Risultati per: Nuovi farmaci per il danno renale acuto (Acute kidney injury – AKI)

La spola del primario da Sciacca ad Agrigento.”Non sono un eroe”

La spola del primario da Sciacca ad Agrigento.”Non sono un eroe”

La spola del primario da Sciacca ad Agrigento.”Non sono un eroe”

Stroke, Ahead of Print. BACKGROUND:Blood-brain barrier (BBB) leakage measured with dynamic susceptibility contrast-enhanced magnetic resonance imaging (MRI) has been associated with hemorrhagic transformation in acute ischemic stroke. However, the influence of prethrombolysis BBB leakage on infarct growth has not been studied. Therefore, we aimed to characterize BBB integrity according to tissue state at admission and tissue fate on follow-up MRI.METHODS:This is a post hoc analysis of the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke). Ischemic cores were segmented on diffusion-weighted imaging at baseline and on fluid-attenuated inversion recovery images at follow-up (22–36 hours). Dynamic susceptibility contrast-enhanced–MRI provided penumbra masks (time to maximum of the tissue residue function >6 s minus ischemic core) and BBB leakage (extraction fraction [EF],Zscored) maps via automated analysis. EF was averaged within the ischemic core, total penumbra, 2 penumbra subtypes (salvaged/infarcted penumbra), and normal tissue. Adjusted linear mixed-effects models tested for differences between tissue types and associations of EF with clinical/imaging outcomes. Complementary voxel-wise analyses were performed.RESULTS:Of 503 patients enrolled in the trial, 165 with suitable dynamic susceptibility contrast-enhanced–MRI data were included in this analysis (mean age 66 years, 38% women, median National Institutes of Health Stroke Scale score of 6; 53% receiving alteplase). EF was significantly increased in the ischemic core and penumbra relative to normally perfused tissue, while differences between total penumbra and ischemic core were statistically nonsignificant. Infarcted penumbra exhibited higher EF than salvaged penumbra, even after adjusting for hypoperfusion severity (P

2025 altro anno record. Anche vaccini, malattie rare e Alzheimer

2025 altro anno record. Anche vaccini, malattie rare e Alzheimer

Stroke, Ahead of Print. BACKGROUND:Obtaining timely informed consent is a key barrier in acute ischemic stroke clinical trial recruitment. Electronic consent (eConsent) allows electronic delivery and documentation of the informed consent process, which may optimize recruitment. eConsent in acute ischemic stroke clinical trials, however, is limited and understudied. We conducted a post hoc analysis of eConsent adoption in MOST (Multi-Arm Optimization of Stroke Thrombolysis Trial), a phase III acute ischemic stroke clinical trial, and studied the impact on recruitment.METHODS:From October 10, 2019, to July 5, 2023, MOST enrolled 514 participants at 57 sites in the United States. Study databases were reviewed to determine informed consent modality for each participant: paper—in person, paper—remote, eConsent—in person, and eConsent—remote. Study sites could use paper consent or eConsent for each enrollment. eConsent adoption trends and participant demographic diversity were reported using descriptive statistics. We utilized χ2and Kruskal-Wallis tests to compare individual site enrollment, remote consent utilization, baseline neuroimaging-to-randomization times, data clarification requests, and reportable consent-related unanticipated events.RESULTS:eConsent was utilized for 173 (33.7%) of 514 participants. Of 57 sites, 32 (56.1%) utilized eConsent at least once: those sites had higher median enrollment over the course of the entire trial than non-eConsent sites (7.5 [interquartile range, 5–17] versus 3 [interquartile range, 2–4];P

Eurostat, +13,5% nel 2024 pari a 313,4 miliardi di euro

A new guideline recommends short duration of DAPT if bleeding risk is high and advises bivalirudin instead of heparin for PCI.

This JAMA Insights discusses the recent FDA approval of obecabtagene autoleucel for adults with relapsed or refractory B-cell acute lymphoblastic leukemia and provides regulatory considerations.

Annals of Internal Medicine, Ahead of Print.

Consigliera Pd chiede un tavolo tecnico sul decreto sicurezza

Objectives
Early MRI use varies in the management of acute wrist injuries in the UK, with only a minority of National Health Service (NHS) centres being able to offer this to patients. In this study, we aim to explore the perspectives of staff and patients on the use of early MRI in the management of wrist injuries.

Design
This is a cross-sectional qualitative study using semistructured, face-to-face and remote interviews. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis.

Setting
10 NHS Trusts in the UK.

Participants
We interviewed a sample consisting of 37 NHS staff members and 21 patients.

Results
We analysed the data into three overarching themes. The first theme described the negative impact of wrist injuries on both staff and patients. Staff reported an uncomfortable feeling that they had ‘short-changed’ patients with older non-MRI based pathways, and that the consequences of missing a scaphoid fracture could be a ‘horrible thing’ for patients. The second theme described how early MRI was perceived as a ‘win for everyone’. For patients, the win encompassed the relief of a speedy diagnosis which helped them to get better. Staff saw early MRI as a win because it ‘revolutionised care’ and ‘reduced the clinic footprint’. The final theme defined the key ingredients of delivering an early MRI pathway: a simple pathway with clear accountability, timely access to MRI and prompt reporting of results, a safe pathway with safety nets to avoid patients being lost, data and audit of the time to MRI and definitive treatment, bottom-up engagement, clear communication and looking after your team.

Conclusions
Our findings contribute to a better understanding of stakeholders’ perspectives on wrist injury pathways in the UK NHS.

A guideline from the American College of Physicians organizes drug treatment options into 3 tiers.

Delaying initiation of RRT for as long as 96 hours was not associated with excess mortality among patients in the ICU.

A guideline from the American College of Physicians makes only two formal recommendations.