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1

Tappen, Ruth, Rebecca Koszalinski e David Newman. "RELATIONSHIP OF SOCIAL SUPPORT AND SOCIAL ENGAGEMENT WITH COGNITION IN AN ETHNICALLY DIVERSE OLDER POPULATION". Innovation in Aging 7, Supplement_1 (1 dicembre 2023): 174–75. http://dx.doi.org/10.1093/geroni/igad104.0570.

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Abstract One quarter of older adults in the U.S. are socially isolated; far more experience subjective loneliness. The potentially negative effects of limited social support and social engagement pose a concern for maintaining the well-being of older individuals, including the effect on cognitive function. To test the hypothesis that cognitive function is associated with social support and social engagement, we employed structural equation modeling (SEM) to analyze data from an ethnically diverse sample (118 African American, 147 Afro-Caribbean, 133 Hispanic, and 235 European American) of 623 community-dwelling older adults age ≥ 65 (173 male, 450 female). Using the model proposed by Cenè et al. (2022), we conceptualized level of social support and engagement as the exposure, emotional state (anxiety, depression, general emotional well-being), and physical function (functional activity, life space, general physical function, and self-rating of health) as mediators and cognitive function as the outcome of interest. Statistically significant direct and indirect effects were found between the three latent variables (emotional state, physical function, and social support and social engagement), indicating that the level of social support and engagement the older individual is related directly and indirectly to cognition (β=-.75, SE=.49, p<.028; β=-0.08, SE=0.795, p=0.017). The SEM models showed goodness of fit with χ2/df=3.001, CFI=0.931, AGFI=0.966, SRMR=0.045, and RMSA=0.058, and explained 35.3% of the variability. These values support the hypothetical model. Results suggest the importance of maintaining existing social support and engagement activities as well as development and testing of approaches to increase social support and engagement in later life.
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2

Culp, William T. N., Eric G. Johnson, Michelle A. Giuffrida, Robert B. Rebhun, James K. Cawthra, Heidi A. Schwanz, Jenna H. Burton e Michael S. Kent. "Evaluation of the use of a novel bioabsorbable polymer drug-eluting microsphere for transarterial embolization of hepatocellular neoplasia in dogs". PLOS ONE 17, n. 8 (8 agosto 2022): e0269941. http://dx.doi.org/10.1371/journal.pone.0269941.

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In dogs with non-resectable hepatic neoplasia, treatment options are limited. The objectives of this study were to describe the use of a novel drug-eluting embolic microsphere containing paclitaxel for use during transarterial chemoembolization (TACE), to compare results of liver-specific owner questionnaires and tumor volume pre- and post-TACE, and to measure systemic paclitaxel concentration post-TACE. Client-owned dogs with non-resectable hepatic neoplasia were prospectively enrolled. All owners completed questionnaires validated for the assessment of subjective outcomes in dogs with cancer before the TACE procedure and approximately 4 weeks after the TACE procedure. A CT scan was performed before TACE and 1 month after TACE; results were compared. Blood samples were obtained at specified time points post-TACE to determine systemic paclitaxel concentrations. Seven dogs (median weight: 8.9 kg; range, 4.3–31 kg) were enrolled. TACE was successfully performed in all dogs, and no intra-procedural complications were encountered. Questionnaire scores improved significantly post-TACE. Among the 6 dogs for which full data were available, median pre-TACE tumor volume was 390 cc (range 152–1,484; interquartile range 231–1,139) and median post-TACE tumor volume was 203 cc (range 98–889; interquartile range 151–369), which was significantly (P = .028) lower. All 6 dogs had a reduction in volume at the post-TACE measurement. Mean percent change in tumor volume was -45.6% (95%CI -58.6 to -32.6%). The mean plasma paclitaxel concentration in canine blood peaked at 4 days post-TACE procedure and was 25.7 ng/mL (range = 3.09–110 ng/mL) Median survival time was 629 days (95%CI 18 to upper limit not reached). The use of a novel paclitaxel-eluting microsphere in this cohort of dogs successfully decreased tumor volume significantly after TACE and improved clinical signs. Future investigation into the use of TACE and other similar therapies is warranted due to the promising outcomes noted in this cohort.
