1,720,990 research outputs found
Care for Older People with Heart Failure - Not Just an Affair of the Heart
No full textFrailty and comorbidity are among the most problematic expressions of advancing age. Frailty is defined as a
state of increased vulnerability to disease resulting from a progressive physiological decline in the functional reserve of
multiple organs and systems. The concept of frailty is distinct from, yet closely related to, that of comorbidity, defined as
the coexistence of two or more diseases in the same individual.
Older patients with heart failure, many of whom are frail and affected by multiple concomitant disorders requiring
complex medication regimens, are at very high risk for adverse outcomes and, therefore, have the greatest need of
assistance and care. Disappointingly, frail older adults with comorbidity and polypharmacy have been completely
excluded from randomized clinical trials of heart failure, such that efficacy and safety of established heart failure
therapies remain largely unproven in these patients.
To derive benefits and avoid harms from existing treatment options, older patients should be managed pragmatically,
tailoring strategies to their individual needs and taking into the greatest consideration the role of frailty and comorbidity
as arbiters of clinical decision makin
Do brain magnetic resonance and ultrasound perfusion imaging elucidate the role of PFO in patients affected by migraine with aura?
No full textCharacterization of Parkinson's Disease using spectral features of kinetic tremor: correlation of on-line digitized handwriting and classical motor scales
No full textTremor is one of the motor impairments of Parkinson’s disease (PD). To date, kinetic tremor in PD is barely examined and there is lack of information on the relation between its severity and scales related to specific motor deficits [1]. In this study, we aimed at investigating the correlation between handwriting-related kinetic tremor and motor score measures by motor part of Unified Parkinson's Disease Rating Scale (UPDRS-III) [2], using a digitizing tablet.
In this preliminary study, eight PD patients (7 M/1 F; age 74.5±8 years) draw an accurate Archimedes’ Spiral (AS) and fast, overlapped Circles (C) for a duration of 15 seconds. All patients underwent motor deficit assessment using UPDRS-III. Power Spectral Density of both velocity and acceleration profiles in their horizontal, vertical, and curvilinear components was estimated by using Welch’s method, with a Hamming window on intervals of 5 s and a 50% overlap. To analyze the power distribution related to different movement-associated phenomena, the ratio between two frequency bands (BME/BT) and the BT bandwidth (BW) were calculated for each subject. BME is the band of voluntary Movement Execution required by the task, ranging from 0.2 to 4 Hz, and BT is the band associated with involuntary Tremor, ranging from 4.0 to 12 Hz [3]. Normalized Jerk, a classic kinematic feature representing handwriting fluidity, was also estimated. The correlation between the parameters and UPDRS-III scores were assessed using Spearman’s rank correlation coefficients. All the evaluations were conducted in the pharmacological on state of PD patients.
A positive correlation was found between Jerk and UPDRS-III scores (Table 1). On the contrary BME/BT correlates negatively with motor scale scores in horizontal and vertical velocities (Vx, Vy) for both tasks, vertical and curvilinear acceleration (Ay, Ac) for AS task, horizontal and vertical acceleration (Ax, Ay) for C task. Only Ay of C task shows correlation with motor scores.
The results highlight that the severity of motor deficits in PD patients, as assessed by a widely employed motor scale, correlates with the outcomes of spectral and kinematic analysis of handwriting that indicate a loss of fluency, an increased power at BT level and a thinning of the spectral peak of BT. This suggests that handwriting assessment of parkinsonian dysgraphia can be used to implement clinical evaluation and represents a non-invasive, low-cost method for the identification of objective and reproducible biomarkers of kinetic tremor
Influence of smoking and other cardiovascular risk factors on heart rate circadian rhythm in normotensive and hypertensive subjects
Full text linkCircadian heart rate (HR) is influenced by hypertension and other cardiovascular risk factors particularly smoking, obesity and dyslipidemia. Until now, to evaluate the HR changes due to presence of these risk factors, a single HR office measure or a mean evaluated on day time or night time or 24h was used. However, since HR shows a circadian behavior, a single value represents only a rough approximation of this behavior. In this study, we analyzed the influence of smoking, obesity and dyslipidemia on the circadian rhythm in normotensive and hypertensive subject groups presenting only one of these risk factors. The 24h HR recordings of 170 normotensive (83 without risk factors, 20 smokers, 44 with dyslipidemia, 23 obese) and 353 hypertensive (169 without risk factors, 32 smokers, 99 with dyslipidemia, 53 obese) subjects were acquired using a Holter Blood Pressure Monitor. Results highlighted a specific circadian behavior with three characteristic periods presenting different HR means and rates of HR change in the eight subject groups. The slopes could be used both to estimate the morning HR surge associated with acute cardiovascular effects in the awakening and to evaluate the decline during the night. Moreover, we suggest to use three HR mean values (one for each identified period of the day) rather than two HR values to better describe the circadian HR behavior. Furthermore, smoking increased and dyslipidemia decreased mean HR values from 10:00 to 04:00, both in normotensive and hypertensive subjects in comparison with subjects without risk factors. In this time interval, hypertensive obese subjects showed higher values while normotensive ones presented quite similar values than subjects without risk factors. During the awakening (05:00-10:00) the slopes were similar among all groups with no significant difference among the mean HR values
A rare Case Of Both Left Carotid Biforcation And Internal Carotid Artery(ICA) Fybrinolysis,But Not Of The Ipsilateral Middle Cerebral Artery(MCA) In An Acute Patient
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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
Effects of Smoking on HR Circadian Rhythm in Hypertensive and Non Hypertensive Subjects
No full textClinical parameters as Blood Pressure and Heart Rate (HR) are influenced by hypertension and smoking. To evaluate how these risk factors influence HR, usually punctual or mean evaluation of these signals on daytime or nighttime are made. However, since HR has a circadian behavior, changing during 24h, a punctual description represents only a rough approximation of this comportment. In this study, we analyzed the influence of smoking and hypertension on the circadian rhythm of HR with a standard temporal resolution. Data coming from 618 hypertensive/non-hypertensive, smokers/non-smokers subjects were recorded using a Holter BP monitor. Results confirmed significant higher values of HR during day and nighttime in smokers than in non-smokers also highlighting different velocity of HR linear changes in three periods of the 24h (daytime, nighttime, early morning)
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