,Skirball Center for Cardiovascular Research | Cheng Y.,Skirball Center for Cardiovascular Research | And 7 more authors.
EuroIntervention | Year: 2013

Aims: The routine use of paclitaxel-coated balloons (PCB) in combination with bare metal stents (BMS) in de novo coronary lesions has been questioned. In this study, we aimed to compare the vascular response of BMS implanted using a second-generation PCB (BMS+PCB) with the TAXUS stent (PES) and a BMS control (BMS) in the familial hypercholesterolaemic swine (FHS) model of coronary injury. Methods and results: A total of 17 stents (PES=6, BMS+PCB=6, and BMS=5) were implanted in the coronary territory of 10 FHS using a 20% overstretch injury ratio. Imaging evaluation (QCA and IVUS) was conducted in all animals at baseline and 28 days following stent implantation. Following terminal imaging all animals were euthanised and stented coronary segments harvested for histological evaluation. At 28 days, the lowest degree of percentage diameter stenosis by QCA was achieved by the PES (2.9±9%) followed by the BMS+PCB (9.5±16.4%) and the BMS group (25.65±18.7%, p<0.05). In histology, percentage area of stenosis (BMS+PCB=29.6±6.4% vs. PES=21.5±3.3% vs. BMS=55.2±12.9%; p<0.01) and neointimal thickness (BMS+PCB=0.26±0.1 mm vs. PES=0.21±0.1 mm vs. BMS=0.59±0.2 mm; p<0.01) were significantly reduced in both paclitaxel groups in comparison to BMS controls. Both BMS+PCB and BMS groups had higher endothelialisation scores (PES=1.50±0.9 vs. BMS+PCB=2.73±0.4 vs. BMS=3.00; p<0.05) and lower peri-strut inflammatory scores (PES=0.83±0.4 vs. BMS+PCB=0.20±0.2 vs. BMS=0.43±0.6, p<0.05) when compared to PES. Neointima maturity (PCB+BMS: 2.00 [2-2.4] vs. PES: 1.00 [0.3-1] vs. BMS: 3.00, p<0.05) and fibrin deposition (PCB+BMS: 1.40±0.3 vs. PES: 2.17±0.7 vs. BMS: 0.27±0.3, p<0.05) scores in PCB+BMS appeared to fall between the PES and the BMS ranges. Conclusions: In the FHS coronary injury model, BMS implantation using a PCB yields a degree of neointimal inhibition comparable to the PES. The BMS+PCB combination presented lower degrees of inflammation and fibrin deposition; however, signs of delayed healing were still present. © Europa Digital & Publishing 2013. All rights reserved.

Handzlik-Orlik G.,University of Silesia | Holecki M.,University of Silesia | Holecki M.,Collaborating Center for Obesity Management | Orlik B.,Center for Cardiovascular Research and Development | And 2 more authors.
Nutrition in Clinical Practice | Year: 2015

Bariatric surgery is considered one of the most effective methods of achieving long-term weight loss when all other medical treatments have failed. The number of bariatric procedures increases each year. Nevertheless, bariatric procedures are associated with a number of complications that require careful multidisciplinary management. Nutrition supervision is of substantial value, as malnutrition, vitamin, and micro- and macronutrient deficiencies may lead to deleterious consequences. In this review, we provide essential information on nutrition management, both before and after bariatric surgical procedures. © 2014 American Society for Parenteral and Enteral Nutrition.

Granada J.F.,Skirball Center for Cardiovascular Research | Buszman P.P.,Skirball Center for Cardiovascular Research | Buszman P.P.,Center for Cardiovascular Research and Development
Current Cardiology Reports | Year: 2012

The treatment of severe hypertension by the surgical obliteration of the renal sympathetic nerves was proposed almost 80 years ago. This approach, although highly effective in reducing blood pressure was associated with a significant amount of side effects and it was rapidly replaced by better tolerated medical therapy. The rapid progress in catheter based technologies occurring within the last 20 years facilitated the development of the first radio frequency renal artery denervation catheter. At the present time, several small trials have demonstrated the safety and efficacy of this approach among patients with refractory hypertension. Besides its effect on reducing blood pressure, other pleiotropic effects (ie, improving glycemia in diabetic patients) have been proposed. In this review, we discuss the anatomical and physiological rationale for this therapy, provide an update on the latest clinical data available and describe additional emerging technologies in this field. © 2012 Springer Science+Business Media, LLC.

