1,720,958 research outputs found
CARDIAC REMODELING IN PATIENTS WITH HFrEF TREATED WITH SACUBITRIL/VALSARTAN: ECHOCARDIOGRAPHIC ANALYSIS
Get PDFAim of the study: The aim of the present study was to assess reverse remodelling in patients with HFrEF after six months of treatment with sacubitril/valsartan through 3D echocardiography and two-dimensional Speckle Tracking echocardiography, which are known to allow automatic and reproducible assessment of ventricular volumes, ejection fraction, left atrium volume and global longitudinal strain of the left ventricle and left atrium, and other additional echocardiographic parameters. Regarding right heart, size and function were assessed, with PAPS, TAPSE and S'TDI estimated.
A further aim of the study was to analyse the clinical and echocardiographic baseline characteristics of the patients in order to identify the presence of factors predictive of significant reverse remodelling, and, thus, of response to sacubitril/valsartan therapy.
Finally, the variation in atrial natriuretic peptides plasmatic levels after sacubitril/valsartan therapy was also evaluated.
Material and Methods: In this prospective longitudinal study, patients with HFrEF treated with sacubitril/valsartan were enrolled. The following were inclusion criteria: age over 18, EF ≤ 35%, NYHA class ≥ II, treatment with the maximum tolerated dosage of ACEi or ARB or patients naïve to ACEi or ARB, undergoing pre-treatment with one of theese drugs. Exclusion criteria were: symptomatic hypotension, systolic blood pressure 5.2 mmol/L, history of angioedema, adverse reactions during ACEi/ARB therapy, concomitant initiation of therapy that may induce reverse remodelling (for example, CRT implantation or coronary revascularization during follow-up or in the six months prior to enrolment), non-sinus rhythm, suboptimal acoustic window. Patients have been undergoing a clinical examination, 12-lead electrocardiogram, transthoracic echocardiogram (2D/3D parameters and 2D-Speckle Tracking), and dosage of natriuretic peptides before the start of therapy with sacubitril/valsartan and in follow-up at 6 months. Functional assessment was performed using the NYHA classification.
Results: The final study population consisted of 32 patients. At the time of the follow up several echocardiographic parameters improved significantly in the entire study population. 13 (41%) of the patients in the study population were classified 'responders' and 19 (59%) were 'super responders'. In the 'responders' group more severe left ventricular remodelling before treatment was documented, in particular greater VTDi values and higher indexed atrial volumes.
An improvement in global ventricular and atrial strain was also observed in 'responders', although less marked than the other group.
Conclusions: Sacubitril/valsartan significantly improves reverse remodeling in patients with HFrEF. This result tends to occur in patients with a ventricular dilation of lesser severity. In accordance with these considerations, the drug should be used early and independently of the apparent clinical "stability" to avoid further progression of ventricular remodelling. Further studies may lead to an indication of sacubitril/valsartan since an earlier stage of the disease
Direct oral anticoagulants use in elderly patients with non valvular atrial fibrillation. state of evidence
Get PDFNon-valvular atrial fibrillation (NVAF) increases the risk of stroke by three-to five-fold, especially in elderly patients, creating a huge burden on medical system as well as a negative impact on patients' lives. Balancing efficacy and bleeding risk is a challenge when considering anticoagulation therapy in elderly patients, because of their frequent high risk of both stroke and bleeding. Real world data reveal the underuse of anticoagulation in the elderly, especially due to physicians' fear of bleeding, often neglecting the thromboembolic risk. Care of elderly patients with NVAF is often complicated by factors including adherence, cognitive impairment, health literacy, risk of falling, adverse effects, involvement of caregivers, and patient-physician relationship. Therefore, shared decision making and conversations between clinicians and patients are crucial. In addition, elderly patients often suffer from multiple comorbidities, requiring multiple concomitant medications, with an increased risk of drug interactions. Four non-Vitamin K antagonist oral anticoagulants, the so-called direct oral anticoagulants (DOACs) - dabigatran, rivaroxaban, apixaban and edoxaban - have been approved for reducing the risk of stroke and systemic embolism in patients with NVAF. Clinical trials and real-world data show the advantages of this class of drugs compared to conventional anticoagulation in the treatment of elderly patients with NVAF and identify subgroups of older patients who may be more suitable candidates for particular agents. However, there are conflicting opinions on the absolute benefit of DOACs use in elderly patients. A key factor to consider is that elderly patients frequently suffer from renal impairment and therefore dose adjustments according to creatinine clearance are mandatory for DOACs. As each DOAC comes with its own unique advantages and safety profile, a personalized case by case approach should be adopted to decide on the appropriate anticoagulation regimen for elderly patients after weighing the overall risks and benefits of therapy
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
Get PDF“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
Get PDFWe 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
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe 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
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Prognostic role of pre- and post-interventional myocardial injury in patients undergoing transcatheter aortic valve implantation
No full textChronic pre-procedural and acute post-procedural myocardial injury are frequently observed in patients with aortic stenosis undergoing trans-catheter aortic valve implantation (TAVI). The aim of our study was to investigate the prognostic role of high sensitivity cardiac troponins (hs-cTns) elevation before and after TAVI
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