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1.
Braz J Cardiovasc Surg ; 39(2): e20220470, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38426709

RESUMO

INTRODUCTION: Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative complications. The feasibility of GDFT in transcatheter aortic valve replacement (TAVR) patients under general anesthesia has not yet been demonstrated. We examined whether GDFT could be applied in patients undergoing TAVR in general anesthesia and its impact on outcomes. METHODS: Forty consecutive TAVR patients in the prospective intervention group with GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion criteria were age ≥ 18 years, elective TAVR in general anesthesia, no participation in another interventional study. Exclusion criteria were lack of ability to consent study participation, pregnant or nursing patients, emergency procedures, preinterventional decubitus, tissue and/or extremity ischemia, peripheral arterial occlusive disease grade IV, atrial fibrillation or other severe heart rhythm disorder, necessity of usage of intra-aortic balloon pump. Stroke volume and stroke volume variation were determined with uncalibrated pulse contour analysis and optimized according to a predefined algorithm using 250 ml of hydroxyethyl starch. RESULTS: Stroke volume could be increased by applying GDFT. The intervention group received more colloids and fewer crystalloids than control group. Total volume replacement did not differ. The incidence of overall complications as well as intensive care unit and hospital length of stay were comparable between both groups. GDFT was associated with a reduced incidence of delirium. Duration of anesthesia was shorter in the intervention group. Duration of the interventional procedure did not differ. CONCLUSION: GDFT in the intervention group was associated with a reduced incidence of postinterventional delirium.


Assuntos
Estenose da Valva Aórtica , Delírio , Substituição da Valva Aórtica Transcateter , Humanos , Adolescente , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estudos Retrospectivos , Estudos Prospectivos , Estudos de Viabilidade , Objetivos , Delírio/etiologia , Delírio/cirurgia , Hidratação/métodos , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Resultado do Tratamento , Fatores de Risco , Tempo de Internação
2.
Arq Bras Cardiol ; 121(1): e20230242, 2024.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38477763

RESUMO

BACKGROUND: The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy. OBJECTIVES: We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients. METHODS: A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests. RESULTS: Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals. CONCLUSIONS: Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.


FUNDAMENTO: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. OBJETIVOS: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. MÉTODOS: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. RESULTADOS: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. CONCLUSÕES: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Infarto do Miocárdio , Humanos , Masculino , Feminino , Estudos Transversais , Pró-Proteína Convertase 9 , LDL-Colesterol , Objetivos , Estudos Retrospectivos , Ezetimiba , Síndrome
3.
Int J Colorectal Dis ; 39(1): 33, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38436757

RESUMO

OBJECTIVE: The use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy. METHODS: Elderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy. RESULTS: The incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group. CONCLUSION: Utilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer. REGISTRATION NUMBER: ChiCTR2300067361; date of registration: January 5, 2023.


Assuntos
Neoplasias Colorretais , Laparoscopia , Idoso , Humanos , Pressão Sanguínea , Objetivos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Laparoscopia/efeitos adversos , Hidratação , Neoplasias Colorretais/cirurgia
5.
BMC Health Serv Res ; 24(1): 318, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38459550

RESUMO

BACKGROUND: The Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO. METHODOLOGY: Analytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05). RESULTS: A third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160-3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002-1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103-1.201; p < 0,001). CONCLUSION: Although most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment.


Assuntos
Objetivos , Periodontia , Humanos , Brasil/epidemiologia , Estudos Transversais , Assistência Odontológica
6.
J Robot Surg ; 18(1): 127, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38492125