Buszman P.P.,Center for Cardiovascular Research and Development | Wojakowski W.,Center for Cardiovascular Research and Development | Wojakowski W.,Medical University of Silesia, Katowice | Milewski K.,Center for Cardiovascular Research and Development | And 12 more authors.
Thrombosis Research | Year: 2012

Introduction: The reperfusion injury (RI) remains a significant limitation of primary PCI, therefore we evaluated the role of intracoronary abciximab and bivalirudin for anticoagulation on myocardial salvage and RI in the porcine model of ischemia/reperfusion. Materials and Methods: Myocardial infarction was induced in 23 pigs by 60-minute over-the-wire (OTW) balloon occlusion of the LAD. Animals received intravenous bivalirudin and then five minutes prior to reperfusion, either a coronary downstream infusion of abciximab (n = 11) or saline (n = 12) through the central lumen of an OTW catheter. All animals were followed for 48 hours. Results: Histological analysis showed that infarct area (IA) and area at risk (AAR) were comparable between groups (IA/AAR%: 57.6 ± 8% vs. 57.1 ± 7%, p = 0.8). Confirming this trend, biochemical markers (troponin I, TNF-alpha, IL-6, hsCRP, adiponectin, and VCAM) and left ventricular ejection fraction were also similar at 48 hours. Adhesion markers like ICAM and P-selectin were significantly decreased in the study group, nevertheless histological evidence of leukocyte extravasation was similar. The enhancement of apoptosis by TUNEL was comparable in both groups. The number of hemorrhagic infarctions confirmed by micro and macroscopic evaluation tended to be higher in the study group (70% vs. 20%, p = 0.07). Conclusions: Despite lowered concentrations of adhesion molecules, intracoronary abciximab with peripheral bivalirudin is not superior to bivalirudin unaided in terms of myocardial salvage caused by RI in the porcine ischemia/reperfusion model. This might be due to local hemorrhage caused by abciximab. © 2011 Elsevier Ltd. All rights reserved.

Zalewski J.,Catholic University of Leuven | Zalewski J.,Jagiellonian University | Claus P.,Catholic University of Leuven | Bogaert J.,Catholic University of Leuven | And 7 more authors.
Basic Research in Cardiology | Year: 2015

Postconditioning and cyclosporine A prevent mitochondrial permeability transition pore opening providing cardioprotection during ischemia/reperfusion. Whether microvascular obstruction is affected by these interventions is largely unknown. Pigs subjected to coronary occlusion for 1 h followed by 3 h of reperfusion were assigned to control (n = 8), postconditioning (n = 9) or cyclosporine A intravenous infusion 10–15 min before the end of ischemia (n = 8). Postconditioning was induced by 8 cycles of repeated 30-s balloon inflation and deflation. After 3 h of reperfusion magnetic resonance imaging, triphenyltetrazolium chloride/Evans blue staining and histopathology were performed. Microvascular obstruction (MVO, percentage of gadolinium-hyperenhanced area) was measured early (3 min) and late (12 min) after contrast injection. Infarct size with double staining was smaller in cyclosporine (46.2 ± 3.1 %, P = 0.016) and postconditioning pigs (47.6 ± 3.9 %, P = 0.008) versus controls (53.8 ± 4.1 %). Late MVO was significantly reduced by cyclosporine (13.9 ± 9.6 %, P = 0.047) but not postconditioning (23.6 ± 11.7 %, P = 0.66) when compared with controls (32.0 ± 16.9 %). Myocardial blood flow in the late MVO was improved with cyclosporine versus controls (0.30 ± 0.06 vs 0.21 ± 0.03 ml/g/min, P = 0.002) and was inversely correlated with late-MVO extent (R2 = 0.93, P < 0.0001). Deterioration of left ventricular ejection fraction (LVEF) between baseline and 3 h of reperfusion was smaller with cyclosporine (−7.9 ± 2.4 %, P = 0.008) but not postconditioning (−12.0 ± 5.5 %, P = 0.22) when compared with controls (−16.4 ± 5.5 %). In the three groups, infarct size (β = −0.69, P < 0.001) and late MVO (β = −0.33, P = 0.02) were independent predictors of LVEF deterioration following ischemia/reperfusion (R2 = 0.73, P < 0.001). Despite both cyclosporine A and postconditioning reduce infarct size, only cyclosporine A infusion had a beneficial effect on microvascular damage and was associated with better preserved LV function when compared with controls. © 2015, The Author(s).

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