International Scientific Societies Research Articles

Sugar and diabetes: international recommendations

Nutrition in the diabetic patient is not just a mere nutrient but his treatment is based. In fact, international scientific societies have called "medical nutrition therapy" to give it the emphasis it deserves. Nutritional recommendations of scientific societies have been changing in recent years with evidence-based medicine. Regarding the consumption of sugar, most believe it does not affect metabolic control if it is replaced by other carbohydrates, but does not indicate a specific amount.

Imaging-Based Diagnostic Systems for Hepatocellular Carcinoma

Noninvasive imaging plays critical roles in the treatment of patients with cirrhosis or other risk factors for the development of hepatocellular carcinoma. In recognition of the critical roles played by imaging, numerous international scientific organizations and societies have, in the past 12 years, proposed diagnostic systems for the interpretation of liver imaging examinations performed of at-risk patients. Although these imaging-based diagnostic systems represent important advances, they have limitations and they are not perfectly consistent with each other. The limitations and inconsistencies potentially cause confusion and may impair the integration of the systems into clinical practice as well as their utilization in research studies. The purpose of this article is to synthesize and critically appraise the current published imaging-based diagnostic systems endorsed by major societies for the noninvasive diagnosis and staging of hepatocellular carcinoma and to propose future directions that we hope may be helpful in further advancing the field.

Diet

Diet

Compliance with the clinical practice guidelines for the management of hepatitis B and C virus-related chronic liver disease: a survey based on hospitalized cirrhotic patients

In recent years, significant progress has been made in furthering our knowledge of chronic liver disease (CLD) and evaluating the therapeutic approaches. These have been updated in the form of recommendations by international scientific societies. Through a retrospective analysis, this study aimed to verify whether these recommendations have been applied in real practice. The study design included data gathered from all patients consecutively hospitalized for decompensated liver cirrhosis during one year. A pre-made master form was used to record data on the patients’ past knowledge of the etiology and management of their liver disease. As expected, hepatitis C virus (HCV) was the most frequent cause of CLD, while 41 cases were cryptogenic. In 69 of 263 patients with HCV infection, viral genotyping had been performed, although only 39 of these cases had been treated. Only 3 of 44 patients suffering from hepatitis B virus (HBV)-related liver cirrhosis had been treated in the past, while 11 patients were still being treated. Among the remaining patients, 15 were not aware that they had CLD and 15 had never been considered for antiviral treatment. In 81 cases, the disease had progressed to hepatocellular carcinoma, but only 19 patients had discovered the tumor following regular ultrasound screening. Thirty-seven patients were receiving specific treatment consistent with the stage of their disease. The management of HBV- and HCV-related CLD in Sicily is far from optimal, and although the natural history and management practices of these diseases are well known, this knowledge is a long way from being applied in our daily practice.

Ask the Expert: How Should Vascular Dementia Be managed?

Kurt A Jellinger is Professor of Neurology and Neuropathology at the Medical University of Vienna (Vienna, Austria) and director of the Institute of Clinical Neurobiology (Vienna, Austria). He received his MD from the Medical University of Vienna, completed his internship in Neurology and Psychiatry at the Department of Neurology and Psychiatry, University of Vienna (Vienna, Austria) and in Neuropathology at the Neurological (Obersteiner) Institute, University of Vienna. He became full professor of Neuropathology in 1973, was director of the Department of Neurology, Lainz Hospital (Vienna, Austria; 1976–1997), the Ludwig Boltzmann Institute of Clinical Neurobiology (Vienna, Austria; 1977–2002) and, since then, of the Institute of Clinical Neurobiology (Vienna, Austria). He has been the recipient of numerous grants and awards, including the T Innitzer Award for Promotion of Clinical Research, the Burda Award of the Austrian Parkinson Society, the Meritorious Service Award of the American Association of Neuropathology and the Cotzias Award of the Spanish Society of Neurology. He is a member of numerous national and international scientific societies, was president of the Austrian Society of Neurology and Neuropathology, vice president of the International Societies of Neuropathology, an honorary member of many national and international societies, including the International Society of Neuropathology, and an honorary research fellow of the Romanian Academy of Medical Sciences. He is an editor and reviewer of many national and international journals of neurology, neuroscience and neuropathology. For the last 50 years, Jellinger’s research has focused on many fields of clinical neuropathology, neurochemistry and descriptive neurobiology. His current research is focused on the neuropathology, molecular pathology and pathogenesis of movement disorders, neurodegenerative dementias, vascular cognitive disorders, late-life dementia and problems of cell death in CNS aging. Professor Jellinger has written 550 papers in international refereed journals, 133 reviews, 163 contributions or chapters in books and has been editor and co-editor of 11 scientific books. His current research is focused on the classification and specific problems of Parkinson’s disease and dementia disorders.