RESUMO

Carotid corrected flow time (FTc) and tidal volume challenge pulse pressure variation (VtPPV) are useful clinical parameters for assessing volume status and fluid responsiveness in robot-assisted surgery, but their usefulness as goal-directed fluid therapy (GDFT) targets is unclear. We investigated whether FTc or VtPPV as targets are inferior to PPV in GDFT. This single-center, prospective, randomized, non-inferiority study included 133 women undergoing robot-assisted laparoscopic gynecological surgery in the modified head-down lithotomy position. Patients were equally divided into three groups, and the GDFT protocol was guided by FTc, VtPPV, or PPV during surgery. Primary outcomes were non-inferiority of the time-weighted average of hypotension, intraoperative fluid volume, and urine output. Secondary outcomes were optic nerve sheath diameter (ONSD) pre- and post-operatively and creatinine and blood urea nitrogen preoperatively and on day 1 post-operatively. No significant differences were observed in intraoperative hypotension index, infusion and urine volumes, and ONSD post-operatively between the FTc and VtPPV groups and the PPV group. No differences in serum creatinine and urea nitrogen levels were identified between the FTc and VtPPV groups preoperatively, but on day 1 post-operatively, the urea nitrogen level in the FTc group was higher than that in the PPV group (4.09 ± 1.28 vs. 3.0 ± 1.1 mmol/L, 1.08 [0.59, 1.58], p < 0.0001), and the difference from the preoperative value was smaller than that in the PPV group (- 2 [- 2.97, 1.43] vs. - 1.34 [- 1.9, - 0.67], p = 0.004). FTc- or VtPPV-guided protocols are not inferior to that of PPV in GDFT during robot-assisted laparoscopic surgery in the modified head-down lithotomy position.Trial registration: Chinese Clinical Trial Registry (ChiCTR2200064419).


Assuntos
Hipotensão , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Feminino , Procedimentos Cirúrgicos Robóticos/métodos , Hidratação/métodos , Estudos Prospectivos , Objetivos , Hipotensão/etiologia , Hipotensão/prevenção & controle , Nitrogênio , Procedimentos Cirúrgicos em Ginecologia , Ureia
7.
J Am Heart Assoc ; 13(6): e032918, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38456410

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in American Indian people. In 2022, the American Heart Association developed the Life's Essential 8 goals to promote cardiovascular health (CVH) for Americans, composed of diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood pressure, and blood glucose. We examined whether achievement of Life's Essential 8 goals was associated with incident CVD among SHFS (Strong Heart Family Study) participants. METHODS AND RESULTS: A total of 2139 SHFS participants without CVD at baseline were included in analyses. We created a composite CVH score based on achievement of Life's Essential 8 goals, excluding sleep. Scores of 0 to 49 represented low CVH, 50 to 69 represented moderate CVH, and 70 to 100 represented high CVH. Incident CVD was defined as incident myocardial infarction, coronary heart disease, congestive heart failure, or stroke. Cox proportional hazard models were used to examine the relationship of CVH and incident CVD. The incidence rate of CVD at the 20-year follow-up was 7.43 per 1000 person-years. Compared with participants with low CVH, participants with moderate and high CVH had a lower risk of incident CVD; the hazard ratios and 95% CIs for incident CVD for moderate and high CVH were 0.52 (95% CI, 0.40-0.68) and 0.25 (95% CI, 0.14-0.44), respectively, after adjustment for age, sex, education, and study site. CONCLUSIONS: Better CVH was associated with lower CVD risk which highlights the need for comprehensive public health interventions targeting CVH promotion to reduce CVD risk in American Indian communities.


Assuntos
Doenças Cardiovasculares , População do Sul da Ásia , Humanos , Estados Unidos/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , American Heart Association , Objetivos , Pressão Sanguínea
8.
PLoS One ; 19(3): e0299854, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38484021

