90 research outputs found
Orthopnea and inspiratory effort in chronic heart failure patients
No full textAbstractStudy objective: Orthopnea is a typical feature of patients with chronic heart failure (CHF), the factors contributing to it are not completely understood. We investigated changes in dyspnea and other respiratory variables, induced by altering posture (from sitting to supine) in 11 CHF patients (NYHA classes II–IV) and 10 control subjects.Methods and Results: We measured dyspnea (Borg scale), the diaphragm pressure time product per minute (PTPdi/m, index of metabolic consumption), and mechanical properties of the lung (lung compliance (C,L) and resistances (R,L). CHF patients also underwent a trial of non-invasive mechanical ventilation (NIMV) in the supine position in order to ascertain whether unloading the inspiratory muscles could somehow relieve dyspnea. While sitting the PTPdi/min was significantly higher in CHF patients than in controls (181±54cm H2O × s/min vs. 96±32;P <0.05). Assuming a supine position caused no major changes in controls, whereas CHF patients showed a significant worsening in dyspnea, a rise in PTPdi/min (243±97 p<0.01) and R, L (4.7±1.2cm H2O/L × s sitting vs. 7.9±2.5 supine; P<0.01) and a decrease in C,L (0.08±0.02L/cm H2O sitting vs. 0.07+0.01 supine; P<0.05). Applying NIMV to supine CHF patients significantly reduced the PTPdi/min to 81±42 (P<0.001). Changes in dyspnea, produced by varying position or applying NIMV, were significantly correlated with PTPdi/min (r=0.80, P<0.005 and r=0.58, P<0.01, respectively). Conclusions: CHF patients had a higher PTPdi/min than controls when sitting, and assuming a supine position induced severe dyspnea, a large rise in R,L, and a reduction in C, L so that PTPdi/min increased further. Orthopnea was strongly correlated with the increased diaphragmatic effort
Regulation in expression of the m-RNA-binding protein pp56 during early development of Xenopus
No full textIntracellular accumulation of ritonavir combined with different protease inhibitors and correlations between concentrations in plasma and peripheral blood mononuclear cells
No full textUse of Post-Natal Antiretroviral Prophylaxis for Prevention of Mother-to-Child Transmission of HIV Is Increasing in Italy
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Early ECMO Flow Index and Arterial Oxygenation Targets and Outcomes in Adults With Cardiogenic Shock Supported With Venoarterial Extracorporeal Membrane Oxygenation
No full textCardiogenic shock (CS) is a life-threatening syndrome characterized by reduced cardiac output and end-organ hypoperfusion, with in-hospital mortality nearing 50% despite contemporary therapies. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a key rescue strategy in refractory CS, providing temporary circulatory support to restore adequate perfusion. However, its use is associated with a high risk of significant complications, including bleeding, thromboembolism, neurologic injury, and limb ischemia.
ECMO flow index and arterial oxygenation are readily modifiable parameters during VA-ECMO support that may influence outcomes. Although full flows (>2.0–2.2 L/min/m²) are commonly targeted, they may increase left ventricular (LV) afterload, impair myocardial recovery, and reduce pulsatile flow. Conversely, partial flows may preserve native ejection, reduce vascular complications, and minimize the need for LV unloading. Additionally, arterial hyperoxia, driven by high oxygen delivery through the membrane oxygenator, has been associated with adverse outcomes, including increased mortality, possibly due to oxidative stress and arterial vasoconstriction. ECMO flows can contribute to the absolute oxygen exposure through shifts in the aortic mixing zone that may expose vital circulations (e.g. coronary, cerebral) to supraphysiologic oxygen levels.
