bluuebunny/crossref_metadata_2025 huggingface dataset:
An overview on Severe Acute Respiratory Syndrome (SARS)
Authors: Hui D.S.C.
Published: July 2016

Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease that has caught the medical profession by surprise in 2003. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache and dyspnoea but diarrhea occurs in 40-70% of patients after hospital admission. Respiratory failure is the major complication of SARS; at least half of the patients require supplemental oxygen during the acute phase whereas about 20% of patients progress to acute respiratory distress syndrome requiring invasive mechanical ventilatory support. In contrast, the severity is generally mild in infected young children. Due to our limited understanding of this new disease, treatment of SARS was empirical in 2003. Protease inhibitor (Lopinavir/ritonavir) in combination with ribavirin may play a role as antiviral therapy in the early phase whereas nelfinavir is a promising alternative. The role of interferon and systemic steroid in preventing immune- mediated lung injury deserves further investigation. In addition, other anti-viral treatment, RNA interference, monoclonal antibody, synthetic peptides, and vaccines are being developed. Rapid diagnosis, early isolation, and good infection control measures are important in preventing spread of the infection.
Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study
Authors: Caramori G. , Fabbri M. , Paioli D. , Falcone F. , Severino C. , Felisatti G. , Arar O. , Adcock I.M. , Fan Chung K. , Barnes P.J. , Ciaccia A. , Papi A.
Published: July 2016

Background. Little is known about the long-term natural history of asthma and the long-term clinical and functional consequences in non-smoking patients. From a functional point of view, non-smoking asthmatic patients may have a significantly greater decline in forced expiratory volume in one second (FEV1) compared with nonasthmatic subjects and may develop chronic irreversible (fixed) airflow limitation. This has been related to the physiological consequences of chronic airway inflammation causing airway remodeling. However these lesions are all potentially reversible and there is little radiological evidence indicating lung destruction (pulmonary emphysema), which is potentially irreversible, in non-smoking asthmatics. Severe chronic respiratory failure is the major cause of mortality in patients with severe chronic lung diseases. Domiciliary long-term oxygen therapy (LTOT) is an accepted treatment for patients with severe chronic respiratory failure. Our reasoning, therefore, was that if asthma is a cause of severe chronic respiratory failure in nonsmokers we should be able to find non-smoking asthmatics within a large population of patients on LTOT. The aim of our study (Asthma and Long-term Oxygen Therapy, “ALOT”) was to investigate the prevalence of non-smoking asthmatics in patients on LTOT in a multicentre, cross-sectional study. Methods. Between June and September 2003 we screened all subjects on long-term domiciliary oxygen therapy in three different hospitals in the North-East area of Italy (within the provinces of Ferrara and Bologna). Taken collectively, we have found one-hundred and eighty-four patients on LTOT. We have reviewed their clinical data (age, sex, smoking, history and physical examination, arterial blood gas analysis, pulmonary function). Results. 114 patients (all smokers) fulfilled the diagnostic criteria for COPD. Seventy patients (all smokers) had other diseases. We were unable to find any non-smokers in our screened population of subjects on long-term domiciliary oxygen therapy. Furthermore, there was no past history of asthma and/or acute wheezing episodes in either of the patient groups. Conclusions. This data suggests that asthma is an uncommon cause of severe chronic respiratory failure necessitating long-term domiciliary oxygen therapy in nonsmokers and supports the current consensus that asthma and COPD are different diseases with differing stages of severity and the concept that long-term avoidance of active smoking is fundamental for the prevention of severe chronic respiratory failure.
GP management of community-acquired pneumonia in Italy: the ISOCAP study
Authors: Sanguinetti C.M. , De Benedetto F. , Donner C.F.
Published: July 2016

Background. Community-Acquired Pneumonia (CAP) is still a significant problem in terms of incidence, mortality rate, particularly in infants and the elderly, and socioeconomic burden. General Practitioners (GPs) are the first reference for patients with this disease, but there are few published studies regarding the outpatient treatment of CAP. Methods. The ISOCAP study aimed to identify the type and outcome of the diagnostic-therapeutic management of CAP by GPs in Italy, within the framework of developing a closer interrelationship between GPs and pulmonary specialists. Thirty-six Pulmonary Divisions throughout Italy each contacted 5 local GPs who agreed to recruit the first 5 consecutive patients who consulted them for suspected CAP within the study’s 1-year observation period. Results. A total of 183 GPs took part in the study and enrolled, by the end of the observation period, 763 CAP patients; of these, complete data was available for 737 patients [males=373, females=364, mean age (±SD) 58.8±19.6 years]. 64.4% of patients had concomitant diseases, mainly systemic arterial hypertension and COPD. Diagnosis of CAP was based by GPs on physical examination only in 41.6% of cases; in the remaining chest X-ray was also performed. In only 4.6% of patients were samples sent for microbiological analysis. All patients were treated with antibiotics: 76.7% in mono-therapy, 23.3% with a combination of antibiotics. The antibiotic class most prevalently used in mono-therapy was cephalosporin, primarily ceftriaxone; the most frequently used combinations were cephalosporin+macrolide and cephalosporin+quinolone. Mono-therapy was effective in 70% of cases, the combination of two or more antibiotics in 91.2% of patients. Overall treatment efficacy was 94.7%; hospitalisation was required in 8.5% of cases. Conclusions. Outpatient management of CAP by GPs in Italy is effective, hospitalisation being necessary only in the most severe cases due to age, co-morbidities or extent of pneumonia. This signifies a very significant savings in national health costs.
Complementary and alternative medicine for the treatment and diagnosis of asthma and allergic diseases
Authors: Passalacqua G. , Compalati E. , Schiappoli M. , Senna G.
Published: July 2016

