Risultati per: Incontinenza urinaria da stress o mista

Circulation, Volume 148, Issue Suppl_1, Page A16689-A16689, November 6, 2023. Introduction:Immune checkpoint inhibitors (ICIs) are a form of immunotherapy widely used in the treatment of different cancers. These inhibitors function by blocking specific proteins, such as PD-1 (programmed cell death protein 1) or CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), which regulate the immune response. While ICIs have demonstrated significant benefits, they can also lead to immune-related adverse drug reactions (ADRs). Although rare, cardiac immune-related ADRs are associated with high mortality rates.Hypothesis:The aim of this study to investigate the potential association between stress cardiomyopathy and the use of immune checkpoint inhibitors.Methods:We conducted an analysis using individual case safety reports obtained from the FDA Adverse Event Reporting System (FAERS) Database. These reports encompassed the period from the marketing authorization of each specific ICIs (ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and cemiplimab) up until March 2023. The synthesized data was further examined based on outcome severity, age, and gender.Results:Among 9,772 individual cardiac adverse events associated with immune checkpoint inhibitors, 121 cases (1.2%) of stress cardiomyopathy were reported from 2013 to 2023. The highest occurrence of stress cardiomyopathy adverse events (57.8%) was observed in the age group of 65-85 , compared to 26.4% in the age group of 14-64. Females were more frequently affected, accounting for 55.3% of the cases, while males constituted 41.3%. The three most commonly reported ICIs associated with stress cardiomyopathy were pembrolizumab (39.6%), nivolumab (33.8%), and ipilimumab (16.5%). Among the 121 cases, 19% resulted in mortality, while 26.5% had life-threatening outcomes. Additionally, 79.3% of cases required hospitalization, 5.7% experienced disability, and 57.8% had outcomes that were not characterized.Conclusions:Immune checkpoint inhibitor-induced cardiac ADRs, specifically stress cardiomyopathy, were found to be serious and associated with unfavorable outcomes. Physicians should remain vigilant regarding cardiac symptoms in patients receiving immune checkpoint inhibitors, as early detection can improve overall outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A14137-A14137, November 6, 2023. Stress-induced cardiomyopathy (SCMP) after permanent pacemaker (PPM) implantation is rare. Here, we report an additional case which was initially misdiagnosed as another disease due to atypical symptoms after PPM implantation.Case presentation:A 79-year-old woman with dizziness and dyspnea for one month visited Cardiology Department. She had a history of hypertension, dyslipidemia, diabetes-mellitus and stage IV chronic kidney disease. We confirmed complete atrioventricular block. Left ventricular ejection fraction (LVEF) was normal. PPM implantation was successfully performed without complications. The next day she felt very well with no symptoms. On the second day, she suddenly developed a fever and complained severe left neck pain. She had cough, sputum and general weakness without chest pain. C-reactive protein level increased and systolic blood pressure was decreased. We started antibiotics considering infection. We also checked implantation site, but there were no signs of infection. On the third day, echocardiography showed decreased LVEF (30%), akinesia of apical and medium segments of LV wall with preserved kinetics of basal segments without pericardial effusion (Figure 1). There was no significant stenosis on coronary angiography and we confirmed SCMP. After few days, her blood pressure and symptoms were improved. We prescribed sacubitril-valsartan, bisoprolol and furosemide. At 10 days after implantation, she was discharged with improved symptoms.Conclusion:Our case emphasizes that even successful implantation of PPM without complications can be a potential risk of SCMP. In the absence of typical cardiac symptoms after PPM implantation, a poor general condition may also be considered as a sign of SCMP. Therefore, it is necessary to monitor the patient for at least three more days after PPM implantation.

