The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation

Non-adherence to prescribed drug regimens is an increasing medical problem affecting physicians and patients and contribute to negative outcomes, such as the increased risk of subsequent cardiovascular events. Analysis of various patient populations shows that the choice of drug, its tolerability and the duration of treatment influence the non-adherence. Intervention is required toward patients and health-care providers to improve medication adherence. This review deals about the prevalence of non-adherence to therapy after medical and surgical cardiac event, the risk factors affecting non-adherence and the strategies to implement it. Interventions that may successfully improve adherence should include improved physician compliance with guidelines, patient education and patient reminders, frequent visits or telephone calls from staff, simplification of the patient's drug regimen by reducing the number of pills and daily doses. Since single interventions do not appear efficaceous, it is necessary to establish multiple interventions simultaneously addressing a number of barriers to adherence

[Nurse involvement in primary care: it is the key to improve the outcomes in primary and secondary prevention?].

Difficulties in management of risk factors, lifestyle and medications adherence to achieve secondary prevention of ischemic heart disease were described. Many studies indicate that the benefit of cardiac rehabilitaton therapy after acute coronary events is only partially maintained during the following year. Thereafter, new strategies of medical care are needed to improve the long-term outcomes in coronary patients. Nurse co-ordinated, multidisciplinary cardiac rehabilitative programme could help patients to improve their lifestyle, to control their risk factors and to achieve their therapeutic goals for secondary prevention of ischemic heart disease

Instrumental profile of MYTHEN detector in Debye-Scherrer geometry

The main aberrations affecting data collected with 1D position sensitive detectors in Debye-Scherrer capillary geometry are examined, and analytical corrections proposed. The equations are implemented in two of the most advanced software based on the Rietveld and Whole Powder Pattern Modelling methods, respectively, for structure and microstructure analysis. Application to MYTHEN, a fast single photon counting detector developed at the Swiss Light Source, is discussed in detai

Lower is better: ENHANCE affair

Ezetimibe lowers the intestinal absorption of cholesterol, being complementary to the effects of statin. To check its efficacy in lowering the carotid intima-media thickness, in 2002 a multicenter international trial called ENHANCE was started, in order to assess by ultrasound the regression of atherosclerotic plaques. The protocol tested the use of simvastatin 80 mg + placebo versus simvastatin 80 mg + ezetimibe 10 mg in 720 randomized patients. Both drugs were well tolerated. Combination therapy was associated with a larger reduction in LDL cholesterol, but there were no differences in the intima-media thickness measured at three sites in the carotid arteries, nor differences in cardiovascular events between the two groups in the trial. These results provoked disappointment of sponsors (Merck, Schering Plough) who, although the results of the trial were available since march 2007, delayed official communication of about 18 months. This led to speculations and rumors among media, American Government, cardiologic scientific associations, and consequences in the Ezetimibe market and at Wall Street. In particular, the American College of Cardiology didn't accept the communication of ENHANCE results to the Late Breaking Trial Session of the Chicago congress, diverting it to another secondary forum. In conclusion, the experience of the ENHANCE trial suggests to pharmaceutical companies, researchers, clinicians, scientific companies and media a deep meditation in order to avoid in the future similar problems in the management of results of medical research

Structure and morphology of shape-controlled Pd nanocrystals

Pd nanocrystals were produced with uniform truncated-cube shape and a narrow size distribution, yielding controlled surface area fractions from low Miller index ({100}, {110}, {111}) crystalline facets. Details on the structure and morphology of the nanocrystals were obtained by combining X-ray powder diffraction line profile analysis, high-resolution transmission electron microscopy and surface electrochemistry based on Cu underpotential deposition.ML acknowledges support from the Italian government (Ministero dell’Istruzione, dell’Università e della Ricerca) through the project FIRB Futuro in Ricerca RBFR10CWDA. JMF acknowledges financial support from the MINECO (Spain) project CTQ2013-44083-P and Generalitat Valenciana project PROMETEOII/2014/013

