Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Annals of Internal Medicine, Ahead of Print.

This randomized clinical trial compares the short-term efficacy of laparoscopic surgery vs open surgery for treatment of low rectal cancer.

This prospective clinical trial examines if expanded size/growth parameters for patients with low-risk thyroid cancer are viable.

This review of current literature evaluates whether ERBB2 (formerly HER2) offers a potential therapeutic target in patients with ERBB2-low breast cancer.

A 66-year-old woman with chronic hepatitis B infection and hepatocellular carcinoma presented with moderate radiating epigastric pain with nausea, anorexia, and water brash without emesis. What is your diagnosis?

This case report describes a patient in their 40s who presented to the emergency department with acute chest pain.

Circulation, Ahead of Print. Background: High-sensitivity cardiac troponin (hs-cTn) laboratory assays are used to rule out myocardial infarction (MI) on presentation, but prolonged result turn-around times can delay patient management. Our primary aim was to identify patients at low risk of index MI using a rapid, point of care (POC), whole blood hs-cTnI assay at presentation, with potential early patient discharge.Methods: Consecutive emergency department patients from two prospective, observational studies with suspected acute coronary syndrome were enrolled. A POC hs-cTnI assay (Atellica®VTLi) threshold using whole blood at presentation, that resulted in a negative predictive value (NPV) of ≥99.5% and sensitivity of ≥99% for index MI, was derived (Safe Emergency department dIscharGE rate [SEIGE]) and validated using plasma (Suspected acute myocardial infarction in Emergency [SAMIE]). Event adjudications were established using hs-cTnI assay results from routine clinical care. The primary outcome was MI at 30-days.Results: 1086 patients (8.1% MI) were enrolled in a US derivation cohort (SEIGE) and 1486 (5.5% MI) in an Australian validation cohort (SAMIE). A derivation whole blood POC hs-cTnI concentration of

Circulation, Volume 146, Issue Suppl_1, Page A14649-A14649, November 8, 2022. Introduction:Transthyretin tetramer destabilization is the rate-limiting step in transthyretin cardiac amyloidosis, which is an underrecognized contributor to heart failure and mortality in older adults. Evidence suggests that low plasma transthyretin is anin vivomarker of transthyretin tetramer instability.Hypothesis:We tested the hypothesis that low plasma transthyretin genetically and observationally associates with all-cause and cardiovascular mortality.Methods:We genotyped 102,204 individuals and measured plasma transthyretin concentrations in 19,619 individuals from two studies of the Danish general population, the Copenhagen City Heart Study and the Copenhagen General Population Study. We first tested whether genetic variants inTTR, which associated with increasing transthyretin tetramer instability, also associated with lower plasma transthyretin and higher risk of all-cause and cardiovascular mortality. Second, we tested whether low plasma transthyretin associated with higher risk of all-cause and cardiovascular mortality.Results:Compared to p.T139M, a well-known transthyretin stabilizing mutation,TTRgenotype was associated with stepwise lower transthyretin concentrations of -20% for wild-type and -30% for heterozygotes for “Other mutations” (p.V142I, p.H110N, p.D119N). The corresponding hazard ratios (HR) for all-cause and cardiovascular mortality were 1.37(95% CI: 1.06-1.77) and 1.63(0.92-2.89) in wild-types, and 1.66(0.95-2.88) and 2.23(0.78-6.34) in carriers of “Other mutations”, respectively (Figure). In adjusted observational analysis individuals with plasma transthyretin ≤5thpercentile (

Circulation, Volume 146, Issue Suppl_1, Page A13104-A13104, November 8, 2022. Introduction:Reduced serum levels of glycosylated apolipoprotein J (ApoJ-Glyc) have been proposed as a marker for the early detection of myocardial ischemia with a potential prognostic value.Objective:The EDICA clinical trial assessed the performance of ApoJ-Glyc as a biomarker for the early detection of myocardial ischemia in patients attending the A&E department with chest pain suggestive of acute coronary syndrome (ACS) and investigated -as a secondary pilot objective- its prognostic value.Methods:EDICA -a multi-centre, international, diagnostic study (NCT04119882) assessed 404 patients. Based on clinical variables and diagnostic tests, 291 patients were considered to have had a “non-ischemic” event and 113 an “ischemic” event. Blood samples were obtained for the assessment of high-sensitivity troponin and ApoJ-Glyc at admission and at 1h and 3h thereafter. GRACE Risk Score was calculated in all ischemic patients. Patients were followed up for 6 months after presentation and the occurrence of MACE (cardiac death, recovered cardiac arrest, re-infarction, cardiac failure, new admission for ACS after discharge, or unplanned revascularization for cardiac ischemia after discharge) was recorded. ApoJ-Glyc serum levels were analyzed with a novel ELISA targeting a specific glycosylated variant of ApoJ (ApoJ-GlycA2).Results:Among the patients in the ischemic group, 8.8% had MACE at 6-months and these showed a 26% mean reduction in ApoJ-GlycA2 levels 3h post-admission compared with levels at presentation. This reduction was not observed in patients without MACE. Patients in the highest GRACE Risk Score tertile ( >118 points) showed a progressive decrease in ApoJ-GlycA2 levels after presentation compared with patients in the lower risk tertiles (mean decrease: 41% at 1h, P=0.01 and 35% at 3h, P=0.02 when compared with admission levels).Conclusions:A progressive decrease in ApoJ-Glyc levels after A&E admission appears to not only identify patients with ischemic events but also those at higher risk of suffering serious recurrent cardiovascular events at 6-months’ follow-up. Further studies in larger cohorts of patients are warranted to validate the potential role of ApoJ-Glyc in risk stratification in the context of cardiac ischemic events.

