Authorship: From credit to accountability - Reflections from the Editors' network.

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new -(fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

La Red de Editores de la Sociedad Europea de Cardiología (SEC) proporciona un foro dinámico para debates editoriales y respalda las recomendaciones del Comité Internacional de Editores de Revistas Médicas (ICMJE) para mejorar la calidad científica de las revistas biomédicas. La autoría confiere crédito e importantes recompensas académicas. Recientemente, sin embargo, el ICMJE enfatizó que la autoría también requiere responsabilidad y compromiso. Estos problemas ahora están cubiertos por el nuevo (cuarto) criterio de autoría. Los autores deben aceptar ser responsables y garantizar que las preguntas sobre la precisión y la integridad de todo el trabajo será abordado adecuadamente. Esta revisión discute las implicaciones de este cambio de paradigma en requisitos de autoría con el objetivo de aumentar la conciencia sobre las buenas prácticas científicas y editoriales.

Complete revascularization with multivessel PCI for myocardial infarction

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS: We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P=0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P=0.62 and P=0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS: Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.). (AU)

Autoría: desde el crédito a la responsabilidad. Reflexiones de la Red de Editores / Authorship: from credit to accountability. Reflections from the Editors´ Network / Autoria: do crédito à responsabilidade. Reflexões da Rede de Editores

Resumen: La Red de Editores de la Sociedad Europea de Cardiología (ESC, por su sigla en inglés) constituye un foro dinámico dedicado a discusiones editoriales y respalda las recomendaciones del Comité Internacional de Editores de Revistas Médicas (ICMJE, por su sigla en inglés) destinadas a mejorar la calidad científica de las revistas biomédicas. La paternidad literaria confiere crédito, además de importantes recompensas académicas. Recientemente, sin embargo, el ICMJE ha destacado que la autoría también exige que los autores sean responsables y se hagan cargo de lo que publican. Estas cuestiones ahora están cubiertas por el nuevo (cuarto) criterio para la autoría. Los autores deben aceptar hacerse responsables de lo que escriben y garantizar un adecuado enfoque de las cuestiones concernientes a la precisión e integridad de todo el trabajo. Esta revisión analiza las implicancias de este cambio de paradigma en los requisitos de autoría con el objetivo de aumentar la conciencia sobre las buenas prácticas científicas y editoriales.

Summary: The Editors´ Network of the European Society of Cardiology provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the International Committee of Medical Journal Editors emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Resumo: A Rede de Editores da Sociedade Europeia de Cardiologia é um fórum dinâmico para discussões editoriais e apoia as recomendações do Comitê Internacional de Editores de Revistas Médicas, visando melhorar a qualidade científica das revistas biomédicas. A autoria confere crédito, além de importantes recompensas acadêmicas. Recentemente, no entanto, o Comitê Internacional de Editores de Revistas Médicas enfatizou que a autoria também requer que os autores sejam responsáveis do que escrevem e se encarreguem do que publicam. Essas questões agora estão cobertas pelo novo (quarto) critério de autoria. Os autores devem concordar em ser responsáveis e garantir que as questões relativas à precisão e integridade de todo o trabalho sejam abordadas de maneira apropriada. Esta revisão discute as implicações dessa mudança de paradigma nos requisitos de autoria, com o objetivo de aumentar a conscientização sobre as boas práticas científicas e editoriais.

Authorship: From credit to accountability - Reflections from the Editors' network.

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new -(fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Autoría: del crédito a la responsabilidad - Reflexiones de la red de editores / Authorship: From credit to accountability - Reflections from the Editors' network

Abstract The Editors’ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Anti-hepatitis C virus treatment may prevent the progression of liver fibrosis in non-responder human immunodeficiency virus/hepatitis C virus coinfected patients

AIM: To evaluate changes in liver histology in patients with human immunodeficiency virus/hepatitis C virus coinfection non-responders to a suboptimal Interferon+Ribavirine regimen. MATERIALS AND METHODS: We investigated 49 patients with two sequential liver biopsies: 18 were non-responders to Interferon+Ribavirine treatment (Group hepatitis C virus Rx) administered after the 1st liver biopsy who underwent a 2nd liver biopsy after a median period of 3.92 year and 31 were patients who remained untreated for hepatitis C virus disease (Group hepatitis C virus untreated) after the 1st liver biopsy because of refusal and underwent a 2nd liver biopsy after a median period of 5.05-years. Most patients in both groups were under highly active antiretroviral therapy. At the time of 1st liver biopsy similar degrees of necro-inflammation, fibrosis and steatosis were observed in both groups. Changes in liver lesions between 1st and 2nd liver biopsys were adjusted for different intervals between liver biopsys by a mathematic formula. RESULTS: Liver fibrosis did not change in 88.9% of patients in Group hepatitis C virus Rx and in 77.4% in Group hepatitis C virus untreated. A marked deterioration in liver fibrosis was observed in 5 (16%) patients in Group hepatitis C virus untreated and in none in Group hepatitis C virus treated. Necro-inflammation and steatosis remained substantially unchanged in both groups. CONCLUSION: Liver histology remained substantially unchanged in human immunodeficiency virus/hepatitis C virus patients non-responder to anti-hepatitis C virus therapy over 4 years observation, suggesting an effective anti-hepatitis C virus early treatment for all hepatitis C virus/human immunodeficiency virus coinfected patients who can reasonably tolerate therapy. .

