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21.
Emanuel Raschi Elisabetta Poluzzi Ariola Koci Francesco Salvo Antoine Pariente Maurizio Biselli Ugo Moretti Nicholas Moore Fabrizio De Ponti 《British journal of clinical pharmacology》2015,80(2):285-293
Aim
We assessed the hepatic safety of novel oral anticoagulants (NOACs) analyzing the publicly available US-FDA adverse event reporting system (FAERS).Methods
We extracted reports of drug-induced liver injury (DILI) associated with NOACs, including acute liver failure (ALF) events. Based on US marketing authorizations, we performed disproportionality analyses, calculating reporting odds ratios (RORs) with 95% confidence interval (CI), also to test for event- and drug-related competition bias, and case-by-case evaluation for concomitant medications.Results
DILI reports represented 3.7% (n = 146) and 1.7% (n = 222) of all reports for rivaroxaban and dabigatran, respectively. No statistically significant association was found for dabigatran, in primary and secondary analyses. Disproportionality signals emerged for rivaroxaban in primary analysis (ALF: n = 25, ROR = 2.08, 95% CI 1.34, 3.08). In a large proportion of DILI reports concomitant hepatotoxic and/or interacting drugs were recorded: 42% and 37% (rivaroxaban and dabigatran, respectively), especially statins, paracetamol and amiodarone. Among ALF reports, fatal outcome occurred in 49% of cases (44% and 51%, rivaroxaban and dabigatran, respectively), whereas rapid onset of the event (<1 week) was detected in 46% of patients (47% and 44%, respectively).Conclusions
The disproportionality signal for rivaroxaban calls for further comparative population-based studies to characterize and quantify the actual DILI risk of NOACs, taking into account drug- and patient-related risk factors. As DILI is unpredictable, our findings strengthen the role of (a) timely pharmacovigilance to detect post-marketing signals of DILI through FAERS and other data sources, (b) clinicians to assess early, on a case-by-case basis, the potential responsibility of NOACs when they diagnose a liver injury. 相似文献22.
Massimo F Piepoli Ugo Corrà Pier Giuseppe Agostoni Romualdo Belardinelli Alain Cohen-Solal Rainer Hambrecht Luc Vanhees 《European journal of cardiovascular prevention and rehabilitation》2006,13(2):150-164
Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ systems in isolation. The non-invasive, dynamic physiological overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. The use of CPET in management of the chronic heart failure patient is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are predicted better by indices of exercise tolerance than by resting measurements. Our aim is to produce a statement which provides recommendations on the interpretation and clinical application of CPET in heart failure, based on contemporary scientific knowledge and technical advances: the focus is on clinical indications, issues of standardization, and interpretative strategies for CPET. 相似文献
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Elisa Veronese Roberto Stramare Andrea Campion Bernd Raffeiner Valeria Beltrame Elena Scagliori Alessandro Coran Luca Ciprian Ugo Fiocco Enrico Grisan 《Medical engineering & physics》2013,35(2):188-194
Rheumatoid arthritis (RA) is a chronic multisystemic autoimmune disease, with an unclear etiopathogenesis. Its early diagnosis and activity assessment are essential to adjust the proper therapy. Among the different imaging techniques, ultrasonography (US) allows direct visualization of early inflammatory joint changes as synovitis, being also rapidly performed and easily accepted by patients. We propose an algorithm to semi-automatically detect synovial boundaries on US images, requiring minimal user interaction. In order to identify the synovia-bone and the synovia-soft tissues interfaces, and to tackle the morphological variability of diseased joints, a cascade of two different active contours is developed, whose composition corresponds to the whole synovial boundary.The algorithm was tested on US images acquired from proximal interphalangeal (PIP) and metacarpophalangeal (MCP) finger joints of 34 subjects. The results have been compared with a consensus manual segmentation. We obtained an overall mean sensitivity of 85 ± 13%, and a mean Dice's similarity index of 80 ± 8%, with a mean Hausdorff distance from the manual segmentation of 28 ± 10 pixels (approximately 1.4 ± 0.5 mm), that are a better performance than those obtained by the raters with respect to the consensus. 相似文献
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26.
Merino C Molés JR Rodrigo A Ferrando J García J Primo J Albert A Aragó M Serra B Amorós I 《Gastroenterologia y hepatologia》2005,28(4):221-224
Because of its unpredictable behavior, renal cell carcinoma is one of the most controversial neoplasms. On the one hand, patients frequently show metastases at diagnosis because of its slight manifestations, while on the other, the neoplasm can remain stable after nephrectomy and can then metastasize many years later. When this happens, the metastases usually involve more than 2 organs. The most frequent sites of metastases are the lung and lymph nodes, followed by the bones and liver, while duodenal involvement is rare. Indeed, intestinal metastases are found in only 2% of autopsies and of these, renal cell carcinoma metastases account for 7.1%. We present a case of a solitary late recurrence presenting as upper gastrointestinal bleeding 19 years after nephrectomy for clear cell renal carcinoma. 相似文献
27.
