Iron deficiency from the standpoint of cardiac rehabilitation : Novel therapeutic opportunities

Anemia is one of the most frequent comorbidities found in patients with coronary artery disease and chronic heart failure (CHF) who are being followed in cardiac rehabilitation facilities. The more frequent type of anemia is that caused by iron deficiency (IDA, iron-deficiency anemia): this review summarizes the state of the art of this topic. First of all, the mechanisms of IDA will be analyzed. Subsequently, a description of the main conditions where IDA can unfavorably affect the clinical course, and of its more frequent complications, will be presented (percutaneous interventions, heart surgery, CHF). Special attention will be paid in the description of anemia in the setting of CHF. To this regard, in recent years a relevant amount of research has been carried out, to determine whether treating anemia (either by directly stimulating erythropoiesis or by correcting iron deficiency by oral or intravenous route) is of any clinical and prognostic relevance in patients with CHF. The results of this research will therefore be summarized and critically discussed. Finally, we will outline the n-commer promising role of cardiac rehabilitation facilities and of its network of experts in the diagnosis, prognostic stratification and treatment of anemia and iron deficiency. o

Shoulder pain due to cervical radiculopathy: an underestimated long-term complication of herpes zoster virus reactivation?

Purpose To evaluate if herpes zoster virus (HZV) reactivation may be considered in the aetiology of cervical radiculopathy. Methods The study group was composed of 110 patients (52 M-58F;mean age ± SD:46.5 ± 6.12; range:40-73) with a clinical diagnosis of cervical radiculopathy. Patients with signs of chronic damage on neurophysiological studies were submitted to an X-ray and to an MRI of the cervical spine in order to clarify the cause of the cervical radiculopathy and were investigated for a possible reactivation of HZV; HZV reactivation was considered as “recent” or “antique” if it occurs within or after 24 months from the onset of symptoms, respectively. Data were submitted to statistics. Results Thirty-eight patients (34,5%,16 M-22F) had a history of HZV reactivation: four (2 M-2F) were “recent” and 34 (14 M-20F) were “antique”. In 68 of 110 participants (61,8%,30 M-38F), pathological signs on X-ray and/or MRI of the cervical spine appeared; in the remaining 42 (38,2%,22 M-20F) X-ray and MRI resulted as negative. Among patients with HZV reactivation, seven (18,4%) had a “positive” X-ray-MRI while in 31 (81,6%) the instrumental exams were considered as negative. The prevalence of “antique” HZV reactivations was statistically greater in the group of patients with no pathological signs on X-ray/MRI of the cervical spine with respect to the group with a pathological instrumental exam (p < 0.01). Conclusions It may be useful to investigate the presence of a positive history of HZV reactivation and to consider it as a long-term complication of a cervical root inflammation especially in patients in which X-ray and MRI of the cervical spine did not show pathological findings

Precision restoration: a necessary approach to foster forest recovery in the 21st century

We thank S. Tabik, E. Guirado, and Garnata Drone SL for fruitful debates about the application of remote sensing and artificial intelligence in restoration. E. McKeown looked over the English version of the manuscript. Original drawings were made by J. D. Guerrero. This work was supported by projects RESISTE (P18-RT-1927) from the Consejeria de Economia, Conocimiento, y Universidad from the Junta de Andalucia, and AVA201601.19 (NUTERA-DE I), DETECTOR (A-RNM-256-UGR18), and AVA2019.004 (NUTERA-DE II), cofinanced (80%) by the FEDER Program. F.M.-R. acknowledges the support of the Agreement 4580 between OTRI-UGR and the city council of La Zubia. We thank an anonymous reviewer for helpful comments that improved the manuscript.Forest restoration is currently a primary objective in environmental management policies at a global scale, to the extent that impressive initiatives and commitments have been launched to plant billions of trees. However, resources are limited and the success of any restoration effort should be maximized. Thus, restoration programs should seek to guarantee that what is planted today will become an adult tree in the future, a simple fact that, however, usually receives little attention. Here, we advocate for the need to focus restoration efforts on an individual plant level to increase establishment success while reducing negative side effects by using an approach that we term “precision forest restoration” (PFR). The objective of PFR will be to ensure that planted seedlings or sowed seeds will become adult trees with the appropriate landscape configuration to create functional and self-regulating forest ecosystems while reducing the negative impacts of traditional massive reforestation actions. PFR can take advantage of ecological knowledge together with technologies and methodologies from the landscape scale to the individual- plant scale, and from the more traditional, low-tech approaches to the latest high-tech ones. PFR may be more expensive at the level of individual plants, but will be more cost-effective in the long term if it allows for the creation of resilient forests able to providemultiple ecosystemservices. PFR was not feasible a few years ago due to the high cost and low precision of the available technologies, but it is currently an alternative that might reformulate a wide spectrum of ecosystem restoration activities.Junta de Andalucia P18-RT-1927European Commission AVA201601.19 A-RNM-256-UGR18 AVA2019.004OTRI-UGR 4580city council of La Zubia 458

Referral from vascular surgery to cardiovascular rehabilitation and related outcomes in patients with peripheral arterial disease: the THINKPAD-RELOADED survey.

