BACKGROUND: Strokes after left atrial appendage closure (LAAC) prophylaxis are generally less severe than those after warfarin prophylaxis-thought to be secondary to more hemorrhagic strokes with warfarin. Hemorrhagic strokes are similarly infrequent with direct oral anticoagulant (DOAC) prophylaxis, so the primary subtype after either LAAC or DOAC prophylaxis is ischemic stroke (IS). OBJECTIVES: The purpose of this study was to compare the severity of IS using the modified Rankin Scale in atrial fibrillation patients receiving prophylaxis with DOACs vs LAAC. METHODS: A retrospective analysis was performed of consecutive patients undergoing LAAC at 8 centers who developed an IS (ISLAAC) compared with contemporaneous consecutive patients who developed IS during treatment with DOACs (ISDOAC). The primary outcome was disabling/fatal stroke (modified Rankin Scale 3-5) at discharge and 3 months later. RESULTS: Compared with ISDOAC patients (n = 322), ISLAAC patients (n = 125) were older (age 77.2 ± 13.4 years vs 73.1 ± 11.9 years; P = 0.002), with higher HAS-BLED scores (3.0 vs 2.0; P = 0.004) and more frequent prior bleeding events (54.4% vs 23.6%; P < 0.001), but similar CHA2DS2-VASc scores (5.0 vs 5.0; P = 0.28). Strokes were less frequently disabling/fatal with ISLAAC than ISDOAC at both hospital discharge (38.3% vs 70.3%; P < 0.001) and 3 months later (33.3% vs 56.2%; P < 0.001). Differences in stroke severity persisted after propensity score matching. By multivariate regression analysis, ISLAAC was independently associated with fewer disabling/fatal strokes at discharge (OR: 0.22; 95% CI: 0.13-0.39; P < 0.001) and 3 months (OR: 0.25; 95% CI: 0.12-0.50; P < 0.001), and fewer deaths at 3 months (OR: 0.28; 95% CI: 0.12-0.64; P < 0.001). CONCLUSIONS: Ischemic strokes in patients with atrial fibrillation are less often disabling or fatal with LAAC than DOAC prophylaxis.

• MeSH
• antikoagulancia škodlivé účinky   MeSH
• cévní mozková příhoda * epidemiologie   etiologie   prevence a kontrola   MeSH
• fibrilace síní * komplikace   farmakoterapie   chirurgie   MeSH
• hemoragická cévní mozková příhoda * chemicky indukované   komplikace   farmakoterapie   MeSH
• ischemická cévní mozková příhoda * chemicky indukované   komplikace   farmakoterapie   MeSH
• krvácení chemicky indukované   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• uzávěr ouška levé síně MeSH
• výsledek terapie MeSH
• warfarin škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

An international, multicenter registry was established to collect retrospective and prospective clinical data on patients with pyruvate kinase (PK) deficiency, the most common glycolytic defect causing congenital nonspherocytic hemolytic anemia. Medical history and laboratory and radiologic data were retrospectively collected at enrollment for 254 patients with molecularly confirmed PK deficiency. Perinatal complications were common, including anemia that required transfusions, hyperbilirubinemia, hydrops, and prematurity. Nearly all newborns were treated with phototherapy (93%), and many were treated with exchange transfusions (46%). Children age 5 years and younger were often transfused until splenectomy. Splenectomy (150 [59%] of 254 patients) was associated with a median increase in hemoglobin of 1.6 g/dL and a decreased transfusion burden in 90% of patients. Predictors of a response to splenectomy included higher presplenectomy hemoglobin (P = .007), lower indirect bilirubin (P = .005), and missense PKLR mutations (P = .0017). Postsplenectomy thrombosis was reported in 11% of patients. The most frequent complications included iron overload (48%) and gallstones (45%), but other complications such as aplastic crises, osteopenia/bone fragility, extramedullary hematopoiesis, postsplenectomy sepsis, pulmonary hypertension, and leg ulcers were not uncommon. Overall, 87 (34%) of 254 patients had both a splenectomy and cholecystectomy. In those who had a splenectomy without simultaneous cholecystectomy, 48% later required a cholecystectomy. Although the risk of complications increases with severity of anemia and a genotype-phenotype relationship was observed, complications were common in all patients with PK deficiency. Diagnostic testing for PK deficiency should be considered in patients with apparent congenital hemolytic anemia and close monitoring for iron overload, gallstones, and other complications is needed regardless of baseline hemoglobin. This trial was registered at www.clinicaltrials.gov as #NCT02053480.

