View on Amazon.com
https://www.amazon.com/dp/B0BPRBVLD3
Audio y Texto
- Original Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation
-
NEW GENRE Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation
This volume has the following three parts:
- PART A: The eTOCs in Spanish in Audio format
- PART B: The eTOCs in Bi-lingual format: Spanish and English in Text format
- PART C: The Editorials of the original e-Books in English in Audio format
PART A: The eTOCs in Spanish in Audio format
Serie A: libros electrónicos acerca de las enfermedades cardiovasculares
SEGUNDO VOLUMEN
Investigación original cardiovascular:
casos de diseño de metodología para la selección de contenidos
El arte de la selección de contenidos científicos y médicos
(LIBRO 2 DE LA SERIE DE LIBROS ELECTRÓNICOS SOBRE BIOMEDICINA)
Traducción a español
Disponible en Amazon.com desde el 30/11/2015
http://www.amazon.com/dp/B018Q5MCN8
Justin D Pearlman, MD, PhD, FACC
y
Leaders in Pharmaceutical Business Intelligence
avivalev-ari@alum.berkeley.edu
Redactora jefe
Indice de contenidos electrónico (IDCe)
Los enlaces indicados llevan al contenido original en inglés
| MD | Licenciado/a en medicina y cirugía (Estados Unidos) |
| FCAP | Miembro distinguido (Fellow) del Colegio de anatomopatólogos de los Estados Unidos |
| PhD | Doctorado/a |
| RN | Enfermero/a titulado/a (National Board of Nursing Registration) |
| FACC | Miembro distinguido (Fellow) del Colegio de cardiólogos de los Estados Unidos |
| MBBS | Licenciado/a en medicina y cirugía (Reino Unido) |
Introducción al segundo volumen
Parte 1: La metodología de curaduría de los resultados de investigaciones científicas
1.1, 1.2, 1.3, 1.4, 1.5
La metodología de curaduría de los resultados de investigaciones científicas
Author: Aviva Lev-Ari, PhD, RN, Editor-in-Chief, BioMed e-Series of e-Books
1.1 Explicación de la metodología
1.1.1 Curaduría por un solo curador
1.1.2 Co-curaduría por varios expertos, autores y escritores
1.1.3 Curaduría por parte del editor del índice de contenidos electrónico (IDCe) de un libro electrónico o impreso
1.2 El proceso de creación de una curaduría como modelo alternativo de publicación científica
1.3 Los CINCO pasos del proceso de creación de una curaduría
1.3.1 CURADURÍA y CO-CURADURÍA de artículos científicos junto con expertos, autores y escritores: crítica y síntesis
1.3.2 Compilación de artículos en libros electrónicos mediante una arquitectura de índice de contenidos electrónico (IDCe) de carácter único
1.3.3 Compilación de libros electrónicos en series electrónicas
1.3.4 Publicación de series electrónicas en Amazon.com
1.3.5 Distribución de la serie electrónica a las asociaciones profesionales a través de sus páginas web
1.4 Otros tipos alternativos al modelo de publicación académico
1.5 Metodología de la curaduría aplicada a los resultados de la investigación médica
1.5.1 La voz del consultor de contenidos sobre la metodología de la curaduría
1.5.2 La curaduría se distingue por los lazos históricos de exploración que la unen
FUENTES sobre curaduría y ciencia
Parte 2: Enfermedades cardiovasculares:
el coste previsto de la atención sanitaria y la Ley de Sanidad Asequible
2.0 El dilema de la relación entre coste y valor en la prestación de servicios sanitarios cardiovasculares
Larry H. Bernstein, MD, FCAP
2.1 Coste de la atención sanitaria de los diagnósticos médicos cardiovasculares
2.1.1 Diagnóstico, tratamiento y prevención de las enfermedades cardiovasculares: costes asistenciales actuales y previstos por la AHA, y la promesa de una medicina individualizada mediante sistemas de ayuda a la toma de decisiones clínicas
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FACP, and Aviva Lev-Ari, PhD, RN
2.1.2 El coste económico de la insuficiencia cardíaca en EE. UU. La previsión del impacto de la insuficiencia cardíaca en Estados Unidos: declaración de principios de la American Heart Association
Aviva Lev-Ari, PhD, RN
2.1.3 Enfermedades cardíacas:efectos económicos y personales
https://pharmaceuticalintelligence.com/2014/01/15/heart-disease-economic-and-personal-effects/
Reporter: Aviva Lev-Ari, PhD, RN
2.2 Impacto de la reforma sanitaria de 2013 en los Estados Unidos
2.2.1 La Ley de Sanidad Asequible: una evaluación meditada. Parte I. La ley (LSA) y el modelo de aplicación (puertas de acceso a la contratación de seguros).
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
2.2.2 La Ley de Sanidad Asequible: una evaluación meditada. Parte II: implantación de la LSA, repercusiones para médicos y pacientes, y el dilema de las entidades asistenciales responsables.
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
2.2.3 La Ley de Sanidad Asequible: una evaluación meditada. Parte III. Aplicación final de la Ley de Sanidad Asequible y el foco puesto en los resultados para el paciente y la sociedad
Larry H Bernstein, MD, FCAP
2.2.4 Atención sanitaria postaguda: impulsora de la variación de los costes sanitarios
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
2.3 Se presenta en RAND la Ley de Protección del Paciente y de Sanidad Asequible
Aviva Lev-Ari, PhD, RN
Parte 3: Causas de las enfermedades cardiovasculares
Introducción a la parte 3
Se recomienda al lector que vea los siguientes VÍDEOS en el sitio web Heart.org como introducción a las enfermedades cardiovasculares
http://watchlearnlive.heart.org/CVML_Player.php
3.1 El genoma humano: orígenes etiológicos congénitos de las enfermedades cardiovasculares
3.1.1 Genómica y genética de los diagnósticos de enfermedades cardiovasculares
3.1.1.1 Genómica y genética de los diagnósticos de enfermedades cardiovasculares: un estudio bibliográfico de Circulation: Cardiovascular Genetics de la AHA, desde marzo de 2010 hasta marzo de 2013
Aviva Lev-Ari, PhD, RN and Larry H Bernstein, MD, FCAP
3.1.2 Base genética de la ateroesclerosis y la pérdida de elasticidad arterial con el envejecimiento
3.1.2.1 Biología sintética: sobre la interpretación genómica avanzada de las variantes y las vías génicas. Cuál es la base genética de la ateroesclerosis y la pérdida de la elasticidad arterial con el envejecimiento?
Aviva Lev-Ari, PhD, RN
3.1.2.2 La terapia génica mediada por transposones mejora la hemodinámica pulmonar y atenúa la hipertrofia del ventrículo derecho: la terapia génica con eNOS reduce la remodelación vascular pulmonar y la hiperplasia de la pared arterial
Aviva Lev-Ari, PhD, RN
3.1.3 Genética de las enfermedades de la conducción
3.1.3.1 Genética de las enfermedades de la conducción: enfermedad (bloqueo) de la conducción auriculoventricular (AV). Mutaciones genéticas: transcripción, excitabilidad y homeostasis energética
Aviva Lev-Ari, PhD, RN
3.2 El papel del calcio en la salud y la enfermedad
3.2.1 Identificación de biomarcadores relacionados con el citoesqueleto de actina. Parte I
Larry H Bernstein, MD, FCAP
3.2.2 El papel del calcio, el esqueleto de actina y las estructuras lipídicas en la señalización y la motilidad celular. Parte II
Larry H. Bernstein, MD, FCAP, Stephen Williams, PhD and Aviva Lev-Ari, PhD, RN
3.2.3 Exocitosis estimulada por Ca2+: el papel de la calmodulina y la proteína-cinasa C en la regulación de hormonas y neurotransmisores por el Ca2+
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.4 Alteración de la homeostasis del calcio: cardiomiocitos y células de músculo liso vascular. El mecanismo de señalización del calcio cardíaco y cardiovascular. Parte VIII
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.5 La sinaptotagmina funciona como un sensor de calcio: ¿Cómo regulan los iones de calcio la fusión de las vesículas con las membranas celulares durante la neurotransmisión? Parte X
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.6 La centralidad de la señalización del Ca(2+) y del citoesqueleto, con implicación de calmodulina-cinasas y receptores de rianodina, en la insuficiencia cardíaca, el músculo liso arterial y la arritmia postisquémica. Similitudes, diferencias y dianas farmacéuticas
Larry H Bernstein, MD, FCAP, Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.2.7 Independencia de la ateroesclerosis: el papel de los polimorfismos genéticos de los canales iónicos en la patogénesis de la disfunción microvascular coronaria y la isquemia miocárdica (arteriopatía coronaria (AC))
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.8 Señalización del calcio, mitocondrias cardíacas y síndrome metabólico
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.3 La vasculatura y el miocardio: diagnóstico del estado de la enfermedad
3.3.1 Estado de la cardiología sobre la tensión parietal, la carga ventricular y la reserva contráctil del miocardio: aspectos de la investigación médica traslativa
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.3.2 Hipertensión y distensibilidad vascular: Frontera del pensamiento en 2013: el foco está en la elasticidad arterial
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.3.3 Complicaciones cardiovasculares: muerte por esternotomía reoperatoria después de una RVC, RVM, RVA o radiación previa; complicaciones de la ICP; septicemia por intervenciones cardiovasculares
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.3.4 Reparación de la válvula mitral: ¿Qué paciente es candidato a un procedimiento no ablativo y totalmente no invasivo?
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
Parte 4: Riesgos y biomarcadores de las enfermedades cardiovasculares
4.1 El papel del calcio en la salud y la enfermedad
4.1.1 Mecanismo de intercambio de Ca2+ en el túbulo distal renal en la salud y la enfermedad. Parte III
Larry H. Bernstein, MD, FCAP, Stephen J. Williams, PhD and Aviva Lev-Ari, PhD, RN
4.2 La vasculatura y el miocardio: diagnóstico del estado de la enfermedad. Biomarcadores de los episodios cardiovasculares agudos
4.2.1 No hay síntomas precoces. ¿Hay algún modo de diagnosticar un aneurisma de aorta antes de que se rompa?
Aviva Lev-Ari, PhD, RN
4.2.2 Mujeres y placa no aterosclerótica: disección espontánea de la arteria coronaria. Nuevos conocimientos de la investigación y estudio en curso del ADN
Aviva Lev-Ari, PhD, RN
4.2.3 Enfermedades cardiovasculares: sistemas de ayuda a la toma de decisiones para el tratamiento de enfermedades
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.2.4 El uso de los análisis de troponina de alta sensibilidad (hs cTn)
https://pharmaceuticalintelligence.com/2013/05/18/dealing-with-the-use-of-the-hs-ctn-assays/
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.5 Importancia como marcador pronóstico de la troponina I en la insuficiencia cardíaca aguda descompensada (ICAD). La troponina I en la insuficiencia cardíaca aguda descompensada: lo aprendido del estudio ASCEND-HF
https://pharmaceuticalintelligence.com/2013/06/30/troponin-i-in-acute-decompensated-heart-failure/
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.6 Más información sobre el rendimiento de la troponina T de alta sensibilidad, sola y con la fracción aminoterminal de la pro-BNP en la diabetes
Larry H. Bernstein, MD, FCAP
4.2.7 El síndrome cardio-renal (SCR) en la insuficiencia cardíaca (IC)
https://pharmaceuticalintelligence.com/2013/06/30/the-cardiorenal-syndrome-in-heart-failure/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.8 Vasoplejía en pacientes con trasplante cardíaco ortotópico
https://pharmaceuticalintelligence.com/2013/06/30/vasoplegia-in-orthotopic-heart-transplants/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.9 Infarto de miocardio: la nueva definición tras la revascularización
