RÉSUMÉ
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)
Sujet(s)
Humains , Maladies cardiovasculaires/prévention et contrôle , Évaluation de l'état nutritionnel , Alimentation et nutritionRÉSUMÉ
Accurately identifying Mycobacterium bovis-infected cattle is critical for bovine tuberculosis prevention and control. One method for identifying infected cattle is an ELISA developed by IDEXX laboratories, which detects antibodies to two M. bovis proteins, MPB70 and MPB83. The assay's sensitivity varies by geographic region, with sensitivities of 77%, 45%, and 9% in bovine serum samples from the United Kingdom (n = 126), the United States (n = 146), and Mexico (n = 128), respectively. We hypothesized that geographically-biased sequence variation in mpb70 and mpb83, or in the genes that regulate their expression (sigK and rskA), may explain these differing sensitivities. This hypothesis was tested by comparing the sequences of these four genes in 455 M. bovis strains isolated from cattle in the aforementioned countries. For each gene, a single, common sequence was identified in most genomes of the M. bovis strains collected in all three countries. Twelve of the 455 strains were isolated from infected cattle for which the IDEXX ELISA was also performed. Five of the seven ELISA-positive genomes and three of the five ELISA-negative genomes contained the most common sequence of all four genes. Thus, sequence variation in mpb70, mpb83, sigK, and rskA does not explain the geographic disparities in IDEXX ELISA sensitivity.
Sujet(s)
Protéines bactériennes/génétique , Mycobacterium bovis/classification , Mycobacterium bovis/génétique , Analyse de séquence d'ADN/méthodes , Tuberculose bovine/diagnostic , Animaux , Anticorps antibactériens/métabolisme , Antigènes bactériens/génétique , Antigènes bactériens/immunologie , Protéines bactériennes/immunologie , Bovins , Test ELISA , Variation génétique , Protéines membranaires/génétique , Protéines membranaires/immunologie , Mexique , Mycobacterium bovis/immunologie , Sensibilité et spécificité , Tuberculose bovine/immunologie , Royaume-Uni , États-UnisSujet(s)
Infections à alphavirus/épidémiologie , Virus du chikungunya/isolement et purification , Épidémies de maladies , Infections à alphavirus/transmission , Infections à alphavirus/virologie , Caraïbe/épidémiologie , Amérique centrale/épidémiologie , Europe , Santé mondiale , Humains , Surveillance de la population , Amérique du Sud/épidémiologie , VoyageRÉSUMÉ
BACKGROUND: Previous studies suggest that the cyclooxygenase-2 (COX-2) inhibitor nimesulide has a remarkable protective effect against different types of brain injury including ischemia. Since there are no reports on the effects of nimesulide on permanent ischemic stroke and because most cases of human stroke are caused by permanent occlusion of cerebral arteries, the present study was conducted to assess the neuroprotective efficacy of nimesulide on the cerebral infarction and neurological deficits induced by permanent middle cerebral artery occlusion (pMCAO) in the rat. METHODS: Ischemia was induced by permanent occlusion of the middle cerebral artery in rats, via surgical insertion of a nylon filament into the internal carotid artery. Infarct volumes (cortical, subcortical and total) and functional recovery, assessed by neurological score evaluation and rotarod performance test, were performed 24 h after pMCAO. In initial experiments, different doses of nimesulide (3, 6 and 12 mg/kg; i.p) or vehicle were administered 30 min before pMCAO and again at 6, 12 and 18 h after stroke. In later experiments we investigated the therapeutic time window of protection of nimesulide by delaying its first administration 0.5-4 h after the ischemic insult. RESULTS: Repeated treatments with nimesulide dose-dependently reduced cortical, subcortical and total infarct volumes as well as the neurological deficits and motor impairment resulting from permanent ischemic stroke, but only the administration of the highest dose (12 mg/kg) was able to significantly (P < 0.01) diminish infarct volume. The lower doses failed to significantly reduce infarction but showed a beneficial effect on neurological function. Nimesulide (12 mg/kg) not only reduced infarct volume but also enhanced functional recovery when the first treatment was given up to 2 h after stroke. CONCLUSIONS: These data show that nimesulide protects against permanent focal cerebral ischemia, even with a 2 h post-treatment delay. These findings have important implications for the therapeutic potential of using COX-2 inhibitors in the treatment of stroke.
RÉSUMÉ
Contenido: Lo que debe saberse sobre tuberculosis - Lo que debe saberse sobre el cáncer - Agua amiga y agua enemiga - Normas para la provisión de agua potable y construcción de excusados higiénicos en la campaña - Dos enfermedades frecuentes en el campo: y - Dos enfermedades parasitarias de los animales capaces de transmitirse al hombre: y - Cómo cumplir las indicaciones del médico - Salud y superstición - Lo que debe saberse sobre alimentación - Consejos a la futura madre - Cómo criar un hijo sano - Sobre la educación del niño pequeño - : lo que debe hacerse y lo que no debe hacerse - La salud, el mayor bien del hombre. Importancia del examen médico periódico - Seis cuentos para el ambiente rural sobre temas de higiene y profilaxis / Noel H. Sbarra
Sujet(s)
Régime alimentaire , Éducation pour la santé , Premiers secours , Amélioration du niveau sanitaire , Santé Maternoinfantile , Santé publique , Zoonoses , ArgentineRÉSUMÉ
Contenido: Lo que debe saberse sobre tuberculosis - Lo que debe saberse sobre el cáncer - Agua amiga y agua enemiga - Normas para la provisión de agua potable y construcción de excusados higiénicos en la campaña - Dos enfermedades frecuentes en el campo: