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

Acute pancreatitis (AP) in children presents unique challenges distinct from adult manifestations, requiring specialized diagnostic and therapeutic approaches. Compared to adults, pediatric AP has lower mortality rates but still carries significant morbidity and potential long-term complications. This review examines current evidence on pediatric AP, highlighting recent advances in diagnosis, risk stratification, and management strategies. Current diagnostic approaches utilize serum lipase and amylase testing, along with various imaging modalities that have different diagnostic values.

Un’azione in 5 fasi proposta a von der Leyen

This study uses 2021 data on the percentage of unavailable opioid tests in the US to examine how opioid involvement informs injury death investigations.

Cirrhosis marks the advanced stage of chronic liver disease characterised by sustained inflammation leading to the loss of hepatocytes and the progression of fibrosis. These structural and functional alterations profoundly impact blood flow within the hepatic microcirculation, potentially culminating in portal hypertension over time. Traditionally, the evolution of cirrhosis has been divided into two clinical phases: An initial asymptomatic stage known as compensated cirrhosis followed by decompensated cirrhosis, marked by the emergence of complications such as ascites, variceal bleeding, hepatic encephalopathy, jaundice, coagulopathy and bacterial infections. Decompensated cirrhosis typically signals a more aggressive disease course with patients susceptible to hepatic and extrahepatic organ dysfunction, complications or necessitating liver transplantation.1 It is imperative to recognise that decompensated cirrhosis transcends hepatic manifestations representing a systemic disorder. Recent observational studies in Europe, including chronic liver failure acute-on-chronic liver failure (CANONIC) and PREDICTing Acute-on-chronic liver failure (PREDICT), have further classified decompensated…

Stroke, Ahead of Print. BACKGROUND:The true incidence of visuospatial neglect, impaired attention toward contralesional space, remains unclear. Common variability sources are sensitivity differences of conventional assessments and the exclusion of patients with language, motor, and other cognitive impairments. We aimed to determine the incidence of visuospatial neglect in an unselected cohort of patients with acute stroke using video oculography during free visual exploration, a newly established assessment overcoming the aforementioned biases.METHODS:Single-center, prospective, observational cohort study. We screened every patient admitted to a representative Swiss stroke center over 1 year (n=626). Two hundred eighty-five patients were eligible (first-ever stroke within 72 hours), and 221 were included. The incidence of visuospatial neglect was determined with conventional paper-pencil assessments and video oculography during free visual exploration. Demographic, risk, and stroke-related factors, as well as stroke localization, were also considered. Feasibility and ability to detect visuospatial neglect of the assessments were evaluated.RESULTS:The overall incidence of visuospatial neglect was ≈38%: widely varying location-specifically: ≈61% and ≈22% for stroke in the right and left cerebral hemispheres, respectively, and ≈14% to ≈37% for some less commonly affected infratentorial areas or multifocal stroke. In hemispheric stroke, visuospatial neglect was most common when the middle (≈64% right and ≈21% left) and posterior (≈53% right and ≈25% left) cerebral artery territories were affected. Neglect patients had higher National Institutes of Health Stroke Scale scores, more commonly atrial fibrillation and thrombectomy, and less commonly an undetermined stroke cause. They were older, with ≈4% yearly increase in the odds of having visuospatial neglect. Video oculography during free visual exploration was administrable and detected visuospatial neglect more often than conventional paper-pencil assessments.CONCLUSIONS:The incidence of visuospatial neglect in an unselected cohort, using a highly sensitive assessment, is considerably higher than previously assumed and can also occur after less typically localized strokes. These results can enhance the awareness of visuospatial neglect in the acute setting, potentially facilitating earlier identification and therapy of this disabling disorder.

Circulation, Volume 151, Issue 14, Page 1047-1050, April 8, 2025.

Our optimal feature selection-based ML model accurately and reliably predicts CT abnormalities in mTBI patients using routine test data. By addressing clinicians’ concerns regarding transparency and decision-making through SHAP and DCA analyses, we strengthen the potential clinical applicability of our ML model.

A rischio settore dei farmaci generici-equivalenti e biosimilari

Objectives
Arterial stiffness as assessed by pulse wave velocity (PWV) improves the prediction of first-ever and recurring stroke and of stroke outcomes when measured in the days after stroke. Here, we investigated the longitudinal dynamics of PWV in the days after acute ischaemic stroke.

Design
Monocentric, prospective cohort study nested within a clinical trial registry with repeated measurement assessment of PWV.

Setting
Comprehensive middle European stroke centre.

Participants
20 men and women that suffered stroke from November 2022 through August 2023.

Primary and secondary outcome measures
Change in carotid-femoral PWV was investigated by recording PWV four times between 1.2 and 9.9 days after stroke using a Vicorder device. Haemodynamic and patient-, stroke- and care-related variables were investigated as potential modifiers of PWV trajectories.

Results
Twenty patients aged 61.3±16.9 years (14 males) were included. There was a daily decline in PWV of –0.19 m/s (95% CI: –0.29 to –0.09; p

Objective
To investigate knowledge, attitude and practice (KAP) of patients with ankle injury regarding osteochondral lesions of the talus (OLT).

Design
A cross-sectional study.

Setting
Between March and September 2023, at the Ninth People’s Hospital of Wuxi, affiliated with Soochow University.

Participants
Among patients with OLT.

Primary and secondary outcome measures
KAP scores and associated factors.

Methods
Data were collected through a researcher-designed, validated questionnaire with four dimensions (sociodemographic characteristics, knowledge, attitude and practice). Structural equation modelling (SEM) was applied to explore associations among variables.

Results
A total of 537 valid (valid rate: 78.85%) questionnaires were obtained from the responders who were aged 27.18±11.01 years, with 151 (28.12) males. The mean KAP scores were 17.28±4.84 (possible range: 0–28), 29.44±4.21 (possible range: 9–45) and 18.01±5.39 (possible range: 6–30), respectively. SEM revealed that employment (employed vs unemployed, β=1.33, p=0.002), had medical insurance (β=1.19, p=0.019) and with a history of ankle sprains (β=1.08, p=0.009) exhibited positive direct effects, while whether with cartilage injury of the talus (no vs yes, β=–0.73, p=0.001) had negative direct effect on knowledge. Additionally, knowledge (β=0.08, p=0.032) showed positive direct effects, while gender (males vs females, β=–1.81, p

Stroke, Ahead of Print. BACKGROUND:Cerebral swelling in relation to cytotoxic edema is a predictor of poor outcome in acute ischemic stroke (AIS) and elevated blood pressure (BP) promotes its development. Whether intensive BP-lowering treatment reduces cerebral swelling is uncertain. We aimed to determine whether intensive BP lowering reduces the severity of cerebral swelling after thrombolysis for AIS.METHODS:A secondary analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial factorial, international, multicenter, open-label, blinded end point, randomized controlled trial of alteplase dose and levels of BP control in thrombolyzed patients with AIS. Participants were randomly assigned to intensive (systolic target 130–140 mm Hg within 1 hour; maintained for 72 hours) or guideline-recommended (systolic target

Cattani, serve una risposta politica ai dazi, siamo in una posizione di forza

Circulation, Ahead of Print. BACKGROUND:TAP-IT (Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial) investigated the effect of therapeutic thoracentesis in addition to standard medical therapy in patients with acute heart failure and sizeable pleural effusion.METHODS:This multicenter, unblinded, randomized controlled trial, conducted between August 31, 2021, and March 22, 2024, included patients with acute heart failure, left ventricular ejection fraction ≤45%, and non-negligible pleural effusion. Patients with very large effusions (more than two-thirds of the hemithorax) were excluded. Participants were randomly assigned 1:1 to upfront ultrasound-guided pleural pigtail catheter thoracentesis in addition to standard medical therapy or standard medical therapy alone. The primary outcome was days alive out of the hospital over the following 90 days; key secondary outcomes included length of admission and 90-day all-cause mortality. All outcomes were analyzed according to the intention-to-treat principle.RESULTS:A total of 135 patients (median age, 81 years [25th; 75th percentile, 75; 83]; 33% female; median left ventricular ejection fraction, 25% [25th; 75th percentile, 20%; 35%]) were randomized to either thoracentesis (n=68) or standard medical therapy (n=67). The thoracentesis group had a median of 84 days (77; 86) alive out of the hospital over the following 90 days compared with 82 days (73; 86) in the control group (P=0.42). The mortality rate was 13% in both groups, with no difference in survival probability (P=0.90). There were no differences in the duration of the index admission (control group median, 5 days [3; 8]; thoracentesis group median, 5 days [3; 7;P=0.69]). Major complications occurred in 1% of thoracenteses performed during the study period.CONCLUSIONS:For patients with acute heart failure and pleural effusion, a strategy of upfront routine thoracentesis in addition to standard medical therapy did not increase days alive out of the hospital for 90 days, all-cause mortality, or duration of index admission. The current findings lay the groundwork for future research to confirm the results.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT05017753.

Stroke, Ahead of Print. BACKGROUND:Lp(a) (lipoprotein[a]) is a risk factor for cardiovascular disease; however, its association with cerebrovascular disease is not as well established.METHODS:Data from a population-based cohort of Hispanics/Latinos included 16 333 individuals with baseline Lp(a) levels (nmol/L) and self-reported prevalent stroke or transient ischemic attack (TIA). A subset of 2642 individuals with brain magnetic resonance imaging was also included. Linear and multivariate logistic regression assessed the association of Lp(a) with (1) self-reported stroke or TIA, (2) cerebral injury defined as self-reported stroke or TIA or evidence of a stroke on brain magnetic resonance imaging, (3) white matter hyperintensity volume, and (4) silent brain infarcts. Sampling weights were utilized given the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) complex sample design.RESULTS:Mean age±SE was 41.1±0.3 years, 52.0% female, and median interquartile range (Q1, Q3) Lp(a) level of 19.7 (7.3–60.6) nmol/L; brain magnetic resonance imaging subset mean age±SE was 49.9±0.4 years, 56.4% female, and median (interquartile range) Lp(a) level of 21.7 (8.1–62.9) nmol/L. Each unit increase in log-transformed Lp(a) was associated with higher odds of self-reported stroke or TIA (odds ratio, 1.13 [95% CI, 1.01–1.27];P=0.03). Lp(a) levels in the highest quintile ( >77 nmol/L) were significantly associated with higher odds of prevalent stroke or TIA compared with Lp(a) 77 nmol/L with Lp(a) of 6 to

Annals of Internal Medicine, Ahead of Print.