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STUDIO SULL'EFFICACIA DELLA TERAPIA ANTICOAGULANTE NEI PAZIENTI CON TROMBOSI PORTALE AFFETTI DA CIRROSI EPATICA
Full text linkBackground & Aims:
Portal Vein thrombosis defines the presence of a thrombus, blocking completely or partially the vein in the trunck of the portal vein or in its intrahepatic collaterals .
For patients whit cirrhosis, it means a preexisting HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=hypertension%20portal&cmd=correctspelling" portal hypertension getting worth adding a presinusoidal part to it. The TP, if complete, can block the liver transplantation.
The aim of this study is to check the efficiency of the anticoagulant oral therapy with heparina in a group of patients affected with epathic cyrrhosis or TP, to value the symptoms of occurances of the TP and the variations of the Child-Pugh score according to the appearance of the resolution or the eventual extension of the TP.
Methods:
This study has been established in a consecutive range of 66 patients enroled retrospectively, affected with CE and trombose of the Portal system, referred to our unit from January 1996 and April 2010. These patients were followed whit blood exams, abdomen ultrasound computerized axial tomogrphy,endoscopy.
Results:
At the time of the TP diagnosis, 17% of the patients belonged to the Child-Pugh A class, 68% to the Child-Pugh B class and 6% to the Child-Pugh C class.
44 Patients (66,7%) has done anticoagulant oral therapy, 17(39%) patients were following the terapia con eparina a basso peso molecolare, 23(52%) patients were following a therapy with Coumadin and 4(9%) were following both therapy alternatively.
Average time of treatment was 38 ± 4 months for the group taking Coumadin, 23 ± 3 months for the group taking Eparina a basso peso molecolare. 2 patients were taking eparina for 8 ± 1 months and then 39 ± 15 months. 2 patients were taking Coumadin for 5 ± 2 months and then eparina for 13 ± 5 mesi.
During the follow-up, 24 patients out of 66 (36%) have obtained a complete resolution( 4 patients without therapy and 20 taking an anticoagulant treatment : 4 patients in therapy with heparin, 12 patients with Coumadin, 4 patients with both simultaneously.)
The partial recanalization was obtained for 28 patients (42%) (4 patients without therapy, 24 patients under an anticoagulant therapy : 8 patients following a therapy with heparin, 14 following a therapy with Coumadin and 2 following both at the same time.
We can observe an extansion for the trombose for 31 patients out of 66 (47%) from which 25 outside of the anticoagulant therapy and 6 during it (2 patients following the heparin therapy, 3 patients with Coumadin and 1 patient following both simultaneously.
20 patients had portal cavernous (for 7 patients it was already diagnosed, for 13 patients it appeared during the follow-up from which 4 patients were not following any therapy, 5 an heparin therapy, 3 an Coumadin therapy and 1 both simultaneously.
Conclusions:
The anticoagulant therapy were proved efficient in the recanalization of the TP during the follow-up (p=0,032).
The anticoagulant therapy were proved efficient in the partial recanalization of the portal vein thrombosis (p=0,018).
Undertaking the anticoagulant therapy did not have a significative impact on the progression of portal vein thrombosis (p=0,168) at the follow-up.
The anticoagulant therapy did not prevent the develop of caverous (p=0,741)
Diagnosis and treatment of portal hypertension
No full textPrevention of the first variceal haemorrhage should start when the patients have developed medium-sized to large varices. Non-selective beta-blockers and band ligation are equally effective in preventing the first bleeding episode. Rubber band ligation is the first choice for patients with contraindications or intolerance to beta-blockers. Treatment of acute bleeding should aim at controlling bleeding and preventing early rebleeding and complications, especially infections. Combined endoscopic (band ligation or sclerotherapy) and pharmacological treatment with vasoactive drugs can control bleeding in up to 90% of patients. Antibiotic prophylaxis is an integral part of the treatment of acute variceal haemorrhage, and must be started as soon as possible. Emergency transjugular intrahepatic portosystemic stent shunt (TIPS) is the standard rescue therapy for patients failing combined endoscopic and pharmacological treatment. All patients who survive a variceal bleed should be treated with beta-blockers or band ligation to prevent rebleeding. All patients in whom bleeding cannot be controlled or who continue to rebleed can be treated with salvage TIPS or, in selected cases, with surgical shunts. Liver transplantation should be considered for patients with severe liver insufficiency in which first-line treatments fail
Acute variceal bleeding : pharmacological treatment and primary/secondary prophylaxis
No full textVariceal bleeding is one of the most severe complications of portal hypertension related to liver cirrhosis. Primary prophylaxis is considered mandatory in patients with cirrhosis and high-risk oesophageal varices, and once varices have bled, every effort should be made to arrest the haemorrhage and prevent further bleeding episodes. In acute variceal bleeding, vasoactive drugs that lower portal pressure should be started even before endoscopy, and should be maintained for up to 5 days. The choice of vasoactive drug should be made according to local resources. Terlipressin, somatostatin and octreotide can be used; vasopressin plus transdermal nitroglycerin may be used if no other drug is available. In variceal bleeding, antibiotic therapy is also mandatory. In primary and secondary prophylaxis, beta-blockers are the mainstay of therapy. In secondary prophylaxis (but not in primary prophylaxis) these drugs can be combined with organic nitrates
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
Metabolites and enzymes involved in the oxidative stress in freshly harvested fruits of sweet cherry germoplasm of Campania region
No full textFruit ripening is accompanied by a progressive increase in oxidative stress that is controlled by a related induction of the antioxidant free radical scavenging system. Dysfunctioning of such system in the later stages of ripening causes an increase of oxidation, that is the second most important factor of fruit decay besides microbial contamination. Production of fruits that preserve high antioxidant metabolites levels, could represent a way to delay fruit senescence and to preserve nutritional and nutraceutical characteristics, significantly saving fruits and costs. The study aims determine the level of antioxidant metabolites (vitamin C, glutathione, tocopherols, polyphenols) and enzymes (peroxidases and polyphenoloxidases) involved in the antioxidant system, in fruits of sweet cherry germoplasm of Campania region. Such data could be used to improve quality and shelf-life of fruits in sweet cherry crop breeding programmes as well as to valorise landraces in more sustainable farming practices. Freshly harvested ripened fruits from over 40 landraces, cultivated in “Improsta Farm” of Campania Region, were used for the analyses. Multivariate analysis applied to the overall landrace data set evidenced 4 clusters: cluster 1 contained the highest vitamin C, vitamin E and polyphenol contents; cluster 2 contained the lowest contents of such metabolites, cluster 3 showed the highest polyphenoloxidase activities; cluster 4, enclosing the most of landraces, did not differed significantly also from some commercial cultivars. the fruits of landraces of cluster 1, could have a lower oxidative damage risk and, therefore, a delayed senescence. On the other hand they could affect consumers and local farmers because of the higher content of such healthy anti-aging compounds
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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