Medicina
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Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for "frail patients", in particular due to high surgical risk or drug interaction. ⋯ These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function.
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Background and objectives: Extracorporeal life support (ECLS) is a widely accepted and effective strategy for use in patients presenting with refractory cardiogenic shock. Implantation in awake and non-intubated patients allows for optimized evaluation of further therapy options while avoiding potential side effects associated with the need for sedation and intubation. The aim of the study was the assessment of safety and feasibility of awake ECLS implementation and of outcomes in patients treated with this concept. ⋯ Two patients (13%) died on ECLS support due to multi-organ dysfunction syndrome. Survival to discharge of initially successfully bridged or weaned patients was 64%. Conclusions: Awake ECLS implantation is feasible and safe with the key advantage of omitting or delaying general anesthesia and intubation, with their associated risks in cardiogenic-shock patients, facilitating further decision making.
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Review Meta Analysis
Smoking and Dental Implants: A Systematic Review and Meta-Analysis.
Background and Objectives: Tobacco is today the single most preventable cause of death, being associated with countless diseases, including cancer and neurological, cardiovascular, and respiratory diseases. Smoking also brings negative consequences to oral health, potentially impairing treatment with dental implants. The present review aimed to evaluate the influence of smoking on dental implant failure rates and marginal bone loss (MBL). ⋯ There was an estimated decrease of 0.001 in OR (p = 0.566) and increase of 0.004 mm (p = 0.279) in the MBL MD between groups for every additional month of follow-up, although without statistical significance. Therefore, there was no clear influence of the follow-up on the effect size (OR) and on MBL MD between groups. Conclusions: Implants placed in smokers present a 140.2% higher risk of failure than implants placed in non-smokers.
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Randomized Controlled Trial
Effects of Acupuncture on Cardiac Remodeling in Patients with Persistent Atrial Fibrillation: Results of a Randomized, Placebo-Controlled, Patient- and Assessor-Blinded Pilot Trial and Its Implications for Future Research.
Background and Objectives: In this study, we attempted to determine the effects of acupuncture on cardiac remodeling and atrial fibrillation (AF) recurrence rates in patients with AF after electrical cardioversion (EC). Materials and Methods: We randomly assigned 44 patients with persistent AF to an acupuncture group or a sham acupuncture group. An electroacupuncture treatment session was administered once weekly for 12 weeks at four acupuncture points (left PC5, PC6, ST36, and ST37). ⋯ The AF recurrence rate and cardiac function did not differ significantly between the two groups. At three months, the acupuncture treatment group showed more favorable atrial structural remodeling compared to the sham acupuncture group. Conclusion: In future research on acupuncture in AF management, it is recommended that the inclusion criteria be amended to include only symptomatic AF, that an appropriate control group is designed, and that the acupuncture treatment frequency is increased to several times per week.
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Multicenter Study
Three-Year Outcomes of Wet Age-Related Macular Degeneration Treatment in Polish Therapeutic Programs.
Background and Objectives: Wet age-related macular degeneration (wAMD) is a chronic, progressive disease of the central part of the retina. Standard treatment for wAMD consists of multiple intravitreal injections of anti-vascular endothelial growth factor drugs. The study goal was to evaluate the three-year effectiveness of wAMD treatment with aflibercept and ranibizumab as part of the therapeutic program in routine clinical practice. ⋯ After the first year, there was a significant difference in the distribution of the best corrected visual acuity according to the Early Treatment Diabetic Retinopathy Study protocol, with more frequent values in the ranges > 35 ≤ 70 for this parameter and > 70 letters in the treatment naïve eye subgroup. After the first year, central retinal thickness in treatment-naïve eyes was significantly reduced. Conclusions: Regular treatment of wet age-related macular degeneration as part of the treatment program achieves functional stabilization and significant morphological improvement over a long-term, three-year follow-up, with significantly fewer injections needed after the first year of treatment.