Risultati per: Nuovo test rapido per distinguere le infezioni virali

Circulation, Volume 148, Issue Suppl_1, Page A16973-A16973, November 6, 2023. Introduction:Despite several off-the-shelf ultrasound systems being used for large vessel access, reliable and safe vascular access remains a problem. This is especially true during combat casualty care where skilled operators may not be available. We tested a novel small-footprint platform for efficacy and timeliness of large vessel access at normovolemic and hypovolemic statesHypothesis:A custom-designed device with optimized ergonomics and workflow will yield high success rates and low training needs for large vessel accessMethods:Vu-Path has a pen-size 10 mm ultrasound transducer with a proprietary needle guide and a lightweight engine deployed with a tablet or laptop. The display has an overlay showing the needle insertion path. Once the vessel is visible within the overlay, insertion of the needle using the needle guide directs insertion to the vessel. We used 3 models to simulate femoral vessel access: 1) a commercially available phantom (CAE Blue Phantom); 2) a custom in-vitro tissue phantom mimicking swine normovolemic and hypovolemic femoral vascular states; 3) an ex-vivo model of a euthanized swine lower-body section with canulated femoral vessels looped with a peristaltic pump to simulate normovolemic and hypovolemic states.Results:Vu-Path tested in these 3 models resulted in 87% successful insertions across all models and conditions; 100% success on the commercial model versus 83% in the custom tissue phantoms. In every model, 2 metrics were evaluated as summarized in Figure: total time to align vessel in the needle track window, and total time after aligning to confirmed insertion. Mean attempts needed to gain system expertise was 6.Conclusions:Vu-Path had high success rates for vessel visualization and needle access guidance in 3 models simulating normovolemic and hypovolemic conditions. Training requirements were minimal. These data suggest Vu-Path is capable of potentially improving safety and reliability of large vessel access.

Circulation, Volume 148, Issue Suppl_1, Page A11613-A11613, November 6, 2023. Background:Adverse hemodynamic responses on exercise stress testing have prognostic impact, but the cumulative effect of multiple abnormalities is not known. These markers include chronotropic incompetence, reduced metabolic equivalents achieved, abnormal hemodynamic gain index, impaired heart rate recovery, and abnormal blood pressure response.Research Questions:In a contemporary population undergoing exercise stress testing, what is the cumulative prevalence and prognostic impact of the number of abnormal stress hemodynamic markers (asHD)?Aims:We measured the prevalence of increasing values of asHD and the associated burden of all-cause mortality and non-fatal myocardial infarction (death/NFMI).Methods:We performed a retrospective, single-center analysis of patients referred for exercise stress myocardial perfusion imaging from 2015-2017. Multivariable Cox proportional hazards modeling was used to explore the relationship between cumulative burden of asHD markers and death/NFMI.Data:The study population included 1,595 patients (mean age 62.1, 36.9% female) with mean follow-up 4.8 years stratified by number of asHD markers (0, 1, 2, or 3+). 60.2% of patients tested had at least one asHD marker. The cumulative burden was 1 asHD in 32%, 2 asHD in 19%, and 3+ asHD in 9.3%. Patients with any asHD were at greater risk for death/NFMI compared to patients with 0 asHD (HR 1.98 [95% CI, 1.39 – 2.83], p

Circulation, Volume 148, Issue Suppl_1, Page A12748-A12748, November 6, 2023. Background:The 6-minute walk test (6MWT) is an established test to assess functional exercise performance and the 6-minute walk distance (6MWD) is strongly correlated with the functional capacity and the prognosis in patients with heart failure (HF). However, the clinical implication of sequential changes in percutaneous oxygen saturation (SpO2) during 6MWT has not been investigated in HF patients.Purpose:To prospectively clarify the association between sequential changes in SpO2 during 6MWT and prognosis in patients with HF.Methods:Fifty patients admitted with acute heart failure were enrolled. The 6MWT was performed at the time before discharge, after hemodynamic stability was confirmed. The average of SpO2 was calculated from data obtained at rest and during 6MWT by employing the wearable pulse-oximeter which is designed to record the SpO2 value every second. Alternations in SpO2 (ΔSpO2) were obtained by subtracting the average during 6MWT from that at rest. Patients were followed up to 9 months for the composite outcome of heart failure-hospitalization and death.Results:The mean age of participants was 78.8 years, and 23 (46%) were female. The mean EF was 46.1% and the number of patients with EF ≦40 was 22. The 6MWD was 250 ± 112m and the ΔSpO2 was 2.88 ± 4.3%. All cases were classified by walk distance and ΔSpO2; long- ( >220m) vs. short-distance group (≦220m) and low- (

