95 research outputs found
Die Rolle von kardialen Biomarkern in der perioperativen Risikoevaluation von nichtkardiochirurgischen Patienten – eine Zusammenfassung der ESAIC-Leitlinie 2023
No full text<jats:title>Zusammenfassung</jats:title><jats:sec>
<jats:title>Hintergrund</jats:title>
<jats:p>Die ESAIC-Leitlinie aus dem Jahr 2023 beleuchtet den klinischen Wert von kardialem Troponin (cTn) und B‑Typ natriuretischen Peptiden (BNP) zur Risikoevaluation in nichtkardiochirurgischen Patienten.</jats:p>
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<jats:title>Ziele der Arbeit</jats:title>
<jats:p>Zusammenfassung der Empfehlungen der neuen ESAIC-Leitlinie.</jats:p>
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<jats:title>Material und Methoden</jats:title>
<jats:p>Die Evidenz für die Empfehlungen der Leitlinie wurde aus Studien extrahiert, die den perioperativen Nutzen von cTn und BNP für die Anwendungsbereiche der Prognoseabschätzung, Risikoprädiktion und Therapieoptimierung untersuchten. Für die Erstellung des Empfehlungsgrads wurden zusätzlich 12 relevante Endpunkte und das Risiko-Nutzen-Verhältnis der systematischen Messung der Biomarker mitberücksichtigt.</jats:p>
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<jats:title>Ergebnisse</jats:title>
<jats:p>Es konnten 115 Studien als Grundlage für die Leitlinienempfehlungen identifiziert werden. Die verfügbare Evidenz variierte stark zwischen den 12 verschiedenen Endpunkten. Zusätzlich zeigte sich ein Evidenzgefälle für die einzelnen Anwendungsbereiche der Biomarker. Es wurden schwache Empfehlungen für die präoperative, postoperative und sequenzielle Messung von cTn und die präoperative Messung von BNP zur Prognoseabschätzung abgegeben. Für die Risikoprädiktion wurde ebenfalls eine schwache Empfehlung für die sequenzielle und postoperative Messung von cTn sowie präoperative Messung von BNP abgegeben. Die Evidenz von kardialen Biomarkern zur Therapieoptimierung war unzureichend, sodass ihr Nutzen unklar blieb und keine Empfehlung abgegeben werden konnte.</jats:p>
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<jats:title>Diskussion</jats:title>
<jats:p>Kardiale Troponine und BNP können bei nichtkardiochirurgischen Patienten für die Prognoseabschätzung und Risikoprädiktion für ausgewählte Endpunkte verwendet werden. Therapieentscheidungen sollten nicht aufgrund der Erhöhung dieser Biomarker getroffen werden.</jats:p>
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Solidariedade por Interesse Comum (Art. 124, Inciso I, do CTN): os Trabalhos de Rubens Gomes de Sousa Preparatórios do CTN e sua Influência na Compreensão do Dispositivo
No full textThe author will analyze papers issued by Rubens Gomes de Sousa during the preparatory studies for CTN. By doing that, the author seeks to demonstrate that Gomes de Sousa’s intention, during those studies, does not fully converge with the literal, systematic and finalistic interpretation of the solidarity rule based on common interest (art. 124, item I). The article concludes that solidarity based on common interest may encompass either a plurality of taxpayers, or a plurality of individuals that are tax liable.Por meio deste artigo, a autora analisará trabalhos de Rubens Gomes de Sousa preparatórios do projeto de lei que deu origem ao CTN. O trabalho buscará demonstrar que a intenção de Gomes de Sousa, ao propor a regra de solidariedade fundada em interesse comum (art. 124, inciso I) não converge integralmente com a interpretação literal, sistemática e finalística da norma. O artigo concluirá que a solidariedade por interesse comum pode abranger ou uma pluralidade de contribuintes, ou uma pluralidade de responsáveis tributários
ECFS CTN measurement of weight standard operating procedure
No full textSCOPE To ensure that ECFS CTN study sites perform weight measurement in a reproducible and standardised manner. To ensure quality and reliability of the data collected and analysed, each individual site should follow the guidelines described below and have received training in the use of growth charts.Access to this document is allowed by the publisher “on request” only to the author Kate Hill to email [email protected]<br/
Energy Efficiency in Transition Economies: Is There Convergence Towards the EU Average?
