Minerva medica
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The relationship between diet and the formation of renal stones is demonstrated, but restrictive diets do not take into account the complexity of metabolism and the complex mechanisms that regulate the saturation and crystallization processes in the urine. The restriction of dietary calcium can reduce the urinary excretion of calcium but severe dietary restriction of calcium causes hyperoxaluria and a progressive loss of bone mineral component. Furthermore urinary calcium excretion is influenced by other nutrients than calcium as sodium, potassium, protein and refined carbohydrates. ⋯ All the diets above mentioned have as a common characteristic the reduction of the potential acid load of the diet that can be correlated with a higher risk of recurrent nephrolithiasis, because the acid load of diet is inversely related to urinary citrate excretion. The restriction of protein and salt with an adequate calcium intake seem to be advisable but should be implemented with the advice to increase the intake of vegetables that can carry a plentiful supply of alkali that counteract the acid load coming from animal protein. New prospective studies to evaluate the effectiveness of the diet for the prevention of renal stones should be oriented to simple dietary advices that should be focused on a few specific goals easily controlled by means of self-evaluation tools, such as the LAKE food screener.
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Optical coherence tomography (OCT) has revolutionized intracoronary imaging. The unprecedented spatial resolution of this technique (15 μm) provides unique insights on the microstructure of the coronary wall. Currently, OCT is increasingly used in clinical practice and also constitutes an emerging, highly robust, research tool. ⋯ Furthermore, during follow-up OCT has a unique value to unravel the presence of strut coverage and to detect mild amounts of neointimal proliferation that might represent a valid surrogate marker of drug-eluting stent safety and efficacy. Finally, OCT has been used to unravel the underlying mechanisms implicated in stent failure, namely in-stent restenosis and stent thrombosis. Therefore, OCT appears ideally suited to help to move forward our understanding on the pathophysiology of coronary artery disease and to improve clinical decision-making processes, meeting the ever-increasing demand on coronary artery anatomical information from clinicians and researchers.
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Chronic or acute pain related to skin ulcers or their management (medication, debridement) is a typical case of mixed pain, both neuropathic and nociceptive. It represents a disabling clinical condition that deteriorates the patient's quality of life. The pharmaceutical therapy must be based on both, intensity and the type of pain. ⋯ Besides, since its opioid action is rather weak, it does not induce the severe side effects typical of traditional opioids. The benefit of such combination comes from their complementary pharmacokinetic profile, since the first has a quick action insurgence, while tramadol has a more prolonged effect. Therefore, this combination allows to obtain a quick and long lasting effect with a high tolerability profile also when treating skin ulcer pain.
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The OPG/RANKL has identified role in immune system via T-cell-activating cytokines. Considering that immune mechanisms play a key role in the pathogenesis of MS, OPG/RANKL might be importance in the underlying mechanism of the disease. The aim of this study is to measure plasma levels of OPG and RANKL as well as to analyze VDR FokI polymorphism (rs2228570) in MS patients and healthy individuals to detect any potential correlation. ⋯ This might define a role for FokI polymorphism and OPG/RANKL system in the pathogenesis and progression of multiple sclerosis with further practical applications.
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Idiopathic membranous nephropathy is the most common cause of nephrotic syndrome. In patients who present with nephrotic range proteinuria the clinical course is variable, with 50% of patients developing end stage renal disease after extended follow-up without therapy. We review the various immunosuppressive treatment modalities. ⋯ However, the efficacy of these agents must be confirmed in randomized trials with adequate renal end points. Immunosuppressive treatment should be restricted to high risk patients. The use of immunosuppressive therapy has improved outcome of patients with iMN, with nowadays less than 10% of patients progressing to end stage renal disease (ESRD).