Risultati per: Standard Italiani per la cura del diabete mellito

Circulation, Volume 148, Issue Suppl_1, Page A13349-A13349, November 6, 2023. Background:While the acute exposure to electronic cigarette (e-C) vapor has been associated with an increase in blood pressure, the chronic effect of e-C vapor on blood pressure compared to standard cigarette smoke has not been extensively studied. We determined the effect of chronic e-C exposure versus standard cigarette smoke on blood pressure and other cardiac functional measures.Methods:Sprague Dawley rats (both sexes) were randomly exposed to air (n=34), e-C with nicotine (e-Cn; n=30), e-C without nicotine (e-C; n= 28) or standard cigarette smoke (SCS; n=27) for 12 weeks. After 12 weeks of exposure hemodynamics were determined by Millar catheter, echocardiography, and thermodilution catheter, a few days after their last exposure.Results:As shown in the Table, SCS was associated with higher systolic, diastolic and mean blood pressures and peak LV systolic pressure compared to air or e-Cn or e-C groups. Neither fractional shortening or cardiac output differed among the groups. dp/dt min, a measure of diastolic LV function, was lowest in the e-C group. Tau, a measure of LV relaxation was worse in this group as well.Conclusions:Standard cigarette smoke exposure was associated with an increase in blood pressure when blood pressure was tested at 12 weeks. Neither electronic cigarette smoke with or without nicotine caused an increase in blood pressure compared to air. However, e-C was associated with worse diastolic function. Standard cigarettes may be associated with a greater sympathetic surge causing elevated blood pressure compared to electronic cigarettes.

Circulation, Volume 148, Issue Suppl_1, Page A306-A306, November 6, 2023. Background:Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings.Research Question:Does a JIT training video improve layperson performance of CPR?Aim:Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course.Methods:A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR.Results:Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%).Conclusions:While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.

Circulation, Volume 148, Issue Suppl_1, Page A415-A415, November 6, 2023. Introduction:Circumferential constriction CPR (CC-CPR) applied by pneumatic vest may be superior to standard sternal compression, and the addition of alternative pumping modalities may further enhance efficacy. Interposed abdominal counterpulsation (IAC-CPR) CC-CPR is one such modality. Early canine studies of IAC reported greater efficacy when the abdominal counterpulsation was started 30% before the thoracic compression, rather than fully counterphase timing as is used clinically. This may be thought of as “Abdominal Preload” IAC (Pre-CPR).Hypothesis:Addition of IAC-CPR to CC-CPR may be associated with improved perfusion pressures, and Pre-CPR may be even more effective.Methods:We compared CC-CPR to IAC-CPR and Pre-IAC in a porcine model of VF (n=6). In IAC-CPR, the constrictions are fully counterphase. In Pre-IAC, abdominal constriction is initiated 30% before thoracic constriction. Alternating 30 second epochs of each treatment were applied via a circumferential abdominal vest. Aortic (Ao) and Right Atrial (RA) pressures were measured by micromanometer catheters. IAC-CPR and Pre-CPR end-epoch pressures were each compared to preceding CC-CPR end-epoch pressures.Results:Addition of IAC-CPR and Pre-IAC to CC-CPR were both associated with similar, significant increases in CPPs. However, the source of these improvements differed (See Table 1). For IAC-CPR, the increase appeared to result from an Ao increase greater than an associated increase in RA. For Pre-CPR, the increase appeared to be solely due to increased Ao.Limitations:Small sample. Surrogate biomarkers. Non-human model.Conclusions:The addition of pulsatile abdominal counter-constriction to vest CC-CPR may be a promising path to multimodality, regardless of the particulars of cycle timing. We do not confirm earlier observations that Pre-CPR may be superior to IAC-CPR.

Circulation, Volume 148, Issue Suppl_1, Page A14207-A14207, November 6, 2023. Introduction:Artificial intelligence (AI) using electrocardiogram (ECG) enabled to predict atrial fibrillation (AF) in patients without documented AF. It needs 12-lead ECG with tremendous data learning. Mobile 1-lead ECG is more convenient to surveil cardiac rhythm with simple measurement. However, AI-enabled arrhythmia predictability by mobile ECG is limited due to single channel utilization and longer duration for arrhythmia diagnosis.Hypothesis:We aimed to enhance mobile ECG AF prediction AI algorithm integrated with 12-lead ECG deep learning model.Methods:Based on 552,372 12-lead ECG data of 318,321 patients, a statistical AF prediction model employing a deep-learning approach was constituted. The raw data of 6,792 1-lead mobile ECGs were acquired from 6,792 patients for about 1 minute at 250Hz. A statistical AF prediction model with mobile ECG employing a deep-learning approach was constituted. Resnet structure was utilized to distinguish subtle changes of the vicinity of P-wave. Both 12-lead ECG and mobile ECG were allocated to training, validation, testing datasets in a 6:2:2 ratio. Then, we conducted transfer learning using the standard 12-lead ECG’s deep learning model to improve performance of 1-lead mobile ECG deep learning model.Results:AF was annotated in 26,541 (4.8%) with 12-lead ECG whereas 1,443 (21.2%) with 1-lead mobile ECG. The area under the curve (AUC) value for predicting AF was 0.910 with 12-lead ECG, and 0.721 with mobile ECG . The predictive performance of mobile ECG was 79.7% in accuracy, 47.5% in sensitivity and 50.3% in F1-score. The AUC value of mobile ECG after applying transfer learning based on 12-lead ECG for AF prediction was increased to 0.905 with accuracy of 89.1%, sensitivity of 71.3% and F1-score of 57.7%.Conclusions:Integration with deep learning algorithm of standard 12-lead ECG significantly improved the model performance of mobile ECG AF prediction model compared to 1-lead mobile ECG only based model. Easy application of mobile ECG with enhanced AF predictability might serve a more convenient method as a pre-emptive assistive tool to provide probabilistic prediction for PAF screening rather than 12-lead ECG.

