Risultati per: Studio REDUCE-IT e appropriatezza prescrittiva degli acidi grassi omega-3

To the Editor We read with great interest the comments by Donia and Prasad suggesting that for patients with tumors exhibiting positive staining (≥1%) for programmed cell death ligand 1 (PD-L1), nivolumab monotherapy offers maximal benefit while cautioning against the necessity of the combination therapy due to toxic effects and cost. However, we wish to address certain points and express our reservations regarding this stance.

Tra i primi pubblicati. Già arrivate richieste internazionali

Introduction
People with type 2 diabetes can experience diabetes distress which can negatively affect health outcomes. Non-pharmacological interventions such as mindfulness can help address diabetes distress. However, face-to-face programmes can be constrained by cost, poor accessibility and lack of availability. Mobile apps for mindfulness may overcome these issues but evidence of their effectiveness is limited, and some have poor interface design with basic visualisations and feedback.

Methods and analysis
Our study will explore using virtual reality (VR) as an immersive and interactive technology that could support mindfulness practice to help reduce diabetes distress. We will use a mixed-methods design to pilot a new co-design process called Artificial Intelligence-informed Experience-Based Co-Design. Phase 1 will identify and evaluate existing VR mindfulness apps, followed by interviews with mindfulness experts to gain their perspectives on practising mindfulness in virtual settings. This will be followed by a participatory design phase with a series of five co-design workshops where adults with type 2 diabetes will (1) discuss diabetes distress and learn about mindfulness, (2) evaluate commercially available VR mindfulness apps, (3) employ artistic methods to produce a personalised mindfulness experience, (4) create digital content for a virtual mindfulness experience via generative artificial intelligence tools and (5) prioritise key design features, functionality and content for a tailored VR mindfulness app. The final phase will focus on developing a bespoke VR mindfulness app and evaluating it with adults with type 2 diabetes using interviews, questionnaires and VR app analytics to determine if the new digital mental health intervention can help reduce diabetes distress and improve quality of life.

Ethics and dissemination
We received ethical approval from The University of Manchester (2024-18262-32710 and 2024-21170-37093). Written informed consent will be obtained from all participants. Dissemination will include scientific publications and presentations, social media, knowledge translation events and educational resources for teaching students.

Objective
In Papua New Guinea (PNG), antenatal clinic attendance averaged 50% for one or more visits, and 30% for four visits in the last decade. In 2016, the WHO revised its focused antenatal care (ANC) model recommending eight rather than four visits. If implemented, this new model would require additional resources. This study estimated provider costs of ANC in PNG, including the expected cost of scaling up to universal ANC coverage as well as recommending eight visits.

Design and setting
Cross-sectional estimation of ANC costs collected from nine health facilities, which were part of a cluster randomised trial. Costs were estimated using both top-down and bottom-up approaches. The cost of the first and follow-up visits were estimated per woman, at the health facility level. Health system and scale-up costs of four visits were calculated by multiplying the aggregate cost of four visits by ANC utilisation rates. A budget impact analysis estimated the expected costs of delivering eight visits over 5 years. Univariate sensitivity analysis was conducted. Discounted costs are reported in local currency and 2019 international dollars using purchasing power parity data.

Results
The average cost of the first and follow-up visits were $17.66–$30.58 (K42.94–K74.34) in Madang and $11.26–$35.61 (K27.37–K86.56) in East New Britain. Four visits per woman cost $70.65–$122.33 (K171.76–K297.36) in Madang and $45.02–$142.45 (K109.50–K346.4) in East New Britain; and salaries represented the largest share of costs. The annual health system cost was $6.9 million (K16.9 million), the expected cost of scaling up to the universal coverage of four visits was $22.7 million (K55.2 million), and $45.4 million (K110.3 million) over 5 years for eight visits.

Conclusion
Costs varied with the number of clinicians, infrastructure and ANC coverage, suggesting scaling up requires increasing the financial investment in ANC services. These results provide a template to strengthen health systems by improving the quality of care.

New England Journal of Medicine, Volume 391, Issue 21, Page 2058-2061, November 28, 2024.