Circulation, Volume 148, Issue Suppl_1, Page A12494-A12494, November 6, 2023. Compared to cis-males and females, risk for cardiovascular disease (CVD) is elevated in trans-females undergoing estrogen-containing gender affirming therapy. We have previously shown that continuous estrogen treatment of arterioles from healthy adults assigned male at birth promotes microvascular endothelial dysfunction, however the mechanism through which estrogen contributes to endothelial damage remains unknown. Estrogen increases expression of neutral sphingomyelinase (NSmase), an enzyme responsible for the production of ceramides. Ceramides are bioactive sphingolipids that can increase cellular levels of hydrogen peroxide (H2O2). Together, we hypothesize that estrogen increases endothelial levels of oxidative stress through NSmase-mediated ceramide formation. Primary male human umbilical vein endothelial cells (HUVECs; pooled from n=3) were seeded in 8-well microscopy plates prior to treatments. Peroxy yellow 1 (PY1) was used to measure changes in endothelial H2O2. Wells were imaged at 20x and analyzed using ImageJ. Difference between %change in fluorescence ±standard error (SE) is reported, and significance is determined using One-Way ANOVA. Treatment with 17β-estradiol (E2; 100nM, 48hrs) increased endothelial H2O2production (control, n=6 vs E2, n=7; 13.9±6.3, p=0.038), an effect diminished in the presence of the NSmase inhibitor GW4869 (GW4869, 4μM, 48hrs; control, n=6 vs E2+GW4869, n=7; 1.7±6.3, p=0.78). Signal specificity for H2O2was confirmed with PEG-catalase treatment (500U/ml, 48hrs; control, n=6 vs E2+catalase, n=3; 2.3±7.9, p=0.77). Together, these results suggest that estrogen increases oxidative stress in endothelial cells isolated from individuals assigned male at birth which can be prevented through inhibition of the ceramide-forming enzyme NSmase. This work offers mechanistic insight into how estrogen containing gender affirming therapy may potentially contribute to endothelial damage and increase CVD risk in trans-females.

Circulation, Volume 148, Issue Suppl_1, Page A12477-A12477, November 6, 2023. Introduction:Renovascular hypertension poses a significant risk for cardiovascular diseases, with endoplasmic reticulum (ER) stress playing a critical role in their development. However, the specific impact of ER stress-induced C/EBP homologous protein (CHOP) expression in endothelial cells on renovascular hypertension-induced cardiovascular complications remains unexplored. This study investigates the effects of disrupting ER stress CHOP in endothelial cells on microvascular dysfunction associated with renovascular hypertension.Hypothesis:We hypothesize that deleting ER stress CHOP in endothelial cells (EC) can mitigate renovascular hypertension-induced vascular endothelial dysfunction.Methods:Eight-week-old male and female mice (CHOPflx/flxand ECCHOP-/-) were divided into eight groups: control groups undergoing a sham operation for 4 weeks and renovascular hypertension groups subjected to 2-kidney-1-clip (2K1C) surgery for 4 weeks. Body weight, blood pressure, running performance, cardiac hypertrophy and fibrosis, lung edema, inflammation, vascular endothelial function, and signaling were assessed.Results:Male and female CHOPflx/flxmice subjected to 2K1C for four weeks exhibited hypertension, cardiac hypertrophy and fibrosis, lung edema, impaired running performance, and endothelium-dependent vascular relaxation dysfunction. In contrast, male and female ECCHOP-/-mice subjected to 2K1C for four weeks were protected against the pathogenesis of renovascular hypertension. Furthermore, mesenteric resistance arteries from CHOPflx/flxmice displayed reduced endothelial nitric oxide synthase (eNOS) phosphorylation, while ECHOP-/-mice showed no such effect.Conclusions:These findings emphasize the significance of targeting ER stress CHOP in endothelial cells of male and female mice to protect against the development and pathogenesis of renovascular hypertension.

