Apical hypertrophic cardiomyopathy(AHCM) is a relatively rare morphologic variant of HCM in which the hypertrophy of myocardium is localized to the left ventricular apex. Symptoms of AHCM might vary from none to other...Apical hypertrophic cardiomyopathy(AHCM) is a relatively rare morphologic variant of HCM in which the hypertrophy of myocardium is localized to the left ventricular apex. Symptoms of AHCM might vary from none to others mimic coronary artery disease including acute coronary syndrome, thus resulting in inappropriate hospitalization. Transthoracic echocardiography is the firstline imaging technique for the diagnosis of hypertrophic cardiomyopathies. However, when the hypertrophy of the myocardium is localized in the ventricular apex might results in missed diagnosis. Aim of this paper is to review the different imaging techniques used for the diagnosis of AHCM and their role in the detection and comprehension of this uncommon disease.展开更多
AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medi...AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers(BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.RESULTS A total of 903 patients were evaluated(mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms(New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia(23% vs 37%), coronary artery disease(28% vs 52%) and left bundle branch block(9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology(50% vs 24%), a history of valve surgery(13% vs 4%) and received overall more devices implantation(31% vs 21%). The use of disease-modifying medications(i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF(72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics(87% vs 69%) and digoxin(51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm(SR)(45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of allcause mortality, the univariate relationship between AF and death(HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant(HR = 0.98, 95%C展开更多
In the last years,endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions.At the same time,the importance of a reliable assessment of such lesions to predict the malignancy and the dept...In the last years,endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions.At the same time,the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged.The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery.Accordingly,this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ.We performed a literature search using electronic databases(MEDLINE/PubMed,EMBASE,and Cochrane Library).We collected all articles about endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)registering the outcomes.Moreover,we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or nonpolypoid lesions of any size,preoperatively estimated as non-invasive.Seven meta-analysis studies,mainly Eastern,were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures.Of these,eighty-two were retrospective,twenty-four perspective,nine casecontrol,and six cohorts,while three were randomized clinical trials.A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions>5-10 mm in size.In conclusion,it is crucial to enhance the preoperative diagnostic workup,especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy.Additionally,the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications.We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions.Nevertheless,despite the lower local recurrence rates,ESD had 展开更多
从儿童到成人的医疗保健系统的转变对许多患有癫痫的年轻人及其家庭来说是一个挑战。最近,加拿大安大略省卫生部和长期医疗部门成立了一个过渡工作组(Transition working group,TWG),为安大略省癫痫患者的过渡提出建议。在此对这项工作...从儿童到成人的医疗保健系统的转变对许多患有癫痫的年轻人及其家庭来说是一个挑战。最近,加拿大安大略省卫生部和长期医疗部门成立了一个过渡工作组(Transition working group,TWG),为安大略省癫痫患者的过渡提出建议。在此对这项工作做出总结。TWG包括儿科和成人癫痫病专家、精神科医生和来自学术界和社区的家庭医生,从事儿童和成人癫痫项目的社区医师、护士和社会工作者,以及青少年内科医师、律师、职业治疗师、社区癫痫机构的代表、癫痫患者和患者父母。该小组主要解决3个领域的问题:(1)癫痫的诊断和管理;(2)癫痫患者心理健康和社会心理需求;(3)癫痫患者经济、社会和法律支持。目前虽然还没有对过渡方案的结果进行系统研究,但TWG能早期识别处于过渡失败风险的青少年,在实际过渡之前即应协调儿童和成人神经科医师以及其他专家。过渡期是重新思考诊断和重复诊断检测(特别是基因检测,现有技术较多年前可发现更多病因)的理想时期。在转至成人医疗系统后部分筛查应重复。文章提出的7个步骤可以促进过渡,从而有助于为青少年癫痫患者转出儿童保健系统提供持续且合理的医疗服务。展开更多
BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different.Resilience may in turn influence the perception of stigma.Patients with inflammatory bowel disease(IBD)...BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different.Resilience may in turn influence the perception of stigma.Patients with inflammatory bowel disease(IBD)are susceptible to stigma,although data are very limited.AIM To validate an Italian translation of the IBD perceived stigma scale(PSS)in relation to patients’resilience.METHODS Consecutive IBD outpatients were prospectively enrolled(December 2018-September 2019)in an Italian,tertiary referral,IBD center.Clinical and demographic data were collected.Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale,respectively.The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality.Higher scores represent greater perceived stigma and resilience.Multivariable analysis for factors associated with greater stigma was computed.RESULTS Overall,126 IBD patients(mean age 46.1±16.9)were enrolled.The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied,with optimal data completeness.There was no ceiling effect,whilst floor effect was present(7.1%).The discriminant validity and the internal consistency reliability were good(Cronbach alpha=0.87).The overall internal consistency was 95%,and the test-retest reliability was excellent 0.996.The median PSS score was 0.45(0.20-0.85).Resilience negatively correlated with perceived stigma(Spearman’s correlation=-0.18,95%confidence intervals:-0.42-0.08,P=0.03).CONCLUSION We herein validated the Italian translation of the PSS scale,also demonstrating that resilience negatively impacts perceived stigma.展开更多
Clostridium difficile is a nosocomial enteric pathogen, considered the main etiological agent of antibiotic-associated diarrhea in hospitals. C. difficile is resistant to several antimicrobial agents used in empiric t...Clostridium difficile is a nosocomial enteric pathogen, considered the main etiological agent of antibiotic-associated diarrhea in hospitals. C. difficile is resistant to several antimicrobial agents used in empiric treatment protocols, which confers selective advantages to this species as compared with other members of the intestinal microbiota. The aim of this study was to evaluate and identify possible alterations of the intestinal microbiota population resulting from the use of antimicrobials associated with infections by C. difficile (CDI). Denaturing Gradient Gel Electrophoresis (DGGE) was used to evaluate fecal samples from two groups: healthy subjects and patients with C. difficile-associated diarrhea (CDAD). A decrease in bacterial diversity was highlighted by the low number of bands in samples from CDAD patients, compared with healthy subjects. This may indicate that antibiotic treatment would affect bacterial diversity, leading to a significant difference between the intestinal microbiota of these two groups, but further studies are still needed. Firmicutes and Verrucomicrobia phyla were detected mainly in healthy individuals, and these could be related to protection factors against the CDI. Klebsiella variicola/K. pneumoniae were found mostly in samples from CDI patients. This study shows the effects of antimicrobials and the CDI itself on human intestinal microbiota.展开更多
变更管理(Management of Change,MOC)在美国OSHA标准和我国工艺安全管理(PSM)体系中均被列为一个重要要素,但是由于我国管理起步较晚和缺乏经验等原因,导致MOC管理普遍存在问题。本文论述了变更管理的概念和起源,并以事故例证方式说明MO...变更管理(Management of Change,MOC)在美国OSHA标准和我国工艺安全管理(PSM)体系中均被列为一个重要要素,但是由于我国管理起步较晚和缺乏经验等原因,导致MOC管理普遍存在问题。本文论述了变更管理的概念和起源,并以事故例证方式说明MOC管理不当是造成国内外很多重大事故的原因,从而阐述了加强其管理的重要意义。以某石化企业借鉴国外先进管理经验并结合企业变更管理实际为例,重点论述变更实施过程管理、风险分析及分类审批方法,以及保障变更资料完整性和准确性3个方面问题的解决对策和方法尝试,供其它企业参考,共同降低整个社会的风险。展开更多
文摘Apical hypertrophic cardiomyopathy(AHCM) is a relatively rare morphologic variant of HCM in which the hypertrophy of myocardium is localized to the left ventricular apex. Symptoms of AHCM might vary from none to others mimic coronary artery disease including acute coronary syndrome, thus resulting in inappropriate hospitalization. Transthoracic echocardiography is the firstline imaging technique for the diagnosis of hypertrophic cardiomyopathies. However, when the hypertrophy of the myocardium is localized in the ventricular apex might results in missed diagnosis. Aim of this paper is to review the different imaging techniques used for the diagnosis of AHCM and their role in the detection and comprehension of this uncommon disease.
