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

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 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 A11734-A11734, November 8, 2022. Introduction:Chest pain is common in patients with Post-acute Sequelae of SARS-CoV-2 (PASC), also known as long COVID, but the mechanism is unknown.Hypothesis:We hypothesized that PASC patients with chest pain have impaired myocardial perfusion reserve (MPR) measured by stress perfusion cardiovascular magnetic resonance (CMR) imaging.Methods:We retrospectively identified the first 30 consecutive patients who underwent clinically ordered adenosine stress perfusion CMR for chest pain persisting >4 weeks after SARS-CoV-2 infection (PASC). Patients with a history of coronary artery disease (CAD) or left ventricular ejection fraction (LVEF) 2 SD below mean MPR for controls.Results:In 30 PASC (67% female, age 43±13) and 13 controls (54% female, age 50±12), with LVEF (61±6% vs 59±8%), native T1 (1001±49 vs 992±57 ms), T2 (49.5±3.7 vs 48.0±3.3 ms), and ECV (24.6±2.9 vs 24.6±2.6%) were similar (p >0.2 for all). Prior pericarditis (n=2) or prior myocarditis (n=3) were infrequent, with no acute disease by CMR. PASC patients had significantly lower global MPR than controls (1.54±0.25 vs. 2.20±0.36, p

Circulation, Volume 146, Issue Suppl_1, Page A9539-A9539, November 8, 2022. Background:The potential association between lower bone mineral density (BMD) and atherosclerotic cardiovascular disease (ASCVD) has been suggested in women. We investigated whether the association between low BMD and ASCVD differs according to the age of ASCVD occurrence.Methods:We retrospectively analyzed 7,932 women aged 50-65 years who underwent dual-energy X-ray absorptiometry to measure total hip BMD. The primary outcome of interest was ASCVD, defined as a composite of ASCVD death, myocardial infarction, and ischemic stroke. Participants were classified into no event (n=7,803), early ASCVD (occured before 70 years of age) (n=97), and late ASCVD (occured at or after 70 years of age) (n=32) groups. The association of low BMD with early and late ASCVD was estimated using multivariate Cox hazard modeling after adjustment for clinical risk factors (age, body mass index, hypertension, diabetes, hyperlipidemia, current smoking, and previous fracture).Results:The median age increased across no event, early ASCVD, and late ASCVD groups (58, 60, and 63 years, respectively). However, the estimated BMD T-score at the age of 65 years was lowest in the early ASCVD group (median -0.9, -1.1, and -0.5, respectively). Lower BMD was an independent predictor for early ASCVD (adjusted hazard ratio [HR]: 1.34 per 1-SD decrease in T-score, 95% confidence interval [CI] 1.08-1.67), but not late ASCVD (adjusted HR: 0.88, 95% CI 0.60-1.30) (Figure). The inverse trend between early ASCVD risk and BMD T-score was consistent regardless of the number of accompanied clinical risk factors.Conclusions:Low BMD is an independent predictor for earlier ASCVD occurrence in women. BMD evaluation can provide prognostic benefit for risk stratification for earlier ASCVD occurrence.

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 A14754-A14754, November 8, 2022. Introduction:Atypical atrial flutters (AFL) are a heterogeneous group of reentrant arrhythmias and can be challenging to map. Peak frequency (PF) mapping is a novel method of identifying local conductivity and may help identify critical portions of myocardial substrate supporting reentry.Hypothesis:The critical isthmuses of left atrial (LA) AFLs demonstrate a combination of low-voltage and high PF.Methods:LA omnipolar voltage and PF maps were generated using the EnSite Precision Mapping System and HD-Grid catheter in 13 patients undergoing AFL ablation. For the purpose of this study, mapping was performed during AFL and normal voltage was defined as ≥ 0.5 mV, low-voltage (LV) 0.1 – 0.5 mV, and scar < 0.1 mV. PF distributions were analyzed in each tissue type. Conduction velocity (CV) was characterized across PF with correlational analysis. The 1-cm radius from sites of arrhythmia termination with ablation were analyzed to characterize mean PF and voltage in nearby myocardial tissue.Results:Mean age was 65.8 ± 9.3 years and 54% were female. A total of 37,331 points were analyzed. Sites of slow conduction included the mitral isthmus (46%), LA roof (23%), pulmonary vein antra (15%), posterior wall (8%), and anterior wall (8%). In normal voltage tissue, mean PF was 337.7 ± 115.4 Hz. LV and scar tissue had left-skewed PF distributions and lower mean PF (p< 0.0001). While CV had no trend across PF in tissue with normal voltage (R2, 0.0002 to 0.1), there was moderate conduction slowing at higher PF in LV tissue (R2, 0.07 to 0.30). In PF-LV overlay maps, all termination sites resided in regions of LV and high PF (Figure). Of the 1-cm areas neighboring termination, 77% had significantly higher PF than the global LA (p< 0.05), of which 80% had significantly lower mean voltage (p< 0.01) or mean voltage < 0.5 mV.Conclusions:Sites of arrhythmia termination can be identified in LV tissue at higher PF. Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical AFL.