• MeSH
• aktivace enzymů MeSH
• cholecystektomie škodlivé účinky   metody   MeSH
• dítě MeSH
• dospělí MeSH
• fenotyp MeSH
• genetické asociační studie * MeSH
• genotyp MeSH
• hemolytická nesférocytická kongenitální anemie diagnóza   etiologie   metabolismus   terapie   MeSH
• kojenec MeSH
• kombinovaná terapie MeSH
• krevní transfuze MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mutace MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• pyruvátkinasa nedostatek   metabolismus   MeSH
• splenektomie škodlivé účinky   metody   MeSH
• určení symptomu MeSH
• vrozené poruchy metabolismu pyruvátu diagnóza   etiologie   metabolismus   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

• MeSH
• biologické markery MeSH
• krevní transfuze MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• management nemoci MeSH
• mutace MeSH
• mutační analýza DNA MeSH
• přetížení železem diagnóza   epidemiologie   etiologie   metabolismus   MeSH
• prevalence MeSH
• pyruvátkinasa nedostatek   MeSH
• železo metabolismus   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH

CRIMEN EN LA CAFÉ (UN MISTERIO COZY DE LACEY DOYLE - LIBRO 3) es el libro número tres de la nueva y fascinante serie de misterios cozy de Fiona Grace. Lacey Doyle, de 39 años y recién divorciada, ha hecho un cambio drástico: se ha marchado de su vida rápida en la ciudad de Nueva York y se ha instalado en la pintoresca ciudad costera de Wilfordshire.El verano ya casi está aquí, y Lacey se ha enamorado más de la ciudad y de su novio chef. Incluso ha hecho una mejor amiga: la nueva propietaria de un B&B. Y cuando su amiga necesita sus servicios para la decoración del hotel, comprando casi todo lo de la tienda de antigüedades de Lacey, su negocio tiene un empujón extra. Todo va perfectamente -hasta que alguien muere misteriosamente en el nuevo B&B de su amiga.El pueblo del revés y el sustento de su amiga en peligro, a Lacey y a su perro les toca llegar al fondo del misterio.¡El libro #4 también está disponible!

I CINQUE DEL SALOTTO (UN GIALLO INTIMO E LEGGERO DI LACEY DOYLE-LIBRO 3) è il terzo libro di un'affascinante nuova serie di 'cozy mystery' firmata Fiona Grace. Lacey Doyle, 39 anni e fresca di divorzio, ha fatto un cambio drastico: ha abbandonato la sua frenetica vita newyorkese e si è stabilita in una pittoresca cittadina inglese sul mare: Wilfordshire.L'estate è vicina e Lacey si è innamorata ancora di più della cittadina e del suo fidanzato pasticcere. Si è anche fatta una migliore amica: la nuova proprietaria di un B&B del posto. E quando l'amica ha bisogno di lei per la decorazione dell'albergo, comprando praticamente tutto quello che Lacey ha in negozio, i suoi affari hanno una grandiosa impennata.Tutto sta andando alla perfezione, fino a che qualcuno muore misteriosamente nel nuovo B&B dell'amica.La cittadina viene sconvolta e l'attività dell'amica è a rischio: tocca a Lacey e al suo cane andare a fondo del mistero.Il libro #4 della serie sarà presto disponibile!