文摘AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers(BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.RESULTS A total of 903 patients were evaluated(mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms(New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia(23% vs 37%), coronary artery disease(28% vs 52%) and left bundle branch block(9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology(50% vs 24%), a history of valve surgery(13% vs 4%) and received overall more devices implantation(31% vs 21%). The use of disease-modifying medications(i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF(72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics(87% vs 69%) and digoxin(51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm(SR)(45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of allcause mortality, the univariate relationship between AF and death(HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant(HR = 0.98, 95%C
文摘In the last years,endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions.At the same time,the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged.The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery.Accordingly,this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ.We performed a literature search using electronic databases(MEDLINE/PubMed,EMBASE,and Cochrane Library).We collected all articles about endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)registering the outcomes.Moreover,we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or nonpolypoid lesions of any size,preoperatively estimated as non-invasive.Seven meta-analysis studies,mainly Eastern,were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures.Of these,eighty-two were retrospective,twenty-four perspective,nine casecontrol,and six cohorts,while three were randomized clinical trials.A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions>5-10 mm in size.In conclusion,it is crucial to enhance the preoperative diagnostic workup,especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy.Additionally,the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications.We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions.Nevertheless,despite the lower local recurrence rates,ESD had
文摘从儿童到成人的医疗保健系统的转变对许多患有癫痫的年轻人及其家庭来说是一个挑战。最近,加拿大安大略省卫生部和长期医疗部门成立了一个过渡工作组(Transition working group,TWG),为安大略省癫痫患者的过渡提出建议。在此对这项工作做出总结。TWG包括儿科和成人癫痫病专家、精神科医生和来自学术界和社区的家庭医生,从事儿童和成人癫痫项目的社区医师、护士和社会工作者,以及青少年内科医师、律师、职业治疗师、社区癫痫机构的代表、癫痫患者和患者父母。该小组主要解决3个领域的问题:(1)癫痫的诊断和管理;(2)癫痫患者心理健康和社会心理需求;(3)癫痫患者经济、社会和法律支持。目前虽然还没有对过渡方案的结果进行系统研究,但TWG能早期识别处于过渡失败风险的青少年,在实际过渡之前即应协调儿童和成人神经科医师以及其他专家。过渡期是重新思考诊断和重复诊断检测(特别是基因检测,现有技术较多年前可发现更多病因)的理想时期。在转至成人医疗系统后部分筛查应重复。文章提出的7个步骤可以促进过渡,从而有助于为青少年癫痫患者转出儿童保健系统提供持续且合理的医疗服务。
文摘BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different.Resilience may in turn influence the perception of stigma.Patients with inflammatory bowel disease(IBD)are susceptible to stigma,although data are very limited.AIM To validate an Italian translation of the IBD perceived stigma scale(PSS)in relation to patients’resilience.METHODS Consecutive IBD outpatients were prospectively enrolled(December 2018-September 2019)in an Italian,tertiary referral,IBD center.Clinical and demographic data were collected.Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale,respectively.The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality.Higher scores represent greater perceived stigma and resilience.Multivariable analysis for factors associated with greater stigma was computed.RESULTS Overall,126 IBD patients(mean age 46.1±16.9)were enrolled.The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied,with optimal data completeness.There was no ceiling effect,whilst floor effect was present(7.1%).The discriminant validity and the internal consistency reliability were good(Cronbach alpha=0.87).The overall internal consistency was 95%,and the test-retest reliability was excellent 0.996.The median PSS score was 0.45(0.20-0.85).Resilience negatively correlated with perceived stigma(Spearman’s correlation=-0.18,95%confidence intervals:-0.42-0.08,P=0.03).CONCLUSION We herein validated the Italian translation of the PSS scale,also demonstrating that resilience negatively impacts perceived stigma.
文摘Clostridium difficile is a nosocomial enteric pathogen, considered the main etiological agent of antibiotic-associated diarrhea in hospitals. C. difficile is resistant to several antimicrobial agents used in empiric treatment protocols, which confers selective advantages to this species as compared with other members of the intestinal microbiota. The aim of this study was to evaluate and identify possible alterations of the intestinal microbiota population resulting from the use of antimicrobials associated with infections by C. difficile (CDI). Denaturing Gradient Gel Electrophoresis (DGGE) was used to evaluate fecal samples from two groups: healthy subjects and patients with C. difficile-associated diarrhea (CDAD). A decrease in bacterial diversity was highlighted by the low number of bands in samples from CDAD patients, compared with healthy subjects. This may indicate that antibiotic treatment would affect bacterial diversity, leading to a significant difference between the intestinal microbiota of these two groups, but further studies are still needed. Firmicutes and Verrucomicrobia phyla were detected mainly in healthy individuals, and these could be related to protection factors against the CDI. Klebsiella variicola/K. pneumoniae were found mostly in samples from CDI patients. This study shows the effects of antimicrobials and the CDI itself on human intestinal microbiota.
文摘变更管理(Management of Change,MOC)在美国OSHA标准和我国工艺安全管理(PSM)体系中均被列为一个重要要素,但是由于我国管理起步较晚和缺乏经验等原因,导致MOC管理普遍存在问题。本文论述了变更管理的概念和起源,并以事故例证方式说明MOC管理不当是造成国内外很多重大事故的原因,从而阐述了加强其管理的重要意义。以某石化企业借鉴国外先进管理经验并结合企业变更管理实际为例,重点论述变更实施过程管理、风险分析及分类审批方法,以及保障变更资料完整性和准确性3个方面问题的解决对策和方法尝试,供其它企业参考,共同降低整个社会的风险。
