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Supplemental Digital Content is available in the text., Background: The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator sensors to identify patients at risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events. Methods: The HeartLogic feature was activated in 366 implantable cardioverter-defibrillator and cardiac resynchronization therapy implantable cardioverter-defibrillator patients at 22 centers. The median follow-up was 11 months [25th–75th percentile: 6–16]. The HeartLogic algorithm calculates a daily HF index and identifies periods IN alert state on the basis of a configurable threshold. Results: The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients. The time IN alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations, and 8 patients died of HF during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (hazard ratio, 24.53 [95% CI, 8.55–70.38], P

Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk. One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months. The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p

A growing social psychological literature reveals that brief interventions can benefit disadvantaged students. We tested a key component of the theoretical assumption that interventions exert long-term effects because they initiate recursive processes. Focusing on how interventions alter students’ responses to specific situations over time, we conducted a follow-up lab study with students who had participated in a difference-education intervention 2 years earlier. In the intervention, students learned how their social-class backgrounds mattered in college. The follow-up study assessed participants’ behavioral and hormonal responses to stressful college situations. We found that difference-education participants discussed their backgrounds in a speech more frequently than control participants did, an indication that they retained the understanding of how their backgrounds mattered. Moreover, among first-generation students (i.e., students whose parents did not have 4-year degrees), those in the difference-education condition showed greater physiological thriving (i.e., anabolic-balance reactivity) than those in the control condition, which suggests that they experienced their working-class backgrounds as a strength.

Previous research indicates that lower-class individuals experience elevated negative emotions as compared with their upper-class counterparts. We examine how the environments of lower-class individuals can also promote greater compassionate responding—that is, concern for the suffering or well-being of others. In the present research, we investigate class-based differences in dispositional compassion and its activation in situations wherein others are suffering. Across studies, relative to their upper-class counterparts, lower-class individuals reported elevated dispositional compassion (Study 1), as well as greater self-reported compassion during a compassion-inducing video (Study 2) and for another person during a social interaction (Study 3). Lower-class individuals also exhibited heart rate deceleration—a physiological response associated with orienting to the social environment and engaging with others—during the compassion-inducing video (Study 2). We discuss a potential mechanism of class-based influences on compassion, whereby lower-class individuals’ are more attuned to others’ distress, relative to their upper-class counterparts.

In this paper we describe the case of a 42-year-old man who presented with rather infrequent episodes of syncope. In view of this symptomatology, he had been repeatedly hospitalized and submitted to a complete diagnostic workup inclusive of brain computed tomography, head-up tilt test, repeated Holter monitoring, and electrophysiologic evaluation. Unfortunately, none of these tests allowed the formulation of a precise diagnosis. When, owing to further episodes of syncope, the patient came to our observation, after an inconclusive new series of noninvasive tests, we decided to implant an insertable loop recorder. This device revealed that a phase of severe bradycardia lasting 53 s, with 15 s of complete asystole, occurred during symptoms thus allowing us to diagnose the cause of syncope.

Basal glycemic oscillations in 3 type I-diabetics treated with continuous subcutaneous insulin infusion (CSII) and without endogenous insulin secretion have been studied. Insulin infusion with different frequencies of square wave-form basal insulin delivery (1 min and 10 min) have been utilized. Aim of the present investigation was to observe whether basal blood glucose oscillations could be affected by the frequency of basal square wave-form insulin delivery. Blood glucose has been measured at 3 min intervals for 90 min for each frequency. The glycemic patterns obtained did not show any periodism in relationship with the two frequencies engaged, hence the glycemic fluctuation, similar between the two experiments, cannot be considered as dependent on the different frequency of insulin pulses.

The authors present three patients with rectus sheath hematoma who were diagnosed with ultrasound and successfully operated upon. The importance of a correct preoperative diagnosis is stressed to avoid an unnecessary laparotomy. Ultrasound helps to localize the presence of an extra-abdominal mass located between the aponeurotic sheaths of the rectus muscle. Surgery is the best treatment since it is possible to evacuate the large hematoma, and at the same time it affords an opportunity to ligate the bleeding vessels, usually the epigastrics. No advantage is seen using conservative treatment, as several weeks may be necessary before complete resolution, while the patient is suffering considerable pain and discomfort.

Background: The number of indications for strictureplasty for Crohn’s disease has been greatly reduced since the widespread use of biologics, although the risk of intestinal failure remains. The aim of the study was to analyze the outcomes of strictureplasty and to identify risk factors for site-specific recurrence in the era of biologics. Methods: Consecutive patients treated with strictureplasty for Crohn’s disease between 2002 and 2018 were retrospectively included. Univariate analysis was carried out. Risk factors for recurrence were identified through a multilevel logistic regression analysis. Results: Two hundred sixty-six patients were included in the study (171 males, median age 39.5years, range 18–76years). The majority of the 718 strictures requiring surgery in these patients were located in the ileum (61%), treated with conventional strictureplasty (89.6%) and required an additional resection (73.7%). Median follow-up time and time to recurrence were 96months and 62.5months respectively. The site-specific recurrence rate was 12.2% at 5years and 25.7% at 10years. Smoking was associated with a higher risk of recurrence in patients with milder disease. The 10-year recurrence rate was significantly higher for strictureplasties performed in the terminal ileum (30.9%, p = 0.0019) as compared to the ileum (21.8%) and the jejunum (8.4%). Multilevel logistic regression analysis showed that postoperative exposure to biologics (OR 4.74, p 0.001), nonconventional strictureplasty (OR 3.57, p 0.008) and a strictureplasty performed on a previous anastomosis (OR 13.58, p 0.002) were associated with site-specific recurrence. Conclusions: Strictureplasty is associated with optimal long-term outcomes in the biologic era and should be performed when feasible, to reduce the risk of intestinal failure in Crohn’s disease patients.

Angiotensin-converting enzyme (ACE) inhibitors reduce mortality, the development of remodeling, left ventricular (LV) dysfunction, and ischemic events, both when administered alone as long-term treatment in patients with impaired LV function and/or heart failure (HF) and as short-term treatment, early after acute myocardial infarction (AMI) and/or HF. The few data available on the use of ACE inhibitors in the elderly after AMI are conflicting. Nothing is known about the effects of ACE inhibitors in elderly postinfarction patients with preserved LV function: these patients have a remarkable medium- to long-term mortality and HF incidence after infarction. The aim of this study is to evaluate, in patients with AMI agedor =65 years, the effects of Perindopril on the combined outcome of death, hospitalization for HF, and heart remodeling, considered to be aor =8% increase in LV end-diastolic volume (LVEDV). Secondary objectives include the same factors listed in the primary end points but considered separately. In addition, safety of the drug, ventricular remodeling, and adaptation are being evaluated. A total of 1100 patients with AMI (first episode or reinfarction), agedor =65 years, and preserved or only moderately depressed LV (LV ejection fractionor =40%), are to be enrolled and randomly assigned to treatment (8 mg for 12 months of Perindopril or placebo, in double-blind conditions). Clinical assessment is performed at fixed times, and periodic evaluations of (1) ventricular shape, dimensions, and function by quantitative 2-D echocardiography, and (2) heart rate variability and arrhythmias by ambulatory electrocardiographic monitoring are anticipated. The results and conclusions will be available by 2002 year.