Risultati per: Le sigarette light sono più pericolose di quelle normali

Circulation, Volume 150, Issue Suppl_1, Page A4144738-A4144738, November 12, 2024. Introduction:Partial heart transplant (HT), the transplantation of living/growing heart valve implants, has emerged as a novel solution for children with complex CHD and semilunar valve dysfunction. Management of immune suppression following partial HT is unclear, and may be aided by understanding how valve function changes during full HT graft rejection.Aims:To compare semilunar and atrioventricular (AV) valvular function before and during biopsy-proven rejection by echocardiogram imaging in pediatric HT recipients.Methods:Single institution retrospective study including all pediatric HT recipients during 2005-2023 with biopsy diagnosed rejection, a preceding biopsy with no rejection (baseline), and available echo within 24 hours of each biopsy. All echos were reviewed by a pediatric imaging cardiologist to qualitatively grade valvular and ventricular function. Change in valvar/ventricular function was assessed by McNemar’s and Fischer’s exact tests.Results:The cohort comprised 87 patients (43.7% female, mean age 14.2 years [SD +/-6.5], 60% with acute cellular rejection and 40% with antibody mediated rejection, median time between baseline and rejection diagnostic biopsy/echo pairs 6.5 months [SD +/-3.9]). At baseline, 99% of patients had no/mildly depressed left and right ventricular systolic function. During rejection 18%(17) patients had progressed to moderate or greater LV dysfunction and 15%(13) had moderate or greater RV dysfunction (p-value mild LV dysfunction during rejection compared to those who did not (82% vs. 22%, p

Circulation, Volume 150, Issue Suppl_1, Page A4142597-A4142597, November 12, 2024. Background:Previous research on the iron deficiency (ID) of patients with light chain cardiac amyloidosis (AL-CA) has been limited.Aims:The purpose of this study was to investigate how different definitions of ID affect its prevalence and association with prognosis in patients with AL-CA.Methods:Consecutive patients diagnosed with AL-CA at Heart failure Center, Fuwai hospital between September 2017 and July 2023 with available iron status were included. ID was defined as (1) serum ferritin concentration of

Circulation, Volume 150, Issue Suppl_1, Page A4142598-A4142598, November 12, 2024. Background:The predictive value of soluble suppression of tumorigenicity-2 (sST2) has been demonstrated in heart failure patients. However, studies on the association between baseline sST2 levels, dynamic changes in sST2, and prognosis in patients with light chain cardiac amyloidosis (AL-CA) are limited.Aim:The study sought to assess the predictive value of baseline circulating sST2 and added prognostic value of change in sST2 levels in patients with AL-CA.Methods:Patients diagnosed with AL-CA patients in Heart Failure Center, Fuwai Hospital between October 2015 to August 2023 were enrolled. The serum sST2 levels were measured at baseline and at 30 days. The change of sST2 (ΔsST2) was defined as the sST2 level at 30 days minus baseline sST2. The primary outcome was all-cause mortality. Kaplan–Meier analysis and Cox hazard models were performed to explore the predictive value of both sST2 at baseline and ΔsST2.Results:Overall, 132 patients were included. The median follow-up was 235 days. The mean age was 58.92 years (standard deviation [SD]: 10.74 years), and 62.1% of the participants were male. The median sST2 level was 30.42 ng/mL (IQR: 18.41–51.98 ng/mL), with the cutoff value set at 35 ng/mL. Higher sST2 levels at baseline ( >35ng/ml) were associated with increased risk of all-cause mortality after adjusting for N-terminal pro–B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTNI), and difference between involved and uninvolved free light chain (dFLC) levels (adjusted hazard ratio [HR] 1.86, 95% confidence interval [CI]: 1.03-3.38; P

Circulation, Volume 150, Issue Suppl_1, Page A4139575-A4139575, November 12, 2024. Background:Left bundle branch area pacing (LBBAP) has been persuasively adopted in clinical practice to achieve electrical and mechanical synchrony of the left ventricle. However, LBBAP in amyloid light chain cardiac amyloidosis (AL-CA) patients has not been studied in detail.Hypothesis:LBBAP could be a feasible and safe approach to rectify the conduction system diseases of AL-CA patients.Aim:To study the feasibility and safety of LBBAP in AL-CA patients.Methods:Consecutive patients with AL-CA and newly implanted pacemaker in our centre between 1st January 2022 and 31st December 2023 were retrospectively included. The diagnosis of AL-CA was confirmed according to the current ESC position statement. Indications for pacemaker fulfilled the current ESC guideline. All patients underwent attempts of LBBAP or right ventricular pacing (RVP) based on operators’ preference.Results:A total of 10 patients were included. RVP was chosen initially in 1 patient and LBBAP was attempted in 9 patients. LBBAP were successfully performed in 6 patients (66.7%, 6/9). Three patients crossed over to RVP group because LBBAP was failed to achieve(Fig.1).Baseline clinical characteristics and pacing parameters was compared between LBBAP group and RVP group (Table.1). Duration of intrinsic QRS was similar and paced QRS was wider in RVP group (P=0.029).During follow-up, one patient in LBBAP group died from sudden death 15 days after implantation, while 2 patients in RVP group died from sudden death and pneumonia 55 days and 17 days after implantation, respectively. Seven patients visited our centre at three-month follow-up without adverse events and interrogation reports were summarized inFig.1.Conclusion:LBBAP appears to be a reasonable method for physiological pacing for patients with AL-CA and bradycardia, but its impact on long-term prognosis needs further investigation.

