Raková, Radka OR 0000000179914670 Dotaz Zobrazit nápovědu
PURPOSE: Post-operative atrial fibrillation (PoAF) occurs in ~ 30% of patients after cardiac surgery. The etiology of PoAF is complex, but a disbalance in autonomic systems plays an important role. The goal of this study was to assess whether pre-operative heart rate variability analysis can predict the risk of PoAF. METHODS: Patients without a history of AF with an indication for cardiac surgery were included. Two-hour ECG recordings one day before surgery was used for the HRV analysis. Univariate and multivariate logistic regression, including all HRV parameters, their combination, and clinical variables, were calculated to find the best predictive model for post-operative AF. RESULTS: One hundred and thirty-seven patients (33 women) were enrolled in the study. PoAF occurred in 48 patients (35%, AF group); the remaining 89 patients were in the NoAF group. AF patients were significantly older (69.1 ± 8.6 vs. 63.4 ± 10.5 yrs., p = 0.002), and had higher CHA2DS2-VASc score (3 ± 1.4 vs. 2.5 ± 1.3, p = 0.01). In the multivariate regression model, parameters independently associated with higher risk of AF were pNN50, TINN, absolute power VLF, LF and HF, total power, SD2, and the Porta index. A combination of clinical variables with HRV parameters in the ROC analysis achieved an AUC of 0.86, a sensitivity of 0.95, and a specificity of 0.57 and was more effective in PoAF prediction than a combination of clinical variables alone. CONCLUSION: A combination of several HRV parameters is helpful in predicting the risk of PoAF. Attenuation of heart rate variability increases the risk for PoAF.
- MeSH
- fibrilace síní * diagnóza epidemiologie etiologie MeSH
- kardiochirurgické výkony * škodlivé účinky MeSH
- lidé MeSH
- pooperační komplikace diagnóza etiologie MeSH
- rizikové faktory MeSH
- ROC křivka MeSH
- srdeční frekvence fyziologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- blokáda Tawarova raménka etiologie terapie MeSH
- elektrokardiografie MeSH
- funkce levé komory srdeční MeSH
- Hisův svazek * MeSH
- kardiomyopatie * etiologie terapie MeSH
- kardiostimulace umělá škodlivé účinky MeSH
- lidé MeSH
- srdeční komory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Right ventricular pacing (RVP) can result in pacing-induced cardiomyopathy (PICM). It is unknown whether specific biomarkers reflect differences between His bundle pacing (HBP) and RVP and predict a decrease in left ventricular function during RVP. AIMS: We aimed to compare the effect of HBP and RVP on the left ventricular ejection fraction (LVEF) and to study how they affect serum markers of collagen metabolism. METHODS: Ninety-two high-risk PICM patients were randomized to HBP or RVP groups. Their clinical characteristics, echocardiography, and serum levels of transforming growth factor β1 (TGF-β1), matrix metalloproteinase 9 (MMP-9), suppression of tumorigenicity 2 interleukin (ST2-IL), tissue inhibitor of metalloproteinase 1 (TIMP-1), and galectin 3 (Gal-3) were studied before pacemaker implantation and six months later. RESULTS: Fifty-three patients were randomized to the HBP group and 39 patients to the RVP group. HBP failed in 10 patients, who crossed over to the RVP group. Patients with RVP had significantly lower LVEF compared to HBP patients after six months of pacing (-5% and -4% in as-treated and intention-to-treat analysis, respectively). Levels of TGF-β1 after 6 months were lower in HBP than RVP patients (mean difference -6 ng/ml; P = 0.009) and preimplant Gal-3 and ST2-IL levels were higher in RVP patients, with a decline in LVEF ≥5% compared to those with a decline of <5% (mean difference 3 ng/ml and 8 ng/ml; P = 0.02 for both groups). CONCLUSION: In high-risk PICM patients, HBP was superior to RVP in providing more physiological ventricular function, as reflected by higher LVEF and lower levels of TGF-β1. In RVP patients, LVEF declined more in those with higher baseline Gal-3 and ST2-IL levels than in those with lower levels.