Anti-hepatitis C virus treatment may prevent the progression of liver fibrosis in non-responder human immunodeficiency virus/hepatitis C virus coinfected patients.

AIM: To evaluate changes in liver histology in patients with human immunodeficiency virus/hepatitis C virus coinfection non-responders to a suboptimal Interferon+Ribavirine regimen. MATERIALS AND METHODS: We investigated 49 patients with two sequential liver biopsies: 18 were non-responders to Interferon+Ribavirine treatment (Group hepatitis C virus Rx) administered after the 1st liver biopsy who underwent a 2nd liver biopsy after a median period of 3.92 year and 31 were patients who remained untreated for hepatitis C virus disease (Group hepatitis C virus untreated) after the 1st liver biopsy because of refusal and underwent a 2nd liver biopsy after a median period of 5.05-years. Most patients in both groups were under highly active antiretroviral therapy. At the time of 1st liver biopsy similar degrees of necro-inflammation, fibrosis and steatosis were observed in both groups. Changes in liver lesions between 1st and 2nd liver biopsys were adjusted for different intervals between liver biopsys by a mathematic formula. RESULTS: Liver fibrosis did not change in 88.9% of patients in Group hepatitis C virus Rx and in 77.4% in Group hepatitis C virus untreated. A marked deterioration in liver fibrosis was observed in 5 (16%) patients in Group hepatitis C virus untreated and in none in Group hepatitis C virus treated. Necro-inflammation and steatosis remained substantially unchanged in both groups. CONCLUSION: Liver histology remained substantially unchanged in human immunodeficiency virus/hepatitis C virus patients non-responder to anti-hepatitis C virus therapy over 4 years observation, suggesting an effective anti-hepatitis C virus early treatment for all hepatitis C virus/human immunodeficiency virus coinfected patients who can reasonably tolerate therapy.

Anti-HBc positivity was associated with histological cirrhosis in patients with chronic hepatitis C.

INTRODUCTION. In patients with chronic hepatitis C it is still debated whether previous exposure to the hepatitis B virus, diagnosed from the presence of the anti-HBc antibody, is linked to a greater risk of severe hepatitis. The aim of the study was to evaluate whether the presence of anti-HBc antibodies is associated with cirrhosis in patients with HBsAg-negative chronic hepatitis C. MATERIAL AND METHODS. Two hundred twenty-two consecutive HBsAg-negative patients with HCV-related chronic hepatitis were enrolled at their first liver biopsy. Ishak's scoring system was used to grade necroinflammation and fibrosis and the patients with stage 5 or 6 were considered as having histological cirrhosis. RESULTS. Patients with histological cirrhosis had a higher mean age, AST, ALT, a lower platelet count and prothrombin activity compared to those with milder fibrosis. The presence of anti-HBc was identified in 21 (63.6%) of the 33 patients with fibrosis score 5 or 6 and in 56 (29.6%; p < 0.001) of the 189 with score ≤ 4. Patients with cirrhosis had a significantly higher grading than those without cirrhosis (median = 8, IQR 6-11 vs. Median = 6, IQR = 4-8, respectively, p < 0.001). A multivariate logistic regression analysis showed that age, sex and anti-HBc positivity were independent predictors of histological cirrhosis. CONCLUSION. Our data support the idea that in patients with chronic hepatitis C the presence in serum of anti-HBc is associated with histological cirrhosis and is therefore a marker of clinical value.

