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1.
Horm Metab Res ; 53(9): 575-587, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34496408

RESUMO

Global warming and the rising prevalence of obesity are well described challenges of current mankind. Most recently, the COVID-19 pandemic arose as a new challenge. We here attempt to delineate their relationship with each other from our perspective. Global greenhouse gas emissions from the burning of fossil fuels have exponentially increased since 1950. The main contributors to such greenhouse gas emissions are manufacturing and construction, transport, residential, commercial, agriculture, and land use change and forestry, combined with an increasing global population growth from 1 billion in 1800 to 7.8 billion in 2020 along with rising obesity rates since the 1980s. The current Covid-19 pandemic has caused some decline in greenhouse gas emissions by limiting mobility globally via repetitive lockdowns. Following multiple lockdowns, there was further increase in obesity in wealthier populations, malnutrition from hunger in poor populations and death from severe infection with Covid-19 and its virus variants. There is a bidirectional relationship between adiposity and global warming. With rising atmospheric air temperatures, people typically will have less adaptive thermogenesis and become less physically active, while they are producing a higher carbon footprint. To reduce obesity rates, one should be willing to learn more about the environmental impact, how to minimize consumption of energy generating carbon dioxide and other greenhouse gas emissions, and to reduce food waste. Diets lower in meat such as a Mediterranean diet, have been estimated to reduce greenhouse gas emissions by 72%, land use by 58%, and energy consumption by 52%.


Assuntos
Mudança Climática , Obesidade/etiologia , Agricultura/economia , Agricultura/tendências , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/patologia , Mudança Climática/história , Comorbidade , Disruptores Endócrinos/toxicidade , Meio Ambiente , Exposição Ambiental/história , Exposição Ambiental/estatística & dados numéricos , Gases de Efeito Estufa/toxicidade , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Obesidade/epidemiologia , Obesidade/metabolismo , Pandemias , Fatores de Risco
3.
BMJ Case Rep ; 14(9)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535492

RESUMO

A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins. In a time where there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalisation, this particular clinical scenario emphasises the need of all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.


Assuntos
COVID-19 , Hipertensão Pulmonar , Trombocitopenia , Trombose , Vacinas , Vacinas contra COVID-19 , Feminino , Hospitais Gerais , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar , SARS-CoV-2 , Reino Unido
5.
AMIA Annu Symp Proc ; 2021: 505-514, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34457166

RESUMO

Parkinson's disease (PD) is an incurable, fatal neurodegenerative disease, and only available treatment is to minimize symptoms. Anecdotal evidence suggests whole body workout can help to reduce PD severity; however, it is challenging to quantify its effect on PD. The increased availability of fitness trackers can help in quantifying the effect of whole-body workout on PD. Before using any over the counter fitness tracker, we must study the ease of use of the fitness trackers in PD patients. We interviewed 32 PD patients with six over the counter fitness trackers and determined their perceptions and attitude towards the fitness trackers. Although none of the fitness trackers received perfect scores for ease of use or comfort due to the presence of tremors, two trackers performed significantly better than the others. Further study is warranted to understand the potential for fitness trackers to be used by PD patients.


Assuntos
Doenças Neurodegenerativas , Doença de Parkinson , Exercício Físico , Monitores de Aptidão Física , Humanos
6.
Curr Probl Cardiol ; : 100959, 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34358587

RESUMO

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.

7.
Artigo em Inglês | MEDLINE | ID: mdl-34400799

RESUMO

BACKGROUND: While multiple randomized trials have evaluated the benefit of radiation therapy (RT) dose escalation and the use and prolongation of androgen deprivation therapy (ADT) in the treatment of prostate cancer, few studies have evaluated the relative benefit of either form of treatment intensification with each other. Many trials have included treatment strategies that incorporate either high or low dose RT, or short-term or long-term ADT (STADT or LTADT), in one or more trial arms. We sought to compare different forms of treatment intensification of RT in the context of localized prostate cancer. METHODS: Using preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines, we collected over 40 phases III clinical trials comparing different forms of RT for localized prostate cancer. We performed a meta-regression of 40 individual trials with 21,429 total patients to allow a comparison of the rates and cumulative proportions of 5-year overall survival (OS), prostate cancer-specific mortality (PCSM), and distant metastasis (DM) for each treatment arm of every trial. RESULTS: Dose-escalation either in the absence or presence of STADT failed to significantly improve any 5-year outcome. In contrast, adding LTADT to low dose RT significantly improved 5-year PCSM (Odds ratio [OR] 0.34, 95% confidence interval [CI] 0.22-0.54, p < 0.001) and DM (OR 0.35, 95% CI 0.20-0.63. p < 0.001) over low dose RT alone. Adding STADT also significantly improved 5-year PCSM over low dose RT alone (OR 0.55, 95% CI 0.41-0.75, p < 0.001). CONCLUSION: While limited by between-study heterogeneity and a lack of individual patient data, this meta-analysis suggests that adding ADT, versus increasing RT dose alone, offers a more consistent improvement in clinical endpoints.