Aviva Lev-Ari, PhD, RN
4.3 Biomarcadores de riesgo a largo plazo de enfermedades cardiovasculares
4.3.1 Consideraciones especiales sobre las lipoproteínas de la sangre, la viscosidad, la evaluación y el tratamiento
Larry H Bernstein, MD FCAP and Aviva Lev-Ari, PhD, RN
4.3.2 Cuál es el papel de la viscosidad del plasma en la hemostasia y el riesgo de enfermedad vascular?
Larry H Bernstein, MD and Aviva Lev-Ari, PhD, RN
4.3.3 Lipoproteína de alta densidad (HDL): factor pronóstico independiente de la función endotelial y la ateroesclerosis; modulador, agonista y biomarcador del riesgo cardiovascular
Aviva Lev-Ari, PhD, RN
4.3.4 Aterogénesis: factor pronóstico de las ECV. Las partículas de LDL, más pequeñas y densas
Aviva Lev-Ari, PhD, RN
4.3.5 Hipertrigliceridemia concurrente con hiperlipidemia: la ultracentrifugación con gradiente de densidad vertical es una prueba mejor para evitar el infratratamiento de los pacientes cardíacos de alto riesgo
Aviva Lev-Ari, PhD, RN
4.3.6 Inhibidor de la proteína de transferencia de ésteres de colesterol (CETP): el potencial del anacetrapib para tratar la ateroesclerosis y la AC
Aviva Lev-Ari, PhD, RN
4.4 Disfunción de la conducción y electrofisiología del corazón
4.4.1 Sobre los dispositivos y los algoritmos: predicción de la arritmia después de la cirugía cardíaca y predicción mediante ECG del inicio de la fibrilación auricular paroxística
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.4.2 Análisis genético de la fibrilación auricular
https://pharmaceuticalintelligence.com/2013/10/27/genetic-analysis-of-atrial-fibrillation/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.4.3 Calcio/calmodulina-cinasa oxidada y fibrilación auricular
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.4.4 La proteína β-traza (BTP), un biomarcador de la función renal, como nuevo biomarcador para el diagnóstico del riesgo cardíaco en pacientes con fibrilación auricular
Aviva Lev-Ari, PhD, RN
4.5 Imágenes cardiovasculares: diagnóstico del estado de la enfermedad y determinación del curso del tratamiento
4.5.1 Biomarcadores por imagen de la rigidez arterial: vías farmacoterapéuticas para el tratamiento de la hipertensión y la hipercolesterolemia
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.2 Evaluación combinada de la circulación coronaria: tomografía de coherencia óptica (TCO), espectroscopia de infrarrojo cercano (NIRS) y ecografía intravascular (EIV). Detección de la placa rica en lípidos y prevención del síndrome coronario agudo (SCA)
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.3 Aplicaciones clínicas emergentes de la TC cardíaca: caracterización de la placa, funcionalidad de la SPECT, medición por angiograma no invasiva de la FFR
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.4 Reserva de flujo fraccional (FFR) e índice diastólico instantáneo sin ondas (iFR): una evaluación de las herramientas del laboratorio de cateterismo (validación del software) para la evaluación de la isquemia (diagnóstico). Cambio paradigmático: el vaso ADECUADO, no TODOS los vasos
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.5 Infarto de miocardio agudo y crónico: cuantificación de la viabilidad miocárdica – FDG-TEP/RM frente a solo RM o TEP
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
Parte 5: Avances en el tratamiento de las enfermedades cardiovasculares
5.1 La vasculatura y el miocardio: diagnóstico del estado de la enfermedad
5.1.1 La eritropoyetina (EPO) y el hierro (Fe) intravenoso como tratamiento de la anemia en la ICC grave y resistente: la elevación de la fracción aminoterminal de pro-BNP como biomarcador
https://pharmaceuticalintelligence.com/2013/12/10/epo-as-therapeutics-for-anemia-in-chf/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
5.1.2 Afectan los nuevos anticoagulantes al TP/CIN? Los casos de XARELTO (rivaroxabán) o PRADAXA (dabigatrán)
Vivek Lal, MBBS, MD, F.Cl.R, Justin D Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
5.1.3 Diseños alternativos para el corazón artificial humano: pacientes con insuficiencia cardíaca. Resultados del trasplante (donante)/implante (artificial) y tecnologías de seguimiento del paciente con trasplante/implante en la comunidad
Larry H. Bernstein, MD, FCAP, Justin D Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
5.1.4 Cirugía vascular: declaración de posicionamiento internacional y multidisciplinar sobre la colocación de stents en la carótida de 2013 y aportaciones de un cirujano vascular en el momento cumbre de su carrera, el Dr. Richard Paul Cambria
Aviva Lev-Ari, PhD, RN
5.1.5 Indicación del trasplante cardíaco (TxC) en la insuficiencia cardíaca (IC): resultados del procedimiento e investigación sobre la IC y el TxC en dos de los principales centros de IC y TxC del país
Aviva Lev-Ari, PhD, RN
5.1.6 Eficacia de la revascularización endovascular de las extremidades inferiores: cirujanos vasculares (CV), cardiólogos intervencionistas (CI) y radiólogos intervencionistas (RI)
Aviva Lev-Ari, PhD, RN
5.1.7 Indicaciones clínicas del uso del óxido nítrico inhalado (iNO) en el mercado de los pacientes adultos: resultados clínicos tras el uso, demanda del tratamiento y coste asistencial
Aviva Lev-Ari, PhD, RN
5.1.8 Cambio en el requisito de contar con respaldo quirúrgico durante una ICP según la AHA y la ACC: clase IIb → clase III, nivel de evidencia A. Justificación de la ICP no urgente sin equipo de cirugía cardiotorácica en el centro (cambio de clase IIb, nivel de evidencia B)
Justin Pearlman, MD, PhD, FACC and Larry H Bernstein, MD, FCAP
5.1.9 Tecnología de biomateriales: modelos de ingeniería tisular para la reperfusión y dispositivos implantables para la revascularización
https://pharmaceuticalintelligence.com/2013/05/05/bioengineering-of-vascular-and-tissue-models/
Larry H Bernstein, MD, FACP and Aviva Lev-Ari, PhD, RN
5.1.10 Reparación vascular: stents e implantes bioactivos
Larry H Bernstein, MD, FACP and Aviva Lev-Ari, PhD, RN
5.1.11 Regeneración: sistema cardíaco (cardiomiogénesis) y vasculatura (angiogénesis)
https://pharmaceuticalintelligence.com/2014/01/15/regeneration-cardiac-system-and-vasculature/
Aviva Lev-Ari, PhD, RN
5.1.12 La lucha contra las enfermedades cardiovasculares ateroscleróticas: un agente biológico, no uno de molécula pequeña. La lecitina-colesterol-aciltransferasa humana recombinante (rhLCAT) propició la adquisición de AlphaCore por parte de AstraZeneca
Aviva Lev-Ari, PhD, RN
5.1.13 Empleo de los nuevos actores en la ateroesclerosis para tratar las enfermedades cardíacas
Aviva Lev-Ari, PhD, RN
5.2 El papel del calcio en la salud y la enfermedad
5.2.1 El ciclo del calcio (bomba ATPasa) en la terapia génica cardíaca: terapia génica inhalable para la hipertensión arterial pulmonar e infusión intracoronaria percutánea para la insuficiencia cardíaca. Las aportaciones del Dr. Roger J. Hajjar. Parte VI
Aviva Lev-Ari, PhD, RN
5.2.2 Contractilidad cardíaca y función miocárdica: arritmias ventriculares e insuficiencia cardíaca no isquémica. Implicaciones terapéuticas de la rianodinopatía (disfunción contráctil relacionada con la liberación de calcio) y respuestas de catecolaminas. Parte VII
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
5.2.3 Los bloqueadores de los canales de calcio, la disfunción contráctil relacionada con la liberación de calcio (rianodinopatía) y el calcio como sensor de neurotransmisores. Parte IX
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
5.3 Disfunción de la conducción y electrofisiología del corazón
5.3.1 Terapia de resincronización cardíaca (TRC) para el tratamiento de las arritmias: inserción de un marcapasos/desfibrilador cardioversor implantable (DCI)
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
5.4 Imágenes cardiovasculares: diagnóstico del estado de la enfermedad y determinación del curso del tratamiento
5.4.1 Sala cardiovascular 3D. Laboratorio de cateterismo/quirófano híbrido, cirugía híbrida, complicaciones tras la ICP y repetición de la esternotomía
Aviva Lev-Ari, PhD, RN
Resumen del segundo volumen
Epílogo del segundo volumen
Investigación original cardiovascular:
casos de diseño de metodología para la selección de contenidos
El arte de la selección de contenidos científicos y médicos
(LIBRO 2 DE LA SERIE DE LIBROS ELECTRÓNICOS SOBRE BIOMEDICINA)
Disponible en Amazon.com desde el 30/11/2015
http://www.amazon.com/dp/B018Q5MCN8
PART B: The eTOCs in Bi-lingual format:
Spanish and English in Text format
Serie A: libros electrónicos acerca de las enfermedades cardiovasculares
SEGUNDO VOLUMEN
Investigación original cardiovascular:
casos de diseño de metodología para la selección de contenidos
El arte de la selección de contenidos científicos y médicos
(LIBRO 2 DE LA SERIE DE LIBROS ELECTRÓNICOS SOBRE BIOMEDICINA)
Traducción a español
Disponible en Amazon.com desde el 30/11/2015
http://www.amazon.com/dp/B018Q5MCN8
Justin D Pearlman, MD, PhD, FACC
y
Leaders in Pharmaceutical Business Intelligence
avivalev-ari@alum.berkeley.edu
Redactora jefe
Series A: e-Books on Cardiovascular Diseases
VOLUME TWO
Cardiovascular Original Research:
Cases in Methodology Design for Content Co-Curation
The Art of Scientific & Medical Curation
(BIOMED E-BOOKS BOOK 2)
Available on Amazon.com since 11/30/2015
http://www.amazon.com/dp/B018Q5MCN8
Justin D Pearlman, MD, PhD, FACC
and
Leaders in Pharmaceutical Business Intelligence
avivalev-ari@alum.berkeley.edu
Editor-in-Chief
Indice de contenidos electrónico (IDCe)
electronic Table of Contents
Los enlaces indicados llevan al contenido original en inglés
| MD | Licenciado/a en medicina y cirugía (Estados Unidos) |
| FCAP | Miembro distinguido (Fellow) del Colegio de anatomopatólogos de los Estados Unidos |
| PhD | Doctorado/a |
| RN | Enfermero/a titulado/a (National Board of Nursing Registration) |
| FACC | Miembro distinguido (Fellow) del Colegio de cardiólogos de los Estados Unidos |
| MBBS | Licenciado/a en medicina y cirugía (Reino Unido) |
Introducción al segundo volumen
Introduction to Volume Two
Parte 1: La metodología de curaduría de los resultados de investigaciones científicas
Part 1: The Methodology of Curation for Scientific Research Findings
1.1, 1.2, 1.3, 1.4, 1.5
La metodología de curaduría de los resultados de investigaciones científicas
1.1, 1.2, 1.3, 1.4, 1.5
The Methodology of Curation for Scientific Research Findings
Author: Aviva Lev-Ari, PhD, RN, Editor-in-Chief, BioMed e-Series of e-Books
1.1 Explicación de la metodología
1.1 The Methodology Explained
1.1.1 Curaduría por un solo curador
1.1.1 Curation by a Single Curator
1.1.2 Co-curaduría por varios expertos, autores y escritores
1.1.2 Co-Curation by Several Experts, Authors, Writers
1.1.3 Curaduría por parte del editor del índice de contenidos electrónico (IDCe) de un libro electrónico o impreso
1.1.3 Editor’s Curation of an electronic Table of Contents (eTOCs) of an e-Book or a Hardcover Volume
1.2 El proceso de creación de una curaduría como modelo alternativo de publicación científica
1.2 The Creation Process of a Curation as an Alternative Model for Scientific Publishing
1.3 Los CINCO pasos del proceso de creación de una curaduría
1.3 FIVE steps in the Creation Process of a Curation
1.3.1 CURADURÍA y CO-CURADURÍA de artículos científicos junto con expertos, autores y escritores: crítica y síntesis
1.3.1 CURATION and Co-CURATION of Scientific articles in conjunction with Experts, Authors, Writers critique and synthesis
1.3.2 Compilación de artículos en libros electrónicos mediante una arquitectura de índice de contenidos electrónico (IDCe) de carácter único
1.3.2 Assembly of articles into e-Books using ONE of a Kind electronic Table of Contents (eTOCs) architecture
1.3.3 Compilación de libros electrónicos en series electrónicas
1.3.3 Assembly of e-Books into e-Series
1.3.4 Publicación de series electrónicas en Amazon.com
1.3.4 Publishing of e-Series on Amazon.com
1.3.5 Distribución de la serie electrónica a las asociaciones profesionales a través de sus páginas web
1.3.5 Distribution of e-Series to Professional Associations via their Internet websites
1.4 Otros tipos alternativos al modelo de publicación académico
1.4 Other Alternative Types to the Academic Publishing Model
1.5 Metodología de la curaduría aplicada a los resultados de la investigación médica
1.5 Methodology of Curation Applied to Medical Research Findings
1.5.1 La voz del consultor de contenidos sobre la metodología de la curaduría
1.5.1 The Voice of Content Consultant on The Methodology of Curation
1.5.2 La curaduría se distingue por los lazos históricos de exploración que la unen
1.5.2 Curation is Uniquely Distinguished by the Historical Exploratory Ties that Bind
FUENTES sobre curaduría y ciencia
Parte 2: Enfermedades cardiovasculares:
el coste previsto de la atención sanitaria y la Ley de Sanidad Asequible
Part 2: Cardiovascular Disease:
Predicted Cost of Care and the Affordable Care Act
2.0 El dilema de la relación entre coste y valor en la prestación de servicios sanitarios cardiovasculares
2.0 The Cost to Value Conundrum in Cardiovascular Healthcare Provision
Larry H. Bernstein, MD, FCAP
2.1 Coste de la atención sanitaria de los diagnósticos médicos cardiovasculares
2.1 Cost of Care for Cardiovascular Medical Diagnoses
2.1.1 Diagnóstico, tratamiento y prevención de las enfermedades cardiovasculares: costes asistenciales actuales y previstos por la AHA, y la promesa de una medicina individualizada mediante sistemas de ayuda a la toma de decisiones clínicas
2.1.1 Diagnosis of Cardiovascular Disease, Treatment and Prevention: Current & AHA Predicted Cost of Care and the Promise of Individualized Medicine Using Clinical Decision Support Systems
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FACP, and Aviva Lev-Ari, PhD, RN
2.1.2 El coste económico de la insuficiencia cardíaca en EE. UU. La previsión del impacto de la insuficiencia cardíaca en Estados Unidos: declaración de principios de la American Heart Association
2.1.2 Economic Toll of Heart Failure in the US: Forecasting the Impact of Heart Failure in the United States – A Policy Statement From the American Heart Association
Aviva Lev-Ari, PhD, RN
2.1.3 Enfermedades cardíacas:efectos económicos y personales
2.1.3 Heart Disease: Economic and Personal Effects
https://pharmaceuticalintelligence.com/2014/01/15/heart-disease-economic-and-personal-effects/
Reporter: Aviva Lev-Ari, PhD, RN
2.2 Impacto de la reforma sanitaria de 2013 en los Estados Unidos
2.2 Impact of 2013 HealthCare Reform in the US
2.2.1 La Ley de Sanidad Asequible: una evaluación meditada. Parte I. La ley (LSA) y el modelo de aplicación (puertas de acceso a la contratación de seguros).