Circulation, Volume 148, Issue Suppl_1, Page A15426-A15426, November 6, 2023. Introduction:Hypertrophic cardiomyopathy (HCM) is a monogenic disorder caused by heterozygous (HET) mutations in sarcomere genes such as MYH7. Recently, human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) carrying HET HCM mutations have shed new insights into the molecular mechanisms of HCM. However, it remains unclear whether the cellular phenotypes of low penetrant mutations such as MYH7 G256E and others, can be adequately elucidated.Hypothesis:We hypothesize that the incorporation of cellular stressors can enhance the manifestation of pathogenic HCM phenotypes in low penetrant MYH7 mutations.Methods:We generated HET and homozygous (HOM) hiPSC-lines for mutation G256E in the MYH7 locus, which is associated with HCM. We performed single-cell RNA sequencing (scRNAseq) with CellPlex technology on wildtype (WT), HET, and HOM iPSC-CMs at day 30 and 60 of cardiac differentiation to establish baseline cellular transcriptional phenotype. We then treated day 30 hiPSC-CMs with 1μM isoproterenol treatment for 5 days or glucose starvation for 10 days and performed scRNAseq to assess their transcriptional shift. Additional Digital Droplet PCR studies were performed to investigate the MYH7 mutant allele expression.Results:In day 30 iPSC-CMs we detected a large clone-to-clone and batch-to-batch variability transcriptionally that obscured the identification of a consistent mutant phenotype in HET MYH G256E vs WT hiPSC lines. These phenotypes correlated with a 1:1 ratio of mutant vs WT allele expression. Implementation of long-term culture or treatment with isoproterenol or glucose starvation led to enhanced hypertrophic and oxidative phosphorylation gene expression in HET hiPSC-CMs. Intriguingly, the expression of MYH6 increased in MYH7-mutant hiPSC-CMs.Conclusions:The application of cellular stressors can enhance the manifestation of hypertrophic phenotypes in HET MYH G256E hiPSC-CMs and suggests a potential mechanism for the variable penetrance of MYH7 mutations in HCM patients.

Circulation, Volume 148, Issue Suppl_1, Page A15210-A15210, November 6, 2023. Introduction:Stress perfusion cardiac magnetic resonance (CMR) is a guidelines-backed non-invasive test for the assessment of coronary artery disease (CAD), and its prognostic value is well validated. However, image interpretation requires a high level of expertise. Furthermore, the direct relationship between image pixels and outcome is not well understood.Hypothesis:Qualitative stress perfusion map based on American Heart Association (AHA) segmentation and direct linkage with outcome can be achieved using artificial intelligence.Methods:Retrospective CMR data collection was performed in one center between 2011 and 2021. Cases with death events were identified. Mean time to event was considered as a follow-up period, and cases without events and with shorter duration from CMR to collection date were excluded. Stress perfusion images were selected from 3 left ventricular (LV) levels: basal, mid and apical. Clinical CMR reports with binary AHA perfusion values were available. Six convolutional neural networks (CNNs) were trained to predict AHA segments values for each level and merged into four CNNs for the apical level. Perfusion, scar image pixels and clinical data were transformed into features, and a hybrid CNN (HNN) was trained to predict mortality. Training, validation, and test split was 70%, 15%, and 15%, respectively. Evaluation metrics included area under curve (AUC).Results:Total number of cases included for AHA plot classification were 2139 (6417 perfusion images). The average AUC for AHA perfusion classifiers was 61%, an example with correct predictions is presented. Follow-up period was calculated at 999 days. Total number of cases included for HNN development was 1294. HNN achieved high prediction value with AUC of 81%.Conclusions:Qualitative AHA stress perfusion map was feasible using artificial intelligence. Outcome prediction with HNN was a powerful new approach for risk stratifying patients with known or suspected CAD.