Aquatic Ecosystem Health and Management Society 20 year celebration

The Aquatic Ecosystem Health and Management Society (AEHMS) is an international scientific society established in 1989 and based in Canada. It encourages and promotes integrated ecosystemic and holostic practices for the protection and conservation of local and global aquatic resources. It goes beyond a strictly scientific focus on aquatic ecosystem functioning and quality by integrating this with environmental management (Vallentyne and Munawar, 1993). The result is the adoption and exploration of the ecosystem health concept and its application in integrated management and restoration. The focus thus expands beyond nature per se to include impacts and implications of the activities of human populations on natural ecosystems. It examines the ecological capacities of our planet to support the needs and desires of human populations that are still rapidly expanding with the increasing size of the human population, and continuing to increase ecosystem stress. It describes the abilities of aquatic ecosystems to repair and recover once human-induced stresses of over-harvesting, pollution, species introductions, and so on are alleviated. The ecosystem health concept recognizes that the human population is integral to the biosphere (Malley, 1993), and that it is the practices of that global population that must be modified and aligned with the requirements of natural ecosystems to continue to function well over time. Globally, we refer to this alignment as sustainable development (The World Commission on Environment and Development, 1987).Science-based, AEHMS operates by providing opportunities to scientists to present new findings in these fields at conferences, symposia, and workshops. Integral from the start has been strong focus on high quality, refereed publication of these findings through the regular publication of an ISI-rated primary journal and a book monograph series publishing refereed articles related to a central topic. The journal, Aquatic Ecosystem Health and Management (AEHM), has published 42 special issues across 15 volumes of AEHM from 1998 to 2012. These special issues and the more than 20 books within the Ecovision World Monograph Series provide considerable coverage of their selected topics. The Ecovision World Monograph Series explores the linkages among society, ecology, ecosystems and the total environment. Subjects range from results from pure science to the multi-disciplinary, human focus that is central to the concept of aquatic ecosystem health.Nevertheless, it is the life, the philosophy, and the culture of the Society that also distinguishes it from many other highly-contributing, environmentally-related scientific societies. The remarkable history and productivity of AEHMS is firstly due to the vision, commitment, productivity, and enduring dedication of Dr. Mohiuddin Munawar. For his achievements, Dr. Munawar has been personally recognized globally by receiving a number of awards. Unlike most scientific societies, AEHMS does not have a stable membership base to provide reliable, on-going funding, and participation at conferences. While the home of AEHMS is the Canada Centre for Inland Waters in Burlington, Ontario, the conferences have been held world-wide at global-scale distances from one another from year to year. Support for operation of AEHMS is largely from revenue from conferences, particularly from the journal and book publications that result. Nevertheless, there are a number of well-established scientists and professionals who have supported and contributed to the AEHMS over some or many of these 20 years. A number of them are among the authors who have generously contributed articles to this tribute to AEHMS’ anniversary, expanding on the activities and achievements of AEHMS on its 20th anniversary.

Editorial introductions

Editorial introductions

Variabilidad en las recomendaciones para el abordaje clínico de la osteoporosis

Background and objectiveAnalysis of the variability in the recommendations of the main guidelines and clinical documents for the management of osteoporosis. Material and methodSearches were carried out in PubMed, Google, web pages of national and international scientific societies related to the management of osteoporosis, and agencies that develop guidelines. We analyzed guidelines and clinical documents that included recommendations for the indication of bone densitometry and/or pharmacological treatment, which could influence the management of osteoporosis in the Spanish National Health System, which have been published between 2006 and 2012. ResultsWe included 12 documents. Eleven recommend performing bone densitometry upon assessing women risk factors, but the number and type of risk factors vary between documents: 6 recommend its implementation to all women over 65 years, 4 in men aged 65-70 years, and 3 when there is radiological suspicion of osteoporosis. There is agreement on the recommendations on the indication for densitometry to monitor drug response. In primary prevention, all national documents combined risk factors and densitometric osteoporosis and 3 of them recommend individual assessment according to risk factors. Most of the international guidelines require the calculation of risk with the FRAX® tool. In secondary prevention, all documents recommend treatment in cases of hip or clinical vertebral fracture; in men, and for the rest of fractures, the recommendations are heterogeneous. ConclusionsOverall there is a high variability in the recommendations of guidelines and other documents for the management of osteoporosis.