The use of Complementary/Alternative Medicines (CAM) is largely diffused and constantly increasing, especially in the field of allergic diseases and asthma. Homeopathy, acupuncture and phytotherapy are the most frequently utilised treatments, whereas complementary diagnostic techniques are mainly used in the field of food allergy- intolerance. Looking at the literature, the majority of clinical trials with CAMS are of low methodological quality, thus difficult to interpret. There are very few studies performed in a rigorously controlled fashion, and those studies provided inconclusive results. In asthma, none of the CAM have thus far been proved more effective than placebo or equally effective as standard treatments. Some herbal products, containing active principles, have displayed some clinical effect, but the herbal remedies are usually not standardised and not quantified, thus carry the risk of toxic effects or interactions. None of the alternative diagnostic techniques (electrodermal testing, kinesiology, leukocytotoxic test, iridology, hair analysis) have been proved able to distinguish between healthy and allergic subjects or to diagnose sensitizations. Therefore these tests must not be used, since they can lead to delayed or incorrect diagnosis and therapy.
Il Programma GICR 2006-2008: continuitÃ ed innovazione
Authors: Griffo Raffaele
Published: July 2016

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Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation
Authors: Diaco Tommaso , Milanesi Geremia , Zaniboni Daniela , Gritti Massimo , Zavatteri Gianna , Claus Marco , Velo Francesco
Published: July 2016

weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.
PuÃ² essere davvero pericoloso esporsi acutamente allâ€™alta quota senza allenamento?
Authors: Donegani Enrico , Chiarottino Flavio , Clemente Roberto , Movalli Franco , Venturino Giovanni , Nuti Claudio , Protto Elio
Published: July 2016

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First National Conference - 1a Conferenza Nazionale â€œLa cardiologia riabilitativa e preventiva nellâ€™era della cardiologia interventisticaâ€
Authors: Pirelli Salvatore
Published: July 2016

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From risk charts to guidelines: tools for evaluation and management of cardiovascular risk
Authors: Castello Cristina , Colivicchi Furio , Sclavo Mariagrazia , Uguccioni Massimo , Genovesi Ebert Alberto , Abrignani Maurizio G. , Faggiano Pompilio , Riccio Carmine
Published: July 2016

Despite the wide improvement of diagnostic techniques and the introduction of effective pharmacological and instrumental therapeutic strategies aimed to the treatment of cardiovascular diseases, their incidence and lethality are still elevated, with economic implications increasingly less sustainable by the public medical systems. The modern practice of cardiovascular prevention requires, thus, that diagnostic and therapeutic interventions, both at population level and on the single patient, should be more and more precise, effective, and appropriate. From this point of view, a correct global cardiovascular risk stratification assumes a preponderant relevance, in order to allow an adequate therapeutical response. For this purpose several work instruments, as risk charts and guidelines, namely dedicated to arterial hypertension and dyslipidemias, were developed and offered to clinicians interested in cardiovascular prevention. The aim of this review is to illustrate, in synthesis, those instruments, aiming to facilitate their implementation, thus reducing the actual gap between theoretical indications and the real world.
Heart failure in Eastern Veneto: prevalence, hospitalization rate, adherence to guidelines and social costs
Authors: Valle Roberto , Baccichetto Renzo , Barro Sabrina , Calderan Alessandro , Carbonieri Emanuele , Chinellato Maura , Chiatto Mario , Dâ€™Eri Alessandra , Corazza Francesco , Dâ€™Atri Massimo , Drigo Raffaela , Fabris Simeone , Fabris Gelli Giuseppe , Lo Giudice Antonio , Noventa Federica , Pollon Alessandro , Santin Paolo , Zanardi Franco , Milani Loredano
Published: July 2016

