scholarly journals Aortic Valve Stenosis and Cardiac Amyloidosis: A Misleading Association

2021 ◽  
Vol 10 (18) ◽  
pp. 4234
Author(s):  
Andrea Bonelli ◽  
Sara Paris ◽  
Matilde Nardi ◽  
Michael Y. Henein ◽  
Eustachio Agricola ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Therapeutic Option ◽  
Diagnostic Process ◽  
Prognostic Impact ◽  
Non Invasive ◽  
History Of ◽  
The Common ◽  
Flow Charts ◽  
Invasive Techniques ◽  
Prevalent Form

The association between aortic stenosis (AS) and cardiac amyloidosis (CA) is more frequent than expected. Albeit rare, CA, particularly the transthyretin (ATTR) form, is commonly found in elderly people. ATTR-CA is also the most prevalent form in patients with AS. These conditions share pathophysiological, clinical and imaging findings, making the diagnostic process very challenging. To date, a multiparametric evaluation is suggested in order to detect patients with both AS and CA and choose the best therapeutic option. Given the accuracy of modern non-invasive techniques (i.e., bone scintigraphy), early diagnosis of CA is possible. Flow-charts with the main CA findings which may help clinicians in the diagnostic process have been proposed. The prognostic impact of the combination of AS and CA is not fully known; however, new available specific treatments of ATTR-CA have changed the natural history of the disease and have some impact on the decision-making process for the management of AS. Hence the relevance of detecting these two conditions when simultaneously present. The specific features helping the detection of AS-CA association are discussed in this review, focusing on the shared pathophysiological characteristics and the common clinical and imaging hallmarks.

scholarly journals New Oral Anticoagulants vs. Vitamin K Antagonists Among Patients With Cardiac Amyloidosis: Prognostic Impact

2021 ◽  
Vol 8 ◽  
Author(s):  
Eve Cariou ◽  
Kevin Sanchis ◽  
Khailène Rguez ◽  
Virginie Blanchard ◽  
Stephanie Cazalbou ◽  
...  
Keyword(s):  
Vitamin K ◽  
Cardiac Amyloidosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Prognostic Impact ◽  
Transthyretin Amyloidosis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
History Of

Background: Atrial arrhythmia (AA) is common among patients with cardiac amyloidosis (CA), who have an increased risk of intracardiac thrombus. The aim of this study was to explore the prognostic impact of vitamin K-antagonists (VKA) and direct oral anticoagulants (DOAC) in patients with CA.Methods and Results: 273 patients with CA and history of AA with long term anticoagulation−69 (25%) light chain amyloidosis (AL), 179 (66%) wild-type transthyretin amyloidosis (ATTRwt) and 25 (9%) variant transthyretin amyloidosis (ATTRv)–were retrospectively included between January 2012 and July 2020. 147 (54%) and 126 (46%) patients received VKA and DOAC, respectively. Patient receiving VKA were more likely to have AL with renal dysfunction, higher NT-proBNP and troponin levels. Patients with ATTRwt were more likely to receive DOAC therapy. There were more bleeding complications among patients with VKA (20 versus 10%; P = 0.013) but no difference for stroke events (4 vs. 2%; P = 0.223), as compared to patients with DOAC. A total of 124 (45%) patients met the primary endpoint of all-cause mortality: 96 (65%) and 28 (22%) among patients with VKAs and DOACs, respectively (P < 0.001). After multivariate analysis including age and renal function, VKA was no longer associated with all-cause mortality.Conclusion: Among patients with CA and history of AA receiving oral anticoagulant, DOACs appear to be at least as effective and safe as VKAs.