On the Realm of Virtual Colloquium

The nature of scientific communications is evolving in the digital age, and leveraging emerging technologies presents ongoing challenges and opportunities to an international scientific society like IUPAC. One of the missions of the Union is to contribute to the advancement of science by enabling communication among scientists across national, cultural, and linguistic boundaries. Historically, there have been two modes to this mission. First, IUPAC is responsible for standardizing the metrics and terminologies pursuant to effective communication among chemists. Second, it disseminates ideas and information through traditional modes of communication, including physical or face-to-face meetings and printed communications. For some time now, digital information and communications technologies have been impacting the traditional modes of communication, while also enabling new ones through the instant transference of actual experimental data, adding a whole new layer to the needs for non-linguistic data standards. In this paper, we will explore these questions, focus on the former challenges, and report on a Virtual Colloquium on IYC2011 which ran concomitant with the ICCE-ECRICE 2012.

Indications for percutaneous myocardial revascularization

Indications and timing of myocardial revascularization procedures are discussed based on the case of a 78-year-old woman suffering from effort angina due to three-vessel coronary artery disease with normal left ventricular function. At present, atherosclerotic patients have a relatively long history of their disease, so that physicians should organize therapeutic strategies resulting from a right trade-off between guidelines of international scientific societies and the peculiar clinical requirements of the individual patient in the particular stage of his/her disease. This kind of tailored therapy may result from a multidisciplinary approach (heart team), which should involve many specialists as comorbidities and frailty of the patients are numerous and significant.

The American Society for Gastrointestinal Endoscopy (ASGE) diagnostic algorithm for obscure gastrointestinal bleeding: Eight burning questions from everyday clinical practice

The diagnosis and management of patients with obscure gastrointestinal bleeding are often long and challenging processes. Over the last 10 years the introduction in clinical practice of new diagnostic and therapeutic procedures (i.e. Capsule Endoscopy, Computed Tomographic Enterography, Magnetic Resonance Enterography, and Device Assisted Enteroscopy) has revolutionized the diagnostic/therapeutic work-up of these patients. Based on evidence published in the last 10 years, international scientific societies have proposed new practice guidelines for the management of obscure gastrointestinal bleeding, which include these techniques. However, although these algorithms (the most recent ones are endorsed by the American Society for Gastrointestinal Endoscopy – ASGE) allow the management of the large majority of patients, some issues still remain unsolved. The present paper reports the results of the discussion, based on the literature published up to September 2011, among a panel of experts and gastroenterologists, working with Capsule Endoscopy and with Device Assisted Enteroscopy, attending the 6th annual meeting of the Italian Club for Capsule Endoscopy and Enteroscopy. Eight unresolved issues were selected: each of them is presented as a “Burning question” and the “Answer” is the strategy proposed to manage it, according to both the available evidence and the discussion among participants.

Preoperative assessment of patients for lung cancer surgery

The aim of this work was to present and analyze the latest published documents about the functional evaluation of patients undergoing lung resection and review articles from the past two years addressing the same topic. In 2009 and 2010, two important task forces, appointed by international scientific societies, have published documents to guide the preoperative evaluation and risk stratification of lung resection candidates. In both documents, cardiac evaluation is prioritized. Detailed cardiologic guidelines have been proposed. After this first step, functional assessment should include a spirometric assessment, asystematic measurement of carbon monoxide diffusion capacity and a cardiopulmonary exercise test evaluation. Differences in the relative importance of these tests in the two guidelines were discussed. Most recent evidences focused on the role of cardiopulmonary exercise test and the use of several direct and indirect ergometric parameters that may refine risk assessment. The use of evidence-based clinical guidelines on preoperative evaluation is recommendable. Nevertheless, scientific evidence is still suboptimal in this field. Aggregate analyses on larger series are needed to improve risk stratification.

Recommendations for the treatment of hypertension in the elderly and very elderly: a scotoma within international guidelines

The recommendations of international scientific societies for the treatment of hypertension in the geriatric population are different. Lack of outcome trials, non-standardised terminology as well as differing levels of evidence contribute to the inconsistencies in the guidelines. This review article compares six international guidelines (ESH-ESC 2007/2009, SHG 2009, DHL 2008, CHEP 2010, NICE 2011 and JNC7 2003) as well as the consensus document of the ACCF/AHA 2011 in terms of their recommendations of drug classes, target blood pressure values and the use of combination therapy. Generally, antihypertensive therapy appears to be clinically beneficial in geriatric patients. Target blood pressure values of <140-150/90 mm Hg and <140/90 mm Hg can be used as a general guideline for octogenarians (80-89 yrs) and septuagenarians (70-79 yrs) respectively. While angiotensin-II converting enzyme inhibitors and diuretics appear to be advantageous in treating combined systolic-diastolic hypertension, calcium-channel blockers and diuretics are to be recommended in the management of isolated systolic hypertension. Combination therapy often increases the efficacy of the treatment as well as patient medication adherence. Furthermore, by making the most of drug combination synergy, lower doses may be used resulting in fewer side-effects.

