Explore the vast range of titles available.

Troponin elevation correlates with an increased short and long-term mortality in patients with acute decompensated heart failure (AHF). However, it has not been included in the development of multiple validated predictive models of mortality. We aim to  determine whether the addition of high-sensitivity troponin T (hs-TnT) to clinical risk scores improves the prediction of in-hospital mortality in patients with AHF. A retrospective analysis of a prospective and consecutive cohort was performed. Adult patients hospitalized between 2015 and 2019 with a primary diagnosis of AHF were included. Hs-TnT was measured on admission. OPTIMIZE-HF, GWTG-HF, and ADHERE risks score were calculated for each patient. The primary endpoint was all-cause in-hospital mortality. Discrimination of isolated hs-TnT and the risk scores with and without the addition of hs-TnT were evaluated using the area under the ROC curve (AUC-ROC). A subanalysis was performed according to left ventricular ejection fraction (LVEF). Of 712 patients, 562 (79%) had hs-TnT measurement upon admission, and was elevated in 91%. In-hospital mortality was 8.7% ( n  = 49). The AUC-ROC was 0.70 (95% CI 0.63–0.77) for isolated hs-TnT, and 0.80 (0.74–0.87), 0.79 (0.72 -0.86) and 0.79 (0.71–0.86) for the OPTIMIZE-HF, GWTG-HF and ADHERE scores, respectively. The addition of hs-TnT to the models did not increase the AUC: 0.72 (0.66–0.79) for the OPTIMIZE-HF + hs-TnT score (difference between AUC − 0.08 p  = 0.04), 0.74 (0.68–0.80) for GWTG-HF (difference between AUC-0.04, p  = 0.2) and 0.7 (0.63–0.77) for ADHERE (difference between AUC − 0.085 p  = 0.07). The models presented good calibration ( p  > 0.05). In the sub-analysis, no differences were found between risk scores with the addition of hs-TnT in the population with LVEF < 40% and ≥ 40%. Elevated hs-TnT on admission was frequent and its incorporation into the validated risk scores did not prove an incremental prognostic benefit in patients hospitalized for AHF, regardless of LVEF. Isolated hs-TnT had a modest ability to predict hospital mortality. Additional prospective studies are needed to validate these findings.

In this trial, administering aspirin before surgery and during the early postsurgical period did not affect the rate of death or nonfatal MI but increased the risk of major bleeding. This was true in patients who had not been taking aspirin and in those on a long-term aspirin regimen. Myocardial infarction is the most common major vascular complication that occurs after noncardiac surgery. 1 – 3 Noncardiac surgery is associated with platelet activation, 4 and coronary-artery thrombus may be a mechanism of perioperative myocardial infarction. 5 , 6 Aspirin inhibits platelet aggregation, 7 and the perioperative administration of aspirin may prevent major vascular complications by inhibiting thrombus formation. 8 In a meta-analysis of data from large, randomized trials involving more than 110,000 patients who were not undergoing surgery, the use of aspirin was shown to prevent myocardial infarction and major vascular events. 9 High-dose aspirin has not been shown to be superior to low-dose aspirin in preventing . . .

The optimal assessment of systemic and lung decongestion during acute heart failure is not clearly defined. We evaluated whether inferior vena cava (IVC) and pulmonary ultrasound (CAVAL US) guided therapy is superior to standard care in reducing subclinical congestion at discharge in patients with AHF. CAVAL US-AHF was an investigator-initiated, single-center, single-blind, randomized controlled trial. A daily quantitative ultrasound protocol using the 8-zone method was used and treatment was adjusted according to an algorithm. The primary endpoint was the presence of more than 5 B-lines and/or an increase in IVC diameter and collapsibility at discharge. And secondary endpoint exploratory outcome was the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days Sixty patients were randomized to CAVAL US (n = 30) or control (n = 30). The primary endpoint was achieved in 4 patients (13.3%) in the CAVAL US group and 20 patients (66.6%) in the control group (P < .001). A significant reduction in HF readmission, unplanned visit for worsening HF or death at 90 days was seen in the CAVAL US group (13.3% vs 36.7%; log rank P = .038). Other endpoints such as NT-proBNP reduction at discharge showed a nonstatistically significant reduction in the CAVAL US group (48% IQR 27-67 vs 37% -3-59; P = .09). Safety outcomes were similar in both groups. IVC and lung ultrasound-guided therapy in AHF patients significantly reduced subclinical congestion at discharge. CAVAL US-AHF provides preliminary evidence for the potential use of a simple technique to guide decongestive therapy during hospitalization for AHF, which may reduce the composite outcome at 90 days.

