1,721,037 research outputs found
Hormonal alterations in heart failure: anabolic impairment in chronic heart failure - diagnostic, prognostic and therapeutic issues
No full textChronic heart failure represents a leading cause of mortality and health care expenditure in developed countries. In the last 20 years, medical therapy of heart failure has dramatically changed thanks to the introduction of agents able to significantly reduce the neurohormonal hyperactivation that underpins the syndrome, and to the growing opportunities of electrical therapies. Although major advances in terms of improved survival and quality of life have been achieved, the reduction in the burden of heart failure is still the primary goal of cardiovascular societies. In the last decades, other research lines have also grown to complement the neurohormonal paradigm. It is increasingly evident that several hormonal systems are down-regulated or impaired in patients with heart failure, including growth and thyroid hormones, androgens and insulin. These abnormalities could be considered interrelated and linked, in turn, to the neurohormonal and cytokine hyperactivation. Since most of these alterations provide prognostic information, these new lines of evidence support the extension of the classical neurohormonal scheme to a more comprehensive pathophysiological model that includes multiple hormonal and metabolic deficiencies. This chapter examines the evidence in support of this concept. Preliminary experience concerning targeted hormonal supplementation or metabolic modulation is also briefly reviewed in this article
GH and the cardiovascular system: an update on a topic at heart
Full text linkIn this review, the importance of growth hormone (GH) for the maintenance of normal cardiac function in adult life is discussed. Physiological effects of GH and underlying mechanisms for interactions between GH and insulin-like growth factor I (IGF-I) and the cardiovascular system are covered as well as the cardiac dysfunction caused both by GH excess (acromegaly) and by GH deficiency in adult hypopituitary patients. In both acromegaly and adult GH deficiency, there is also increased cardiovascular morbidity and mortality possibly linked to aberrations in GH status. Finally, the status of the GH/IGF-I system in relation to heart failure and the potential of GH as a therapeutic tool in the treatment of heart failure are reviewed in this article. © 2014 The Author(s)
Hormone replacement therapy in heart failure
No full textDespite major advances in medical treatments, survival rates of chronic heart failure (CHF) have not significantly changed in the past 50 years, making it imperative to search for novel pathophysiological mechanisms and therapeutic targets. In this article, we summarize the current knowledge regarding the possibility to treat such anabolic deficiencies with hormone replacement therapy (HRT)
Growth Hormone Therapy in Heart Failure
No full textSeveral studies have shown that growth hormone (GH) deficiency is common in chronic heart failure and is associated with impaired functional capacity and poor outcomes. Data derived from animal models showed beneficial effects of GH treatment on peripheral vascular resistance, cardiac function, and survival. Despite this solid background, when translated onto the clinical field, these results did not lead to unequivocal results. This article focuses on the assessment of GH deficiency in chronic heart failure, the underlying molecular background, the impact on disease progression and outcomes, the effects of GH therapy, and the novel and more encouraging approach of GH-replacement therapy
The GH/IGF-1 axis in chronic heart failure.
No full textThe classic model of Chronic Heart Failure (CHF) is rooted in the overexpression of neurohormonal molecules. To complement this paradigm, increasing evidence indicates that a variety of hormones may be down-regulated in CHF patients. The list includes growth hormone (GH) and its tissue effector insulin-like growth factor-1 (IGF-1). The GH/IGF-1 axis regulates cardiac growth, stimulates myocardial contractility, and influences the vascular system. The relationship between the GH/IGF-1 axis and the cardiovascular system has been extensively demonstrated in numerous studies in animals models and confirmed by the cardiac derangements secondary to both GH excess and deficiency in humans. Impaired activity of the GH/IGF-1 axis in CHF has been described by several independent groups and includes a wide array of abnormalities, including low IGF-1 levels, GH deficiency (GHD), and GH resistance that may be related to the severity of heart disease. According to several observations, these derangements are associated with poor clinical status and outcome. Since the first study of GH therapy in CHF in 1996, several placebo-controlled trials have been conducted with conflicting results. These discordant findings are likely explained by the degree of CHF-associated GH/IGF-1 impairment that may impact on individual responsiveness to GH administration. Biological actions of GH and IGF-1, cardiovascular implication of GH deficiency and GH excess, relation between somatotrophic axis and CHF are discussed. Results from trials of GH therapy, emerging therapeutic strategies, safety issues, and lack in evidence are also reported
The dual relationship between polypharmacy and frailty in nursing home residents: polypharmacy as a cause or a consequence?
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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