Search Results for: Sindromi coronariche acute

The HALT model showed superior predictive ability over eight current models and may help for LT candidate selection and optimal organ allocation. Though the findings need to be verified in prospective studies and among different patient populations.

Stroke, Ahead of Print. BACKGROUND:Despite significant improvements in early reperfusion, many patients with acute ischemic stroke with large vessel occlusion experience poor outcomes, which indicates a clear need for adjunct therapies. RNS60 is a proprietary combination of oxygen supersaturated in saline with cerebroprotective and immunomodulatory effects. RNS60 showed therapeutic promise in rodent and nonhuman primate models of acute ischemic stroke. RESCUE was the proof-of-concept trial testing adjunctive treatment with RNS60 in patients with acute ischemic stroke with large vessel occlusion undergoing endovascular thrombectomy with or without prior treatment with an intravenous thrombolytic.METHODS:This randomized multicenter, placebo-controlled, double-blind, phase 2 study enrolled 82 participants, assigned 1:1:1 to 48-hour infusion of RNS60 0.5 mL/kg per hour, RNS60 1.0 mL/kg per hour, or placebo 1.0 mL/kg per hour, and followed for 90 days. Rates of serious adverse events and mortality were the primary end points. Efficacy end points included the modified Rankin Scale score, infarct volume growth, National Institutes of Health Stroke Scale, worsening of stroke, Barthel Index, and the EuroQoL health-related quality of life scale.RESULTS:The RNS60 groups met the primary end points with similar rates of serious adverse events (33.3%, 25.0%, and 28.6%) and fewer deaths (6.7%, 8.3%, and 14.3%) across RNS60 0.5 mL/kg per hour, RNS60 1.0 mL/kg per hour, and placebo, respectively. The RNS60 1.0 mL/kg per hour group showed reduced infarct growth by 47% at 48 hours post–endovascular thrombectomy (21.4 mL [interquartile range, 5.0–29.1] versus 40.6 mL [interquartile range, 6.3–62.3];P

Stroke, Ahead of Print. BACKGROUND:International guidelines recommend standardized dysphagia screening in acute stroke, as up to 75% of patients develop poststroke dysphagia. While medication swallowing is also advised for assessment, no validated screening tools or instrumental evidence exist on solid dosage form (SDF) management. Whole tablets are often crushed to reduce aspiration risk, yet the actual risk of aspiration for both forms remains unknown. Despite its widespread clinical use, crushed medication swallowing has never been evaluated using fiberoptic endoscopic evaluation of swallowing. Closing this evidence gap is essential for guiding safe medication administration in patients with dysphagic stroke.METHODS:A prospective, single-center, cross-sectional study with an experimental design was conducted on 60 patients with acute stroke (

Stroke, Ahead of Print. BACKGROUND:In the aftermath of intracerebral hemorrhage (ICH), the clearance of harmful substances from the hematoma helps to mitigate brain edema and reduce the risk of subsequent neurological damage. This study aimed to investigate the mechanism underlying early hematoma processing following ICH and to explore the potential of modulating this process via astrocyte regulation.METHODS:ICH was induced by intrastriatal injection of bacterial collagenase. A calcium channel blocker, pyr3, was used to suppress astrocyte activity, or combined with PPARγ (peroxisome proliferator-activated receptor gamma) agonists (rosiglitazone and pioglitazone) as the intervention approach. The rats were randomly assigned to the following groups: ICH with vehicle treatment, ICH with pyr3 treatment, ICH with rosiglitazone treatment, ICH with pioglitazone treatment, ICH with pyr3 and rosiglitazone treatment, and ICH with pyr3 and pioglitazone treatment. Drugs were administered via the intraventricular route into the contralateral ventricle 10 minutes after ICH induction. The evolution of hematoma within the first 21 hours was meticulously examined using T2-weighted magnetic resonance imaging. Motor behavioral testing and diffusion-weighted imaging were used to assess longer-lasting functional outcomes and edema. To assess astrocyte-specific responses, an astrocyte cell line was incubated with hemin followed by different drug treatments. An intracellular hemin assay was used to quantify the hemin uptake capacity of astrocytes.RESULTS:Delayed signaling transitions of the hematoma were observed in the ICH with pyr3 treatment group in T2-weighted images, manifesting in different ICH models (ANOVA;P

Uno studio prospettico pubblicato su Pain and Therapy condotto presso il centro regionale per le cure palliative dell’Ospedale La Maddalena di Palermo ha analizzato, a distanza di 12 anni da una precedente indagine, le strategie di prescrizione degli oppioidi e l’efficacia analgesica in pazienti ricoverati in un’Unità di Cure Palliative Acute (APCU). I risultati mostrano che un approccio intensivo e personalizzato consente un controllo efficace del dolore senza necessità di aumentare l’equivalente in morfina orale (OME), e sottolineano l’importanza di una gestione esperta nella terapia del dolore oncologico.

Circulation, Ahead of Print. BACKGROUND:Direct reprogramming of fibroblasts to cardiomyocytes is a potentially curative strategy for ischemic heart disease. However, current reprogramming strategies require excessive factors due to epigenetic barriers of adult mouse and human fibroblasts. Recently, we identified the epigenetic factor PHF7 from a screen of gene-regulatory factors as the most potent activator of adult fibroblast-to-cardiomyocyte reprogramming in vitro.METHODS:Through in vitro assays coupled with genome-wide studies, we interrogated the ability of PHF7 to induce reprogramming events with minimal reprogramming factors. Using in vivo murine models of myocardial infarction and intramyocardial reprogramming factor delivery coupled with genetic fibroblast lineage tracing, we delivered retroviral PHF7 cocktails to the murine heart and interrogated reprogramming events as well as the acute and chronic functional impact of these cocktails. Deployment of 10X multiomics in vivo generated a combinatorial single-nucleus transcriptomic and epigenomic atlas of PHF7 reprogramming in the infarcted heart.RESULTS:Genome-wide in vitro transcriptomic analyses revealed that addition of PHF7 to Tbx5 or Mef2c and Tbx5 in fibroblasts induced global reprogramming through upregulation of unique cardiac transcriptomes. Further, PHF7 itself upregulated cardiac master regulators when overexpressed in dermal fibroblasts. Delivery of PHF7 cocktails to the infarcted murine heart induced in vivo reprogramming events and improved cardiac function and remodeling in both acute and chronic heart failure. When delivered as a single factor to the infarcted heart, PHF7 improved survival, function, and fibrosis up to 16 weeks after injury. Genetic lineage tracing analyses revealed that PHF7 induced bona fide fibroblast-to-cardiomyocyte reprogramming events in vivo. Comprehensive multiomics of PHF7 cocktails in the infarcted heart exposed the impact of PHF7 on chromatin structure, generating population-level shifts in nonmyocyte and cardiomyocyte cellular identity.CONCLUSIONS:Here, we report the ability of a single epigenetic factor, PHF7, to induce reprogramming and improve cardiac function in the mouse heart following myocardial infarction. Together, these data support the premise that a single factor, when deployed into the infarcted mouse heart, can induce reprogramming events and recover function in the ischemic heart.

Introduction
Septic shock-associated acute kidney injury (AKI) is known to carry a poor prognosis. The present study aims to evaluate the effect of absorptive blood purification on haemodynamic status and clinical outcomes in patients with septic shock-associated AKI.

Methods and analysis
This multicentre, randomised controlled trial will evaluate an adsorbent filter (oXiris) in patients with abdominal septic shock requiring continuous renal replacement therapy (CRRT). The study plans to recruit 192 participants from intensive care units, who will be randomly assigned to either the intervention group (oXiris set) or the control group (ST 150 set). The primary endpoint is the reduction in norepinephrine equivalence following the initiation of CRRT. Key secondary endpoints include changes in cardiac index and systemic vascular resistance index, as measured by pulse indicator continuous cardiac output, following CRRT initiation, as well as overall survival and kidney recovery rates.

Ethics and dissemination
The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. The Ethics Committee of Shanghai Jiaotong University School of Medicine, Renji Hospital (no. LY-2024–082-B) approved this study on 27 May 2024. The results will be published in peer-reviewed journals and presented at international conferences.

Trial registration number
NCT06504316 (https://clinicaltrials.gov/study/NCT06504316).

Objectives
To investigate the association between triglyceride-glucose (TyG) index levels at hospital admission and the risk of in-hospital adverse events, including all-cause mortality, in patients with acute myocardial infarction (AMI). The primary hypothesis was that higher TyG index levels are associated with greater risk of adverse in-hospital outcomes.

Design
Retrospective cohort study.

Setting
Tertiary hospital inpatient care in China. The study included consecutively hospitalised patients with AMI between 1 August 2011 and 10 January 2022.

Participants
A total of 3458 patients with AMI were included. The mean age was 60.8 years, and 78.4% were men. Patients were excluded if they had incomplete data for TyG index calculation or outcome ascertainment.