Circulation, Volume 148, Issue Suppl_1, Page A16611-A16611, November 6, 2023. Introduction:The treadmill test (TMT) is commonly used as a screening test to identify myocardial ischemia. The sensitivity of the TMT in diagnosing obstructive CAD was approximately 50%, with a specificity of approximately 90%. However, the challenge with TMT is the variability in interpretation.Hypothesis:We aimed to develop an Artificial intelligence (AI) to interpret TMT. The primary endpoint was the accuracy comparison between the initial assessment (of AI or cardiologist) for obstructive CAD.Methods:Out of a total of 800 TMTs performed on adults for any clinical indications in 2018-2020, Of these, we used 500 as training data, 200 as validation data, and 100 as test data. A one-dimensional convolutional block was applied to each of the 12 leads of the TMT, and then all the leads were concatenated to apply a dense layer, which was then trained to predict the presence of obstructive coronary artery disease. This deep learning model was developed based on convolutional neural networks (CNNs) using TensorFlow (Google, Mountain View, CA, USA) and Keras packages based on the Python language. TMT were simultaneously interpreted by an AI algorithm or by the cardiologist. This assessment was subsequently reviewed by blinded interventional cardiologist who provided a final report of obstructive coronary artery disease (CAD) with coronary compute tomography.Results:The mean age was 58.1 (20-78) years, 68% were male, and 33% had obstructive coronary artery disease (≥70% stenosis in at least one vessel). The performance of AI was compared with that of conventional TMT. Accuracy of AI model was comparable to cardiologist (0.720 vs. 0.680,p=0.845) F1 score was also similar between AI and cardiologist (0.440 vs. 0.384.p=0.845)Conclusions:Artificial intelligence is comparable to a cardiologist in the initial interpretation of the treadmill test. These approaches might be applicable to data obtained from wearable electrocardiography technologies during exercise.

Circulation, Volume 148, Issue Suppl_1, Page A15449-A15449, November 6, 2023. Background:The six-minute walking test (6MWT) is a commonly used test for assessing the functional capacity of patients with pulmonary hypertension (PH), providing functional and prognostic information. Functional capacity depends on RV-PA coupling, the matching of right ventricular contractility to afterload. However, the dynamics of RV-PA coupling during the 6MWT have never been studied.Methods:We used a wireless hemodynamic monitoring system (CorLog, emka-medical, Germany) to continuously measure right ventricular pressure in 10 patients with PH (8 = group I, 1 = III, 1 = IV) during a 6MWT. We calculated right ventricular ejection fraction (RVEF) and Ees/Ea based on the pressure signal as shown in the figure (panel a). Dyspnea was evaluated using the Borg scale.Results:By analyzing the hemodynamic response during the 6MWT, we identified two patterns: 1) Improved/preserved coupling: Five patients exhibited an initial improvement in Ees/Ea and maintained coupling at least at the baseline level throughout the test, without requiring pauses. 2) Uncoupling associated with pauses: Five patients experienced a slight increase in Ees/Ea at the beginning, followed by a progressive loss of coupling and ejection fraction, necessitating pauses. During pauses, Ees/Ea values restored, enabling patients to resume walking. Patients of the second phenotype reported higher levels of dyspnea. The highest reported Borg score was 8 ± 0.9 vs. 4.6 ± 1.2 in the first group. Also, the covered distance was shorter in the second group (159 ± 64m vs. 288 ± 88m, p=0.03). Both groups showed differences in Ees/Ea (0.47 [0.46 – 0.57] vs. 0.34 [0.30 – 0.43], P=0.05) and RVEF (34 ± 4.1% vs. 28.5 ± 2.6%, P=0.03) at baseline, with Group One exhibiting superior values.Conclusion:This is the first investigation into the significance of RV-PA coupling in real-life exercise limitation and dyspnea during the 6MWT. Pauses observed during the 6MWT can serve as indicators of exercise-induced uncoupling.