5-Fluorouracilo y cisplatino en carcinoma localmente avanzado: del conducto anal resultados preliminares / 5-Fluorouracil and cisplatin in local advanced carcinoma of the anal canal: preliminary reports

El índice de sobrevida libre de enfermedad a 5 años con esquema 5-fluorouracilo/mitomicina/ radiación para carcinomas del conducto anal, alcanza cifras de 65 por ciento de sobrevida libre de enfermedad que deben ser mejoradas. El propósito del trabajo es determinar la respuesta de un nuevo esquema de quimioterapia neoadyuvante y quimiorradioterapia concurrente para carcinoma escamo-celular localmente avanzado del conducto anal. 60 pacientes ingresados entre el 2001 y 2005, 37 fueron incluidos en el estudio. Edad media fue 57 años, con predominio del sexo femenino (73 por ciento). Veinte y cinco pacientes (67 por ciento) presentaron tamaño tumoral > 5 cm, 57 por ciento ganglios linfáticos comprometidos. Se administraron dos ciclos de inducción de 5- fluorouracilo (1 000 mg/m2 días 1-5 y 21-25) más cisplatino (100 mg/m2 días 1 y 21) seguidos de dos ciclos de 5- fluorouracilo (1 000 mg/m2 días 42-46 y 63-67) y mitomicina (10 mg/m2 días 42 y 63) concurrentes con radiación (45 a 59 Gy; inicio día 42) por seis semanas (semanas 7 a 12). Período de seguimiento promedio de 21 meses, se obtuvo respuesta completa en 20 (54 por ciento) pacientes, respuesta parcial en 15 (41 por ciento) pacientes, 27 por ciento sobrevida libre de enfermedad y 35 por ciento de sobrevida libre de colostomía. Los índices de toxicidad grado 3/4: no hematológicos 32 por ciento y hematológicos 54 por ciento. La inducción con 5-fluorouracilo/cisplatino seguida de 5 fluorouracilo/ mitomicina/radiación es eficaz para preservación del esfínter anal y el control local de la enfermedad.

Comparación entre quimiorradioterapia definitiva y quimiorradioterapia y cirugía: en cáncer de cuello uterino estadios IB2 y IIA / Comparative study between definitive chemo-radiotherapy and chemo-radiotherapy following by surgery in cervix cancer stages IB2 y IIa

Comparar el tratamiento de pacientes que reciben radioquimioterapia definitiva, con pacientes a quienes se ofrece cirugía luego de tratamiento quimiorradiante, en carcinoma de cuello uterino estadios IB2, IIA. Desde enero 2001 a abril 2006, 86 pacientes con carcinoma de cuello uterino estadios IB2 IIA fueron seleccionadas. Se identificaron 3 grupos de tratamiento: 1. Quimiorradiación sola (quimiorradioterapia externa más implantes): 44 pacientes. 2. Quimiorradioterapia externa seguida de histerectomía ampliada tipo II (27 pacientes). 3. Quimiorradioterapia externa más implantes seguida de histerectomía ampliada tipo I (15 pacientes). La comparación basó en respuesta clínica, patológica, sobrevida global, sobrevida libre de enfermedad, complicaciones. La mediana en seguimiento fue 24 meses (rango 4 a 64). En los grupos que recibieron cirugía, la respuesta patológica completa fue de 60 por ciento en el sometido a histerectomía tipo I, y 33 por ciento en el sometido a histerectomía tipo II. Sobrevida libre de enfermedad 64 meses 61,36 por ciento, 59,2 por ciento y 60 por ciento respectivamente. No hubo diferencias significativas al aplicar tres diferentes pruebas estadísticas en sobrevida global y libre de enfermedad para los tres grupos. Las complicaciones fueron mínimas. La cirugía aplicada luego de tratamiento quimiorradiante integral no parece mejorar tasas de control local, sobrevida global en pacientes con carcinoma de cuello uterino estadio IB2, IIA. En pacientes que no puedan recibir implantes, la histerectomía ampliada tipo II luego de quimioradiación externa es una alternativa útil que garantiza un adecuado control locorregional de enfermedad.

Experiencia en reconstrucción mamaria posterior a la mastectomía: en el Instituto de Oncología "Luis Razetti" 2000-2004 / Experience in mammary reconstruction following a mastectomy at the Instituto de Oncologia

Revisar la experiencia en reconstrucción mamaria posterior a la mastectomía en un grupo de pacientes tratadas por cáncer de mama. Revisión retrospectiva de las historias clínicas de pacientes con cáncer de mama sometidas a reconstrucción mamaria posterior a una mastectomía entre enero de 2000 y diciembre de 2004. Se registró edad, estadio de la enfermedad, tiempo en que se efectuó la reconstrucción, técnica utilizada y complicaciones. Un total de 146 pacientes fueron sometidas a reconstrucción mamaria, con edad promedio de 41 años. A 110 pacientes se les realizó la reconstrucción con colgajo miocutáneo de dorsal ancho (75,3 por ciento) y a 36 pacientes con colgajo miocutáneo de recto anterior del abdomen (24,7 por ciento). En 69,9 por ciento de las pacientes el procedimiento de reconstrucción fue realizada en forma inmediata. El 30,8 por ciento de las pacientes presentaron complicaciones secundarias al procedimiento de reconstrucción. La principal complicación en la reconstrucción con colgajo de dorsal ancho fue la formación de contractura capsular sintomática (28,8 por ciento). La complicación más frecuente con el colgajo de recto anterior fue la eventración abdominal (13,3 por ciento). La reconstrucción mamaria posterior a la mastectomía representa un procedimiento seguro, que puede ser realizado de manera inmediata a la mastectomía, empleando diversas técnicas quirúrgicas. El tratamiento adyuvante con radioterapia no afecta de manera significativa sus resultados estéticos, con un gran beneficio psicológico para la paciente mastectomizada. Igualmente se puede realizar en cualquier estadio sin afectar la morbilidad posoperatoria