Interventions
No therapeutic intervention was assigned; the study was observational. TyG index was calculated using fasting triglycerides and fasting plasma glucose levels at admission.

Primary and secondary outcome measures
The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock and fatal rapid arrhythmia. Outcomes were identified through standardised clinical records.

Results
Among 3458 patients, 375 (10.84%) died during hospitalisation, 236 (6.84%) developed cardiogenic shock and 147 (4.25%) experienced fatal rapid arrhythmia. After multivariable adjustment, higher TyG index levels were significantly associated with increased odds of all-cause mortality (OR, 1.27; 95% CI, 1.02 to 1.57; p

Objectives
This study conducted a comprehensive probabilistic cost-effectiveness analysis comparing robotic exoskeleton therapy to conventional physiotherapy for stroke rehabilitation in Singapore, focusing on three patient groups categorised by their Functional Ambulation Category (FAC) scores.

Design
A probabilistic cost-effectiveness analysis was conducted alongside a non-randomised controlled study. Costs and Quality-Adjusted Life Years (QALYs) for both interventions were calculated and compared over a 6 month period.

Setting
The study was carried out at Alexandra Hospital, Jurong Community Hospital and St Luke’s Hospital in Singapore.

Participants
Individuals requiring inpatient gait rehabilitation from acute to subacute stages of stroke recovery, with FAC scores of 0–1, were included in the analysis.

Primary outcome measure
The primary outcome measure was QALYs, a composite measure combining the length and quality of life into a single value.

Results
Robotic exoskeleton therapy was found to be cost-effective compared with conventional physiotherapy across all patient groups, with Group 2 (FAC 0) showing the most favourable cost-effectiveness profile (incremental cost-effectiveness ratio (ICER): US$ 28 259.62 per QALY gained). The probabilistic sensitivity analysis demonstrated the robustness of the results, with QALY gains and the cost of the robotic exoskeleton having the largest impact on the ICER.

Conclusion
The findings suggest that robotic exoskeleton therapy is likely to be cost-effective for stroke rehabilitation in Singapore, particularly for patients with severe mobility impairments (FAC 0). The results have important implications for clinical practice, resource allocation and future research in the field of stroke rehabilitation in Singapore.

Trial registeration number
NCT05659121.

Introduction
Patients with total hip arthroplasties and hemiarthroplasties are both subject to hip dislocations. Although the incidence of complications differs, both patient groups suffer immediate high pain and need acute treatment. The purpose of this study is to design a fast-track pathway for patients with a dislocated hip prosthesis primarily to reduce the time from arrival to reduction and the total hospitalisation time. The secondary aim is to investigate whether quicker prosthesis reduction influences subsequent hip function and quality of life, reduces pain experience immediately and in the long term, and increases patient satisfaction.

Methods and analysis
This is a prospective observational cohort study, initiated on 1 December 2024 and continuing for 2 years. During the first year, patients admitted to the University Hospital of Southern Denmark, Esbjerg, will follow the current standard treatment pathway. After 1 December 2025, a newly developed treatment pathway (fast-track) will be adhered to. Based on a sample size calculation, 120 patients will be included. The main clinical outcomes (time to reduction (primary outcome), total hospitalisation) are registered from patient files. The patients are followed up for 1 year to measure patient-reported outcomes.

Ethics and dissemination
The study is conducted as a treatment quality study and is locally approved by the Executive Board at the University Hospital of Southern Denmark. The results will be published in relevant national and/or international journals and presented at relevant congresses.

Trial registration number
NCT06639334.

