1,720,963 research outputs found
Nuove frontiere per il trattamento dell’arteriopatia periferica nel paziente diabetico: il ruolo dalla terapia angiogenica
Full text linkIntroduzione: Il presente progetto di ricerca si pone come obiettivo quello di valutare e quantificare, nel medio termine, il possibile effetto adiuvante della terapia rigenerativa con PBMNCs (Peripheral blood mononuclear cells), nei pazienti diabetici sottoposti a trattamento endovascolare confrontando i risultati con quelli ottenuti nei pazienti diabetici sottoposti alla sola procedura di rivascolarizzazione endovascolare.
Materiali e Metodi: Sono stati raccolti ed analizzati i risultati ottenuti nel gruppo di pazienti diabetici affetti da ischemia critica degli arti inferiori, e sottoposti sia ad intervento di rivascolarizzazione endovascolare che ad impianto di PBMNCs (gruppo adiuvante). I risultati ottenuti sono stati confrontati con quelli raccolti nel gruppo di pazienti diabetici affetti da ischemia critica ma sottoposti alla sola rivascolarizzazione endovascolare (gruppo di controllo). Sono stati considerati come endpoint primari il tasso di salvataggio d’arto e le variazioni dei valori di TcPO2 nel tempo, mentre come endpoint secondario il grado di riduzione del dolore nel follow up.
Risultati: Venti pazienti diabetici affetti da ischemia critica sono stati sottoposti a terapia adiuvante mentre 12 pazienti con le medesime caratteristiche sono stati sottoposti alla sola rivascolarizzazione endovascolare. Confrontando i valori di TcPO2 nel pre-operatorio e nel follow up in entrambi i gruppi si è osservato un incremento significativo dei valori di TcPO2, maggiore nel gruppo adiuvante (P<0.001 nel gruppo adiuvante e P=0.008 nel gruppo di controllo).
Dall’analisi dei valori medi di VAS score registrati nel pre-operatorio e nel follow up, in entrambi i gruppi dopo il trattamento, si è evidenziata una riduzione significativa del dolore, maggiore nel gruppo adiuvante (P<0.001 nel gruppo adiuvante e P=0.003 nel gruppo di controllo).
Nel gruppo adiuvante ed in quello di controllo, si è inoltre osservata una percentuale di salvataggio d’arto rispettivamente del 90% e del 91.7%.
Conclusioni: Nei pazienti diabetici affetti da ischemia critica, l’associazione della rivascolarizzazione periferica con la terapia rigenerativa con PBMNCs sembra rappresentare una valida opzione terapeutica, determinando il miglioramento di quadri clinici resistenti alla guarigione con la sola rivascolarizzazione periferica
Carotid Endarterectomy or Stenting in Octogenarians in a Monocentric Experience
No full textBackground: Carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA) in patients at high risk for complications from surgery. The very elderly (≥80-year-old) are 1 subgroup of patients identified as being at increased risk for carotid surgery. However, there is concern that the very elderly are also at increased risk for complications of CAS. A stroke and death rate of 12% were reported in very elderly patients during the roll-in phase of Carotid Revascularization Endarterectomy versus Stent Trial. We are reporting on a clinical series of CAS and CEA with independent neurologic assessment in the very elderly. The aim of this article is to evaluate early and mild-term results obtained in the treatment of the carotid artery stenosis in symptomatic and asymptomatic octogenarians, comparing the data of CEA and CAS in academic hospital.
Methods: Between 2002 and 2013, a consecutive series of 129 CAS and 45 CEA patients (≥80-year-old) were treated in our academic hospital, a center with extensive carotid revascularization experience. Independent neurologic assessment was performed before and after procedures. Exclusion criteria were cerebral hemorrhage diagnosed within 6 months, cerebral tumors and dementia. Hostile aortic arches were nevertheless treated with alternative approaches like cervical or radial access. All the procedures have been performed by the senior authors.
Results: The average age was 86.9 years. Most patients were male (56%), and the target lesion carotid stenosis was asymptomatic in 80% of patients. No significant differences were obtained regarding gender, symptoms, risk factors or comorbidities, and evident CT lesions among the 2 groups of different treatments. Embolic protection devices were used in all cases with the CAS procedure. The overall 30-day incidence of stroke and death was 2.3% (3 of 129) in CAS group and 4.4% (2 of 45) in CEA group.
Conclusions: Exclusion of high-risk patients from CAS, based on age alone, seems to be unjustified. Octogenarians are not at increased risk of periprocedural adverse events after CAS compared with younger patients. The key to obtain satisfactory results is CAS to be performed by an experienced team able to use not only standard filter protected CAS but also familiar with all the other types of access and protection techniques
Fattori predisponenti acuti e cronici dell'occlusione di branca dopo EVAR
No full textL’ischemia degli arti inferiori è una grave complicanza del trattamento endovascolare degli AAA (EVAR). L’occlusione di branca, l’embolia o problemi correlati all’accesso sono le principali cause. In questo studio abbiamo analizzato le occlusioni di branca precoci e tardive dopo EVAR in 10 anni di esperienza nel nostro centro.
MATERIALI E METODI
Da Gennaio a 2004 a Ottobre 2014 sono stati sottoposti a EVAR nel nostro centro 412 pazienti. Abbiamo utilizzato tutte le endoprotesi in commercio. I pazienti con occlusione di branca sono stati sottoposti a ECD, ANGIO TC e in casi selezionati ad arteriografia. Tutti i dati riguardanti le caratteristiche cliniche e anatomiche sono stati raccolti in un database dedicato e analizzati mediante analisi statistica con SPSS e Med Calc for Windows. Per individuare fattori predisponenti all’occlusione di branca.