Heart failure is a preminent problem of public health, requiring innovating methods of health services organization. Nevertheless, data are still not available on prevalence, hospitalization rate, adherence to Guidelines and social costs in the general Italian population. The necessity to identifying patients with heart failure derives from the efficacy of new therapeutic interventions in reducing morbidity and mortality. In this study we aimed to identify, in a subset of the Eastern Veneto population, patients with heart failure through a pharmacologic-epidemiologic survey. The study was divided in 5 phases: 1) identification of patients on furosemide in the year 2000 in the ASL 10 of Eastern Veneto general population, through an analysis of a specific pharmaceutic service database; 2) definition of the actual prevalence of heart failure in a casual sample of these patients, through data base belonging to general practitioners, cardiologists, or others. Diagnosis was based on the following criteria: a) previous diagnosis of heart failure; b) previous hospitalization for heart failure; c) clinical evidence, with echocardiographic control in unclear cases; 3) survey of hospitalizations; 4) evaluation of adhesion to guidelines, through both databases and questionnaires; 5) analysis of the social costs of the disease, with a retrospective â€œbottom upâ€ approach. From a total population of 198.000 subjects, we identyfied 4502 patients on furosemide. In a casual sample of 10.661 subjects we defined a prevalence of heart failure in Eastern Veneto of 1.1%, that rised to 7.1% in octuagenarians. The prescription of life saving drugs was satisfactory, while rather poor was the indication to echocardiography and to cardiologic consultation. Hospitalization rate for DRG 127 was low: 2.1/1000 inhabitants/year in the general polulation and 12.5 /1000 inhabitants/year in patients >70 years of age. Yearly mortality was 10.3%. Social costs were elevated (15.394 â‚¬/patient/year), due to a relevant sanitary component (hospital 53%, drugs 28%) and particularly a to an indirect cost component. In conclusion, the assumption of furosemide lends itself as a good marker for identifying patients with heart failure. Patient identification is simple, cheap and cost-efficient, and can be easily reproduced in other regional areas.
Prevenzione delle Malattie Cardiovascolari Work in Progress 2006
Authors: Malattie Cardiovascolari Prevenzione delle
Published: July 2016

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Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy
Authors: Stratakos G. , Zisis C. , Bellenis I. , Filaditaki V. , Liapikou A. , Zakynthinos S. , Roussos C.
Published: July 2016

Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement.
Primary alveolar hypoventilation and XXXXY chromosopathy
Authors: Samolski D. , AntÃ³n A. , Mayos M. , Subirana M. , GÃ¼ell R.
Published: July 2016

The association of primary alveolar hypoventilation (PAH) and chromosomic diseases has not been described previously. A 19 year-old man with Fraccaroâ€™s syndrome (XXXXY karyotype) was admitted to evaluate chronic hypercapnic respiratory failure, pulmonary arterial hypertension and cor pulmonale. PAH was diagnosed. As effective treatment, such as non-invasive positive pressure ventilation (NIPPV), is available for this disorder we should intensify the search for PAH in patients with chromosome disease.
Pulmonary complications in primary hypogammaglobulinemia: a survey by high resolution CT scan
Authors: Gharagozlou M. , Ebrahimi F.A. , Farhoudi A. , Aghamohammadi A. , Bemanian M.-H. , Chavoshzadeh Z. , Heidarzadeh M. , Mehdizadeh M. , Moin M. , Movahedi M. , Nabavi M. , Pourpak Z. , Rezaei N.
Published: July 2016

Background. Primary hypogammaglobulinemia disorders are a group of heterogeneous immunodeficiency syndromes with an increased susceptibility to pulmonary complications. Methods. The aim of this study was to evaluate the extent of lung abnormalities in primary hypogammaglobulinaemic patients by high resolution computed tomography (HRCT) scan and pulmonary function test (PFT). HRCT and PFT were performed in 22 Iranian patients with primary hypogammaglobulinemia. Results. Pathological bronchial findings were observed in thirteen patients: three patients showed only peribronchial thickening and the remaining ten patients suffered from both bronchiectasis and peribronchial wall thickening. Mild type of bronchiectasis and peribronchial wall thickening were the most common type, predominantly observed in the right middle and both right and left lower lobe segments of lungs. Although bullae were not found, emphysema, air-trapping, and collapse/consolidation were observed in two patients. Bronchial involvement was mostly limited to 1 up to 5 bronchopulmonary segments; only one HRCT indicated bronchial involvement in more than nine bronchopulmonary segments. Pathological bronchial findings mostly observed in the proximal bronchi; meanwhile the involvement of the distal bronchi was less common. Decreasing FEV1 and FVC were observed in 65% and 55% of patients, respectively. There was a significant correlation between the HRCT score and the predicted values by PFT. The delay of diagnosis in patients with bronchiectasis was significantly higher than those without bronchiectasis. Conclusions. It seems that the majority of hypogammaglobulinaemic patients suffer from the mild type of bronchiectasis, which is mostly observed in the proximal bronchi of the lower lobe segments. The delay of diagnosis plays an important role in the occurrence of this complication in these patients.
Partial flow/volume curves and airway resistances in obese subjects: new tools for investigating flow limitation?
Authors: Drigo R. , Coin A. , Fontana M. , Enzo E. , Ferraresso A. , Zambotto F.
Published: July 2016

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Pleural tuberculosis
Authors: Chakrabarti B. , Davies P.D.O.
Published: July 2016

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in â€œprimaryâ€ effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.
Allergen-specific immunotherapy: an update on immunological mechanisms of action
Authors: Ciprandi G. , Marseglia G.L. , Tosca M.A.
Published: July 2016