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3

Sasaki, Koji, Ildefonso Ismael Rodriguez-Rivera, Hagop M. Kantarjian, Susan O'Brien, Elias Jabbour, Gautam Borthakur, Farhad Ravandi, Michael J. Burke, Patrick A. Zweidler-McKay e Jorge E. Cortes. "Correlation of Lymphocyte Count with Treatment Response to Tyrosine Kinase Inhibitors in Newly Diagnosed Chronic Myeloid Leukemia in Chronic Phase". Blood 124, n. 21 (6 dicembre 2014): 4538. http://dx.doi.org/10.1182/blood.v124.21.4538.4538.

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Abstract Background: Total lymphocyte count (TLC) has been shown to correlate with outcomes in patients (pts) with acute leukemia. The clinical correlation to TLC in pts with chronic myeloid leukemia in chronic phase (CML-CP) who were treated with a tyrosine-kinase inhibitor (TKI) is unclear. Methods: Lymphocyte data in pts with newly diagnosed CML-CP who were enrolled in consecutive or parallel clinical trials with front-line imatinib (IM), nilotinib (Nilo), or dasatinib (Dasa) were collected at the time of diagnosis, and 3 and 6 months (M) after the start of TKI. Relative lymphocytrosis (RLC) was defined as lymphocyte >150% at 3 or 6M compared with baseline at diagnosis. Absolute lymphocytosis (ALC) was defined as lymphocyte > 4,000 /µL at 3 or 6M after the start of TKI. Pts were assessed for response, overall survival (OS), event-free survival (EFS), transformation-free survival (TFS), and failure-free survival (FFS) based on ALC and RLC. The Kaplan-Meier method was used to calculate OS, EFS, TFS, and FFS. A log-rank test and Cox regression were used for univariate (UVA) and multivariate analysis (MVA), respectively. Results: A total of 483 pts were enrolled in this study: 271 in IM, 105 in Nilo, and 107 in Dasa. Patient characteristics and outcomes are summarized in Table 1. Median age at diagnosis was 48 years, and median follow-up was 85M and ongoing (5-154+). Time from diagnosis to start of TKI, Sokal risk score, and ALC at baseline between groups did not differ clinically. Of 481 pts, 93 (19%) developed RLC at 3 or 6M; IM, 38 (14%); Nilo, 23 (22%); Dasa, 32 (30%) (p= .001). ALC at 3 or 6M was observed in 15 (3%); IM, 3 (1%); Nilo, 1 (1%); Dasa, 11 (10%) (p<.001). Overall, cumulative incidence of complete cytogenetic response (CCyR) at 6M, major molecular response (MMR) at 12M, molecular response with 4.5 log reduction by IS (MR4.5) at 24M did not differ significantly between RLC and non-RLC (3 or 6M), or between ALC and non-ALC (3 or 6M). 5-y TFS, EFS and OS in ALC group were significantly worse than those in non-ALC group (p= .002, p=.016, p=.008, respectively). By UVA and MVA related to OS, age [p <.001; Hazard ratio (HR), 1.062; 95% confidence interval (95%CI), 1.036-1.089], presence of ALC at 3 or 6M [p = .028; HR, 10.948; 95%CI, 1.297-92.415], absence of MMR at 24M [p=.016; HR, 2.263; 95%CI, 1.165-4.393] were identified as adverse prognostic factors for OS. Conclusion: The presence of ALC ≥4,000/µL at 3 or 6M of TKI therapies is rare but is adversely associated with overall survival. Table 1. Patient Characteristics and Outcomes (N=483)a Overall [n= 481] IM [n= 271] Nilo [n= 105] Dasa [n= 107] Age, (year) 48 (15-85) 48 (15-85) 49 (17-82) 48 (16-83) Sokal Risk, No. (%) Low 334 (69) 175 (65) 79 (75) 80 (75) Intermediate 114 (24) 74 (27) 18 (17) 22 (21) High 32 (7) 20 (7) 8 (8) 4 (4) Time from diagnosis to start of TKI, (M) 0.9 (0-12.6) 1.0 (0-12.6) 0.5 (0-5.6) 0.7 (0.1-7.8) ALC at baseline, (/109L) 2.5 (0-86.6) 2.4 (0-16.7) 2.6 (0.4-9.2) 2.7 (0.3-86.6) Incidence of Relative Lymphocytosis, No. (%) At 3M 65 (14) 25 (9) 16 (15) 24 (22) At 6M 76 (16) 32 (12) 20 (19) 24 (22) Overall 93 (19) 38 (14) 23 (22) 32 (30) Incidence of Absolute Lymphocytosis, No. (%) At 3M 8 (2) 1 (0) 0 7 (7) At 6M 11 (2) 3 (1) 1 (1) 7 (7) Overall 15 (3) 3 (1) 1 (1) 11 (10) Outcomes of RLC and ALC at any time in each group, +/- (%/%) (p) <10% BCR-ABL/ABL at 3M RLC 36/40 (.596) 22/44 (.213) 50/37 (.280) 31/38 (.537) ALC 38/39 (.952) 0/42 (.394) 100/39 (.214) 36/35 (.952) Cumulative CCyR at 6M RLC 75/75 (.288) 50/66 (.063) 96/90 (.413) 90/87 (.628) ALC 67/75 (.711) 33/64 (.276) 0/92 (.001) 82/89 (.599) Cumulative MMR at 12M RLC 67/74 (.406) 53/70 (.030) 83/82 (.921) 72/74 (.903) ALC 60/73 (.488) 33/68 (.197) 0/83 (.033) 73/74 (.745) Cumulative MR4.5 at 24M RLC 46/52 (.564) 37/50 (.139) 57/55 (.889) 50/57 (.729) ALC 33/52 (.332) 33/48 (.610) 0/56 (.264) 36/57 (.252) 5-y FFS RLC 61/71 (.133) 56/69 (.167) 62/70 (.710) 61/74 (.285) ALC 50/69 (.076) 0/68 (<.001) 0/70 (<.001) 71/70 (.974) 5-y TFS RLC 90/93 (.369) 88/93 (.597) 91/88 (.115) 91/99 (.213) ALC 72/93 (.002) 67/93 (.014) 0/90 (<.001) 80/97 (.121) 5-y EFS RLC 80/86 (.213) 71/83 (.154) 84/87 (.450) 86/93 (.486) ALC 64/85 (.016) 33/82 (<.001) 0/87 (<.001) 80/92 (.574) 5-y OS RLC 89/93 (.068) 81/94 (.007) 100/84 (.126) 96/99 (.207) ALC 82/93 (.008) 67/93 (.001) 100/88 (.847) 83/99 (.040) a Two in IM and 1 in Dasa were not evaluable due to lack of differential data at 3 and 6M. Figure 1. OS in Pts with ALC Figure 1. OS in Pts with ALC Disclosures O'Brien: Amgen, Celgene, GSK: Consultancy; CLL Global Research Foundation: Membership on an entity's Board of Directors or advisory committees; Emergent, Genentech, Gilead, Infinity, Pharmacyclics, Spectrum: Consultancy, Research Funding; MorphoSys, Acerta, TG Therapeutics: Research Funding.
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4

Singhal, Seema, David S. Siegel, Thomas Martin, Ravi Vij, Luhua Wang, Andrzej J. Jakubowiak, Sagar Lonial et al. "Integrated Safety From Phase 2 Studies of Monotherapy Carfilzomib in Patients with Relapsed and Refractory Multiple Myeloma (MM): An Updated Analysis". Blood 118, n. 21 (18 novembre 2011): 1876. http://dx.doi.org/10.1182/blood.v118.21.1876.1876.