Circulation, Volume 146, Issue Suppl_1, Page A10088-A10088, November 8, 2022. Electronic cigarettes (e-cigarettes) are advertised as a healthier alternative for combustible cigarettes and have become the most commonly used smoking product. There is limited data regarding the association of e-cigarettes and risk of cardiovascular disease (CVD). We assessed the association of chest pain reports across tobacco product use groups. We used data from the Population Assessment of Tobacco and Health (PATH) study which is a nationally representative longitudinal study of tobacco use behavior and health effects. We categorized tobacco use patterns into 4 groups: cigarette use, dual use, e-cigarette use, and non-use. Participants were asked if they have ever had chest pain and if they have had chest pain in the past 30 days. Binominal regression models were used to examine the association between tobacco use categories and the 2 chest pain outcomes. We adjusted for covariates including age, sex, race, education, BMI, hypercholesterolemia, hypertension, current use of other combustible tobacco products, secondhand smoke exposure, marijuana use in the past 30 days, recreational drug use and history of respiratory diseases. The cohort included 9,284 participants after excluding those with established CVD and those with missing outcome or exposure data. The Mean age was 57 (SD±11) years and 54% of participants were female. Among the participants, 3,020 were exclusive cigarette users, 213 were dual users, 175 were exclusive e-cigarette users (94% were former smokers), and 5,876 were non-users. Compared to non-use, combustible cigarette use had 1.48 (95% CI, 1.27, 1.73) odds of ever having chest pain and 1.72 (95% CI, 1.4, 2.11) odds of having chest pain in the past 30 days. Dual use was associated with 1.52 (CI 95%, 1.05, 2.19) odds of chest pain ever and 1.82 (95% CI, 1.17, 2.83) odds of 30 days chest pain. Exclusive e-cigarette use had 0.78 (95% CI, 0.49, 1.26) odds of ever having chest pain and 0.75 (95% CI, 0.39, 1.42) odds of having chest pain in the past 30 days. Our findings suggest that compared to non-use, exclusive e-cigarette use has similar rates of chest pain; whereas dual use and combustible cigarette use have increased rates of chest pain outcomes.

Circulation, Volume 146, Issue Suppl_1, Page A15009-A15009, November 8, 2022. Introduction:Patients with single ventricle physiology frequently demonstrate decreased exercise tolerance after the Fontan operation. The objective of this study was to investigate the contribution of ventricular stiffness to exercise function in these patients.Hypothesis:We hypothesized that ventricular stiffness, both extremes of high and low stiffness, would be associated with exercise tolerance in Fontan patients.Methods:We previously validated an echocardiographic measure of ventricular stiffness, lateral Doppler E: tissue Doppler e’/end-diastolic volume (lateral E:e’/EDV) in children. Core-lab echocardiograms and exercise test results were obtained from the publicly-available Pediatric Heart Network Fontan Cross-sectional Study database. Exercise function was quantified as % predicted VO2. Ejection fraction (EF) was considered abnormal if < 50%. Diastolic function was defined as high stiffness if the lateral E:e’/EDV was > 90th percentile or low stiffness if < 10th percentile. Patients were divided into four groups: 1 = normal EF and normal diastolic function, 2 = decreased EF with normal diastolic function, 3 = normal EF with high ventricular stiffness, and 4 = normal EF with low ventricular stiffness.Results:239 patients (61% left, 29% right, 10% mixed ventricular dominance) had EF, lateral E:e’/EDV, and VO2measured. Differences between groups are reported in the Table.Conclusion:Single ventricle patients with both high and low stiffness and preserved EF had worse exercise capacity than patients with both normal and abnormal EF. To our knowledge, this is the first study detecting a low stiffness heart failure phenotype in single ventricle physiology. Future studies should further investigate the pathophysiologic mechanisms that lead to these extremes of stiffness in Fontan patients.

