BACKGROUND: Cardiac resynchronization therapy (CRT) has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony. While CRT improves symptoms, reduces hospitalizations, and enhances survival, the role of implantable cardioverter-defibrillators (ICDs) alongside CRT in patients with non-ischemic cardiomyopathy (NICM) remains controversial. To evaluate and compare the outcomes of CRT with ICD (CRT-D) versus CRT with pacemaker-only (CRT-P) in individuals diagnosed with NICM, with a specific focus on the elderly. METHODS: A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted in January 2024. Studies comparing CRT-D and CRT-P in patients with NICM were included, with subgroup analyses focusing on patients aged 75 years and older. RESULTS: Twelve studies, including two randomized clinical trials, with a total of 62,145 patients and 16,754 pooled death events (9,171 in CRT-D and 7,583 in CRT-P), were analyzed. CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P (pooled OR = 0.72; 95% CI: 0.61-0.85; P < 0.01), with significant heterogeneity (I ² = 83%). RCT subgroup analysis, was not statistically significant (pooled OR = 0.82; 95% CI: 0.64-1.06; P = 0.41; I ² = 0%). In patients older than 75 years, no significant difference in mortality risk was observed (pooled OR 0.96; 95% CI: 0.81-1.15; I ²=39%). CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality. However, this benefit does not extend to cardiovascular mortality, likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure. The survival advantage of CRT-D is most pronounced in younger patients, with those over 75 years of age deriving less benefit. This highlights the importance of careful patient selection, considering age and comorbidities, when deciding on ICD implantation in NICM patients.

BACKGROUND/AIMS: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. METHODS: This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding. RESULTS: A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. CONCLUSIONS: Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.
Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Inpatients ; Intensive Care Units ; Patient Outcome Assessment ; Retrospective Studies

PURPOSE: The use of tolerogenic dendritic cells (TolDCs) to control exacerbated immune responses may be a prophylactic and therapeutic option for application in autoimmune and allergic conditions. The objective of this work was to evaluate the effects of TolDC administration in a mouse model of allergic airway inflammation caused by mite extract. METHODS: Mouse bone marrow-derived TolDCs were induced by incubation with granulocyte-macrophage colony-stimulating factor (GM-CSF) and dexamethasone, and then characterized by flow cytometry and cytokine production by enzyme-linked immunosorbent assay (ELISA). For the in vivo model of Blomia tropicalis-induced allergy, mice transplanted with antigen-pulsed TolDCs were sensitized intraperitoneally with B. tropicalis mite extract (BtE) adsorbed to aluminium hydroxide. After challenge by nasal administration of BtE, bronchoalveolar lavage fluid (BALF), lungs, spleen and serum were collected for analysis. RESULTS: Induction of TolDCs was efficiently achieved as shown by low expression of major histocompatibility complex (MHC) II, programmed death-ligand (PD-L) 2 and pro-inflammatory cytokine production, and up-regulation of interleukin (IL)-10, upon LPS stimulation in vitro. Transplantation of 1 or 2 doses of BtE-pulsed TolDCs reduced the number of inflammatory cells in BALF and lungs as well as mucus deposition. Moreover, compared to saline-injected controls, TolDC-treated mice showed lower serum levels of anti-BtE immunoglobulin E (IgE) antibodies as well as reduced Gata3 and IL-4 gene expression in the lungs and decreased IFN-γ levels in the supernatant of splenocyte cultures Transplantation of TolDCs increased the percentage of the regulatory T cells in the spleen and the lungs. CONCLUSIONS: Preventive treatment with TolDCs protects against dust mite-induced allergy in a mouse model, reinforcing the use of tolerogenic dendritic cells for the management of allergic conditions.
Administration, Intranasal ; Animals ; Antibodies ; Antigens, Dermatophagoides ; Asthma ; Bronchoalveolar Lavage Fluid ; Dendritic Cells* ; Dexamethasone ; Dust* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Gene Expression ; Granulocyte-Macrophage Colony-Stimulating Factor ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; In Vitro Techniques ; Inflammation* ; Interleukin-4 ; Interleukins ; Lung ; Major Histocompatibility Complex ; Mice ; Mites* ; Mucus ; Spleen ; T-Lymphocytes, Regulatory ; Up-Regulation

This erratum is being published to correct the printing error on page 406 of the article. Corrections for author names are needed.