RESUMEN
In this rapid communication, accelerated undergraduate medical education is examined using prior literature as well as experiences of those who have completed or are in the process of completing accelerated medical curricula. The Consortium of Accelerated Medical Pathway Programs (CAMPP) hosts an annual multi-institutional conference for all its members. During the meeting in July 2023, a virtual panel was convened from multiple constituent programs (N = 4) including medical students (N = 2), resident physicians (N = 4), and faculty (N = 2). Panel participants represented current learners or graduates from accelerated pathways of varying specialties (N = 5) to share firsthand experiences about acceleration to an audience representing over 25 medical schools. Five key themes were identified for accelerated students and trainees: Reduced debt as motivating factor to accelerate, Feeling prepared for residency, Ideal accelerated students are driven, Ability to form early professional relationships, and Less time for additional clinical experiences. Discourse from the CAMPP panel can inform current and developing accelerated programs at institutions looking to create or improve accelerated learning.
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Curriculum , Educación de Pregrado en Medicina , Facultades de Medicina , Estudiantes de Medicina , Humanos , Educación de Pregrado en Medicina/organización & administración , Facultades de Medicina/organización & administración , Estudiantes de Medicina/psicología , Motivación , Internado y Residencia/organización & administración , Apoyo a la Formación Profesional , Docentes Médicos/psicología , Factores de TiempoRESUMEN
PURPOSE: Esaxerenone, a mineralocorticoid receptor blocker, attenuates global ischemia-induced myocardial damage and coronary endothelial dysfunction. This study aimed to determine whether esaxerenone exerted cardioprotective effects against cardioplegic arrest in Wistar rat hearts. METHODS: Isolated male Wistar rat hearts aerobically perfused via the Langendorff method for 20 min were randomly allocated to the Control (n = 6; perfused for an additional 10 min and subjected to no treatment) or Esax (n = 6; perfused with 0.1 µmol/L esaxerenone in perfusate for 10 min before ischemia) groups. Hearts in both groups were perfused with St. Thomas' Hospital No. 2 solution (STH2) for 2 min and subjected to 28 min of global ischemia. The recovery of left ventricular developed pressure (LVDP) and total troponin T leakage were measured after reperfusion. RESULTS: The final recovery of LVDP (expressed as a percentage of pre-ischemic value) in the Control and Esax groups was 50.8 ± 3.5% and 62.1 ± 5.6%, respectively (p <0.05, Esax vs. Control). The total troponin T leakage in the Control and Esax groups was 138.8 ± 18.5 ng/g heart wt and 74.3 ± 18.6 ng/g heart wt, respectively (p <0.05, Esax vs. Control). CONCLUSION: The administration of esaxerenone before cardioplegic arrest enhanced the cardioprotective effect exerted by STH2.
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Modelos Animales de Enfermedad , Paro Cardíaco Inducido , Preparación de Corazón Aislado , Antagonistas de Receptores de Mineralocorticoides , Daño por Reperfusión Miocárdica , Ratas Wistar , Sulfonas , Troponina T , Función Ventricular Izquierda , Presión Ventricular , Animales , Masculino , Función Ventricular Izquierda/efectos de los fármacos , Antagonistas de Receptores de Mineralocorticoides/farmacología , Daño por Reperfusión Miocárdica/prevención & control , Daño por Reperfusión Miocárdica/fisiopatología , Troponina T/sangre , Factores de Tiempo , Sulfonas/farmacología , Presión Ventricular/efectos de los fármacos , Recuperación de la Función , Miocardio/metabolismo , Miocardio/patología , Soluciones Cardiopléjicas/farmacología , PirrolesRESUMEN
BACKGROUND: Despite impressive improvements in the safety profile of Transcatheter aortic valve replacement (TAVR), the risk for peri-procedural stroke after TAVR has not declined substantially. In an effort to reduce periprocedural stroke, cerebral embolic protection (CEP) devices have been utilized but have yet to demonstrate benefit in all-comers. There is a paucity of data supporting the utilization of CEP in TAVR patients with an anticipated high risk for peri-procedural stroke. METHODS: The Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) score is a clinical risk tool for predicting the in-hospital stroke risk of patients undergoing transfemoral TAVR. This score was used to identify high-risk patients and calculate the expected in-hospital stroke risk. This was a single-centre cohort study in all consecutive TAVR patients who had placement of CEP. The observed versus expected ratio for peri-procedural stroke was calculated. To obtain 95% credible intervals, we used 1000 bootstrapped samples of the original cohort sample size without replacement and recalculated the TASK predicted scores. RESULTS: The study included 103 patients. The median age was 83 (IQR 78,89). 63 were male (61.1%) and 45 (43.69%) had a history of previous Stroke or TIA. Two patients had an in-hospital stroke after TAVR (1.94%). The expected risk of in-hospital stroke based on the TASK score was 3.39% (95% CI 3.07-3.73). The observed versus expected ratio was 0.57 (95% CI 0.52-0.64). CONCLUSION: In this single-center study, we found that in patients undergoing TAVR with high stroke risk, CEP reduced the in-hospital stroke risk by 43% when compared with the risk-score predicted rate. CLINICAL TRIAL NUMBER: N/A.