2.2.1 The Affordable Care Act: A Considered Evaluation. Part I. The legislative act (ACA) and the model for implementation (Insurance Gateways).
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
2.2.2 La Ley de Sanidad Asequible: una evaluación meditada. Parte II: implantación de la LSA, repercusiones para médicos y pacientes, y el dilema de las entidades asistenciales responsables.
2.2.2 The Affordable Care Act: A Considered Evaluation. Part II: The Implementation of the ACA, Impact on Physicians and Patients, and the Dis-Ease of the Accountable Care Organizations.
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
2.2.3 La Ley de Sanidad Asequible: una evaluación meditada. Parte III. Aplicación final de la Ley de Sanidad Asequible y el foco puesto en los resultados para el paciente y la sociedad
2.2.3 The Affordable Care Act: A Considered Evaluation. Part III. Final Implementation of the Affordable Care Act and a Patient and Community Outcomes Focus
Larry H Bernstein, MD, FCAP
2.2.4 Atención sanitaria postaguda: impulsora de la variación de los costes sanitarios
2.2.4 Post Acute Care – Driver of Variation in Healthcare Costs
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
2.3 Se presenta en RAND la Ley de Protección del Paciente y de Sanidad Asequible
2.3 Patient Protection and Affordable Care Act Featured at RAND
Aviva Lev-Ari, PhD, RN
Parte 3: Causas de las enfermedades cardiovasculares
Part 3: Causes of Cardiovascular Diseases
Introducción a la parte 3
Introduction to Part 3
Se recomienda al lector que vea los siguientes VÍDEOS en el sitio web Heart.org como introducción a las enfermedades cardiovasculares
The e-Reader is advised to View the following VIDEOS on the Heart.org website as an Introduction to Cardiovascular Diseases
http://watchlearnlive.heart.org/CVML_Player.php
3.1 El genoma humano: orígenes etiológicos congénitos de las enfermedades cardiovasculares
3.1 Human Genome: Congenital Etiological Sources of Cardiovascular Disease
3.1.1 Genómica y genética de los diagnósticos de enfermedades cardiovasculares
3.1.1 Genomics & Genetics of Cardiovascular Disease Diagnoses
3.1.1.1 Genómica y genética de los diagnósticos de enfermedades cardiovasculares: un estudio bibliográfico de Circulation: Cardiovascular Genetics de la AHA, desde marzo de 2010 hasta marzo de 2013
3.1.1.1 Genomics & Genetics of Cardiovascular Disease Diagnoses: A Literature Survey of AHA’s Circulation Cardiovascular Genetics, 3/2010 – 3/2013
Aviva Lev-Ari, PhD, RN and Larry H Bernstein, MD, FCAP
3.1.2 Base genética de la ateroesclerosis y la pérdida de elasticidad arterial con el envejecimiento
3.1.2 Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging
3.1.2.1 Biología sintética: sobre la interpretación genómica avanzada de las variantes y las vías génicas. Cuál es la base genética de la ateroesclerosis y la pérdida de la elasticidad arterial con el envejecimiento?
3.1.2.1 Synthetic Biology: On Advanced Genome Interpretation for Gene Variants and Pathways: What is the Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging
Aviva Lev-Ari, PhD, RN
3.1.2.2 La terapia génica mediada por transposones mejora la hemodinámica pulmonar y atenúa la hipertrofia del ventrículo derecho: la terapia génica con eNOS reduce la remodelación vascular pulmonar y la hiperplasia de la pared arterial
3.1.2.2 Transposon-mediated Gene Therapy improves Pulmonary Hemodynamics and attenuates Right Ventricular Hypertrophy: eNOS gene therapy reduces Pulmonary vascular remodeling and Arterial wall hyperplasia
Aviva Lev-Ari, PhD, RN
3.1.3 Genética de las enfermedades de la conducción
3.1.3 Genetics of Conduction Disease
3.1.3.1 Genética de las enfermedades de la conducción: enfermedad (bloqueo) de la conducción auriculoventricular (AV). Mutaciones genéticas: transcripción, excitabilidad y homeostasis energética
3.1.3.1 Genetics of Conduction Disease: Atrioventricular (AV) Conduction Disease (block): Gene Mutations – Transcription, Excitability, and Energy Homeostasis
Aviva Lev-Ari, PhD, RN
3.2 El papel del calcio en la salud y la enfermedad
3.2 The Role of Calcium in Health and Disease
3.2.1 Identificación de biomarcadores relacionados con el citoesqueleto de actina. Parte I
3.2.1 Identification of Biomarkers that are Related to the Actin Cytoskeleton – Part I
Larry H Bernstein, MD, FCAP
3.2.2 El papel del calcio, el esqueleto de actina y las estructuras lipídicas en la señalización y la motilidad celular. Parte II
3.2.2 Role of Calcium, the Actin Skeleton, and Lipid Structures in Signaling and Cell Motility – Part II
Larry H. Bernstein, MD, FCAP, Stephen Williams, PhD and Aviva Lev-Ari, PhD, RN
3.2.3 Exocitosis estimulada por Ca2+: el papel de la calmodulina y la proteína-cinasa C en la regulación de hormonas y neurotransmisores por el Ca2+
3.2.3 Ca2+-Stimulated Exocytosis: The Role of Calmodulin and Protein Kinase C in Ca2+ Regulation of Hormone and Neurotransmitter
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.4 Alteración de la homeostasis del calcio: cardiomiocitos y células de músculo liso vascular. El mecanismo de señalización del calcio cardíaco y cardiovascular. Parte VIII
3.2.4 Disruption of Calcium Homeostasis: Cardiomyocytes and Vascular Smooth Muscle Cells: The Cardiac and Cardiovascular Calcium Signaling Mechanism – Part VIII
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.5 La sinaptotagmina funciona como un sensor de calcio: ¿Cómo regulan los iones de calcio la fusión de las vesículas con las membranas celulares durante la neurotransmisión? Parte X
3.2.5 Synaptotagmin functions as a Calcium Sensor: How Calcium Ions Regulate the fusion of vesicles with cell membranes during Neurotransmission – Part X
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.6 La centralidad de la señalización del Ca(2+) y del citoesqueleto, con implicación de calmodulina-cinasas y receptores de rianodina, en la insuficiencia cardíaca, el músculo liso arterial y la arritmia postisquémica. Similitudes, diferencias y dianas farmacéuticas
3.2.6 The Centrality of Ca(2+) Signaling and Cytoskeleton Involving Calmodulin Kinases and Ryanodine Receptors in Cardiac Failure, Arterial Smooth Muscle, Post-ischemic Arrhythmia, Similarities and Differences, and Pharmaceutical Targets
Larry H Bernstein, MD, FCAP, Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.2.7 Independencia de la ateroesclerosis: el papel de los polimorfismos genéticos de los canales iónicos en la patogénesis de la disfunción microvascular coronaria y la isquemia miocárdica (arteriopatía coronaria (AC))
3.2.7 Atherosclerosis Independence: Genetic Polymorphisms of Ion Channels Role in the Pathogenesis of Coronary Microvascular Dysfunction and Myocardial Ischemia (Coronary Artery Disease (CAD))
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.2.8 Señalización del calcio, mitocondrias cardíacas y síndrome metabólico
3.2.8 Calcium Signaling, Cardiac Mitochondria and Metabolic Syndrome
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
3.3 La vasculatura y el miocardio: diagnóstico del estado de la enfermedad
3.3 Vasculature and Myocardium: Diagnosing the Condition of Disease
3.3.1 Estado de la cardiología sobre la tensión parietal, la carga ventricular y la reserva contráctil del miocardio: aspectos de la investigación médica traslativa
3.3.1 State of Cardiology on Wall Stress, Ventricular Workload and Myocardial Contractile Reserve: Aspects of Translational Medicine (TM)
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.3.2 Hipertensión y distensibilidad vascular: Frontera del pensamiento en 2013: el foco está en la elasticidad arterial
3.3.2 Hypertension and Vascular Compliance: 2013 Thought Frontier – An Arterial Elasticity Focus
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.3.3 Complicaciones cardiovasculares: muerte por esternotomía reoperatoria después de una RVC, RVM, RVA o radiación previa; complicaciones de la ICP; septicemia por intervenciones cardiovasculares
3.3.3 Cardiovascular Complications: Death from Reoperative Sternotomy after prior CABG, MVR, AVR, or Radiation; Complications of PCI; Sepsis from Cardiovascular Interventions
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
3.3.4 Reparación de la válvula mitral: ¿Qué paciente es candidato a un procedimiento no ablativo y totalmente no invasivo?
3.3.4 Mitral Valve Repair: Who is a Patient Candidate for a Non-Ablative Fully Non-Invasive Procedure?
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
Parte 4: Riesgos y biomarcadores de las enfermedades cardiovasculares
Part 4: Risks and Biomarkers for Cardiovascular Diseases
4.1 El papel del calcio en la salud y la enfermedad
4.1 The Role of Calcium in Health and Disease
4.1.1 Mecanismo de intercambio de Ca2+ en el túbulo distal renal en la salud y la enfermedad. Parte III
4.1.1 Renal Distal Tubular Ca2+ Exchange Mechanism in Health and Disease – Part III
Larry H. Bernstein, MD, FCAP, Stephen J. Williams, PhD and Aviva Lev-Ari, PhD, RN
4.2 La vasculatura y el miocardio: diagnóstico del estado de la enfermedad. Biomarcadores de los episodios cardiovasculares agudos