Circulation, Volume 148, Issue Suppl_1, Page A16552-A16552, November 6, 2023. BACKGROUND:Coronary artery spasm (CAS) is a major cause of variant angina in patients with chest pain without significant coronary stenosis. However, whether there are differences in the incidence of CAS according to the severity of underlying coronary artery fixed stenosis is limited.Methods:A total of 608 patients without significant coronary artery disease (CAD) who underwent the ergonovine (ERG) provocation test between January 2018 and December 2021 were enrolled. Significant CAS was defined as having≥70% of temporary narrowing by ERG test. Patients were divided into three groups, based on the presence of coronary artery stenosis: None group (n=456), mild group (30-49%,n=114) and moderate group (50-69%,n=38).Results:In patients with chest pain without significant coronary artery stenosis, mild stenosis was 18.8%, and moderate stenosis was 6.3% in the population. The baseline characteristics of the patients were worse in the mild and moderate group than in the None group, including age, hypertension, diabetes, and smoking habit. In the ERG test, CAS occurred in 44.4% (270/608) of the overall population. The incidence of CAS of the mild (55.3%) and moderate (52.6%) groups were higher than the None group (41.0%). Also, in the case of CAS occurrence, focal CAS (Length

Circulation, Volume 148, Issue Suppl_1, Page A11812-A11812, November 6, 2023. Background:Cardiopulmonary exercise test (CPET )is currently used to quantify functional limitation and to evaluate the indications for surgery among patients with hypertrophic cardiomyopathy (HCM). Patients with HCM often have atrial fibrillation (AF) and their relationship is not clear.Objective:To investigate the function limitation among HCM patients who meet indications for septal myectomy and the association between it and AF. Method: We reviewed 565 consecutive patients who underwent myectomy from February 2019 to October 2021, of which 212 did CPET and 24h Holter before surgery.Results:In this cohort (median age: 50.55(37.6-58) years; male: 126(59.4%); left ventricular outflow tract gradient (LVOTG)≥ 50 mmHg: 190(89.6%)), there was a severely impaired function (Peak Oxygen consumption (Peak VO2): 16.44 ± 4.02 ml/min/kg, adjusted Peak VO2%: 58.27%). Comparing different groups divided by Peak VO2, the lowest group was characterized by older age (58 vs 50 vs 43.9 years, p < 0.001), more female patients (57.7% vs 38% vs 25.7%, p < 0.001), higher NT-proBNP level (1299 pg/ml vs 1049 pg/ml vs 742.5 pg/ml, p = 0.004), and larger left atrial diameter (46.8mm vs 43.77 mm vs 42.71 mm, p < 0.001). The incidence of AF also significantly increased (30.98% vs 14.08% vs 7.14%, p < 0.001). Among various indicators of CPET, Peak VO2 showed the strongest correlation with AF (point-biserial correlation coefficient: -0.347, p < 0.001; 0.2279, p = 0.011; -0.2502, p < 0.001; for Peak VO2, ventilatory efficiency, and anaerobic threshold, respectively). Additionally, the incidence of AF decreased with increasing severity of obstruction (60% vs 33.3% vs 16.2% vs 7.1% among non-obstructive, 30≥maximum LVOTG < 50 mmHg, 50≥LVOTG < 100 mmHg, >100 mmHg patients, respectively, p = 0.001). In multivariate regression analysis adjusting for age, sex, BMI, and left atrial diameter, Peak VO2 and LVOTG remained independently associated with the development of AF (OR 0.854, 95% CI 0.743-0.973, p = 0.021 and OR 0.969, 95% CI 0.949-0.987, p = 0.002, respectively).Conclusions:CPET indicator, particularly PeakVO2, was independently associated with the occurrence of AF in eligible surgical patients with HCM. We also found that the higher extent of obstruction, the lower the incidence of AF.