The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p<0.05). LEPAD patients entering the CR programme were similar to those who did not according to sex, age, the vascular surgery setting of evaluation, and localization of arterial lesions. Patients with moderate intermittent claudication and patients with acute limb ischemia as index event were more represented among those who attended CR (41% vs 21% and 9% vs 2% respectively, p<0.05). Patients referred to CR had five times more episodes of acute coronary syndrome and heart failure as complication of the index event. The cardiovascular risk profile (obesity 29.5% vs 11%, p<0.05; hypercholesterolemia 80% vs 61%, p<0.05) was much worse in LEPAD patients referred to CR, but conversely, they better achieved secondary prevention targets, particularly for blood pressure control (97% vs 57%, p<0.05). All-cause 2-year mortality in the whole patients' population was 6%. Patients entering the CR programme displayed less events (13.5% vs 37.7%, p<0.05), mainly death (3.1% vs 11.3%, p<0.05) and limb-related events (4.2% vs 15.2%, p<0.05). The results of our study suggest that when a cohesive network of vascular surgery and CR facilities becomes available, the referral rate to rehabilitation may increase up to one third of eligible patients. Patients with higher comorbidity and cardiovascular risk seem to have priority in the referral process, nevertheless those with peripheral revascularization are still underestimated. Entering CR may ensure better cardiovascular risk profile and cardiovascular prognosis in LEPAD patients, and consequently the systematic adoption of this care model needs to be strongly recommended and facilitated

Protesi dentale fissa con cantilever supportata da impianti (PDFIC) ultracorti: nostra esperienza clinica

In questo studio siti edentuli mandibolari posteriori con osso alveolare molto riassorbito di tre pazienti sono stati riabilitati con Protesi dentale fissa con cantilever supportata da impianti (PDFIC) ultracorti e ne è stata valutata la sopravvivenza a due anni (T2) dalla protesizzazione. MATERIALI E METODI L'osteointegrazione degli impianti è stata valutata radiograficamente con l'utilizzo di radiografie periapicali, eseguite al tempo 0 (T0 applicazione della protesi), al tempo 1 (T1 a sei mesi) ed al tempo 2 (T2 a due anni), secondo la tecnica del cono lungo con centratore di Rinn e l’ausilio di una griglia millimetrata in rame di dimensioni 31x41 mm, applicata sulla pellicola radiografica , al fine di misurare in mm l'eventuale riassorbimento di osso crestale. RISULTATI In tutti e tre i pazienti si è osservato un riassorbimento medio (mesio-distale) della cresta ossea di 0.5 mm a T1; non ci sono state modifiche fra T1 e T2. CONCLUSIONI L’utilizzo di impianti corti e ultracorti si è dimostrato essere un’interessante opzione terapeutica e alternativa agli interventi di aumento verticale della cresta ossea, più rapida, più economica e con una ridotta morbilità (1) (2) (3) (4). Nonostante ciò, spesso ci si trova di fronte all'impossibilità di inserire un impianto nel sito edentulo. L'ausilio del cantilever in protesi implantare si è dimostrata essere una buona opzione per sopperire a tali problematiche. (5) (6). L'utilizzo di impianti corti per supportare una protesi con cantilever ha mostrato risultati simili a quelli degli impianti con lunghezze tradizionali (7). Nonostante il numero limitato di pazienti, in questo studio abbiamo osservato come, nei casi di pazienti con quantità di osso alveolare molto limitate, l'utilizzo di impianti ultracorti per supportare protesi dentale fisse con cantilever è da considerarsi una valida opzione terapeutica.Posterior mandibular edentulous ridges with extreme residual bone resorption within three patients have been rehabilitated using ultrashort implant-supported cantilever fixed dental prostheses (ICFDPs)(one5.0x5.0, three4.5x6, two4.0x5.0 Bicon Dental Implants, Boston, MA, USA) and 2 years survival rate since prosthetic rehabilitation (T2) has been evaluated. MATERIALS AND METHODS Implants’ osseointegration has been evaluated at T0 (prostheses insertion) T1 (12 months after prostheses insertion) and T2 (24 months after prostheses insertion) using Periapical x-rays performed accordingly to the long cone paralleling technique and using both a Rinn positioning system and a radiographic template in order to evaluate in millimetres the amount of marginal bone loss in both mesial and distal point. RESULTS We have observed an average mesio-distal bone-loss of 0,5 mm at T1 within all the three patients while there hasn’t been any modification between T1 and T2, so as in accordance with other literature works (4). CONCLUSIONS Short and ultrashort implants rehabilitation have proven to be a valuable alternative therapy when compared to surgical vertical bone ridge augmentation procedures, the former being more inexpensive, more rapid and presenting less morbidity (1) (2) (3) (4); yet, it could still be impossible to insert an implant on the edentulous ridge. Implant-supported cantilever fixed dental prosthesis is a good option in order to provide such cases (5) (6).The choice of short implants instead of traditional ones as prosthesis’ support has proven to give similar results (7). Despite the limited number of patients, it’s been possible to show that ultrashort implant-supported cantilever fixed dental prosthesis (ICFDPs) is a valuable therapeutic option for patients with reduced amount of bone left. 1 Carl E. Misch, Jennifer Steigenga, Eliane Barboza, Francine Misch-Dietsh, Louis J. Cianciola, Christopher Kazor Short Dental Implants in Posterior Partial Edentulism: A Multicenter Retrospective 6-Year Case Series Study J Periodontol 2006;77:1340-1347. 2 Douglas Deporter, Bunnai Ogiso,Dong-Seok Sohn,Kevin Ruljancich, Michael PharoahUltrashort Sintered Porous-Surfaced Dental Implants Used To Replace Posterior Teeth J Periodontol 2008;79:1280-1286. 3 M. Esposito, G. Cannizarro, E. Soardi, G. Pellegrino, R. Pistilli, and P. Felice, “A 3-year post-loading report of a randomised controlled trial on the rehabilitation of posterior atrophic mandibles: Short implants or longer implants in vertically ugmented bone?” European Journal of Oral Implantology, vol. 4, no. 4, pp. 301–311, 2011). 4 Eduardo Anitua, MD, DDS, PhD, Laura Piñas, Degree of Dentistry; Gorka Orive, PhDRetrospective Study of Short and Extra-Short Implants Placed in Posterior Regions: Influence of Crown-to-Implant Ratio on Marginal Bone LossClinical Implant Dentistry and Related Research 2013 5 Marco Aglietta Vincenzo Iorio Siciliano Marcel Zwahlen Urs Bragger Bjarni E. Pjetursson Niklaus P. Lang Giovanni E. Salvi A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 years Clin. Oral Impl. Res. 20, 2009 / 441–451 6 Aglietta M, Iorio Siciliano V, Blasi A, Sculean A, Bragger U, Lang NP, Salvi GE. Clinical and radiographic changes at implants supporting single-unit crowns (SCs) and fixed dental prostheses (FDPs) with one cantilever extension. A retrospective study.Clin. Oral Impl. Res. 23, 2012, 550–555 7 Anka k Ipikcioglu H Finite element stress analysis of the effect of short implants usage in place of cantilever exension in mandibular posterior edentulism Jornal of oral rehabilitation 2002 29; 350-35