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Dispositivos de Protección Embólica , Accidente Cerebrovascular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Masculino , Femenino , Anciano , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Factores de Riesgo , Medición de Riesgo , Anciano de 80 o más Años , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Resultado del Tratamiento , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Factores de Tiempo , Embolia Intracraneal/prevención & control , Embolia Intracraneal/etiología , Embolia Intracraneal/epidemiología , Embolia Intracraneal/diagnóstico , Estudios Retrospectivos , Técnicas de Apoyo para la Decisión , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: As low probability events, United States producers, value chain actors, and veterinary services (VS) have limited experience with identifying foreign animal disease (FAD), which can allow FADs to spread undetected. Point-of-care (POC) diagnostic testing may help reduce the time from detecting an initial suspect case to implementing actionable interventions compared to the current approach of only using laboratory diagnostic testing for disease diagnosis and confirmation. To evaluate the value of the reduced response time, we compare the associated costs between the two diagnostic approaches while accounting for the uncertainty surrounding the size of a FAD event. METHODS: We apply a state-contingent approach (SCA) to model the uncertainty surrounding a FAD through alternative events, where the event defines the scale of outbreak size and its duration. We apply this approach within a cost-benefit framework (CBA) to determine the economic value from the two testing investment strategies to help explain the policymaker's response (and costs) to alternative FAD events while also considering the cost impacts on the producers from each event. RESULTS: Compared to the current laboratory strategy, a POC strategy that reduces response time by 0.5-days (swine, cattle scenarios) and 1.5-days (poultry scenario) may provide cost-saving to both producers and public response efforts. The benefit-cost analysis further suggests that despite the higher fixed costs to adopt the POC strategy, the swine and cattle sectors may benefit while the benefits may not be as pronounced in the poultry sector. DISCUSSION: POC testing that can reduce the time between detection and response during a FAD event may be a sound strategy for public expenditure and provide cost-savings for producers, especially when minimal fixed costs are incurred. However, to fully determine the value of POC testing, the consequences (costs) associated with potential actions if something goes wrong, (e.g. false positive results), should be considered in future studies.