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Abstract Abstract 1876 Carfilzomib (CFZ), a next-generation proteasome inhibitor that selectively and irreversibly binds to its target, resulting in sustained inhibition absent of off-target effects relative to bortezomib, is being evaluated in MM patients. The selectivity of CFZ for the proteasome may explain the low rates of peripheral neuropathy (PN) relative to historical data for bortezomib (BTZ). Safety data have been compiled for >700 patients who received CFZ in 9 Phase (Ph) 1 or 2 trials, 4 of which are completed. The majority of patients had relapsed and refractory (R/R) MM, and many had comorbidities including baseline PN and renal insufficiency. This abstract updates and summarizes mature safety data for single-agent CFZ in 526 patients with R/R MM who took part in 1 of 3 Ph 2 studies and is a follow-up with more mature data compared with those presented at ASH 2010. Patients enrolled and treated with CFZ in the following trials are included in this analysis: PX-171-003 (conducted in 2 parts, a pilot study, PX-171-003-A0 [R/R MM], followed by PX-171-003-A1 [R/R MM]), PX-171-004 (relapsed MM), and PX-171-005 (R/R MM with varying degrees of renal function). In all studies, CFZ was dosed on Days 1, 2, 8, 9, 15, and 16 of a 28-day cycle (C). Doses were 20 mg/m2 in C1, escalating to 27 mg/m2 in C2 for all studies with the exception of 005 (15 mg/m2 in C1, 20 mg/m2 in C2, and 27 mg/m2 in C3). Overall, CFZ had a favorable safety profile in these studies. The most frequently reported adverse events (AEs) occurring in ≥30% of patients included fatigue (55%), anemia (47%), nausea (45%), thrombocytopenia (36%), dyspnea (35%), diarrhea (33%), and pyrexia (30%). The most common (≥10% of patients overall) ≥G3 AEs were thrombocytopenia (23%), anemia (22%), lymphopenia (18%), pneumonia (11%), and neutropenia (10%). The assessment of PN was based on a pooled aggregate of PN preferred terms, including neuropathy peripheral, neuropathy, peripheral sensory neuropathy, and peripheral motor neuropathy. PN was reported infrequently (14% overall) across all studies. Although 378 (72%) patients had baseline PN (≤G 2), only 13% reported treatment-emergent symptoms during the study. PN was generally mild to moderate in severity (1.3% G3 PN with no G4 PN), and only 5 patients (1%) required dose modification or discontinuation due to PN. Renal AEs (mainly ≤G2) were reported in 174 (33%) patients, and CFZ was discontinued because of a renal AE in only 21 patients (4%). A summary of CFZ exposure and discontinuation rates is reported in the table. There were a total of 37 (7%) deaths on study, including within 30 days of the last dose of study drug. The primary cause of death was due to disease progression in 22/37 patients (4.2%); however, AEs, including in order of frequency, cardiac events, hepatic failure, and infection, contributed to 14 of these deaths.No. of Patients (%) in Ph 2 MM Studies Who Received Carfilzomib003-A0 (N = 46)003-A1 (N = 266)004 (N = 164)005 (N = 50)All Patients (N = 526)Cycles, mean, n (SD)4.4 (3.4)5.3 (4.1)7.0 (4.4)5.5 (3.7)5.7 (4.2)Completed ≥12 cycles4 (8.7)40 (15.0)47 (28.7)3 (6.0)94 (17.9)Reason for not completing 12 cycles Progressive Disease23 (50.0)157 (59.0)64 (39.0)24 (48.0)268 (51.0) Adverse Event13 (28.3)33 (12.4)26 (15.9)6 (12.0)78 (14.8) Withdrew Consent2 (4.3)22 (8.3)9 (5.5)4 (8.0)37 (7.0) Other4 (8.7)14 (5.3)10 (6.1)028 (5.3) Of the 526 patients included in these analyses, >50% were treated on the 003-A1 dose and schedule (20/27 mg/m2), and fewer than 10% required dose reduction. 18% of patients completed ≥12 cycles (∼1 y) and were eligible to participate in an ongoing, multicenter, open-label Ph 2 study (PX-171-010) to monitor long-term single-agent CFZ safety. To date, patients in this extension trial have not shown evidence of cumulative toxicity. In summary, these data confirm and extend results that were previously presented, namely that single-agent CFZ has an acceptable safety profile in heavily pretreated patients with R/R MM, including those with pre-existing renal dysfunction and PN. Disclosures: Singhal: Onyx Pharmaceuticals: Research Funding, Speakers Bureau; Millennium: Speakers Bureau; Celgene: Speakers Bureau. Siegel:Millennium: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Martin:Celgene: