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Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults.
No full textnot availabl
Acute ischemic stroke
No full textIn the Clinical Practice article by
van der Worp and van Gijn (Aug. 9 issue),1 the question
of the age at which a patient could be selected
for treatment with intravenous thrombolysis warrants
further attention. According to the Safe Implementation
of Thrombolysis in Stroke Monitoring
Study (SITS-MOST) selection criteria,2 this
treatment cannot be delivered to patients older
than 80 years of age in routine clinical practice,
but it has been shown that early treatment with
recombinant tissue plasminogen activator (rt-PA)
in carefully selected elderly patients is as safe and
efficacious as it is in younger patients.3 A specific
randomized trial is highly advisable before implementation
of this therapy in routine clinical practice.
The authors discuss the use of alteplase, but
they do not discuss other fibrinolytic drugs (such
as tenecteplase and desmoteplase) as being potential
alternatives to this agent
Ordinamenti interconnessi. Il contributo dell'interlegalità alla regolazione della rete.
No full textDall’armonizzazione all’interlegalità: la tutela dell’utente finale nella disciplina europea del diritto d’autore
No full textComplice la sua longevità, il diritto d’autore è in costante evoluzione. Motore del suo rinnovamento è oggi la tecnologia digitale, che ha introdotto nuove infrastrutture e prassi nella produzione e consumo di opere creative e ne ha messo in discussione numerosi profili normativi. L’ambiente digitale ha infatti acuito la contrapposizione tra autori ed utenti finali, polarizzando il dibattito pubblico e rimarcando la centralità del dilemmatico trade-off tra diritti di esclusiva ed accesso ai contenuti. Incapace di sciogliere tale nodo normativo da sé, il diritto d’autore europeo si interroga, in maniera sempre più ricorrente, sull’efficacia delle proprie disposizioni nel calibrare gli interessi in gioco in un contesto tecnologico in rapido cambiamento. A fronte di recenti riforme legislative ed una fiorente giurisprudenza, lo studio si sofferma sulla prospettiva dell’utente finale, contestualizzandola non solo all’interno del processo di armonizzazione ed “europeizzazione” del diritto d’autore attualmente in corso, bensì anche nel contesto digitale. Così facendo, l’analisi intende andare oltre le constatazioni relative alla persistente frammentazione territoriale della disciplina e pone enfasi sullo sfaccettato significato che la nozione di giusto equilibrio assume online. Richiamare l’attenzione sulle diverse razionalità normative coinvolte nella tutela dell’utente finale si dimostra un esercizio affine alla nozione di interlegalità, che ben ne inquadra le caratteristiche di concomitanza ed interdipendenza. L’utilità di tale approccio analitico si manifesta tanto sul piano descrittivo quanto su quello prescrittivo, mettendo in luce l’emergente e necessaria consapevolezza della normatività tecnologica quale legalità “altra” e concorrente nel definire il giusto equilibrio nel diritto d’autore europeo e digitale
Stroke symptoms and the decision to call for an ambulance: turn on people's minds!
No full textWe read with great interest the article by Mosley et al1 on
factors related to calling an ambulance for stroke patients. The
authors reported that “stroke” was referred as the problem
(unprompted) by 50% of callers, whereas fewer than half of the
calls were made within 1 hour from symptom onset. We agree
with the authors on the necessity of interventions to more strongly
link stroke recognition to immediate action to increase the
number of stroke patients eligible for acute treatment.
With the aim of evaluating the impact of a community intervention
on stroke perception among people, we have administered a
structured questionnaire to all participants in 2 distinct stroke
initiatives, in which people were given a free screening for
cerebrovascular risk assessment.
These initiatives, which included clinical and instrumental
(carotid and vertebral ultrasound scanning) examinations, took
place in Pisa in May and September 2006, and were potentially
addressed to all inhabitants of the city (85 000 people). Before
the screening, all participants were asked to fill in a questionnaire
composed of multi-option questions about stroke definition,
incidence, symptoms, consequences, and behavior in case of
stroke. In the months between the 2 initiatives, a widespread
stroke information campaign (specific posters, leaflets an booklets
dispensed in drugstores and in offices of General Practitioners,
in addition to those given at the end of the screening during
the first stoke initiative in May 2006; articles published in local
newspapers; announcements and Neurologist interviews shown
by local television) was implemented. The characteristics of the participants to these 2 initiatives
(before and after stroke information campaign) and the answers
given to the questionnaires are shown in the Table. Despite the
older age and a comparable educational level, the participants in
the second stroke initiative showed an overall better knowledge
about stroke than the participants to the previous one.
Our data show that information campaigns addressed to the
community represent a powerful tool to enhance people knowledge
about stroke. In particular, in accordance with a previous
study,2 we think that providing continuous, full, and at the same
time concise information about stroke (explaining all the items of
our questionnaire, for instance) is an educationally correct
method to link stroke recognition to rapid call for ambulance and
acute treatment implementation
Stroke and age-brain barrier: how many bricks in the wall?
No full textAlthough older people contribute more and more to the increasing social burden of stroke, they are often excluded from potentially effective treatments in clinical practice. With the aim to separate myth from reality, we have examined the barriers preventing such therapies (with reference to atrial fibrillation, thrombolysis, carotid stenosis and patent foramen ovale) in the elderly. We conclude that elevated age alone should not be considered an exclusion criterion and both stroke physicians and researchers should make efforts to greatly improve management of these patients
Regarding "In-stent restenosis after carotid artery stenting is asynptomatic because of low embolic potential"
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