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Análisis Costo-Beneficio , Pruebas en el Punto de Atención , Animales , Estados Unidos , Bovinos , Pruebas en el Punto de Atención/economía , Porcinos , Enfermedades de los Porcinos/diagnóstico , Enfermedades de los Porcinos/economía , Enfermedades Transmisibles Importadas/veterinaria , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/prevención & control , Enfermedades Transmisibles Importadas/economía , Enfermedades de los Bovinos/diagnóstico , Enfermedades de los Bovinos/economía , Enfermedades de las Aves de Corral/diagnóstico , Enfermedades de las Aves de Corral/economía , Sistemas de Atención de Punto/economía , Aves de Corral , Brotes de Enfermedades/veterinaria , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/economía , Factores de TiempoRESUMEN
BACKGROUND: Septic shock is associated with increases in end-diastolic volume (EDV) and decreases in ejection fraction that reverse within 10 days. Nonsurvivors do not develop EDV increases. The mechanism is unknown. METHODS AND RESULTS: Purpose-bred beagles (n=33) were randomized to receive intrabronchial Staphylococcus aureus or saline. Over 96 hours, cardiac magnetic resonance imaging and echocardiograms were performed. Tissue was obtained at 66 hours. From 0 to 96 hours after bacterial challenge, septic animals versus controls had significantly increased left ventricular wall edema (6%) and wall thinning with loss of mass (15%). On histology, the major finding was nonocclusive microvascular injury with edema in myocytes, the interstitium, and endothelial cells. Edema was associated with significant worsening of biventricular ejection fractions, ventricular-arterial coupling, and circumferential strain. Early during sepsis, (0-24 hours), the EDV decreased; significantly more in nonsurvivors (ie, greater diastolic dysfunction). From 24 to 48 hours, septic animals' biventricular chamber sizes increased; in survivors significantly greater than baseline and nonsurvivors, whose EDVs were not different from baseline. Preload, afterload, or heart rate differences did not explain these differential changes. CONCLUSIONS: The cardiac dysfunction of sepsis is associated with wall edema. In nonsurvivors, at 0 to 24 hours, sepsis induces a more severe diastolic dysfunction, further decreasing chamber size. The loss of left ventricular mass with wall thinning in septic survivors may, in part, explain the EDV increases from 24 to 48 hours because of a potentially reparative process removing damaged wall tissue. Septic cardiomyopathy is most consistent with a nonocclusive microvascular injury resulting in edema causing reversible systolic and diastolic dysfunction with more severe diastolic dysfunction being associated with a decreased EDV and death.
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Modelos Animales de Enfermedad , Choque Séptico , Volumen Sistólico , Animales , Perros , Choque Séptico/fisiopatología , Choque Séptico/complicaciones , Imagen por Resonancia Magnética , Edema Cardíaco/fisiopatología , Edema Cardíaco/patología , Edema Cardíaco/diagnóstico por imagen , Función Ventricular Izquierda , Factores de Tiempo , Humanos , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/fisiopatología , Ecocardiografía , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , MasculinoRESUMEN
BACKGROUND: Chronological age (CA) is an imperfect proxy for the true biological aging state of the body. As novel measures of biological aging, Phenotypic age (PhenoAge) and Phenotypic age acceleration (PhenoAgeAccel), have been shown to identify morbidity and mortality risks in the general population. HYPOTHESIS: PhenoAge and PhenoAgeAccel might be associated with mortality in heart failure (HF) patients. METHODS: This cohort study extracted adult data from the National Health and Nutrition Examination Survey (NHANES) databases. Weighted univariable and multivariable Cox models were performed to analyze the effect of PhenoAge and PhenoAgeAccel on all-cause mortality in HF patients, and hazard ratio (HR) with 95% confidence intervals (CI) was calculated. RESULTS: In total, 845 HF patients were identified, with 626 all-cause mortality patients. The findings suggested that (1) each 1- and 10-year increase in PhenoAge were associated with a 3% (HR = 1.03, 95% CI: 1.03-1.04) and 41% (HR = 1.41, 95% CI: 1.29-1.54) increased risk of all-cause mortality, respectively; (2) when the PhenoAgeAccel < 0 as reference, the ≥ 0 group was associated with higher risk of all-cause mortality (HR = 1.91, 95% CI = 1.49-2.45). Subgroup analyses showed that (1) older PhenoAge was associated with an increased risk of all-cause mortality in all subgroups; (2) when the PhenoAgeAccel < 0 as a reference, PhenoAgeAccel ≥ 0 was associated with a higher risk of all-cause mortality in all subgroups. CONCLUSION: Older PhenoAge was associated with an increased risk of all-cause mortality in HF patients. PhenoAge and PhenoAgeAccel can be used as convenient tools to facilitate the identification of at-risk individuals with HF and the evaluation of intervention efficacy.
