A New Computer-aided Technique for Planning the Aesthetic Outcome of Plastic Surgery

Plastic surgery plays a major role in today health care. Planning plastic face surgery requires dealing with the elusive concept of attractiveness for evaluating feasible beautification of a particular face. The existing computer tools essentially allow to manually warp 2D images or 3D face scans, in order to produce images simulating possible surgery outcomes. How to manipulate faces, as well as the evaluation of the results, are left to the surgeon's judgement. We propose a new quantitative approach able to automatically suggest effective patient-specific improvements of facial attractiveness. The general idea is to compare the face of the patient with a large database of attractive faces, excluding the facial feature to be improved. Then, the feature of the faces more similar is applied, with a suitable morphing, to the face of the patient. In this paper we present a first application of the general idea in the field of nose surgery. Aesthetically effective rhinoplasty is suggested on the base of the entire face profile, a very important 2D feature for rating face attractivenes

The heart and the gut

The heart and the gut seem to be two organs that do not have much in common. However, there is an obvious and clinically relevant impact of gut functions on the absorption of drugs and oral therapies on the one hand. On the other hand, the gut determines the quantity of nutrient uptake and plays a central role in metabolic diseases. Patients with inflammatory bowel diseases appear to have a higher risk for coronary heart disease despite a lower prevalence of ‘classical' risk factors, indicating additional links between the gut and the heart. However, they certainly have a ‘leaky' intestinal barrier associated with increased permeability for bacterial wall products. An impaired intestinal barrier function will be followed by bacterial translocation and presence of bacterial products in the circulation, which can contribute to atherosclerosis and chronic heart failure (CHF) as recent data indicate. Impaired cardiac function in CHF vice versa impacts intestinal microcirculation leading to a barrier defect of the intestinal mucosa and increased bacterial translocation. These pathways and the most recent insights into the impact of the gut on acute and chronic heart disease will be discussed in this revie

Metabolic approach to heart failure: The role of metabolic modulators

Abstract Heart failure (HF) is a systemic and multiorgan syndrome with metabolic failure as fundamental mechanism. As a consequence of its impaired metabolism, other processes are activated in the failing heart, further exacerbating the progression of HF. Metabolic agents are a relatively new class of drugs that act through optimisation of cardiac substrate metabolism. Among the metabolic modulators, Trimetazidine (TMZ) and perhexiline are the only two agents with proven anti-ischaemic effect currently available. However, due to its major side effects, perhexiline is not yet approved in the US or Europe. Clinical trials have demonstrated that the adjunct of TMZ to optimal medical therapy improves symptoms and prognosis of HF without exerting negative hemodynamic effects. Due to its anti-ischaemic/anti-anginal effect and excellent tolerability, the modulation of cardiac metabolism with TMZ represents a promising approach for the treatment of patients with HF

Trimetazidine improves left ventricular function in diabetic patients with coronary artery disease: a double-blind placebo-controlled study

BACKGROUND: Patients with diabetic cardiomyopathy have an impaired myocardial glucose handling and distal distribution of coronary atherosclerosis. Trimetazidine, an anti-ischemic metabolic agent, improves myocardial glucose utilization though inhibition of fatty acid oxidation. Aim of the present study was to evaluate whether the metabolic effect of trimetazidine on left ventricular function in patients with diabetic cardiomyopathy. METHODS: 32 patients (24 males and 8 females, mean (SE) age = 67 ± 6 years) with type 2 diabetes and ischemic cardiomyopathy were randomized to receive either trimetazidine (20 mg, t.d.s.) or placebo (t.d.s.) for six months in a randomized parallel study. Patients performed an echocardiogram at baseline and after 6 months. RESULTS: Demographic data were comparable between the two groups. After six month baseline left ventricular end-diastolic diameters increased from 62.4 ± 1.7 to 63 ± 2.1 mm in the placebo group, while decreased from 63.2 ± 2.1 to 58 ± 1.6 mm (p < 0.01 compared to baseline) in the trimetazidine group. Compared to baseline, left ventricular ejection fraction increased by 5.4 ± 0.5% (p < 0.05) in the trimetazidine group while remained unchanged in the placebo group -2.4 ± 1.1% (NS), p < 0.01 between groups. A significant improvement in wall motion score index and in the E/A wave ratio was detected in patients treated with trimetazidine, but not in those receiving placebo. CONCLUSION: in diabetic patients with ischemic heart disease trimetazidine added to standard medical therapy has beneficial effect on left ventricular volumes and on left ventricular ejection fraction compared to placebo. This effect may be related to the effect of trimetazidine upon cardiac glucose utilization

Who approves/pays for additional monitoring?

Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems

Evaluating the metabolic approach to treatment of diabetic coronary patients

Diabetic patients with coronary artery disease have an altered myocardial metabolism of glucose and free fatty acids (FFA) and accelerated and diffuse atherogenesis with involvement of peripheral coronary segments that causes chronic hypoperfusion and hibernation. Therefore, in coronary diabetic patients the ischaemic metabolic changes that occur as a consequence of the mismatch between blood supply and cardiac metabolic requirements are heightened by the diabetic metabolic alterations. Important metabolic alterations in diabetic patients are the decreased utilization of glucose and the increase in muscular and myocardial FFA uptake and oxidation. These metabolic changes are responsible for the increased susceptibility of the diabetic heart to myocardial ischaemia and to a greater decrease of myocardial performance for a given amount of ischaemia compared to non diabetic hearts. A therapeutic approach aimed at an improvement of cardiac metabolism through manipulations of the utilization of metabolic substrates should result in an improvement of myocardial ischaemia and of left ventricular function. The inhibition of FFA oxidation improves cardiac metabolism at rest, increases the cardiac resistance to ischaemia and therefore reduces the decline of left ventricular function due to chronic hypoperfusion and repetitive episodes of myocardial ischaemia in patients with and without diabetes. Modulation of myocardial FFA metabolism should be the key target for metabolic interventions in diabetic patients with coronary artery disease

Cost-effectiveness of direct acting oral anticoagulants in the prevention of thromboembolic complications : limits and concerns of economic evaluations

Economic evaluations have a widespread application in many areas of clinical research and play a key role in the clinical decision-making process. However, economic analyses have been sometimes used to produce new 'evidence' that is not adequately tested in the target population. This is the case of data arising from a systematic review of clinical trials evaluating the use of direct acting oral anticoagulants for the prevention of stroke in patients with atrial fibrillation. Taking into account this example, here we discuss the concerns raised by the improper interpretation of the results. Our conclusions are three-fold. Data from economic analyses should not be shifted to a clinical recommendation. Simulation models should not be used to generate new 'evidence' that is not supported by experimental data and is misleading. Clinical judgment is therefore pivotal to interpret results emerging from economic analyses