Specific immunotherapy (SIT) is the only treatment able to modify the natural history of the allergic subjects. Several aspects of the immunopathological response modified by SIT have been investigated; the first parameter historically studied was the production of allergen-specific antibodies. An increase of allergen-specific IgG4 and a decrease of IgE appear after SIT. A shift from Th2-polarized immune response toward Th1-oriented pattern has been reported after SIT. More recently, a crucial role for a subpopulation of T cells has been evidenced: T regulatory cells (Treg). Allergic patients have a defect of Tregs. SIT is able of inducing a specific Treg response. Sublingual immunotherapy is an alternative route of administration for SIT. Recent evidence shows that SLIT is also able of inducing a Treg response as detected by IL- 10 production.
Collapse of a new type of self-expanding metallic tracheal stent
Authors: Trisolini R. , Paioli D. , Fornario V. , Lazzari Agli L. , Grosso D. , Patelli M.
Published: July 2016

Airway stent insertion is a procedure increasingly used in patients with complex post-intubation tracheal stenosis (PITS) who are unfit for or refuse surgery [1-3]. Very recently, a new self-expanding metallic stent (Alveolus TB-STSTM, Alveolus Inc., Charlotte, NC, USA) which is supposed to be easy to remove and for which indication for the treatment of benign tracheobronchial conditions has been obtained from the FDA, has been put on the market and is under evaluation. We report on a very unusual complication of an Alveolus tracheal stent in a patient with PITS.
Prevenzione delle Malattie Cardiovascolari Work in Progress 2007
Authors: Malattie Cardiovascolari Prevenzione delle
Published: July 2016

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The united airways concept: from bench to bedside
Authors: Braunstahl G.J.
Published: July 2016

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What happens when oral tuberculosis is not treated?
Authors: Erbaycu A.E. , Taymaz Z. , Tuksavul F. , Afrashi A. , GÃ¼Ã§lÃ¼ S.Z.
Published: July 2016

Pulmonary tuberculosis (TB) is the most important form of the disease, although infection may also occur by way of the intestinal tract, tonsils and skin. Oral lesions consist of persistent ulcers or granulomatous masses. A 50 year old man had been diagnosed â€œnecrotising granulomatous inflammationâ€ following a biopsy of a lesion on lower lip, 21 months before at a medical centre. A chest-X-ray had not been performed and he had not been given any advise in respect of treatment. He was admitted to the hospital with cough, sputum, weakness, weight loss and lesions on his lower lip. In radiology, it was detected that he had supraclavicular, submental, cervical, mediastinal lymphadenopathies, pulmonary infiltrations with cavities, thickening and roughness on left oropharengial tonsil, thickenning on inner parts of larynx and bilateral surrenal thickening. The biopsy of lesions on larynx, tonsil and epiglottis revealed â€œnecrotising granulomatous inflammationâ€ and histopathology supported TB infection. Sputum acid-fast bacilli was positive and culture was positive for Mycobacterium tuberculosis complex. Two months of combination treatment resulted in a gradual relief of the symptoms, radiological response, disappearing of neck swelling and healing of lesions on lip, tonsil and larynx. Although unusual oral cavity manifestations of TB are rare, clinicians should be aware of possible occurrance.
Features of hospitalisations for acute exacerbation of COPD resulting in death
Authors: Kinnunen T. , SÃ¤ynÃ¤jÃ¤kangas O. , Keistinen T.
Published: July 2016

Background. Hospitalisation periods for the acute exacerbation phase of COPD are a strain on health facilities and entail high rates of hospital mortality. The aim of this study was to ascertain the characteristics of treatment periods resulting in death and the risk factors involved on the basis of treatment registers and death certificates. Methods. Data on all treatment periods for persons over 44 years of age with a principal diagnosis of COPD that began as emergency admissions applying to the period 1993-2001 was gathered from the hospital treatment register maintained by the Finnish National Research and Development Centre for Welfare and Health, yielding a total of 72 896 cases. Data on the deaths of the patients concerned was then obtained from Statistics Finland and those treatment periods which could be shown to have ended in death (N=2331) were taken to form the material for analysis. These were compared with a same number of control hospitalisation periods (not ending in death) in terms of specialisation, type and geographical location of the hospital, length of the treatment period and the occurrence of subsidiary diagnoses. Attention was also paid to the season of the year and the days of the week on which admission and death took place. Results. The proportion of emergency admissions that ended in death was 3.2%, The patients concerned having a mean age of 74.5 years for men and 75.0 years for women on admission. The mean duration of the treatment period was 11.5 days (SD 14.8), compared with 8.0 days (SD 7.9) for the controls. A subsidiary diagnosis existed in the case of 53.6% of the periods ending in death and 37.5% of the control periods. Deaths were most frequent on Fridays, 15.6%, and least so on Tuesdays, 13.0%. Where 24.2% of patients admitted on Saturdays or Sundays died during the first 24 hours, the figure for those admitted on weekdays was only 17.7%. Altogether 62.8% of the treatment periods ending in death took place between December and May. Conclusions.The COPD patients admitted at weekends showed the poorest survival, while concurrent diseases and protraction of the treatment period in winter and early spring increased the risk of death. Recognition of risk cases on admission could enable mortality to be reduced and allow savings in terms of costs through the intensification of treatment in these cases.
Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly
Authors: Dâ€™Ippolito R. , Foresi A. , Castagnetti C. , Gesualdi S. , Castagnaro A. , Marangio E. , Olivieri D.
Published: July 2016

