Search Results for: AGA: linee guida sulla de-prescrizione degli inibitori della pompa protonica

Gastric cancer (GC) is a leading cause of preventable cancer and mortality in certain US populations. The most impactful way to reduce GC mortality is via primary prevention, namely Helicobacter pylori eradication, and secondary prevention, namely endoscopic screening and surveillance of precancerous conditions, such as gastric intestinal metaplasia (GIM). An emerging body of evidence supports the possible impact of these strategies on GC incidence and mortality in identifiable high-risk populations in the United States.

Rinviato a metà gennaio voto su piano revisione Rete oncologica

Introduction
Diabetic macular oedema (DMO), a serious ocular complication of diabetic retinopathy (DR), is a leading cause of vision impairment worldwide. If left untreated or inadequately treated, DMO can lead to irreversible vision loss and blindness. Intravitreal injections using antivascular endothelial growth factor (anti-VEGF) and laser are the current standard of treatment for DMO. These treatments are costly and invasive and must be repeated over several years with a high service load. Fenofibrate has been shown to reduce the progression of DR. However, there is a lack of high-quality data on the effects of fenofibrate on established DMO. This study aims to evaluate the effectiveness of oral fenofibrate for the treatment of DMO.

Methods and analysis
This randomised double-blind, placebo-controlled trial recruited 204 patients with DMO across three different clinics in Sydney. Participants will be randomly allocated in a 1:1 ratio to intervention and control groups. The intervention group will receive oral fenofibrate (145 mg) taken once daily for 24 months, while the control group will receive placebo tablets taken once daily for 24 months. Standard care with anti-VEGF injections, focal lasers or observation will also be provided to all participants regardless of their group allocation. The primary outcome is the reduction in DMO measured using central macular subfield thickness (CSMT) on optical coherence tomography imaging at 24 months. Secondary outcomes at 24 months include the proportion of eyes with CSMT

Introduction
Pre-eclampsia is a pregnancy-related complication estimated to affect up to 8% of pregnancies worldwide. It is associated with an increased risk of postpartum sustained hypertension, coronary artery disease, cerebrovascular disease, peripheral arterial disease and cardiovascular-related mortality. Nevertheless, these associations have seldom been addressed in younger women from sub-Saharan Africa (SSA). Hence, this study aims to assess the association between pre-eclampsia and cardiovascular impairment within the first year after delivery, among younger women in SSA.

Methods and analysis
This is a prospective cohort study conducted at Hospital Nacional Simão Mendes in Bissau, Guinea-Bissau. A total of 230 pregnant women aged below 25 years (115 diagnosed with pre-eclampsia and 115 normotensive age-matched pregnancies), will be enrolled after their 20th gestational week. Exclusion criteria include diabetes, hypertension or other serious maternal diseases present before pregnancy. Participants will be assessed at baseline (pre-labour period), 4 and 12 months after delivery; evaluations started in March 2023 and are expected to end in December 2026. At each follow-up assessment, the women will have their blood pressure measured with a digital sphygmomanometer and a 24-hour ambulatory blood pressure monitor. Cardiac and renal function will be assessed using echocardiography and laboratory testing, respectively. Primary outcomes include the mean differences in cardiovascular and renal parameters between women who had pre-eclampsia and those who had normotensive pregnancies. Age, parity, age at first pregnancy, family history of cardiovascular diseases, smoking habits, gestational diabetes diagnosed before pre-eclampsia, body mass index and labour complications will be considered a priori as potential confounders of the association between pre-eclampsia and postpartum cardiovascular impairment.

Ethics and dissemination
This study was approved by the Comité Nacional de Ética em Pesquisa na Saúde, Guinea-Bissau (008/CNES/INASA/2023), and participants provide written informed consent. Results will be disseminated among the scientific community and the public.

Objectives
Intensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/– de-escalation to aid stop decisions. We hypothesised that a direct infection indicator, PCR-POCT, would influence stop judgements more than indirect PCT. Accordingly, we tested antibiotic-stop decisions when presented with a negative PCR-POCT despite borderline-positive PCT.

Designs
Observational prospective study.

Setting
ICU.

Participants
66 ICU clinicians from University hospitals.

Methods
Clinicians saw four scenarios of different clinico-biological trajectories: (1) clear improvement, (2) clear worsening, (3) discordant—clinically better/biologically worse and (4) discordant—clinically worse/biologically better. Participants gave an initial decision (stop/continue/continue–escalate/continue–de-escalate). Then PCR-POCT and/or PCT was offered (accept/decline). After a negative PCR-POCT and borderline-positive PCT result, a final antibiotic decision was taken.

Measures
Proportion of stop decisions before versus after test results per scenario. The association of the final decision with the clinician’s change in confidence, willingness to request the biomarker(s) and the case trajectory was determined.