Circulation, Volume 148, Issue Suppl_1, Page A17390-A17390, November 6, 2023. Introduction:Interventions to reduce cardiovascular disease (CVD) risk factors are key for improving the health and well-being of rural caregivers who are often referred to as invisible patients. The Rural Intervention for Caregivers’ Heart Health (RICHH), a CVD risk reduction intervention (2017-2022) included a stress management module. The COVID-19 pandemic (2020-2021) had an unknown impact on this intervention on perceived stress. The aim of this study was to determine whether the COVID-19 pandemic moderated the effects of RICHH on perceived stress for rural caregivers.Methods:This was a randomized controlled trial of a CVD risk reduction intervention that promoted self-care. Caregivers were randomized to usual care or the RICHH intervention. Data were collected at baseline, 4 and 12 months. Participants were grouped into two groups by COVID-19 timing: 1) the pre-pandemic group (n=145) completed the study before the pandemic; and 2) the pandemic group (n=114) completed the study during the pandemic. A piecewise linear mixed-effect model was used to evaluate the impact of the intervention and COVID-19 timing on perceived stress (Cohen’s Perceived Stress Scale).Results:The effect of the intervention on perceived stress in 259 participants (mean age = 55 ± 13 years, 78% female, 95% white, and 73 % married) was significant in the pandemic group (β= -.59, SE = .14, P < .001) but not in the pre-pandemic group (β = -.10, SE = .13, P = .45 [Figure1). The differences in perceived stress changes between the pre-COVID and during-COVID groups was significant, indicating a moderating effect of COVID (β = -.50, SE = .19, P = .009).Conclusion:The RICHH intervention helped to mitigate stress during the COVID-19 pandemic among those in the intervention group at the 4 months, however this effect was not sustained at 12 months. It remains unclear if the reduction in perceived stress during the pandemic was due to participation in the intervention or weekly contact with an interventionist.

Le donne di mezza età a rischio maggiore aterosclerosi carotidea

This Viewpoint discusses the value of assessing specific stressors that may vary by gender when assessing mental health to better inform our knowledge of stress effects and aid in developing better targeted, gender-informed prevention and treatment efforts in psychiatry.

Various forms of psychological intervention have proven to be powerful in the treatment of posttraumatic stress disorder (PTSD). Two of the best-studied interventions, prolonged exposure (PE) and cognitive processing therapy (CPT), have strong support for their efficacy and have been extensively disseminated by Veterans Affairs, while a third intervention, eye movement desensitization and reprocessing, also is efficacious and widely practiced. Each of these treatments requires considerable therapist training, typically involves numerous sessions over several months, and is variably tolerated by patients. These limitations of extant psychotherapies for PTSD have hastened the demand for therapies that might provide alternatives that are less burdensome for therapists and patients.

Introduction
Botulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The pain felt during the injection causes most patients to experience significant stress for further injections, the level of which is variable between patients.
Immersive virtual reality is a digital technique that simulates the three-dimensional spatial and sound environment around a person said to be immersed in this virtualised world. The effectiveness of virtual reality comes from the intensity of this multisensory immersion, known as the feeling of presence (ie, subjective experience of being in one place or one environment, even when you are physically in another one).
Only one research article in paediatrics has shown that immersive reality technique has a positive impact on the level of pain and agitation suffered during botulinum toxin injections. The purpose of this study is therefore to evaluate with sufficient assurance the following research hypothesis: virtual reality can help adults cope with the stress and pain of botulinum toxin treatment injection.

Methods and analysis
The research hypothesis will be tested using a randomised stepped-wedge method versus a non-invasive technique (headset with virtual reality session) to its control (headset with no image nor audio).
The design leads to considering the injection as a statistical unit as all participants will undergo the standard condition, the control technique and virtual reality technique.

Ethics and dissemination
Patients will be fully and fairly informed in terms of their understanding of the objectives and constraints of the study and the possible risks involved. They will also be entitled to refuse the study and/or withdraw, and this refusal will have no impact on their follow-up as part of their pathology. Dissemination of the results of this study will be through peer-reviewed publications, and national and international conferences.
Ethics were approved by the Comité de Protection des Personnes Nord-Ouest in January 2022.

Trial registration number
NCT05364203.

Giorlandino, ‘obesità dopo il parto è una sfida clinica e di salute pubblica’

Objectives
The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

Design
A longitudinal study with follow-ups from 42 days to 6 months after delivery.

Settings and participants
A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

Methods
Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

Results
Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p

Higher use was not associated with improved outcomes.

Stroke, Ahead of Print. Background:Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status.Methods:Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported.Results:Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31–3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18,P