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Causas de Muerte , Insuficiencia Cardíaca , Encuestas Nutricionales , Fenotipo , Humanos , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Medición de Riesgo/métodos , Factores de Riesgo , Causas de Muerte/tendencias , Factores de Edad , Estados Unidos/epidemiología , Envejecimiento , Pronóstico , Factores de Tiempo , Modelos de Riesgos Proporcionales , Tasa de Supervivencia/tendencias , Adulto , Anciano de 80 o más AñosRESUMEN
ABSTRACT: Cardiogenic shock (CS) is a life-threatening condition. The aim of this study is to evaluate the clinical characteristics, management, and complication rate of patients with CS admitted to a high-volume hospital in Italy. We retrospectively reviewed the clinical, echocardiographic, and laboratory data, therapeutic management, and outcomes of patients with CS admitted to the Policlinico Gemelli (Rome) between January 1, 2020, and January 1, 2023. We included 96 patients [median age 71 years, interquartile range 60-79; 65 (68%) males], of whom 49 patients (51%) presented CS secondary to acute myocardial infarction and 60 (63%) with a de novo presentation of CS. Dobutamine was the most frequently used inotrope and noradrenaline the most frequently used vasopressor (adopted in 56% and 82% of cases, respectively). Forty-five (47%) patients died during the hospitalization. Nonsurvivors were older and had a higher inflammatory burden at admission, elevated lactate levels, a greater increase in lactate levels, higher left ventricular filling pressures, and worse right ventricular function. C-reactive protein levels [odds ratio (OR) 1.03, 95% confidence interval (CI) (1.00-1.04), P = 0.027], lactate levels at admission (OR 3.49, 95% CI, 1.59-7.63, P = 0.02), and increase in lactate levels (OR 2.8, 95% CI, 1.37-5.75, P = 0.005) were independent predictors of in-hospital all-cause death. Our data contribute to the assessment of the regional variations in the management and outcomes of patients with CS. We observed a high mortality and complication rate. Lactate acidosis and C-reactive protein measured at admission may help in identifying patients at higher risk of adverse in-hospital outcomes.
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Mortalidad Hospitalaria , Hospitales de Alto Volumen , Choque Cardiogénico , Humanos , Choque Cardiogénico/mortalidad , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/terapia , Choque Cardiogénico/fisiopatología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Italia/epidemiología , Resultado del Tratamiento , Factores de Riesgo , Unidades de Cuidados Coronarios , Factores de Tiempo , Biomarcadores/sangre , Medición de Riesgo , Cardiotónicos/uso terapéuticoRESUMEN
Fluctuations in the financial market are influenced by various driving forces and numerous factors. Traditional financial research aims to identify the factors influencing stock prices, and existing works construct a common neural network learning framework that learns temporal dependency using a fixed time window of historical information, such as RNN and LSTM models. However, these models only consider the short-term and point-to-point relationships within stock series. The financial market is a complex and dynamic system with many unobservable temporal patterns. Therefore, we propose an adaptive period-aggregation model called the Latent Period-Aggregated Stock Transformer (LPAST). The model integrates a variational autoencoder (VAE) with a period-to-period attention mechanism for multistep prediction in the financial time series. Additionally, we introduce a self-correlation learning method and routing mechanism to handle complex multi-period aggregations and information distribution. Main contributions include proposing a novel period-aggregation representation scheme, introducing a new attention mechanism, and validating the model's superiority in long-horizon prediction tasks. The LPAST model demonstrates its potential and effectiveness in financial market prediction, highlighting its relevance in financial research and predictive analytics.
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Modelos Económicos , Redes Neurales de la Computación , Estaciones del Año , Humanos , Inversiones en Salud/economía , Administración Financiera , Algoritmos , Factores de TiempoRESUMEN
The Mediterranean diet, featuring sourdough bread, shows promise in managing metabolic syndrome. This study explored the effects of two sourdough breads, with differing fermentation times but similar nutritional profiles, on inflammation, satiety, and gut microbiota composition in adults with metabolic syndrome. In a double-blind clinical trial, participants were randomized to consume either Elias Boulanger® long-fermentation (48 h) sourdough bread (EBLong) or Elias Boulanger® short-fermentation (2 h) sourdough bread (EBShort) over a two-month period. We assessed clinical parameters, inflammatory biomarkers, satiety-related hormones, and the richness and abundance of gut microbiota at baseline and follow-up. The participants included 31 individuals (mean age, 67, 51.6% female). EBShort was associated with reduced levels of soluble intercellular adhesion molecule (sICAM), and all participants, regardless of the intervention, exhibited a decrease in sICAM and diastolic pressure from baseline (p < 0.017). At follow-up, plasminogen activator inhibitor-1 (PAI-1) levels were lower in EBShort (-744 pg/mL; 95%CI: -282 to -1210 pg/mL) compared to EBLong. No differences in microbiota richness or abundance were observed. EBShort bread was effective in reducing some inflammation markers. The consumption of sourdough bread may offer potential benefits in reducing inflammation markers in individuals with metabolic syndrome; however, longer fermentation times did not show additional benefits.