Aim. To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. Methods. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older (â€œvery elderlyâ€; =>75 yrs), were reviewed. Results. Patients aged 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged <75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively.Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Conclusions. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.
Doping and Respiratory System
Authors: Casali L. , Pinchi G. , Puxeddu E.
Published: July 2016

Historically many different drugs have been used to enhance sporting performances. The magic elixir is still elusive and the drugs are still used despite the heavy adverse effects. The respiratory system is regularly involved in this research probably because of its central location in the body with several connections to the cardiovascular system. Moreover people are aware that O2 consumption and its delivery to mitochondria firstly depend on ventilation and on the respiratory exchanges. The second step consists in the tendency to increase Vâ€™O2 max and to prolong its availability with the aim of improving the endurance time and to relieve the fatigue. Many methods and substances had been used in order to gain an artificial success. Additional oxygen, autologous and homologous transfusion and erithropoietin, mainly the synthetic type, have been administered with the aim of increasing the amount of oxygen being delivered to the tissues. Some compounds like stimulants and caffeine are endowed of excitatory activity on the CNS and stimulate pulmonary ventilation. They did not prove to have any real activity in supporting the athletic performances. Beta-adrenergic drugs, particularly clenbuterol, when administered orally or parentherally develop a clear illicit activity on the myosin fibres and on the muscles as a whole. Salbutamol, terbutaline, salmeterol and formoterol are legally admitted when administrated by MDI in the treatment of asthma. The prevalence of asthma and bronchial hyperactivity is higher in athletes than amongst the general population. This implies that clear rules must be provided to set a correct diagnosis of asthma in the athletes and a correct therapy to align with the actual guidelines according to the same rights of the â€œotherâ€ asthmatic patients.
Pulmonary hemosiderosis with normocomplementemic urticarial vasculitis in a child
Authors: Yuksel H. , Yilmaz O. , Savas R. , Kirmaz C. , Sogut A. , Ã–zalp S.
Published: July 2016

urticarial vaculitis especially if normocomplementemic. An eigth year old girl presented with relapsing and remitting chronic and persistent urticarial lesions, conjunctival injection, recurrent cough and hemoptysis. Respiratory findings started at seven years of age. Physical examination revealed diffuse skin lesions mainly settled on the extremites, nonpurulent conjunctival injection, rare ronchi and fine crackles in bilateral lower zones of the lungs. Biopsy of the urticaria like skin lesions demonstrated leukocytoclastic vasculitis. Rheumatological markers were negative. Levels of complement fractions 3 and 4 were normal. Chest x-ray demonstrated diffuse alveolar infiltrative images. High Resolution Computed Tomography of the chest revealed diffuse ground-glass appearance, increased interstitial density. Diagnostic flexible fiberoptic bronchoscopy was performed and bronchoalveolar lavage fluid revealed hemosiderin laden alveolar macrophages. She was started on systemic corticosteroid treatment. During follow up, pulmonary symptoms disappeared, however skin lesions and conjunctival symptoms persisted and exacerbated four times in two years. CT of lungs after two years of treatment revealed rare patchy areas of ground glass appearance in bilateral lower lobes and right upper lobe as well as a few of milimetric pleural nodules. This patient is still followed up under low dose steroids and pulmonary findings regressed but low grade inflammation due to vasculitis is thought to continue as supported by the persistence of tomographic findings in the lungs despite the absence of any symptoms. This case demonstrates association of urticarial vasculitis and pulmonary hemosiderosis in the setting of normocomplementemia.
Efficacy, Safety and Cost of Regorafenib in Patients with Metastatic Colorectal Cancer in French Clinical Practice
Authors: Calcagno Fabien , Lenoble Sabrina , Lakkis Zaher , Nguyen Thierry , Limat Samuel , Borg Christophe , Jary Marine , Kim Stefano , Nerich Virginie
Published: July 2016

Background

Regorafenib is an orally administered multikinase inhibitor that has been approved for patients with chemotherapy-refractory metastatic colorectal cancer (mCRC). Even though regorafenib significantly improved survival in two international phase 3 trials (CORRECT and CONCUR), a high rate of treatment-related toxic effects and dose modifications were observed with a modest benefit. The aim of this study was to provide information concerning the efficacy, safety, and cost of regorafenib in patients with mCRC in clinical practice.

Material and Methods

We retrospectively reviewed patients treated with regorafenib monotherapy for unresectable mCRC in five Franche-Comté cancer hospitals (France). The primary end point was overall survival. Secondary end points were safety and descriptive cost analyses of patients treated with regorafenib in clinical practice. Another aim of this study was to assess the impact of regorafenib prescription on the risk of hospitalization in real-life practice.

