Search Results for: Le cause della polmonite nei bambini

Stroke, Ahead of Print. BACKGROUND:National studies on reversible cerebral vasoconstriction syndrome (RCVS) point to differences between Asian and European patients. We investigated geographic variations in neurological complications, outcomes, and causes.METHODS:We conducted an exploratory analysis of pooled individual patient data from the Reversible Cerebral Vasoconstriction Syndrome International Collaborative network, a multicenter observational cohort study including patients with definite RCVS from 2 French, 32 Italian, 1 South Korean, and 1 Taiwanese centers. Data on demographics, precipitants, symptoms, imaging, treatment, and outcomes were collected. The primary end point was RCVS-associated brain lesions, including ischemic stroke, cortical subarachnoid hemorrhage, intracerebral hemorrhage, posterior reversible encephalopathy syndrome, and subdural hematoma. Secondary end points included unfavorable 3-month outcomes (modified Rankin Scale score ≥1) and causes (idiopathic versus secondary). Odds ratios and 95% CIs were calculated using multivariable logistic regression, adjusting for potential confounders.RESULTS:From 2009 to 2021, we included 1127 patients (528 European and 599 Asian). Recruitment occurred either through emergency settings or outpatient clinics, with most Asian patients recruited from outpatient clinics (65.8%) and most European patients from emergency settings (99.8%). Brain lesions were more frequent in European patients (29.2% versus 6.3%; odds ratio, 4.09 [95% CI, 2.66–6.30]). In a sensitivity analysis restricted to hospitalized patients (n=651), the association persisted. Unfavorable 3-month outcomes (5.5% versus 1.7%; odds ratio, 3.01 [95% CI, 1.35–6.68]) and secondary RCVS (50.4% versus 10.9%; odds ratio, 7.09 [95% CI, 5.14–9.76]) were also associated with European residency.CONCLUSIONS:RCVS presentations vary across regions, with higher lesion rates, more secondary forms, and worse outcomes in European patients. While these exploratory results may reflect selection bias from differing health care structures, further research is needed to determine the contribution of genetic, environmental, and societal factors.

Stroke, Ahead of Print. BACKGROUND:Studies evaluating health system factors associated with major adverse cardiovascular events (MACE) among intracerebral hemorrhage (ICH) survivors are lacking. We evaluate differences in MACE incidence across postacute ICH care settings—inpatient rehabilitation facilities (IRF), home, or skilled nursing facilities (SNF).METHODS:Using data from Florida, New York, Maryland, Washington, and Georgia, we identified adult ICH survivors discharged to home, IRF, or SNF (April 2016–December 2018). Multivariable logistic models, adjusted for sociodemographic factors, treatment intensity, comorbidities, and frailty, estimated adjusted odds ratios (aORs) and 95% CIs for the association between discharge disposition (IRF versus home; IRF versus SNF) and MACE (a composite of acute stroke, acute myocardial infarction, systemic embolism, and vascular death), recurrent ICH, acute ischemic stroke, acute myocardial infarction, vascular death, and all-cause mortality within 1 year. Cardiovascular outcomes were ascertained usingInternational Classification of Diseases, Tenth Revisioncodes. We assessed age-discharge disposition interaction, performing stratified analyses for patients

RZV vaccination is associated with a reduced risk of HZ among patients with RA aged 50 years and older. While we observed a reduction in all-cause mortality among RZV recipients, this finding should be interpreted with caution, as the effect size may not be entirely attributable to HZ prevention alone. Given the established efficacy of RZV in preventing HZ and its potential to reduce mortality, vaccination should be prioritized among eligible patients with RA.

Screening della popolazione pediatrica. Il diabete è simile ai paesi Ue

Purpose
Congenital cytomegalovirus (cCMV) is an important cause of long-term childhood disability. In Australia, the identification and treatment practices and the long-term clinical and neurodevelopmental outcomes of children with cCMV are unknown. The Australasian cCMV Register (ACMVR) is a longitudinal register and resource for research that aims to describe and explore, in Australian children with cCMV: (1) their clinical characteristics over time, (2) antiviral therapy use/prescribing up to 1 year of age and (3) risk factors and potential avenues for prevention of adverse sequelae of the virus.