4.2 Vasculature and Myocardium: Diagnosing the Condition of Disease – Biomarkers of Acute Cardiovascular Events
4.2.1 No hay síntomas precoces. ¿Hay algún modo de diagnosticar un aneurisma de aorta antes de que se rompa?
4.2.1 No Early Symptoms – An Aortic Aneurysm Before It Ruptures – Is There A Way To Know If I Have it?
Aviva Lev-Ari, PhD, RN
4.2.2 Mujeres y placa no aterosclerótica: disección espontánea de la arteria coronaria. Nuevos conocimientos de la investigación y estudio en curso del ADN
4.2.2 Females and Non-Atherosclerotic Plaque: Spontaneous Coronary Artery Dissection: New Insights from Research and DNA Ongoing Study
Aviva Lev-Ari, PhD, RN
4.2.3 Enfermedades cardiovasculares: sistemas de ayuda a la toma de decisiones para el tratamiento de enfermedades
4.2.3 Cardiovascular Diseases: Decision Support Systems for Disease Management Decision Making
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.2.4 El uso de los análisis de troponina de alta sensibilidad (hs cTn)
4.2.4 Dealing with the Use of the High Sensitivity Troponin (hs cTn) Assays
https://pharmaceuticalintelligence.com/2013/05/18/dealing-with-the-use-of-the-hs-ctn-assays/
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.5 Importancia como marcador pronóstico de la troponina I en la insuficiencia cardíaca aguda descompensada (ICAD). La troponina I en la insuficiencia cardíaca aguda descompensada: lo aprendido del estudio ASCEND-HF
4.2.5 Prognostic Marker Importance of Troponin I in Acute Decompensated Heart Failure (ADHF): Troponin I in acute decompensated heart failure: insights from the ASCEND-HF study
https://pharmaceuticalintelligence.com/2013/06/30/troponin-i-in-acute-decompensated-heart-failure/
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.6 Más información sobre el rendimiento de la troponina T de alta sensibilidad, sola y con la fracción aminoterminal de la pro-BNP en la diabetes
4.2.6 More on the Performance of High Sensitivity Troponin T and with Amino Terminal Pro BNP in Diabetes
Larry H. Bernstein, MD, FCAP
4.2.7 El síndrome cardio-renal (SCR) en la insuficiencia cardíaca (IC)
4.2.7 The Cardio-Renal Syndrome (CRS) in Heart Failure (HF)
https://pharmaceuticalintelligence.com/2013/06/30/the-cardiorenal-syndrome-in-heart-failure/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.8 Vasoplejía en pacientes con trasplante cardíaco ortotópico
4.2.8 Vasoplegia in Orthotopic Heart Transplant Patients
https://pharmaceuticalintelligence.com/2013/06/30/vasoplegia-in-orthotopic-heart-transplants/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.2.9 Infarto de miocardio: la nueva definición tras la revascularización
4.2.9 Myocardial Infarction: The New Definition After Revascularization
Aviva Lev-Ari, PhD, RN
4.3 Biomarcadores de riesgo a largo plazo de enfermedades cardiovasculares
4.3 Biomarkers of Long Term Risk of Cardiovascular Disease
4.3.1 Consideraciones especiales sobre las lipoproteínas de la sangre, la viscosidad, la evaluación y el tratamiento
4.3.1 Special Considerations in Blood Lipoproteins, Viscosity, Assessment and Treatment
Larry H Bernstein, MD FCAP and Aviva Lev-Ari, PhD, RN
4.3.2 Cuál es el papel de la viscosidad del plasma en la hemostasia y el riesgo de enfermedad vascular?
4.3.2 What is the Role of Plasma Viscosity in Hemostasis and Vascular Disease risk?
Larry H Bernstein, MD and Aviva Lev-Ari, PhD, RN
4.3.3 Lipoproteína de alta densidad (HDL): factor pronóstico independiente de la función endotelial y la ateroesclerosis; modulador, agonista y biomarcador del riesgo cardiovascular
4.3.3 High-Density Lipoprotein (HDL): An Independent Predictor of Endothelial Function & Atherosclerosis, A Modulator, An Agonist, A Biomarker for Cardiovascular Risk
Aviva Lev-Ari, PhD, RN
4.3.4 Aterogénesis: factor pronóstico de las ECV. Las partículas de LDL, más pequeñas y densas
4.3.4 Artherogenesis: Predictor of CVD – the Smaller and Denser LDL Particles
Aviva Lev-Ari, PhD, RN
4.3.5 Hipertrigliceridemia concurrente con hiperlipidemia: la ultracentrifugación con gradiente de densidad vertical es una prueba mejor para evitar el infratratamiento de los pacientes cardíacos de alto riesgo
4.3.5 Hypertriglyceridemia concurrent Hyperlipidemia: Vertical Density Gradient Ultracentrifugation a Better Test to Prevent Undertreatment of High-Risk Cardiac Patients
Aviva Lev-Ari, PhD, RN
4.3.6 Inhibidor de la proteína de transferencia de ésteres de colesterol (CETP): el potencial del anacetrapib para tratar la ateroesclerosis y la AC
4.3.6 Cholesteryl Ester Transfer Protein (CETP) Inhibitor: Potential of Anacetrapib to treat Atherosclerosis and CAD
Aviva Lev-Ari, PhD, RN
4.4 Disfunción de la conducción y electrofisiología del corazón
4.4 Conduction Dysfunction and ElectroPhysiology of the Heart
4.4.1 Sobre los dispositivos y los algoritmos: predicción de la arritmia después de la cirugía cardíaca y predicción mediante ECG del inicio de la fibrilación auricular paroxística
4.4.1 On Devices and On Algorithms: Arrhythmia after Cardiac Surgery Prediction and ECG Prediction of Paroxysmal Atrial Fibrillation Onset
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.4.2 Análisis genético de la fibrilación auricular
4.4.2 Genetic Analysis of Atrial Fibrillation
https://pharmaceuticalintelligence.com/2013/10/27/genetic-analysis-of-atrial-fibrillation/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.4.3 Calcio/calmodulina-cinasa oxidada y fibrilación auricular
4.4.3 Oxidized Calcium Calmodulin Kinase and Atrial Fibrillation
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
4.4.4 La proteína β-traza (BTP), un biomarcador de la función renal, como nuevo biomarcador para el diagnóstico del riesgo cardíaco en pacientes con fibrilación auricular
4.4.4 Renal Function Biomarker, β-trace protein (BTP) as a Novel Biomarker for Cardiac Risk Diagnosis in Patients with Atrial Fibrilation
Aviva Lev-Ari, PhD, RN
4.5 Imágenes cardiovasculares: diagnóstico del estado de la enfermedad y determinación del curso del tratamiento
4.5 Cardiovascular Imaging: Diagnosing the Condition of the Disease and Determining Course of Treatment
4.5.1 Biomarcadores por imagen de la rigidez arterial: vías farmacoterapéuticas para el tratamiento de la hipertensión y la hipercolesterolemia
4.5.1 Imaging Biomarker for Arterial Stiffness: Pathways in Pharmacotherapy for Hypertension and Hypercholesterolemia Management
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.2 Evaluación combinada de la circulación coronaria: tomografía de coherencia óptica (TCO), espectroscopia de infrarrojo cercano (NIRS) y ecografía intravascular (EIV). Detección de la placa rica en lípidos y prevención del síndrome coronario agudo (SCA)
4.5.2 Coronary Circulation Combined Assessment: Optical Coherence Tomography (OCT), Near-Infrared Spectroscopy (NIRS) and Intravascular Ultrasound (IVUS) – Detection of Lipid-Rich Plaque and Prevention of Acute Coronary Syndrome (ACS)
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.3 Aplicaciones clínicas emergentes de la TC cardíaca: caracterización de la placa, funcionalidad de la SPECT, medición por angiograma no invasiva de la FFR
4.5.3 Emerging Clinical Applications for Cardiac CT: Plaque Characterization, SPECT Functionality, Angiogram’s and Non-Invasive FFR
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.4 Reserva de flujo fraccional (FFR) e índice diastólico instantáneo sin ondas (iFR): una evaluación de las herramientas del laboratorio de cateterismo (validación del software) para la evaluación de la isquemia (diagnóstico). Cambio paradigmático: el vaso ADECUADO, no TODOS los vasos
4.5.4 Fractional Flow Reserve (FFR) & Instantaneous wave-free ratio (iFR): An Evaluation of Catheterization Lab Tools (Software Validation) for Ischemic Assessment (Diagnostics) – Change in Paradigm: The RIGHT vessel not ALL vessels
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
4.5.5 Infarto de miocardio agudo y crónico: cuantificación de la viabilidad miocárdica – FDG-TEP/RM frente a solo RM o TEP
4.5.5 Acute and Chronic Myocardial Infarction: Quantification of Myocardial Perfusion Viability – FDG-PET/MRI vs. MRI or PET alone
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
Parte 5: Avances en el tratamiento de las enfermedades cardiovasculares
Part 5: Advances in Treatment of Cardiovascular Diseases
5.1 La vasculatura y el miocardio: diagnóstico del estado de la enfermedad
5.1 Vasculature and Myocardium: Diagnosing the Conditions of Disease
5.1.1 La eritropoyetina (EPO) y el hierro (Fe) intravenoso como tratamiento de la anemia en la ICC grave y resistente: la elevación de la fracción aminoterminal de pro-BNP como biomarcador
5.1.1 Erythropoietin (EPO) and Intravenous Iron (Fe) as Therapeutics for Anemia in Severe and Resistant CHF: The Elevated N-terminal proBNP Biomarker
https://pharmaceuticalintelligence.com/2013/12/10/epo-as-therapeutics-for-anemia-in-chf/
Larry H. Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
5.1.2 Afectan los nuevos anticoagulantes al TP/CIN? Los casos de XARELTO (rivaroxabán) o PRADAXA (dabigatrán)
5.1.2 Do Novel Anticoagulants Affect the PT/INR? The Cases of XARELTO (rivaroxaban) or PRADAXA (dabigatran)
Vivek Lal, MBBS, MD, F.Cl.R, Justin D Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
5.1.3 Diseños alternativos para el corazón artificial humano: pacientes con insuficiencia cardíaca. Resultados del trasplante (donante)/implante (artificial) y tecnologías de seguimiento del paciente con trasplante/implante en la comunidad
5.1.3 Alternative Designs for the Human Artificial Heart: The Patients in Heart Failure – Outcomes of Transplant (donor)/Implantation (artificial) and Monitoring Technologies for the Transplant/Implant Patient in the Community
Larry H. Bernstein, MD, FCAP, Justin D Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
5.1.4 Cirugía vascular: declaración de posicionamiento internacional y multidisciplinar sobre la colocación de stents en la carótida de 2013 y aportaciones de un cirujano vascular en el momento cumbre de su carrera, el Dr. Richard Paul Cambria
5.1.4 Vascular Surgery: International, Multispecialty Position Statement on Carotid Stenting, 2013 and Contributions of a Vascular Surgeon at Peak Career – Richard Paul Cambria, MD
Aviva Lev-Ari, PhD, RN
5.1.5 Indicación del trasplante cardíaco (TxC) en la insuficiencia cardíaca (IC): resultados del procedimiento e investigación sobre la IC y el TxC en dos de los principales centros de IC y TxC del país
5.1.5 Heart Transplant (HT) Indication for Heart Failure (HF): Procedure Outcomes and Research on HF, HT @ Two Nation’s Leading HF & HT Centers
Aviva Lev-Ari, PhD, RN
5.1.6 Eficacia de la revascularización endovascular de las extremidades inferiores: cirujanos vasculares (CV), cardiólogos intervencionistas (CI) y radiólogos intervencionistas (RI)
5.1.6 Endovascular Lower-extremity Revascularization Effectiveness: Vascular Surgeons (VSs), Interventional Cardiologists (ICs) and Interventional Radiologists (IRs)
Aviva Lev-Ari, PhD, RN
5.1.7 Indicaciones clínicas del uso del óxido nítrico inhalado (iNO) en el mercado de los pacientes adultos: resultados clínicos tras el uso, demanda del tratamiento y coste asistencial
5.1.7 Clinical Indications for Use of Inhaled Nitric Oxide (iNO) in the Adult Patient Market: Clinical Outcomes after Use, Therapy Demand and Cost of Care
Aviva Lev-Ari, PhD, RN
5.1.8 Cambio en el requisito de contar con respaldo quirúrgico durante una ICP según la AHA y la ACC: clase IIb → clase III, nivel de evidencia A. Justificación de la ICP no urgente sin equipo de cirugía cardiotorácica en el centro (cambio de clase IIb, nivel de evidencia B)
5.1.8 AHA, ACC Change in Requirement for Surgical Support for PCI Performance: Class IIb -> Class III, Level of Evidence A: Support Nonemergent PCI without Surgical Backup (Change of class IIb, Level of evidence B)
Justin Pearlman, MD, PhD, FACC and Larry H Bernstein, MD, FCAP
5.1.9 Tecnología de biomateriales: modelos de ingeniería tisular para la reperfusión y dispositivos implantables para la revascularización
5.1.9 Biomaterials Technology: Models of Tissue Engineering for Reperfusion and Implantable Devices for Revascularization
https://pharmaceuticalintelligence.com/2013/05/05/bioengineering-of-vascular-and-tissue-models/
Larry H Bernstein, MD, FACP and Aviva Lev-Ari, PhD, RN
5.1.10 Reparación vascular: stents e implantes bioactivos
5.1.10 Vascular Repair: Stents and Biologically Active Implants
Larry H Bernstein, MD, FACP and Aviva Lev-Ari, PhD, RN
5.1.11 Regeneración: sistema cardíaco (cardiomiogénesis) y vasculatura (angiogénesis)
5.1.11 Regeneration: Cardiac System (cardiomyogenesis) and Vasculature (angiogenesis)
https://pharmaceuticalintelligence.com/2014/01/15/regeneration-cardiac-system-and-vasculature/
Aviva Lev-Ari, PhD, RN
5.1.12 La lucha contra las enfermedades cardiovasculares ateroscleróticas: un agente biológico, no uno de molécula pequeña. La lecitina-colesterol-aciltransferasa humana recombinante (rhLCAT) propició la adquisición de AlphaCore por parte de AstraZeneca
5.1.12 Fight against Atherosclerotic Cardiovascular Disease: A Biologics not a Small Molecule – Recombinant Human lecithin-cholesterol acyltransferase (rhLCAT) attracted AstraZeneca to acquire AlphaCore
Aviva Lev-Ari, PhD, RN
5.1.13 Empleo de los nuevos actores en la ateroesclerosis para tratar las enfermedades cardíacas
5.1.13 Harnessing New Players in Atherosclerosis to Treat Heart Disease
Aviva Lev-Ari, PhD, RN
5.2 El papel del calcio en la salud y la enfermedad
5.2 The Role of Calcium in Health and Disease
5.2.1 El ciclo del calcio (bomba ATPasa) en la terapia génica cardíaca: terapia génica inhalable para la hipertensión arterial pulmonar e infusión intracoronaria percutánea para la insuficiencia cardíaca. Las aportaciones del Dr. Roger J. Hajjar. Parte VI
5.2.1 Calcium Cycling (ATPase Pump) in Cardiac Gene Therapy: Inhalable Gene Therapy for Pulmonary Arterial Hypertension and Percutaneous Intra-coronary Artery Infusion for Heart Failure: Contributions by Roger J. Hajjar, MD – Part VI
Aviva Lev-Ari, PhD, RN
5.2.2 Contractilidad cardíaca y función miocárdica: arritmias ventriculares e insuficiencia cardíaca no isquémica. Implicaciones terapéuticas de la rianodinopatía (disfunción contráctil relacionada con la liberación de calcio) y respuestas de catecolaminas. Parte VII
