Cooperative effects
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AIMS: Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. METHODS AND RESULTS: This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). CONCLUSION: In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement.
- MeSH
- cévní mozková příhoda * etiologie MeSH
- dospělí MeSH
- fibrilace síní * diagnóza etiologie chirurgie MeSH
- katetrizační ablace * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- venae pulmonales * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Behavioural synchronization has been shown to facilitate social bonding and cooperation but the mechanisms through which such effects are attained are poorly understood. In the current study, participants interacted with a pre-recorded confederate who exhibited different rates of synchrony, and we investigated three mechanisms for the effects of synchrony on likeability and trusting behaviour: self-other overlap, perceived cooperation, and opioid system activation measured via pain threshold. We show that engaging in highly synchronous behaviour activates all three mechanisms, and that these mechanisms mediate the effects of synchrony on liking and investment in a Trust Game. Specifically, self-other overlap and perceived cooperation mediated the effects of synchrony on interpersonal liking, while behavioural trust was mediated only by change in pain threshold. These results suggest that there are multiple compatible pathways through which synchrony influences social attitudes, but endogenous opioid system activation, such as β-endorphin release, might be important in facilitating economic cooperation.
- MeSH
- dospělí MeSH
- důvěra * MeSH
- endorfiny fyziologie MeSH
- interpersonální vztahy MeSH
- kooperační chování * MeSH
- lidé MeSH
- mladý dospělý MeSH
- postoj MeSH
- práh bolesti fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Allowing players to punish their opponents in Public Goods Game sustains cooperation within a group and thus brings advantage to the cooperative individuals. However, the possibility of punishment of the co-players can result in antisocial punishment, the punishment of those players who contribute the most in the group. To better understand why antisocial punishment exists, it must be determined who are the anti-social punishers and who are their primary targets. METHODS: For resolving these questions we increased the number of players in a group from usual four to twelve. Each group played six rounds of the standard Public Goods Game and six rounds of the Public Goods Game with punishment. Each player in each round received 20 CZK ($ 1.25). Players (N = 118) were rematched after each round so that they would not take into consideration opponents' past behavior. RESULTS: The amount of the punishment received correlated negatively with the contribution (ρ = -0.665, p<0.001). However, this correlation was positive for players in the highest contributors-quartile (ρ = 0.254, p<0.001). Therefore, the graph of relation between the contribution given and punishment obtained was U-shaped (R2 = 0.678, p<0.001) with the inflection point near the left boarder of the upper quartile. The antisocial punishment was present in all groups, and in eight out of ten groups the Justine Effect (the positive correlation between the contribution to the public pool and the risk of suffering punishment in the subpopulation of altruistic players) emerged. In our sample, 22.5% subjects, all of them Free riders and low contributors, punished the altruistic players. CONCLUSIONS: The results of our experimental game-study revealed the existence of the Justine effect--the positive correlation between the contribution to the public pool by a subpopulation of the most altruistic players, and the amount of punishment these players obtained from free-riders.
- MeSH
- altruismus * MeSH
- kooperační chování * MeSH
- lidé MeSH
- sociální spravedlnost * MeSH
- teorie her MeSH
- trest * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. CONCLUSIONS: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.
- MeSH
- celková dávka radioterapie MeSH
- dospělí MeSH
- kauzalita MeSH
- komorbidita MeSH
- kraniální ozáření MeSH
- lidé středního věku MeSH
- lidé MeSH
- mezinárodní spolupráce MeSH
- míra přežití MeSH
- nádory mozkového kmene mortalita radioterapie sekundární MeSH
- radiační poranění MeSH
- radiochirurgie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- rozložení podle pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- věkové rozložení MeSH
- výsledek terapie MeSH
- vztah dávky záření a odpovědi MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Chronické srdeční selhání se v evropských zemích vyskytuje u 1–2 % populace s výrazným vzestupem ve vyšších věkových skupinách. Příčinou narůstajícího počtu těchto nemocných je stále se zlepšující péče o akutní stavy a zvyšující se počet pacientů s metabolickými onemocněními. Chronické srdeční selhání představuje soubor příznaků a známek způsobených poškozením srdce, které není schopno pokrýt metabolické potřeby tkání. Cílem léčby pacientů se srdečním selháním je zlepšit jejich klinický stav, výkonnost, zabránit jejich opakovaným hospitalizacím, tím pozitivně ovlivnit kvalitu života a snížit úmrtnost na toto onemocnění. V posledních letech se objevují nová účinná léčiva, která dokáží ovlivnit výše zmíněné modality. Nově jsou pro léčbu chronického srdečního selhání u pacientů s diabetem i bez něj indikovány inhibitory SGLT2.