- MeSH
- biologické markery MeSH
- elektrokardiografie MeSH
- funkce levé komory srdeční * fyziologie MeSH
- Hisův svazek MeSH
- interleukin-1 receptor-like 1 protein MeSH
- kardiomyopatie * MeSH
- kardiostimulace umělá škodlivé účinky MeSH
- kolagen MeSH
- lidé MeSH
- tepový objem fyziologie MeSH
- tkáňový inhibitor metaloproteinasy 1 MeSH
- transformující růstový faktor beta1 MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
OBJECTIVES: This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations. BACKGROUND: Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited. METHODS: Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions. RESULTS: Fifty-nine patients (age: 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60.0% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI: 41.3-66.8) at 1 year and 43.8% (95% CI: 30.7-57.0) at 2 years. CONCLUSIONS: The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní * farmakoterapie chirurgie MeSH
- katetrizační ablace * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- supraventrikulární tachykardie * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Metodika: Koncentrace paklitaxelu v plazmě byly měřeny u 8 pacientek s rakovinou prsu před infuzí, během 60minutové infuze a dále 10 až 1 380 min po infuzi pomocí HPLC s UV detekcí. Výsledky: Individuální farmakokinetické parametry paklitaxelu v plazmě pacientek se během tří infuzí podaných jednou týdně nezměnily, ale pacientky se vzájemně významně lišily. Tyto rozdíly přetrvávaly u všech sledovaných parametrů: t0,5α, t0,5β a t0,5γ a odpovídající rychlosti vylučování, AUC0-t, AUC0-∞, střední residenční čas, objem při ustáleném stavu Vss, Cmax a clearance byly signifikantně odlišné mezi pacientkami podle parametrické analýzy ANOVA. Při signifikantních rozdílech v Barttlettově testu variability byly rozdíly mezi pacientkami potvrzeny neparametrickým Kruskal-Wallisovým testem. Individuální hodnoty t0.5α všech pacientek signifikantně korelovaly s t0,5β (r = 0,587, p < 0,01). Ve srovnání s pacientkou s nejvyšší eliminací paklitaxelu byla AUC0-t u pacientky s nejpomalejší eliminací 3,2krát vyšší, CL0-t a CL0-∞ byly 3,6krát nižší a CL/kg byla 3krát nižší. V souladu s tím byla rychlost eliminace v α fázi 3krát vyšší a t0.5α byl kratší u pacientky s nejvyšší clearance. Podobné rozdíly byly nalezeny i v β fázi. Pacientka s nejnižší clearance měla navíc 2,4krát vyšší Cmax. Farmakokinetické rozdíly mezi pacientkami byly tedy signifikantní a nezměnily se během opakovaných infuzí paklitaxelu. Značné individuální rozdíly by mohly potenciálně ovlivnit léčebné účinky, jež závisí na koncentraci. Závěr: Farmakokinetika paklitaxelu u pacientek s rakovinou prsu se individuálně výrazně lišila a rozdíly trvaly při opakovaných infuzích, takže nelze vyloučit vliv na účinnost léčby.
Objective: Analysis of pharmacokinetic parameters of Taxol® (paclitaxel) in patients with breast cancer in repeated infusions and determination of possible individual differences Methods: Paclitaxel plasma concentrations were determined by HPLC with UV detection in 8 breast cancer patients before, during 60min of infusion and 10 to 1 380 min after infusion. Results: Pharmacokinetic parameters of the individual patients did not significantly change during 3 repeated weekly infusions. However, these parameters (half-lives t0,5α, t 0.5β and 0.5γ and corresponding rates, intercepts, area under concentration AUC0-t, AUC0-∞, mean residence time, volume at the steady state, maximal concentration and clearance) were significantly different among the patients as proved by parametric analysis ANOVA. Significant differences among the patients detected by the Barttlett’s test for variability were confirmed by the non-parametric Kruskal-Wallis test. The individual values of t0.5α of all patients significantly correlated with t0.5β (r = 0.587, p < 0.01), but there was no correlation between t0.5β and t0.5γ. The observed differences between patients with most rapid and slowest elimination of paclitaxel were 3.2-fold (AUC0-t), 3.6-fold (CL0-t and CL0-∞) and 3-fold (CL/kg). In accordance, the difference in rate of α phase in these patients was 3-fold and t0.5α was also shorter in the patient with the most rapid clearance. Similar differences were found in β phase. Moreover, the patient with the lowest clearance had 2.4-higher maximal concentration (Cmax). Conclusion: Pharmacokinetic parameters in the followed patients were significantly different and the differences remained unchanged during repeated infusions. These differences could potentially influence outcome of the therapy.
- MeSH
- farmakokinetika MeSH
- farmakologie klinická metody statistika a číselné údaje MeSH
- finanční podpora výzkumu jako téma MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- nádory prsu farmakoterapie MeSH
- paclitaxel farmakokinetika MeSH
- vysokoúčinná kapalinová chromatografie statistika a číselné údaje využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
BACKGROUND AND AIMS: There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. METHODS: This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. RESULTS: Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 ± 7.0 to 5.8 ± 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). CONCLUSIONS: Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety.
- MeSH
- aortální stenóza * chirurgie MeSH
- benchmarking * MeSH
- bezpečnost pacientů MeSH
- délka pobytu * statistika a číselné údaje MeSH
- kritické cesty MeSH
- lidé MeSH
- pooperační komplikace epidemiologie prevence a kontrola MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transkatetrální implantace aortální chlopně * metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
Rakovina patří bezesporu k nejobávanějším civilizačním nemocem naší doby. Žádná jiná choroba nevyvolává v lidech tolik emocí. Ačkoli příčin transformace normální buňky na rakovinnou může být celá řada a jednotlivé nádory se liší po genetické stránce, jedno mají společné: rakovinné buňky zcela změní úroveň svého metabolismu, aby uspokojily nároky na rychlý buněčný růst a dělení (proli - feraci). V následujících řádcích se budeme snažit popsat složitou problematiku fyziologických rozdílů v metabolismu zdravé a rakovinné buňky a naznačit, jak tyto poznatky použít jako vhodnou zbraň v onkologické léčbě.
