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BACKGROUND Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. METHODS We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The primary safety outcome was myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular outcome, the upper boundary of the one-sided 9Z5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025. RESULTS A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1°6) in the tranexamic acid group and in 561 of 4778 patients (11.790) in the placebo group (hazard ratio, 0.76; 95% confidence interval [CI], 0.67 to 0.87; absolute difference, -2.6 percentage points; 95% CI, -3.8 to -1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.20/0) in the tranexamic acid group and in 639 of 4601 patients (13.986) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 percentage points; 95% CI, -1.1 to 1.7; one-sided P=0.04 for noninferiority). CONCLUSIONS Among patients undergoing noncardiac surgery, the incidence of the composite bleeding outcome was significantly lower with tranexamic acid than with placebo. Although the between-group difference in the composite cardiovascular outcome was small, the noninferiority of tranexamic acid was not established. (Funded by the Canadian Institutes of Health Research and others; POISE-3 Clinica]Trials.gov number, NCT03505723.). [ABSTRACT FROM AUTHOR]

A Post-Authorization Safety Study (PASS) global program was designed to assess safety and effectiveness of rAHF-PFM (ADVATE) use in haemophilia patients in routine clinical settings. The main aim of this project was to estimate the rate of inhibitors and other adverse events across ADVATEPASS studies by meta-analysing individual patient data (IPD). Eligible Studies: PASS studies conducted in different countries, between 2003 and 2013, for which IPD were provided. Eligible patients: haemophilia A patients with baseline FVIII:C < 5%, with a known number of prior exposure days (EDs). Primary outcome: de novo inhibitors in severe, previously treated patients (PTPs) with > 150 EDs. Secondary outcomes: de novo inhibitors according to prior exposure and disease severity; other adverse events; annualized bleeding rate (ABR). Analysis: randomeffects logistic regression. Five of seven registered ADVATE-PASS (Australia, Europe, Japan, Italy and USA) and 1188 patients were included (median followup 384 days). Among severe PTPs with > 150 EDs, 1/ 669 developed de novo inhibitors (1.5 per 1000; 95% confidence interval [CI] 0.2, 10.6 per 1000). Among all patients included in the PASS studies, 21 developed any type of inhibitors (2.0%, 95% CI: 0.8%, 4.7%). Less than 1% of patients presented with other serious adverse events possibly related to ADVATE. The overall median ABR was 3.83 bleeds/year (first, third quartiles: 0.60, 12.90); 1.66 (0, 4.78) in the 557 patients continuously on prophylaxis ≥ twice/week. Metaanalysing PASS data from different countries confirmed the overall favourable safety and effectiveness profile of ADVATE in routine clinical settings. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Current guidelines for ischemic stroke prevention in atrial fibrillation or flutter (AFF) recommend Vitamin K antagonists (VKAs) for patients at high-intermediate risk and aspirin for those at intermediate-low risk. The cost-effectiveness of these treatments was demonstrated also in elderly patients. However, there are several reports that emphasize the underuse of pharmacological prophylaxis of cardio-embolism in patients with AFF in different health care settings. Aims: To evaluate the adherence to current guidelines on cardio-embolic prophylaxis in elderly (>65years old) patients admitted with an established diagnosis of AFF to the Italian internal medicine wards participating in REPOSI registry, a project on polypathologies/polytherapies stemming from the collaboration between the Italian Society of Internal Medicine and the Mario Negri Institute of Pharmacological Research; to investigate whether or not hospitalization had an impact on guidelines adherence; to test the role of possible modifiers of VKAs prescription. Methods: We retrospectively analyzed registry data collected from January to December 2008 and assessed the prevalence of patients with AFF at admission and the prevalence of risk factors for cardio-embolism. After stratifying the patients according to their CHADS2 score the percentage of appropriateness of antithrombotic therapy prescription was evaluated both at admission and at discharge. Univariable and multivariable logistic regression models were employed to verify whether or not socio-demographic (age >80years, living alone) and clinical features (previous or recent bleeding, cranio-facial trauma, cancer, dementia) modified the frequency and modalities of antithrombotic drugs prescription at admission and discharge. Results: Among the 1332 REPOSI patients, 247 were admitted with AFF. At admission, CHADS2 score was ≥2 in 68.4% of patients, at discharge in 75.9%. Among patients with AFF 26.5% at admission and 32.8% at discharge were not on any antithrombotic therapy, and 43.7% at admission and 40.9% at discharge were not taking an appropriate therapy according to the CHADS2 score. The higher the level of cardio-embolic risk the higher was the percentage of antiplatelet- but not of VKAs-treated patients. At admission or at discharge, both at univariable and at multivariable logistic regression, only an age >80years and a diagnosis of cancer, previous or active, had a statistically significant negative effect on VKAs prescription. Moreover, only a positive history of bleeding events (past or present) was independently associated to no VKA prescription at discharge in patients who were on VKA therapy at admission. If heparin was considered as an appropriate therapy for patients with indication for VKAs, the percentage of patients admitted or discharged on appropriate therapy became respectively 43.7% and 53.4%. Conclusion: Among elderly patients admitted with a diagnosis of AFF to internal medicine wards, an appropriate antithrombotic prophylaxis was taken by less than 50%, with an underuse of VKAs prescription independently of the level of cardio-embolic risk. Hospitalization did not improve the adherence to guidelines. [Copyright &y& Elsevier]