Honoraria; Onyx Pharmaceuticals: Consultancy. Vij:Onyx Pharmaceuticals: Consultancy, Research Funding; Celgene: Research Funding, Speakers Bureau; Millennium: Speakers Bureau. Wang:Onyx Pharmaceuticals: Research Funding. Jakubowiak:Ortho Biotech: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau; Millennium: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Onyx Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Exelixis: Consultancy, Honoraria. Lonial:Millennium: Consultancy; Celgene: Consultancy; Novartis: Consultancy; BMS: Consultancy; Onyx Pharmaceuticals: Consultancy; Merck: Consultancy. Kukreti:Celgene: Honoraria. Zonder:Millennium: Consultancy, Research Funding, Speakers Bureau; Celgene: Speakers Bureau; Medtronics: Honoraria; Amgen: Consultancy. Wong:Onyx Pharmaceuticals: Employment, Equity Ownership. McCulloch:Onyx Pharmaceuticals: Employment. Niesvizky:Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millennium Pharmaceuticals, Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Onyx: Research Funding; Seattle Genetics Inc: Research Funding, Speakers Bureau. Orlowski:Onyx Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees. Stewart:Celgene: Consultancy, Research Funding; Millennium: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Onyx: Consultancy, Research Funding. Kotlovker:Onyx Pharmaceuticals: Employment. Jagannath:Millennium: Honoraria; Celgene: Honoraria; Onyx Pharmaceuticals: Honoraria; Merck: Honoraria; OrthoBiotec. Imedex: Membership on an entity's Board of Directors or advisory committees; Medicom World Wide: Membership on an entity's Board of Directors or advisory committees; Optum Health Education: Membership on an entity's Board of Directors or advisory committees; PER Group: Membership on an entity's Board of Directors or advisory committees.
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5

Квітіньйо Макарена Мартінез, Соріано Федеріко Ґонзало, Яйченко Вірджинія, Стіб Бренда e Барейро Хуан Пабло. "Predictors of Picture Naming and Picture Categorization in Spanish". East European Journal of Psycholinguistics 6, n. 1 (30 giugno 2019): 6–18. http://dx.doi.org/10.29038/eejpl.2019.6.1.cui.

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Abstract (sommario):
The aim of this paper was to identify which psycholinguistic variables are better predictors of performance for healthy participants in a picture naming task and in a picture categorization task. A correlation analysis and a Path analysis were carried out. The correlation analysis showed that naming accuracy and naming latency are significant and positively correlated with lexical frequency and conceptual familiarity variables, whereas they are negatively correlated with H index. Reaction times in the categorization task were negatively correlated with lexical frequency and conceptual familiarity variables and positively correlated with visual complexity variable. The Path analysis showed that subjective lexical frequency and H index are the better predictors for picture naming task. In picture categorization task, for reaction times, the better predictor variables were subjective lexical frequency, conceptual familiarity and visual complexity. These findings are discussed considering previous works on the field. References Akinina, Y., Malyutina, S., Ivanova, M., Iskra, E., Mannova, E., & Dragoy, O. (2015). Russian normative data for 375 action pictures and verbs. Behavior research methods, 47(3), 691-707. doi: 10.3758/s13428-014-0492-9 Alario, F. X., & Ferrand, L. (1999). A set of 400 pictures standardized for French: Norms for name agreement, image agreement, familiarity, visual complexity, image variability, and age of acquisition. Behavior Research Methods, Instruments, & Computers, 31(3), 531-552. Alario, F. X., Ferrand, L., Lagnaro, M., New, B., Frauenfelder, U. H., & Seguí, J. (2004). Pre­dictors of picture naming speed. Behavior Research Methods, Instruments and Computers, 36, 140-155. doi: 10.3758/BF03195559 Albanese, E., Capitani, E., Barbarotto, R., & Laiacona, M. (2000). Semantic category disso­ciations, familiarity and gender. Cortex, 36, 733-746. Almeida, J., Knobel, M., Finkbeiner, M., & Caramazza, A. (2007). 