Results

From January 2014 to August 2014, 29 consecutive patients were enrolled. Patients were heavily pretreated and were refractory to standard chemotherapies. The primary tumor sites were the colon and the rectum for 55% and 45% of patients, respectively. Fifteen patients (51%) harbored an RAS mutation. Eastern Cooperative Oncology Group - Performance Status (PS) was 0–1 for 86% of patients and 2 for 14% of patients. Nineteen patients (66%) initially received reduced doses of 120 or 80 mg/day. The median duration of treatment was 2.5 months (range, 0.13–11.4 months). Treatment-related adverse events occurred in 86% of patients. The most frequent adverse events of any grade were fatigue (35%), diarrhea (20%), and hand-foot skin reaction (20%). Grade 3 or 4 treatment-related adverse events occurred in 10 patients (35%). Three patients (10%) were admitted to hospital due to drug-related severe adverse events. The mean cost of patient management with regorafenib for the duration of treatment was 9908 ± 8191€, and median cost was 7917€ (Interquartile range (IQR) 4469-13,042). The median overall survival was six months (95% confidence interval, five to eight months).

Conclusions

The safety and efficacy of regorafenib in heavily pretreated mCRC patients was comparable, in our study, to prospective and retrospective trials. Toxic effects were mostly manageable in an outpatient setting. Regorafenib itself represented the most important (93%) part of supported costs. Even though most side effects were manageable in an outpatient setting, severe adverse events occurred from hospitalization in 10% of patients. These data should be confirmed in a larger real-life-based cohort. Identification of predictive biomarkers is needed for mCRC patient selection for regorafenib treatment.
О сложности обратимых схем, состоящих из функциональных элементов NOT, CNOT и 2-CNOT
Authors: Zakablukov Dmitry Vladimirovich
Published: July 2016

Рассматривается вопрос о сложности обратимых схем, состоящих из функциональных элементов NOT, CNOT и 2-CNOT. Определяется функция Шеннонa $L(n, q)$ сложности обратимой схемы, реализующей отображение $f\colon \mathbb Z_2^n \to \mathbb Z_2^n$, как функция от $n$ и количества $q$ дополнительных входов схемы. Установлены нижняя оценка сложности обратимой схемы $L(n,q) \geqslant \frac{2^n(n-2)}{3\log_2(n+q)} - \frac{n}{3}$, верхняя оценка сложности $L(n,0) \leqslant 48n2^n(1+o(1)) \mathop / \log_2n$ в случае отсутствия дополнительных входов, асимптотическая верхняя оценка сложности $L(n,q_0) \lesssim 2^n$ в случае использования $q_0 \sim n2^{n-o(n)}$ дополнительных входов.
Спектральный метод оценки числа решений систем нелинейных уравнений с линейными рекуррентными аргументами
Authors: Kamlovskii Oleg Vital'evich
Published: July 2016

Предлагается общий подход к получению оценок числа решений систем нелинейных уравнений. Окончательные оценки устанавливаются в случае, когда аргументами функций в системе выступают знаки линейных рекуррентных последовательностей над кольцами Галуа.
О числе полиномиальных функций $k$-значной логики по составному модулю $k$
Authors: Selezneva Svetlana Nikolaevna
Published: July 2016

Функция $k$-значной логики называется полиномиальной, если ее можно предствить полиномом по модулю $k$. В работе для каждого составного числа $k$ предлагается однозначный канонический вид полиномов для полиномиальных функций $k$-значной логики, зависящих от произвольного числа переменных. При помощи этого канонического вида при каждом составном $k$ найдена формула, которая выражает число полиномиальных функций $k$-значной логики, зависящих от $n$ переменных. Как следствие при каждом составном $k$ получена асимптотика логарифма числа полиномиальных функций $k$-значной логики, зависящих от $n$ переменных.
Работа поддержана РФФИ, грант 16-01-00593-а.
Об $1$-устойчивых совершенно уравновешенных булевых функциях
Authors: Smyshlyaev Stanislav Vitalevich
Published: July 2016

Рассматривается связь между корреляционной иммунностью (устойчивостью) и совершенной уравновешенностью булевых функций. Показано, что для произвольной совершенно уравновешенной булевой функции не выполняется даже некоторое более слабое, чем $1$-устойчивость, свойство, что опровергает некоторые результаты Маркуса Дихтла. С другой стороны, доказываются новые утверждения о барьерах совершенно уравновешенных булевых функций, с помощью которых удается доказать, что все совершенно уравновешенные функции, сумма длин барьеров которых меньше числа переменных, являются $1$-устойчивыми.
Работа поддержана Российским фондом фундаментальных исследований (проекты 16-01-00226 А и 16-01-00470 А).
Оценки средней сложности монотонных булевых функций
Authors: Chashkin Aleksandr Viktorovich
Published: July 2016

Рассматривается средняя сложность вычисления монотонных булевых функций неветвящимися программами с условной остановкой в базисе из всех не более чем двухместных булевых функций. При $n\to\infty$ для множества всех $n$-местных монотонных булевых функций установлены новые верхние и нижние оценки средней сложности шенноновского типа.
Работа выполнена при финансовой поддержке Российского фонда фундаментальных исследований, проект 14-01-00598.
Модулярный алгоритм приведения матриц к смитовой нормальной форме
Authors: Cherepnev Mikhail Alekseevich
Published: July 2016

