摘要 :
Keeping pace with the stream of new data and evolving evidence on which guideline recommendations are based is an ongoing challenge to timely development of clinical practice guidelines. In an effort to respond promptly to new evi...
展开
Keeping pace with the stream of new data and evolving evidence on which guideline recommendations are based is an ongoing challenge to timely development of clinical practice guidelines. In an effort to respond promptly to new evidence, the American College of Cardiology Foundation/ American Heart Association (ACCF/AHA) Task Force on Practice Guidelines (Task Force) has created a "focused update" process to revise the existing guideline recommendations that are affected by the evolving data or opinion. New evidence is reviewed in an ongoing fashion to more efficiently respond to important science and treatment trends that could have a major impact on patient outcomes and quality of care. Evidence is reviewed at least twice a year, and updates are initiated on an as-needed basis and completed as quickly as possible while maintaining the rigorous methodology that the ACCF and AHA have developed during their partnership of >20 years.
收起
摘要 :
This document is a compilation of the current American College of Cardiology Foundation/American Heart Association (ACCF/AHA) practice guideline recommendations for peripheral artery disease from the ACC/AHA 2005 Guidelines for th...
展开
This document is a compilation of the current American College of Cardiology Foundation/American Heart Association (ACCF/AHA) practice guideline recommendations for peripheral artery disease from the ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)* and the 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline), t Updated and new recommendations from 2011 are noted and outdated recommendations have been removed. No new evidence was reviewed, and no recommendations included herein are original to this document. The ACCF/ AHA Task Force on Practice Guidelines chooses to repub-lish the recommendations in this format to provide the complete set of practice guideline recommendations in a single resource. Because this document includes recommendations only, please refer to the respective 2005 and 2011 articles for all introductory and supportive content until the entire full-text guideline is revised. In the future, the ACCF/AHA Task Force on Practice Guidelines will maintain a continuously updated full-text guideline.
收起
摘要 :
Abdominal aortic aneurysm (AAA) is a common disease with often life-threatening consequences. This vascular disorder is responsible for 1-2% of all deaths in men aged 65 years or older. Autoimmunity may be responsible for the path...
展开
Abdominal aortic aneurysm (AAA) is a common disease with often life-threatening consequences. This vascular disorder is responsible for 1-2% of all deaths in men aged 65 years or older. Autoimmunity may be responsible for the pathogenesis of AAA. Although it is well documented that infiltrating T cells are essentially always present in AAA lesions, little is known about their role in the initiation and/or progression of the disease. To determine whether T cells infiltrating AAA lesions contain clonally expanded populations of T cells, we amplified b-chain TCR transcripts by the nonpalindromic adaptor-PCR/Vβ-specific PCR and/or Vβ-specific PCR, followed by cloning and sequencing. We report in this article that aortic abdominal aneurysmal lesions from 8 of 10 patients with AAA contained oligoclonal populations of T cells. Multiple identical copies of β-chain TCR transcripts were identified in these patients. These clonal expansions are statistically significant. These results demonstrate that αβ TCR + T lymphocytes infiltrating aneurysmal lesions of patients with AAA have undergone proliferation and clonal expansion in vivo at the site of the aneurysmal lesion, in response to unidentified self- or nonself Ags. This evidence supports the hypothesis that AAA is a specific Ag-driven T cell disease.
收起
摘要 :
The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult mal...
展开
The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.
收起
摘要 :
Although a direct correlation between poor nutrition status and increased risk of readmission has yet to be established, it is reasonable to assume that patients who are identified as undernourished while hospitalized would be "at...
展开
Although a direct correlation between poor nutrition status and increased risk of readmission has yet to be established, it is reasonable to assume that patients who are identified as undernourished while hospitalized would be "at increased risk of adverse outcomes" following discharge. Also, the evidence that links nonadherence to dietary prescriptions after discharge, with increased readmissions in patients with heart failure (HF), is fairly robust. Nutrition screening prior to discharge should be mandated, just as it is at admission. However, the criteria to assess a patient's ability to adequately and appropriately nourish themselves after discharge are very different from those used to diagnose and treat malnutrition on admission or during a hospital stay. The U.S. healthcare environment germane to the readmissions rates policy that was adopted for implementation in October 2012 by the Centers for Medicare & Medicaid Services is characterized. Factors critical to the successful development and implementation of a post-acute nutrition care plan are described. Nutrition-related contributors to readmissions in HF are delineated. Transitional care models that could be adapted to enhance nutrition care plan efficacy are identified, as is the need to adopt a multidisciplinary approach to nutrition in transitional care that includes care coordination and routine follow-up. An evidence-based systematic approach to determine those patients in whom palliative vs restorative nutrition care is appropriate needs to be developed.
收起
摘要 :
We appreciate Dr. Kroon and Dr. Taanman's interest and comments on our manuscript demonstrating the presence of clonally expanded T cells in aneurysmal lesions of patients with aortic abdominal aneurysm (AAA) (1). The current trea...
展开
We appreciate Dr. Kroon and Dr. Taanman's interest and comments on our manuscript demonstrating the presence of clonally expanded T cells in aneurysmal lesions of patients with aortic abdominal aneurysm (AAA) (1). The current treatment modalities for AAA involve surgical treatment which reduces the risk of death from aneurysm rupture but does not eliminate the underlying disease process and does not prevent additional aneurysm formation. Effective noninvasive medical treatment of AAA is not currendy available. However, few potential therapeutic agents have been mentioned (reviewed in Ref. 2). The most promising of them is perhaps a well-known antibiotic, doxycycline, a tetracycline and inhibitor of matrix metalloproteinases (MMP) (reviewed in Ref. 2). Several reports have suggested that doxycycline inhibits the growth/propagation of AAA in animal models of aneurysmal disease (reviewed in Ref. 2).
收起
原文获取