RESUMO

OBJECTIVES: While state-based models of health-related quality of life (HRQL) are well-established in providing clinically relevant descriptions of HRQL status, they do not provide information on how to maintain or improve HRQL. The EvalUation of goal-diRected activities to prOmote well-beIng and heAlth (EUROIA), rooted in a novel process-based model of HRQL, measures goal-directed activities that are self-reported to promote HRQL as part of an individual's process of adapting to dynamic changes in health status. Our objectives were to condense and summarize the psychometric properties of the EUROIA by (i) defining and confirming its factor structure, (ii) evaluating its construct validity, and (iii) examining its internal consistency. METHODS: Principal component analysis was performed on the 18-item EUROIA to explore the underlying factor structure and condense the scale. Confirmatory factor analysis was conducted on the revised 14-item, 4-factor structure EUROIA instrument to evaluate the model fit. Data was obtained from adult participants with a diagnosis of chronic heart failure or advanced chronic kidney disease from 3 hospitals in Toronto, Canada. RESULTS: The revised 14-item EUROIA demonstrated 4 dimensions-Social Affiliation, fulfillment of Social Roles and Responsibilities, Self-Affirmation, and Eudaimonic Well-being-with a Cronbach's alpha of 0.83, representing good internal consistency. Our confirmatory factor analysis final model achieved good overall model fit: (χ2 / df = 1.80; Tucker-Lewis index = 0.90; comparative fit index = 0.93; standardized root-mean-square residual = 0.06; root-mean-square error of approximation = 0.06). All items exhibited a factor loading greater than λ > 0.4 and p < 0.001. CONCLUSION: The EUROIA holds clinical potential in its ability to provide informed feedback to patients on how they might maintain or modify their use of goal-directed activities to maintain and optimize perceived well-being.


Assuntos
Objetivos , Qualidade de Vida , Adulto , Humanos , Psicometria , Inquéritos e Questionários , Reprodutibilidade dos Testes , Análise Fatorial
9.
Perception ; 53(4): 263-275, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38517398

RESUMO

Previous research has shown that state anxiety facilitates stimulus-driven attentional capture and impairs goal-directed attentional control by increasing sensitivity to salient distractors or threat cues or narrowing spatial attention. However, recent findings in this area have been mixed, and less is known about how state-dependent anxiety may affect attentional performance. Here, we employed a novel dual-target search paradigm to investigate this relationship. This paradigm allowed us to investigate attentional control and how focus narrows under different anxiety states. Participants watched a short movie-either anxiety-inducing or neutral-before engaging in the dual-target visual search task. We found that they performed faster and more accurately in trials without the salient distractor compared to those with distractors, and they performed better in tasks presented on the center than the periphery. However, despite a significant increase in self-reported anxiety in the anxiety-inducing session, participants' performance in terms of speed and accuracy remain comparable across both anxious and neutral sessions. This resilience is likely due to compensatory mechanisms that offset anxiety, a result of the high demands and working memory load inherent in the dual-target task.


Assuntos
Atenção , Objetivos , Humanos , Tempo de Reação , Ansiedade , Motivação
10.
PLoS One ; 19(3): e0288859, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38512859

RESUMO

The main objective of this study was to determine whether hope for success mediates the relationship between personality and goal orientation in high performance and recreational athletes. The cross-sectional study included 289 high performance and recreational athletes of various sports (age: M = 20.34, SD = 1.86). To examine personality, we used the Big Five IPIP-BFM-20 questionnaire. To assess hope for success, we used the Hope for Success Questionnaire. The Task and Ego Orientation in Sport Questionnaire (TEOSQ) was employed to examine goal orientation. Hope for success significantly mediates the relationships between conscientiousness, extraversion, emotional stability, intellect, and task goal orientation in sport. Higher levels of these personality traits are related to athletes' higher hope for success, which, in turn, is positively related to their task orientation. Personality traits may underpin the hope for success that develops from childhood. This, in turn, appears to be an important component on which, combined with the positive interaction and support from coaches, a task goal orientation beneficial to sport can be shaped in athletes.


Assuntos
Objetivos , Motivação , Humanos , Criança , Estudos Transversais , Logro , Atletas/psicologia
11.
PLoS One ; 19(3): e0298855, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38507393

