194 research outputs found
The possible clinical impact of a threshold left atrial diameter associated with new AF in ESUS patients
No full textThe possible clinical impact of a threshold left atrial diameter associated with new AF in ESUS patient
Ten questions on venous thromboembolism
No full textVenous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a leading cause of morbidity and mortality worldwide. Based on new evidence, the management and treatment of VTE have changed over the years. For several decades, low molecular weight heparin and vitamin K antagonists have been the two cornerstones of anticoagulant therapy for VTE. Recently, the introduction in clinical practice of the new oral anticoagulants has radically changed the management of VTE for their easy use and their better efficacy and safety profile. Here, we report on recent evidence of 10 still controversial clinical questions concerning common diagnostic and therapeutic aspects of VTE
Patients with Atrial Fibrillation receiving NOACs: The boundary between appropriate and inappropriate dose
No full textSince their introduction in 2010, non-vitamin K oral anticoagulants
(NOACs) changed the landscape of stroke prevention in patients with
atrial fibrillation (AF). Because of their favorable benefit-harm profile,
the fixed dose administration, the no need for laboratory monitoring and
dose adjustment, NOAC prescription increased rapidly and overcome
the use of vitamin K antagonists (VKAs
History of cardiac embolism
No full textFrom 1742, the first time Gerhard van Swieten postulated that embolism might arise inside the heart chambers and great vessels, another century was needed before that clinicians became accustomed to the concept that an embolism can lead to an occlusion of a brain artery. In fact, in 1875, Gowers described a case of blindness and contralateral hemiplegia in a patient with mitral stenosis. At autopsy, emboli were found in the middle cerebral artery and in the central retinal artery. Specifically, the emboli were found to originate from clots on the auricular appendices. Subsequently, in 1954, Fisher demonstrated that a thromboembolic mechanism underlies most ischemic strokes and that the source of thrombus might be the heart rather than a proximal arterial lesion. He suggested that the embolus might have arisen after myocardial infarction, in the fibrillating atrial appendage.
In 1977, a necropsy study provided additional evidence supporting the role of atrial fibrillation as a crucial cause of cerebral embolism which was later confirmed by large epidemiological studies. Finally, in the first part of the 1990’s, several studies reported that oral anticoagulants consistently reduced the risk of stroke in patients with atrial fibrillation. Oral anticoagulants currently remain the most powerful stroke prevention strategy available for patients with atrial fibrillation
Venous thromboembolism and COVID-19: Mind the gap between clinical epidemiology and patient management
No full textBeyond the guidelines: Novelties, changes and unsolved issues from the 2019 ESC guidelines on pulmonary embolism
No full textImproving runway strip performance to fulfill international requirements through eco-efficient soil treatments: Case study of a major italian airport
No full textThe paper presents a case study of a significant intervention conducted on a major Italian airport for improving the structural and functional properties of the runway safety STRIP in order to fulfill specific national and international standards. The STRIP had to accomplish strict requirements in terms of the maximum longitudinal and transversal terrain slope and minimum values of bearing capacity; in particular, soil bearing capacity was identified as the main lack and thus the most urgent action to be carried out in the airport. However, the STRIP itself is located in a very critical area due to its closeness to the runway and several constraints were therefore identified during the design stage. The optimal strategy was identified as the one that minimized the intervention timing and costs, reducing the handling of construction material to/from the airport, avoiding delays to the air traffic, and maximizing the performance of the treated soils in terms of bearing capacity. In this framework, an energy-controlled stabilization technique of in-situ soils was developed. Several measurements, in both laboratory and field environment, were also conducted at different stages: i) before the intervention took place, ii) during the construction stage, and iii) at the conclusion of the work to monitor and validate the expected results. The intervention was able to provide the STRIP areas with a smooth surface presenting terrain slopes and bearing capacity in accordance with the standards. The illustrated methodology could also be applied to other airports saving time, costs, materials, and limiting air traffic delays
Empires of mud: wars and warlords of Afghanistan
No full textWarlords, namely charismatic military leaders who exploit the weakness of central authorities to seize control of and autonomously rule a sub-national area, have earned much notoriety in recent years on account of the excesses of civil wars in Liberia, Somalia and Afghanistan. But notwithstanding their bad reputation, warlords have often participated in state formation. In 'Empires of Mud' Giustozzi analyses the dynamics of warlordism in Afghanistan within the context of such debates. He approaches this complex task by first analysing aspects of the Afghan environment that might have been conductive to the fragmentation of central authority and the emergence of warlords and then accounts for the emergence of warlordism in the 1980s and subsequently the lion's share of this book consists of an in-depth analysis of the systems of rule - political, economic, military - which developed under Afghanistan's two foremost warlords, Ismail Khan and Abdul Rashid Dostum, both of whom still wield considerable power even after the intervention of Allied forces in Afghanistan in 2001. Their two systems are compared, highlighting convergences and divergences, in order to explain how warlords administer the areas that they control within so-called 'failed states', in the process challenging much of the received wisdom in scholarly and policy circles about warlordism. The author also discusses Ahmad Shah Massoud, whose 'system' incorporated elements of rule not dissimilar from that of the warlords. Giustozzi concludes that although charismatic leaders play a key role in shaping the specific characteristics of each warlord polity, there are some common elements that underlie the emergence of warlordism. In particular, the role of local military leaders and their gradual acquisition of a form of 'class consciousness' appear to be key processes in allowing the formation of warlord polities, while the latter have repeatedly shown the ability over time to evolve in to more sophisticated, state-like, or political party-like, structures
Investigation on the functional and mechanical performance of differentially compacted pervious concrete for road pavements
No full textPervious concrete aims at being a sustainable and eco-efficient paving material. A lot of studies have indeed been conducted on pervious concrete pavements (PCP) during the last decade but technical standards and rigorous construction specifications are still missing. The present study tested several laboratory-made pervious concrete specimens to define the proper compaction energy able for achieving specific design requirements in terms of porosity (void content) and bulk density; this to therefore guarantee adequate mechanical and functional performances. Different mixes, prepared by combining several water/cement ratios, were compacted using diverse energies and afterwards tested evaluating the void content, the bulk density, the indirect tensile strength, the compressive strength, the elastic modulus, and the permeability coefficient. Outcomes identified the optimal ranges of void contents and bulk densities for each mixture complying to specific permeability and mechanical requirements such as for allowing a wider adoption of PCP on roadways, even if subjected to mid/high traffic levels
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