Risultati per: Short Acting Opioid

Cole SW, Glick JL, Campoamor NB, et al. Willingness and preferences for long-acting injectable PrEP among US men who have sex with men: a discrete choice experiment. BMJ Open 2024;14:e083837. doi: 10.1136/bmjopen-2023-083837
The article has been corrected since it was published online. The authors would like to inform the readers that the incorrect version of figure 2 was published. Figure 2 has been updated now.

Fewer early neurological deterioration events and no safety signals were observed with clopidogrel plus aspirin compared with aspirin alone.

Mortality and recurrent pneumonia didn’t differ in patients who were treated for median durations of 6 days or 14 days.

This phase 1 randomized study assesses the safety and tolerability of zerlasiran, a short interfering RNA targeting hepatic synthesis of apolipoprotein(a), and its effects on serum concentrations of lipoprotein(a), in healthy participants and patients with stable atherosclerotic cardiovascular disease.

Introduction
Twin pregnancies have a high risk of extreme preterm birth (PTB) at less than 28 weeks of gestation, which is associated with increased risk of neonatal morbidity and mortality. Currently there is a lack of effective treatments for women with a twin pregnancy and a short cervix or cervical dilatation. A possible effective surgical method to reduce extreme PTB in twin pregnancies with an asymptomatic short cervix or dilatation at midpregnancy is the placement of a vaginal cerclage.

Methods and analysis
We designed two multicentre randomised trials involving eight hospitals in the Netherlands (sites in other countries may be added at a later date). Women older than 16 years with a twin pregnancy at

Circulation, Ahead of Print. BACKGROUND:G protein–coupled receptors play a critical role in atrial fibrillation (AF). Spexin is a novel ligand of galanin receptors (GALRs). In this study, we investigated the regulation of spexin and GALRs on AF and the underlying mechanisms.METHODS:Global spexin knockout (SPX-KO) and cardiomyocyte-specific GALRs knockout (GALR-cKO) mice underwent burst pacing electrical stimulation. Optical mapping was used to determine atrial conduction velocity and action potential duration. Atrial myocyte action potential duration and inward rectifying K+current (IK1) were recorded using whole-cell patch clamps. Isolated cardiomyocytes were stained with Fluo-3/AM dye, and intracellular Ca2+handling was examined by CCD camera. A mouse model of AF was established by Ang-II (angiotensin II) infusion.RESULTS:Spexin plasma levels in patients with AF were lower than those in subjects without AF, and knockout of spexin increased AF susceptibility in mice. In the atrium of SPX-KO mice, potassium inwardly rectifying channel subfamily J member 2 (KCNJ2) and sarcolipin (SLN) were upregulated; meanwhile,IK1current was increased and Ca2+handling was impaired in isolated atrial myocytes of SPX-KO mice. GALR2-cKO mice, but not GALR1-cKO and GALR3-cKO mice, had a higher incidence of AF, which was associated with higherIK1current and intracellular Ca2+overload. The phosphorylation level of CREB (cyclic AMP responsive element binding protein 1) was upregulated in atrial tissues of SPX-KO and GALR2-cKO mice. Chromatin immunoprecipitation confirmed the recruitment of p-CREB to the proximal promoter regions of KCNJ2 and SLN. Finally, spexin treatment suppressed CREB signaling, decreasedIK1current and intracellular Ca2+overload, which thus reduced the inducibility of AF in Ang-II–infused mice.CONCLUSIONS:Spexin reduces atrial fibrillation susceptibility by inhibiting CREB phosphorylation and thus downregulating KCNJ2 and SLN transcription by GALR2 receptor. The spexin/GALR2/CREB signaling pathway represents a novel therapeutic avenue in the development of agents against atrial fibrillation.

We read with great interest the study by Familiari et al entitled ‘Long versus short peroral endoscopic myotomy (POEM) for the treatment of achalasia: results of a non-inferiority randomised controlled trial’.1 Short myotomy was non-inferior to long myotomy with regard to clinical success at 2 years with the added advantage of reduced procedure time. Gastro-oesophageal reflux was similar in both the groups. Although the study essentially confirms the conclusions drawn from two randomised trials published previously, the sample size is larger and follow-up longer.2 3 The authors must be congratulated for conducting a well-designed study with noteworthy implications on clinical practice. We would like to highlight several points relevant to the study. First, the term ‘short oesophageal myotomy’ appears to be more appropriate because the length of gastric myotomy is not intended to be modified. More importantly, ‘short’ and ‘long’ myotomy have been defined…

Objective
Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated with SDD-enhanced infection control compared with conventional infection control.

Design
We conducted shotgun metagenomic microbiome and resistome analysis on serial oropharyngeal and faecal samples collected from critically ill, mechanically ventilated patients in a pilot multicentre cluster randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and intergroup changes. Of consented patients, faecal microbiome baseline samples were obtained in 89 critically ill children. Additionally, samples collected during and after critical illness were collected in 17 children treated with SDD-enhanced infection control and 19 children who received standard care.

Results
SDD affected the alpha and beta diversity of critically ill children to a greater degree than standard care. At cessation of treatment, the microbiome of SDD patients was dominated by Actinomycetota, specifically Bifidobacterium, at the end of mechanical ventilation. Altered gut microbiota was evident in a subset of SDD-treated children who returned late longitudinal samples compared with children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared with standard care. SDD did not affect the composition of the oral microbiome compared with standard treatment.

Conclusion
Short interventions of SDD caused a shift in the microbiome but not of the AMR gene pool in critically ill children at the end mechanical ventilation, compared with standard antimicrobial therapy.