5.2.2 Cardiac Contractility & Myocardium Performance: Ventricular Arrhythmias and Non-ischemic Heart Failure – Therapeutic Implications for Cardiomyocyte Ryanopathy (Calcium Release-related Contractile Dysfunction) and Catecholamine Responses – Part VII
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
5.2.3 Los bloqueadores de los canales de calcio, la disfunción contráctil relacionada con la liberación de calcio (rianodinopatía) y el calcio como sensor de neurotransmisores. Parte IX
5.2.3 Calcium-Channel Blockers, Calcium Release-related Contractile Dysfunction (Ryanopathy) and Calcium as Neurotransmitter Sensor – Part IX
Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
5.3 Disfunción de la conducción y electrofisiología del corazón
5.3 Conduction Dysfunction and ElectroPhysiology of the Heart
5.3.1 Terapia de resincronización cardíaca (TRC) para el tratamiento de las arritmias: inserción de un marcapasos/desfibrilador cardioversor implantable (DCI)
5.3.1 Cardiac Resynchronization Therapy (CRT) to Arrhythmias: Pacemaker/Implantable Cardioverter Defibrillator (ICD) Insertion
Justin Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN
5.4 Imágenes cardiovasculares: diagnóstico del estado de la enfermedad y determinación del curso del tratamiento
5.4 Cardiovascular Imaging: Diagnosing the Condition of the Disease and Determining Course of Treatment
5.4.1 Sala cardiovascular 3D. Laboratorio de cateterismo/quirófano híbrido, cirugía híbrida, complicaciones tras la ICP y repetición de la esternotomía
5.4.1 3D Cardiovascular Theater – Hybrid Cath Lab/OR Suite, Hybrid Surgery, Complications Post PCI and Repeat Sternotomy
Aviva Lev-Ari, PhD, RN
Resumen del segundo volumen
Summary to Volume Two
Epílogo del segundo volumen
Epilogue to Volume Two
Investigación original cardiovascular:
casos de diseño de metodología para la selección de contenidos
El arte de la selección de contenidos científicos y médicos
(LIBRO 2 DE LA SERIE DE LIBROS ELECTRÓNICOS SOBRE BIOMEDICINA)
Cardiovascular Original Research:
Cases in Methodology Design for Content Co-Curation
Disponible en Amazon.com desde el 30/11/2015
http://www.amazon.com/dp/B018Q5MCN8
PART C: The Editorials of the original e-Books in
English in Audio format
Introduction to Volume Two
The Voice of our Content Consultant to Seven-Volume e-SERIES A: Cardiovascular Diseases:
Justin Pearlman, MD, PhD, FACC
The leading causes of death and disability involve the heart and blood vessels. The basic causes of disease are nature and nurture, i.e., genetic or epigenic predisposition (nature) versus behavior mediated exposures (nurture).
The full list of cardiovascular diseases stems quite simply from looking at all cardiovascular structures and functions, for each can have deviant design and/or function. Murphy’s law “what can go wrong will” does not entirely apply because many deviations are incompatible with life in the first place. Furthermore, the body has a limited number of ways that it responds.
Nonetheless, there is a wide variety of cardiovascular disease. The blood pressure can be too high (hypertension) or too low (hypotension). The heart can be too big (cardiomegaly) or too small (hypoplastic heart), too stiff (diastolic failure, restrictive cardiomyopathy, constrictive cardiomyopathy) or too soft (aneurysm). The heart can pump too much (high output failure) or too little (low output failure). The heartbeat rhythm may be too slow (bradycardia) or too fast (tachycardia). In addition to too much or too little, there are numerous other ways to invoke Murphy’s law. For example, there are hundred arrhythmias (abnormal rhythm mechanisms). Mechanisms for abnormal structure or function include: congenital, developmental, neoplastic, metabolic, inflammatory, infectious, extrinsic (injury), and degenerative.
Teleologically many of the genetic issues may be labeled “maladaptive” in the sense that in certain circumstances the genetically programmed organic functions cause more harm than benefit. For example, when a patient develops heart failure and reduces blood delivery to the kidneys, the kidneys fight back by retaining sodium desperately, and by sending signals to stimulate thirst. Whether or not it is “well-intended” the kidneys make the problem worse, as the retained salt water volume overloads the beleaguered failing heart, so the heart dilates and develops worsening mitral valve leakage, thus delivering even less forward to the kidneys, while in addition the lungs get wetter and struggle to take up sufficient oxygen. On the nurture side, the patient’s intake of salt has major impact on this harmful chain of events, which can be counteracted by disciplined behavior (salt restriction, optimal use of diuretics).
As we learn more about the details of the body’s signals and receptors, we can manufacture medications to counteract the “maladaptive genetics” as well as learn about additional behavior changes that may mitigate or even reverse each disease state. The reason for the quotation marks about “maladaptive genetics” is that the genetic and homeostatic systems may in fact be truly adaptive to the overriding population reproductive success that drives gene pool prevalence, as that drive may include promoting death of the elderly to make room for the young and not compete for their resources. Some of the most fascinating enigmas relate to the teleology of disease. For example, why do we have complex systems that disassemble circulating cholesterol lipoproteins only to reassemble them within the wall of blood vessels, where they lead to endothelial (vessel lining) disruption, thrombosis, and vessel occlusion. Such arterial wall damage is the leading mechanism of strokes and heart attacks.
As part of my PhD research, I documented that the lipids that cause hardening of arteries are liquid crystals which transition between solid and liquid at body temperature (37C) under the influence of the concentration of triglycerides. One could posit a protective effect against vessel dilation, at a large cost. Thus stroke and heart attack may be consequences of a defense mechanism gone awry (maladaptive defenses). Similarly, is inflammation a defense mechanism gone awry? Inflammation is a component of the damage to blood vessels, but patients who take an anti-inflammatory medication for more than 18 months have a 50% risk of developing a new arterial blockage. These are complex systems, and we simply do not know enough about them. As you read through the discoveries and ideas in the following sections, consider their value in clarifying many aspects of health and disease, including causation, assessment, management, and also edification of the complex systems, their purposes, as well as their “maladaptive” impact and the checks and balances.
On the Domain Universe of Volume Two
Curation, HealthCare System in the US, and Calcium Signaling Effects on Cardiac Contraction, Heart Failure, and Atrial Fibrillation, and the Relationship of Calcium Release at the Myoneural Junction to Beta Adrenergic Release
by Larry H. Bernstein, MD, FCAP
The Curation approach to the scientific document has advantages over the multiple authored textbooks that are and have been pervasive as a result of the traditional publication technology. It has been stated by the founder of ScoopIt, that amount of time involved is considerably less than required for the original publications used, but the organization and construction is a separate creative process.
In these curations we amassed on average five articles in one curation, to which, two or three curators contributed their views. There were surprises, and there were unfulfilled answers along the way. The greatest problem that is being envisioned is the building a vision that bridges and unmasks the hidden “dark matter” between the now declared “OMICS”, to get a more real perspective on what is conjecture and what is actionable. This is in some respects unavoidable because the genome is an alphabet that is matched to the mino acid sequences of proteins, which themselves are three dimensional drivers of sequences of metabolic reactions that can be altered by the accumulation of substrates in critical placements, and in addition, the proteome has functional proteins whose activity is a regulatory function and not easily identified. In the end, we have to have a practical conception, recognizing the breadth of evolutionary change, and make sense of what we have, while searching for more.
We introduced the content as follows:
- The concept of Curation in the digital context, and it’s application to medicine and related scientific discovery.
Topics were chosen were used to illustrate this process in the form of a pattern, which is mostly curation, but is significantly creative, as it emerges in the context of this e-book.
- Alternative solutions in Treatment of Heart Failure (HF), medical devices, biomarkers and agent efficacy is handled all in one chapter.
- PCI for valves vs Open heart Valve replacement
- PDA and Complications of Surgery — only curation could create the picture of this unique combination of debate, as exemplified of Endarterectomy (CEA) vs Stenting the Carotid Artery (CAS), ischemic leg, renal artery stenosis.
- The Etiology, or causes, of cardiovascular diseases consist of mechanistic explanations for dysfunction relating to the heart or vascular system. Every one of a long list of abnormalities has a path that explains the deviation from normal. With the completion of the analysis of the human genome, in principle all of the genetic basis for function and dysfunction are delineated. While all genes are identified, and the genes code for all the gene products that constitute body functions, there remains more unknown than known.
- Human genome, and in combination with improved imaging methods, genomics offers great promise in changing the course of disease and aging.
- If we tie together Part 2 and Part 3, there is ample room for considering clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go.
Curation
Curation is an active filtering of the web’s content and peer reviewed literature found by such means – immense amount of relevant and irrelevant content. As a result, content may be disruptive. However, in doing good curation, one does more than simply assign value by presentation of creative work in any category. Great content curators comment and share experience across content, authors and themes.
Great curators may see patterns others don’t, or may challenge or debate complex and apparently conflicting points of view. Answers to specifically focused questions comes from the hard work of many in laboratory settings creatively establishing answers to definitive questions, each a part of the larger knowledge-base of reference. There are those rare “Einstein’s” who imagine a whole universe, unlike the three blindmen of the Sufi tale. One held the tail, the other the trunk, the other the ear, and they all said this is an elephant!
In my reading, I learn that the optimal ratio of curation to creation may be as high as 90% curation to 10% creation. Creating content is expensive. Curation, by comparison, is much less expensive. The same source says “Scoop.it is my content marketing testing “sandbox”. In sharing, he says that comments provide the framework for what and how content is shared.
Healthcare and Affordable Care Act
We enter year 2014 with the Affordable Care Act off to a slow start because of the implementation of the internet signup requiring a major repair, which is, unfortunately, as expected for such as complex job across the US, and with many states unwilling to participate. But several states – California, Connecticut, and Kentucky – had very effective state designed signups, separate from the federal system. There has been a very large rush and an extension to sign up. There are many features that we can take note of:
- The healthcare system needed changes because we have the most costly system, are endowed with advanced technology, and we have inexcusable outcomes in several domains of care, including, infant mortality, and prenatal care – but not in cardiology.
- These changes that are notable are:
- The disparities in outcome are magnified by a large disparity in highest to lowest income bracket.
- This is also reflected in educational status, and which plays out in childhood school lunches, and is also affected by larger class size and cutbacks in school programs.
- This is not helped by a large paralysis in the two party political system and the three legs of government unable to deal with work and distraction.
- Unemployment is high, and the banking and home construction, home buying, and rental are in realignment, but interest rates are problematic.
- The medical care system is affected by the issues above, but the complexity is not to be discounted.
- The medical schools are unable at this time to provide the influx of new physicians needed, so we depend on a major influx of physicians from other countries
- The technology for laboratories, proteomic and genomic as well as applied medical research is rejuvenating the practice in cardiology more rapidly than any other field.
- In fields that are imaging related the life cycle of instruments is shorter than the actual lifetime use of the instruments, which introduces a shortening of ROI.
- Hospitals are consolidating into large consortia in order to maintain a more viable system for referral of specialty cases, and also is centralizing all terms of business related to billing.
- There is reduction in independent physician practices that are being incorporated into the hospital enterprise with Part B billing under the Physician Organization – as in Partners in Greater Boston, with the exception of “concierge” medical practices.
- There is consolidation of specialty laboratory services within state, with only the most specialized testing going out of state (Quest, LabCorp, etc.)
- Medicaid is expanded substantially under the new ACA.
- The federal government as provider of services is reducing the number of contractors for – medical devices, diabetes self-testing, etc.
