BackgroundAlthough there are robust data about the pathophysiology and prognostic implications of left ventricular (LV) systolic dysfunction in patients with acquired heart disease, similar prognostic data about LV systolic dysfunction are sparse in the tetralogy of Fallot (TOF) population. The purpose of this study was to perform a meta-analysis of all studies that assessed the relationship between LV ejection fraction (LVEF) and cardiovascular adverse events (CAEs) defined as death, aborted sudden death, or sustained ventricular tachycardia.MethodsWe used random-effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsOf the 1,809 citations, 7 studies with 2,854 patients (age 28 ± 4 years) were included. During 5.6 ± 3.4 years' follow-up, there were 82 deaths, 17 aborted sudden cardiac deaths, and 56 sustained ventricular tachycardia events. Overall, CAEs occurred in 5.1% (144 patients). As a continuous variable, LVEF was a predictor of CAE (HR 1.29, 95% CI, 1.09-1.53, P = 0.001) per 5% decrease in LVEF. Similarly, LVEF < 40% was also a predictor of CAE (HR 3.22, 95% CI, 2.16-4.80, P < 0.001).ConclusionsLV systolic dysfunction was an independent predictor of CAE, and we observed a 30% increase in the risk of CAE for every 5% decrease in LVEF, and a 3-fold increase in the risk of CAE in patients with LVEF <40% compared with other patients. These findings underscore the importance of incorporating LV systolic function in clinical risk stratification of patients with TOF and the need to explore new treatment options to address this problem. 相似文献
Immuno-oncology therapies engage the immune system to treat cancer. BiTE (bispecific T-cell engager) technology is a targeted immuno-oncology platform that connects patients' own T cells to malignant cells. The modular nature of BiTE technology facilitates the generation of molecules against tumor-specific antigens, allowing off-the-shelf immuno-oncotherapy. Blinatumomab was the first approved canonical BiTE molecule and targets CD19 surface antigens on B cells, making blinatumomab largely independent of genetic alterations or intracellular escape mechanisms. Additional BiTE molecules in development target other hematologic malignancies (eg, multiple myeloma, acute myeloid leukemia, and B-cell non-Hodgkin lymphoma) and solid tumors (eg, prostate cancer, glioblastoma, gastric cancer, and small-cell lung cancer). BiTE molecules with an extended half-life relative to the canonical BiTE molecules are also being developed. Advances in immuno-oncology made with BiTE technology could substantially improve the treatment of hematologic and solid tumors and offer enhanced activity in combination with other treatments. 相似文献
There is an increased mortality associated with adrenal insufficiency despite glucocorticoid replacement therapy with a standardized mortality ratio greater than two. The cause of the increased mortality is yet to be definitively elucidated, but may be due to excess steroid exposure, or replacement regimens that are uncoupled from the normal physiological cortisol profile. Cortisol secretion follows an ultradian pattern which is not possible to reproduce using oral replacement. With the advent of new pumps, it is now possible to mimic the pulsatility of the adrenal glands. While the cognitive and emotional benefits of reproducing the ultradian rhythm are known, the presence of long‐term benefits is not yet clear. There is a dearth of evidence and high‐quality studies to underline our current understanding of the pathophysiology of adrenal insufficiency and replacement therapy. There is a particular lack of research comparing objective outcomes between patients receiving hydrocortisone replacement (either standard therapy or new sustained release preparations), prednisolone replacement and ultradian pumps. Direct comparative studies are now warranted to understand the optimal approach. 相似文献
Objective: To examine the effect of race differences on sprint performance, Hemoglobin (Hb), Hematocrit (Ht) and plasma volume (PV) variation in response to repeated sprint exercise.
Design: Thirty-six healthy, moderately trained men and women (20.8?±?0.2 year-old) volunteered to participate in this study. They were allocated to one of the four groups according to their gender and race: Black men’s group (BM, n?=?9), White men’s group (WM, n?=?9), Black women’s group (BW, n?=?9) and White women’s group (WW, n?=?9). All participants performed the running-based anaerobic sprint test (RAST), which consists of six?35-m sprints with 10 s of recovery in-between. Six venous blood samples were collected to determine Hb, Ht and PV levels at rest, after warm-up, immediately post- and at 5, 15 and 30 min post-RAST. Blood lactate is also sampled during the 3rd minutes of recovery.
Results: The best running time was significantly shorter (P?=?.002) in BW compared to WW. We have observed significantly higher Hb (P?=?.010) and Ht (P?=?.004) levels in BW compared to WW during the 5th minute of recovery. During RAST, the PV decreased significantly (P?=?.007) in WM only. Black groups had lower (P?<?.05) lactate levels compared to the white subjects. During recovery, PV increase was significantly (P?=?.003) higher in WW compared to BW during the 5th minute of recovery.
Conclusion: This study demonstrated that sprint and repeated sprint performances were different between white and black women. Differences in anaerobic performance between the groups were associated with racial differences in lactate levels and blood count among women’s group during recovery time. Hence, it is important to take into account this race-related difference in hematological parameters in responses to intense efforts. 相似文献