В статье приведено полное обоснование модулярного алгоритма приведения к эрмитовой нормальной форме, которое позволило построить новый модулярный алгоритм приведения к смитовой нормальной форме, вычисляющий одновременно и левую матрицу преобразований. Главный член оценки числа операций имеет вид $2(n^3\log D)$, где $n$ - размер, а $D$ - определитель рассматриваемой матрицы (или кратное ему число).
Работа поддержана грантом РФФИ офи м2 13-01-12420.
Diurnal variability of the Atmospheric Boundary Layer height over a tropical station in the Indian Monsoon Region
Authors: Mehta Sanjay Kumar , Ratnam Madineni Venkat , Sunilkumar Sukumarapillai V. , Narayana Rao Daggumati , Krishna Murthy Boddapati V.
Published: July 2016

Abstract. The diurnal variation of atmospheric boundary layer (ABL) height is studied using high resolutions radiosonde observations available every 3-h intervals for 3 days continuously from 34 intensive campaigns conducted during the period December 2010–March 2014 over a tropical station Gadanki (13.5° N, 79.2° E), in the Indian monsoon region. The heights of the ABL during the different stages of its diurnal evolution, namely, the convective boundary layer (CBL), the stable boundary layer (SBL), and the residual layer (RL) are obtained to study the diurnal variability. A clear diurnal variability in 9 campaigns is observed while in 7 campaigns the SBL does not form for the entire day and in the remaining 18 campaigns the SBL form intermittently. The SBL forms 33 %–55 % during nighttime and 9 % and 25 % during the evening and morning hours, respectively. The mean SBL height is within 0.3 km above the surface which increases slightly just after midnight (0200 IST) and remain almost steady till morning. The mean CBL height is within 3.0 km above the surface which generally increases from morning to evening. The mean RL height is within 2 km above the surface which generally decreases slowly as the night progresses. Diurnal variation of the ABL height over the Indian region is stronger during the pre-monsoon and weaker during winter season. The CBL is higher during the summer monsoon and lower during the winter season while the RL is higher during winter season and lower during summer season. During all the seasons, the ABL height peaks during the afternoon (~ 1400 IST) and remains elevated till evening (~ 1700 IST). The ABL suddenly collapses at 2000 IST due to cooling after the sunset and increases slightly over night. Interestingly, it is found that the low level clouds have an effect on the ABL height variability, but not the deep convective clouds.
A high-resolution synthetic bed elevation grid of the Antarctic continent
Authors: Graham Felicity S. , Roberts Jason L. , Galton-Fenzi Ben K. , Young Duncan , Blankenship Donald , Siegert Martin J.
Published: July 2016

Abstract. Digital elevation models of Antarctic bed topography are heavily smoothed and interpolated onto low-resolution (> 1 km) grids as our current observed topography data are generally sparsely and unevenly sampled. This issue has potential implications for numerical simulations of ice-sheet dynamics, especially in regions prone to instability where detailed knowledge of the topography, including fine-scale roughness, is required. Here, we present a high-resolution (100 m) synthetic bed elevation terrain for the whole Antarctic continent. The synthetic bed surface preserves topographic roughness characteristics of airborne and ground-based ice-penetrating radar data from the Bedmap1 compilation and the ICECAP consortium. Broad-scale features of the Antarctic landscape are incorporated using a low-pass filter of the Bedmap2 bed-elevation data. Although not intended as a substitute for Bedmap2, the simulated bed elevation terrain has applicability in high-resolution ice-sheet modelling studies, including investigations of the interaction between topography, ice-sheet dynamics, and hydrology, where processes are highly sensitive to bed elevations. The data are available for download at the Australian Antarctic Data Centre (doi:10.4225/15/57464ADE22F50).
A multi-service data management platform for scientific oceanographic products
Authors: D'Anca Alessandro , Conte Laura , Nassisi Paola , Palazzo Cosimo , Lecci Rita , Cretì Sergio , Mancini Marco , Nuzzo Alessandra , Mirto Maria , Mannarini Gianandrea , Coppini Giovanni , Fiore Sandro , Aloisio Giovanni
Published: July 2016

Abstract. An efficient, secure, and interoperable data platform solution has been developed in the TESSA project to provide fast navigation and access to the data stored in the data archive, as well as a standard-based metadata management support. The platform mainly targets scientific users and the Situational Sea Awareness high-level services such as the Decision Support Systems (DSS). These datasets are accessible through the following three main components: the Data Access Service (DAS), the Metadata Service, and the Complex Data Analysis Module (CDAM). The DAS allows access to data stored into the archive by providing interfaces for different protocols. OPeNDAP, THREDDS, and WMS are just some of the solutions that have been integrated into the TESSA infrastructure. Metadata Service is the heart of the information system of the TESSA products and completes the overall infrastructure for data and metadata management. This component enables data search & discovery, and addresses interoperability by exploiting ISO standards for geospatial data (ISO 19115 and ISO 19139). Finally, the CDAM represents the back-end of the TESSA DSS by performing on-demand complex data analysis tasks.
Determinants of Baseball Success: An Econometric Approach
Authors: Loree Jacob Andrew
Published: July 2016