- The current rearrangements seeks to provide a balance between capital expenses and fixed labor costs that it can control, reduce variable costs (reagents, pharmaceutical), and to take in more patients with less delay and better performance – defined by outside agencies.
Cardiology, Genomics, and calcium ion signaling and ion-channels in cardiomyocyte function in health and disease – including heart failure, rhythm abnormalities, and the myoneural release of neurotransmitter at the vesicle junction
It is increasingly clear that there are mutations that underlie many human diseases, and this is true of the cardiovascular system. The mutations are mistakes in the insertion of a purine nucleotide, which may or may not have any consequence. This is why the associations that are being discovered in research require careful validation, and even require demonstration in “models” before pursuing the design of pharmacological “target therapy”. The genomics in cardiovascular disease involves very serious congenital disorders that are asserted early in life, but the effects of and development of atherosclerosis involving large and medium size arteries has a slow progression and is not dominated by genomic expression. This is characterized by loss of arterial elasticity. In addition, there is the development of heart failure, which involves the cardiomyocyte specifically. The emergence of regenerative medical interventions, based on pleuripotent inducible stem cell therapy is developing rapidly as an intervention in this sector.
Part 2: Cardiovascular Disease: Predicted Cost of Care and the Affordable Care Act
The voice of Series A Content Consultant, Justin D Pearlman, MD, PhD, FACC
This Section addresses the burgeoning cost of cardiovascular health care and the role of the Affordable Care Act.
There is no denying the rising costs of healthcare, with key cardiovascular examples documented herein. Nor can anyone effectively deny potential gains from changes in American Healthcare, many of which the Affordable Care Act had intended to improve. Key aspects include promotion of prevention, improved widespread timely access to care and improved compliance with prevention. This section aims to sidestep the partisan politics to highlight reasons for healthcare change and reasons for contentions about the current and planned changes.
The main reasons for change are that our healthcare system has been on a non-sustainable course of increase in its portion of the gross national product as well as its portion of family budgets, and despite its escalating expense numerous measures of net public as well as personal benefit rank low. Furthermore, there is general agreement on a level of publicly supported safety net, at least for the elderly and for children, and that support is on a course towards bankruptcy. Also, it is widely recognized that the safety net should not rely as heavily as it has on expensive emergency department care. Also, there were unfair practices such as an insurance company dropping coverage after a patient became seriously ill. There are also ideologic arguments, that government is better or worse than a competitive private sector at administering efficient fair protection. Private enterprise is expected to place profits first, but satisfaction of each additional customer is generally favored, whereas politicians arguably are influenced by their ability to win over 51% of the population just before elections and their ability to garner major campaign contributions which may favor special interests. Businesses that are regulated to be transparent generally cannot cater to special interest funding the way politicians can. Hence one of the major arguments is why insurance cannot be an open competition across the entire country, or possibly world-wide, to drive down prices. As an alternative to requiring nation-wide insurance coverage, consider regulation to get rid of the group bundling advantage altogether (require that all service providers must price match the lowest they offer without regard to “insurance”). As another alternative to insurance, convert healthcare cost coverage to a long-term loan and cap the “insurance agency premium” to a shrinking percentage so that “insurance” becomes an unnecessary value-added service analogous to concierge parking).
Major areas of contention include who and how to measure and control healthcare costs, the role of individual responsibility and individual freedom versus overriding public interests, the merits and demerits of government control of choices, the role of insurance, and the full impact of changes (however well-intended) on health care delivery, choices, employment and the cost of doing business.
There are many aspects of these issues that are prone to confusion and manipulation. For example, the cost of healthcare includes the cost of development of new and improved methods of prevention, diagnosis, and disease management. The United States has long shoulder a large share of that development cost for the entire world, then lets other countries get bulk purchase discounts on the product, while Americans pay top dollar.
The total costs of healthcare can rise as the scope of opportunities to intervene expands with new discoveries, but that can be offset by improvements in efficiency and prevention. When estimating costs, include the role of investment in the future, return on that investment, and the impact of healthcare changes on revenue, employment, and prevention.
It is vital to our future to consider fully not only the wishful thinking upsides but also the downsides of every proposal. Halting the rise in the cost of healthcare can mean shackling innovation and progress. The new tax on medical devices has that impact. The innovations that are curtailed could have been contributors to our gross national product, stimulating revenues, employment, and exports. If cost of development goes up in the United States, developments may ship overseas or stagnate (or both), and we may end up paying more to other countries for the technology that would have been a home-grown revenue path.
The issue of individual freedom versus overriding public interest is manifest in the legality of tobacco use, its increased taxation, and the legality and illegality of many other means of self-harm. To the extent that the government pays for the costs of the harm, it can invoke a public interest in preventing the choices that promote harm. Those issues have led to the arguments supporting limitation on the size of your drinks, limiting your access to salt and sugar, and suggested penalties for obesity and so on, which subjugate choice in pursuit of attempts to reduce public support burdens. Curtailment of individual choice risks imposing “typically beneficial” choices on individuals who may not fit the mold and may actually be harmed. For example, in addition to people who develop or worsen hypertension or heart failure due to excess sodium intake. There are people who need elevated sodium intake to prevent postural hypotension and syncope. We are all genetically different. Policies aim for the typical often to the detriment of variants.
The ideas of a “universal insurance” or a “mandated insurance” have implicitly redefined what insurance really means. Insurance originated as a means of distributing actual risk, such that 100 fishermen, for example, might contribute to a joint fund to replace a fishing boat in case one sinks. Someone with no interest in fishing had very little interest in buying a share of such a fund. Individual choice enabled risk sharing over virtually anything, such that Jordan’s Furniture of Boston could make a giveaway deal with customers dependent on future Red Sox game play, and buy insurance to cover the risk of a fluke season that might create exorbitant expenses of honoring the deal with fans. Similarly, oil companies could get support for risky ventures with insurance to defray the low likelihood high costs of failures or reparations. Insurance enables a small entity to participate at an affordable cost when the deep pockets needed for contingencies would otherwise be prohibitive. The Affordable Care Act removed risk as a factor in healthcare “insurance” and spread the cost of healthcare expenses to include many people at minimal or no risk (for example, men paying for gynecologic costs and elderly paying for birth control coverage). The implicit change technically does not qualify any more as insurance but rather as a new tax to cover the cost of a distributed health benefits system, so declared by the Supreme Court. Why should such a system have any linkage at all to employment? Should change of employer result in change of coverage and thereby potential requirements to change physicians? Should such a system block people from the original benefits of insurance, i.e., choosing a level of risk reduction and benefits suited to the individual choices and concerns? Should all citizens be forced to focus on health as the same level of priority? In that case, it may become reasonable to block someone from working “too hard,” require no more than part time work for all, and block people from employments that pose elevated risks.
To keep a perspective, consider as an alternative means of health safety net a requirement that every hospital would provide space and support, and every pharmacist, nurse, physician, medical administrator and technologist as well as pharmacies and medical equipment companies would contribute a portion of time and resources to a free care safety net system with no overhead of paperwork for qualifications, a lawsuit free zone, that would address the basics of prevention and management of prevalent conditions such as obesity, diabetes, hypertension and heart failure, at near zero cost to taxpayers, with pairing of providers for quality control instead of government oversight or threat of lawsuit. This safety net could be independent of health savings accounts or insurance policies for additional care coverage suitable to the individuals interests and choices. Contrast that with a system that requires layers of investment in non-medical support of a new system that includes expansion of the internal revenue service as administrators of taxes guised as penalties to the healthy who legally evade paying for a medical service they don’t feel they need (the Affordable Care act does not in fact require insurance, rather it modifies tax according to coverage).
Regarding specific controversies, consider the delay of requirement for specific companies but not for small businesses or the public, exemptions for the White House, Supreme Court and Congress, and consider the presumably unintended consequence of driving companies to limit the number of employees and curtail full time employment in favor of more people with partial employment and fewer benefits (promoting a “part time society”). Also consider the leveling impact of government which some feel punishes extraordinary care and promotes game-players delivering cheap mediocre care focused on the government measures instead of the patient. The government has suggested linking payments to outcomes, but that is subject to patient selection bias and gamesmanship. Also consider the medium- and long-term impact of curtailing physician incomes such that those with highest skill will benefit from switching professions or countries. The Affordable Care Act includes making it ILLEGAL to provide free care that might be a competition to Medicare, and it provides specific punishment to physicians who are outliers for any reason (there are cases claiming they were punished for seeing high numbers of Medicare patients, for NOT charging, or were subject to fines for being more efficient than their peers). As a specific issue from the new laws that some deem contra-productive, cardiology intervention centers recently have been levied hefty new fines for catheterization of more patients than the median number for the size of their community.
What are the best methods of maintaining checks and balances to avoid abuses, promote low-cost health and provide a reasonable safety net for all Americans? Is “insurance” really the best way to reign in the cost factor? Do we require government takeover of healthcare? Should the safety net pay for all illegals? Should it not include personal responsibility regarding self-inflicted injuries? Should it require means testing, at the expense of a burgeoning administration layer? Should everyone pay to maximize the health of those who abuse their health? Can we have a distinction between safety net care and our entire healthcare system? Is it really reasonable to have no caps on the cost of care for an individual at the expense of curtailing benefits to the majority (for example, unlimited expenditure for a non-curable permanently unconscious child thereby reducing funds to help hardworking adults)? This is by no means an exhaustive list of the controversies. It is a strong argument for continued analysis of actual as opposed to desired impact of legislation, greater participation at the helm of people trained in health care, greater transparency and openness to alternative solutions.
Are there viable alternatives? How about generating a safety net completely independent of insurance, by requiring every hospital to provide 5% of space to free care, and 5% time from each nurse, doctor, technician, 5% of production from each medical equipment manufacturer and each pharmaceutical company, in a liability-free zone policed by independent double coverage instead of burdensome documentation, with virtually no overhead costs and no government funding or tax payer costs. How about the government contribution simplified to (a) enforcement of transparency, (b) provision of a secure world-wide database controlled by the patient to receive every report and enable access to a caretaker on a permission and as needed basis (to substantially alleviate duplicate testing, data access difficulties, and current need to regenerate patient information frequently from scratch), and (c) patient rights and patient education to improve appropriate basis for selection and reward of efficient quality services.
Introduction to Part 2
Larry H Bernstein, MD, FCAP
The Cost to Value Conundrum in Cardiovascular Healthcare Provision
Author: Larry H. Bernstein, MD, FCAP
Volume 2 of the e-series on Cardiovascular Diseases curates the basic structure and physiology of the heart, the vasculature, and related structures, e.g., the kidney, with respect to:
- Pathogenesis
- Diagnosis
- Treatment
Curation is an introductory portion to Volume Two, which is necessary to introduce the methodological design used to create the following articles. More needs not to be discussed about the methodology, which will become clear, if only that the content curated is changing based on success or failure of both diagnostic and treatment technology availability, as well as the systems needed to support the ongoing advances. Curation requires:
- meaningful selection,
- enrichment, and
- sharing combining sources and
- creation of new synthesis – the most important contribution of the curator’s role
Curators have to create a new perspective or idea on top of the existing media which supports the content in the original. The curator has to select from the myriad upon myriad options available, to re-share and critically view the work. A search can be overwhelming in size of the output, but the curator has to successfully pluck the best material straight out of that noise.
Part 2 is a highly important treatment that is not technological, but about the system now outdated to support our healthcare system, the most technologically advanced in the world, with major problems in the availability of care related to economic disparities. It is not about technology, per se, but about how we allocate healthcare resources, about individuals’ roles in a not full list of lifestyle maintenance options for self-care, and about the important advances emerging out of the Affordable Care Act (ACA), impacting enormously on Medicaid, which depends on state-level acceptance, on community hospital, ambulatory, and home-care or hospice restructuring, which includes the reduction of management overhead by the formation of regional healthcare alliances, the incorporation of physicians into hospital-based practices (with the hospital collecting and distributing the Part B reimbursement to the physician, with “performance-based” targets for privileges and payment – essential to the success of an Accountable Care Organization (AC)). One problem that ACA has definitively address is the elimination of the exclusion of patients based on preconditions. One problem that has been left unresolved is the continuing existence of private policies that meet financial capabilities of the contract to provide, but which provide little value to the “purchaser” of care. This is a holdout that persists in for-profit managed care as an option. A physician response to the new system of care, largely fostered by a refusal to accept Medicaid, is the formation of direct physician-patient contracted care without an intermediary.
In this respect, the problem is not simple, but is resolvable. A proposal for improved economic stability has been prepared by Edward Ingram. A concern for American families and businesses is substantially addressed in a macroeconomic design concept, so that financial services like housing, government, and business finance, savings and pensions, boosting confidence at every level giving everyone a better chance of success in planning their personal savings and lifetime and business finances.