Vibrational Properties of Pd Nanocubes

The atomic disorder and the vibrational properties of Pd nanocubes have been studied through a combined use of X-ray diffraction and molecular dynamics simulations. The latter show that the trend of the mean square relative displacement as a function of the radius of the coordination shells is characteristic of the nanoparticle shape and can be described by a combined model: A correlated Debye model for the thermal displacement and a parametric expression for the static disorder. This combined model, supplemented by results of line profile analysis of the diffraction patterns collected at different temperatures (100, 200, and 300 K) can explain the observed increase in the Debye–Waller coefficient, and shed light on the effect of the finite domain size and of the atomic disorder on the vibrational properties of metal nanocrystals.This research was partly supported by the Autonomous Province of Trento, within the framework of the programmatic Energy Action 2015–2017

Re-Ingeniería de apatita natural para soporte de tejidos óseos

Actualmente los grandes progresos en la medicina ortopédica, traumatológica y odontológica, han originado una gran necesidad por biomateriales, especialmente por aquellos productos que tienen una composición en base de ortofosfato de calcio, el cual es similar a la estructura inorgánica de los huesos. Ante este escenario, se ha generado una intensa búsqueda de nuevos orígenes y recursos, siendo los materiales naturales un foco de importantes estudios, debido a que estos pueden abastecer plenamente la gran demanda por biomateriales. Los estudios de estos materiales naturales han reportado interesantes avances, especialmente en lo que respecta a la regeneración de tejidos biológicos en medicina reparativa. De manera de seguir contribuyendo con este desafío, se analizaron muestras de minerales provenientes de un extenso depósito geológico hidrotermal, para proponer estos materiales como posible fuente de recursos. Los minerales extraídos fueron disgregados, para posteriormente fabricar probetas cilíndricas mediante Sinterización por Arco de Plasma, para luego ser biológicamente testeadas. La caracterización mineralógica del material extraído, reveló altos contenidos de fosfatos en forma de apatita, seguidas de pequeñas cantidades de otras especies mineralógicas asociadas, como el cuarzo y yeso. Dadas estas características, el polvo de mineral presentó una buena disposición a la sinterización, siendo capaz de densificar completamente a temperatura sobre los 1000ºC. Los resultados de la sinterización fueron correlacionados con las fases obtenidas con las diferentes temperaturas de proceso, presentando la apatita muy buena estabilidad termoquímica. Pruebas preliminares in vitro de proliferación y adhesión celular de osteoblastos humanos, MG63, en las muestras preparadas, parecen ser bastantes prometedoras, siendo la probeta sinterizada a 1200ºC la que presentó la mejor activación celular, semejante al comportamiento biológico de las hidroxiapatitas comerciales reportadas

Supramolecular Structure and Mechanical Properties of Wet-Spun Polyacrylonitrile/Carbon Nanotube Composite Fibers Influenced by Stretching Forces

The effect of different elongation conditions on the crystalline structure and physical and mechanical properties of polyacrylonitrile/carbon nanotube (PAN/CNT) microfibers during the wet spinning process was studied. It turns out that the response of polymer chains in PAN/CNT and in PAN fibers to the stretching forces from jet stretching and steam drawing is different. The X-ray diffraction (XRD) results showed that the crystalline domain size in steam-drawn PAN/CNT fibers is 1.5 times larger than in PAN fibers. CNTs alter the optimum stretching conditions, as they improve the crystalline structure of the PAN/CNT fibers at lower steam drawing ratios than PAN fibers, through nucleation of crystals on their surface. Synchrotron-radiation XRD studies revealed that the presence of CNTs improves the crystal orientation of PAN/CNT fibers significantly. In addition, steam drawing is more effective in improving the crystal orientation than jet stretching. The mechanical properties of PAN/CNT fibers have also been affected by steam drawing more than jet stretching. Multiwalled CNTs have the biggest impact on Young's modulus. The Young's modulus of PAN/CNT fibers could increase up to 19% higher than PAN fibers at specific stretching conditions, i.e., steam drawing ratio of 2.5. Better orientation of polymers and crystals in the fiber direction is the reason for the enhancement of Young's modulus. To our knowledge, the differences between the response of PAN/CNT and PAN fibers to stretching forces inside coagulation bath and after fiber coagulation as well as the difference in evolution of crystalline structure at different stretching stages has not been reported elsewhere