While much has been investigated into the relationship between several baseball statistics and success, the literature is more heavily focused on individual level characteristics and the salary of individual baseball players. This paper investigates, at a more macro level, the importance of key baseball statistics on the level of wins a team can expect on average using the Lahman Baseball Database for all teams from 1985 to 2015. After several robustness tests, the most important variables an average team should focus on is the total number of runs a team gives up and getting on base as often as possible (by walks as well as base hits). The paper finds that while team salary is statistically significant, it takes an unreasonably large change in salary to be meaningful in terms of number of wins recorded. Therefore, previous research on the effect of salary on team success may be overblown.
LESÃO RENAL AGUDA EM UNIDADE DE TRATAMENTO INTENSIVO: CARACTERÍSTICAS CLÍNICAS E DESFECHOS
Authors: Luft Jaqueline , Boes Adilson Adair , Lazzari Daniele Delacanal , Nascimento Eliane Regina Pereira do , Busana Juliano De Amorim , Canever Bruna Pedroso
Published: July 2016

Estudo quantitativo, documental, retrospectivo, que objetivou caracterizar o perfil clínico-demográfico e o desfecho de pacientes com insuficiência renal, submetidos à terapia dialítica em uma unidade de terapia intensiva adulto de um hospital geral da região sul do Brasil. Os dados foram coletados no período de janeiro a fevereiro de 2013 e a amostra, constituída por 74 prontuários. Identificou-se prevalência do sexo masculino, média de 63,43 ± 14,73 anos, o motivo clínico foi o mais frequente para internação, com uma ou mais comorbidades associadas. A lesão renal com maior prevalência foi a crônica agudizada, pré-renal. Com relação aos motivos que levaram à lesão, o choque séptico foi mais recorrente. O tratamento de escolha foi hemodiálise convencional, por cateter. O desfecho mais comum foi o óbito. Desta forma, a identificação de fatores de risco e conhecimento dos fatores associados fornece subsídios para rápida identificação de problemas e implementação de ações de enfermagem.
CONTEXTO DE AMBIENTE DE TRABALHO ENTRE ENFERMEIRAS ASSISTENCIAIS EM HOSPITAL UNIVERSITÁRIO
Authors: Boaretto Flávia , Haddad Maria do Carmo Fernandez Lourenço , Rossaneis Mariana Angela , Gvozd Raquel , Pissinati Paloma De Souza Cavalcante
Published: July 2016

Objetivou-se analisar o ambiente de trabalho favorável à prática profissional de enfermeiros em hospital universitário público. Estudo transversal e quantitativo, realizado com 60 enfermeiros assistenciais, com o questionário Nursing Work Index – Revised. Os dados foram coletados entre novembro 2014 e janeiro de 2015. Dentre os pesquisados, 45 (75%) enfermeiros consideravam-se satisfeitos com seu trabalho. Todos os 12 setores da instituição apresentaram características favoráveis à prática do enfermeiro nos aspectos de suporte dos gestores, autonomia e controle dos processos de trabalho, sobretudo nas unidades de Transplante de Medula Óssea e a Unidade de Doenças Infectocontagiosas, que se diferenciavam por serem especializadas e com menor de rotatividade de funcionários. A relação médico-enfermeiro foi destacada como um dos pontos críticos, obtendo escores mais insatisfatórios. Conclui-se que a análise de características que favorecem a prática profissional do enfermeiro pode ampliar a discussão de estratégias que contribuam para o trabalho em Enfermagem em serviços de saúde.
PERFIL EPIDEMIOLÓGICO DE GESTANTES DE ALTO RISCO
Authors: Dalla Costa Lediana , Cales Cura Caroline , Rodrigues Perondi Alessandro , França Vivian Francielle , Schiavoni Bortoloti Durcelina
Published: July 2016

O objetivo do presente estudo foi traçar o perfil epidemiológico de gestantes de alto risco atendidas no Instituto da Mulher, Secretaria de Saúde do município de Francisco Beltrão. O estudo avaliou 61 prontuários, entre janeiro e junho de 2015. Verificou-se que 82% (n=50) das gestantes tinham de 15 a 35 anos; 47,5% (n=29) possuíam o segundo grau completo; 52,5% (n=32) casadas; 62,3% (n=38) da cor branca; 88,5% (n=54) com antecedentes familiares de doença crônica, sendo 63,9% (n=39) com hipertensão arterial; 82% (n=50) com antecedentes pessoais, somando 52,5% (n=32) casos de infecção urinária; 70,5% (n=43) eram multíparas. A gestação de risco evoluiu para cesarianas em 80,3% (n=49) dos casos. Este estudo produziu informações importantes a respeito do perfil desta população, o que permite os profissionais envolvidos no atendimento a gestante de alto rico possa exercer um papel fundamental na redução da mortalidade materna. Conclui-se que estas gestantes de alto risco aparentemente não apresentam perfil diferente da realidade de outros municípios do Brasil, principalmente quando a hipertensão foi constatada como importante fator de antecedente familiar, pessoal e prevalência atual.