The main objective was to estimate the frequency of early vascular aging (EVA) in a sample of subjects from Latin America, with emphasis in young adults. We included 1416 subjects from 12 countries in Latin America who provided information about lifestyle, cardiovascular risk factors (CVRF), and anthropometrics. We measured pulse wave velocity (PWV) as a marker of arterial stiffness, and blood pressure (BP) using an oscillometric device (Mobil-O-Graph). To determine the frequency of EVA, we used multiple linear regression to estimate each subject’s PWV expected for his/her age and systolic BP, and compared with observed values to obtain standardized residuals (z-scores). We defined EVA when z-score was ≥1.96. Finally, a multivariable logistic regression analysis was performed to determine baseline characteristics associated with EVA. Mean age was 49.9 ± 15.5 years, male gender was 50.3%. Mean PWV was 7.52 m/s (SD 1.97), mean systolic BP was 125.3 mmHg (SD 16.7) and mean diastolic BP was 78.9 mmHg (SD 12.2). The frequency of EVA was 5.7% in the total population, 9.8% in adults of 40 years or less and 18.7% in those 30 years or less. In these young adults, multiple logistic regression analyses demonstrated that dyslipidemia and hypertension showed an independent association with EVA, and smoking a borderline association (p  =  0.07). In conclusion, the frequency of EVA in a sample from Latin America was around 6%, with higher rates in young adults. These results would support the search of CVRF and EVA during early adulthood.

IntroductionClinical guidelines recommend measurement of arterial (carotid and femoral) plaque burden by vascular ultrasound (VUS) as a risk modifier in individuals at low or moderate risk without known atherosclerotic cardiovascular disease (ASCVD).AimTo evaluate the prevalence of carotid and femoral plaques by age and sex, the burden of subclinical atherosclerosis (SA), and its association with classic CVRF in subjects over 30 years of age without ASCVD.MethodsWe prospectively enrolled 5775 consecutive subjects referred for cardiovascular evaluation and determined the prevalence and burden of SA using 2D-VUS in carotid and femoral arteries.ResultsSixty-one percent were men with a mean age of 51.3 (SD 10.6) years. Overall, plaque prevalence was 51% in carotid arteries, 39.3% in femoral arteries, 62.4% in carotid or femoral arteries, and 37.6% in neither. The prevalence of plaques and SA burden showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral sites. There was also an increasing prevalence of plaques according to the number of CVRF, and interestingly we found a high prevalence of plaques in subjects with 0 or 1 classic CVRF.ConclusionsWe observed an increased prevalence and burden of carotid or femoral SA, higher in men, beginning before the fourth decade of life and increasing with age. Despite a significant association with classic CVRF, a significant number of subjects with low CVRF were diagnosed with SA.

Between 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment. To evaluate if inferior vena cava (IVC) and lung ultrasound (CAVAL US)-guided therapy for AHF patients reduces subclinical congestion at discharge. CAVAL US-AHF is a single-centre, single-blind randomised controlled trial designed to evaluate if an IVC and lung ultrasound-guided healthcare strategy is superior to standard care to reduce subclinical congestion at discharge. Fifty-eight patients with AHF will be randomised using a block randomisation programme that will assign to either lung and IVC ultrasound-guided decongestion therapy ('intervention group') or clinical-guided decongestion therapy ('control group'), using a quantitative protocol and will be classified in three groups according to the level of congestion observed: none or mild, moderate or severe. The treating physicians will know the result of the test and the subsequent adjustment of treatment in response to those findings guided by a customised therapeutic algorithm. The primary endpoint is the presence of more than five B-lines and/or an increase in the diameter of the IVC, with and without collapsibility. The secondary endpoints are the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days, variation of pro-B-type natriuretic peptide at discharge, length of hospital stay and diuretic dose at 90 days. Analyses will be conducted as between-group by intention to treat. Ethical approval was obtained from the Institutional Review Board and registered in the PRIISA.BA platform of the Ministry of Health of the City of Buenos Aires. NCT04549701.