Psychiatric Disturbances in a Patient with Melas Syndrome: a Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S466-S467
Author(s):  
M.C. Rizza ◽  
S. Di Marco ◽  
C. Delicato ◽  
C. Vecchi ◽  
C. Gramaglia ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Positive Family History ◽  
Genetic Diagnosis ◽  
Diagnostic Process ◽  
Psychiatric Ward ◽  
Melas Syndrome ◽  
Psychiatric Disturbances ◽  
History Of ◽  
The Common ◽  
Competing Interest

IntroductionMitochondrial disorders of energetic metabolism (MD) represent a heterogeneous group of diseases manifesting at any age and its one of a number of mitochondria syndromes that share the common characteristics of encephalopathy and myopathy. The clinical expression of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis and Stroke-like episodes) is highly variable and ppsychiatric symptoms are rarely reported in literature even if are more common in MELAS syndrome than in the general population.ObjectiveThe first aim of the study is describing the clinically observed primary psychiatric symptoms in a patient affected by MELAS syndrome admitted to the Psychiatric ward. The second aim is to go back over the diagnostic process, which led, from the uncommon psychiatric symptoms and signs to the final genetic diagnosis of MD.Methods and resultsWe report the case of a 44-year-old male with MELAS in whom psychiatric symptoms preceded the establishment of the clinical diagnosis for several months. Diagnosis was initially based on the neuroimaging and metabolic findings and subsequently confirmed with genetic analysis.ConclusionsIn case of aggressive and paranoid behaviour with delusions of persecution and disorganised behaviour mmitochondrial disorders deserve consideration as part of the differential diagnosis, especially if there is suspected involvement of other organ groups or positive family history of MD. There is no specific consensus approach for treating MELAS syndrome. Management is largely symptomatic and should involve a multidisciplinary team.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Original Flow Chart for the Management of Hydroureteronephrosis Caused by Pessary Placement

2017 ◽  
Vol 84 (4) ◽  
pp. 240-243 ◽  
Author(s):  
Matteo Balzarro ◽  
Emanuele Rubilotta ◽  
Antonio B. Porcaro ◽  
Nicolò Trabacchin ◽  
Antonio D'Amico ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Obstruction ◽  
Pelvic Organ ◽  
Flow Chart ◽  
Concomitant Increase ◽  
Abdominal Ultrasonography ◽  
Non Invasive ◽  
History Of ◽  
Underlying Causes ◽  
Flow Charts

Hydroureteronephrosis due to pessary is a dangerous complication that can become critical if urosepsis is present. We propose a flow chart to manage the condition. Introduction The use of a pessary to treat a pelvic organ prolapse (POP) is a valid non-invasive option. Severe complications are usually associated with neglected, oversized, or misplaced pessaries. Major complications include fistulas, bowel or bladder erosion, and hydroureteronephrosis (HUN). Materials and Methods We reviewed the literature and our experience in the management of HUN in the last decade, as a consequence of pessary placement. Results We used flow charts to take an accurate medical history of each patient. Blood and urine analyses were taken at admission to assess the potential presence of sepsis, renal failure, and urinary tract infection. Physical examination included vaginal examination. In cases of pessary presence with a concomitant increase of serum creatinine value, a possible ureteral obstruction is suspected. In order to assess the presence of HUN and its underlying causes, a computed tomography (CT) scan should be performed to assess the mechanism of urinary tract obstruction. However, in case of renal insufficiency, abdominal ultrasonography (US) could be sufficient. If HUN is detected in a patient with no signs of urosepsis, we suggest a conservative management by the removal of the pessary and catheter placement. When urosepsis is suspected, it is mandatory to administer antibiotic therapy and evaluate the HUN drainage by nephrostomy. Conclusions There is no uniform management of women with HUN and a concomitant pessary. For this reason, and based on the literature and our experience, we propose an original management flowchart.

scholarly journals How Many Secret Details Could a Systematic Multi-Analytical Study Reveal About the Mysterious Fresco Trionfo della Morte?

