BackgroundLittle is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED).ObjectivesThe aim of this study was to assess the prevalence of acute ...myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population.MethodsPatients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort.ResultsAmong 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer 26.8% vs 1,561 of 7,407 without cancer 21.1%; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non-ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 95% CI: 0.86-0.92 vs 0.94 95% CI: 0.93-0.94 P < 0.001; for hs-cTnI, area under the curve: 0.93 95% CI: 0.91-0.95 vs 0.95 95% CI: 0.94-0.95 P = 0.10). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort.ConclusionsPatients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation APACE Study; NCT00470587).
Chest Pain in Cancer Patients Bima, Paolo; Lopez-Ayala, Pedro; Koechlin, Luca ...
JACC CardioOncology,
October 2023, 2023-10-00, Letnik:
5, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Little is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED).
The aim of this study was to assess the prevalence of acute myocardial infarction ...(AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population.
Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort.
Among 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer 26.8% vs 1,561 of 7,407 without cancer 21.1%; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non–ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 95% CI: 0.86-0.92 vs 0.94 95% CI: 0.93-0.94 P < 0.001; for hs-cTnI, area under the curve: 0.93 95% CI: 0.91-0.95 vs 0.95 95% CI: 0.94-0.95 P = 0.10). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort.
Patients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation APACE Study; NCT00470587)
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Extreme ocean warming events, known as marine heatwaves (MHWs), have been observed to perturb significantly marine ecosystems and fisheries around the world. Here, we propose a detection method for ...long-lasting and large-scale summer MHWs, using a local, climatological 99th percentile threshold, based on present-climate (1976–2005) daily SST. To assess their future evolution in the Mediterranean Sea we use, for the first time, a dedicated ensemble of fully-coupled Regional Climate System Models from the Med-CORDEX initiative and a multi-scenario approach. The models appear to simulate well MHW properties during historical period, despite biases in mean and extreme SST. In response to increasing greenhouse gas forcing, the events become stronger and more intense under RCP4.5 and RCP8.5 than RCP2.6. By 2100 and under RCP8.5, simulations project at least one long-lasting MHW every year, up to three months longer, about 4 times more intense and 42 times more severe than present-day events. They are expected to occur from June-October and to affect at peak the entire basin. Their evolution is found to occur mainly due to an increase in the mean SST, but increased daily SST variability also plays a noticeable role. Until the mid-21st century, MHW characteristics rise independently of the choice of the emission scenario, the influence of which becomes more evident by the end of the period. Further analysis reveals different climate change responses in certain configurations, more likely linked to their driving global climate model rather than to the individual model biases.
Extremely high association constants (K a's) of up to 2 × 107 M-1 in CH2Cl2 at room temperature are measured for chemically stable AAA−DDD and AA−DDD complexes which feature novel and readily ...accessible multiple hydrogen bond acceptors.
Abstract
Introduction
Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP).
Aims and Methods
We aimed to compare and ...contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018.
Results
Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the “null scenario” or joint smoking and MRTP habits in an “alternative scenario”. The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized.
Conclusions
Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction.
Implications
There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.
Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort ...tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery.
This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated.
In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic ROC AUC) over an internal clinical risk model (ROC AUCbaseline 0.74 0.71–0.77, ROC AUCbaseline+4METs 0.74 0.71–0.77, ROC AUCbaseline+floors climbed 0.75 0.71–0.78, AUCbaseline+fitnessvspeers 0.74 0.71–0.77, and AUCbaseline+physical activity 0.75 0.72–0.78).
Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery.
NCT03016936.