No full textThis paper investigates the relationship between energy intensity in the 12 countries of Eastern Europe that can be considered as in transition to a full market economy, and that of the present EU members. The raw data shows some evidence of convergence, and a carefully estimated econometric model of lagged adjustment confirms this. On average, a 1% decrease in the per capita income gap between developed and transition economies leads to a decrease in the energy intensity growth rate of a transition country by 0.7%. There are differences in the rate of convergence across countries, and these depend on two parameters that are allowed to vary across countries: ?, the elasticity of desired energy intensity with respect to the per capita income gap; and µ, the rate at which actual energy intensity adjusts to the desired energy intensity. The countries with the fastest convergence rates given these parameters are the Czech Republic, Bulgaria, Croatia and Turkey. The forecast values for energy intensity and actual energy demand levels of seven transition countries were estimated. Results show that the energy intensities of transition countries except Estonia converge to EU levels significantly. On the other hand, actual energy demand levels between 2000 and 2020 show an increasing demand in all 7 countries despite the reductions in energy intensity. Therefore, it will not be feasible to use as a target a non-increasing level of total energy consumption.Energy, Convergence, Transition
Troponin Messenger or Actor?
No full textCardiac troponin (cTn) is a biomarker of myocardial damage. New generations of high-sensitivity assays find circulating cTn in virtually all subjects. Multiple studies in various populations and patient groups have found higher levels of cTn to be predictive of future heart failure. The author proposes that initial myocardial damage from various mechanisms may lead to anti-cTn antibodies that participate in ongoing myocardial damage that eventually results in heart failure
Em Busca de um Interesse Comum: Considerações acerca dos Limites da Solidariedade Tributária do Art. 124, Inc. I, do CTN
No full textIn this paper the author envisages the identification of limits to solidarity in tax matter. An essential question would be which is the meaning of the term “common interest” set forth in article 124, I, of the Brazilian Tax Code, that once verified could give rise to solidary tax liability between taxpayers. The author also argues that the legal concept of “common interests” remains the one that best fits to Brazilian tax system despite the criticisms of legal authorities in Normative Report COSIT n. 04/2018 and its alleged imperfections. Besides legal certainty, the legal concept of “common interest” had been repeatedly reaffirmed by Brazilian Superior Court of Justice. The paper has a dogmatic approach and pursuits elements in legal doctrine which could allow for a better understanding of the normative scope of the legal norms that set forth solidary tax liability.No presente artigo, busca-se identificar limites à solidariedade tributária. Questiona-se, essencialmente, qual seria o significado da expressão “interesse comum” do art. 124, inc. I, do CTN, que, uma vez constatado, poderá dar azo à solidariedade entre sujeitos passivos na obrigação tributária. Pretende-se demonstrar que o conceito jurídico de interesse comum, não obstante as críticas a ele dispensadas no Parecer Normativo COSIT/RFB n. 04/2018 e suas alegadas imperfeições, permanece como aquele que guarda maior aderência com o sistema tributário brasileiro, pois, sobre promover maior segurança jurídica pela objetividade em sua delimitação, tem sido reiteradamente reafirmado pelo Superior Tribunal de Justiça. O artigo parte de uma abordagem eminentemente dogmática, buscando-se, a partir de textos doutrinários, elementos que permitam a melhor compreensão da exata dimensão normativa dos enunciados prescritivos que disciplinam a solidariedade tributária
Personalized diagnosis in suspected myocardial infarction
