1,720,981 research outputs found
SPECKLE-TRACKING GLOBAL LONGITUDINAL STRAIN AS A PREDICTOR OF DEATH AND CARDIOVASCULAR EVENTS IN PATIENTS WITH SYSTEMIC SCLEROSIS: A PROSPECTIVE OBSERVATIONAL STUDY
No full textIntroduzione: Seppur più spesso asintomatico, il coinvolgimento cardiaco nei pazienti affetti da sclerosi sistemica (SSc) rappresenta un fattore prognostico negativo, determinante quasi un quarto di tutte le morti. Lo strain longitudinale globale (GLS) è uno strumento efficace nell'individuare il coinvolgimento cardiaco in pazienti affetti da SSc senza precedente coinvolgimento cardiaco e permette il riconoscimento precoce di patologia e il suo monitoraggio longitudinale, tuttavia non vi sono dati sul suo ruolo nel valutare endpoint clinici. L'endpoint primario del nostro studio è stata l'associazione tra GLS destro e sinistro e mortalità per tutte le cause. L'endpoint secondario è stato l'associazione tra GLS destro e sinistro e ospedalizzazioni. Metodi: Abbiamo condotto uno studio longitudinale prospettico che includesse tutti i pazienti consecutivi affetti da SSc in assenza di danno cardiaco strutturale e eventi cardiovascolari precedenti. Risultati: Sono stati arruolati un totale di 164 pazienti, di cui 19 (11.5%) sono morti durante il follow-up, mentre 48 (29.3%) hanno necessitato di ospedalizzazione. Sia il GLS sinistro che destro all'arruolamento è risultato associato in maniera indipendente ad un aumentato rischio di morte per tutte le cause e di ospedalizzazione. Quei pazienti con un GLS sinistro peggiore di -19.5% presentavano un rischio di morte di 6 volte maggiore nel periodo di follow up (6.9% vs 36.4%; p=.01), così come pazienti con un GLS destro peggiore di -19.1% (9.0% vs 54.6%; p=.001). L'incidenza di ospedalizzazione risultava quasi raddoppiata in paziente con GLS sinistro peggiore di -20% (23.3% vs 55.7%; p=.01) o GLS destro peggiore di -19% (29.8% vs 59.0%; p=.03). Conclusioni: Il GLS risulta essere associato ad un aumentato rischio di morte e ospedalizzazioni in pazienti affetti da SSc durante un follow up medio di 3 anni e dunque rappresenta uno strumento affidabile in termini prognostici, utilizzabile in pratica clinica.Introduction: Albeit often asymptomatic, heart involvement in systemic sclerosis (SSc) represents a negative prognostic factor, accounting for nearly one-fourth of all deaths. Global longitudinal strain (GLS) is accurate in detecting heart involvement in patients with SSc and no overt cardiac disease and allows early detection and longitudinal monitoring, but its association with clinical endpoints has not been tested so far. The primary outcome was the association between left and right GLS and mortality for all causes. The secondary outcome was the association between left and right GLS and hospitalizations. Methods:prospective longitudinal study enrolling all consecutive SSc patients without structural heart disease or previous cardiovascular event. Results: A total of 164 patients were enrolled, of which 19 (11.5%) died during follow-up, while 48 (29.3%) were hospitalized. Both left and right ventricle GLS at enrolment were independently associated with an increased risk of death for all causes and hospitalizations. Patients with left GLS worse than -19.5% had a 6-fold increased risk of death over the follow-up period (6.9% vs 36.4%; p=.01), as well as patients with right GLS worse than -19.1% (9.0% vs 54.6%; p=.001). Incidence of hospitalization was nearly doubled in patients with left GLS worse than -20% (23.3% vs 55.7%; p=.01) or right GLS worse than -19.0% (29.8% vs 59.0%; p=.03). Conclusion: GLS is associated with an increased risk of death and hospitalization in patients with SSc during a median of 3-year follow-up, acting as a reliable and accurate prognostic tool in everyday practice
Safety and tolerability of a cardiologist-only approach to sedation for electrical cardioversion in the Emergency Department: The INSTEAD pilot trial
No full text
Anti-arrhythmic drugs in atrial fibrillation: tailor-made treatments
No full textDuring the last decades, many improvements have been made regarding the treatment of atrial fibrillation in terms of risk prevention, anti-coagulation strategies, and gain in quality of life. Among those, anti-arrhythmic drugs (AADs) have progressively fallen behind and overtaken by technological aspects as devices as procedures are now the standards of care for many patients. But is this it? Are AADs doomed to be relegated to an obscure and rarely read paragraph of the European recommendations? Or could they be still employed safely and effectively? In the present paper, we will discuss contemporary evidence in order to define where AADs still play a pivotal role, how should AADs be used, and whether a tailored approach can be the way to propose the right treatment to the right patient
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
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
Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department
Full text linkBackground: A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency procedures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC.
Methods: Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance.
Results: Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced peri- procedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam.
As the procedure was shorter when midazolam was used, the median cost of urgent/emergency DCC with midazolam was estimated to be 129.0 € (1st-3rd quartiles 114.6–151.6) and 195.6 € (1st-3rd quartiles 147.3–726.7) with propofol
(p < .001).
Conclusions: Procedural sedation with midazolam given by the cardiologist alone was feasible, well-tolerated and cost-effective in emergency DCC
Myocardial Infarction Without Obstructive Coronary Artery Disease (MINOCA): A Practical Guide for Clinicians
No full textMyocardial infarction without obstructive coronary artery disease (MINOCA) is defined by the evidence of spontaneous acute myocardial infarction (MI) and angiographic exclusion of coronary stenoses ≥50% in any potential infarct related artery, after having ruled out other clinically overt causes for the acute presentation. The introduction of this new concept was meant to encourage discovery of putative pathophysiological mechanisms and development of specific therapeutic measures. In recent years, we have witnessed significant advances in the fields of epidemiology, pathophysiology, diagnosis, prognosis estimation and therapeutics of MINOCA. So far, however, the definition of MINOCA has been rather heterogeneous since specific cardiac conditions such as myocarditis and Takotsubo syndrome have often been included, generating conflicting results. In this review, we summarize the current state-of-the-art in the expanding MINOCA field and propose a comprehensive stepwise approach for the rational diagnostic assessment of these challenging patients. Our aim is to provide clinicians with an "Ariadne's thread" according to the recent fourth universal definition of MI in order to not get lost in MINOCA's labyrinth
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