Participants
Children

Objectives
This study aimed to evaluate the prognostic significance of preoperative serum lipid profiles, particularly high-density lipoprotein cholesterol (HDL-C), in gastric cancer (GC) patients undergoing gastrectomy.

Design
A hospital-based retrospective cohort study.

Setting
A tertiary hospital in Eastern China.

Participants
771 consecutive GC patients who underwent gastrectomy between 2014 and 2018, had complete pathological data, and received standardised adjuvant chemotherapy (fluoropyrimidine or taxane-based regimens).

Exposures
Preoperative serum lipid profiles, including total cholesterol (TC), triglycerides (TG), HDL-C and low-density lipoprotein cholesterol (LDL-C), along with clinicopathological data, were collected. Patients were stratified by sex-specific lipid tertiles (T1–T3).

Outcome measures
The primary outcome was overall survival (OS), defined as the time from surgery to death from any cause or to the last follow-up. Secondary outcomes included stage-specific survival rate (stage III+IV versus stage I/II; M0 versus M1 status). Mortality HRs were estimated using Cox proportional hazards models: Model 1 adjusted for age and sex, and Model 2 fully adjusted for Tumor-Node-Metastasis (TNM) stage and tumour characteristics. OS was analysed using Kaplan-Meier curves and log-rank tests. Subgroup analyses were performed for variables with significant interactions.

Results
The cohort had a median follow-up of 41.0 months (range: 0.03–89.8 months), and an OS rate of 58.2%. In multivariable analysis, HDL-C was an independent prognostic factor (highest versus lowest tertile: HR 0.728 (95% CI 0.558 to 0.949), P-trend=0.019). The strongest associations were observed in the stage III+IV subgroup (HR 0.699 (95% CI 0.515 to 0.949), p-trend=0.021) and the M0 subgroup (HR 0.734 (95% CI 0.560 to 0.963), p-trend=0.025). After full adjustment, no significant associations were found for TG, TC or LDL-C.

Conclusions
Preoperative HDL-C predicted OS in GC patients, especially in those with locally advanced or non-metastatic patients. These findings suggest that lipid metabolism may affect tumour biology and prognosis in operable GC.

Peggioramento dal 2010, fatale il Covid

Report Aletheia, eccesso cibi ultra-formulati. Partire da scuole

Objective
Prognostic nutritional index (PNI) is an index for assessing nutritional and immune status. The aim of this study is to investigate the predictive value of PNI for long-term major adverse cardiac and cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (T2DM).

Design, setting and participants
This retrospective cohort study analysed 1582 STEMI patients with T2DM who underwent percutaneous coronary intervention from January 2015 to June 2023 in Urumqi, China. Patients were followed up for MACCE.

Primary and secondary outcome measures
The primary endpoint was new-onset MACCE including all-cause death, non-fatal MI and non-fatal stroke.

Results
This study ultimately included 1582 patients for analysis with a median follow-up period of 48 months (IQR: 24–84 months) and 282 patients (17.8%) developed MACCE. Of them, 138 (8.7%), 84 (5.3%) and 60 (3.8%) patients developed all-cause death, a non-fatal MI and a non-fatal stroke, respectively. Incidences of MACCE and all-cause death conversely correlated with PNI. Kaplan-Meier curves showed a significant difference in all components of MACCE between PNI quartiles (p

Background
Angina, a major manifestation of ischaemic heart disease, affects 3–7% of adults and is a leading cause of cardiovascular morbidity. As an ambulatory care-sensitive condition, its outcomes can be improved through proactive outpatient management. However, the real-world impact of continuity of care (COC) and medication adherence, measured by the medication possession ratio (MPR)—on angina complications in South Korea remains poorly understood.

Objective
This study evaluated the effectiveness of COC and MPR in patients with angina using comprehensive national data and examined the outcomes at the hospital level.

Methods
This retrospective cohort study used data from the National Health Insurance Service of Korea between 2002 and 2019. We identified 11 127 patients aged >30 years newly diagnosed with angina, applying strict exclusion criteria to ensure cohort validity. COC was categorised as high (COC index=1.0) or low (

Objective
To estimate the prevalence of autism among adults living in Canada.

Design
A Monte Carlo simulation modelling approach was employed. Input parameters included adult population estimates and mortality rates; autism population all-cause mortality risk ratios; and autism prevalence estimates derived from child and youth data due to the lack of adult data. This approach was executed through 10 000 simulations, with each iteration generating a distinct data scenario. Prevalence estimates were reported as the mean with the 2.5th and 97.5th percentiles, corresponding to a 95% simulation interval (SI).

