Michigan's Continuing Abolition of the Death Penalty and the Conceptual Components of Symbolic Legislation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68316/2/10.1177_096466399300200304.pd

The use of mesenchymal stem cells for cartilage repair and regeneration: a systematic review.

BACKGROUND: The management of articular cartilage defects presents many clinical challenges due to its avascular, aneural and alymphatic nature. Bone marrow stimulation techniques, such as microfracture, are the most frequently used method in clinical practice however the resulting mixed fibrocartilage tissue which is inferior to native hyaline cartilage. Other methods have shown promise but are far from perfect. There is an unmet need and growing interest in regenerative medicine and tissue engineering to improve the outcome for patients requiring cartilage repair. Many published reviews on cartilage repair only list human clinical trials, underestimating the wealth of basic sciences and animal studies that are precursors to future research. We therefore set out to perform a systematic review of the literature to assess the translation of stem cell therapy to explore what research had been carried out at each of the stages of translation from bench-top (in vitro), animal (pre-clinical) and human studies (clinical) and assemble an evidence-based cascade for the responsible introduction of stem cell therapy for cartilage defects. This review was conducted in accordance to PRISMA guidelines using CINHAL, MEDLINE, EMBASE, Scopus and Web of Knowledge databases from 1st January 1900 to 30th June 2015. In total, there were 2880 studies identified of which 252 studies were included for analysis (100 articles for in vitro studies, 111 studies for animal studies; and 31 studies for human studies). There was a huge variance in cell source in pre-clinical studies both of terms of animal used, location of harvest (fat, marrow, blood or synovium) and allogeneicity. The use of scaffolds, growth factors, number of cell passages and number of cells used was hugely heterogeneous. SHORT CONCLUSIONS: This review offers a comprehensive assessment of the evidence behind the translation of basic science to the clinical practice of cartilage repair. It has revealed a lack of connectivity between the in vitro, pre-clinical and human data and a patchwork quilt of synergistic evidence. Drivers for progress in this space are largely driven by patient demand, surgeon inquisition and a regulatory framework that is learning at the same pace as new developments take place

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Pain and Frailty in Hospitalized Older Adults

Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

La storia della signora Silvana: uno scompenso cardiaco afrazione di eiezione depressa sui generis. Dalla fase acutaal follow-up

ST, donna, aa 67, in passato buone condizioni; sindrome ansioso-depressiva in tp con triciclico, dislipidemia, familiarit\ue0 per cardio-patia ischemica. Maggio \u201814: giunge al PS di Osimo per dispneaingravescente da 1 settimana, cardiopalmo, ortopnea. BNP: 818.Versamento pleurico bilaterale.Diagnosi:Scompenso cardiaco\u201dde novo\u201d. Ricovero in Medicina In-terna-Osimo. ECG: IVSx,FC:162 bpm, QRS:130 msec. Eco: FE 22%,Vsx dilatato; E/A>2, insuff. mitralica severa su base funzionale. Co-ronaro: non lesioni stenosanti. Iniziata terapia+ivabradina 7,5 mgx2.Dimissione 11a giornata stabile. E/A 55%. Luglio \u201815: marcata astenia. Hb:9,7(13 al ricovero); creat:1,27 (prima: 0,67) VFG:33 ml/min. SOF.Ipotesi diagnostica: Anemia secondaria a progressivo deteriora-mento della funzione renale, esitata in IRC, a possibile eziologia ia-trogenasospesi furosemide/spironolattone,ridotto Tareg a 80 mgx2.Feb \u201816: buone condizioni (no astenia), creat:1,1; Hb:12 (instaurataterapia marziale). FE:63%. Ridotto pantoprazolo a 20 mg/die allaluce delle ultime evidenze (associazione con IRC). Mantenuti Biso-prolo 2,5 mg e Ivabradina 7,5x2. Rivalutata questa settimana,buonecondizioni, mantenuto Valsartan 40 \ubd 1 cp. Caso esemplificativodi gestione dello scompenso cardiaco in ambiente internistico,c hedimostra la necessit\ue0 di follow-up ambulatoriale seriato, con parti-colare attenzione alle comorbilit\ue0 del paziente

History and physical examination: the cornerstones of the third millennium in medicine

Woman, 76aa, log on to first aid point of for fever, sore throat and polyarthralgia 2 weeks EO: right knee arthritis, palpable cervical-axil-lary lymphnodes, soft ankle edema,functional impairment with pain in shoulder blades, small flat scar interscapular hepatosplenomegaly con-firmed by US. Lab tests: marked phlogosis (VES: 57 mm/h; PCR: 35mg/dl) with rise ferritin and procalcitonin (0,89 pg/ml), anemia, neutrophilic leucocytosis (20000/ml), 3 out of 3 blood cultures pos for MSSA, pos RF, no consumption of complement, immune serology neg-ative CT chest-abdomen: structural upheaval right subscapularis mus-cle to cystic degeneration, with uptake of contrast medium (measures: 13 x 12 cm). Smaller similar injury to the left of the subscapularis (7x6 cm), with colliquativa of deltoid and infraspinatus TTE: thickened an-terior mitral cusp TEE: small non-mobile vegetations on mitral valve, in resolution.After review of anamnesis,previous month excision of small lipoma interscapular,without sequelae and surgical wound in order to follow-up. We therefore posed diagnosis of sepsis with infection of soft tissues of shoulder girdle, associated with bacterial endocarditis by MSSA. After 1 month of continuous IV infusion prolonged antibiotic therapy, patient\u2019s overall conditions were satisfactory. Emblematic case of soft tissue infection secondary to the front door by contiguit