In this thesis, we leveraged data from the Extracorporeal Life Support Organization (ELSO) Registry to examine two interrelated questions. In the first study, we assessed whether initial ECMO flow index was associated with in-hospital mortality, metrics of perfusion, and major complications. In the second study, we evaluated the interaction between flow index and arterial oxygenation and their impact on outcomes. Together, these analyses aim to inform future strategies for optimizing VA-ECMO support in adults with CS.Graduate Educatio
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Prediabetes and Gout Risk: The Role of Metformin Use and Longitudinal Serum Urate Analysis
No full textBackground:
Despite the strong association between gout and prediabetes, the role of antidiabetic medications in managing gout among individuals with prediabetes remains uncertain. We estimated the incidence of gout and additionally compared the survival distribution of gout development in prediabetic patients starting metformin with prediabetic patients not using any antidiabetic treatments.
Methods:
We conducted a new-user, propensity score-matched cohort study using electronic health record data from an academic health system (2007-2022). Prediabetics were defined based on haemoglobin A1c levels. Metformin users were identified and followed from the first metformin prescription date. Non-users of antidiabetic medications were matched to metformin users based on propensity score and the start of follow-up. The primary outcome was incident gout. Cox proportional hazards models estimated the hazard ratio for metformin. Linear regression analyses assessed the association between metformin use and changes in serum urate (SU) or C-reactive protein (CRP).
Results:
We identified 25,064 prediabetics and propensity score-matched 1,154 metformin initiators to 13,877 non-users. Baseline characteristics were well balanced (all standardized mean differences .1). Median follow-up was 3.9 years. The incidence rate of gout per 1000 person-years was lower in metformin users 7.1 (95% CI 5.1 to 10) compared to non-users 9.5 (95% CI 8.8 to 10.2). Metformin initiation was associated with a reduced relative risk of gout (HR 0.68, 95% CI 0.48 to 0.96). No relationship was found between metformin use and changes in SU or CRP.
Conclusions:
Metformin use was associated with a lower risk of gout among patients with prediabetes, suggesting that treatment with metformin may have a role in lowering the risk of gout in individuals with prediabetes.
Keywords: Gout, incidence, crystal arthropathie
Improvement of pisingallo maize (Zea mays L.) for the semi-arid region of Córdoba, Argentina. Dialelic analysis between pisingallo and colorado duro populations.
No full textUtilizando el c.v. MPB-FCA 856 (P1), maíz colorado duro, y las poblaciones de maíz pisingallo: Paraná (P2), Anaranjado (P3), Amarillo (P4) y Colorado (P5), se efectuó un análisis dialélico parcial (Gritting, Mét. I-Mod. II). Los caracteres evaluados fueron: Días a Floración femenina (DFF), Longitud de espiga (LONG), Rendimiento (Rto.) y Expansión (Exp.). Los valores de heterosis de las F1 en relación al padre de mayor expresión fueron negativos en varios casos. En el carácter DFF, (P1) tendría mayor diversidad genética que algunos de los otros padres, manifestándose en el cruzamiento una interacción epistática que causa la depresión heterótica. El grupo de poblaciones parentales muestra una predominancia de los efectos aditivos sobre los de dominancia, lo cual conduciría a la mejora poblacional. Las poblaciones (P2), (P3) y (P5) mostraron potencialidad para mejorar poblaciones por Exp., y (P4) se presentó como muy buen progenitor pisingallo, a utilizar para aumentar los rendimientos.A partial diallel mating design was performed among four popcorn varieties: Paraná (P2), Anaranjado (P3), Amarillo (P4), and Colorado (P5), along with one adapted flint population of corn, MPB-FCA 856. Data was collected on the following characters: days to female flowering (DDF), ear length (LONG), grain yield (Rto.), and popping expansion (Exp.). Heterotic values were negative for several characters in relation to the best parent. DDF exhibited greater genetic diversity, with an epistatic effect that causes heterotic depression. The parental population showed a predominance of additive over dominance effects, allowing for population improvement schemes. Populations P2, P3, and P5 could be used to enhance popping expansion (Exp.), while P4 is a good popcorn parent and could be utilized to increase grain yield
Risky Business: Human Factors in Critical Care
No full text Remarkable achievements have occurred in pediatric cardiac critical care over the past two decades. The specialty has become well defined and extremely resource intense. A great deal of focus has been centered on optimizing patient outcomes, particularly mortality and early morbidity, and this has been achieved through a focused and multidisciplinary approach to management. Delivering high-quality and safe care is our goal, and during the Risky Business symposium and simulation sessions at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, December 2010, human factors, systems analysis, team training, and lessons learned from malpractice claims were presented. </jats:p
Human immunodeficiency virus-related cancer in children: Incidence and treatment outcome - Report of the Italian Register
No full textPurpose: to outline the incidence, presenting features, treatment response, and outcome of human immunodeficiency virus (HIV)-associated malignancies in infancy and childhood, together with the estimated risk of HIV-associated cancer in children born to mothers infected with HIV.
