323,188 research outputs found
Cost-effectiveness in Italy of preventive treatment with ramipril in patients at high risk of cardiovascular events
No full textOBJECTIVES: A cost-effectiveness analysis was conducted in Italy of preventive treatment with ramipril (an angiotensin converting enzyme [ACE] inhibitor) compared to no treatment in patients at high risk of cardiovascular death. The analysis was based on data extracted from the HOPE trial. METHODS: The current life table method was used in order to model a lifetime time horizon for outcomes and costs. The cohorts used were 1000 subjects on ramipril, and 1000 subjects on placebo enrolled in the HOPE trial. Kaplan-Meier curves at 5 years of the clinical study were fitted using an exponential model over a lifetime horizon, the outcome variables being myocardial infarction, stroke, revascularization and death. Total direct medical costs have been considered from a third-party payer's perspective--the Italian National Health Service. Resources involved in each event/activity were estimated using the modified Delphi technique with a panel of six clinicians. Types of resources reported included drug therapies, laboratory and imaging tests, physician visits, outpatient and inpatient rehabilitation, as well as medical and surgical hospital admissions. The incremental cost per life year gained was the main measure of the analysis. RESULTS: ICER (incremental cost-effectiveness ratio) decreases with the length of the treatment period. After the first year the ICER is 55,062 euros and subsequently decreases to about 12,770 euros at 5 years, 5945 euros at 10 years and 3726 euros at 20 years. The two ways sensitivity analysis showed that at 5 years ICERs range from a saving of 4059 euros to a cost of 22,929 euros (at 20 years they are 1814 euros and 4434 euros), mainly depending on the cost of drug and cost of events. Previous analyses in other countries based on the HOPE study obtained ICER values which are comparable with our results, when taking into account the different cost structure of the health care systems. CONCLUSIONS: On the basis of these results, the use of ramipril is likely to represent an efficient use of public health expenditure in the Italian healthcare system
An evaluation of patisiran: a viable treatment option for transthyretin-related hereditary amyloidosis
No full textIntroduction: Hereditary transthyretin-mediated amyloidosis (ATTRv; v for variant) is a rare, progressive, fatal multi-systemic disease, autosomal dominantly inherited with heterogeneous clinical phenotype caused by mutations in the TTR gene. Mutations promoting proteolytic remodeling and tetramer dissociation result in fragmented and full-length TTR monomers that misfold, aggregate and deposit at multiple sites (mainly nerves and heart) causing peripheral neuropathy and/or cardiomyopathy. Areas covered: The authors discuss patisiran, the first approved RNA interference-based therapeutic agent that suppresses the circulating levels of the amyloidogenic protein TTR both wild-type and mutant. This compound demonstrated a safe clinical profile in phase I and II studies and showed a significant clinical effect in a phase III (APOLLO) trial in ATTRv patients. An open-label-extension study is still underway but, based on the positive results, the regulatory agencies granted approval for the treatment of ATTRv with polyneuropathy in Stage I and II. Expert opinion: The patisiran program has demonstrated that substantial TTR concentration reduction is associated with significant and sustained improvement in polyneuropathy scores, quality-of-life profile and several outcome measures that capture the systemic burden of the disease. The drug resulted safe also in long term follow-up studies while its efficacy for ATTR with cardiomyopathy is under investigation
Nonischemic end-systolic performance. Effects of alterations in regional and global left ventricular contractility.
No full textNonischemic end-systolic performance decreases during ischemia. These changes in performance are likely to be dependent on the size and site of the ischemic zone, as well as the prevailing loading conditions. This study was designed to examine the effect of regional and generalized changes in inotropy on nonischemic end-systolic performance, independent of the ischemic zone size. Twenty dogs were instrumented with sonomicrometers and micromanometer pressure gauges. End-systolic pressure-thickness relationship data were obained during vena-caval balloon inflation. Measurements were obtained before and 90 s after left circumflex (LC) artery occlusion. Then, simultaneous with the occlusion of the LC artery, isoproterenol (0.04 microg/ml) was infused into the left anterior descending artery. After recovery, the same protocol was repeated before and after propranolol (0.5 mg/kg). In a separate set of animals, the same measurements were made following 2.5 and 5 microg/kg/min dobutamine. The effect of ischemia on the nonischemic end-systolic pressure-thickness relationship was expressed as the extent to which the relationship is shifted to the left. Infusion of intracoronary isoproterenol into the perfusion bed of the nonischemic zone produced a significant increase in the slope of the end-systolic pressure-thickness relationship. During ischemia, however, the extent of leftward shift of this relationship was less than that following beta-blockade. Intravenous dobutamine resulted in a dose-dependent increase in the slope of the nonischemic end-systolic pressure thickness relationship, but the extent of leftward displacement of the relationship in response to regional ischemia was less than that following the control occlusion. The nonischemic segment is coupled with the nonfunctioning ischemic zone in such a way that it is required of the nonischemic segment to operate at decreased end-systolic thickness for any end-systolic pressure, the extent of which is to be determined, in part, by the size of the ischemic zone and the contractile state of the nonischemic myocardium. The lower the contractile state prior to coronary occlusion the greater extent of leftward shift of the pressure-thickness relationship
Diffusive author(s), cohesive author: Analysis of S/N (1994)