Heritage ◽  
2019 ◽  
Vol 2 (3) ◽  
pp. 2370-2383
Author(s):  
Alberghina ◽  
Schiavone ◽  
Greco ◽  
Saladino ◽  
Armetta ◽  
...  
Keyword(s):  
Ir Spectroscopy ◽  
Analytical Study ◽  
Multispectral Imaging ◽  
Imaging Analysis ◽  
X Ray ◽  
Small Areas ◽  
Non Invasive ◽  
History Of ◽  
Invasive Techniques

The “Trionfo della morte” is a detached fresco painting dated at the half of the XV century. Its history is strictly connected with the history of Palermo and it is considered a symbol of the late Gothic period. Some small areas of the fresco were analyzed using a combination of non-invasive techniques and hand-held instrumentations (multispectral imaging analysis, X-ray fluorescence (XRF), and IR spectroscopy). The characterization of the nature of pigments used in its realization and restoration works was performed and some indications about its conservation state were obtained. More interestingly, some hidden details were revealed on the mysterious painting. They constitute additional evidence of the preciousness of the fresco.

scholarly journals A Brief History of Cerebellar Neurostimulation

2021 ◽  
Author(s):  
Gustavo V. Ponce ◽  
Jana Klaus ◽  
Dennis J. L. G. Schutter
Keyword(s):  
Electric Stimulation ◽  
Magnetic Stimulation ◽  
Animal Experiments ◽  
Systematic Research ◽  
Brain Functions ◽  
Non Invasive ◽  
History Of ◽  
Future Direction ◽  
Invasive Techniques ◽  
Cerebellar Stimulation

AbstractThe first attempts at using electric stimulation to study human brain functions followed the experiments of Luigi Galvani and Giovanni Aldini on animal electricity during the eighteenth century. Since then, the cerebellum has been among the areas that have been studied by invasive and non-invasive forms of electrical and magnetic stimulation. During the nineteenth century, animal experiments were conducted to map the motor-related regions of cerebellar cortex by means of direct electric stimulation. As electric stimulation research on the cerebellum moved into the twentieth century, systematic research of electric cerebellar stimulation led to a better understanding of its effects and mechanism of action. In addition, the clinical potential of cerebellar stimulation in the treatment of motor diseases started to be explored. With the introduction of transcranial electric and magnetic stimulation, cerebellar research moved to non-invasive techniques. During the twenty-first century, following on groundbreaking research that linked the cerebellum to non-motor functions, non-invasive techniques have facilitated research into different aspects of cerebellar functioning. The present review provides a brief historical account of cerebellar neurostimulation and discusses current challenges and future direction in this field of research.

Toward a Speech Sciences Community

2012 ◽  
Vol 22 (1) ◽  
pp. 14-20
Author(s):  
Donald Finan ◽  
Stephen M. Tasko
Keyword(s):  
Science Research ◽  
Knowledge Generation ◽  
Speech Language Pathology ◽  
Mandated Curriculum ◽  
Professional Discipline ◽  
Common Area ◽  
Language Pathology ◽  
History Of ◽  
The Common ◽  
Speech Science

The history of speech-language pathology as a profession encompasses a tradition of knowledge generation. In recent years, the quantity of speech science research and the presence of speech scientists within the domain of the American Speech-Hearing-Language Association (ASHA) has diminished, even as ASHA membership and the size of the ASHA Convention have grown dramatically. The professional discipline of speech science has become increasingly fragmented, yet speech science coursework is an integral part of the mandated curriculum. Establishing an active, vibrant community structure will serve to aid researchers, educators, and clinicians as they work in the common area of speech science.

The Utility of Non-invasive Tests for Detection of Previous Proximal-vein Thrombosis

1995 ◽  
Vol 73 (04) ◽  
pp. 592-596 ◽  
Author(s):  
Sabina Villalta ◽  
Paolo Prandoni ◽  
Alberto Cogo ◽  
Paola Bagatella ◽  
Andrea Piccioli ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Femoral Vein ◽  
Clinical Score ◽  
Diagnostic Methods ◽  
Popliteal Vein ◽  
Venous Reflux ◽  
Study Objective ◽  
Vein Thrombosis ◽  
Non Invasive ◽  
The Common

