Goldenlorentzen2379

8] vs 3.7 [SD 6.4]; P = 0.005, including among female patients only [ST vs MICS 4.6 (SD 6.9) vs 4.2 (SD 6.3); P = 0.04]. Mortality did not significantly vary by procedure among women [MICS vs ST, 2.4% vs 2.8%; hazard ratio 1.09, 95% confidence interval 0.71-1.73; P (surgical approach × sex) = 0.51]. The results also did not vary after adjusting for confounders.

Female sex was associated with higher mortality in patients undergoing valve surgery, regardless of surgical approach. In female patients, MICS did not provide any benefits over ST in terms of in-hospital deaths or postoperative complications.

117, 125.

117, 125.The potato psyllid, Bactericera cockerelli (Šulc), is a major pest of potato (Solanales Solanaceae) as a vector of 'Candidatus Liberibacter solanacearum' (Lso). Bactericera cockerelli colonizes potato from noncrop host plants, yet we do not yet know which noncrop species are the primary sources of Lso-infected psyllids. The perennial weed, Physalis longifolia Nutt., is a high-quality host for B. cockerelli and Lso under laboratory conditions but has been overlooked in recent field studies as a source of Lso-infected psyllids. Our current study had four objectives 1) determine whether P. longifolia is abundant in potato-growing regions of Washington and Idaho, 2) determine whether stands of P. longifolia harbor B. cockerelli and Lso, 3) identify the psyllid haplotypes occurring on P. longifolia, and 4) use molecular gut content analysis to infer which plant species the psyllids had previously fed upon prior to their capture from P. longifolia. Online herbaria and field searches revealed that P. longifolia is abundant in western Idaho and is present at low densities in the Columbia Basin of Washington. Over 200 psyllids were collected from P. longifolia stands in 2018 and 2019, confirming that B. cockerelli colonizes stands of this plant. Gut content analysis indicated that a proportion of B. cockerelli collected from P. longifolia had arrived there from potato. Confirmation that P. longifolia is abundant in certain potato-growing regions of the Pacific Northwest, and that B. cockerelli readily uses this plant, could improve models to predict the risk of future psyllid and Lso outbreaks.

The aim of this study was to evaluate the short- to mid-term outcomes of descending thoracic aortic aneurysm (DTAA) repair from the Gore Global Registry for Endovascular Aortic Treatment (GREAT).

This is a multicentre sponsored prospective observational cohort registry. The study population comprised those treated for DTAA receiving GORE thoracic aortic devices for DTAA repair between August 2010 and October 2016. Major primary outcomes were early and late survival, freedom from aorta-related mortality and freedom from aorta-related reintervention.

There were 180 (58.1%) males and 130 (41.9%) females the mean age was 70 ± 11 years (range 18-92). The median maximum DTAA diameter was 60 mm (interquartile range 54-68.8). Lithium Chloride Technical success was achieved in all patients. Operative mortality, as well as immediate conversion to open repair, was never observed. At the 30-day window, mortality occurred in 4 (1.3%) patients, neurological events occurred in 4 (1.3%) patients (transient ischaemic attacks/stroke n = 3, paraplegia n = 1) and the reintervention rate was 4.5% (n = 14). Estimated survival was 95.6% [95% confidence interval (CI) 92.6-97.4] at 6 months, 92.7% (95% CI 89.1-95.2) at 1 year and 57.3% (95% CI 48.5-65.1) at 5 years. Freedom from aorta-related mortality was 98.3% (95% CI 96.1-99.3) at 6 months, 98.3% (95% CI 96.1-99.3) at 1 year and 92.2% (95% CI 83.4-96.4) at 5 years. Freedom from thoracic endovascular aortic repair (TEVAR)-related reintervention at 5 years was 87.2% (95% CI 81.2-91.4).

TEVAR for DTAAs using GORE thoracic aortic devices is associated with a low rate of device-related reinterventions and is effective at preventing aorta-related mortality for up to 5 years of follow-up.

NCT number NCT01658787.

161, 164.

161, 164.

Analysis of circulating tumor DNA (ctDNA) in plasma is a powerful approach to guide decisions in personalized cancer treatment. Given the low concentration of ctDNA in plasma, highly sensitive methods are required to reliably identify clinically relevant variants.

We evaluated the suitability of 5 droplet digital PCR (ddPCR) assays targeting KRAS, BRAF, and EGFR variants for ctDNA analysis in clinical use.

We investigated assay performance characteristics for very low amounts of variants, showing that the assays had very low limits of blank (0% to 0.11% variant allele frequency, VAF) and limits of quantification (0.41% to 0.7% VAF). Nevertheless, striking differences in detection and quantification of low mutant VAFs between the 5 tested assays were observed, highlighting the need for assay-specific analytical validation. Besides in-depth evaluation, a guide for clinical interpretation of obtained VAFs in plasma was developed, depending on the limits of blank and limits of quantification values.

It is possible to provide comprehensive clinical reports on actionable variants, allowing minimal residual disease detection and treatment monitoring in liquid biopsy.

