ABSTRACT
Interventional Radiology residency training programs experienced significant impacts secondary to the COVID-19 pandemic. Prospective resident recruitment and resident education were particularly affected due to limitations on in-person gatherings in effort to curb exposure. Finding ways to mitigate the pandemic's effect on recruitment and education was a challenge faced by residency programs across the nation. This article discusses a single Interventional Radiology program's approach to adapting to the reality of limited interpersonal interaction as well as efforts to maintain engagement for resident recruitment and education in a virtual setting.
Subject(s)
COVID-19 , Internship and Residency , Humans , Pandemics , Prospective Studies , Radiology, Interventional/education , SARS-CoV-2Subject(s)
Endovascular Procedures , Leiomyosarcoma/complications , Retroperitoneal Neoplasms/complications , Vascular Diseases/therapy , Vena Cava, Inferior , Adult , Azygos Vein/physiopathology , Collateral Circulation , Endovascular Procedures/instrumentation , Female , Humans , Leiomyosarcoma/diagnostic imaging , Leiomyosarcoma/pathology , Neoplasm Staging , Regional Blood Flow , Retroperitoneal Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/pathology , Stents , Treatment Outcome , Vascular Diseases/diagnostic imaging , Vascular Diseases/etiology , Vascular Diseases/physiopathology , Vascular Patency , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/physiopathologySubject(s)
Brachiocephalic Veins , Carcinoma, Non-Small-Cell Lung/complications , Endovascular Procedures/instrumentation , Lung Neoplasms/complications , Stents , Superior Vena Cava Syndrome/therapy , Vena Cava, Superior , Aged, 80 and over , Brachiocephalic Veins/diagnostic imaging , Brachiocephalic Veins/physiopathology , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/secondary , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Male , Superior Vena Cava Syndrome/diagnostic imaging , Superior Vena Cava Syndrome/etiology , Superior Vena Cava Syndrome/physiopathology , Treatment Outcome , Vena Cava, Superior/diagnostic imaging , Vena Cava, Superior/physiopathologyABSTRACT
PURPOSE: The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends high-intensity statin therapy in patients aged ≤75 y with clinical coronary artery disease (CAD). The effectiveness of cardiac rehabilitation (CR) in lipid management and guideline adherence is unknown. The purpose of this study is to determine whether CR participation affects guideline-driven achievement for statin use. METHODS: This multicenter retrospective study evaluated statin utilization in patients pre- and post-CR between January 1, 2014, and August 31, 2015. Records for patients with known CAD who completed 18 or more CR sessions were reviewed for statin-drug use and dose before and after CR and documented statin intolerance. RESULTS: Of the total 468 patients, 76% were male with mean age ± SD = 66.0 ± 10.8 y and range of 32 to 89 y. Patients aged ≤75 y (n = 375) showed a modest but statistically significant increase (P = .0006) in high-intensity statin use post-CR (56.3%-61.1%). Males demonstrated a significant increase in high-intensity statin use (P = .0005). Of the 146 patients aged ≤75 y not on high-intensity statins post-CR, only 21 had history of statin intolerance. Of the subjects aged >75 y (n = 93), 91% were already on high- or moderate-intensity statins with no significant change during CR. CONCLUSIONS: Patients aged ≤75 y following CR completion increased high-intensity statin use but only by 4.8% and 33% of subjects were inadequately treated. The updated 2013 treatment recommendations simplified statin use, yet substantial data continue to reveal that guideline achievement even post-CR remains limited.
Subject(s)
Cardiac Rehabilitation , Coronary Artery Disease/drug therapy , Coronary Artery Disease/rehabilitation , Guideline Adherence/statistics & numerical data , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Male , Middle Aged , Practice Guidelines as Topic , Retrospective Studies , Sex FactorsABSTRACT
Mitochondrial fission, regulated by dynamin-related protein-1 (Drp1), is a newly recognized determinant of mitochondrial function, but its contribution to left ventricular (LV) impairment following ischemia-reperfusion (IR) injury is unknown. We report that Drp1 activation during IR results in LV dysfunction and that Drp1 inhibition is beneficial. In both isolated neonatal murine cardiomyocytes and adult rat hearts (Langendorff preparation) mitochondrial fragmentation and swelling occurred within 30 min of IR. Drp1-S637 (serine 637) dephosphorylation resulted in Drp1 mitochondrial translocation and increased mitochondrial fission. The Drp1 inhibitor Mdivi-1 preserved mitochondrial morphology, reduced cytosolic calcium, and prevented cell death. Drp1 siRNA similarly preserved mitochondrial morphology. In Langendorff hearts, Mdivi-1 reduced mitochondrial reactive oxygen species, improved LV developed pressure (92±5 vs. 28±10 mmHg, P<0.001), and lowered LV end diastolic pressure (10±1 vs. 86±13 mmHg, P<0.001) following IR. Mdivi-1 was protective if administered prior to or following ischemia. Because Drp1-S637 dephosphorylation is calcineurin sensitive, we assessed the effects of a calcineurin inhibitor, FK506. FK506 treatment prior to IR prevented Drp1-S637 dephosphorylation and preserved cardiac function. Likewise, therapeutic hypothermia (30°C) inhibited Drp1-S637 dephosphorylation and preserved mitochondrial morphology and myocardial function. Drp1 inhibition is a novel strategy to improve myocardial function following IR.
