Risultati per: Nota 13 AIFA - Guida pratica

Via libera in tumori stomaco, esofago e colon-retto metastatico

Ritorno sintomi per 45% persone depresse in passato 

Magrini, no a falso mito che terapia non va interrotta se iniziata

Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici

Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici

Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici

E’ un’ulteriore opzione a disposizione

Objectives
Previous studies suggested an inverse association between lipoprotein cholesterols and bleeding risk, while limited data were available about the predictive value of lipoproteins on intracerebral haemorrhage (ICH). Our recent research series showed that higher non-high-density lipoprotein cholesterol (non-HDLC) was an independent predictor of favourable 3-month outcome in ICH patients, we thus aimed to further investigate the association between non-HDLC levels and 1-year functional outcomes after ICH.

Design
Prospective multicentre cohort study.

Setting
13 hospitals in Beijing, China.

Participants
A total of 666 ICH patients were included between December 2014 and September 2016.

Methods
Non-HDLC was calculated by subtracting HDL-C from total cholesterol. Patients were then grouped by non-HDLC levels into three categories:

Circulation, Volume 146, Issue Suppl_1, Page A15799-A15799, November 8, 2022. Objective:To assess intermediate outcomes among patients older than 13 years old who underwent a Ross procedure at a single center and to describe the relationship of external reinforcement with the need for aortic reinterventionsMethods:Retrospective analysis of a single center clinical records from 2005 to 2020. Comparative analysis of baseline and perioperative variables was done using non-parametric test between Ross procedure and modified Ross procedure. Kaplan Meier function was used to evaluate the survival free from aortic reintervention.Results:A total of 40 patients with a median age of 17.9 years (IQR 15.4 – 20.1), 88% (n= 35) males and median weight of 64.1 Kg (IQR 55.8-83.2) were included, where 15% (n= 6) had a Ross-Konno procedure and 85% (n= 34) a Ross procedure. Overall, 70% (n= 28) of the patients had the pulmonary autograft reinforced with a woven vascular graft, with a median size of 28 mm (IQR 26 – 28). The most common indication for surgery was a mixed stenotic/insufficiency lesion in 75% (n=10) of cases, and the most common anatomic configuration was a bicuspid valve in 73% (n= 29); 65% (n= 26) of the patients had had a pre-Ross aortic intervention. No differences were observed between the reinforced and non-reinforce group in terms of age (16 vs 18 years: p=0.29), and weight (63 vs. 69 kg; p=0.57) nor indication for surgery (Table 1). After a median follow up time of 5.1 years (IQR 2.6 – 7.8), 25% (n=3) of the non-reinforced Ross had required aortic reinterventions compared to 4% (n=1) with the reinforced group. The survival free from aortic reintervention at 5 years was 96% (CI 87 – 99) in the cohort, without differences in the Kaplan Meier curves between the 2 groups (log rank= 0.18)Conclusion:Intermediate outcomes after the Ross procedure in patients >13 years old are favorable, with a lower rate of reintervention in patients with a reinforced autograft. Long term outcomes are needed to further elucidate the greater impact of external support of valve competency.

Circulation, Volume 146, Issue Suppl_1, Page A12809-A12809, November 8, 2022. Background:Major adverse cardiac events (MACE) are a leading cause of morbidity and mortality after orthotopic liver transplantation (OLT). Cirrhotic cardiomyopathy (CCM) is relatively common and a source of MACE in patients after OLT. Initial diagnostic criteria based on transthoracic echocardiogram (TTE) were described in 2005 and revised in 2019 with echocardiographic advancements (Table 1). We sought to identify CCM related predictors of MACE at 13 months post-OLT.Methods:This is a retrospective study of adult patients who underwent OLT between 2009-2019. All patients had TTE’s within one year pre-OLT and one month to 13 months post-OLT. We excluded TTE’s within one-month post-OLT to reduce contributions from stress cardiomyopathy. Patients with a left ventricular ejection fraction less than 50% pre-OLT were excluded. MACE was defined as death, MI, CHF hospitalization, or cardiac arrest. Multivariable Cox regression was used to identify independent predictors of MACE.Results:Of 568 OLT patients screened, 131 met inclusion criteria for this study. There were 103 and 23 patients who met 2005 and 2019 criteria, respectively. During the 13 month follow up period, 42 patients had MACE. Compared to those without MACE, patients with MACE had more ascites (93 vs 70%, p 0.003), hepatorenal syndrome (HRS) (17 vs 4%, p 0.019), delayed OLT >10 days after admission (19 vs 7%, p 0.033), pre-OLT CCM per 2005 criteria (90% vs 73%, p 0.023), and lower diastolic blood pressure (60.81 vs 66.88, p 0.014). There was no difference in pre-OLT CCM per 2019 criteria (19 vs 17%, p 0.758) or MELD-Na score (21.24 vs 19.40, p 0.166). In multi-variable cox regression analysis adjusted for diastolic blood pressure, HRS, ascites, and OLT timing during admission, CCM per 2005 criteria remained significant as seen in Figure 1 (Hazard Ratio = 3, p 0.038).Conclusion:CCM per 2005 criteria is an independent predictor of MACE at 13 months post-OLT while CCM per 2019 criteria is not.

Circulation, Volume 146, Issue Suppl_1, Page A13-A13, November 8, 2022. Background:Cardiac rearrest after return of spontaneous circulation (ROSC) is a significant barrier to successful resuscitation, making it a high priority for emergency care research. Regardless of initial arrest rhythm, rearrest is commonly due to pulseless electrical activity (PEA). However, mechanisms underlying PEA rearrest are poorly understood. Previously, myocardial contractile function during ischemia-reperfusion has been tied to alterations in extracellular sodium (Na+) and calcium (Ca2+) concentrations.Objective:To determine physiological predictors and explore potential mechanisms underlying susceptibility to PEA rearrest.Methods:Acute myocardial infarction (AMI) induced by left anterior descending artery (LAD) occlusion was followed by 8 min of VF, then pigs were resuscitated (defibrillation, CPR, epinephrine) to ROSC and the LAD was reperfused. Pigs were instrumented to measure metabolic variables from arterial and coronary sinus venous blood gases, electrolytes, and hemodynamics. Subjects that had PEA rearrest (n=7) were compared to those that did not rearrest (n=4).Results:Hemodynamic and primary arrest characteristics were similar between PEA and no rearrest groups, including ischemia duration, time to ROSC, CPR events, and epinephrine administration. At ROSC, hemodynamic and metabolic variables including pH, myocardial lactate consumption, myocardial arterial/venous oxygen difference were also similar between groups. Importantly, post-ROSC myocardial lactate consumption was significantly increased in the PEA group (3.9 vs. 0.5 mmol, p