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 A13323-A13323, November 8, 2022. Introduction:Acute heart failure is associated with higher post-discharge mortality, especially in low-middle income countries (LMIC). There are limited studies on adherence to the recommended post-discharge care guidelines in these settings. The study assessed adherence to the 2020 ACC/AHA inpatient heart failure performance and quality measure in Gaza Strip, Palestine.Methods:The study was a cross-sectional survey study. We chose a stratified random sample from the three different geographical areas across Gaza Strip with numbers proportional to the size of each region. Patients selected were adults ( >18 years) admitted to the various hospitals for acute decompensated heart failure between 4/2021 and 12/2021. We collected data through chart review. Measures were β blockers, ACEi/ARB and MRA prescription, and outpatient follow-up. Results reported as proportion with 95% CI.Results:The sample size was 155 patients. The mean age was 64 years. 59% were males. The mean length of stay was 2.8 days. β blockers were prescribed to 85.1% [79.5,90.8] of patients. For ACEi/ARB use, it was 42.7% [34.9,50.5]. For MRA, after excluding ineligible patients, it was prescribed in 48.5% [39.9, 57.2]. None of the patients were prescribed hydralazine/nitrate. Only 30.1% [ 23.6, 38.1] of patients had an outpatient appointment. The median time between discharge and appointment date was 22 days. Only 9.7% [5.0,14.3] of patients were discharged with all quality measures fulfilled.Conclusions:There are considerable gaps in the post-discharge care of heart failure patients in the Gaza Strip. There is a need to develop local care guidelines to improve care.

Circulation, Volume 146, Issue Suppl_1, Page A12772-A12772, November 8, 2022. Introduction:Aortic stenosis (AS) is the most common valvular disease, and severe disease can significantly impact morbidity. Less data exists examining the functional and quality of life (QOL) effects of transcatheter aortic valve replacement (TAVR) in patients with severe low-gradient AS in both low-flow and normal-flow states.Hypothesis:Patients with symptomatic, severe, low-gradient AS would have improvements in functional and QOL outcomes at 30-days and 1-year following TAVR procedures.Methods:A single center, retrospective study examined symptomatic, severe, low-gradient AS variants. These had an aortic valve area of ≤1.0 cm2, mean transvalvular gradient

Circulation, Volume 146, Issue Suppl_1, Page A13226-A13226, November 8, 2022. Introduction:Evidence regarding associations between overall low-carbohydrate diets (LCDs) and the risk of developing type 2 diabetes (T2D) remains to be mixed. In the current analysis, we aimed to prospectively assess associations of various LCDs that emphasize different quality of protein, fat, and carbohydrate with T2D risk in U.S. men and women.Methods:A prospective cohort study was conducted in 203,541 men and women participating in the Nurses’ Health Study (NHS), NHSII, and Health Professionals Follow-Up Study who were free of T2D, cardiovascular disease, and cancer at baseline and were followed for up to >30 years. Five LCD scores based on sources of protein, fat, and carbohydrate differentiated by their qualities were derived every four years based on dietary assessments by a validated food frequency questionnaire.Results:During 5,095,048 person-years of follow-up, 19,675 T2D cases were documented. In the multivariable model, a higher overall LCD score was associated with higher T2D risk in a dose-response manner: the hazard ratio (HR) comparing highest vs. lowest quintile was 1.28 (95% confidence interval: 1.22-1.34;P-trend