Dieris-Hirche J, Bottel L, Pape M, et al. Effects of an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS): study protocol for a randomised controlled trial. BMJ Open 2021;11:e045840. doi:10.1136/ bmjopen-2020-045840
This article has been corrected since it was published online.
The original domain of the project homepage www.onlinesucht-hilfe.com, which was named in this article, has been exchanged for the domain www.ompris.de, which is now valid. The original domain is no longer valid and should therefore no longer be used.

Le donne possono partecipare inviando un campione biologico

In a U.S. postmarketing surveillance study, only 1 in 6 IVC filters were retrieved.

UniCamillus, oggi 99,6% dei piccoli trattato nel modo sbagliato

Objectives
To assess the prevalence and severity of paruresis (‘shy bladder syndrome’) in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis.

Design
We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined ‘mild’ and ‘severe’ paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a ‘mild’ and ‘severe’ paruresis diagnosis.

Setting
We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites.

Results
We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18–30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of ‘mild’ paruresis was 25.8% and of ‘severe’ paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19,

Circulation, Volume 150, Issue Suppl_1, Page A4128491-A4128491, November 12, 2024. Introduction:N-3 very-long-chain polyunsaturated fatty acids (VLCPUFA; C≥24), which are found primarily in retina and a few other select tissues, are known to play critical roles in specific biological systems. Although n-3 PUFA, such as eicosapentanoic acid (EPA, C20:5 n-3) and docosahexaenoic acid (DHA, C22:6 n-3), may confer cardiovascular benefits, they did not improve age-related macular degeneration (AMD), a leading cause of blindness worldwide, in clinical trials. The activity of ELOVL fatty acid elongase 2 (ELOVL2), an enzyme that converts EPA into tetracosapentaenoic acid (TPA, C24:5 n-3), is known to decrease in the retina with age due to promoter methylation.Hypothesis:We hypothesized that dietary VLCPUFA may delay or prevent AMD, by bypassing the ELOVL2-mediated lipid elongation step. We also hypothesize that VLCPUFA may benefit cardiometabolic health like shorter-chain n-3 PUFA through similar mechanisms.Aims:We aimed to investigate the effect of dietary VLCPUFA on retinal function and cardiometabolic risk factors in mice.Methods:We have produced a new fish oil that contains ~40% (w/w) of C24-C28-rich VLCPUFA. We fed 9-month-old ApoE -/- mice with normal or VLCPUFA fortified diet (1% or 3% (w/w)) for 8 weeks, and age-matched C57BL/6J mice were used as control. We conducted electroretinography (ERG) and cognitive ability tests at the end of feeding period. Inin vitrostudies, we performed PPAR reporter assay and investigated the anti-inflammatory effects of TPA in lipopolysaccharide-stimulated RAW264.7 cells.Results:Supplementation of VLCPUFA showed a significant and dose-dependent improvement in ERG response. Like EPA and DHA, we also observed favorable cardiometabolic changes and decreased atherosclerotic plaque area due to dietary VLCPUFA. Intriguingly, VLCPUFA supplemented aging mice exhibit better cognitive performance compared with control. Transcriptome analysis revealed that VLCPUFA-enriched fish oil favorably regulated genes involved in nuclear receptor signaling pathways, lipid metabolism and inflammation. Furthermore, purified TPA potently activates PPARs, and suppressed inflammation in macrophage cells.Conclusions:Overall, our studies revealed for the first time several potential health benefits for our new VLCPUFA-enriched fish oil in several age-related diseases and support its future development as a new dietary supplement.

Circulation, Volume 150, Issue Suppl_1, Page A4140142-A4140142, November 12, 2024. Background:Cardiovascular-kidney metabolic (CKM) syndrome is exacerbated among individuals experiencing chronic exposure to both environmental and psychosocial stressors. Both neighborhood and individual-level stressors increase chronic inflammation resulting in worsened CKM factors, such as hypertension, diabetes, and dys/hyperlipidemia. However, associations between neighborhood perceptions (NP) and lipid profiles remain understudied. Therefore, we examined associations between NP domains and lipid profiles among African-American (AA) women with ≥Stage 1 CKM syndrome (overweight/obesity) residing in resource-limited neighborhoods within the Washington, DC area.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged physical activity (PA) intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using Nuclear Magnetic Resonance (NMR) spectroscopy. Factor analysis of overall NP identified four perception sub-scores: disorder, social cohesion, violence, and safety (higher score=favorable perception). Associations between NP domains and lipoprotein particles were analyzed using multivariable regression adjusting for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:Participants (n=169) had mean age=57.16 ± 12.00 and BMI 35.99 ± 6.57. Perceptions of safety were positively associated with LDL concentrations (LDLc) and large LDL particles (L-LDLp) (β=4.70 [SD=2.41], p=0.05, β= 43.75 [17.70], p= 0.01), respectively). Perceptions about neighborhood violence were positively associated with L-LDLp (marginally) and very-low-density lipoprotein size (VLDLz) (β= 7.10 [3.96], p=0.08, β= 0.31 [0.14], p= 0.02, respectively). No associations were found between disorder and social cohesion with lipid biomarkers.Conclusions:After adjusting for BMI, ASCVD risk, and lipid-lowering therapy, there were significant associations between neighborhood perceptions of safety and violence with lipid profiles among AA women with CKM syndrome. Greater perceived safety was associated with higher LDLc and L-LDLp while more favorable perception about neighborhood violence was associated with higher L-LDLp. Future work should examine whether improving neighborhood resources and perceptions may improve CKM health among urban AA women.

Circulation, Volume 150, Issue Suppl_1, Page A4141461-A4141461, November 12, 2024. Introduction:Left atrial appendage occlusion (LAAO) is an effective method of stroke prevention in patients with atrial fibrillation (AF). However, peri-device leakage (PDL) and device related thrombus (DRT) are common limitations of LAAO. Notably, PDL is associated with an increased risk of thromboembolic events. In order to minimize DRT, the Watchman FLX Pro is coated with PVDF-HFP. We aim to minimize both DRT and PDL with our novel zonal coating application system (ZCAS). ZCAS integrates a two-part thromboresistant and endothelialization promoting coating onto LAAO devices (Figure 1). In order to determine the optimal coating for the endothelialization promoting zone of ZCAS, we validated coating candidates in an in vitro model of LAAO device endothelialization (Figure 2).Hypothesis:We hypothesized that polyethylene terephthalate (PET) mesh coated with collagen type IV, fibronectin + VEGF, or poly-L-lysine would improve endothelial cell viability and proliferation.Methods:Human umbilical vein endothelial cells (HUVEC) were cultured in DMEM/F12 supplemented with ATCC’s Endothelial Cell Growth Kit and antibiotics. For the cell viability and proliferation assay, HUVEC cells were cultured in DMEM/F12 supplemented with 2% FBS, 10 mM L-glutamine, and antibiotics. A 96 well plate with PET inserts was coated with three coating candidates. Each coating was applied in three concentrations ([1x], [10x], and [100x]) with triplicates for each concentration. The coatings included collagen type IV ([1x]: 1 ug/cm2), fibronectin ([1x]: 1 ug/cm2) + VEGF ([1x]: 10 ng/cm2), and poly-L-lysine ([1x]: 4 ug/cm2). An MTS assay was performed at 48 hours after plating to assess cell viability and proliferation.Results:MTS absorbance relative to the uncoated control (MTS absorbance coated well/MTS absorbance uncoated well) for collagen type IV at [1x], [10x], and [100x] was 0.81, 1.29, and 0.84 respectively (Table 1). Fibronectin + VEGF at [1x], [10x], and [100x] was 1.31, 1.62, and 0.96. Finally, poly-L-lysine at [1x], [10x], and [100x] was 0.69, 0.90, and 0.91 respectively.Conclusion(s):Among the coating candidates, fibronectin (1 ug/cm2) + VEGF (100 ng/cm2) had the greatest increase in cell viability and proliferation compared to the uncoated PET control. The significance of this finding lies in the potential for ZCAS to improve the endothelial seal between the LAAO device and LAA orifice, which may significantly reduce PDL post-implantation.