No full textBackground: In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hs-cTn)-based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to build a digital tool to directly estimate the individual probability of MI, allowing for numerous hs-cTn assays. Methods: In 2,575 patients presenting to the emergency department with suspected MI, two ensembles of machine-learning models using single or serial concentrations of six different hs-cTn assays were derived to estimate the individual MI probability (ARTEMIS model). Discriminative performance of the models was assessed using area under the receiver operating characteristic curve (AUC) and logLoss. Model performance was validated in an external cohort with 1688 patients and tested for global generalizability in 13 international cohorts with 23,411 patients. Results: Eleven routinely available variables including age, sex, cardiovascular risk factors, electrocardiography, and hs-cTn were included in the ARTEMIS models. In the validation and generalization cohorts, excellent discriminative performance was confirmed, superior to hs-cTn only. For the serial hs-cTn measurement model, AUC ranged from 0.92 to 0.98. Good calibration was observed. Using a single hs-cTn measurement, the ARTEMIS model allowed direct rule-out of MI with very high and similar safety but up to tripled efficiency compared to the guideline-recommended strategy. Conclusion: We developed and validated diagnostic models to accurately estimate the individual probability of MI, which allow for variable hs-cTn use and flexible timing of resampling. Their digital application may provide rapid, safe and efficient personalized patient care. Trial Registration numbers: Data of following cohorts were used for this project: BACC (www.clinicaltrials.gov ; NCT02355457), stenoCardia (www.clinicaltrials.gov ; NCT03227159), ADAPT-BSN (www.australianclinicaltrials.gov.au ; ACTRN12611001069943), IMPACT (www.australianclinicaltrials.gov.au , ACTRN12611000206921), ADAPT-RCT (www.anzctr.org.au ; ANZCTR12610000766011), EDACS-RCT (www.anzctr.org.au ; ANZCTR12613000745741); DROP-ACS (https://www.umin.ac.jp , UMIN000030668); High-STEACS (www.clinicaltrials.gov ; NCT01852123), LUND (www.clinicaltrials.gov ; NCT05484544), RAPID-CPU (www.clinicaltrials.gov ; NCT03111862), ROMI (www.clinicaltrials.gov ; NCT01994577), SAMIE (https://anzctr.org.au ; ACTRN12621000053820), SEIGE and SAFETY (www.clinicaltrials.gov ; NCT04772157), STOP-CP (www.clinicaltrials.gov ; NCT02984436), UTROPIA (www.clinicaltrials.gov ; NCT02060760). Graphical Abstract: [Figure not available: see fulltext.] © 2023, The Author(s)
Personalized diagnosis in suspected myocardial infarction [Elektronisk resurs]
No full textBackground: In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hs-cTn)-based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to build a digital tool to directly estimate the individual probability of MI, allowing for numerous hs-cTn assays. Methods: In 2,575 patients presenting to the emergency department with suspected MI, two ensembles of machine-learning models using single or serial concentrations of six different hs-cTn assays were derived to estimate the individual MI probability (ARTEMIS model). Discriminative performance of the models was assessed using area under the receiver operating characteristic curve (AUC) and logLoss. Model performance was validated in an external cohort with 1688 patients and tested for global generalizability in 13 international cohorts with 23,411 patients.Results: Eleven routinely available variables including age, sex, cardiovascular risk factors, electrocardiography, and hs-cTn were included in the ARTEMIS models. In the validation and generalization cohorts, excellent discriminative performance was confirmed, superior to hs-cTn only. For the serial hs-cTn measurement model, AUC ranged from 0.92 to 0.98. Good calibration was observed. Using a single hs-cTn measurement, the ARTEMIS model allowed direct rule-out of MI with very high and similar safety but up to tripled efficiency compared to the guideline-recommended strategy. Conclusion: We developed and validated diagnostic models to accurately estimate the individual probability of MI, which allow for variable hs-cTn use and flexible timing of resampling. Their digital application may provide rapid, safe and efficient personalized patient care. Trial Registration