8.
J Natl Med Assoc ; 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34373113

RESUMO

INTRODUCTION: Kikuchi-Fujimoto (KF) disease, also known as necrotizing histiocytic lymphadenitis, is a rare cause of fever of unknown origin. Most commonly seen in Japanese populations, it presents with fever and diffuse lymphadenopathy. KF can present a diagnostic challenge as its presentation can mimic sepsis, autoimmune disease, and/or malignancy. We present a case of KF disease presenting with innumerable pulmonary nodules and suspected sepsis. CASE REPORT: A 24-year old African-American male inmate with no past medical history presented to the Emergency Department with two witnessed generalized tonic-clonic seizures. Initial vitals were notable for a fever of 101.5 F, tachycardia, and tachypnea. He was lethargic with a diffuse, erythematous, scaly, necrotic rash. Additionally, cervical, axillary, and inguinal mobile, non-tender lymph nodes were noted. Laboratory studies revealed white blood cells 1.9 × 10 3 cells/µL with 25% bands, hemoglobin 9.4 G/dL, and platelet count of 110 × 10 3 cells/µL. He was subsequently admitted for sepsis due to presumed meningitis and started on broad-spectrum antibiotics. Lumbar puncture revealed no pleocytosis. Peripheral blood smear showed bandemia with Pelger Huet cells. Computed Tomography of chest, abdomen, and pelvis with contrast revealed diffuse pulmonary nodules involving all lobes of the lungs in addition to bulky hilar and retroperitoneal lymphadenopathy. Interventional Radiology performed a retroperitoneal lymph nodes biopsy that revealed lymphoplasmacytic cell infiltrate with extensive necrosis. Otolaryngology performed an excisional biopsy of a lymph node, which showed histiocytic necrotizing lymphadenitis. The final diagnosis was Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis. OUTCOME: The patient completed a 7-day course of empiric antibiotics. Workup for infectious etiologies was negative. The patient had a repeat CT of the chest with interval resolution of his pulmonary nodules on outpatient follow-up. CONCLUSION: Patients with innumerable pulmonary nodules and fever of unknown origin should be evaluated early in their hospital course for KF as early diagnosis can reduce excessive testing and shorten hospital stay.

9.
Neurosci Biobehav Rev ; 129: 351-366, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34384843

RESUMO

Development of epilepsy or epileptogenesis promotes recurrent seizures. As of today, there are no effective prophylactic therapies to prevent the onset of epilepsy. Contributing to this deficiency of preventive therapy is the lack of clarity in fundamental neurobiological mechanisms underlying epileptogenesis and lack of reliable biomarkers to identify patients at risk for developing epilepsy. This limits the development of prophylactic therapies in epilepsy. Here, neural network dysfunctions reflected by oscillopathies and microepileptiform activities, including neuronal hyperexcitability and hypersynchrony, drawn from both clinical and experimental epilepsy models, have been reviewed. This review suggests that epileptogenesis reflects a progressive and dynamic dysfunction of specific neuronal networks which recruit further interconnected groups of neurons, with this resultant pathological network mediating seizure occurrence, recurrence, and progression. In the future, combining spatial and temporal resolution of neuronal non-invasive recordings from patients at risk of developing epilepsy, together with analytics and computational tools, may contribute to determining whether the brain is undergoing epileptogenesis in asymptomatic patients following brain injury.


Assuntos
Lesões Encefálicas , Epilepsia , Encéfalo , Humanos , Neurônios , Convulsões
10.
J Am Heart Assoc ; 10(16): e021293, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34387127