SummaryBackground. Despite the availability of several diagnostic methods for the detection of deep-vein thrombosis (DVT), the identification of previous episodes of DVT remains a diagnostic challenge.Study objective. To assess the reliability of a combination of a standardized clinical score with three non-invasive tests: compression ultrasonography (CUS), Doppler ultrasound (DUS), and photoplethysmography (PPG), in determining the presence or the absence of previous proximal DVT.Methods. One hundred consecutive unselected outpatients were identified, who had undergone contrast venography six to nine years previously because of the clinical suspicion of DVT (confirmed in 43). They were blindly reinvestigated by a panel of trained operators unaware of venography results. They underwent a clinical evaluation of the lower limb, by applying a standardized score to five symptoms and six signs (grading each item from 0 to 3); a PPG test to determine the venous refilling time; a DUS test to determine the venous reflux separately in the common femoral and the popliteal vein; and a CUS test to determine vein compressibility in the same regions.Results. An abnormal CUS test and/or the demonstration of venous reflux in the popliteal region and/or a high clinical score (≥ 8) identified twenty-four of the 43 (56%) DVT + patients with a specificity of 89%. The combination of normal CUS with the absence of venous reflux in both the common femoral and popliteal vein and a low clinical score excluded previous thrombosis in 45 (79%) of the 57 DVT- patients (negative predictive value, 78%). Abnormal venous reflux in the isolated common femoral vein did not reliably predict the presence or absence of previous DVT. However, this occurred in only 13 (13%) patients. The PPG determination of venous refilling time did not improve the results obtained with the other tests.Conclusions. The combination of a standardized clinical evaluation with the results of CUS and DUS can reliably diagnose or exclude previous proximal-vein thrombosis in almost 90% of patients with previous episodes of suspected DVT.

Charles de Gaulle and European Community

2020 ◽  
Vol 2020 (10-3) ◽  
pp. 70-81
Author(s):  
David Ramiro Troitino ◽  
Tanel Kerikmae ◽  
Olga Shumilo
Keyword(s):  
World War Ii ◽  
European Community ◽  
World War ◽  
Charles De Gaulle ◽  
The United Kingdom ◽  
History Of ◽  
The Common ◽  
Post War ◽  
De Gaulle

This article highlights the role of Charles de Gaulle in the history of united post-war Europe, his approaches to the internal and foreign French policies, also vetoing the membership of the United Kingdom in the European Community. The authors describe the emergence of De Gaulle as a politician, his uneasy relationship with Roosevelt and Churchill during World War II, also the roots of developing a “nationalistic” approach to regional policy after the end of the war. The article also considers the emergence of the Common Agricultural Policy (hereinafter - CAP), one of Charles de Gaulle’s biggest achievements in foreign policy, and the reasons for the Fouchet Plan defeat.

Philosophcal review of h. white̕s tropological theory in the context of the new philosophy of history

2020 ◽  
Vol 3 (152) ◽  
pp. 92-99
Author(s):  
S. M. Geiko ◽  
◽  
O. D. Lauta
Keyword(s):  
Modern Science ◽  
Historical Knowledge ◽  
Text Organization ◽  
The Social ◽  
History Of ◽  
Actual Material ◽  
The Common ◽  
Historical Nature ◽  
Selection Of

The article provides a philosophical analysis of the tropological theory of the history of H. White. The researcher claims that history is a specific kind of literature, and the historical works is the connection of a certain set of research and narrative operations. The first type of operation answers the question of why the event happened this way and not the other. The second operation is the social description, the narrative of events, the intellectual act of organizing the actual material. According to H. White, this is where the set of ideas and preferences of the researcher begin to work, mainly of a literary and historical nature. Explanations are the main mechanism that becomes the common thread of the narrative. The are implemented through using plot (romantic, satire, comic and tragic) and trope systems – the main stylistic forms of text organization (metaphor, metonymy, synecdoche, irony). The latter decisively influenced for result of the work historians. Historiographical style follows the tropological model, the selection of which is determined by the historian’s individual language practice. When the choice is made, the imagination is ready to create a narrative. Therefore, the historical understanding, according to H. White, can only be tropological. H. White proposes a new methodology for historical research. During the discourse, adequate speech is created to analyze historical phenomena, which the philosopher defines as prefigurative tropological movement. This is how history is revealed through the art of anthropology. Thus, H. White’s tropical history theory offers modern science f meaningful and metatheoretically significant. The structure of concepts on which the classification of historiographical styles can be based and the predictive function of philosophy regarding historical knowledge can be refined.

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