Circulation, Volume 146, Issue Suppl_1, Page A10423-A10423, November 8, 2022. Introduction:Nationwide broadband internet access is a major federal priority. The bipartisan infrastructure law invested $65 billion into equitable broadband expansion, driven by concern that broadband access is a social determinant of health. However, the difference in health outcomes between counties with low vs. higher broadband access has not been studied, and could provide insights on the implications of expansion efforts.Objectives:We evaluated demographic factors, health resources, and cardiovascular disease (CVD) burden in counties with low broadband access compared to those with higher access.Methods:We assessed all 3,142 US counties in 2019 and identified those with low broadband access, defined as 25 Mbps download / >3 Mbps upload, using the US Broadband Usage Percentages Dataset. We linked these data to the American Community Survey, American Health Resource File, PLACES, and CDC WONDER for demographic, health resource, CVD risk factor and outcomes, and mortality data respectively.Results:There were 461 counties with low broadband access and 2,650 counties with higher access. Compared to those with higher broadband access, counties with low broadband access had lower high school graduation rates (47% vs 54%, p

Circulation, Volume 146, Issue Suppl_1, Page A10438-A10438, November 8, 2022. Introduction:Increased levels of low-density lipoprotein cholesterol (LDL-C) and its constituent apolipoprotein B (ApoB) are associated with atherosclerotic coronary disease, a risk factor for heart failure (HF). However, among patients with established HF, increased LDL-C has been associated with a lower risk of death. The potential causality of this association is unclear.Hypothesis:This study investigated the relationship between ApoB/LDL-C and adverse outcomes in participants with HF.Methods:We measured ApoB levels using the SomaScan assay among participants in the Penn Heart Failure Study (PHFS, n=1268). We performed one-sample Mendelian Randomization (MR) for ApoB and two-sample MR for ApoB and LDL-C.Results:Measured ApoB levels were inversely associated with the risk of death (Fig 1A) or death and heart failure hospital admission (DHFA; Fig 1B). One-sample MR revealed no significant association between genetically determined ApoB and the risk of death (HR 0.497, [95% CI, 0.20-1.2], p=0.125) or DHFA (HR 0.653, [95% CI, 0.35-1.2], p=0.182). Two-sample MR analyses were also consistent with a non-significant association between ApoB (Fig 2) or LDL-C (Fig 3) and risk of death or DHFA.Conclusions:ApoB is associated with the risk of death or DHFA in established HF. However, MR does not support a causal link between ApoB/LDL-C and the risk of adverse outcomes in this population.

Circulation, Volume 146, Issue Suppl_1, Page A9618-A9618, November 8, 2022. Introduction:Many patients with acute coronary syndrome (ACS) presented with elevated troponin level and reversible changes in the thallium scan. When they patients underwent coronary angiogram, the results showed patent coronary arteries. WHY?Hypothesis:Could abnormal coronary flow explain ACS, abnormal thallium and patent coronary arteries?Methods:Patients with newly diagnosed ACS and abnormal Thallium scan underwent a new dynamic coronary angiogram. 10 patients without ACS, normal EF and no coronary artery disease served as control. In this new technique, the contrast and blood flow were recorded at 15 images per second. The first image was of the index artery completely filled with contrast. The subsequent images showed the blood in white color moving in over a background of black contrast. The arterial phase started when the blood began moving in and ended when the contrast disappeared from the distal arterial vasculature as the contrast was replaced by blood. The machine learning (ML) program had 2 models (built on Python). Model 1 was built based on U-net and Densenet-121 for vessel segmentation. Model 2 was used for classification of flow. The model 2 was trained based on the convolutional neural network. The data to be collected was the duration of the arterial phase and the recurrence of ACS within one year follow-upResults:45 patients with ACS (elevated troponin level (50-100mg), reversible stress thallium), underwent coronary angiogram. The angiograms of 10 control patients showed a normal arterial phase (AP) of 1.56 sec. It was prolonged at 2.5sec in 45 patients with ACS (p

Circulation, Volume 146, Issue Suppl_1, Page A12725-A12725, November 8, 2022. Introduction:Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes.Hypothesis:We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF).Methods:Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile.Results:The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p

Circulation, Volume 146, Issue Suppl_1, Page A15165-A15165, November 8, 2022. Introduction:Guidelines recommend the use of Dobutamine stress echocardiography (DSE) in case of low flow low gradient aortic stenosis (LFLG AS) when left ventricular ejection fraction (LVEF)