RESUMO

Background Anticoagulation is the mainstay for stroke prevention in patients with atrial fibrillation, but concerns about bleeding inhibit its use in residents of long-term care facilities. Risk-profiling algorithms using comorbid disease information (eg, CHADS2 and ATRIA [Anticoagulation and Risk Factors in Atrial Fibrillation]) have been available for years. In the long-term care setting, however, providers and residents may place more value on geriatric conditions such as mobility impairment, activities of daily living dependency, cognitive impairment, low body mass index, weight loss, and fall history. Methods and Results Using a retrospective cohort design, we measured the association between geriatric conditions and anticoagulation use and type. After merging nursing home assessments containing information about geriatric conditions (Minimum Data Set 2015) with Medicare Part A 2014 to 2015 claims and prescription claims (Medicare Part D) 2015 to 2016, we identified 228 741 residents with atrial fibrillation and elevated stroke risk (CHA2DS2-VASc score ≥2) for our main analysis. Recent fall, activities of daily living dependency, moderate and severe cognitive impairment, low body mass index, and unintentional weight loss were all associated with lower anticoagulation use even after adjustment for multiple predictors of stroke and bleeding (odds ratios ranging from 0.51 to 0.91). Residents with recent fall, low body mass index, and unintentional weight loss were more likely to be using a direct oral anticoagulant, although the magnitude of this effect was smaller. Conclusions Geriatric conditions were associated with lower anticoagulation use. Preventing stroke in these residents with potential for further physical and cognitive impairment would appear to be of paramount significance, although the net benefit of anticoagulation in these individuals warrants further research.

11.
Appetite ; 167: 105593, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34246713

RESUMO

Recent evidence suggests that atypical major depressive disorder (MDD) - whose key features include the reversed somatic symptoms of hyperphagia (increased appetite) and hypersomnia (increased sleep) - is a stronger predictor of future obesity than other MDD subtypes. The mechanisms underlying this relationship are unclear. The present study sought to elucidate whether the individual symptoms of hyperphagia, hypersomnia, poor appetite, and disturbed sleep have differential relationships with food attentional bias, emotional eating, external eating, and restrained eating. This cross-sectional laboratory study involved 103 young adults without obesity (mean age = 20 years, 79% female, 26% non-White, mean BMI = 23.4 kg/m2). We measured total depressive symptom severity and individual symptoms of hyperphagia, poor appetite, and disturbed sleep using the Hopkins Symptom Checklist-20 (SCL-20) and added an item to assess hypersomnia; food attentional bias using a Food Stroop task; and self-reported eating behaviors using the Dutch Eating Behavior Questionnaire. Hyperphagia was positively associated with emotional eating but negatively associated with food attentional bias. Hypersomnia was negatively associated with emotional eating. Poor appetite was negatively associated with emotional eating. Disturbed sleep was positively associated with food attentional bias and emotional eating. An aggregate of the remaining 15 depressive symptoms (SCL-15) was positively associated with emotional and restrained eating. Our findings highlight the importance of examining the direction of somatic depressive symptoms, and they set the stage for future research to identify subgroups of people with depression at greatest risk for obesity (e.g., those with hyperphagia and/or disturbed sleep) and the mechanisms responsible for this elevated risk (e.g., emotional eating).

12.
Clin Chem ; 67(8): 1062-1070, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34263288

RESUMO

BACKGROUND: Widespread application of massively parallel sequencing has resulted in recognition of clonal hematopoiesis in various clinical settings and on a relatively frequent basis. Somatic mutations occur in individuals with normal blood counts, and increase in frequency with age. The genes affected are the same genes that are commonly mutated in overt myeloid malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). This phenomenon is referred to as clonal hematopoiesis of indeterminate potential (CHIP). CONTENT: In this review, we explore the diagnostic and clinical implications of clonal hematopoiesis. In addition to CHIP, clonal hematopoiesis may be seen in patients with cytopenia who do not otherwise meet criteria for hematologic malignancy, a condition referred to as clonal cytopenia of undetermined significance (CCUS). Distinguishing CHIP and CCUS from overt myeloid neoplasm is a challenge to diagnosticians due to the overlapping mutational landscape observed in these conditions. We describe helpful laboratory and clinical features in making this distinction. CHIP confers a risk of progression to overt hematologic malignancy similar to other premalignant states. CHIP is also associated with a proinflammatory state with multisystem implications and increased mortality risk due to cardiovascular events. The current approach to follow up and management of patients with clonal hematopoiesis is described. SUMMARY: Nuanced understanding of clonal hematopoiesis is essential for diagnosis and clinical management of patients with hematologic conditions. Further data are needed to more accurately predict the natural history and guide management of these patients with respect to both malignant progression as well as nonhematologic sequelae.

13.
Mini Rev Med Chem ; 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34254913

RESUMO

Cancer is a frightful disease that still poses a 'nightmare' worldwide, causing millions of casualties annually due to one of the human race's most significant healthcare challenges that requires a pragmatic treatment strategy. However, plants and plant-derived products revolutionize the field as they are quick, cleaner, eco-friendly, low-cost, effective, and less toxic than conventional treatment methods. Plants are repositories for new chemical entities and have a promising cancer research path, supplying 60% of the anticancer agents currently used. Alkaloids are important chemical compounds that serve as a rich reservoir for drug discovery and development. However, some alkaloids derived from natural herbs display anti-proliferation and antimetastatic activity on different forms of cancer, both in vitro and in vivo. Alkaloids have also been widely formulated as anticancer medications, such as camptothecin and vinblastine. Still, more research and clinical trials are required before final recommendations can be made on specific alkaloids. This review focuses on the naturally-derived bioactive alkaloids with prospective anticancer properties based on the information in the literature.