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Pan , Dieta Mediterránea , Fermentación , Microbioma Gastrointestinal , Síndrome Metabólico , Humanos , Síndrome Metabólico/dietoterapia , Síndrome Metabólico/microbiología , Síndrome Metabólico/terapia , Femenino , Masculino , Método Doble Ciego , Persona de Mediana Edad , Anciano , Biomarcadores/sangre , Inhibidor 1 de Activador Plasminogénico/sangre , Factores de Tiempo , Molécula 1 de Adhesión Intercelular/sangre , InflamaciónRESUMEN
PURPOSE: This meta-analysis aimed to compare the prognosis of lung transplantation recipients based on donor age. METHODS: A detailed search was performed in PubMed, Embase, Web of Science, and the Cochrane Library for cohort studies on lung transplantation. The prognosis of lung transplant recipients was investigated based on the donor age, with the primary outcomes being 1-year overall survival (OS), 3-year OS, 5-year OS, and 5-year chronic lung allograft dysfunction (CLAD)-free survival. RESULTS: This meta-analysis included 10 cohort studies. Among the short-term outcomes, the older donor group demonstrated no significant difference from the young donor group in primary graft dysfunction within 72 hours, use of extracorporeal membrane oxygenation, length of ventilator use, and intensive care unit hours. However, a longer hospital stay was associated with the older donor group. In terms of long-term outcomes, no difference was found between the two groups in 1-year OS, 3-year OS, and 5-year OS. Notably, patients with older donors exhibited a superior 5-year CLAD-free survival. CONCLUSIONS: The results of this meta-analysis indicate that older donors are not inferior to younger donors in terms of long-term and short-term recipient outcomes. Lung transplantation using older donors is a potential therapeutic option after rigorous evaluation.
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Trasplante de Pulmón , Donantes de Tejidos , Humanos , Trasplante de Pulmón/mortalidad , Trasplante de Pulmón/efectos adversos , Factores de Edad , Factores de Tiempo , Donantes de Tejidos/provisión & distribución , Factores de Riesgo , Persona de Mediana Edad , Adulto , Masculino , Femenino , Resultado del Tratamiento , Medición de Riesgo , Selección de Donante , Adulto Joven , Supervivencia de Injerto , Supervivencia sin Progresión , Disfunción Primaria del Injerto/mortalidad , Disfunción Primaria del Injerto/etiología , Disfunción Primaria del Injerto/diagnósticoRESUMEN
PURPOSE: Although minimally invasive colorectal surgery has been proven to have a shorter hospital stay and fewer short-term complications than open surgery, the advantages of laparoscopic surgery for colorectal cancer patients undergoing hemodialysis have not been validated. This study compared the outcomes of open and laparoscopic approaches in these patients. MATERIALS AND METHODS: Between January 2007 and December 2020, we retrospectively analyzed the clinical data of 78 hemodialysis patients who underwent curative-intent, elective colorectal surgery. Patients were divided into two groups according to the surgical method: open and laparoscopic. RESULTS: Postoperative morbidity (p = 0.480) and mortality (p = 0.598) rates and length of hospital stay (28.8 vs. 27.5 days, p = 0.830) were similar between the groups. However, laparoscopic surgery patients had a shorter return to clear liquid, full liquid, or soft food time than open surgery patients (p < 0.001, p = 0.007, and p = 0.002, respectively). Disease-free survival and long-term cancer-specific survival rates were also similar between the two groups (p = 0.353 and p = 0.201, respectively). Multivariate analysis revealed that intraoperative blood transfusion was a risk factor for severe complications and mortality (OR 6.055; p = 0.046), and the odds ratio (OR) of laparoscopic surgery was not significantly greater than that of open surgery (OR = 0.537, p = 0.337). CONCLUSION: Although laparoscopic surgery did not result in hemodialysis patients having a shorter postoperative hospital stay, our results suggest that the laparoscopic approach is as safe as open surgery for hemodialysis patients and may be beneficial for shortening the return time to food intake.