Stroke, Ahead of Print. BACKGROUND:Left atrial (LA) diverticula are focal outpouchings of the LA wall and may increase ischemic stroke risk. We studied recurrent ischemic stroke in patients with acute ischemic stroke and LA diverticula detected on cardiac computed tomography.METHODS:We used data from a prospective cohort study of patients with acute ischemic stroke undergoing cardiac computed tomography acquired during the acute stroke imaging protocol. Cardiac radiologists systematically assessed the presence and characteristics of LA diverticula, defined as LA wall outpouchings with a length/ostium width ratio >0.5 and length ≥3 mm. We compared recurrent ischemic stroke and functional outcome (modified Rankin Scale) after 2 years between patients with and without LA diverticula, adjusting for age, history of atrial fibrillation and ischemic stroke, and anticoagulation use.RESULTS:Of 447 included patients (median age 72 [interquartile range (IQR), 62–81], 59% male), 126 (28%) had LA diverticula: median length 6 mm (IQR, 4–8), width 5 mm (IQR, 4–7), and volume 113 mm3(IQR, 52–254). There was no statistically significant difference in age (median 70 [IQR, 58–79] versus 73 [IQR, 63–81];P=0.06), sex (64% versus 57% male;P=0.28), history of ischemic stroke (21% versus 17%;P=0.48), atrial fibrillation (11% versus 19%;P=0.09), or baseline National Institutes of Health Stroke Scale score (median 5 [IQR, 2–14] versus 5 [IQR, 3–14];P=0.54) between patients with and without LA diverticula, respectively. Recurrent ischemic stroke was more common in patients with LA diverticula (18/124 [15%] versus 24/314 [8%], adjusted hazard ratio, 2.01 [95% CI, 1.08–3.77]), and recurrence risk increased with diverticulum volume (adjusted hazard ratio, 1.02 [95% CI, 1.01–1.03] per 10 mm3). Functional outcome was better in patients with diverticula (median modified Rankin Scale score of 2 [IQR, 1–3] versus 3 [IQR, 1–6], adjusted common odds ratio, 0.62, [95% CI, 0.42–0.92]).CONCLUSIONS:LA diverticula are a common finding on cardiac computed tomography in patients with acute ischemic stroke, and the risk of recurrent ischemic stroke was increased in these patients, particularly in those with larger diverticula. Atrial diverticula may be a risk factor for recurrent ischemic stroke.REGISTRATION:URL:https://www.onderzoekmetmensen.nl/nl/trial/50352; Unique identifier: NL6413901818.

Stroke, Ahead of Print. BACKGROUND:As populations age, there is an increasing need to optimize endovascular treatment (EVT) and to understand country-specific differences in East Asia. We harmonized stroke registries from Korea and Taiwan to enable comparisons of patient characteristics and outcomes, with a particular focus on the impact of age.METHODS:Multicenter prospective stroke registries in Korea (CRCS-K [Clinical Research Collaboration for Stroke in Korea]) and Taiwan (TREAT-AIS [Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke]) were harmonized to form a unified data set of patients undergoing EVT. Outcomes included 3-month modified Rankin Scale, symptomatic intracranial hemorrhage, and successful recanalization. We assessed the association between age and outcomes in the overall population and those who were aged ≥80 years using logistic regression models, adjusting for relevant covariates.RESULTS:A total of 9934 EVT cases (7835 from Korea and 2099 from Taiwan) were included from 2011 to 2023. Patients had a mean age of 70.1±12.9 years (57.6% male; median National Institutes of Health Stroke Scale score, 14 [interquartile range, 9–19]). Compared with Korean patients, Taiwanese patients had a higher prevalence of risk factors and more severe strokes, contributing to lower rates of favorable 3-month outcomes. Increasing age was associated with poorer EVT results; among patients ≥80 years, 18% achieved a modified Rankin Scale score of 0 to 2, compared with 46% of younger patients. However, the risk of symptomatic intracranial hemorrhage did not significantly increase with age (adjusted odds ratio per year, 1.01 [0.99–1.02]; adjusted odds ratio of ≥80 years, 0.98 [0.75–1.29]). Prestroke functional independence, baseline hemoglobin, and bridging thrombolysis were identified as significant modifiers of outcomes in the oldest patients.CONCLUSIONS:Taiwanese EVT patients had more risk factors and worse outcomes than Korean patients. Advanced age is associated with poorer functional recovery, yet selected older patients, particularly those who were functionally independent before the stroke or received bridging thrombolysis, demonstrated meaningful benefit. These results underscore the importance of individualized treatment strategies and careful patient selection, especially as populations continue to age.

Background and aims
Quantifying systemic inflammation (SI) in acutely decompensated cirrhosis (ADC) is of major importance because SI is a driver of the most severe forms of ADC, including acute-on-chronic liver failure (ACLF). Blood biomarkers of SI already evaluated in ADC failed to appropriately assess SI in ADC. We aimed to investigate whether gene expression related to circulating immune cells could quantify SI in ADC.

Methods
Standard biomarkers (white cell count, C reactive protein, cytokines) and genome-wide RNA expression (RNA-sequencing) were obtained in blood from 700 patients with ADC at the time of their hospital admission. A composite score based on standard biomarkers of SI (Chronic Liver Failure-Standard Biomarkers Composite (CLIF-SBC) score) and a gene score (CLIF-Systemic Inflammation Gene (SIG) score) composed of the 28 top differentially expressed immune cell-related genes in the comparison between high-severity and low-severity clinical phenotypes were computed. Among the 700 patients, the CLIF-SIG score was repeated once during follow-up in 375 patients, and 3 times or more in 46 patients.