RESUMO

Six years remain to achieve the Sustainable Development Goals (SDGs). Despite some progress, institutional effectiveness for SDG achievement has not been delivered at a national level. Identification and establishment of an institutional framework to operationalise the 2030 Agenda within national plans, giving science-based coordination of SDG implementation a central role, is urgently required to accelerate progress. This paper tackles this challenge. Drawing on literature analysis, it asks: 1) What are the deficiencies in institutional national arrangements that hinder SDG implementation? 2) How can existing institutional deficiencies in SDG implementation be addressed? and 3) How can institutional changes support fast-tracking of SDG implementation processes at national level? Findings show that country-specific horizontal institutional arrangements are usually advanced. However, national visions to improve mainstreaming across decision-making at different levels to enable whole-of-government and whole-of-society approaches to SDG implementation are commonly under-developed. Deficiencies are due to poor systematic engagement of scientific and technical expertise in operational day-to-day communication, as well as in the design, validation, implementation, monitoring and reporting of domestic SDG-related multi-stakeholder actions. Vertical institutional arrangements are complex, and risk resource-consuming, uncoordinated implementation. Our analyses suggest countries may benefit from establishing a national, centralised independent scientific and technical coordinating body for SDG implementation at national level, within existing science-based institutional arrangements. Such a body would not be led by governmental processes but would provide technical support to government agencies. We argue that scientific and technical skills in data and information management and quality control are central to coordinated and evidence-informed support, and could help to accelerate national SDG implementation. Such a supporting body would also enable a more joined-up approach between stakeholders working in the areas of science and technology, government and practice, improving orchestrated science-based actions and their auditing across sectors and stakeholder communities at national and sub-national levels. It would further guide actions to reduce trade-offs within national sustainable development aspirations, and would facilitate consideration of diverse values in advancing towards a durable and just transformative future. Such efforts are vital given the rapidly closing window of time for SDG achievement.


Assuntos
Governo , Desenvolvimento Sustentável , Humanos , Órgãos Governamentais , Ataxia , Comunicação , Objetivos
12.
BMC Endocr Disord ; 24(1): 29, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38443972

RESUMO

As the population ages, the global burden of cardiometabolic disorders will increase. This study aimed to investigate the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) in elderly and to evaluate the effects of various variables including age, sex, education, marital status, smoking, income, physical activity, dementia and depressed mood on untreated cardiometabolic disorders. This was a cross sectional study conducted in Bushehr Elderly Health Program. A total 2381 participants were included. Medical data were collected by trained interviewers. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20-2.15), older adults (OR = 1.02, 95%CI = 1.00-1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52-0.92). Males (OR = 2.16, 95%CI = 1.64-2.84) and current smokers (OR = 1.42, 95%CI = 1.05-1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08-0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29-0.89) and dementia (OR = 0.78, 95%CI = 0.61-1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19-2.66) and males (OR = 1.66, 95%CI = 1.21-2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53-6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28-1.01).


Assuntos
Demência , Diabetes Mellitus , Hiperlipidemias , Hipertensão , Idoso , Masculino , Humanos , Estudos Transversais , Objetivos , Prevalência , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Demência/diagnóstico , Demência/epidemiologia
13.
AMA J Ethics ; 26(3): E199-204, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38446723

RESUMO

Inpatient psychiatric units' policies and restrictions for suicide prevention can exacerbate harm rather than promote wellness. This commentary on a case examines ethics concerns about prevention policies that overly rely on liberty restriction, as expressed in the design of inpatient psychiatric unit structures and spaces. Person-centered approaches to design are key to promoting healing and preserving dignity.


Assuntos
Objetivos , Prevenção ao Suicídio , Humanos , Pacientes Internados , Políticas
14.
Lipids Health Dis ; 23(1): 62, 2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38419043