"Muy entretenido. Recomiendo este libro a la biblioteca personal de cualquier lector que aprecie un misterio muy bien escrito, con algunos giros y una trama inteligente. No le decepcionará. ¡Excelente manera de pasar un fin de semana frío!"--Books and Movie Reviews, Roberto Mattos (sobre Asesinato en la mansión)UNAS VACACIONES TORMENTOSAS (UN MISTERIO COZY DE LACEY DOYLE -LIBRO 4) es el cuarto libro de una nueva y encantadora serie de misterio de Fiona Grace. Lacey Doyle, de 39 años y recién divorciada, ha hecho un cambio drástico: se ha alejado de la rápida vida de la ciudad de Nueva York y se ha establecido en la pintoresca ciudad costera inglesa de Wilfordshire.El verano ha llegado, y Lacey está encantada cuando su novio chef la sorprende con una oferta para un viaje de fin de semana largo, una escapada romántica a los pueblos costeros vecinos de la campiña británica, con su amado perro, y la oportunidad de ir a buscar antigüedades.Pero Lacey se sorprende aún más cuando su familia llega desde Nueva York en una visita sorpresa, ¡y cuando quieren acompañarlos!Aún peor, Lacey, en un pueblo vecino, se encuentra en medio de la escena de un asesinato. Y una vez más, con su reputación en juego, puede ser la única que puede resolverlo.¡El libro número 5 de la serie estará disponible pronto!

LA MUERTE Y UN PERRO (UN MISTERIO COZY DE LACEY DOYLE - LIBRO 2) es el segundo libro de una encantadora nueva serie de misterio cozy escrita por Fiona Grace. Lacey Doyle, de 39 años y recién divorciada, ha llevado a cabo un cambio drástico: ha dejado atrás su vida acelerada en Nueva York y se ha asentado en el pintoresco pueblo costero inglés de Wilfordshire.La primera está en el aire. Con el misterioso asesinato del mes pasado por fin dejado atrás, un nuevo mejor amigo bajo la forma de su pastor inglés y una creciente relación con el chef del otro lado de la calle, parece que todo empieza a encajar por fin. Lacey está tan entusiasmada con su primera gran subasta, especialmente cuando un valioso artefacto de lo más misterioso se añade a su catálogo.Todo parece marchar sin problemas hasta que dos misteriosos postores llegan al pueblo... y uno de ellos acaba aparece muerto.Con el pequeño pueblo sumido en el caos y la reputación de su negocio en juego, ¿podrá Lacey y su fiel compañero perruno resolver este crimen y salvar su buen nombre?¡El tercer libro de la serie, CRIMEN EN LA CAFETERÍA, también está disponible para reserva!

It has been suggested that atmospheric CO2 concentration and frequency of cloud cover will increase in future. It remains unclear, however, how elevated CO2 influences photosynthesis under complex clear versus cloudy sky conditions. Accordingly, diurnal changes in photosynthetic responses among beech trees grown at ambient (AC) and doubled (EC) CO2 concentrations were studied under contrasting sky conditions. EC stimulated the daily sum of fixed CO2 and light use efficiency under clear sky. Meanwhile, both these parameters were reduced under cloudy sky as compared with AC treatment. Reduction in photosynthesis rate under cloudy sky was particularly associated with EC-stimulated, xanthophyll-dependent thermal dissipation of absorbed light energy. Under clear sky, a pronounced afternoon depression of CO2 assimilation rate was found in sun-adapted leaves under EC compared with AC conditions. This was caused in particular by stomata closure mediated by vapour pressure deficit.

• MeSH
• biologické modely MeSH
• buk (rod) fyziologie   MeSH
• fotosyntéza fyziologie   MeSH
• látky znečišťující vzduch metabolismus   MeSH
• listy rostlin fyziologie   MeSH
• oxid uhličitý metabolismus   MeSH
• počasí * MeSH
• světlo MeSH
• xanthofyly metabolismus   MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points. METHODS: Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data. RESULTS: In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay). CONCLUSION: Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice.

• MeSH
• dospělí MeSH
• elektronické zdravotní záznamy * MeSH
• ischemické přivykání metody   MeSH
• kardiochirurgické výkony škodlivé účinky   MeSH
• kardiovaskulární nemoci diagnóza   chirurgie   MeSH
• lidé MeSH
• pooperační komplikace * diagnóza   etiologie   MeSH
• randomizované kontrolované studie jako téma metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH

BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING: None.

• MeSH
• COVID-19 * epidemiologie   MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• nádory štítné žlázy * epidemiologie   chirurgie   patologie   MeSH
• pandemie MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• uzle štítné žlázy * epidemiologie   chirurgie   diagnóza   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH