1,720,971 research outputs found
"Effect of permanent right internal mammary artery occlusion on right coronary artery supply. A randomized placebo-controlled clinical trial"
No full textAtypical femur fractures
No full textAlready from the late 1970s, some fractures of the subtrochanteric and diaphyseal region of the femur were defined "atypical" and described as "fatigue" fractures. In 2005, Odvina reported an unusual type of femoral fracture after the administration of alendronate as a result of a severely repressed bone turnover and Lenart defined femoral fractures occurring on the subtrocanteric or diaphyseal region in post-menopause women after alendronate therapy as "atypical" (AFFs). Hence the hypothesis that these fractures could be associated with the use of bisphosphonates (BP). Even with a "normal" dose of BP, the risk of fracture is highest if therapy lasts more than 5 years, although cases have recently been reported with short-term therapies. However, many of the studies on this association did not consider the radiographic patterns and the atypical or typical radiographic definition did not evaluate the BP doses used and patient compliance; they just state if there was an association or not, and this had led to an underestimation of the real incidence of these fractures. It is the latest revision of the diagnostic criteria made in 2013 by the American Society for Bone and Mineral Research (ASBMR) Task Force to determine that to be defined as AFF, a fracture localized along the femoral diaphysis just distal from the small trochanter to just proximal to the supracondylar region must have certain clinical and radiographic patterns. They also defined exclusion and minor criteria. In general, incidence is still low. Considering the incidence of all femoral fractures of about 460/100,000 people-year, the sub-trochanteric ones represent 7 to 10% of these, and atypical ones are even rarer: 32 per million people-year and 5, 9 per 100,000 person-years in a retrospective study from 1996 to 2009. Morbidity and mortality are similar to neck or intertrochanteric femoral fractures. However, AFF was also found in patients who had never used BP, so BP therapy could not be the only risk factor. Among them, recent attention has been given to hypoposphatasia, picnodisostosis with mutant catepsin gene, osteopetrosis, tumors, use of glucocorticoids (GC), high body mass index (BMI) and use of proton pump inhibitors (PPI). About pathogenesis it seems that the accumulation of microlesions, the increase of mineralization with reduced heterogeneity of mineralization, accumulation of Advanced Glycation End-products (AGEs), reduced vascularization and reduced antiangiogenic effects, alterations of normal collagen reticulation and maturation variations of crosslinks of collagen are all factors involved. Histological studies have demonstrated how these stress fractures occur: at the fracture site there are thin cracks that even micro-movements can distort and bring to their enlargement. In presence of predisposing conditions (femoral conformation, hypophosphatasia, use of GC...) in BP patients, these cracks are trapped in free mineral deposits at the site of the fracture, particularly at intracortical level and act longer by suppressing just in that site where the remodeling processes are essential to healing. Initial alteration occurs precisely on the lateral cortex, which is subjected to increased stress in the subtrochanteric and diaphyseal region, causing a femur bending. This observation has led to studies that have shown how femoral conformation plays a role in determining an increased risk of AFF. With a same BP therapy duration, for conformation characteristics, more is the lateral curvature of the femur and greater the knee valgus and more frequent are the AFFs; these features are more common in some breeds (Asiatic). Recently AFF case reports have also been published with denosumab, a monoclonal antibody that similarly to BP has an anti-resorptive effect. Some Authors and the ASBMR themselves have outlined guidelines for AFF diagnosis and management. Following patients who are taking BP therapy with DEXA is useful: evidence of certain pre-lesions to DEXA and the presence of prodromal symptoms are strong predictors of a subsequent fracture. Also useful is the dosage and monitoring of biochemical markers of bone remodeling. With regard to surgical strategy, the use of an intramedullary nail is the best treatment. In cases of particularly curved femur it is more appropriate to use angular stability plates because in the case of incomplete fracture the use of a nail may turn it into complete and because even in the case of complete fractures, the risk of non-union is higher. To date, even stopping of BP alone in the AFF suspect and the use of teriparatide as supportive drug therapy are two key elements to enable proper AFF healing
ST-elevation myocardial infarction in the COVID-19 era
Full text linkThe worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). The risk of adverse outcomes in patients with COVID-19 is strongly associated with advanced age, comorbidities, and pre-existing cardiovascular risk factors. Moreover, the patient experienced a delay in clinical presentation reducing numbers of daily calls for primary PCI. We aimed at formally appraise the daily incidence and corresponding symptom-to-reperfusion time in patients with AMI at our institution between March 1 and March 19, 2020, comparing the findings with the same period in 2019. Our data showed that the COVID-19 scare is associated with fewer STEMIs and NSTEMIs, as well as calls to the STEMI networks and increase in symptom-to-balloon times
Renal arteries denervation. From the treatment of resistant hypertension to the treatment of atrial fibrillation
No full textRenal denervation (RDN) is a therapeutic strategy for patients with uncontrolled arterial hypertension characterized by considerable fluctuations during its progression. After initial strong enthusiasm, the procedure came to an abrupt halt following the publication of the Symplicity HTN-3 study results. The results of recently published studies highlight the reduction in blood pressure values after RDN and justify the inclusion in the Guidelines of new recommendations for the use of RDN in clinical practice, in selected patients. Additionally, RDN findings are summarized in view of other potential indications such as atrial fibrillation. Six prospective, randomized studies are presented that evaluated RDN as an adjunct therapy to pulmonary vein isolation for the treatment of atrial fibrillation. In five studies, patients had uncontrolled hypertension despite therapy with three antihypertensive drugs. The analysis of these studies showed that RDN reduced the recurrence of atrial fibrillation (AF) by 57% compared to patients with pulmonary vein isolation (PVI) only. Modulation of the autonomic nervous system by RDN has been shown not only to reduce blood pressure but also to have an antiarrhythmic effect in symptomatic AF patients when the strategy is combined with PVI, thus opening up new therapeutic scenarios
Continuous intra jejunal infusion of levodopa-carbidopa intestinal gel by jejunal extension tube placement through percutaneous endoscopic gastrostomy for patients with advanced Parkinson's disease: a preliminary study
Full text linkLevodopa is the gold standard in the pharmacological treatment of Parkinson's disease (PD) and its oral administration is associated with the development of disabling motor and non-motor complications in advanced disease. Levodopa is rapidly metabolized and has a short plasma half-life thus requiring frequent, repeated dosing. Impaired gastric emptying is common in PD, and likely contributes to the unpredictable motor responses observed with orally-dosed levodopa. A new therapeutic protocol for patients with advanced PD include a carbidopa/levodopa combination using continuous, modulated enteral administration achieved inserting a Jejunal Extension Tube Placement through Percutaneous Endoscopic Gastrostomy (PEG-J). The aim of this work is to assess efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) delivered continuously through an intrajejunal percutaneous tube (PEG-J)
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
- …