Part 3: Causes of Cardiovascular Diseases
Introduction to Part 3
Larry H Bernstein, MD, FCAP
The etiology, or causes, of cardiovascular diseases consist of mechanistic explanations for dysfunction relating to the heart or vascular system. Every one of a long List of Abnormalities has a path that explains the deviation from normal. With the completion of the analysis of the human genome, in principle all of the genetic basis for function and dysfunction are delineated. While all genes are identified, and the genes code for all the gene products that constitute body functions, there remains more unknown than known. In part, the discrepancy is due to additional factors such as regulation of gene expression, post transcriptional modifications of gene products, and complex interactions. In addition, we do not have complete characterization of deviations from normal function, nor do we have a very well-developed ability to modify the genes, gene products, complex interactions. We also have limitations in evaluating the impact of interventions intended either to correct a flaw, or compensate for it. Never-the-less, the story starts with the human genome, and in combination with improved imaging methods, genomics offers great promise in changing the course of disease and aging.
Part 3 is a collection of scientific articles on the current advances in cardiac care by the best trained physicians the world has known, with mastery of the most advanced vascular instrumentation for medical or surgical interventions, the latest diagnostic ultrasound and imaging tools that are becoming outdated before the useful lifetime of the capital investment has been completed.
If we tie together Part 2 and Part 3, there is ample room for considering clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go. Why should this be? Because for generations of IT support systems, they are historically focused on billing and have made insignificant inroads into the front-end needs of the clinical staff.
The Role of Calcium in Health and Disease
Introduction by Larry H. Bernstein, MD, FCAP
It is incumbent on me to call attention to the huge contribution that research on calcium (Ca2+) signaling has made toward the understanding of cardiac contraction and to the maintenance of the heart rhythm. The heart is a syncytium, different than skeletal and smooth muscle, and the innervation is by the vagus nerve, which has terminal endings at vesicles which discharge at the myocyte junction. The heart specifically has calmodulin kinase CaMK II, and it has been established that calmodulin is involved in the calcium spark that triggers contraction. That is only part of the story. Ion transport occurs into or out of the cell, the latter termed exostosis. Exostosis involves CaMK II and pyruvate kinase (PKC), and they have independent roles. This also involves K+-Na+-ATPase. The cytoskeleton is also discussed, but the role of aquaporin in water transport appears elsewhere, as the transport of water between cells. When we consider the Gibbs-Donnan equilibrium, which precedes the current work by a century, we recall that there is an essential balance between extracellular Na+ + Ca2+ and theintracellular K+ + Mg2+, and this has been superceded by an incompletely defined relationship between ions that are cytoplasmic and those that are mitochondrial. The glass is half full!
Part 4: Risks and Biomarkers for Cardiovascular Diseases
Introduction
Larry H Bernstein, MD, FCAP
Biomarkers are biologic indicators of the status, severity, mechanism or genetic predisposition to disease, typically consisting of a test for the concentration of a protein or chemical. Many of the biomarker tests use antibodies (biologic molecules designed to match the biomarker like a glove), linked to production of a color signal so that color intensity reports concentration (prevalence of the marker). The completion of the human genome map means that all candidate precursors are known in principle. The genetic map is not the whole story, because the rate of production (translation) from the genetic map and the post-translational modifications as well as the distribution and clearance rates (destruction, transport) all play important roles.
There are many roles for biomarkers:
- risk assessment
- disease status
- mechanism of injury
- severity of disease
- response to interventions. The following addresses a small set of examples from an exhausting list of biomarkers.
Part 5: Advances in Treatment of Cardiovascular Diseases
Introduction
Justin D Pearlman, MD, PhD, FACC
When a patient presents to an emergency room with reduced exertion tolerance and other symptoms suggestive of heart attack, the urgent issue is to identify whether or not there is an imminent risk of permanent and progressively on-going muscle damage. If the electrocardiogram shows diagnostic elevations (STEMI) then emergency intervention is generally vital, embodied by the expression “time is muscle.”
The term “chest pain” is widely used, but we teach patients that it is a convenience phrase but it does not have to be in the chest and it does not have to be pain. There is a wide range of symptoms that qualify as “chest pain” including pressure in the chest, neck, left arm or jaw, a sense of oppression or doom, squeezing, or other symptoms above the waist that may correspond to personalized symptoms of inadequate blood supply to the heart.
When a threat to the heart is identified, the next step is to activate an “acute coronary syndrome” (ACS) protocol which aims to abort thrombosis and promote improved blood delivery to the impaired region of the heart.
In some cases the propensity to form a thrombus (blood clot) contributing to impairment of blood delivery to a part of the heart is chronic. After stent placement, medications to impede the contribution of platelets to thrombosis is a standard treatment (aspirin, and typically for the first two years after stent placement other anti-platelet agents), but there is a growing interest in anticoagulants (the fibrinous spider-web like component of thrombosis). This matter is addressed in our article: Do Novel Anticoagulants Affect the PT/INR?
Conduction Dysfunction and ElectroPhysiology of the Heart
The voice of our Series A Content Consultant: Justin D Pearlman, MD, PhD, FACC
Therapeutic intervention in cardiovascular disease comprises numerous avenues including genetic manipulation, pharmaceuticals, electric and mechanical devices, and physiologic manipulations as well as emotional and logistic support.
The opportunities to halt progression, mitigate and even reverse harm take many forms: replace missing signals, suppress excessive signals, provide genes and/or cells to replace or repair damage, compensate for over or under activity with complementary functions, or intervene electrically and/or mechanically. While it is often quite effective to intervene at the source of a problem, effective treatments have often been devised that act downstream from the cause, interrupting or countermanding some aspect of the cascade of consequences. For example, ion channels may cause sinus arrest, leading to failure to activate heart contractions in a timely fashion. Pacemakers do not correct the malfunctioning sinus node, but rather act downstream to provide an alternative means to activate timely heart contractions. Currently pacemakers do not aim to bridge into the specialized conduction system of the heart, rather they directly activate distal muscle. Consequently the activation sequence is distinct and is not as well synchronized, resulting in a wobbling motion of the heart called dysynchrony. In extreme, the distinct activation pattern of dysynchrony can lower the effectiveness of each heart beat (reduced stroke volume and reduced ejection fraction). More advanced pacemakers initiate contraction from two different locations (left and right ventricle) at staggered times aimed to produce a more synchronized net contraction timing. If a patient has an intact specialized conduction system, pacing to activate that system produces a more normal synchronized contraction of heart muscle. Atrial pacemakers have that effect, but often disease requiring pacemakers includes not only sinus node dysfunction but also abnormal conduction. Theory has to be tested to evaluate reliability and extent of benefit. Solutions that cover a wide range of abnormalities are generally easiest to apply, whereas solutions that are very specific often have better results.
As the mysteries of the human genome products are unraveled, we learn more and more about key components. As we learn more details about the controlling biologic functions we can expand our ability to manipulate them, predict the consequences, and identify new and possibly more effective or more efficient means to promote an improved outcome.
Summary to Volume Two
Voice of Justin D Pearlman, MD, PhD, FACC
This volume introduces a fresh look at keeping abreast of cardiovascular disease. In particular it explains and exemplifies the how and why of curation as a methodology for discourse. Curation is designed to edify and facilitate awareness and cohesive access to biomedical knowledge otherwise buried in subspecialty scientific journals in the Life Sciences and Medicine. Particular themes of focus include discovery, innovation and translation to clinical care, including linkages and underpinnings that might otherwise be mislabeled as esoteric. Key components of curation include expert identification of data, ideas and innovations of interest, expert interpretation of the original research results, integration with context, digesting, highlighting, correlating and presenting in novel light.
Three aspects of curation are notable:
(1) self-driven analytic reviews by a content expert,
(2) exciting topics assigned to an expert curator for analytic coherent fusion,
(3) teamwork of multiple experts on a focused theme, complementing each other’s contributions by weaving distinct threads.
Examples presented included review of electro-mechanical coupling and action potential, the roles of calcium redistribution in biology, the roles of biomarkers, healthcare and the Affordable Care Act, the human genome as basis for cardiovascular diseases, and the evolution of treatment options to manage cardiovascular diseases. These examples of Curation demonstrate added value of curation over traditional stand-alone single author or multi-author research reports and review articles.
The superstructure of curations includes multiple additional creative elements:
- eTOCs – electronic table of contents: fresh thought-provoking organizing themes link a path to a diverse trail of publications (analogous to creating a path in the forest)
2. Extracts highlighting notable elements of publications that mark a path
3. Voice of Expert commentary providing context and direction
The Electronic Table of Contents (eTOCs) serves several functions:
1. eTOCs collates information from multiple sources into coherent themes
2. eTOCs enables multiple pathways to information, including both Longitudinal and cross-sectional organizational themes.
3. eTOCs presents nested pathways through the forest, including nesting of topics by overreaching theme, chapters, Curations, reports and references.
4. eTOCs assemblies of thought provide fresh vistas that promote innovation and rethinking
In ekistics (urban design) Francis Bacon emphasized the importance of pathways linked to purpose, recommending a landmark magnet as an attractor for pursuits along a created path. Analogously, if the continually expanding collective knowledge embodied in subspecialty publications represents a forest of data and ideas, then Curation creates pathways in that forest that serve not only to keep the reader from getting lost, but also, as recommended by Francis Bacon, creates pathways that serve attractive purposes, with special vistas, highlights, themes, coherence, motivations and purposes.
CONTEXT (for each, Causes, Risks, Biomarkers and Therapeutics):
- Volume One: Perspectives on Nitric Oxide in Disease Mechanisms
- Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation
- Volume Three: Etiologies of Cardiovascular Diseases – Epigenetics, Genetics & Genomics
- Volume Four: Therapeutic Promise: Cardiovascular Diseases, Regenerative & Translational Medicine
- Volume Five: Pharmaco-Therapies for Cardiovascular Diseases
- Volume Six: Interventional Cardiology, Cardiac Surgery and Cardiovascular Imaging for Disease Diagnosis and Guidance of Treatment
Epilogue to Volume Two
Aviva Lev-Ari, PhD, RN, Editor-in-Chief, BioMed e-Series of e-Books
Part 1: Curation is another Methodology for Creation of Scientific Knowledge.
OPINION LEADERSHIP: We are developers of new methodologies for Research Finding exposition and dissemination
The Curation process involves development of numerous avenues for exposition of the scientific product and its dissemination, among them:
- scientific articles on Scientific Journals,
- Books, e-Books
- Addresses by Leader Scientists,
- multimedia presentations (Audio and Video),
- Expert Panel Discussions,
- Correspondence among Scientists,
- archive of experiment results, thematic Literature surveys,
- Libraries of Open-Source Code,
- Comprehensive Thematic Bibliographies,
- Shareable Libraries of Annotated Genomics Research
In our curations we have used several from the above list. We take great pride in our presentations of critiques and synthesis of research results. We represent one alternative to Academic Publishing. Instead of divergence into millions of publications per year, we focus on the Frontier, we select several seminal articles and aggregate the outcomes, their significance in context and creatively we identify interrelations not included in each of the components of the assembly.
Part 2: Cardiovascular Diseases – Predicted Cost of Care and the Affordable Care Act
- Cost of Care for Cardiovascular Medical Diagnoses
- Impact of 2013 HealthCare Reform in the US
- Patient Protection and Affordable Care Act Featured at RAND
OPINION LEADERSHIP: We identify the potential of Cardiac Regeneration to be the frontier for Cardiovascular Disease near-cure
On Cardiac Regeneration, Prof. Anthony Rosenzweig wrote in Science 21 December 2012
In the United States, heart failure afflicts about 6 million people (1), costs $34.4 billion each year (2), and is now the single most common discharge diagnosis in those over 65 (3). Although enormous progress has been made in managing acute cardiovascular illnesses such as heart attacks, many patients go on to develop late sequelae of their disease, including heart failure and arrhythmia. Thus, the growing number of these patients in some ways represents a burden of our success. It also reflects the incomplete success of most current therapies, which mitigate and manage but do not cure the disease.
https://www.sciencemag.org/content/338/6114/1549.summary
OPINION LEADERSHIP: We identify ACCESS to HealthCare Services to be the cardinal factor of success for the Affordable Care Act (ACA).
On January 10, 2014 Jonathan Cohn wrote in the New Republic: The Kids Are Alright: Another Obamacare Lesson from Massachusetts
It’s going to take insurers a few months, at least, to figure out exactly what kind of customers their plans are attracting. That’s focused attention on the one variable that can be measured now: Age.
Youth is not be the same thing as health. A 33-year-old with diabetes will run up bigger physician and drug bills than a 61-year-old with no serious medical problems. But, as a general rule, younger means healthier. And the early numbers haven’t seemed that encouraging.