Manuel Zorzi Nicola Gennaro Giulia Capodaglio Emanuele Damiano Luca Urso Salvatore Pucciarelli Laura Memo Eva Carpin Mariachiara Corti Massimo Rugge Ugo Fedeli 《Digestive and liver disease》2019,51(2):304-309
Background
Growing evidence suggests that colorectal cancer (CRC) screening based on the fecal immunochemical test (FIT) reduces CRC incidence and surgical resection rates.Aims
To compare trends in surgery for proximal and distal CRC among Italian regions at different stages of screening implementation.Methods
From the National Hospital Discharge Database we selected hospitalizations with CRC resection of residents aged 50–74 years during 2002–2014, and computed surgery rates for the 8 most populous Italian regions with/without a screening program.Results
In regions with screening, implemented around 2006–2007, the annual percent change (APC) of distal CRC resection was +1.7 (95% confidence interval ?1.0, 4.4) during 2002–2007 and ?9.1 (?10.6, ?7.7) during 2007–2014. No significant change was observed in regions without screening. The APC for proximal colon resection in regions with screening was +5.8 (2.5, 9.0) during 2002–2007 and ?4.1 (?5.8, ?2.4) during 2007–2014, while in regions without screening surgical rates increased through the whole study period. Compared to 2002, in 2014 distal CRC resection rates were greatly reduced in regions with screening, reaching values similar to proximal CRC resection.Conclusion
Following the implementation of screening programs surgery rates steeply decreased, confirming the deep impact of FIT-based screening on the burden of CRC. 相似文献28.
Presently, 12 human polyomaviruses are known: BK polyomavirus (BKPyV), JCPyV, KIPyV, WUPyV, Merkel cell polyomavirus (MCPyV), HPyV6, HPyV7, Trichodysplasia spinulosa‐associated polyomavirus, HPyV9, HPyV10, STLPyV and HPyV12. In addition, the non‐human primate polyomavirus simian virus 40 (SV40) seems to circulate in the human population. MCPyV was first described in 2008 and is now accepted to be an etiological factor in about 80% of the rare but aggressive skin cancer Merkel cell carcinoma. SV40, BKPyV and JCPyV or part of their genomes can transform cells, including human cells, and induce tumours in animal models. Moreover, DNA and RNA sequences and proteins of these three viruses have been discovered in tumour tissue. Despite these observations, their role in cancer remains controversial. So far, an association between cancer and the other human polyomaviruses is lacking. Because human polyomavirus DNA has been found in a broad spectrum of cell types, simultaneous dwelling with other oncogenic viruses is possible. Co‐infecting human polyomaviruses may therefore act as a co‐factor in the development of cancer, including those induced by other oncoviruses. Reviewing studies that report co‐infection with human polyomaviruses and other tumour viruses in cancer tissue fail to detect a clear link between co‐infection and cancer. Directions for future studies to elaborate on a possible auxiliary role of human polyomaviruses in cancer are suggested, and the mechanisms by which human polyomaviruses may synergize with other viruses in oncogenic transformation are discussed. Copyright © 2014 John Wiley & Sons, Ltd. 相似文献
29.
Marco Valgimigli Paolo Calabrò Bernardo Cortese Enrico Frigoli Stefano Garducci Paolo Rubartelli Giuseppe Andò Andrea Santarelli Mario Galli Roberto Garbo Alessandra Repetto Salvatore Ierna Carlo Briguori Ugo Limbruno Roberto Violini Andrea Gagnor 《Journal of cardiovascular translational research》2014,7(1):101-111
Early invasive management and the use of combined antithrombotic therapies have decreased the risk of recurrent ischaemia in patients with acute coronary syndrome (ACS) but have also increased the bleeding risk. Transradial intervention (TRI) and bivalirudin infusion compared to transfemoral intervention (TFI) or unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibitors (GPI) decrease bleeding complications in patients with ACS. To what extent, a bleeding preventive strategy incorporating at least one of these two treatment options translates into improved outcomes is a matter of debate. The Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX study is a large-scale, multicenter, prospective, open-label trial, conducted at approximately 100 sites in Europe aiming to primarily assess whether TRI and bivalirudin infusion, as compared to TFI and UFH plus provisional GPI, decrease the 30-day incidence of death, myocardial infarction or stroke across the whole spectrum of ACS patients. 相似文献
30.