When the disease is rare and/or the outcome is uncommon the trial design does not warrant precise and unbiased estimates due to a lack of power or the expected length of recruitment and observation periods. Is there any reliable method to control for bias and consequently achieve an advantage from estimates generated by different study designs? An interesting statistical approach suitable to solve this problem has been theorized by Thomas Bayes. A Bayesian analysis is aimed at answering the question ‘How this trial will modify our belief about that treatment effect?’ In summary, the Bayesian approach can be defined as the explicit and quantitative use of any kind of external evidence in the design, analysis, and interpretation of an experimental trial. The results of a Bayesian analysis is the 95% credible interval in which we believe the estimate to lie with a probability of 95%, or the estimate of the probability that the quantity of interest is less than a specific value. The principal advantages of the Bayesian approach are that it allows to directly make probability statements about quantities of interest; it allows to easily make predictive statements, conditional on the current state of knowledge; it enables evidence from a variety of sources to be taken into account within a coherent modelling framework; it requires the investigator to explicit prior beliefs and demands. Exemplifications of the advantages of the Bayesian approach will be given discussing some papers published in Haemophilia. [ABSTRACT FROM AUTHOR]

Abstract: This study set out to ascertain the incidence of a heel strike transient (HST) and to verify whether modifications of muscle activation time could be correlated with the presence and the characteristic of a HST. Lower limb kinematics, kinetics and surface electromyography (SEMG) of normal subjects were examined during barefoot walking. A short-lived sharp HST was present in 76% of the trials while a smooth HST, of longer duration was seen in 13.3% of the trials. The transient phenomenon was absent in the remaining 10.7% of trials. The SEMG showed that alteration in the activation timing of muscles correlated with the presence of a HST. [Copyright &y& Elsevier]

The experimental results of the pilot scale application of different membrane technologies, supported by clariflocculation and ozonization, for textile wastewater reuse are described. The investigation has been carried out by treating two different textile effluents: a secondary effluent coming from a biological activated plant and a wastewater coming directly from several textile departments. In the first case the pilot plant used sand filtration and microflitration (MF) as pre-treatments for nanofiltration (NF). The MF and NF membranes tested were of the spiral wound type. The NF permeate can be reused in all production steps, including dyeing with light coloration. In the second case, the chemical-physical pre-treatment and the advanced treatment of water have been experimented for different kind of wastewater (from the carbonising process, from dyeing and fulling). The most interesting experimental results were obtained from the treatment of wastewater from the carbonising process. A scheme process in which ultrafiltration (UF) with flat membranes operating under vacuum is placed downstream an ozonization treatment has been evaluated. The UF permeate quality was suitable to the reuse in production processes. [Copyright &y& Elsevier]

This paper briefly reviews some planned future developments of the SuperDARN radar network and in particular the two Dome C radars which will fill the azimuthal gaps which still affect the coverage of the southern auroral and polar ionosphere. [ABSTRACT FROM AUTHOR]

The complex interaction between shocks and plasma turbulence is extremely important to address crucial features of energy conversion in a broad range of astrophysical systems. We study the interaction between a supercritical, perpendicular shock and pre-existing, fully developed plasma turbulence, employing a novel combination of magnetohydrodynamic and small-scale, hybrid-kinetic simulations where a shock is propagating through a turbulent medium. The variability of the shock front in the unperturbed case and for two levels of upstream fluctuations is addressed. We find that the behaviour of shock ripples, i.e. shock surface fluctuations with short (a few ion skin depths, d i) wavelengths, is modified by the presence of pre-existing turbulence, which also induces strong corrugations of the shock front at larger scales. We link this complex behaviour of the shock front and the shock downstream structuring with the proton temperature anisotropies produced in the shock–turbulence system. Finally, we put our modelling effort in the context of spacecraft observations, elucidating the role of novel cross-scale, multispacecraft measurements in resolving shock front irregularities at different scales. These results are relevant for a broad range of astrophysical systems characterized by the presence of shock waves interacting with plasma turbulence. [ABSTRACT FROM AUTHOR]

Presents the National Aeronautics and Space Administration solar electric propulsion technology applications readiness project which was started in 1992 to complete the development of an electric propulsion technology for space vehicles. Project structure and teaming; Ground and flight unit tests; Correlation of preflight with flight data.