Numa área centrada entre as bacias do Távora e Douro, em plena Região Demarcada do Douro e património da UNESCO, está localizado o concelho de São João da Pesqueira. A presente dissertação assenta no estudo do seu território medieval.Tentando centrar a nossa atenção no período da Reconquista, sobretudo em torno do reinado de Fernando Magno, devido à carta de foral concedida por este monarca, propusemo-nos a elaborar uma teoria explicativa do povoamento medieval para este espaço geográfico.O trabalho desenvolvido assentou fundamentalmente em investigação arqueológica, sobretudo no que concerne à Arqueologia Extensiva e suas aplicabilidades. Através do recurso à prospecção arqueológica, prospecção geofísica, da Arqueogeografia, da “Arqueologia da arquitectura” e dos Sistemas de Informação Geográfica foi-nos possível abordar o tipo de exploração e ocupação que este território conheceu durante os tempos mediévicos.Embora o número de sítios arqueológicos inéditos não seja significativo, a relocalização de sítios, já anteriormente identificados por outros investigadores e consequente análise, permitiu retirar algumas conclusões.A continuidade das villae, associadas a uma subsistência assente em comunidades agro-pastoris, parece ter sido o grande fio condutor da organização deste território. A par desta constante, a existência de uma consistente rede viária com uma formação rádio concêntrica, em torno de Paredes da Beira, assim como os numerosos vestígios aí existentes, parecem ser um importante dado para localizar Omina, capital de civitas dos Arabrigenses e consequente paróquia sueva. O eremitério rupestre de São Salvador do Mundo, a aldeia medieval abandonada de Covas, e vestígios pré-românicos no centro histórico de São João da Pesqueira revelaram-se também importantes indicadores de ocupação humana durante a Idade Média neste território.Com uma longa diacronia ocupacional em muitos dos sítios, e perfeita associação à rede viária, o estudo destes locais, nesta dissertação, servirá como mais uma prova que desmente, a cada vez mais abandonada, tese do ermamento do Douro.

The widespread presence of estrogenic pollutants in aquatic environments poses a significant threat to ecosystems and human health, necessitating the development of efficient and sustainable removal technologies. This study aimed to develop a cost-effective biocatalyst for estrogen biodegradation using a fungal laccase. The enzyme was produced by the native strain under semi-solid-state fermentation conditions optimized using a statistical Design of Experiments. The design evaluated carbon sources (glucose/glycerol), nitrogen sources (peptone/urea), inoculum size, and bark as a solid support/substrate. The resulting laccase was entrapped within a hydrogel made of lignocellulosic biopolymers derived from a second-generation bioethanol by-product. Maximum laccase production was achieved with a high concentration of peptone (12 g/L), a low amount of bark (below 2.8 g), 8.5 g/L glucose and 300 mg/flask of inoculum. The subsequent immobilized laccase achieved 98.8 ± 0.5% removal of ethinylestradiol, outperforming the soluble enzyme. Furthermore, the treatment reduced the estrogenic biological activity by more than 170-fold. These findings demonstrate that the developed biocatalyst not only valorizes an industrial by-product but also represents an effective and sustainable platform for mitigating hazardous estrogenic pollution in water.

In recent years, several solutions for structural vibration control of buildings have been proposed. In particular, the combination of base-isolated structures with complementary variable damping devices has been successful in reducing the base isolator displacements without increasing the building superstructure response when subjected to earthquake loads. In this paper, a magnetorheological device is installed on a 2-DOF mechanical model mounted on an experimental uniaxial shaking table. A simple numerical simulation model is derived for the experimental setup and it represents a typical base-isolated structure with a semi-active vibration controller. The control law combines a force tracking integral action with a clipped on–off adaptation rule that changes the magnetorheological damping in real time. The effectiveness of the proposed solution is demonstrated for both earthquake-like and real earthquake input ground motions. A comparison between the numerical and the experimental results validates the numerical simulations and it gives confidence in using this model for validation and evaluation of other semi-active control solutions based on magnetorheological dampers.

Trypanosoma cruzi, the protozoan causative of Chagas disease, is primarily transmitted through blood-sucking insects and infects mammalian and some reptilian hosts. In Chile, insects of the Mepraia genus are key vectors of T. cruzi in its wild transmission cycle. High prevalence and mixed infection of T. cruzi lineages have been reported in a Mepraia population on Santa María Island in the Atacama Desert. However, no small mammals have been reported. The island’s vertebrate community is dominated by the lizard Microlophus atacamensis and marine and scavenger birds. This study aimed to research blood samples of M. atacamensis for the presence of T. cruzi DNA (kDNA and satDNA) using conventional PCR (cPCR) and quantitative real-time PCR (qPCR) and estimate parasitemia. Our findings reveal that 39.4% of 33 individuals were positive with both cPCR and qPCR, while when assessing infection with either technique, it rises up to 81.8%. These findings confirm that M. atacamensis is a host of T. cruzi, suggesting its potential role as a key reservoir in the island’s transmission cycle. This study provides new insights into the life cycle of T. cruzi in the coastal Atacama Desert, highlighting the importance of reptiles in the epidemiology of this parasite.