background We examined whether a fixed dose of both isosorbide dinitrate and hydralazine provides additional benefit in blacks with advanced heart failure, a subgroup previously noted to have a favorable response to this therapy. methods A total of 1050 black patients who had New York Heart Association class III or IV heart failure with dilated ventricles were randomly assigned to receive a fixed dose of isosorbide dinitrate plus hydralazine or placebo in addition to standard therapy for heart failure. The primary end point was a composite score made up of weighted values for death from any cause, a first hospitalization for heart failure, and change in the quality of life. results The study was terminated early owing to a significantly higher mortality rate in the placebo group than in the group given isosorbide dinitrate plus hydralazine (10.2 percent vs. 6.2 percent, P = 0.02). The mean primary composite score was significantly better in the group given isosorbide dinitrate plus hydralazine than in the placebo group (i0.1±1.9 vs. i0.5±2.0, P=0.01; range of possible values, –6 to +2), as were its individual components (43 percent reduction in the rate of death from any cause [hazard ratio, 0.57; P=0.01] 33 percent relative reduction in the rate of first hospitalization for heart failure [16.4 percent vs. 22.4 percent, P=0.001], and an improvement in the quality of life [change in score, i5.6±20.6 vs. i2.7±21.2, with lower scores indicating better quality of life; P=0.02; range of possible values, 0 to 105]). conclusions The addition of a fixed dose of isosorbide dinitrate plus hydralazine to standard therapy for heart failure including neurohormonal blockers is efficacious and increases survival among black patients with advanced heart failure.

Combination of isosorbide dinitrate and hydralazine in blacks with heart failure.

Combination of isosorbide dinitrate and hydralazine in blacks with heart failure

Experimental work during the past 15 years has demonstrated that endothelial cells in the heart play an obligatory role in regulating and maintaining cardiac function, in particular, at the endocardium and in the myocardial capillaries where endothelial cells directly interact with adjacent cardiomyocytes. The emerging field of targeted gene manipulation has led to the contention that cardiac endothelial-cardiomyocytal interaction is a prerequisite for normal cardiac development and growth. Some of the molecular mechanisms and cellular signals governing this interaction, such as neuregulin, vascular endothelial growth factor, and angiopoietin, continue to maintain phenotype and survival of cardiomyocytes in the adult heart. Cardiac endothelial cells, like vascular endothelial cells, also express and release a variety of auto- and paracrine agents, such as nitric oxide, endothelin, prostaglandin I(2), and angiotensin II, which directly influence cardiac metabolism, growth, contractile performance, and rhythmicity of the adult heart. The synthesis, secretion, and, most importantly, the activities of these endothelium-derived substances in the heart are closely linked, interrelated, and interactive. It may therefore be simplistic to try and define their properties independently from one another. Moreover, in relation specifically to the endocardial endothelium, an active transendothelial physicochemical gradient for various ions, or blood-heart barrier, has been demonstrated. Linkage of this blood-heart barrier to the various other endothelium-mediated signaling pathways or to the putative vascular endothelium-derived hyperpolarizing factors remains to be determined. At the early stages of cardiac failure, all major cardiovascular risk factors may cause cardiac endothelial activation as an adaptive response often followed by cardiac endothelial dysfunction. Because of the interdependency of all endothelial signaling pathways, activation or disturbance of any will necessarily affect the others leading to a disturbance of their normal balance, leading to further progression of cardiac failure.

/pdf/cardiac-endothelial-myocardial-signaling-its-role-in-cardiac-2fjkofy30k.pdf

Cardiac Endothelial-Myocardial Signaling: Its Role in Cardiac Growth, Contractile Performance, and Rhythmicity

BACKGROUNDFollicular Unit Transplantation (FUT) is performed using large numbers of naturally occuring individual follicular units obtained by single-strip harvesting and stereo-microscopic dissection. Donor wound scarring from strip excision, although an infrequent complication, still concerns enou

/pdf/follicular-unit-extraction-minimally-invasive-surgery-for-4x8qzdnxhj.pdf

Follicular unit extraction: minimally invasive surgery for hair transplantation.

Mitochondrial reserve capacity in endothelial cells: the impact of nitric oxide and reactive oxygen species

The logic of follicular unit transplantation

Follicular unit transplantation: 2005.

background. The increasing importance that hair transplant surgeons are placing on maintaining the integrity of the naturally occurring follicular unit has generated great interest in finding the ideal method of graft dissection.



objective. The present study attempts to compare two popular dissecting techniques: the dissecting microscope, and magnifying loupes with transillumination, in the preparation of follicular unit grafts.



methods. Donor strips from 41 patients were used in a prospective, bilateral controlled fashion to compare the two different dissecting techniques.



results. Microscopic dissection produced a 17% greater yield of hair as compared with magnifying loupes with transUlumination.



conclusion. The results of this study show an increase in the yield of follicular unit grafts, as well as the total amount of hair harvested from the donor strip, when using the dissecting microscope as compared with magnifying loupes with transUlumination. This increase was observed when only the latter part of the dissecting procedure was studied. When complete microscopic dissection is used, the advantage should be even more significant.

Dissecting microscope versus magnifying loupes with transillumination in the preparation of follicular unit grafts. A bilateral controlled study.

BACKGROUNDThe most common type of donor closure in hair transplantation is with nonabsorbable, running sutures, usually of nylon or polypropylene. This is accomplished with or without buried absorbable sutures. Another popular method of closure is with stainless steel staples. Each of these methods

A New Suture for Hair Transplantation: Poliglecaprone 25

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