Results
Fewer clinicians than expected stopped antibiotics versus baseline (36%, 94/264 vs 42%, 110/264, p=0.045). This was so in three of four scenarios, significantly less in the improvement (p

Circulation, Ahead of Print. BACKGROUND:Cardiac fibrosis, characterized by excessive extracellular matrix (ECM) deposition in the myocardium, is an important target for heart disease treatments.Pw1(paternally expressed gene 3) is an imprinted gene expressed from the paternal allele, and de novo purine biosynthesis (DNPB) is a crucial pathway for nucleotide synthesis. However, the roles of PW1 and DNPB in ECM production by cardiac fibroblasts during myocardial ischemia are not yet understood.METHODS:To induce myocardial damage, we performed left anterior descending coronary artery ligation. We generatedPw1CreER-2A-eGFPandPw12A-CreERknock-in mouse lines to evaluate the expression of the 2Pw1alleles in normal and injured hearts. Bisulfite sequencing was used to analyze the DNA methylation of thePw1imprinting control region. We identified the phosphoribosylformylglycinamidine synthase (Pfas) gene, encoding the DNPB enzyme PFAS, as a direct target of PW1 using chromatin immunoprecipitation sequencing and real-time quantitative polymerase chain reaction. The role of DNPB in ECM production and cardiac fibrosis after injury was examined in vitro using cultured cardiac fibroblasts and in vivo withPfas-deficient mice.RESULTS:Our study demonstrates that myocardial infarction reduces DNA methylation at the imprinting control region of the maternally imprinted genePw1, triggering a switch from monoallelic imprinting to biallelic expression ofPw1in cardiac fibroblasts. In activated cardiac fibroblasts, increasedPw1expression promotes purine biosynthesis and induces ECM production by transcriptionally activating the DNPB factorPfas. We identified that DNPB is essential for ECM production in activated fibroblasts and that loss ofPfasin fibroblasts limits cardiac fibrosis and improves heart function after injury.CONCLUSIONS:This study demonstrates thatPw1imprinting is disrupted after injury and reveals a novel role for the downstream target PFAS in ECM production and cardiac fibrogenesis. Targeting the PW1/PFAS signaling pathway presents a promising therapeutic strategy for improving cardiac repair after injury.

Portal vein thromboses (PVTs) are common in patients with cirrhosis and are associated with advanced portal hypertension and mortality. The treatment of PVTs remains a clinical challenge due to limited evidence and competing risks of PVT-associated complications vs bleeding risk of anticoagulation. Significant heterogeneity in PVT phenotype based on anatomic, host, and disease characteristics, and an emerging spectrum of therapeutic options further complicate PVT management. This Clinical Practice Update (CPU) aims to provide best practice advice for the evaluation and management of PVT in cirrhosis, including the role of direct oral anticoagulants and endovascular interventions.

Inflammatory bowel disease (IBD) presents a persistent challenge owing to its chronic and often aggressive nature. Although maintenance therapy remains the standard approach to prevent relapse and complications, there are compelling reasons to explore de-intensification strategies. These include patient preferences to avoid chronic therapy, concerns about long-term risks, and the potential for over-treatment. An updated re-appraisal of the significant ethical issues related to such approaches has not occurred.

Dopo il via libera della Stato Regioni alle linee guida la sua messa a regime è prevista entro il prossimo febbraio

Cardiologi, tante potenzialità diagnosi e gestione ma nodi etici

Introduction
Up to one-third of patients with cerebral palsy (CP) develop hip migration. Current standard care for early hip migration is bilateral adductor-psoas tenotomy; however, the failure rate is relatively high with 34%–74% of patients with CP requiring secondary hip surgery. Using temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF), the morphology of the hip can be changed. This technique aims to reduce further hip migration and the need for secondary surgical management. Further research is necessary to determine the benefit of TMH-PF in addition to adductor-psoas tenotomy. The hypothesis of this study is that TMH-PF combined with adductor-psoas release decreases the chance of progressive hip migration and the need for secondary hip surgery, compared with adductor-psoas release alone.

Methods and analysis
The GUIDANCE study is an open-label multicentre randomised controlled trial. Patients with CP aged between 2 and 8 years, with spastic CP—Gross Motor Function Classification System IV or V, hip abduction ≤40° and hip migration of 30%–50% can be included in this trial. They will be randomised into a control arm (adductor-psoas tenotomy) or an intervention arm (adductor-psoas tenotomy+TMH PH). The primary outcome will be treatment failure at 5-year follow-up. At 2-year follow-up a preliminary analysis will be performed. Secondary outcomes will be differences in patient-reported outcome measures (CPCHILD and CPG pain score), range of motion, radiological measurements including head shaft angle and hip migration percentage and three-dimensional (3D) morphological changes to the proximal femur. Furthermore, an analysis will be performed to identify predictors for treatment failure in both treatment arms.

Ethics and dissemination
The GUIDANCE study should provide evidence on the effectiveness of TMH-PF in addition to adductor-psoas tenotomy in children with CP with early hip migration. If beneficial, larger hip reconstructive procedures can be delayed or prevented, providing a distinct benefit for these vulnerable children. The study’s strengths lie in its methodological framework, incorporating randomised allocation and intervention assessment. The main limitation is the inability to blind the treating physician or the researcher for the treatment arm the participant is allocated to. The results of the GUIDANCE study will be presented at scientific meetings and published in international peer-reviewed journals. The aim is to publish the results at 2 years follow-up and 5 years follow-up and to publish the results of the analysis on the 3D morphology of the hip after TMH-PF. Individual de-identified participant data that underlie the results from the GUIDANCE study and the study protocol will be shared if requested.

Trial registration number
Clinical Trial Registry number: NCT06118736. Registered on 3 November 2023.