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The performance of echocardiography for the detection of LV thrombus was not different between NICM and ICM. The 12-month incidence of embolism associated with LV thrombus was not different between NICM and ICM (8.7% vs. 6.8%; P = 0.69) but both were higher compared with no LV thrombus in NICM (1.5%).
Independent predictors of LV thrombus in NICM were lower LVEF, LGE presence, and greater LGE extent. The 12-month incidence of embolism associated with LV thrombus in NICM was not different compared with LV thrombus in ICM.
Independent predictors of LV thrombus in NICM were lower LVEF, LGE presence, and greater LGE extent. The 12-month incidence of embolism associated with LV thrombus in NICM was not different compared with LV thrombus in ICM.
We aimed to provide an evidence-supported update of the ECCO-ESPGHAN guideline on the medical management of paediatric Crohn's disease [CD].
We formed 10 working groups and formulated 17 PICO-structured clinical questions [Patients, Intervention, Comparator, and Outcome]. A systematic literature search from January 1, 1991 to March 19, 2019 was conducted by a medical librarian using MEDLINE, EMBASE, and Cochrane Central databases. A shortlist of 30 provisional statements were further refined during a consensus meeting in Barcelona in October 2019 and subjected to a vote. In total 22 statements reached ≥ 80% agreement and were retained.
We established that it was key to identify patients at high risk of a complicated disease course at the earliest opportunity, to reduce bowel damage. Patients with perianal disease, stricturing or penetrating behaviour, or severe growth retardation should be considered for up-front anti-tumour necrosis factor [TNF] agents in combination with an immunomodulator. Therapeutic drug monitoring to guide treatment changes is recommended over empirically escalating anti-TNF dose or switching therapies. Patients with low-risk luminal CD should be induced with exclusive enteral nutrition [EEN], or with corticosteroids when EEN is not an option, and require immunomodulator-based maintenance therapy. Favourable outcomes rely on close monitoring of treatment response, with timely adjustments in therapy when treatment targets are not met. Serial faecal calprotectin measurements or small bowel imaging [ultrasound or magnetic resonance enterography] are more reliable markers of treatment response than clinical scores alone.
We present state-of-the-art guidance on the medical treatment and long-term management of children and adolescents with CD.
We present state-of-the-art guidance on the medical treatment and long-term management of children and adolescents with CD.
The implications of herbivory for plant reproduction have been widely studied; however, the relationship of defoliation and reproductive success is not linear, as there are many interacting factors that may influence reproductive responses to herbivore damage. In this study we aimed to disentangle how the timing of foliar damage impacts both male and female components of fitness, and to assess when it has greater impacts on plant reproductive success.
We measured herbivore damage and its effects on floral production, male and female floral attributes as well as fruit yield in three different phenological phases of Casearia nitida (Salicaceae) over the course of two consecutive years. Then we tested two models of multiple causal links among herbivory and reproductive success using piecewise structural equation models.
The effects of leaf damage differed between reproductive seasons and between male and female components of fitness. Moreover, the impact of herbivory extended beyond the year when it was exerted. The previous season's cumulated foliar damage had the largest impact on reproductive characters, in particular a negative effect on the numbers of inflorescences, flowers and pollen grains, indirectly affecting the numbers of infructescences and fruits, and a positive one on the amount of foliar damage during flowering.
For perennial and proleptic species, the dynamics of resource acquisition and allocation patterns for reproduction promote and extend the effects of herbivore damage to longer periods than a single reproductive event and growing season, through the interactions among different components of female and male fitness.
For perennial and proleptic species, the dynamics of resource acquisition and allocation patterns for reproduction promote and extend the effects of herbivore damage to longer periods than a single reproductive event and growing season, through the interactions among different components of female and male fitness.
Patients with APS are at increased risk of thromboembolism. selleck chemical Neutrophils have been shown to play a role in inducing thrombosis. We aimed to investigate differences in neutrophil subpopulations, their potential of activation and neutrophil extracellular trap (NET) formation comparing high and low-density neutrophils (HDNs/LDNs) as well as subpopulations in patients with APS and controls to gain deeper insight into their potential role in thrombotic manifestations in patients with APS.
HDNs and LDNs of 20 patients with APS and 20 healthy donors were isolated by density gradient centrifugation and stimulated. Neutrophil subpopulations, their activation and NET release were assessed by flow cytometry.
LDNs of both groups showed higher baseline activation, lower response to stimulation (regulation of activation markers CD11b/CD66b), but higher NET formation compared with HDNs. In patients with APS, the absolute number of LDNs was higher compared with controls. HDNs of APS patients showed higher spontaneous activation [%CD11b high median (interquartile range) 2.78% (0.58-10.24) vs 0.56% (0.19-1.37)] and response to stimulation with ionomycin compared with HDNs of healthy donors [%CD11b high 98.20 (61.08-99.13) vs 35.50% (13.50-93.85)], whereas no difference was found in LDNs. NET formation was increased in patients' HDNs upon stimulation.
HDNs and LDNs act differently, unstimulated and upon various stimulations in both healthy controls and APS patients. Differences in HDNs and LDNs between patients with APS and healthy controls indicate that neutrophils may enhance the risk of thrombosis in these patients and could thus be a target for prevention of thrombosis in APS.
HDNs and LDNs act differently, unstimulated and upon various stimulations in both healthy controls and APS patients. Differences in HDNs and LDNs between patients with APS and healthy controls indicate that neutrophils may enhance the risk of thrombosis in these patients and could thus be a target for prevention of thrombosis in APS.