14.
Inorg Chem ; 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34270212

RESUMO

In the present work, an attempt has been made to induce chirality in copper-substituted phosphotungstate (PW11Cu) by functionalization with (S)-(+)-1-phenylethylamine (S-PEA) via a ligand substitution approach. The formation of a N→Cu dative bond was confirmed by 13C NMR, while 1H NMR, circular dichroism spectroscopy and optical rotation studies confirmed the introduction of chirality to the Keggin structure. The synthesized material was used as the heterogeneous catalyst for the asymmetric epoxidation of styrene using various green oxidants to obtain high enantiomeric excess (ee), and the reaction with molecular oxygen was found to give the best ee. Regeneration studies were carried out, and the catalyst was found to be suitable for the same. A probable mechanism is also proposed. A comparison with other copper-based polyoxometalate catalysts clearly demonstrate the superiority and novelty of the present catalyst in terms of the reaction conditions as well as the obtained ee.

15.
Neuro Oncol ; 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174070

RESUMO

BACKGROUND: Longitudinal measurement of tumor burden with MRI is an essential component of response assessment in pediatric brain tumors. We developed a fully automated pipeline for the segmentation of tumors in pediatric high-grade gliomas, medulloblastomas, and leptomeningeal seeding tumors. We further developed an algorithm for automatic 2D and volumetric size measurement of tumors. METHODS: A preoperative and postoperative cohort were randomly split into training and testing sets in a 4:1 ratio. A 3D U-Net neural network was trained to automatically segment the tumor on T1 contrast-enhanced and T2/FLAIR images. The product of the maximum bidimensional diameters according to the RAPNO criteria (AutoRAPNO) was determined. Performance was compared to that of two expert human raters who performed assessments independently. Volumetric measurements of predicted and expert segmentations were computationally derived and compared. RESULTS: A total of 794 pre-operative MRIs from 794 patients and 1,003 post-operative MRIs from 122 patients were included. There was excellent agreement of volumes between preoperative and postoperative predicted and manual segmentations, with ICCs of 0.912 and 0.960 for the two preoperative and 0.947 and 0.896 for the two postoperative models. There was high agreement between AutoRAPNO scores on predicted segmentations and manually calculated scores based on manual segmentations (Rater 2 ICC=0.909; Rater 3 ICC=0.851). Lastly, the performance of AutoRAPNO was superior in repeatability to that of human raters for MRIs with multiple lesions. CONCLUSIONS: Our automated deep learning pipeline demonstrates potential utility for response assessment in pediatric brain tumors. The tool should be further validated in prospective studies.

16.
J Am Coll Cardiol ; 77(22): 2807-2818, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34082911

RESUMO

BACKGROUND: Anatomic interventions for pulmonary vein stenosis (PVS) in infants and children have been met with limited success. Sirolimus, a mammalian target of rapamycin inhibitor, has demonstrated promise as a primary medical therapy for PVS, but the impact on patient survival is unknown. OBJECTIVES: The authors sought to investigate whether mTOR inhibition with sirolimus as a primary medical therapy would improve outcomes in high-risk infants and children with PVS. METHODS: In this single-center study, patients with severe PVS were considered for systemic sirolimus therapy (SST) following a strict protocol while receiving standardized surveillance and anatomic therapies. The SST cohort was compared with a contemporary control group. The primary endpoint for this study was survival. The primary safety endpoint was adverse events (AEs) related to SST. RESULTS: Between 2015 and 2020, our PVS program diagnosed and treated 67 patients with ≥moderate PVS. Of these, 15 patients were treated with sirolimus, whereas the remaining patients represent the control group. There was 100% survival in the SST group compared with 45% survival in the control group (log-rank p = 0.004). A sensitivity analysis was completed to address survival bias using median time from diagnosis of PVS to SST. A survival advantage persisted (log-rank p = 0.027). Two patients on sirolimus developed treatable AEs. Patients in the SST group underwent frequent transcatheter interventions with 3.7 catheterizations per person-year (25th to 75th percentile: 2.7 to 4.4 person-years). Median follow up time was 2.2 years (25th to 75th percentile: 1.2 to 2.9 years) in the SST group versus 0.9 years (25th to 75th percentile: 0.5 to 2.7 years) in the control group. CONCLUSIONS: The authors found a survival benefit associated with SST in infants and children with moderate-to-severe PVS. This survival benefit persisted after adjusting the analysis for survival bias. There were 2 mild AEs associated with SST during the study period; both patients were able to resume therapy without recurrence.

