1,720,999 research outputs found
Predittori clinici, radiologici e biologici di decorso clinico in pazienti con fibrosi polmonare idiopatica.
No full textLa fibrosi polmonare idiopatica (IPF) è una malattia polmonare cronica e progressiva ad eziologia non nota. La prognosi dei pazienti affetti da IPF è scarsa e il decorso clinico dell'IPF è altamente variabile da paziente a paziente ed imprevedibile nel tempo, alternando periodi di stabilità a periodi di rapido declinico clinico e funzionale.
Alcuni criteri di stadiazione sono stati presi in considerazione per stimare la prognosi e per guidare le decisioni terapeutiche nei pazienti affetti da IPF. Tuttavia, ad oggi il tasso di mortalità per IPF non è cambiato in modo significativo dopo la recente diffusione dei due nuovi farmaci antifibrosanti nintedanib e pirfenidone, sottolineando la necessità di una comprensione più completa dei meccanismi di patogenesi della malattia e nel predire il comportamento clinico della IPF.
In questa tesi sono stati studiati i potenziali indicati clinici, radiologici e biologici di andamento clinico nei pazienti affetti da IPF. In particolare, ho dimostrato che le opacità a vetro smerigliato visibili alla TC eseguita al momento della diagnosi sono associate ad un peggiore declino funzionale e aumentano nel tempo in quei pazienti che progrediscono nonostante la terapia. Il polimorfismo di MUC5B influisce sulla prognosi dei pazienti con IPF in trattamento antifibrosante e, in particolare, il portatore dell'allele T mutante è associato ad un aumento delle opacità del vetro smerigliato e ad una peggiore sopravvivenza. I follicoli linfoidi sono strutture fondamentali nella storia naturale dell'IPF e nella progressione di malattia.
Negli ultimi tre o quattro anni alcuni dati hanno sottolineato che quasi il quaranta per cento dei pazienti con malattia polmonare interstiziale non-IPF, può presentare un decorso clinico simile all'IPF nonostante siano trattati con farmaci specifici per la malattia di base; queste entità cliniche vengono deifinite fibrosi polmonari progressive (PPF). Nel mio progetto di ricerca ho identificato dunque il fenotipo progressivo tra i pazienti affetti da miopatie infiammatorie idiopatiche (IIM) seguiti nel nostro centro, e ho descritto i pazienti che presentavano un fenotipo progressivo.
Infine, la mia ricerca sulla malattia da Coronavirus 19 (COVID-19) ha valutato che l'ecografia toracica è uno strumento utile nella pratica clinica perché correla con i parametri clinici e radiografici. La carica virale sul tampone nasofaringeo alla diagnosi di COVID-19 è simile nei pazienti asintomatici e ricoverati in ospedale e non è associata a nessun esito peggiore durante il ricovero. Una minoranza di pazienti con polmonite COVID-19 presenta anomalie polmonari al follow-up radiologico di 6 mesi. Questi pazienti sono prevalentemente maschi, più anziani e con una degenza ospedaliera più lunga. La presenza di reticolazioni e consolidamenti al ricovero in ospedale può predire la persistenza di anomalie radiologiche.Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease, with an unknown leading cause. The prognosis of IPF is poor and the clinical course of IPF is highly heterogeneous and unpredictable, alternating periods of stability to periods of rapid deterioration.
Staging systems are increasingly considered to estimate prognosis and to guide management decisions in IPF. Nonethelss, to date the mortality rate for IPF is not significantly changed after the recent worldwide diffusion of the two new antifibrotic drugs nintedanib and pirfenidone, emphasizing the need for a more complete understanding in the mechanisms of disease pathogenesis and in predicting IPF clinical behavior.
In this thesis potential clinical, radiological and biological predictors of disease course in IPF were investigated. Specifically, I demonstrated that ground glass opacities at CT scan performed at diagnosis are associated with worse functional decline in IPF patients, and increase over time among progressors. MUC5B polymorphism affects prognosis of the IPF patients on antifibrotic treatment and carrying the mutant T allele is associated to increased ground glass opacities and worst survival. Lymphoid follicles are fundamental structures in IPF natural history and progression of patients with IPF.
In the last three or four years some evidence suggested that almost the forty per cent of non-IPF interstitial lung disease patients, currently treated with specific treatment, may present a clinical course similar to IPF and were named progressive pulmonary fibrosis (PPF). In my research project, I identified the progressive phenotype among the idiopathic inflammatory myopathies (IIMs) of patients followed in our center, and I described patients presenting a progressive phenotype.
Finally, my Coronavirus Disease 19 (COVID-19) research assessed that ultrasound is a useful tool in clinical practice because it correlates with clinical and radiographic parameters. Viral load on nasopharyngeal swab at diagnosis of COVID-19 is similar in asymptomatic and hospitalized patients and is not associated with either worse outcome during hospitalization. A minority of patients with COVID-19 pneumonia showed persisting lung abnormalities at the 6-month follow-up. These patients are predominantly older males with longer hospital stay. The presence of reticulations and consolidation at hospital admission may predict the persistence of radiological abnormalities
Novel drug targets for idiopathic pulmonary fibrosis
No full textIdiopathic Pulmonary Fibrosis (IPF) is a progressive, fatal lung disorder of unknown cause with a highly variable and unpredictable clinical course. The advances made in deciphering IPF pathobiology over the last decades have led to the approval of two anti-fibrotic molecules, pirfenidone and nintedanib, that showed to be effective in significantly reducing the rate of progression of the disease. Such pharmacological breakthroughs represent a dramatic change in the management of these patients and are reflected in updated international guidelines. However, the need to find a cure for this devastating disease remains unmet and the development of novel therapeutic agents remains hurdled by several factors. Here, we review the latest insights into therapeutic approaches for IPF and the available evidence for the most promising novel compounds currently under development, and discuss the challenges and evolution of IPF clinical research over the next few years
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
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
CA 19-9 serum levels in patients with end-stage idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs): Correlation with functional decline
Full text linkIdiopathic pulmonary fibrosis presents a progressive and heterogeneous functional decline. CA 19-9 has been proposed as biomarker to predict disease course, but its role remains unclear. We assessed CA 19-9 levels and clinical data in end-stage ILD patients (48 IPF and 20 non-IPF ILD) evaluated for lung transplant, to correlate these levels with functional decline. Patients were categorized based on their rate of functional decline as slow (n = 20; ΔFVC%pred ≤ 10%/year) or rapid progressors (n = 28; ΔFVC%pred ≥ 10%/year). Nearly half of the entire patients (n = 32; 47%) had CA 19-9 levels ≥37kU/L. CA 19-9 levels in IPF were not different from non-IPF ILD populations, however, the latter group had a median CA 19-9 level above the normal cut-off value of 37 KU/l (60 [17-247] kU/L). Among IPF patients, CA 19-9 was higher in slow than in rapid progressors with a trend toward significance (33vs17kU/L; p = 0.055). In the whole population, CA19-9 levels were inversely related with ΔFVC/year (r = -0.261; p = 0.03), this correlation remained in IPF patients, particularly in rapid progressors (r = -0.51; p = 0.005), but not in non. Moreover, IPF rapid progressors with normal CA 19-9 levels showed the greater ΔFVC/year compared to those with abnormal CA 19-9 (0.95 vs. 0.65 L/year; p = 0.03). In patients with end-stage ILD, CA 19-9 may represent a marker of disease severity, whereas its level is inversely correlated with functional decline, particularly among IPF rapid progressors
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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