Setting
Where possible, Canadian data sources were used, including the 2019 Canadian Health Survey on Children and Youth and Statistics Canada mortality rates and population estimates.

Primary outcome measure
National prevalence estimates of autistic adults living in private dwellings in Canada, with variations in prevalence by sex at birth and province/territory considered.

Results
The findings suggest the prevalence of autism among adults in Canada to be 1.8% (95% SI 1.6%, 2.0%). National prevalence estimates by sex at birth were 0.7% (95% SI 0.6%, 0.9%) for females and 2.9% (95% SI 2.6%, 3.2%) for males. Provincial/territorial estimates ranged from 0.7% in Saskatchewan (95% SI 0.3%, 1.3%) to 3.6% in New Brunswick (95% SI 2.4%, 5.1%).

Conclusions
The limited availability of data on autistic adults constrains our ability to fully understand and address their unique needs. In this study, autism prevalence was estimated based on diagnosed cases, which excludes individuals without a formal diagnosis. Additionally, other factors such as data availability and methodological assumptions may influence the modelling of prevalence estimates. As a result, our findings should be interpreted within the context of these limitations. Nevertheless, this study provides a valuable reference point for understanding autism prevalence among adults in Canada.

Maggior rischio di parto prematuro e complicanze dopo i 45 anni

Maggior rischio di parto prematuro e complicanze dopo i 45 anni

Circulation, Ahead of Print. BACKGROUND:Allograft arteriosclerosis, a significant cause of graft failure, is linked to the formation of tertiary lymphoid organs. T follicular helper (Tfh) cells are a vital subset of helper T cells that control the formation of the germinal center in tertiary lymphoid organs. Thus, understanding the origins and regulatory mechanisms of Tfh cells in allograft arteriosclerosis is essential for developing targeted therapies.METHODS:We used a lineage-tracing strategy to track Tfh cell fate in mouse models. Single-cell RNA sequencing, flow cytometry, and immunofluorescence staining were employed to analyze cell populations in remodeled arteries 2 and 4 weeks after transplantation. Additionally, we used VEGFR-3 inhibitors and lymph node dissection to suppress lymphatic vessel formation. Metabolic signatures and flux in different cell types were investigated using ultrahigh-performance liquid chromatography and high-resolution mass spectrometry–based metabolomics. CD4+T cell–specific MTHFD2 knockout mice were used to corroborate our hypothesis about the role of mitochondrial 1-carbon metabolism in Tfh cell differentiation. Mechanisms discovered in vivo were also tested ex vivo.RESULTS:CD34-lineage cells were found to be the major source of cells differentiating into T cell populations in allograft arteries. CD34-lineage cells mainly originated from the thymus, with drainage through lymphatic vessels, and differentiated into effective T cells around grafting arteries. Using CD34 lineage-tracing mice and single-cell RNA sequencing, we identified a Tfh cell population derived from CD34-lineage CD4+T cells. Untargeted and targeted metabolomics revealed distinct upregulation of 1-carbon metabolism during CD4+T-to-Tfh cell differentiation. Supplementation of amino acids essential for 1-carbon metabolism, such as serine, methionine or glycine, facilitated differentiation from CD4+T to Tfh cells. Using deuterium-labeled serine, we found that the mitochondrial 1-carbon pathway is predominant. Inhibition of the mitochondrial 1-carbon metabolic enzyme MTHFD2 by administration of DS18561882 or generating CD4+T cell–specific MTHFD2 knockout mice, significantly inhibited the numbers of Tfh cells and tertiary lymphoid organ formation as well as vascular remodeling.CONCLUSIONS:This study provides insights into the critical role of mitochondrial 1-carbon metabolism and MTHFD2 in governing the differentiation of CD34-lineage cells into Tfh cells, which contributes to tertiary lymphoid organ formation in transplant vasculopathy, offering potential therapeutic targets to enhance transplant outcomes.

