Background The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). Methods Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). Results The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. Conclusions In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.
Рязанский государственный медицинский университет им. акад. И.П. Павлова, г. Рязань Целью исследования было оценить распространенность поведенческих факторов риска и информированность населения Рязанской области о них. В исследование было включено 367 человек городского населения 25-64 лет, проживающих в Железнодорожном районе г. Рязани. Среди включенных в исследование было 157 (42,8%) мужчин и 210 (57,2%) женщин. Распределение граждан по полу и возрасту в выборке соответствовало распределению по полу и возрасту населению Рязанской области (p>0,05). При изучении вреда от различных факторов риска опрошенные придавали меньшее значение избыточной массе тела, повышенному артериальному давлению и правильному питанию, чем курению, физической активности или алкоголю. Наиболее популярными источниками информации о факторах риска был интернет, телевидение и научно-популярная литература. Среди всех обследованных 35% мужчин и 8% женщин курили в настоящее время. 9% принимали более 5-6 доз алкоголя за 1 раз, что свидетельствует о необходимости формирования культуры его употребления. 4,5% опрошенных злоупотребляли алкоголем. Характер питания населения существенно отличался от рекомендуемого в настоящее время. Уровень тревоги/депрессии населения с 2011 года практически не изменился и составляет 40,3%. Несмотря на небольшие позитивные тенденции в уменьшении распространенности некоторых факторов риска (курение, употребление алкоголя) их уровень все еще остается высоким и это диктует необходимость дальнейшей работы по популяризации здорового образа жизни, рационального питания и борьбу с имеющимися факторами риска сердечно-сосудистых заболеваний.Ключевые слова: мониторинг факторов риска, эпидемиология, хронические неинфекционные заболевания, курение, питание, программа профилактики. MONITORING BEHAVIORAL RISK FACTORS FOR CHRONIC NONCOMMUNICABLE DISEASES IN 2014 E.V. FilippovTo estimate the prevalence of behavioral risk factors and awareness of the Ryazan area about them. The study included 367 people of the urban population aged 25-64 years living in the Railway area of Ryazan. Among the included in the study was 157 (42,8%) men and 210 (57,2%) women. Distribution of citizens by sex and age in the sample corresponds to the distribution by sex and age of the population of the Ryazan region (p>0,05). In the study of harm from a variety of risk factors respondents gave less importance overweight, high blood pressure and nutrition, physical activity than smoking or alcohol. The most popular sources of information on risk factors was the Internet, television, and popular scientific literature. Among all the examined 35% of men and 8% of women currently smoke. 9% took more than 5-6 doses of alcohol for 1 time, indicating the need for building a culture of its use. 4,5% of respondents abused alcohol. Level of anxiety/depression of the population not changed -40,3%. Although not a small positive trend in reducing the prevalence of some risk factors (smoking, alcohol), their level is still high, and this dictates the need for further work t...
A 33-year-old man in Baltimore, Maryland, USA, with untreated HIV infection had a 74-day course of mpox with multiorgan system involvement and unique clinical findings. In this clinical experience combining 3 novel therapeutic regimens, this patient died from severe mpox in the context of untreated HIV and advanced immunodeficiency.
Hydraulic fracturing is an effective way to stimulate oil production, which is currently widely used in various conditions, including complex carbonate reservoirs. In the conditions of the considered field, hydraulic fracturing leads to a significant differentiation of technological efficiency indicators, which makes it expedient to study in detail the crack formation patterns. For all affected wells, the assessment of the resulting fractures spatial orientation was performed using the developed indirect technique, the reliability of which was confirmed by geophysical methods. In the course of the analysis, it was found that in all cases the fracture is oriented in the direction of the development system element area, which is characterized by the maximum reservoir pressure. At the same time, reservoir pressure values for all wells were determined at one point in time (at the beginning of hydraulic fracturing) using machine learning methods. The reliability of the used machine learning methods is confirmed by high convergence with the actual (historical) reservoir pressures obtained during hydrodynamic studies of wells. The obtained conclusion about the influence of the formation pressure on the patterns of fracturing should be taken into account when planning hydraulic fracturing in the considered conditions.
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