Cleveland Clinic journal of medicine
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Traditional therapies for emphysema such as bronchodilators and anti-inflammatory drugs have limited value due to permanent structural changes in the emphysematous lung that result in hyperinflation. Surgical lung volume reduction partially corrects hyperinflation by removing emphysematous lung and is an option in selected patients, but it carries a risk of morbidity and death. Valve therapy is a less-invasive option that involves bronchoscopic implantation of 1-way valves in emphysematous lung segments to allow air flow and mucus clearance in the direction of central airways. The authors review the rationale, evidence, and applications of valve therapy.
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Perinatal depression affects 10% to 20% of women in the United States during pregnancy, the postpartum period, or both, but it can be difficult to recognize. Identifying and treating this problem can reduce the alarming number of suicides among depressed perinatal women and the possible adverse effects of untreated maternal depression on their child's cognitive and behavioral development. In this review, we discuss the latest developments in screening, treatment, and prevention methods.
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Recent trials evaluated the impact of aspirin for primary prevention of cardiovascular events in patients at intermediate risk, patients with diabetes, and the elderly, and the results have been incorporated into the most recent professional guidelines. For the most part, the role of aspirin in primary prevention remains limited, albeit not adequately tested in those at higher risk.
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Functional tricuspid regurgitation (TR) develops secondary to annular dilation and leaflet tethering as a result of right ventricular remodeling. Invasive surgery for isolated TR is rarely performed due to high inpatient mortality. Transcatheter tricuspid valve intervention is an appealing solution but is challenging as crucial structures are closely related to the tricuspid valve, and intracardiac devices pose further challenges to device delivery and implantation.
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Lifestyle factors remain the bedrock of atherosclerotic cardiovascular disease (ASCVD) prevention. Statins remain the first-line therapy for primary and secondary prevention of ASCVD. ⋯ Nonstatins and proprotein convertase subtilisin-kexin type 9 inhibitors are recommended for secondary prevention in patients with clinical ASCVD. For patients at intermediate risk of ASCVD, new risk-enhancing factors, including chronic inflammatory conditions and ethnicity, should be considered to better risk stratify these patients.