17.
Curr Probl Cardiol ; : 100883, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34103192

RESUMO

Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.

18.
Theranostics ; 11(15): 7144-7158, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34158841

RESUMO

Objectives: Extracellular vesicles (EVs) are lipid bilayer membrane vesicles that are present in various bodily fluids and have been implicated in autoimmune disease pathogenesis. Type I interferons (IFN), specifically IFN-ß, are uniquely elevated in dermatomyositis (DM). The stimulator of interferon genes (STING) works as a critical nucleic acid sensor and adaptor in type I IFN signaling with possible implications in autoimmune diseases such as DM. In the current study, we investigated whether circulating EVs contribute to proinflammatory effects in DM, whether these proinflammatory responses are mediated by the STING signaling pathway, and if so, by what mechanism STING is activated. Methods: We collected and characterized EVs from plasma of healthy controls (HC) and DM patients; analyzed their abilities to trigger proinflammatory cytokines release by ELISA, and explored STING signaling pathway activation using immunoblot and immunofluorescent staining. STING signaling pathway inhibitors and RNAi were used to further investigate whether STING was involved in EVs-triggered proinflammatory response. DNase/lipid destabilizing agent was utilized to digest EVs and their captured DNA contents to evaluate how EVs triggered STING-mediated proinflammatory response in DM. Results: EVs isolated from DM plasma triggered proinflammatory cytokines including type I IFN release with STING signaling pathway activation. The activated STING pathway was preferentially mediated by dsDNA captured by EVs. Suppression of STING or its downstream signaling proteins attenuated the EVs-mediated proinflammatory response. Conclusions: Plasma-derived, DNA containing-EVs induced STING-mediated proinflammatory effects in DM. Targeting the STING pathway may be a potential therapeutic approach for DM.


Assuntos
Ácidos Nucleicos Livres/sangue , Dermatomiosite/metabolismo , Vesículas Extracelulares/metabolismo , Proteínas de Membrana/metabolismo , Animais , Dermatomiosite/patologia , Humanos , Inflamação/metabolismo , Inflamação/patologia , Camundongos
19.
Curr Probl Cardiol ; 46(8): 100854, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33994039

RESUMO

Capecitabine has been more recognized for its cardiotoxicity with an incidence that varies widely. It demonstrates its toxicity in the forms of acute coronary syndrome, arrhythmias and, to a lesser extent, cardiomyopathy. There are several proposed theories including coronary vasospasm, endothelial injury, and oxidative stress. We present a case of capecitabine-induced cardiomyopathy in a patient with pancreatic cancer and mild coronary artery disease, and shed light on other cardio-toxic agents, their proposed mechanism of cardiotoxicity, and on cardiomyopathy in general.


Assuntos
Neoplasias , Cardiomiopatia de Takotsubo , Capecitabina/efeitos adversos , Humanos , Incidência , Cardiomiopatia de Takotsubo/induzido quimicamente , Cardiomiopatia de Takotsubo/diagnóstico
20.
Clin Transplant ; 35(7): e14345, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33977552

RESUMO

In 2018, the United Network for Organ Sharing (UNOS) adopted a 6-tier system for heart allocation which shifted patterns in listing strategies. The effects of the change on waitlist survival and transplantation rates have yet to be substantiated by analysis of competing outcomes among various listing strategies. This study included all adult patients listed for first-time heart transplantation in UNOS between 10/17/15 and 6/12/20. Clinical characteristics were compared before and after allocation change among various listing strategies: no support, inotropes, intra-aortic balloon pump, durable left ventricular assist device (LVAD), temporary VAD, and extracorporeal membrane oxygenation. Fine-Gray proportional subhazard models were used to estimate the effect of allocation change on competing waitlist outcomes-transplantation, death, or removal from waitlist-among each strategy. During the study period, there were 17 422 patients listed for heart transplantation. Among each listing strategy, clinical characteristics were similar before and after allocation change. Subhazard models demonstrated reduced risk for waitlist mortality (p < .001) among each strategy except temporary VAD and increased transplantation rates (p < .001) among each strategy except for durable LVAD. These results validate the association of the new allocation system on waitlist outcomes across listing strategies.


Assuntos
Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Adulto , Insuficiência Cardíaca/cirurgia , Humanos , Balão Intra-Aórtico , Listas de Espera
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