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Picture naming by young children: Norms for name agreement, familiarity, and visual complexity. Journal of Experimental Child Psychology, 65(2), 171-237. doi: 10.1006/jecp.1996.2356 D´amico, S., Devescovi, A., & Bates, E. (2001). Picture naming and lexical access in italian children and adults. Journal of Cognition and Development, 2(1), 71-105. Dell´Acqua, R., Lotto, L., & Job, R. (2000). Naming times and standardized norms for the Italian PD/DPSS set of 266 pictures. Direct comparisons with American, English, French and Spanish published databases. Behavior Research Methods, Instruments, & Computers, 31, 588-615. Ellis, A. W., & Morrison, C. M. (1998). Real age of acquisition effects in lexical retrieval. Journal of Experimental Psychology: Learning, Memory & Cognition, 24, 515-523. doi: 10.1037/0278-7393.24.2.515 Forster, K. I., & Forster, J. C. (2003). DMDX: A Windows display program with millisecond accuracy. 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Gulf Arabic nouns and verbs: A standardized set of 319 object pictures and 141 action pictures, with predictors of naming latencies. Behavior Research Methods, 50(6), 2408-2425. doi: 10.3758/s13428-018-1019-6 Laws, K. R. (1999). Gender afects latencies for naming living and nonliving things: implications for familiarity. Cortex, 35, 729–733. Laws, K. R. (2000). Category-specificity naming errors in normal subjects: The influence of evolution and experience. Brain and Language, 75, 123-133. doi: 10.1006/brln.2000.2348 Laws, K. R., & Neve, C. (1999). A `normal` category-specific advantage for naming living things. Neuropsychologia, 37, 1263-1269. doi: 10.1016/S0028-3932(99)00018-4 Lloyd-Jones, T. J., & Humphreys, G. W. (1997). Perceptual differentiation as a source of category effects in object processing: evidence from naming and object decision. Memory and Cognition, 25, 18-35 doi: 10.3758/BF03197282 Manoiloff, L., Artstein, M., Canavoso, M., Fernández, L., & Seguí, J. (2010). 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Fuster, Valentin, Lars E. Rydén, Richard W. Asinger, David S. Cannom, Harry J. Crijns, Robert L. Frye, Jonathan L. Halperin et al. "ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation31This document was approved by the American College of Cardiology Board of Trustees in August 2001, the American Heart Association Science Advisory and Coordinating Committee in August 2001, and the European Society of Cardiology Board and Committee for Practice Guidelines and Policy Conferences in August 2001.32When citing this document, the American College of Cardiology, the American Heart Association, and the European Society of Cardiology would appreciate the following citation format: Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Lévy S, McNamara RL, Prystowsky EN, Wann LS, Wyse DG. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2001;38:XX-XX.33This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www.americanheart.org), the European Society of Cardiology (www.escardio.org), and the North American Society of Pacing and Electrophysiology (www.naspe.org). Single reprints of this document (the complete Guidelines) to be published in the mid-October issue of the European Heart Journal are available by calling +44.207.424.4200 or +44.207.424.4389, faxing +44.207.424.4433, or writing Harcourt Publishers Ltd, European Heart Journal, ESC Guidelines – Reprints, 32 Jamestown Road, London, NW1 7BY, United Kingdom. Single reprints of the shorter version (Executive Summary and Summary of Recommendations) published in the October issue of the Journal of the American College of Cardiology and the October issue of Circulation, are available for $5.00 each by calling 800-253-4636 (US only) or by writing the Resource Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20814. To purchase bulk reprints specify version and reprint number (Executive Summary 71-0208; full text 71-0209) up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or E-mail: pubauth@heart.org." Journal of the American College of Cardiology 38, n. 4 (ottobre 2001): 1266. http://dx.doi.org/10.1016/s0735-1097(01)01586-8.

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Castro, Pedro, Ana Rita Silva, Alice Lança, Nuno Oliveira e Rui Alves. "MO731: Predictors of Early and 1-Year Mortality After an Acute Coronary Event in Haemodialysis Patients". Nephrology Dialysis Transplantation 37, Supplement_3 (maggio 2022). http://dx.doi.org/10.1093/ndt/gfac079.011.