RESUMO

OBJECTIVE: To investigate the baseline and six-month follow-up data of the main lipid indices as well as low-density lipoprotein cholesterol (LDL-C) target goal attainment in accordance with the current guidelines among patients with acute cerebral infarction (ACI). METHODS: One thousand ninety-nine patients were consecutively enrolled from January 2021 to December 2022 and divided into ACI, old cerebral infarction (OCI), and control groups. General data [sex, age, body mass index (BMI), medications, smoking status, disease history, etc.], baseline data, and six-month follow-up main laboratory data were collected and analyzed. ACI patients were grouped into dyslipidemia and normal groups according to the lipid management guidelines of the European, American, and Chinese populations. Statistical methods were used to screen for possible predictors of dyslipidemia. RESULTS: Patients with ACI or OCI had higher total cholesterol (TC) and LDL-C levels than did the control group (all P < 0.05). According to European (94.7%, 89.0% and 13.4%, P < 0.01), American (94.7% vs. 67.7% vs. 45.9%, P < 0.001) and Chinese (85.1% vs. 59.1% vs. 18.6%, P < 0.001) standards, the proportion of dyslipidemia in the ACI group was greater than that in the OCI and control groups. According to European and American standards, increases in BMI and the estimated glomerular filtration rate (eGFR) are predictors of dyslipidemia in ACI patients. According to Chinese standards, increases in BMI, glycated hemoglobin (HbA1c) levels, and eGFRs are independent predictors of dyslipidemia in ACI patients. The 6-month follow-up of the main lipid levels revealed that among the ACI group, TC, LDL-C and triglyceride(TG) levels (4.86 vs. 3.79, P < 0.001; 2.98 vs. 2.01, P < 0.001; 1.46 vs. 1.20, P < 0.001) and the proportion of dyslipidemia decreased significantly in accordance with European/American and Chinese standards (86.8% vs. 64.6%, P = 0.015; 97.2% vs. 84.7%, P = 0.012). CONCLUSION: These results revealed that lipid management is still not optimal for patients with ACI. More attention should be given to ACI patients with elevated BMI, eGFR, and HbA1c values, which could lead to more individualized lipid management. Although the main lipid levels decreased significantly 6 months after discharge with lipid-lowering therapy, there is still a long way to go to enable more ACI patients to meet the guideline-recommended LDL-C target goal.


Assuntos
Isquemia Encefálica , Dislipidemias , Humanos , LDL-Colesterol , Estudos Retrospectivos , Objetivos , Seguimentos , Hemoglobinas Glicadas , Dislipidemias/tratamento farmacológico , Infarto Cerebral , Hospitais
15.
PLoS Biol ; 22(2): e3002500, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38363801

RESUMO

The frontopolar cortex (FPC) is, to date, one of the least understood regions of the prefrontal cortex. The current understanding of its function suggests that it plays a role in the control of exploratory behaviors by coordinating the activities of other prefrontal cortex areas involved in decision-making and exploiting actions based on their outcomes. Based on this hypothesis, FPC would drive fast-learning processes through a valuation of the different alternatives. In our study, we used a modified version of a well-known paradigm, the object-in-place (OIP) task, to test this hypothesis in electrophysiology. This paradigm is designed to maximize learning, enabling monkeys to learn in one trial, which is an ability specifically impaired after a lesion of the FPC. We showed that FPC neurons presented an extremely specific pattern of activity by representing the learning stage, exploration versus exploitation, and the goal of the action. However, our results do not support the hypothesis that neurons in the frontal pole compute an evaluation of different alternatives. Indeed, the position of the chosen target was strongly encoded at its acquisition, but the position of the unchosen target was not. Once learned, this representation was also found at the problem presentation, suggesting a monitoring activity of the synthetic goal preceding its acquisition. Our results highlight important features of FPC neurons in fast-learning processes without confirming their role in the disengagement of cognitive control from the current goals.


Assuntos
Objetivos , Aprendizagem , Córtex Cerebral , Comportamento Exploratório , Neurônios
16.
PLoS Comput Biol ; 20(2): e1011312, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38377074

RESUMO

Humans have the ability to craft abstract, temporally extended and hierarchically organized plans. For instance, when considering how to make spaghetti for dinner, we typically concern ourselves with useful "subgoals" in the task, such as cutting onions, boiling pasta, and cooking a sauce, rather than particulars such as how many cuts to make to the onion, or exactly which muscles to contract. A core question is how such decomposition of a more abstract task into logical subtasks happens in the first place. Previous research has shown that humans are sensitive to a form of higher-order statistical learning named "community structure". Community structure is a common feature of abstract tasks characterized by a logical ordering of subtasks. This structure can be captured by a model where humans learn predictions of upcoming events multiple steps into the future, discounting predictions of events further away in time. One such model is the "successor representation", which has been argued to be useful for hierarchical abstraction. As of yet, no study has convincingly shown that this hierarchical abstraction can be put to use for goal-directed behavior. Here, we investigate whether participants utilize learned community structure to craft hierarchically informed action plans for goal-directed behavior. Participants were asked to search for paintings in a virtual museum, where the paintings were grouped together in "wings" representing community structure in the museum. We find that participants' choices accord with the hierarchical structure of the museum and that their response times are best predicted by a successor representation. The degree to which the response times reflect the community structure of the museum correlates with several measures of performance, including the ability to craft temporally abstract action plans. These results suggest that successor representation learning subserves hierarchical abstractions relevant for goal-directed behavior.