Overall, according to a study by the Kaiser Family Foundation, about 40 percent of the people who could eventually buy coverage through Obamacare marketplaces are between the ages of 18 and 34. But, as of December, just 22 percent of the people signing up for coverage in California were in that demographic. Other states reported similar data. The federal government hasn’t yet provided an age breakdown for people getting insurance through healthcare.gov, the website it operates on behalf of 36 other states. But it will probably provide that information soon. When it does, the numbers may not look any better.
Is this a big deal? One way to answer that question is by looking at the best test case available: Massachusetts, which introduced a similar reform scheme in 2007. Thanks to analysis from Jonathan Gruber, the MIT economist who was an architect of both the Massachusetts and federal reforms, we know that enrollment was slow to get rolling in Massachusetts—and that, relatively speaking, healthy people came into the system late. Now Gruber has done a new analysis, breaking down enrollment specifically by age, and provided it to the New Republic.
The graph above tells the story. Over the course of the first year, the proportion of young people (in this case, ages 19 to 34) who had obtained health coverage through the Massachusetts insurance exchange grew. In other words, they were more likely to sign up late.
The precise figures don’t mean a lot, in part because the Massachusetts analogy is hardly perfect. John Sexton of Breitbart (yes, that Breitbart) has written about some of the key distinctions. But the trend is pretty clear—and, according to Gruber, it provides some important lessons. “These data aren’t 100 percent predictive for every state, most importantly because of differences across states in the share of the potential market that is young,” Gruber says. “But these facts highlight two things. First, you don’t need a huge/majority share of enrollees to be young for markets to function well. Second, the young tend to wait to sign up until closer to the deadline.
Obamacare could obviously unfold differently, with plenty of variation from state to state. In some places, participation among the young might not rise the way it did in Massachusetts—or, at least, it might not reach the same levels. But that doesn’t mean those states are destined for an insurance “death spiral,” in which carriers jack up rates so high that only the very sick stay in the system.
http://www.newrepublic.com/node/116173/print
Part 3: Causes of Cardiovascular Diseases
- Human Genome: Congenital Etiological Sources of Cardiovascular Disease
- The Role of Calcium in Health and Disease
- Vasculature and Myocardium: Diagnosing the Conditions of Disease
OPINION LEADERSHIP: We identify two pivotal research directions in the effort to understand the Etiology of Cardiovascular Diseases
- The Research Frontier on Cardiac Regenerationby Anthony Rosenzweig, M.D.
Professor of Medicine, Beth Israel Deaconess Medical Center on Cardiac Regeneration and How does Excercise help the Heart
1.1 Regeneration: Cardiac System (cardiomyogenesis) and Vasculature (angiogenesis)
This article represents the FRONTIER on Cardiac Regeneration as developed by Anthony Rosenzweig in Science 338, 1549 (2012).
Point #1: Current Pharmacotherapy for Cardiovascular Diseases and Heart Failure
Point #2: Dynamic model for the Adult heart capacity for cardiomyogenesis to compensate for losses occurring in heart failure: recognition of even limited regenerative capacity in the heart
Point #3: Results of Multiple Cell Therapy Clinical Trials
Point #4: The Endogenous Regeneration Potential
Point #5: On pathways regulating cardiomyocyte regeneration in animal models
Point #6: Prof. A. Rosenzweig’s Summary and His Future Outlook of Cardiac Regeneration
Detailed, below is Point #6: Prof. A. Rosenzweig’s Summary and His Future Outlook of Cardiac Regeneration
- We are still relatively early in the development of new approaches to cardiovascular disease. It will be some time before we know the conclusion of what will likely be a long and challenging road ahead.
- Almost as challenging is conveying to patients and policymakers an appropriate perspective that balances unmitigated enthusiasm for the scientific discoveries, cautious optimism for the broader implications, and humble acknowledgmentthat though even the most appealing ideas may fail, there is only one way to find out.
1.2 Cardiology Research – How does exercise help the heart?
Anthony Rosenzweig, M.D. Professor of Medicine, Beth Israel Deaconess Medical Center
We are interested in why the heart fails. Heart failure is an enormous and growing cause of death and disability throughout the world. In addition, the heart provides a model system for studying fundamental cellular processes from cell growth and programmed death, to cell-lineage determination and regeneration. Recently we’ve been interested in understanding how exercise protects the heart against heart failure. A variety of high throughput profiling techniques are being used to identify pathways differentially regulated in heart growth associated with exercise in comparison to the heart growth that precedes heart failure. A recently identified transcriptional pathway involved C/EBPβ and CITED4 not only reproduces many of the effects of exercise and protects the heart from heart failure, but appears to enhance the heart’s regenerative capacity (Bostrom et al Cell, 2010). In vivo gain- and loss-of-function models are being used to explore the functional effects and molecular mechanisms of this pathway in more detail. Other ongoing studies are investigating cardiac micro-RNAs regulated by exercise and their potential protective effects in the heart.
http://connects.catalyst.harvard.edu/Profiles/display/Person/10161
- Biology of the Nucleus and Gene Expression@ Spiegelman Lab, Harvard Medical School
- Transcriptional Basis of Energy Metabolism
- Regulation of Fat Cell Differentiation
- Metabolic Control through the PGC-1 Coactivators
- Chemical Biology of the PGC-1 Coactivators
Exercise induces hippocampal BDNF through a PGC-1α/FNDC5 pathway. Cell Metab.
Part 4: Risks and Biomarkers for Cardiovascular Diseases
OPINION LEADERSHIP: We identify as fruitful area of further study –
- Genetic Determinants of Potassium Sensitivity and Hypertension. Integrated Computational and Experimental Analysis of the Neuroendocrine Transcriptome in Genetic Hypertension Identifies Novel Control Points for the Cardiometabolic Syndrome
- Essential hypertension, a common complex disease, displays substantial genetic influence. Contemporary methods to dissect the genetic basis of complex diseases such as the genome-wide association study are powerful, yet a large gap exists betweens the fraction of population trait variance explained by such associations and total disease heritability.
- There are many roles for biomarkersto be subject for further research:
- risk assessment
- disease status
- mechanism of injury
- severity of disease
- response to interventions
The following topics address a small set of examples from an exhausting list of biomarkers:
- The Role of Calcium in Health and Disease
- Vasculature and Myocardium: Diagnosing the Conditions of Disease
- Conduction Dysfunction and ElectroPhysiology of the Heart
- Cardiovascular Imaging: Diagnosing the Condition of the Disease and Determining Course of Treatment
Part 5: Advances in Treatment of Cardiovascular Diseases
- Vasculature and Myocardium: Diagnosing the Conditions of Disease
- The Role of Calcium in Health and Disease
- Conduction Dysfunction and ElectroPhysiology of the Heart
- Cardiovascular Imaging: Diagnosing the Condition of the Disease and Determining Course of Treatment
OPINION LEADERSHIP: We identify the frontier of Treatment for Cardiovascular diseases to embrace potentially the following trends:
Sources of Evidence in Identifying Risk Factors for Cardiovascular Disease will continue to be derived from a combination of research methodologies:
- Basic research
- Epidemiological research
- Descriptive
- Analytical
- Observational
- Case-control studies
- Cohort studies
- Randomized trials
Physical Activity:
- Cumulative long-term PA has a protective effect on incidence of all-cause and CVD-attributable mortality compared with long-term physical inactivity.
- In men, but not women, long-term PA also appears to have a protective effect on incidence of CVD.
Is it Hypertension or Physical Inactivity: Cardiovascular Risk and Mortality – New results in 3/2013
Heart doi:10.1136/heartjnl-2012-303461
Cardiovascular Imaging:
Comparison of the longitudinal, radial, circumferential, rotational and torsional mechanics of the left ventricle (LV) in patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), and detect the new quantitative parameters to differentiate CP and RCM using two-dimensional speckle tracking imaging (2-D STI) method. Torsion, longitudinal and radial strain measured by 2-D STI method can provide useful information to differentiate CP and RCM.
http://heart.bmj.com/content/97/Suppl_3/A210.2.abstract
Pharmacotherapy:
Increase in use of Biological Based Therapy (BBT) among cardiovascular patients to avoid side effects of prescription drugs.
In recent years, the interest of using Biological Based Therapy (BBT) in disease management has increased dramatically in the medical and layman communities. The amount of valid scientific research in this area of therapy continues to increase. Yet, there are still many unknowns concerning BBT, especially in the area of adverse effects and drug interactions. The finding of a high prevalence of BBT (47.5%) use among cardiovascular patients and the lack of communication between patients and their physicians/pharmacists should be addressed by the health care community. Higher education level, as shown in the present study and other previous investigations [1,3,6,22], is associated with an increased use of BBT, but it does not necessarily mean that these patients are aware of the potential detrimental effects of BBT, as demonstrated in the current study. In cardiovascular patients, the perceived effectiveness and safety of BBT, and assumed lack of side effects of these products as opposed to traditional medications, highlights an area for further education. A high incidence of potential drug-BBT interactions was also identified in this study (42 interactions in 94 users). Given that the use of BBT can have a direct effect on patient care, and users of these therapies do not always voluntarily report their use of these products to their providers, health care professionals need to inquire about BBT use routinely. Collecting complete patient histories and educating patients about potential dangers and possibilities of adverse effects and interactions between prescription medications and BBT (or other CAM) will lead to better overall patient care.
http://www.biomedcentral.com/1472-6882/5/4
Genomics is been harnessed for Familial and non-familial Cardiomyopathies Diagnosis and Treatment
Genetic and phenotypic heterogeneity that characterizes all cardiomyopathies pose major clinical challenges. In this article, we focus on the task of diagnosis, exploring how a systematic clinical approach can be used to identify specific disorders and guide the selection of further diagnostic tests, including molecular genetic analysis.
Cardiomyopathies are defined as disorders of heart muscle unexplained by coronary artery disease, hypertension, valvular disease or congenital heart disease. They are classified by morphological and functional phenotype into
- hypertrophic cardiomyopathy (HCM),
- dilated cardiomyopathy (DCM),
- restrictive cardiomyopathy (RCM), and
- arrhythmogenic right ventricular cardiomyopathy (ARVC) subtypes
http://heart.highwire.org/content/99/19/1451.extract
Iron Metabolism and Mitochondrial Mechanisms
Mitochondrial iron trafficking and the integration of iron metabolism between the mitochondrion and cytosol
The field of mitochondrial iron metabolism and trafficking that has recently been stimulated by the discovery of proteins involved in mitochondrial iron storage (mitochondrial ferritin) and transport (mitoferrin-1 and -2). In addition, recent work examining mitochondrial diseases (e.g., Friedreich’s ataxia) has established that communication exists between iron metabolism in the mitochondrion and the cytosol. This finding has revealed the ability of the mitochondrion to modulate whole-cell iron-processing to satisfy its own requirements for the crucial processes of heme and ISC synthesis. Knowledge of mitochondrial iron-processing pathways and the interaction between organelles and the cytosol could revolutionize the investigation of iron metabolism.
http://www.pnas.org/content/early/2010/05/20/0912925107
Role of Calcium and Gene therapy in treatment of Pulmonary Arterial Hypertension and Heart Failure
Inhalable Gene Therapy for Pulmonary Arterial Hypertension and Percutaneous Intra-coronary Artery Infusion for Heart Failure
Sinus Node Dysfunction (SND): Patient Education
Educate patients to recognize symptoms of SND. Family members should learn cardiopulmonary resuscitation (CPR).
Because most pediatric patients with SND have already received surgery for CHD (eg, Mustard procedure, Fontan procedure), their education is focused on recognizing symptoms of CHF and tachyarrhythmias, such as atrial flutter/fibrillation, which are usually poorly tolerated.
Patients who are on antiarrhythmic medication for atrial flutter or fibrillation should be instructed to take their medication regularly and to visit the cardiologist as scheduled. They should also be cognizant of the adverse effects and toxicity of the medication.
In patents who have already received a Mustard or Fontan procedure, undergoing yearly echocardiography to monitor cardiac function is advisable. If cardiac function is decreased, anti-CHF management should be started and close follow-ups with the cardiologist are advisable.
Patients who have a pacemaker should be instructed on the means of obtaining regular checks. Such checks are usually achieved from home with a transtelephonic monitor that transmits to a central monitoring station, which, in turn, contacts the cardiologist in case a problem is detected (e.g., device malfunction, arrhythmia).
Patients who have an intracardiac defibrillator (ICD) device should receive the same instructions that patients who have pacemakers receive. Because patients with ICDs often are placed on antiarrhythmic medication, they also should receive instruction regarding medication schedules and information about adverse effects and toxicity.
In addition, in patients with frequent atrial flutter or fibrillation episodes, which are followed by a shock from the ICD, patients are instructed to avoid activities that may pose a risk to themselves and/or other people (eg, driving). They also receive instruction on when to go to the cardiologist or the emergency department.
http://emedicine.medscape.com/article/158064-overview#aw2aab6b2b6
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