No full textThis study indicates the ways in which various aspects of the author(s) are brought forth in Dumb type’s performance art, the S/N production. Previous research has suggested a non-hierarchical organization of Dumb type and the absence of a “privileged author” in Dumb type’s collaborative work, S/N. However, the results that I have investigated from member’s interviews on the creative process of S/N along with my analysis of the recorded images of S/N, indicate a different aspect of the author(s). First, S/N was created through, so to speak, the collective ideas of the members of Dumb type. Further, S/N has at least nine quotations from previous performances, installations, and printed writings, besides the work-in-progress technique. Explicating one of the “author functions” as given by Michel Foucault, each text has plural subjects of the author. However, it has been revealed from members’ interviews that Teiji Furuhashi had a decision-making role in selecting the members’ ideas within the performance. Since then, S/N has had plural subjects of creation; however, Furuhashi is one of the subjects of creation along with the “privileged author.” S/N has plural authors (diffusive authors) yet at the same time, it has a “privileged author,” Teiji Furuhashi (cohesive author)
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe 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
Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice
No full textExcessive or inappropriate use of non-steroidal anti-inflammatory drugs can affect cardiovascular and renal function. Non-steroidal anti-inflammatory drugs, both non-selective and selective cyclooxygenase 2 inhibitors, are among the most widely used drugs, especially in the elderly, with multiple comorbidities. Exposition to a polypharmacy burden represents a favourable substrate for the onset of non-steroidal anti-inflammatory drug-induced deleterious effects. Cardiovascular and renal issues concerning the occurrence of myocardial infarction, atrial fibrillation, heart failure and arterial hypertension, as well as acute or chronic kidney damage, become critical for clinicians in their daily practice. We discuss current available knowledge regarding prostanoid physiology in vascular, cardiac and renal systems, pointing out potential negative non-steroidal anti-inflammatory drug-related issues in clinical practice
Effects of preload on regional nonischemic end-systolic performance
No full textBACKGROUND: Nonischemic segmental performance, assessed by end-systolic measures of shortening and thickening, decreases during ischemia. These changes in performance are likely to be dependent on the size, and, possibly, the site of the ischemic zone. This study was designed to examine the effect of preload, independently from ischemic zone size, on nonischemic end-systolic performance. METHODS: Twelve beagles were instrumented with sonomicrometers and micromanometer pressure gauges. End-systolic pressure length and thickness relationship data were obtained during vena caval balloon inflation. Control data were obtained both in left anterior descending and in left circumflex regions at left ventricular end-diastolic pressures of 5, 10 and 15 mmHg. The left circumflex artery was occluded for 90 s and nonischemic end-systolic pressure length and thickness data were obtained at each diastolic pressure. A 20 min recovery period was allowed between coronary occlusions. RESULTS: The isovolumic bulge in the ischemic area was more pronounced at an end-diastolic pressure of 5 mmHg than it was at an end-diastolic pressure of 15 mmHg. The slope of the nonischemic end-systolic pressure length and thickness relationships decreased at an end-diastolic pressure of 5 mmHg, whereas at 10 and 15 mmHg the slope of these relationships did not change significantly. The shift in the nonischemic end-systolic pressure-length relationship to the right was more pronounced at a low end-diastolic pressure (5 mmHg) than it was at a high end-diastolic pressure (15 mmHg). Similarly, the extent of the shift in the end-systolic pressure-thickness relationship to the left was more marked at a low end-diastolic pressure than it was at the higher end-diastolic pressure. CONCLUSION: Regional ischemia decreases the end-systolic performance of the nonischemic region. The extent of the shift and the degree to which the slopes of the nonischemic end-systolic relations decrease are influenced by loading conditions
Applying neuroimaging to detect neuroanatomical dysconnectivity in psychosis
No full textThis editorial discusses the application of a novel brain imaging analysis technique in the assessment of neuroanatomical dysconnectivity in psychotic illnesses. There has long been a clinical interest in psychosis as a disconnection syndrome. In recent years graph theory metrics have been applied to functional and structural imaging datasets to derive measures of brain connectivity, which represent the efficiency of brain networks. These metrics can be derived from structural neuroimaging datasets acquired using diffusion imaging whereby cortical structures are parcellated into nodes and white matter tracts represent edges connecting these nodes. Furthermore neuroanatomical measures of connectivity may be decoupled from measures of physiological connectivity as assessed using functional imaging, underpinning the need for multi-modal imaging approaches to probe brain networks. Studies to date have reported a number of structural brain connectivity abnormalities associated with schizophrenia that carry potential as illness biomarkers. Structural connectivity abnormalities have also been reported in well patients with bipolar disorder and in unaffected relatives of patients with schizophrenia. Such connectivity metrics may represent clinically relevant biomarkers in studies employing a longitudinal design of illness course in psychosis
Karl Drlica ja David S. Perlini teose "Antibiotic resistance: understanding and responding to an emerging crisis" kahe peatüki tõlge ja tõlke analüüs
No full textMagistriprojekti jaoks tõlgiti ja toimetati kaks peatükki Karl Drlica ja David S. Perlini õpikust „Antibiotic Resistance: Understanding and Responding to an Emerging Crisis“ ning analüüsiti seejärel tehtud tööd. Magistriprojekti autor valis tõlkimiseks selle teose eelkõige isikliku huvi tõttu ja seetõttu, et ta oli sama teemaga tegelenud ka bakalaureuseõppes. Samuti on antibiootikumiresistentsus oluline globaalne probleem ja magistriprojekti autori arvates on oluline selle suhtes teadlikkust tõsta. Tõlgiti esimene ja viies peatükk. Esimene peatükk on sissejuhatavat laadi ja annab lugejale üldise ettekujutuse probleemi suurusest. Viiendas peatükis kirjeldatakse lähemalt resistentsuse tekkemehhanisme. Samuti tõlkis magistriprojekti autor õpikus sisaldunud sõnaseletuste loendi need kirjed, mis neis kahes peatükis esinesid. See loend on toodud magistriprojekti lisas 1.https://www.ester.ee/record=b5239362*es
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