Aims: The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older). Methods: Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 ( n = 1332), 2010 ( n = 1380), and 2012 ( n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed. Results: Among 3906 patients prescribed at least one drug at admission, 2156 (55.2 %) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95 % CI 1.01-1.03), multimorbidity (OR 2.69, 95 % CI 2.33-3.10), hypokalemia (OR 2.79, 95 % CI 1.32-5.89), atrial fibrillation (OR 1.66, 95 % CI 1.40-1.98), and heart failure (OR 3.17, 95 % CI 2.49-4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8 % were prescribed them at discharge. Conclusions: Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people. [ABSTRACT FROM AUTHOR]

Background It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. Methods We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality. Results Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p = 0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy. Conclusions Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of xanthine oxidase (XO) inhibitors prescription at admission and discharge in elderly hospital in-patients, to analyze the appropriateness of their use in relation to evidence-based indications, to evaluate the predictors of inappropriate prescription at discharge and the association with adverse events 3 months after hospital discharge. Methods: This cross-sectional study, based upon a prospective registry, was held in 95 Italian internal medicine and geriatric hospital wards. The sample included 4035 patients aged 65 years or older at admission and 3502 at discharge. The prescription of XO inhibitors was considered appropriate in patients with diagnosis of gout, gout nephropathy, uric acid nephrolithiasis, tophi, and chemotherapy-induced hyperuricemia. In order to evaluate the predictors of inappropriate prescription of XO inhibitors, we compared the characteristics of patients considered inappropriately treated with those appropriately not treated. Results: Among the 4035 patients eligible for the analysis, 467 (11.6 %) were treated with allopurinol or febuxostat at hospital admission and 461 (13.2 %) among 3502 patients discharged. At admission, 39 (8.6 %) of patients receiving XO inhibitors and 43 (9.4 %) at discharge were appropriately treated. Among those inappropriately treated, hyperuricemia, polytherapy, chronic renal failure, diabetes, obesity, ischemic cardiomyopathy, heart failure, and cardiac dysrhythmias were associated with greater prescription of XO inhibitors. Prescription of XO inhibitors was associated with a higher risk of adverse clinical events in univariate and multivariate analysis. Conclusions: Prevalence of inappropriate prescription of XO inhibitors remained almost the same at admission and discharge. Inappropriate use of these drugs is principally related to treatment of asymptomatic hyperuricemia and various cardiovascular diseases. [ABSTRACT FROM AUTHOR]

What is known and objective Inappropriate prescribing is highly prevalent for older people and has become a global healthcare concern because of its association with negative health outcomes including ADEs, hospitalization and resource utilization. Beers' criteria are widely utilized for evaluating the appropriateness of medications, and an up-to-date version has recently been published. To assess the prevalence of patients exposed to PIMs at hospital discharge according to the 2003 and 2012 versions of Beers' criteria and to evaluate the risk of adverse clinical events, re-hospitalization and all-cause mortality at 3-month follow-up. Methods This cross-sectional study was held in 66 Italian internal medicine and geriatric wards. The sample included 1380 inpatients aged 65 years or older. Prescriptions of PIM were analysed at hospital discharge. We considered all patients with complete 3-month follow-up. Results and discussion The prevalence of patients receiving at least one PIM was 20·1% and 23·5% according to the 2003 and 2012 versions of the Beers' criteria, respectively. The 2012 Beers' criteria identified more patients with at least one PIM than the 2003 version, although a high percentage of those patients (72·2%) were also identified by the criteria updated in 2003. The main difference in the prevalence of patients receiving a PIM according to the two versions of Beers' criteria involved prescriptions of benzodiazepines for insomnia or agitation, chronic use of non-benzodiazepine hypnotics, prescription of antipsychotics in people with dementia and oral iron at dosage higher than 325 mg/day. Prescription of PIMs was not associated with a higher risk of adverse clinical events, re-hospitalization and all-cause mortality at 3-month follow-up in both univariate and multivariate analysis, after adjusting for age, sex and CIRS comorbidity index. What is New and Conclusions This study found no significant effect of inappropriate drug use according to Beers' criteria on health outcomes among older adults 3 month after discharge. Even though these criteria have been suggested as helpful in promoting appropriate prescribing, reducing drug-related adverse events and associated healthcare costs, to date there is no clear evidence that their application can achieve objective and quantifiable improvements in clinical outcomes. A possible explanation is that both versions of the Beers' criteria have several recognized limitations, one of the main ones being the restricted availability of some drugs in Europe or their limited prescription in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Women live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people. Methods Retrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied. Results A total of 1380 hospitalized elderly subjects, 50.5% women and 49.5% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men. Conclusions Our study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare. [ABSTRACT FROM AUTHOR]