RISULTATI
Sono state evidenziate 31 occlusioni di branca (7,5%) su 412 pz. In 10 casi (32,2%) l’occlusione è stata acuta (<24h). In 21 casi (67,7%) si è evidenziata durante il follow up. Di questi il 52% si è evidenziata entro 30 giorni dall’impianto. In 5 pazienti (16 %) l’occlusione è stata asintomatica. Nel 20% si è evidenziata oltre un anno di follow up. L’occlusione di branca è risultata associata nel 72% dei casi a severa tortuosità dell’asse iliaco e nel 13% dei casi a AOCP severa. Si è evidenziata una maggiore incidenza nei pazienti impiantati off label (3,17% IFU vs 12,03% OL, p=0,0004).
DISCUSSIONE/CONCLUSIONE
Con l’avvento di endoprotesi di ultima generazione, piú flessibili e con profili ridotti, la percentuale di pazienti esclusi a causa di un anatomia ostile per EVAR si è ridotta. Questo al prezzo di una maggiore incidenza di complicanze graft correlate e un maggior numero di procedure secondarie durante il follow up. La severa angolazione dell’asse iliaco rimane con conseguente kinking della branca endoprotesica il fattore predominante per le occlusioni precoci. La concomitante AOCP severa e il diametro ridotto del carrefour oltre all’atterraggio in iliaca esterna rappresentano i fattori di rischio per le occlusioni tardive
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
Trans-Atlantic Inter-Society Consensus II C and D Iliac Lesions Can Be Treated by Endovascular and Hybrid Approach: A Single-Center Experience
No full textPurpose: To evaluate the long-term results of endovascular and hybrid treatment in patients with Trans-Atlantic Inter-Society Consensus (TASC) II type C and D aortoiliac lesions and to highlight, in contrast to TASC II guidelines, the importance to analyze individually the lesions of a single iliac axis. Methods: From January 2008 to December 2012, 50 patients with TASC II type C and D aortoiliac lesions underwent endovascular or hybrid treatment. In 38 patients (76%), the lesions were treated by endovascular approach, while in 12 (24%) patients surgical treatment was adopted. All patients underwent a postoperative surveillance program at 1, 3, and 6 months for the first year and every 6 months thereafter. Results: Technical success was achieved in all patients (100%). The postoperative complication rate was 4%. Primary patency rate was 93.3% at 1 year, 90.2% at 2 years, and 86.6% at 3 years. Cumulative secondary patency rate was 97.7% at 1, 2, and 3 years. Survival after 1 and 2 years was 94.8% and after 3 years was 91.1%. Limb salvage was 100% for the entire period of follow-up. Conclusions: In contrast to TASC II guidelines, the endovascular or hybrid treatment should be considered a valid approach for type C and D lesions. The hybrid treatment, in selected cases, is an effective method to improve the runoff, which plays a key role in the success of the treatment of multilevel stenoocclusive lesions. In TASC II C to D iliac lesions, a specific overview of each axis is necessary in order to select the most appropriate treatment
Hybrid treatment for thoracoabdominal aortic aneurysms in patients with marfan syndrome
No full textMarfan syndrome is a heritable disorder of connective tissue leading to aortic aneurysms and other cardiovascular complications associated with reduced life expectancy. Although contemporary management of ascending aortic disease requires open surgical reconstruction, the combined retrograde visceral revascularization and endovascular exclusion (hybrid procedure) of entire thoracoabdominal aorta has been introduced for the management of descending thoracic and abdominal aortic pathology. The present experience reports 2 cases of thoracoabdominal aortic aneurysms, in Marfan patients, previously submitted to major cardiovascular surgical procedures, through a hybrid approach
Peripheral Blood Mononuclear Cells Therapy for Treatment of Lower Limb Ischemia in Diabetic Patients: A Single-Center Experience
No full textBackground: The aim of this study is to analyze the effects of peripheral blood mononuclear cells (PBMNCs) therapy in diabetic patients with critical limb ischemia (CLI), with particular regard to its application, as adjuvant therapy in patients underwent endovascular revascularization. Methods: Fifty diabetic patients affected by CLI were enrolled. All patients underwent PBMNCs therapy. Thirty-two patients underwent PBMNCs therapy associated with endovascular revascularization (adjuvant therapy group). In 18 patients, who were considered nonrevascularizable or underwent unsuccessful revascularization, regenerative therapy with PBMNCs was performed as the therapeutic choice (PBMNCs therapy group). Results: The median follow-up period was 10 months. The baseline and end point results in adjuvant group were as follows. The mean transcutaneous partial pressure of oxygen (TcPO2) improved from 25 ± 9.2 mmHg to 45.6 ± 19.1 mmHg (P < 0.001), and visual analogue scale (VAS) score means decreased from 8.6 ± 2.1 to 3.8 ± 3.5 (P = 0.001). In PBMNCs therapy group, the mean TcPO2improved from 16.2 ± 7.2 mmHg to 23.5 ± 8.4 mmHg (P < 0.001), and VAS score means decreased from 9 ± 1.1 to 4.1 ± 3.3 (P = 0.001). Major amputation was observed in 3 cases (9.4%), both in adjuvant therapy group and in PBMNCs therapy one (16.7%) (P = 0.6). Conclusions: The role of cellular therapy with PBMNCs is decisive in the patients that are not susceptible to revascularization. In diabetic patients with CLI and healing resistant ulcers, the adjuvant PBMNCs therapy could represent a valid therapeutic option
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
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