Biomedical subjects

Nirav Vora

Publications and source records attributed to Nirav Vora.

3 recordsLinked to original sources

PubMed2006

Cell transplantation for ischemic stroke.

Cell replacement therapy has been evaluated as a regenerative strategy for patients with fixed neurologic deficits after ischemic stroke. Animal models have identified specific cell lines which lead to regeneration and improvement in behavior and motor function after implantation into areas of ischemic injury. This has led to the development of pilot studies in humans, which have mainly investigated the safety and pilot efficacy of such approaches with promising early results. As research in this area progresses, further prospective trials are necessary not only to demonstrate clinical efficacy but also to understand the mechanisms underlying the early positive experiences, to select appropriate patients for cell replacement therapy, and to elucidate the optimal timing and mode of cell delivery.

Animals↗

PubMed2005

Comparison of results of carotid stenting followed by open heart surgery versus combined carotid endarterectomy and open heart surgery (coronary bypass with or without another procedure).

We compared a novel strategy of carotid stenting (CS) followed by open heart surgery (OHS) to the combined carotid endarterectomy (CEA) and the OHS approach in patients requiring coronary and carotid revascularization. Between 1997 and 2002, CS as a prelude to OHS was performed in 56 patients, and 111 patients underwent combined CEA+OHS. Adverse events included stroke, myocardial infarction (MI), death, and their combinations. At baseline, the CS+OHS group had more unstable/severe angina (52% vs 27%, p = 0.002), severe left ventricular dysfunction (20% vs 9%, p = 0.05), symptomatic carotid disease (46% vs 23%, p = 0.002), and the need for repeat OHS (32% vs 9%, p = 0.0002). Severe contralateral carotid disease was more prevalent in the CEA+OHS group (28% vs 11%, p = 0.01). At 30 days, CS+OHS patients had a significantly lower incidence of stroke or MI (5% vs 19%, p = 0.02). A propensity score was created for each patient to account for baseline differences. In a final logistic regression model that included the propensity score, CS+OHS was associated with a trend toward reduced stroke or MI (odds ratio 0.26, 95% confidence interval 0.06 to 1.09, p = 0.06) and reduced death, stroke, or MI (odds ratio 0.40, 95% confidence interval 0.12 to 1.27, p = 0.12). In conclusion, despite a higher baseline risk profile, patients who underwent CS+OHS had significantly fewer adverse events than those undergoing CEA+OHS. CS may be a safer carotid revascularization option for this challenging patient population.

Aged↗

PubMed2005

Subarachnoid hemorrhage and inflammation: bench to bedside and back.

Subarachnoid hemorrhage (SAH) is a devastating and complicated disease. The development of therapeutic interventions has been hampered by a poor understanding of the three components of the disease pathology in SAH: aneurysm rupture, cerebral edema, and vasospasm. The role of inflammation in the pathology of subarachnoid hemorrhage will be reviewed. The events leading up to aneurysm rupture are heralded by degradation of the endothelial cell layer integrity and inflammatory cell infiltration into the wall of the aneurysm. This is associated with release of active agents that can digest the basement membrane and may cause rupture. After rupture, cytokine release by mononuclear leukocytes is associated with early edema. Vasospasm is a complicated process that includes arterial wall thickening and vasoconstriction. Evidence supports the role of inflammation in free radical formation and in perturbations in nitric oxide and endothelin-1 levels that are important mediators of the vasoconstriction in vasospasm. Targeting the inflammatory mediators associated with the three prominent events in SAH is a promising strategy for reducing the mortality and morbidity in these patients. More study is needed to determine which specific effectors in the inflammatory cascade may serve as targets for intervention.

Aneurysm, Ruptured↗