Applicazione percutanea di collagene (VASOSEAL): un\u2019efficace sistema di emostasi dopo cateterismo o procedure interventistiche per via arteriosa

Introduction. The widespread use of PTCA and complex percutaneous interventional techniques has significantly increased peripheral vascular complications prompting the development of innovative hemostatic closure devices. Methods. To evaluate the efficacy and safety of a bovine collagen plug (VasoSeal), we sealed 362 consecutive femoral artery puncture sites in 324 patients (240 males) (mean age 57.9 \ub1 11.3 years), who underwent interventional procedures or diagnostic catheterization during acute or chronic anticoagulant treatment. Results. Complete hemostasis was achieved in 2.31 \ub1 1.97 minutes in 342 cases (94.4%), with a mean activated clotting time at collagen deployment of 197 \ub1 56''. In 20 cases, mechanical arterial compression was needed in order to obtain vascular hemostasis (mean time: 44 \ub1 13 min). We observed 1 arteriovenous fistula and 1 acute arterial thrombosis (collagen related at surgical inspection) which underwent successful surgical treatment. Minor complications without clinical sequelae were: small hematomas in 13 cases (3.8%), 4 groin abscesses (1.1%) and 4 cases of lymphangitis (1.1%). Conclusions. Percutaneous collagen application at the femoral artery puncture site allows quick and effective hemostasis with low incidence of peripheral vascular complications following interventional percutaneous procedures or catheterization during anticoagulant treatment

Efficiency of hyaloglide ® in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: A randomized, controlled, multicentre clinical trial

Hyaloglide® is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomized controlled trial comparing the results of flexor tenolysis in zone 2 following failed flexor tendon repairs. In the control group a standard release was performed. In the treated group, Hyaloglide® was applied into the flexor sheath and around the site of tenolysis. Forty-five patients, 19 controls and 26 treated with Hyaloglide®, were enrolled in 13 centres. All the patients were evaluated at 30, 60, 90 and 180 days after surgery by testing Total Active Motion, Quick-DASH questionnaire and number of working days lost after surgery. Patients in the Hyaloglide® group had a statistically better recovery of finger motion at all time intervals and returned earlier to work and daily activities. The use of Hyaloglide® did not appear to increase the complication rate. © 2010 The British Society for Surgery of the Hand