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Neoplasias Colorrectales , Laparoscopía , Diálisis Renal , Humanos , Masculino , Laparoscopía/efectos adversos , Femenino , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Tiempo de Internación , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Factores de TiempoRESUMEN
This cross-sectional study assesses the associations between patient and clinical factors and variations in time emergency department physicians spend using electronic health record (EHR) systems.
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Benchmarking , Registros Electrónicos de Salud , Humanos , Registros Electrónicos de Salud/estadística & datos numéricos , Registros Electrónicos de Salud/normas , Benchmarking/métodos , Masculino , Femenino , Servicio de Urgencia en Hospital/estadística & datos numéricos , Persona de Mediana Edad , Adulto , Médicos/estadística & datos numéricos , Factores de Tiempo , Anciano , Medicina de Emergencia/normasRESUMEN
In the event of a large-scale incident involving radiological or nuclear exposures, there is a potential for large numbers of individuals to have received doses of radiation sufficient to cause adverse health effects. It is imperative to quickly identify these individuals in order to provide information to the medical community to assist in making decisions about their treatment. The cytokinesis-block micronucleus assay is a well-established method for performing biodosimetry. This assay has previously been adapted to imaging flow cytometry and has been validated as a high-throughput option for providing dose estimates in the range of 0-10â¯Gy. The goal of this study was to test the ability to further optimize the assay by reducing the time of culture to 48â¯h from 68â¯h as well as reducing the volume of blood required for the analysis to 200 µL from 2â¯mL. These modifications would provide efficiencies in time and ease of processing impacting the ability to manage large numbers of samples and provide dose estimates in a timely manner. Results demonstrated that either the blood volume or the culture time could be reduced while maintaining dose estimates with sufficient accuracy for triage analysis. Reducing both the blood volume and culture time, however, resulted in poor dose estimates. In conclusion, depending on the needs of the scenario, either culture time or the blood volume could be reduced to improve the efficiency of analysis for mass casualty scenarios.
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Citocinesis , Citometría de Flujo , Pruebas de Micronúcleos , Pruebas de Micronúcleos/métodos , Humanos , Citometría de Flujo/métodos , Factores de Tiempo , Volumen Sanguíneo , Relación Dosis-Respuesta en la Radiación , AnimalesRESUMEN
Roasting is necessary for bringing out the aroma and flavor of coffee beans, making coffee one of the most consumed beverages. However, this process also generates a series of toxic compounds, including acrylamide and furanic compounds (5-hydroxymethylfurfural, furan, 2-methylfuran, 3-methylfuran, 2,3-dimethylfuran, and 2,5-dimethylfuran). Furthermore, not much is known about the formation of these compounds in emerging coffee formulations containing alcohol and sugars. Therefore, this study investigated the effect of roasting time and degree on levels of acrylamide and furanic compounds in arabica coffee using fast and slow roasting methods. The fast and slow roasting methods took 5.62 min and 9.65 min, respectively, and reached a maximum of 210 °C to achieve a light roast. For the very dark roast, the coffee beans were roasted for 10.5 min and the maximum temperature reached 245 °C. Our findings showed that the levels of acrylamide (375 ± 2.52 µg kg-1) and 5-HMF (194 ± 11.7 mg kg-1) in the slow-roasted coffee were 35.0 % and 17.4 % lower than in fast-roasted coffee. Furthermore, light roast coffee had significantly lower concentrations of acrylamide and 5-HMF than very dark roast, with values of 93.7 ± 7.51 µg kg-1 and 21.3 ± 10.3 mg kg-1, respectively. However, the levels of furan and alkylfurans increased with increasing roasting time and degree. In this study, we also examined the concentrations of these pollutants in new coffee formulations consisting of alcohol-, sugar-, and honey-infused coffee beans. Formulations with honey and sugar resulted in higher concentrations of 5-HMF, but no clear trend was observed for acrylamide. On the other hand, formulations with honey had higher concentrations of furan and alkylfurans. These results indicate that optimizing roasting time and temperature might not achieve the simultaneous reduction of all the pollutants. Additionally, sugar- and honey-infused coffee beans are bound to have higher furanic compounds, posing a higher health risk.