Assuntos
Formação de Conceito , Objetivos , Animais , Humanos , Aprendizagem , Alimentos , Músculos
17.
Int J Behav Nutr Phys Act ; 21(1): 24, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38408993

RESUMO

BACKGROUND: Maintaining a healthy body weight and reaching long-term dietary goals requires ongoing self-monitoring and behavioral adjustments. How individuals respond to successes and failures is described in models of self-regulation: while cybernetic models propose that failures lead to increased self-regulatory efforts and successes permit a reduction of such efforts, motivational models (e.g., social-cognitive theory) make opposite predictions. Here, we tested these conflicting models in an ecological momentary assessment (EMA) context and explored whether effort adjustments are related to inter-individual differences in perceived self-regulatory success in dieting (i.e., weight management). METHODS: Using linear mixed effects models, we tested in 174 diet-interested individuals whether current day dietary success or failure (e.g., on Monday) was followed by self-regulatory effort adjustment for the next day (e.g., on Tuesday) across 14 days. Success vs. failure was operationalized with two EMA items: first, whether food intake was higher vs. lower than usual and second, whether food intake was perceived as more vs. less goal-congruent than usual. Trait-level perceived self-regulatory success in dieting was measured on a questionnaire. RESULTS: Intended self-regulatory effort increased more strongly after days with dietary success (i.e., eating less than usual / rating intake as goal-congruent) than after days with dietary failure (i.e., eating more than usual / rating intake as goal-incongruent), especially in those individuals with lower scores on perceived self-regulatory success in dieting. CONCLUSIONS: Findings support mechanisms proposed by social-cognitive theory, especially in unsuccessful dieters. Thus, future dietary interventions could focus on preventing the decrease in self-regulatory effort after instances of dietary failures and thereby mitigate the potential risk that a single dietary failure initiates a downward spiral into unhealthy eating.


Assuntos
Objetivos , Autocontrole , Humanos , Avaliação Momentânea Ecológica , Comportamento Alimentar/psicologia , Dieta
19.
PLoS One ; 19(2): e0294736, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38422054

RESUMO

Post-stratification is applied when the subpopulation membership is observed only for sampled values and the goal is to estimate stratum-specific parameters which leads the survey statisticians towards primary goals i.e., classification of non-sampled units into different strata and prediction of the values of the study variables. Regression models, on one side, optimize the prediction of the study variable's non-sampled values while the classification algorithms, on the other side, look for the classification of non-sampled cases into different strata. Hence, it is crucial to deal with these two goals simultaneously for the estimation of stratum-specific parameters. This study introduces the idea of a double-objective classification and regression trees (CARTs) approach for estimating stratum-specific parameters. Theoretical properties of the total estimator are derived. An application on the estimation of health outcomes in different domains is given to delineate the practical significance as well as the efficiency of the proposed CART-based method. The proposed estimator of population total performs better than the existing stratum-specific estimator in terms of relative efficiency for all choices of parameters. As an ensemble model, the random forest CART outperforms the other competing tree-based models and homogenous population model without using any auxiliary variable.


Assuntos
Algoritmos , Objetivos , Humanos , Paquistão , Pesquisadores , Avaliação de Resultados em Cuidados de Saúde
20.
J Cardiothorac Surg ; 19(1): 60, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38317166

RESUMO

BACKGROUND: Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. METHODS: Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. RESULTS: A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29-1.14). However, GDFT decreased the total intra-operative fluid input (MD, - 244.40 ml; 95% CI - 397.06 to - 91.74). There was no statistical difference in the duration of hospitalization (MD; - 1.31, 95% CI - 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29-1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27-1.40). CONCLUSIONS: The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.


Assuntos
Nefropatias , Cirurgia Torácica , Adulto , Humanos , Objetivos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Hidratação/métodos
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