Circulation, Volume 148, Issue Suppl_1, Page A12194-A12194, November 6, 2023. Introduction:We previously reported that a computational modeling-guided antiarrhythmic drug (AAD) test was feasible for assessing diverse AADs in patients with atrial fibrillation (AF). In this study, we took the virtual AAD test (V-AAD) in patients who took AADs after AF catheter ablation (AFCA).Hypothesis:Patients using an effective drug in the VAAD test will have fewer AF recurrences than patients using an ineffective drug.Methods:This single-center retrospective study included 246 patients (72.8% male, 60.7±10.2 years of age, 38.6% paroxysmal AF) prescribed AADs within 3 months after AFCA. Using realistic computational modeling, we evaluated the effects of five AADs (amiodarone, sotalol, dronedarone, flecainide, and propafenone; 2 doses for each drug). Clinical AADs (C-AAD) were chosen at the discretion of the physicians blinded to the V-AAD test. We defined the effective V-AAD as the V-AAD that terminated AF or converted AF to atrial tachycardia (AT) and the best V-AAD as the V-AAD that ended virtual AF the fastest. We compared AF recurrence rates after the AAD prescription depending on the results of the V-AAD test.Results:The ineffective and best V-AAD were administered in 64 (26.0 %) and 70 patients (28.5%). The recurrence rate within a year after using the ineffective, effective, and best V-AAD were 46.9%, 35.7%, and 25.7%, respectively (log-rank p=0.013). The recurrence rate within a year in patients with at least one V-AAD terminating AF and those without was 33.9% and 50.0%, respectively (log-rank p=0.034). The use of best V-AAD (OR 0.43, 95% CI [0.18-0.96]; p=0.042, vs. ineffective V-AAD) is an independent predictor of AF recurrence within a year of using AAD after AFCA.Conclusions:The digital twins-guided V-AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF who had a high chance of recurrence after AFCA. We need a prospective randomization study to assess the prediction power of the V-AAD test.

Da polmonite a meningite, in molti casi efficacia dimezzata

Permette di avere vaccini più mirati e diete meno restrittive

Permette di avere vaccini più mirati e diete meno restrittive

Objective
This study explored whether plant-based and animal-based dietary patterns are associated with plasma glucose levels during oral glucose tolerance test in women with gestational diabetes mellitus (GDM).

Design
A prospective cohort study was conducted using a Food Frequency Questionnaire to collect dietary data. Dietary patterns were derived using principal component analysis. Multivariate logistic regression analysis was performed to explore the association between dietary patterns and plasma glucose levels. Stratified analyses were conducted according to maternal age, prepregnancy body mass index (BMI) and other confounders.

Setting and participants
The study, conducted in January 2022 in two hospitals in Fujian, China, involved 424 women diagnosed with GDM using a 75 g 2-hour oral glucose tolerance test at 24–28 gestational weeks.

Results
Six maternal dietary patterns (plant based and animal based) were identified. Participants with plant-based pattern had lower 2-hour plasma glucose levels than those with animal-based pattern (β=–0.314; 95% CI (–0.596 to –0.032)). After adjusting the regression model covariates, this significant association remained (β=–0.288; 95% CI (–0.568 to –0.008)) and appeared more pronounced in women aged 30 years or above and those with prepregnancy BMI

Fondazione Tettamanti: ‘Più semplice e meno costoso delle Car-T’

Introduction
Young adults with HIV (YWH) experience worse clinical outcomes than adults and have high rates of substance use (SU) and mental illness that impact their engagement in care and adherence to antiretroviral therapy (ART). The intervention for Virologic Suppression in Youth (iVY) aims to address treatment engagement/adherence, mental health (MH) and SU in a tailored manner using a differentiated care approach that is youth friendly. Findings will provide information about the impact of iVY on HIV virological suppression, MH and SU among YWH who are disproportionately impacted by HIV and at elevated risk for poor health outcomes.

Methods and analysis
The iVY study will test the effect of a technology-based intervention with differing levels of resource requirements (ie, financial and personnel time) in a randomised clinical trial with an adaptive treatment strategy among 200 YWH (18–29 years old). The primary outcome is HIV virological suppression measured via dried blood spot. This piloted and protocolised intervention combines: (1) brief weekly sessions with a counsellor via a video-chat platform (video-counselling) to discuss MH, SU, HIV care engagement/adherence and other barriers to care; and (2) a mobile health app to address barriers such as ART forgetfulness, and social isolation. iVY has the potential to address important, distinct and changing barriers to HIV care engagement (eg, MH, SU) to increase virological suppression among YWH at elevated risk for poor health outcomes.

Ethics and dissemination
This study and its protocols have been approved by the University of California, San Francisco Institutional Review Board. Study staff will work with a Youth Advisory Panel to disseminate results to YWH, participants and the academic community.

Trial registration number
NCT05877729.

Testato con successo su topi, efficacia dura più di degenza media

Si conferma la netta prevalenza di EG.5