Circulation, Volume 148, Issue Suppl_1, Page A242-A242, November 6, 2023. Background:Multiple biomarkers have been used in prognostication of outcome after out-of-hospital cardiac arrest (OHCA) and standard cardiopulmonary resuscitation (CPR). Limited evidence exists for patients resuscitated with extracorporeal CPR (ECPR). We hypothesized that (1) the time course and (2) prognostic performance of biomarkers will differ between CPR and ECPR.Methods:This is a pre-planned sub-analysis of Prague-OHCA study. Patients were randomized to either CPR or ECPR. The primary outcome was poor neurologic outcome at 180 days, defined as a cerebral performance category (CPC) of 3-5. Secondary outcomes included assessment of biomarkers of neurologic injury (NSE), inflammation (procalcitonin – PCT, C-reactive protein – CRP, neutrophil-lymphocyte ratio – NLR) and hematology (platelets – Plt, D-dimers – D-dim, and fibrinogen – Fg) using Mann-Whitney test with Bonferroni correction, and ROC analysis of data at 24-72 h.Results:In as-treated analysis, ECPR was used in 92 patients. The primary outcome was not different between groups: CPR, CPC 1-2 48 (29.3%) vs CPC 3-5 116 (70.7%); ECPR, CPC 1-2 20 (21.7%) vs CPC 3-5 72 (78.3%); p= 0.191. In general, individual biomarkers exhibited similar trajectories over 72 h, with worse values in patients with CPC 3-5 in both CPR and ECPR groups. PCT was higher in ECPR group at 24-72 h (all p

Circulation, Volume 148, Issue Suppl_1, Page A16773-A16773, November 6, 2023. Introduction:Lp(a) is a robust predictor of coronary heart disease outcomes, with targeted therapies currently under investigation. However, there is a paucity of data regarding the risk of elevated Lp(a) in relation to other cardiovascular risk factors.Objective:To evaluate the association of high Lp(a) with standard modifiable risk factors (SMuRFs) for incident first acute myocardial infarction (AMI).Methods:This retrospective study utilized the MGB Lp(a) Registry which included patients ≥18 years with an Lp(a) measurement between 2000-2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasm, and prior known atherosclerotic cardiovascular disease (ASCVD). Diabetes mellitus, hyperlipidemia, hypertension, and smoking were considered SMuRFs. High Lp(a) was defined as >90thpercentile and low Lp(a) as

Attività svolta da un’equipe interdisciplinare

Attività svolta da un’equipe interdisciplinare

Introduction
Imprecise nutritional recommendations due to a lack of diagnostic test accuracy are a frequent problem for individuals with adverse reactions to foods but no precise diagnosis. Consequently, patients follow very broad and strict elimination diets to avoid uncontrolled symptoms such as diarrhoea and abdominal pain. Dietary limitations and the uncertainty of developing gastrointestinal symptoms after the inadvertent ingestion of food have been demonstrated to reduce the quality of life (QoL) of affected individuals and subsequently might increase the risk of malnutrition and intestinal dysbiosis. This trial aims to investigate the effects of a tailored diet based on the confocal laser endoscopy (CLE) examination result to limit the side effects of unspecific and broad elimination diets and to increase the patient’s QoL.

Methods and analysis
The study is designed as a prospective, double-blind, monocentric, randomised and controlled trial conducted at the University Hospital of Schleswig-Holstein, Campus Lübeck, Germany. One hundred seventy-two patients with non-IgE-related food allergies and positive CLE results will be randomised to either a tailored diet or a standard fivefold elimination diet. The primary endpoints are the difference between the end and the start of the intervention in health-related QoL and the sum score of the severity of symptoms after 12 weeks. Key secondary endpoints are changes in the severity of symptoms, further QoL measurements, self-assessed state of health and number of days with a pathologically altered stool. Microbiome diversity and metabolome of stool, urine and blood will also be investigated. Safety endpoints are body composition, body mass index and adverse events.

Ethics and dissemination
The study protocol was accepted by the ethical committee of the University of Lübeck (AZ: 22-111) on 4 May2022. Results of the study will be published in peer-reviewed journals and presented at scientific meetings.

Trial registration number
German Clinical Trials Register (DRKS00029323).

“I giovani vanno all’estero, da noi condizioni non competitive” ha detto il Capo dello Stato. “La battaglia contro il cancro è una grande impresa collettiva, richiede impegno, collaborazione, sostegno reciproco, fiducia”

Su 12 milioni colpiti, 6 milioni potrebbero immunizzarsi. Esperti, pesano costi

Programma nazionale esiti, per il secondo anno consecutivo

Fnomceo:, Spesa privata supera i 40 miliardi. Sanità sia pubblica’