numbers: Data of following cohorts were used for this project: BACC (www.clinicaltrials.gov ; NCT02355457), stenoCardia (www.clinicaltrials.gov ; NCT03227159), ADAPT-BSN (www.australianclinicaltrials.gov.au ; ACTRN12611001069943), IMPACT (www.australianclinicaltrials.gov.au , ACTRN12611000206921), ADAPT-RCT (www.anzctr.org.au ; ANZCTR12610000766011), EDACS-RCT (www.anzctr.org.au ; ANZCTR12613000745741); DROP-ACS (https://www.umin.ac.jp , UMIN000030668); High-STEACS (www.clinicaltrials.gov ; NCT01852123), LUND (www.clinicaltrials.gov ; NCT05484544), RAPID-CPU (www.clinicaltrials.gov ; NCT03111862), ROMI (www.clinicaltrials.gov ; NCT01994577), SAMIE (https://anzctr.org.au ; ACTRN12621000053820), SEIGE and SAFETY (www.clinicaltrials.gov ; NCT04772157), STOP-CP (www.clinicaltrials.gov ; NCT02984436), UTROPIA (www.clinicaltrials.gov ; NCT02060760). Graphical Abstract: [Figure not available: see fulltext.] © 2023, The Author(s)
High-sensitivity cardiac troponin assays for cardiovascular risk stratification in the general population
No full textCardiac troponins (cTns) I and T have long been the most successful cardiac-specific circulating biomarkers in cardiovascular (CV) medicine, having changed dramatically the diagnosis of acute myocardial infarction, while being independent predictors of outcome in several cardiac conditions and non-cardiac conditions. The latest-generation high-sensitivity (hs) cTn assays demonstrate both enhanced diagnostic performance and improved analytical performance, with the ability to measure detectable concentrations in a substantial proportion of the asymptomatic and presumably healthy populations. Given this unique analytical feature, recent evidence suggests that hs-cTn can be used for the stratification of CV risk in the general population. High-sensitivity cTn predicts future CV events, are responsive to preventive pharmacological or lifestyle interventions, change in parallel to risk modifications, and offer incremental risk prediction when added to well-established prognosticators. The implementation of CV risk stratification and prevention strategies incorporating hs-cTn requires further investigation to define the optimal target populations, timing of measurement, and preventive interventions. © The Author(s) 2020
Association of myocardial injury with adverse long-term survival among cancer patients.
No full textOver time, cardiovascular disease (CVD) deaths increasingly exceed those from malignancy among cancer survivors. However, the association of myocardial injury with long-term survival (beyond three years) in cancer patients has not been previously described. The National Health and Nutrition Examination Survey high-sensitivity cardiac troponin (hs-cTn) and morbidities databases (1999-2004) were linked with the latest mortality dataset isolating records were respondents reported cancer diagnosis by a healthcare professional. Myocardial injury was then determined by elevated hs-cTn. 16,225,560 weighted records (1,058 unweighted) were included in this observational study, with myocardial injury identified in 14·2%. Those with myocardial injury had progressively worse survival at 5 (51·6% vs. 89·5%), 10 (28·3% vs. 76·0%), and 15 years (12·6% vs. 61·4%) compared to those without myocardial injury. After adjusting for baseline characteristics, those with myocardial injury had an adjusted hazard ratio (aHR) of 2·10 (95% CI 2·09-2·10, p<0·001) for all-cause mortality, 2·23 (2·22-2·24, p<0·001) for cardiovascular mortality, and 1·59 (95% CI 1·59-1·60, p<0·001) for cancer mortality compared to those without myocardial injury. Among patients with no pre-existing CVD, the hs-cTn I Ortho assay was a strong independent predictor of all cause (aHR 6·29, 95% CI 6·25-6·33, p<0·001), CVD (aHR 11·38, 95% CI 11·23-11·54, p<0·001), and cancer (aHR 5·02, 95% CI 4·96-5·07, p<0·001) mortality. As a marker for myocardial injury, hs-cTn/s were independently associated with worse long-term survival among cancer patients with a stronger relationship with all-cause, cardiovascular, and cancer mortality using hs-cTn I ortho assay. [Abstract copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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