[Non-hemorrhagic stroke, of possible aortoembolic origin, in the course of acute myocardial infarct treated with thrombolysis]. / Stroke non emorragico, di possibile origine aortoembolica, in corso di infarto miocardico acuto trattato con trombolisi.

We describe the case of a middle-aged man with nonhemorrhagic stroke occurred during thrombolysis for acute myocardial infarction. The ischemic etiology of stroke was demonstrated by cerebral computed tomography scan. Transthoracic echocardiogram excluded left ventricular thrombosis. Transesophageal echocardiogram displayed complicated atheromas of the aortic arch. The reported case emphasizes that aortic atheromas may be the source of emboli during thrombolytic therapy.

[Oral anticoagulants combined with aspirin in the prolonged treatment after acute coronary syndrome]. / Associazione di anticoagulanti orali e aspirina in trattamento prolungato dopo sindrome coronarica acuta.

The incidence of death or myocardial infarction after acute coronary syndrome (ACS) is still high despite the widespread use of aspirin. Oral anticoagulant therapy (OAT) reducing thrombin activity has the potential to be beneficial when administered alone or in combination with aspirin after ACS. Low-intensity OAT in combination with aspirin is not superior to aspirin alone. Moderate-intensity OAT in combination with aspirin is superior to aspirin alone in reducing death, myocardial infarction or stroke after ACS. However, this regimen has higher rates of both minor and major hemorrhages. The bleeding risk combined with the difficulties of OAT management contributes to suboptimal compliance and has the potential to mitigate the superior efficacy of combined regimens.

[Concomitant left atrial myxoma and atrial fibrillation in patients with peripheral embolism]. / Concomitanza di mixoma atriale sinistro e fibrillazione atriale in pazienti con embolia periferica.

In the present article, 2 cases of left atrial myxoma and peripheral embolism in patients with concomitant paroxysmal or permanent atrial fibrillation are reported. In both cases, the embolic event was considered to be related to atrial fibrillation and the diagnosis of atrial myxoma was established later on at echocardiography. In view of the above, transesophageal echocardiography should be always performed after an embolic event, even in patients with established atrial fibrillation.

[Atrial fibrillation: always cardioversion? No]. / Fibrillazione atriale: cardiovertire sempre? Parere contro.

Two major treatment strategies have emerged in the management of patients with atrial fibrillation (AF): restoration of sinus rhythm and antiarrhythmic drug prophylaxis versus ventricular rate control and chronic anticoagulation. Besides the potential benefits of the restoration of sinus rhythm, several considerations support the choice of controlling the heart rate, mainly the poor efficacy of antiarrhythmic drug prophylaxis. The decision of pursuing the AF cardioversion should be based mainly on the importance of sinus rhythm restoration and the probability of sinus rhythm maintenance. The factors conditioning the maintenance of sinus rhythm following cardioversion are the duration of AF, cardiac size and function, underlying heart disease, the NYHA functional class, and the timing and number of AF recurrences. At least one attempt at cardioversion is warranted in the majority of patients with a first ever episode of AF; however, it seems advisable to give up even the first attempt at cardioversion in the mildly symptomatic patients who are very old, in patients with AF episodes dating back more than 24-36 months and in those with severe valvular heart disease or severe left ventricular dysfunction. A repeated attempt at cardioversion is usually indicated at the first recurrence of AF; repeated cardioversion seems unadvisable in patients with long-standing AF and early recurrence, in case of failure of amiodarone prophylaxis or of side effects of antiarrhythmic drugs, and when the patient is inclined not to undergo a new electrical cardioversion procedure. In patients with further recurrences of AF it is convenient to give up the cardioversion in case of mild symptoms, of failure of several antiarrhythmic drug regimens and when the withdrawal of oral anticoagulant therapy following sinus rhythm restoration is not safe. With regard to mortality, morbidity, quality of life and cost-effectiveness, the strategy of choice has not yet been established. Several large prospective randomized clinical trials comparing cardioversion and antiarrhythmic prophylaxis versus ventricular rate control are ongoing. The results of these studies could, in the near future, provide useful indications for the choice of the therapeutic regimen to be employed.