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Acrilamida , Café , Furaldehído , Furanos , Calor , Acrilamida/análisis , Furanos/análisis , Café/química , Furaldehído/análisis , Furaldehído/análogos & derivados , Culinaria/métodos , Coffea/química , Semillas/química , Manipulación de Alimentos/métodos , Factores de Tiempo , Aditivos Alimentarios/análisisRESUMEN
Purpose: Triple therapy (long-acting muscarinic antagonist/long-acting ß2-agonist/inhaled corticosteroid) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence. This study assessed comparative adherence and persistence to single-inhaler triple therapy (SITT) versus MITT among patients with COPD in a real-world setting in Germany. Patients and Methods: This retrospective analysis using the WIG2 benchmark database identified patients with COPD newly initiating triple therapy with MITT or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or formoterol/beclomethasone/glycopyrronium bromide [FOR/BDP/GLY]) November 2017-June 2019. Eligible patients were ≥35 years with 1 year's continual insurance prior to triple therapy initiation and no previous record of triple therapy. Inverse probability of treatment weighting was used to balance baseline characteristics. Adherence was measured using proportion of days covered (PDC) at 6, 12, and 18 months post-treatment initiation; persistence (time until treatment discontinuation) was measured at 6, 12, and 18 months, with a gap of >30 days used to define non-persistence. Results: Of 5710 patients included in the analysis (mean age 66 years), 71.4% initiated MITT and 28.6% initiated SITT (FF/UMEC/VI: 41.4%; FOR/BDP/GLY: 58.6%). Mean PDC was higher among SITT versus MITT users at all time points; at each time point, mean PDC was highest among FF/UMEC/VI users. During the first 6 months following treatment initiation, higher adherence was exhibited by FF/UMEC/VI (29%) and FOR/BDP/GLY (19%) users versus MITT users. Over the entire observation period, FF/UMEC/VI users had the highest proportion of persistent patients; at 18 months, 16.5% of FF/UMEC/VI users were persistent versus 2.3% of MITT users. Conclusion: Patients initiating SITT in Germany had significantly higher adherence and persistence compared with patients initiating MITT over 6 to 18 months following treatment initiation. Among SITT, FF/UMEC/VI users had the highest proportion of adherence and persistence.
Asunto(s)
Agonistas de Receptores Adrenérgicos beta 2 , Broncodilatadores , Combinación de Medicamentos , Cumplimiento de la Medicación , Antagonistas Muscarínicos , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Masculino , Femenino , Alemania , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Administración por Inhalación , Antagonistas Muscarínicos/administración & dosificación , Broncodilatadores/administración & dosificación , Resultado del Tratamiento , Quinuclidinas/administración & dosificación , Factores de Tiempo , Bases de Datos Factuales , Clorobencenos/administración & dosificación , Clorobencenos/uso terapéutico , Reclamos Administrativos en el Cuidado de la Salud , Quimioterapia Combinada , Alcoholes Bencílicos/administración & dosificación , Alcoholes Bencílicos/uso terapéutico , Nebulizadores y Vaporizadores , Glicopirrolato/administración & dosificación , Pulmón/efectos de los fármacos , Pulmón/fisiopatologíaRESUMEN
BACKGROUND: The Valve Academic Research Consortium (VARC)-3 definition for neurologic events after transcatheter aortic valve replacement (TAVR) lacks clinical validation. OBJECTIVES: This study sought to determine the incidence, predictors, and clinical impact of neurologic events following TAVR as defined by VARC-3 criteria. METHODS: This was a multicenter study including 2,924 patients with severe aortic stenosis undergoing TAVR. Based on Neurologic Academic Research Consortium (NeuroARC) classification, neurologic events were classified as NeuroARC type 1 (stroke), NeuroARC type 2 (covert central nervous system injury), and NeuroARC type 3 (transient ischemic attack and delirium). Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. RESULTS: After a median follow-up of 13 (7-37) months, neurologic events occurred in 471 patients (16.1%), NeuroARC type 1, 2, and 3 in 37.4%, 4.7%, and 58.0% of cases, respectively, and the majority (58.6%) were periprocedural. Advanced age, chronic kidney disease, atrial fibrillation, major vascular complications, and in-hospital bleeding determined an increased risk of periprocedural events (P < 0.03 for all). Neurologic events occurring during the periprocedural time frame were independently associated with a substantial increase in mortality at 1 year after the intervention (HR: 1.91; 95% CI: 1.23-2.97; P = 0.004). However, although NeuroARC type 1 was associated with an increased mortality risk (IRR: 3.38; 95% CI: 2.30-5.56; P < 0.001 and IRR: 21.7; 95% CI: 9.63-49.1; P < 0.001 for ischemic and hemorrhagic stroke, respectively), the occurrence of NeuroARC type 3 events had no impact on mortality. CONCLUSIONS: Neurologic events after TAVR were associated with poorer short- and long-term survival. This correlation was related to the type of NeuroARC event defined by the VARC-3 criteria. Given the negative impact on clinical outcomes, every attempt should be made to reduce the risk of neurologic complications after TAVR.