A brief history of INA and ICOH SCNP: International Neurotoxicology Association and International Congress on Occupational Health Scientific Committee on Neurotoxicology and Psychophysiology

Two international scientific societies dedicated to research in neurotoxicology and neurobehavioral toxicology are the International Neurotoxicology Association (INA) and the International Congress on Occupational Health International Scientific Committee on Neurotoxicology and Psychophysiology (ICOH SCNP). From June 5–10, 2011 these two societies held a joint conference in Xi’an China entitled the Xi’an International Neurotoxicology Conference, Neurotoxicity and Neurodegeneration: Local Effect and Global Impact. At the conference two featured talks presented a brief history of the two societies. This article is a synthesis and expansion of those two presentations. The history of INA and ICOH SCNP is described in relation to the antecedent events leading to the formation of the two societies, their parallel developments, the nature of the societies and their scientific conferences, and a brief description of some of their accomplishments. Together, the historical development of these two societies is an important component of the development of the scientific discipline of neurotoxicology.

Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM)

Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific societies describing the proper use and clinical indications of CCT; in particular, there are no complete guidelines. This document reflects the position of the Working Group of the Cardiac Radiology Section of the Italian Society of Radiology concerning the indications for CCT.

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth.

BackgroundThe International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).MethodsAll types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.ResultsThe contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.ConclusionThese Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

Highlights and hot topics from 2011 in Thrombosis and Haemostasis

We would like to maintain our tradition to provide a short overview on excellent articles published in Thrombosis and Haemostasis that – based on online search engines – were found to have been highly cited by scientists in 2010–2011, or those felt to merit and be worth highlighting by the Editors. Since 2011, Thrombosis and Haemostasis has served as the official journal of another European research organisation, the European Society of Cardiology (ESC) Working Group Atherosclerosis. Our fruitful collaboration with our European and international scientific societies has resulted in the publication of several important consensus documents such as the position paper of the ESC Working Group of Atherosclerosis and Vascular Biology on stabilisation of atherosclerotic plaques (1), and a joint position paper including the ESC Working Group on Thrombosis on the peri-operative management of antiplatelet therapy in patients with CAD (2).

An appropriate general circulation model (GCM) to investigate climate change impact

There is a wide agreement in the international scientific society that climate change will modify climatic variables. Atmosphere-Ocean General Circulation Model (AOGCM) is an appropriate model to produce climatic scenarios. The first step to climate change studies is currently using the most appropriate AOGCM output. In this study, AOGCM’s for a time period of 1961–1990 in Shahrekord synoptic station are therefore compared and finally the best AOGCM is presented. The employed models in the paper include CCSR, CGCM2, CSIRO and HADCM3 which was mentioned in the Third Assessment Reports of IPCC. The results display that the HADCM3 output has more appropriate correlation than the other models comparing with the observed data of the station. According to the evaluation of climatic scenarios, climate change has the unfavourable impacts on hydrology and water resources of the basin, thus these results are suitable ones of the most achievements to study climate change effects on stream flow changes and variability in Northern Karoon region, Iran.

Off-label drugs prescription in neonatology: a physician’s duty or a medical hazardous attitude?

The off-label and unlicensed use of drugs in neonatology is a widespread reality in all the NICUs. Several explanations may be given to justify the extension of this phenomenon and, among them, the lack of ad hoc clinical trials in neonatal subpopulation and the freedom to cure worldwide recognized to relatives and physicians. It is well known that adverse effects are more frequent, more serious and more underreported when medicines are used unauthorized or off-label, being physicians in theory responsible for the newborn physical damage. To avoid this responsability, we believe that a shared legal framework may be helpfull where the informative process on risks/benefits ratio for the newborn has a pivotal role. The National and International Scientific Societies should promote a common guidelines also for the informations on drug effects to be supplied to relatives. But at the same time EMA has to implement its strong policy towards the mandatory request on trials, for every new drug, on specific neonatal and pediatric subpopulations.

Evolution of the strength of recommendations in guidelines for the management of atrial fibrillation

Clinical practice guidelines are issued by international scientific societies to assist health care providers in the management of patients according to the most recently available data. When a significant amount of new knowledge has been gained, standards of care usually change and guidelines are updated. With time, areas of uncertainty in the treatment or management of specific diseases are expected to shrink and the level of evidence underlying guidelines is expected to rise. However a review of American College of Cardiology (ACC) and American Heart Association (AHA) guidelines did not support this statement in many of the considered topics [1].