Panminerva medica
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The myocardial extracellular matrix (ECM) is the dynamic environment that is fundamental for the structural and physiological homeostasis of the heart. Alterations in ECM homeostasis may lead to diastolic or systolic dysfunction and consequent development of heart failure (HF). For degradation of ECM, matrix metalloproteinases (MMPs) are responsible. ⋯ Majority of studies enrolling the higher count of participants suggested that the state of active myocardial remodeling is accompanied by enhanced activation of MMP-2 and MMP-9 and may be also represented by changes in their circulating concentrations. Their levels may be a useful marker for the identification of patients at risk for HF development and poor outcome by themselves, or at the very least as a components of multimarker approach. At the same time MMP-2 and MMP-9 circulating levels can serve as indicators of efficiency of the therapy provided to HF patients, as well as for identification of patients who could profit from particular therapeutic intervention via modification of MMP pathway.
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Catastrophic antiphospholipid syndrome (CAPS) is a rare variant that accounts for 1% of patients with APS. Despite its low frequency, the mortality-related is very high ranging from 50% of patients in the first series to 37% in the most recent data. The current knowledge of this potential devastating entity comes from the International Registry of patients with CAPS, named CAPS Registry. ⋯ Therefore, treatment strategy is based on the combination of anticoagulation, glucocorticoids, plasma exchange and/or intravenous immunoglobulins, the so-called triple therapy. In refractory cases or in those with initial life-threatening situation, rituximab may be an effective option. Recently, some cases of CAPS have been effectively treated with the addition of eculizumab to the triple therapy.
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Editorial Comment
HOTAIR and gastric cancer: a lesson from two meta-analyses.
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Review Meta Analysis
Methotrexate and lung disease in rheumatoid arthritis.
Rheumatoid arthritis (RA) is a common chronic inflammatory disease affecting many tissues and resulting in substantial morbidity and increased mortality. Arthritis is the most notable clinical feature, but extra-articular features can have devastating consequences. Pulmonary manifestations are common in RA, with high rates of disease related lung disease and a propensity to pulmonary infections. ⋯ Increasing recognition of the importance and prevalence of interstitial lung disease in RA, and recent studies on the incidence of lung disease among RA and non-RA populations have cast doubt on the role of methotrexate as a causative agent. A correct understanding of the complex pulmonary disease processes in RA is crucial if we are to improve outcomes in this patient group. In this article we will discuss the epidemiology and characteristics of lung disease in rheumatoid arthritis and its possible relationship to methotrexate use.
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Review Meta Analysis
Applications of cardiotoxicity in breast cancer: a meta-analysis.
Breast cancer is the most common type of cancer in women. Many antineoplastic agents used to treat breast cancer have potentially cardiotoxic effects and may lead to chemotherapy induced cardiomyopathy and heart failure. We conducted a meta-analysis to clarify the applications of cardiotoxicity in breast cancer. ⋯ In this meta-analysis, there was evidence indicated that there was not a significant decrease on LVEF and EF in patients who received trastuzumab plus lapatinib and trastuzumab plus pertuzumab combination. Our study suggests that the combination of two anti-HER2 agents does not significantly increase the risk for adverse compared with anti-HER2 monotherapy in patients with adequate cardiac function prior to start of therapy.