The solar energetic particle (SEP) events from impulsive solar flares are often characterized by short-timescale modulations affecting, at the same time, particles with different energies. Several models and simulations suggest that these modulations are observed when SEPs propagate through magnetic structures with a different connection with the flare site. However, in situ observations rarely showed clear magnetic signatures associated with these modulations. In this paper we used the Grad-Shafranov reconstruction to perform a detailed analysis of the local magnetic field topology during the SEP event of 9-10 January 1999, characterized by several SEP dropouts. An optimization procedure is used to identify, during this SEP event, the magnetic structures which better satisfy the Grad-Shafranov assumptions and to evaluate the direction of their invariant axis. We found that these two-dimensional structures, which are flux ropes or current sheets with a more complex field topology, are generally associated with the maxima in the SEP counts. This association suggests that the SEPs propagate within these structures and, since their gyration radii is much smaller than the transverse dimension of these structure, cannot escape from them [ABSTRACT FROM AUTHOR]

In situ observations of solar energetic particles (SEPs) often show rapid variations of their intensity profile, affecting all energies simultaneously, without time dispersion. A previously proposed interpretation suggests that these modulations are directly related to the presence of magnetic structures with a different magnetic topology. However, no compelling evidence of local changes in magnetic field or in plasma parameters during SEP modulations has been reported. In this paper, we performed a detailed analysis of SEP events and we found several signatures in the local magnetic field and/or plasma parameters associated with SEP modulations. The study of magnetic helicity allowed us to identify magnetic boundaries, associated with variations of plasma parameters, which are thought to represent the borders between adjacent magnetic flux tubes. It is found that SEP dispersionless modulations are generally associated with such magnetic boundaries. Consequently, we support the idea that SEP modulations are observed when the spacecraft passes through magnetic flux tubes, filled or devoid of SEPs, which are alternatively connected and not connected with the flare site. In other cases, we found SEP dropouts associated with large-scale magnetic holes. A possible generation mechanism suggests that these holes are formed in the high solar corona as a consequence of magnetic reconnection. This reconnection process modifies the magnetic field topology, and therefore, these holes can be magnetically isolated from the surrounding plasma and could also explain their association with SEP dropouts. [ABSTRACT FROM AUTHOR]

Background: As chronicity represents one of the major challenges in the healthcare of aging populations, the understanding of how chronic diseases distribute and co-occur in this part of the population is needed. Objectives: The aims of this study were to evaluate and compare patterns of diseases identified with cluster analysis in two samples of hospitalized elderly. Methods: Data were obtained from the multicenter 'Registry Politerapie SIMI (REPOSI)' that included people aged 65 or older hospitalized in internal medicine and geriatric wards in Italy during 2008 and 2010. The study sample from the first wave included 1,411 subjects enrolled in 38 hospitals wards, whereas the second wave included 1,380 subjects in 66 wards located in different regions of Italy. To analyze patterns of multimorbidity, a cluster analysis was performed including the same diseases (19 chronic conditions with a prevalence >5%) collected at hospital discharge during the two waves of the registry. Results: Eight clusters of diseases were identified in the first wave of the REPOSI registry and six in the second wave. Several diseases were included in similar clusters in the two waves, such as malignancy and liver cirrhosis; anemia, gastric and intestinal diseases; diabetes and coronary heart disease; chronic obstructive pulmonary disease and prostate hypertrophy. Conclusion: These findings strengthened the idea of an association other than by chance of diseases in the elderly population. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to explore the association of dementia with in-hospital death in acutely ill medical patients. Methods Thirty-four internal medicine and 4 geriatric wards in Italy participated in the Registro Politerapie SIMI-REPOSI-study during 2008. One thousand three hundred and thirty two in-patients aged 65 years or older were enrolled. Logistic regression models were used to evaluate the association of dementia with in-hospital death. Socio-demographic characteristics, morbidity (single diseases and the Charlson Index), number of drugs, and adverse clinical events during hospitalization were considered as potential confounders. Results One hundred and seventeen participants were diagnosed as being affected by dementia. Patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia, and a higher number of adverse clinical events during hospitalization. The percentage of patients affected by dementia who died during hospitalization was higher than that of patients without dementia (9.4 versus 4.9%). After multiadjustment, the diagnosis of dementia was associated with in-hospital death (OR = 2.1; 95% CI = 1.0-4.5). Having dementia and at least one adverse clinical event during hospitalization showed an additive effect on in-hospital mortality (OR = 20.7; 95% CI = 6.9-61.9). Conclusions Acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission. Having dementia and adverse clinical events during hospital stay increases the risk of death. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Background: Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern among elderly patients, who have often multiple comorbidities and need many drugs. Methods: We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease (GERD) in a sample of elderly patients (65years old or older) at admission and discharge in 38 internal medicine wards between January 2008 and December 2008, according to the presence of specific conditions or gastro-toxic drug combinations. Results: Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after adjustment for age, sex and number of diagnoses at admission (OR 95% CI=1.26 (1.18–1.34), p =.0001) or discharge (OR 95% CI=1.11 (1.05–1.18), p =0.0003). Conclusions: Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are essential for a rational and cost-effective use of drugs for peptic ulcer or GERD. [Copyright &y& Elsevier]