New England Journal of Medicine, Ahead of Print.

Introduction
Elderly patients are at a high risk of postoperative delirium (POD), leading to increased postoperative morbidity and mortality. The use of dexmedetomidine and depth of anaesthesia may influence POD. This study aims to determine the effects of dexmedetomidine infusion versus normal saline placebo during light versus deep anaesthesia on POD among elderly patients undergoing major non-cardiac surgery.

Methods and analysis
This prospective, multicentre, randomised, controlled, factorial trial will be conducted at three tertiary hospitals in Jiangsu, China. We will recruit a total of 420 patients who are at least 60 years old and undergoing major non-cardiac surgery (thoracic, abdominal, urology, orthopaedic and spine surgery) under general anaesthesia. Patients will be randomised (1:1:1:1) to receive one of four anaesthesia regimens: (1) dexmedetomidine and light anaesthesia, (2) dexmedetomidine and deep anaesthesia, (3) placebo and light anaesthesia or (4) placebo and deep anaesthesia. Dexmedetomidine will be infused at 0.5 µg/kg/h throughout surgery, and intraoperative bispectral index target will be 55 for light anaesthesia and 40 for deep anaesthesia. The primary outcome is the occurrence of POD during the first 7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method two times per day. The secondary outcomes include days with POD, type of POD, pain scores at rest and on movement at 24 and 48 hours postoperatively, patient-controlled intravenous fentanyl consumption during 0–24 and 24–48 hours postoperatively, hypotension, bradycardia, postoperative nausea and vomiting, non-delirium complications, length of postoperative hospital stay, 30-day cognitive function and 30-day mortality. Data will be analysed on a modified intention-to-treat basis.

Ethics and dissemination
This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University and each participating centre. The trial results will be published in a peer-reviewed journal.

Trial registration
Chinese Clinical Trial Registry (ChiCTR2300073271)

‘Continueremo questa battaglia, è una misura di sanità pubblica’

Da Mpox ad aviaria, 15 fattori delineano il rischio di pandemia

6 euro contro oltre 10 di altri paesi. 62% favorevole ad aumenti

Ricavo di 13 mld. Il fumo è causa del 90% dei tumori al polmone. Emendamento in manovra

Ricavo 13 mld, causa 90% tumori polmone. Emendamento Castellone

This cohort study examines graded kidney response criteria and their association with kidney and overall survival for patients with kidney light chain amyloidosis.

New England Journal of Medicine, Volume 391, Issue 12, Page 1164-1166, September 26, 2024.

Circulation, Ahead of Print. BACKGROUND:Biomarkers reflecting brain injury are not routinely used in risk assessment of stroke in atrial fibrillation (AF). Neurofilament light chain (NFL) is a novel biomarker released into blood after cerebral insults. We investigated the association between plasma concentrations of NFL, other biomarkers, and risk of stroke and death in patients with AF not receiving oral anticoagulation.METHODS:For this observational study, baseline plasma samples were available from 3077 patients with AF randomized to aspirin in ACTIVE A (Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events; 2003 to 2008) and AVERROES (Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment; 2007 to 2009). Median follow-up was 1.5 years. NFL was analyzed with a Single Molecule Array (Simoa). Associations with outcomes (total stroke or systemic embolism, ischemic stroke, cardiovascular death, and all-cause death) were explored with Cox regression models.RESULTS:In the combined cohort, the median NFL level was 16.9 ng/L (interquartile range, 11.1–26.5 ng/L), the median age was 71 years, 58% were men, and 13% had a history of previous stroke. NFL was associated with older age, higher creatinine, lower body mass index, previous stroke, female sex, and diabetes but not cardiac rhythm. Higher NFL was associated with a higher risk of stroke or systemic embolism (n=206) independently of clinical characteristics (hazard ratio, 1.27 [95% CI, 1.10–1.46] per doubling of NFL) and other biomarkers (hazard ratio, 1.18 [95% CI, 1.01–1.37]) and including in patients without previous stroke (hazard ratio, 1.23 [95% CI, 1.02–1.48]). NFL was also independently associated with cardiovascular (n=219) and all-cause (n=311) death. The C index for stroke using only NFL was 0.642, on par with the currently used clinical risk scores. Addition of information on NFL improved discrimination in a model also including clinical information, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and high-sensitivity cardiac troponin T, yielding a C index of 0.727.CONCLUSIONS:NFL reflects overt and covert episodes of cerebral ischemia and improves risk assessment of stroke and death in patients with AF without oral anticoagulation, including in patients without previous stroke. The combination of NFL with information on age, history of stroke, and other biomarkers should be explored as a future avenue for stroke risk assessments in patients with AF.

Il testo in aula con alcune modifiche come quella che riscrive le misure sui controlli nella gestione delle liste che tornano in capo alle Regioni

This randomized clinical trial evaluates bright light therapy vs treatment as usual for youth with depression.