Asunto(s)
Estenosis de la Válvula Aórtica , Ataque Isquémico Transitorio , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Masculino , Factores de Riesgo , Femenino , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Incidencia , Anciano , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Anciano de 80 o más Años , Factores de Tiempo , Medición de Riesgo , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/epidemiología , Resultado del Tratamiento , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/epidemiología , Delirio/epidemiología , Delirio/etiología , Delirio/diagnóstico , Delirio/mortalidad , Bases de Datos Factuales , Válvula Aórtica/cirugía , Válvula Aórtica/fisiopatología , Válvula Aórtica/diagnóstico por imagenAsunto(s)
Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Factores de Riesgo , Resultado del Tratamiento , Medición de Riesgo , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/clasificación , Terminología como Asunto , Factores de Tiempo , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & controlRESUMEN
BACKGROUND: In patients with in-stent restenosis (ISR) bioresorbable vascular scaffolds (BVS) provide similar results to drug-coated balloons (DCBs) but are inferior to drug-eluting stents (DES) at 1 year. However, the long-term efficacy of BVS in these patients remains unknown. OBJECTIVES: This study sought to assess the long-term safety and efficacy of BVS in patients with ISR. METHODS: RIBS VI (Restenosis Intrastent: Bioresorbable Vascular Scaffolds Treatment; NCT02672878) and RIBS VI Scoring (Restenosis Intrastent: Bioresorbable Vascular Scaffolds Treatment With Scoring Balloon; NTC03069066) are prospective multicenter studies designed to evaluate the results of BVS in patients with ISR (N = 220). The inclusion and exclusion criteria were identical to those used in the RIBS IV (ISR of DES) (Restenosis Intra-stent of Drug-eluting Stents: Drug-eluting Balloon vs Everolimus-eluting Stent; NCT01239940) and RIBS V (ISR of bare-metal stents) (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs Everolimus-eluting Stent; NCT01239953) randomized trials (including 249 ISR patients treated with DCBs and 249 ISR patients treated with DES). A prespecified comparison of the long-term results obtained with these treatment modalities (ie, DES, DCBs, and BVS) was performed. RESULTS: Clinical follow-up at 3 years was obtained in all (100%) 718 patients. The 3-year target lesion revascularization rate after BVS was 14.1% (vs 12.9% after DCBs [not significant], and 5.2% after DES [HR: 2.80; 95% CI: 1.47-5.36; P = 0.001]). In a landmark analysis (>1 year), the target lesion revascularization rate after BVS was higher than after DES (adjusted HR: 3.41; 95% CI: 1.15-10.08) and DCBs (adjusted HR: 3.33; 95% CI: 1.14-9.70). Very late vessel thrombosis was also more frequent with BVS (BVS: 1.8%, DCBs: 0.4%, DES: 0%; P = 0.03). CONCLUSIONS: In patients with ISR, late clinical results of DES are superior to those obtained with DCBs and BVS. Beyond the first year, DCBs are safer and more effective than BVS.