Patients and Methods: The Italian Register for HN Infection in Children collected data by specific registration and follow-up forms. By March 1999, 5,060 children were recruited, including 4,889 with perinatal exposure to HIV-1. Overall, 1,331 infected children were enrolled onto the Register and classified according to current Centers for Disease Control criteria; of them, 1,163 were vertically infected (24% of those with perinatal exposure). Of these 1,163, 569 (49%) were considered to have been prospectively followed-up since they had been registered at birth or within the first 3 months of age.
Results: Of the 1,331 children observed for a median time of 6.5 years, 35 developed 36 malignancies, four of which occurred in patients with blood-borne risk. For the 1,163 vertically infected children, the cumulative number of years of observation was 7,178 child-years and the cumulative incidence of HIV-associated tumors was 4. 18 per 1,000 children/yr (95% confidence interval [CI], 2.92 to 5.98). When only the 569 vertically infected children prospectively followed up since birth were considered, the cumulative number of years of observation was 2,803 child-years. In this group, 10 rumors were observed, with a cumulative incidence of HIV-associated tumors of 3.57 per 1,000 children per year (95% CI, 1.92 to 6.63).
Conclusion: The risk of cancer was significantly higher but nor restricted to symptomatic and/or immune-compromised children. Cancer-directed treatment should be given promptly to these patients, who have ct fair chance to survive their tumor in view of potential highly aggressive antiretroviral therapy-associated improvement in survival and quality of life
A time-frequency approach for cerebral embolic load monitoring
No full textObjective: To enable reliable cerebral embolic load monitoring from high-intensity transient signals (HITS) recorded with single-channel transcranial Doppler (TCD) ultrasound. Methods: We propose a HITS detection and characterization method using a weighted-frequency Fourier linear combiner that estimates baseline Doppler signal power. An adaptive threshold is determined by examining the Doppler signal power variance about the baseline estimate, and HITS are extracted if their Doppler power exceeds this threshold. As signatures from multiple emboli may be superimposed, we analyze the detected HITS in the time-frequency (TF) domain to segment the signals into individual emboli. A logistic regression classification approach is employed to classify HITS into emboli or artifacts. Data were collected using a commercial TCD device with emboli-detection capabilities from twelve children undergoing mechanical circulatory support or cardiac catheterization. A subset of 696 HITS were reviewed, annotated, and split into training and testing sets for developing and evaluating the HITS classification algorithm. Results: The classifier yielded 98% and 96% sensitivity for 100% specificity on training and testing data, respectively. The TF approach decomposed 38% of candidate embolic signals into two or more embolic events that ultimately account for 69% of the overall embolic counts. Our processing pipeline resulted in highly accurate emboli identification and produced emboli counts that were lower (by a median of 64%) compared to the commercial ultrasound system's estimates. Significance: Using only single-channel, single-frequency Doppler ultrasound, the proposed method enables sensitive detection and segmentation of embolic signatures. Our approach paves the way towards accurate real-time cerebral emboli monitoring
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