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Seerup George posted an update 6 months, 3 weeks ago
Examine the trajectory of left ventricular ejection fraction (EF) among patients eligible for implantable cardioverter-defibrillator (ICD) therapy.
EF is the cornerstone criterion for ICD therapy, but the risk of sudden cardiac death remains after an improvement in EF.
We examined the trajectory of EF among 1178 participants of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) who had three or more assessments of EF, at least 90 days apart. A follow-up EF>35% or>10% absolute increase in EF from baseline were examined as the criteria for EF improvement.
At first follow-up, 381 (32%) patients had an improvement of EF to>35%. However, EF had returned back to≤35% in 109 (27%) of these patients at second follow-up. Similarly, 446 (38%) patients experienced a>10% improvement in EF at first follow-up, but 109 (24%) of these had a subsequent>10% decrease in EF at the second follow-up. Of the 32 patients with normalized EF (≥55%) at first follow-up, 18 (56%) had a subsequent>10% decrease in EF. The fluctuation in EF was present in both ischemic and nonischemic cardiomyopathy but a higher proportion of patients with nonischemic cardiomyopathy had an improvement in EF to>35% at first follow-up compared to those with ischemic cardiomyopathy (38%vs. 27%, p=<.0001).
There is substantial fluctuation of EF among patients who are eligible for ICD therapy.
There is substantial fluctuation of EF among patients who are eligible for ICD therapy.Morphology plays a vital role in determining the biological effects of silica nanoparticles (NPs), but its influence on the toxicity of silica NPs in endothelial cells (ECs) is still inconclusive. We synthesized five kinds of Santa Barbara 15 amorphous (SBA-15) particles with different shapes and added them to human umbilical vein endothelial cells (HUVEC). After 24 After incubation and treatment with 100 ml, more than 80% of the cells are still alive. The microgram/ml of SBA-15 indicates that SBA-15 has high biocompatibility. Fibrous SBA-15 (5) leads to the highest Si element concentration in HUVEC. No NP reduces the release of NO, and NO is an important signaling molecule in the vascular system. Only the aggregated spherical SBA-15 (3) will moderately reduce the endothelial nitric oxide synthase (eNOS) protein. Regarding transcription factors regulating eNOS, we found that all SBA-15 types significantly increased Kruppel-like factor 2 (KLF2) protein, irregular SBA-15 (1), non-aggregated spherical SBA-15 (2) and aggregation The spherical SBA-15 (3) greatly reduces KLF4 by more than 50%. Overall, our results indicate that SBA-15 with different morphologies can be internalized into HUVEC and only cause moderate cytotoxicity. All silica NPs have the smallest effect on the NO-eNOS pathway, but the irregular spherical SBA-15 reduces the eNOS modifier KLF4. The rod-shaped SBA-15 (4) seems to have higher biocompatibility because they are internalized and have negligible adverse effects on HUVEC. Chlorogenic Acid nmr These results provide new evidence for the toxic effects of different forms of silica nanoparticles on HUVEC.Human interactions are often improvised rather than scripted, which suggests that efficient coordination can emerge even when collective plans are largely underspecified. One possibility is that such forms of coordination primarily rely on mutual influences between interactive partners, and on perception-action couplings such as entrainment or mimicry. Yet some forms of improvised joint actions appear difficult to explain solely by appealing to these emergent mechanisms. Here, we focus on collective free improvisation, a form of highly unplanned creative practice where both agents’ subjective reports and the complexity of their interactions suggest that shared intentions may sometimes emerge to support coordination during the course of the improvisation, even in the absence of verbal communication. In four experiments, we show that shared intentions spontaneously emerge during collective musical improvisations, and that they foster coordination on multiple levels, over and beyond the mere influence of shared information. We also show that musicians deploy communicative strategies to manifest and propagate their intentions within the group, and that this predicts better coordination. Overall, our results suggest that improvised and scripted joint actions are more continuous with one another than it first seems, and that they differ merely in the extent to which they rely on emergent or planned coordination mechanisms.
Malnutrition among hospitalized adults with cerebral palsy (CP) has not been extensively explored. We sought to identify impacts of malnutrition on clinical and resource outcomes among hospitalized adults with CP.
This retrospective cohort study surveyed years 2016 and 2017 from the National Inpatient Sample database. Regression models evaluated mortality and resource utilization.
154,219 adults with CP were hospitalized. Among them, 21,064/154,219 (13.5%) had malnutrition. Patients with and without malnutrition were similar in age (mean age ± SEM, 45.1 ± 0.30 vs 45.2 ± 0.18 years; P = .70). Patients with malnutrition were more likely male (12,175/21,604 vs 72,929/133,155 , P < .01) and had higher comorbidity scores (Charlson comorbidity score ≥ 3; 2,464/21,064 vs 14,380/133,155 ; P = .01). Mortality rates were higher among patients with malnutrition (905/21,064 vs 2,796/21,064 , P < .01), and they had higher odds for mortality (adjusted odds ratio = 2.1; CI, 1.7-2.5; P < .01). Those with malnutrition were less likely discharged home (aOR = 0.52; CI, 0.48-0.56; P < .01). Hospital charges were higher (adjusted mean difference = +$42,540; CI, $36,934-48,146; P < .01) and length of stay longer (aMD = +4.3 days; CI, 3.9-4.7; P < .01) among patients with malnutrition.
Malnutrition in hospitalized patients with CP is associated with increased mortality and hospital resource utilization. Flagging these patients as being “high risk” when they are hospitalized may result in heightened attentiveness about clinical outcomes in this vulnerable population.
Malnutrition in hospitalized patients with CP is associated with increased mortality and hospital resource utilization. Flagging these patients as being “high risk” when they are hospitalized may result in heightened attentiveness about clinical outcomes in this vulnerable population.
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