Background/Purpose: Rapid hemostasis, an essential prerequisite of good surgical practice during surgical bleeding, including soft tissue open surgery, often requires adjunctive treatment. We ...evaluated the safety and hemostatic effectiveness of a human plasma-derived fibrin sealant (FS Grifols) in soft tissue open surgery. Methods: Patients with moderate soft tissue bleeding during open, urologic, gynecologic or general surgery were studied. The trial consisted of a preliminary phase (to familiarize investigators with the technique for FS Grifols application and the intraoperative procedures required by the clinical protocol) and a primary phase: in both phases, patients were randomized 1:1 to FS Grifols or Surgicel
®
. The primary efficacy endpoint, based on analysis of subjects in the primary phase of the study, was to evaluate whether FS Grifols was non-inferior to Surgicel
®
in achieving hemostasis, based on the proportion of subjects in both treatment groups who achieved hemostasis at the target bleeding site (TBS) by 4 min (T
4
) following the start of treatment application. Safety assessments included adverse events (AEs), vital signs, physical assessments, common clinical laboratory tests, viral markers, and immunogenicity. Results: A total of 224 subjects were randomized (primary phase): FS Grifols (N = 116), Surgicel
®
(N = 108). The 95% CI at T
4
for the ratio of the proportion of patients achieving hemostasis in the two treatment groups was 1.064 (0.934, 1.213), indicating non-inferiority for FS Grifols vs. Surgicel
®
. The rate of hemostasis at the TBS by T
4
in both phases of the study was higher in the FS Grifols treatment group (preliminary phase: 90.2%; primary phase: 82.8%) than in the Surgicel
®
treatment group (preliminary phase: 78.8%; primary phase: 77.8%). Overall, reported AEs were as expected in surgical patients and were similar between the two treatment groups. Conclusions: This study shows the non-inferiority in time to hemostasis of FS Grifols vs. Surgicel as an adjunct to hemostasis in patients undergoing soft tissue open surgery, and a similar rate of AEs.
AAA−DDD Triple Hydrogen Bond Complexes Blight, Barry A; Camara-Campos, Amaya; Djurdjevic, Smilja ...
Journal of the American Chemical Society,
10/2009, Letnik:
131, Številka:
39
Journal Article
Recenzirano
Experiment and theory both suggest that the AAA−DDD pattern of hydrogen bond acceptors (A) and donors (D) is the arrangement of three contiguous hydrogen bonding centers that results in the strongest ...association between two species. Murray and Zimmerman prepared the first example of such a system (complex 3•2) and determined the lower limit of its association constant (K a) in CDCl3 to be 105 M−1 by 1H NMR spectroscopy ( Murray T. J. ; Zimmerman S. C. J. Am. Chem. Soc. 1992, 114, 4010−4011 ). The first cationic AAA−DDD pair (3•4 + ) was described by Bell and Anslyn ( Bell D. A. ; Anslyn E. A. Tetrahedron 1995, 51, 7161−7172 ), with a K a > 5 × 105 M−1 in CH2Cl2 as determined by UV−vis spectroscopy. We were recently able to quantify the strength of a neutral AAA−DDD arrangement using a more chemically stable AAA−DDD system, 6•2, which has an association constant of 2 × 107 M−1 in CH2Cl2 ( Djurdjevic S. ; Leigh D. A. ; McNab H. ; Parsons S. ; Teobaldi G. ; Zerbetto F. J. Am. Chem. Soc. 2007, 129, 476−477 ). Here we report on further AA(A) and DDD partners, together with the first precise measurement of the association constant of a cationic AAA−DDD species. Complex 6•10 + B(3,5-(CF3)2C6H3)4 − has a K a = 3 × 1010 M−1 at RT in CH2Cl2, by far the most strongly bound triple hydrogen bonded system measured to date. The X-ray crystal structure of 6•10 + with a BPh4 − counteranion shows a planar array of three short (NH···N distances 1.95−2.15 Å), parallel (but staggered rather than strictly linear; N−H···N angles 165.4−168.8°), primary hydrogen bonds. These are apparently reinforced, as theory predicts, by close electrostatic interactions (NH−·−N distances 2.78−3.29 Å) between each proton and the acceptor atoms of the adjacent primary hydrogen bonds.
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