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Abstract BACKGROUND AND AIMS Cardiovascular disease (CVD) is the leading cause of mortality in haemodialysis (HD) patients (40%), mainly secondary to a coronary event (17%). According to the European Society of Cardiology (ESC), beta-blockers (BBs), anti-platelets, angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs) and statins are the cornerstones of CVD prevention. However, a great percentage of dialysis patients remain undermedicated. Our aim is to identify the predictors of mortality in HD patients after an acute myocardial infarction (AMI) during hospitalization and 1 year after the cardiac event. Methods We performed an observational retrospective study of all HD patients admitted to the coronary intensive care unit between January 2017 and December 2020 due to a myocardial infarction. Our variables of interest were collected before and after hospital discharge and 1 year after. We assessed patients’ frailty using the clinical frailty scale (CFS) and baseline cardiovascular (CV) risk using ESC’s classification; as we focused in HD patients (very-high risk of CVD), we classified CV risk regardless of the kidney disease. IBM SPSS 23.0 was used to perform statistical analysis; the confidence interval (CI) was set at 95%. RESULTS We collected 70 patients (males: n = 51, 73.2%), with a mean age of 70.9 ± 12.2 years and a median time in HD of 73.2 ± 60 months. Identifiable CV risk factors were: dyslipidaemia (98.6%), arterial hypertension (95.7%), heart failure (74.3%), diabetes (57.1%) and obesity (55.7%); mean total cholesterol and low-density lipoprotein cholesterol (LDL) levels were 151 ± 39.6 and 97.5 ± 34.1 mg/dL, respectively. As a result, 81.4% of our sample was classified as having a very high baseline CV risk. Before admission, most patients were on statin therapy (87.1%), but only 34.2% were taking the proper statin class/dosage adjusted to their CV risk. In fact, only 7.1% were previously medicated with all prognosis-modifying drugs (ACEis/ARBs, statins, anti-platelets and BBs). The mean hospitalization stay was 10.3 ± 9 days, and the early mortality rate (30 days post-admission) was 18.6%. Mortality was higher in older patients (72.5 ± 10.3 versus 69.1 ± 10.9 years; P = .3), males (21.6 versus 10.5%), with longer HD vintage (82.8 ± 46.8 versus 70.8 ± 48 months; P = 0.41) and higher CV risk (very-high CV risk, 84.6 versus 80%; P = .7); hypoalbuminemia (serum albumin &lt; 3.0 g/dL) (OR 5.4, 95% CI 1.2–25.1; P = .028) and higher frailty score (CFS ≥ 4) (OR 6.1, 95% CI 1.2–30.0; P = .002) prompt a worse short-term prognosis. The mortality rate after 1 year was 30%, with a median time of 5.6 ± 2.4 months since the cardiac event. Mortality was also higher in older patients (71.5 ± 10 versus 69 ± 10 years; P = .34), males (31.3 versus 26.3%; P = 0.70), with longer dialysis vintage (85.2 ± 45.6 versus 67.2 ± 48; P = .14) and longer hospitalizations (12.8 ± 9.9 versus 9.3 ± 8.3; P = .12). After discharge, patients prescribed with at least three prognosis-modifying drugs had a lower 1-year mortality rate (3.2 versus 26.9%; OR 11, 95% CI 1.2–97.0; P = .003). Hypoalbuminemia (OR 9.4, 95% CI 2.3–4.3’; P = .002) and higher frailty scores (CFS ≥ 4) (OR 4.1, 95% CI 1.2–14.0; P = .025) were associated with worse outcomes. CONCLUSION We concluded that most HD patients were undermedicated prior to a coronary event given their baseline CV risk. Despite most studies in HD patients did not find a beneficial long-term effect of starting statin therapy after HD initiation, one must always individualize therapy according to the patient's CV risk. In our series, better-nourished patients with at least three prognosis-modifying drugs had a lower mortality rate, which highlights the importance of these drugs on survival together with optimal nutritional care.
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