Introduction
Patient safety incidents during healthcare cause a high burden and mortality, but many go unreported. Involving patients and caregivers in the identification and reporting of safety incidents would add value to the current incident reporting systems used by health professionals. Identifying and analysing patient safety incidents is essential to prevent future events, allowing organisations to apply a learning-from-error approach and to implement improvement plans. Patient-Reported Incident Measures are tools for patients and caregivers to report safety issues related to their healthcare. In accordance with WHO’s patient safety taxonomy, the term patient safety incidents is used throughout this protocol to encompass events that do and do not reach the patient, including what are commonly referred to as near misses and adverse events. We aim to identify and describe the published literature about tools for patients or caregivers to report patient safety incidents in healthcare.

Methods and analysis
We will conduct a scoping review. We have developed inclusion criteria using the PCC (population, concept and context) format, where population includes adult patients or caregivers; concept refers to documents describing formal tools used to report patient safety incidents; and context includes any healthcare setting, such as hospitals or mental health centres, during or immediately after care. The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Evidence sources include primary research, systematic reviews, meta-analyses, conference abstracts, letters, guidelines, as well as policy documents, reports, blogs and websites, without language restriction. An initial database search in Medline, Embase, CINAHL, and Cochrane Library from database inception up to June 2023 identified 4500 initial citations, of which 4103 were selected for evaluation after duplicates were removed. We will supplement the search by checking the reference lists of included studies for additional sources of evidence and an additional search in Google to identify non-peer-reviewed documents. This initial search will be updated before completing the review. We will use a self-created data collection form for data extraction and perform a narrative synthesis to integrate and summarise the review findings. We will describe the general characteristics of the tool: setting, scope, format, content, type of patient safety incident and severity, the moment of notification, relation to patient safety incident reporting and learning systems, development process, testing, validation, or piloting, among other characteristics. As a result of this scoping review, we intend to provide an index of patient/caregiver-reported safety notification tools and a list of descriptive or evaluation studies.

Ethics and dissemination
We will only use published data. Approval from the human research ethics committee is not required. The results of this scoping review will be submitted for publication in an international peer-reviewed journal and scientific meetings. Findings will also be disseminated through digital science platforms and academic social media.

Introduction
Up to 40% of late preterm and early term infants require neonatal admission with respiratory disease being the most common cause. Less invasive surfactant administration (LISA) has previously been used with good success in the very preterm population, but it is unclear whether late preterm infants suffering from respiratory distress syndrome and early term infants suffering from secondary surfactant deficiency might also benefit from LISA. Continuous positive airway pressure (CPAP) in that population can increase asynchrony and air leaks, whereas these may be avoided by using high flow nasal cannula (HFNC). This trial will investigate whether LISA during HFNC reduces the need for invasive ventilation.

Methods and analysis
This non-blinded, single-centre study with a treatment and a control arm will take place on the Neonatal Intensive Care Unit at King’s College Hospital National Health Service (NHS) Foundation Trust and the local neonatal unit at the Princess Royal University Hospital. The study will recruit 245 infants born between 34+0 and 38+6 weeks gestational age, who are requiring respiratory support via HFNC. The 245 participants will be placed into a control and treatment group. Those infants eligible for SURFactant Or Not (SurfON) will be randomised as per the SurfON protocol. The remaining infants will, where possible, be recruited to the treatment group. All recruited infants will have 2 minutes of respiratory function monitoring. Those receiving LISA will receive a further 2 minutes of monitoring after the procedure. As HFNC, LISA and respiratory monitoring are part of routine clinical practice, retrospective consent will be gained from parents or guardians after the procedure to analyse the respiratory function data. The primary outcome will be the percentage of neonates needing invasive ventilation within 72 hours from birth. The secondary outcomes are length of neonatal unit stay; the cost of stay as estimated via standard NHS tariffs; and the lung function parameters including tidal volume, respiratory rate, end tidal CO2 (ET CO2), fraction of inspired oxygen (FiO2) and ratio of oxygen saturations to fraction of inspired oxygen (SpO2/ FiO2) ratio before and 2 minutes after LISA and the SpO2/FiO2 ratio 2 hours after the administration of LISA.

Ethics and dissemination
A favourable opinion was sought and obtained from the London – Hampstead Research Ethics Committee and Health Research Authority for the study protocol and other relevant documentation (informed consent forms and patient information leaflets) prior to commencing the study (REC reference: 24/PR/0431). Anonymised study data will be presented at conferences and published by the investigators in peer-reviewed journals

Trial registration number
NCT06421506.