RESUMO
Individual patient data (IPD)-based meta-analysis (ACCRUE, meta-analysis of cell-based cardiac studies, NCT01098591) revealed an insufficient effect of intracoronary cell-based therapy in acute myocardial infarction. Patients with ischemic heart failure (iHF) have been treated with reparative cells using percutaneous endocardial, surgical, transvenous or intracoronary cell delivery methods, with variable effects in small randomized or cohort studies. The objective of this meta-analysis was to investigate the safety and efficacy of percutaneous transendocardial cell therapy in patients with iHF. Two investigators extracted the data. Individual patient data (IPD) (n = 8 studies) and publication-based (n = 10 studies) aggregate data were combined for the meta-analysis, including patients (n = 1715) with chronic iHF. The data are reported in accordance with PRISMA guidelines. The primary safety and efficacy endpoints were all-cause mortality and changes in global ejection fraction. The secondary safety and efficacy endpoints were major adverse events, hospitalization and changes in end-diastolic and end-systolic volumes. Post hoc analyses were performed using the IPD of eight studies to find predictive factors for treatment safety and efficacy. Cell therapy was significantly (p < 0.001) in favor of survival, major adverse events and hospitalization during follow-up. A forest plot analysis showed that cell therapy presents a significant benefit of increasing ejection fraction with a mean change of 2.51% (95% CI: 0.48; 4.54) between groups and of significantly decreasing end-systolic volume. The analysis of IPD data showed an improvement in the NYHA and CCS classes. Cell therapy significantly decreased the end-systolic volume in male patients; in patients with diabetes mellitus, hypertension or hyperlipidemia; and in those with previous myocardial infarction and baseline ejection fraction ≤ 45%. The catheter-based transendocardial delivery of regenerative cells proved to be safe and effective for improving mortality and cardiac performance. The greatest benefit was observed in male patients with significant atherosclerotic co-morbidities.
RESUMO
BACKGROUND: Students with low socio-economic status (SES) are typically depicted as low performers and more likely to fail in school. However, a group of students, despite their background, manage to succeed in school. The capacity to overcome adversities and achieve successful educational outcomes is referred to as Academic Resilience. Research on the relationship between personality traits and academic performance shows that conscientiousness is a crucial factor in predicting academic success and resilience. However, it has also been shown that achievement is a result of an interaction between conscientiousness and students' interest in the subject. AIMS: The study aims to investigate how students' school-related perseverance and interest predict academic achievement among resilient and non-resilient pupils over time in the Swedish compulsory school setting. SAMPLE: Study subjects were a subset (N = 1,665) of the sampled compulsory school students from the 1992 birth cohort in the evaluation through follow-up (ETF) database. METHODS: Multigroup structural equation modelling (SEM) with latent variable interaction was used. Measurement invariance was tested to examine the comparability of the constructs across groups. RESULTS: The results suggest that resilient students rely heavily on both perseverance of effort and interest in school subjects to succeed in their education. For the non-resilient group, the later perseverance level was conditioned on the level of the interest, and neither their early nor later grade interest was related to their achievement. CONCLUSIONS: The academically resilient students displayed more consistency in interest and perseverance over time, which might explain their relative success compared to the non-resilient group.