On day 7 May 2005, the plasma instruments on board Double Star TC1 and Cluster SC3 spacecraft register inside the magnetosheath, at 19:15:12 and 19:16:20 UT, respectively, a strong pressure pulse due to the impact of an interplanetary shock wave (IS) on the terrestrial bow shock. The analysis of this event provides clear and quantitative evidences confirming and strengthening some results given by past simulations and observational studies. In fact, here we show that the transmitted shock is slowed down with respect to the incident IS (in the Earth's reference frame) and that, besides the transmitted shock, the IS - bow shock interaction generates a second discontinuity. Moreover, supported also by a special set three-dimensional magnetohydrodynamic simulation, we discuss, as further effects of the interaction of the IS with the magnetosphere, other two interesting aspects of the present event, that is: the TC1 double crossing of the bow shock (observed few minutes after the impact of the IS) and the presence, only in the SC3 data, of a third discontinuity produced inside the magnetosheath. [ABSTRACT FROM AUTHOR]

To examine the mechanism by which free fatty acids (FFAs) induce insulin resistance in vivo, awake chronically catheterized rats underwent a hyperinsulinemic-euglycemic clamp with or without a 5-h preinfusion of lipid/heparin to raise plasma FFA concentrations. Increased plasma FFAs resulted in insulin resistance as reflected by a approximately 35% reduction in the glucose infusion rate (P < 0.05 vs. control). The insulin resistance was associated with a 40-50% reduction in 13C nuclear magnetic resonance (NMR)-determined rates of muscle glycogen synthesis (P < 0.01 vs. control) and muscle glucose oxidation (P < 0.01 vs. control), which in turn could be attributed to a approximately 25% reduction in glucose transport activity as assessed by 2-[1,2-3H]deoxyglucose uptake in vivo (P < 0.05 vs. control). This lipid-induced decrease in insulin-stimulated muscle glucose metabolism was associated with 1) a approximately 50% reduction in insulin-stimulated insulin receptor substrate (IRS)-1-associated phosphatidylinositol (PI) 3-kinase activity (P < 0.05 vs. control), 2) a blunting in insulin-stimulated IRS-1 tyrosine phosphorylation (P < 0.05, lipid-infused versus glycerol-infused), and 3) a four-fold increase in membrane-bound, or active, protein kinase C (PKC) theta (P < 0.05 vs. control). We conclude that acute elevations of plasma FFA levels for 5 h induce skeletal muscle insulin resistance in vivo via a reduction in insulin-stimulated muscle glycogen synthesis and glucose oxidation that can be attributed to reduced glucose transport activity. These changes are associated with abnormalities in the insulin signaling cascade and may be mediated by FFA activation of PKC theta. [ABSTRACT FROM AUTHOR]

Knowledge of the clinical evolution of corneal transplantation is fundamental to its improvement by upgrading the modalities and conservation methods in eye banking. The purpose of this retrospective study was to review of the results obtained with corneal transplantation performed at 50 Italian hospitals supplied by our center. From July 1997 through December 2002, 2721 corneas were used for transplantation. A questionnaire was mailed to every transplant center, that included queries about the number of corneal transplants performed, the number of primary and late failures, and the prevalence of posttransplant endopthalmitis. Preliminary results revealed no correlation between primary/late failures and the morphologic properties of the cornea, donor age, although a few failures seemed related to the pathology of the recipient. [Copyright &y& Elsevier]