It is possible to provide comprehensive clinical reports on actionable variants, allowing minimal residual disease detection and treatment monitoring in liquid biopsy.

Patients with heart failure and preserved ejection fraction (HFpEF) frequently have difficult-to-control hypertension. We examined the effect of neprilysin inhibition on 'apparent resistant hypertension' in patients with HFpEF in the PARAGON-HF trial, which compared the effect of sacubitril-valsartan with valsartan.

In this post hoc analysis, patients were categorized according to systolic blood pressure at the end of the valsartan run-in (n = 4795). 'Apparent resistant hypertension' was defined as systolic blood pressure ≥140 mmHg (≥135 mmHg if diabetes) despite treatment with valsartan, a calcium channel blocker, and a diuretic. 'Apparent mineralocorticoid receptor antagonist (MRA)-resistant' hypertension was defined as systolic blood pressure ≥140 mmHg (≥135 mmHg if diabetes) despite the above treatments and an MRA. The primary outcome in the PARAGON-HF trial was a composite of total hospitalizations for heart failure and death from cardiovascular causes. We examined clinical endpoints and the safety o systolic blood pressure by Week 16 was 47.9% in the sacubitril-valsartan group and 34.3% in the valsartan group [adjusted odds ratio (OR) 1.78, 95% CI 1.30-2.43]. In patients with apparent MRA-resistant hypertension, the respective proportions were 43.6% vs. 28.4% (adjusted OR 2.63, 95% CI 1.18-5.89).

Sacubitril-valsartan may be useful in treating apparent resistant hypertension in patients with HFpEF, even in those who continue to have an elevated blood pressure despite treatment with at least four antihypertensive drug classes, including an MRA.

PARAGON-HF ClinicalTrials.gov Identifier NCT01920711.

PARAGON-HF ClinicalTrials.gov Identifier NCT01920711.The Italian National Health Service (NHS) provides universal and almost free health coverage to all Italian citizens. However, since 1992 the NHS has been progressively decentralized, with a gradual transfer of health powers to the regions. This has made a radical difference in terms of health administration and service delivery. Here we focus our analysis on two of the most important and populous northern Italian regions Lombardy and Veneto. Although they are two neighboring regions and similar in many aspects, nevertheless they are totally different as regards their regional health services. Large differences stand out above all in the number of health sector agencies and the density of acute care hospitals. This heterogeneity is mainly due to the profound local political interference, which have been deeply rooted within the NHS over the years. Finally, we analyze the main implications of this situation and try to give insights for an indispensable future (re)harmonization of the NHS.The article proposes a summary of the initiatives, technologies and integrated activities proposed by pharmaceutical companies for the improvement of adherence to drug treatment in four specific areas of intervention patient, health system, drug treatment and socio-economic context.Although the Audit & Feedback (A&F) strategy is widely used in the healthcare context, a margin of uncertainty remains regarding the actual effectiveness in actually improving healthcare quality. Effectiveness research on A&F should be improved, without replicating studies and results already consolidated over the years. Comparative efficacy studies are needed in order to evaluate A&F strategies in poorly explored research areas, such as community care or home care. In these areas, a translational research framework has been developed by the Tuscan Regional Health Agency its aim is to make the results available to the professionals involved in the territorial management of chronic patients. Doctors coordinating the territorial functional aggregations and referring community physicians are the main targets. A&F can also be a tool to improve the performance of general practitioners in their actions aimed at maintaining patients' adherence to clinical prescriptions, highlighting any significant difference between the monitored performances.From traditional alert systems based on applications or text messages to MEMS (Medication Event Monitoring System), up to technologically advanced systems such as the so-called "smart pills", and those printed with 3D technology containing sensors capable of regulating the gradual release of the active substance based on the patient's health, the article offers a brief review of the experiences of applying digital health to improve adherence to drug treatment.The deontological duties of the pharmacist recommend advising customers on the correct use of medicines. In addition, they recommend giving the citizen up-to-date and complete information on drugs, understandable to the customer. These are the prerequisites for improving the effectiveness of doctor's prescriptions and counteract the inappropriate use of medicines. Recent scientific literature confirms the effectiveness of the pharmacist's interventions based on counseling for patients with chronic diseases. The article provides an account of some of the projects and studies on the role of the so-called "farmacia dei servizi" carried out in Italy in recent years.Observational studies report low adherence to chronic polytherapy indicated by the international guidelines for the secondary prevention of acute myocardial infarction. However, current scientific evidence does not allow to quantify how much of the distance from the guidelines is attributable to the patient's behavior, to the providers of local care (general practitioners, district, Local Health Authority) or to the hospital of discharge. A cohort of about 17,600 patients with incident myocardial infarction, discharged from hospitals of Lazio region was selected, with the aim to measure the adherence in real clinical practice. Pharmaceutical prescriptions recorded in the two years following discharge were collected and analyzed. Results show low adherence to polytherapy and substantial intra-regional variability and identify in the hospital of discharge the care setting most responsible for the variability found in adherence levels, even after two years from acute episode.