Risultati per: Linee guida per la malattia arteriosa periferica (PAD)

Senza DRG, i pazienti non hanno accesso a farmaci e monitoraggio

Senza DRG, i pazienti non hanno accesso a farmaci e monitoraggio

Neurologi: ‘si apre una nuova storia per i pazienti’

Circulation, Volume 150, Issue Suppl_1, Page ASu404-ASu404, November 12, 2024. Background:Out-of-hospital cardiac arrest (OHCA) cause significant patient morbidity and mortality. Double sequential external defibrillation (DSED) represents an alternative treatment for OHCA patients, but the use is currently reserved for patients in refractory ventricular fibrillation. However, OHCA patients may achieve return of spontaneous circulation earlier with the use of DSED as the initial treatment.Aims:To compare the necessary times needed to establish pad placement in DSED compared to standard pad placement in a live patient simulation model.Methods:This study was an observational cohort study with ambulance personnel and live patient models. Two-member teams established two defibrillators ready for rhythm analysis. Time spent for standard pad placement and DSED was registered in the same procedure. The procedure was performed on two patient categories, with BMI 20,9 (patient A) and BMI 32,8 (patient B). All team members performed the procedure on both patient categories.Results:In total, 108 procedures were performed on both patient categories. Mean difference in time needed for DSED versus standard pad placement was 13.7 ± 4.8 seconds for patient A, and 13.9 ± 4.6 seconds for patient B. There was no significant difference in time spent between the two patient categories (p=0.725).Conclusion:The necessary time to establish DSED versus standard defibrillation pad placement was short. This may support clinical studies on DSED as initial treatment for OHCA patients without risk of significant increase in time to first defibrillation.

Circulation, Volume 150, Issue Suppl_1, Page A4141112-A4141112, November 12, 2024. Background:It is estimated that Peripheral Artery Disease (PAD) affects between 8.5 and 12 million Americans and its prevalence among adults over 40 years of age is increasing. PAD disproportionately affects Black Americans who, at any age, are twice as likely to experience PAD as their white counterparts but are less likely to be screened and benefit from early diagnosis and treatment.Research Questions/Hypothesis:Despite the high prevalence of PAD and the importance of early intervention, screening for PAD remains limited and/or underutilized particularly in primary care settings where most cases of PAD can be identified. This study sought to understand provider knowledge of PAD, associated risk factors, treatment, understanding of disparities in PAD and barriers and facilitators of PAD screening. It was hypothesized that limited resources, lack of awareness on the part of providers and patients, limitations of training in vascular medicine, and other issues are contributing to PAD morbidity and mortality, particularly among Black and Hispanic populations.Methods:Because no current PAD survey was found in the literature, a survey for providers to determine their knowledge, attitude, and beliefs about PAD and the importance and process of PAD screening for patients at risk was developed. The survey was administered to CommonSpirit Health providers in Sacramento, CA between December 2023- January 2024. Specialties engaged in the survey (N=145) included primary care, endocrine, nephrology, cardiology and podiatry providers.Results:Response rate was 21%. Of those responding, primary care was the specialty most represented(69%). A total of 65% of respondents identified medical treatment of risk factors as the primary way to treat PAD, 32% rated their knowledge of risk reduction therapies in PAD as below average, and 88% of respondents were either somewhat or not familiar with racial disparities in PAD. 24% of respondents identified the ‘lack of knowledge of PAD management guidelines’ as the most important barrier to their patients with PAD not receiving risk reduction therapies.Conclusions:Initial survey of providers identifies lack of knowledge as a key indicator of PAD screening practices, including knowledge on racial disparities in PAD. These identified gaps can inform targeted interventions to improve screening, early detection and treatment of PAD.

Circulation, Volume 150, Issue Suppl_1, Page A4140883-A4140883, November 12, 2024. Background:Peripheral artery disease (PAD) can lead to amputation in advanced cases, making cell therapy using human induced pluripotent stem cells (hiPSCs) a promising therapeutic option. hiPSC-derived endothelial cells (hiPSC-ECs) have shown favorable effects in treating experimental ischemic cardiovascular disease. An autologous approach for PAD patients is preferable to avoid immunological reactions. However, it is yet unknown whether hiPSCs and hiPSC-ECs derived from PAD patients have similar characteristics and potency compared to those derived from healthy volunteers. Therefore, we explored whether there are significant differences in the characteristics and potency of hiPSCs and hiPSC-ECs between non-PAD donors and PAD patients.Methods and Results:We successfully generated hiPSCs from the blood of seven non-PAD donors and eight PAD patients. Both non-PAD and PAD-derived hiPSCs exhibited similar expression levels of pluripotency markers, as determined by qRT-PCR, flow cytometry, and immunostaining. All hiPSCs, regardless of the group, formed teratomas and showed normal karyotypes. RNA-seq analyses revealed similar gene expression profiles between the groups. We then differentiated hiPSCs into endothelial cells (ECs) in a clinically compatible manner. hiPSC-ECs derived from both non-PAD and PAD donors exhibited similar expression levels of EC markers at both the gene (qRT-PCR) and protein levels (immunostaining and flow cytometry). RNA-seq analyses showed no significant overall differences in gene expression profiles between the groups. In vitro nitric oxide assays and tubular structure formation assays demonstrated similar endothelial characteristics and function in hiPSC-ECs from both groups. When injected into the hindlimb muscle following induction of hindlimb ischemia, both groups showed similar perfusion recovery, limb salvage, and vessel-forming capacity. Engrafted hiPSC-ECs from both groups also exhibited similar angiogenic and vessel-forming capabilities.Conclusions:Our study demonstrated no significant differences in hiPSCs and hiPSC-ECs derived from non-PAD donors and PAD patients in terms of molecular and cell biological characteristics, therapeutic effects, and vessel-forming capability. Our study indicates that hiPSCs and hiPSC-ECs derived from PAD patients can serve as a novel platform for autologous cell therapy.