Results
The CLIF-SIG score was more accurate in reflecting clinical severity induced by SI than the CLIF-SBC score (area under the curve 0.803 vs 0.658). A CLIF-SIG score of 0.386 (Youden Index) was the best cut-off level discriminating patients with poor outcomes from the others, in all clinical scenarios. Sequential measurement of the CLIF-SIG score showed that 78% of patients were admitted at the peak or descending part of the SI-wave. ACLF developed during hospitalisation in 80% of patients with a CLIF-SIG score >0.386 on admission.

Conclusions
In patients with ADC, the CLIF-SIG score is an accurate estimator of SI, clinical course severity and prognosis.

Acute severe ulcerative colitis (ASUC) remains one of the challenging presentations in inflammatory bowel disease (IBD) where progress on therapeutic approaches has been limited since 1955 when corticosteroids revolutionised care 1 to reduce the mortality associated with ASUC. Despite the advent of rescue therapy options, short- and long-term colectomy rates remain stubbornly high2 . While newer strategies to reduce the need for in-hospital colectomy during an index admission are being considered with variable success, there is limited data guiding the management of steroid-responsive patients with ASUC. In GUT, Amiot et al 3 aimed to address this gap in knowledge by randomising ASUC patients responding to intravenous steroids (IV) to infliximab with azathioprine (IFX+AZA) or azathioprine (AZA) alone. The results indicate a 28% reduction in treatment failure at week 52, defined as the composite of the absence of steroid-free clinical remission and endoscopic response…

Introduction
Liver cirrhosis accounts for over 10 000 deaths in the UK each year with a total loss of 60 000 quality-adjusted life-years. There is a substantial cost to the NHS of £4.5 billion, with new liver-related decompensation events accounting for the majority of this. Following an acute cirrhosis decompensating event, there is a significant risk of hospital readmission with 90-day readmission rates as high as 53%. Current care in the UK is reactive and patients are often only readmitted when they have presented acutely as an emergency with significant decompensation.

Methods and analysis
CirrhoCare is a prospective, multicentre, randomised controlled trial comparing the CirrhoCare management system with standard-of-care for high-risk cirrhosis patients who have been discharged following an admission with acute decompensation. The CirrhoCare management system comprises a novel digital platform for use in a patient’s home, designed to proactively detect the first signs of new decompensation in patients with established cirrhosis, discharged to the community. This enables a clinician to instigate early community-based care or, if needed, to triage the patient for hospital interventions.
214 patients will be recruited to the CirrhoCare trial from at least 12 UK centres. Patients will be randomised on a 1:1 ratio allocation to the CirrhoCare Management System or standard of care. Participants who are randomised to CirrhoCare will receive a CirrhoCare health kit comprising a smart watch, smart phone with enabled SIM (Subscriber Identity Module) network card, blood pressure monitor, weighing scales and thermometer. Participants will take measurements every morning Monday to Friday and will be followed up for 90 days postdischarge.
The primary objective of this study is to assess the clinical effectiveness of the CirrhoCare digital management system. We hypothesise that its early community-based intervention will reduce the number of unplanned hospital interventions and admissions and prevent liver-related complications when compared with standard-of-care management.

Ethics and dissemination
CirrhoCare is a National Institute for Health and Care Research-funded study (NCT06223893). The study has UK Research Ethics Committee and Health Research Authority (HRA) approvals, with approval granted by the HRA and Health and Care Research Wales committee. The results of this study will be published in peer review journals, disseminated at international conferences as well as established Patient and Public Involvement and Engagement networks.

Trial registration number
ISRCTN11380842.

Objectives
COVID-19 in children is generally of short duration, but some may take longer to recover. This study investigated the time to symptom resolution following SARS-CoV-2 infection among children in a community setting on the outskirts of an urban centre in Brazil.

Design
Prospective cohort study.

Setting
This is a community-based cohort of children living in Manguinhos, a favela in Rio de Janeiro. The cohort was followed through home visits and telephone monitoring of symptoms. The analysis focused on symptomatic children from this cohort with confirmed SARS-CoV-2 infection. Recovery time was defined as the interval between the first date with symptoms and the first date without symptoms following a positive SARS-CoV-2 test.

Participants
A total of 1276 children (boys and girls aged 2–