Chronic heart failure occurs in 1‑2% of the population in European countries, with a significant increase in numbers in older age groups. The cause of the growing numbers of these patients is the ever‑ improving care for acute conditions and the growing number of patients with metabolic diseases. Chronic heart failure is a set of symptoms and signs that are caused by heart damage that is unable to cover the metabolic needs of tissues. The aim of the treatment of patients with heart failure is to improve their clinical condition and performance, prevent their re‑hospitalization, thus affecting the quality of life and, last but not least, reduce mortality from this disease. In recent years, a new, effective drug has emerged that can affect the above‑mentioned modalities. New in the indication for the treatment of chronic heart failure are SGLT2 inhibitors, even in patients with or without diabetes.
- Klíčová slova
- Forxiga (dapagliflozin),
- MeSH
- diabetes mellitus 2. typu epidemiologie farmakoterapie MeSH
- diastolické srdeční selhání diagnostické zobrazování epidemiologie farmakoterapie MeSH
- glifloziny aplikace a dávkování farmakologie MeSH
- hyperglykemie farmakoterapie MeSH
- ischemická choroba srdeční diagnostické zobrazování epidemiologie farmakoterapie MeSH
- lékové předpisy normy MeSH
- lidé MeSH
- systolické srdeční selhání * diagnostické zobrazování epidemiologie farmakoterapie MeSH
- transportér 2 pro sodík a glukózu účinky léků MeSH
- týmová péče o pacienty MeSH
- Check Tag
- lidé MeSH
Imunoterapie checkpoint inhibitory je považována za jeden z největších pokroků v onkologické terapii za poslední dekádu. Její účinnost přináší naději pro pacienty s různými typy nádorů, jak solidních tak hematologických. Na druhou stranu však vzhledem ke specifickému mechanismu účinku, musíme čelit diametrálně odlišným nežádoucím účinkům, než jsme byli zvyklí v minulosti. Jedná se o účinky podobné autoimunitním onemocněním, označované jako imunitně podmíněné nežádoucí účinky (irAE, immune-related adverse events). Ve většině případů se jedná o snadno zvládnutelné nežádoucí účinky nižšího stupně závažnosti. V některých případech, či při opožděné intervenci však mohou mít i fatální dopad. Hlavním předpokladem pro zvládnutí nežádoucích účinků je jejich dobrá znalost (výskyt, dynamika, mortalita, apod.). Podstatné je, že při správném managementu a pozitivní motivaci pacientů je možné těmto situacím předcházet.
Immunotherapy with checkpoint inhibitors is considered to be one of the greatest advances in cancer therapy in the last decade. Its effectiveness brings hope for patients with various types of tumors, both solid and hematologic. On the other hand, due to the specific mechanism of action, we have to face diametrically different side effects, we were used to be in the past. These effects are similar to autoimmune diseases, called as immune-related adverse events (irAEs). In most cases, these effects are of lower severity and are easily manageble. However, in some cases, or in cases of delayed intervention, they may have a fatal outcome. The main prerequisite for managing side effects is their good knowledge (occurrence, dynamics, mortality, etc.). It is essential to mention that these situations can be prevented with proper management and patient cooperation.
- MeSH
- autoimunitní nemoci MeSH
- biologické markery MeSH
- imunoterapie * škodlivé účinky MeSH
- inhibitory kontrolních bodů ekonomika klasifikace škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- nádory farmakoterapie MeSH
- nežádoucí účinky léčiv * epidemiologie farmakoterapie klasifikace patofyziologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
