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Purpose: To assess the pattern of in-hospital changes in drug use in older patients from 2010 to 2016. Methods: People aged 65years or more acutely hospitalized in those internal medicine and geriatric wards that did continuously participate to the REgistro POliterapie Società Italiana di Medicina Interna register from 2010 to 2016 were selected. Drugs use were categorized as 0 to 1 drug (very low drug use), 2 to 4 drugs (low drug use), 5 to 9 drugs (polypharmacy), and 10 or more drugs (excessive polypharmacy). To assess whether or not prevalence of patients in relation to drug use distribution changed overtime, adjusted prevalence ratios (PRs) was estimated with log-binomial regression models. Results: Among 2120 patients recruited in 27 wards continuously participating to data collection, 1882 were discharged alive and included in this analysis. The proportion of patients with very low drug use (0-1 drug) at hospital discharge increased overtime, from 2.7% in 2010 to 9.2% in 2016. Results from a log-logistic adjusted model confirmed the increasing PR of these very low drug users overtime (particularly in 2014 vs 2012, PR 1.83 95% CI 1.14-2.95). Moreover, from 2010 to 2016, there was an increasing number of patients who, on polypharmacy at hospital admission, abandoned it at hospital discharge, switching to the very low drug use group. Conclusion: This study shows that in internal medicine and geriatric wards continuously participating to the REgistro POliterapie Società Italiana di Medicina Interna register, the proportion of patients with a very low drug use at hospital discharge increased overtime, thus reducing the therapeutic burden in this at risk population.

BACKGROUND Key aspects in a lifestyle analysis are physical activity level and eating habits. An unhealthy lifestyle results in fat mass increase and in a predisposition to non-communicable chronic diseases even in young age. The purpose of this study was to investigate the lifestyle and body composition in young athletes. METHODS The subjects underwent to an assessment of body composition and they completed two questionnaires, one concerning the level of physical activity and the other regarding eating habits. RESULTS One hundred fifty-two young athletes (63 females and 89 males) aged 8 to 18 years (13.4±2.5 years, height 159±14 cm) were enrolled in this study. 80.3% of subjects were normal weight (13.4±2.6 years) and 19.7% subjects (13.5±2.5 years) were overweight or obese. Greater sedentary behaviors were found in the overweight or obese participants compared to normal weight (618±125 vs. 523±89 min; P

Purpose: Bicuspid aortic valve (BAV) represents a common congenital cardiac disease (1−2%) normally compatible with sports activity. In the case of competitive sports, eligibility can be barred by the presence of symptoms, aortic valve dysfunction, or arrhythmias. This investigation of a large cohort of BAV athletes aims to verify the prevalence of premature ventricular beats (PVBs) found in the exercise test (ET) at the first sports medicine clinical evaluation. Methods: A sample of 356 BAV athletes, regularly examined over a period of 10 years at the Sports Medicine Center of the University of Florence, was retrospectively evaluated for arrhythmic events found in the first sports medicine check-up carried out. The athletes (321 M and 79 F), aged between 8−50 years (mean age 21.8 ± 11.6), practised sports at high dynamic cardiovascular intensity (mainly soccer, basketball, and athletics). Criteria for participation included a 2D echocardiography and ET conducted at 85% of maximal effort. Ventricular arrhythmic events were reported if found to be ≥3 at rest and/or during the exercise test and for subjects with any other cardiac or systemic structural diseases. Individuals aged >50 were excluded from the study. The selected participants were matched with a control group of 400 athletes with similar levels of training (age 20.0 ± 9.9) without BAV. Results: Only 25 (7.02%) of BAV athletes showed PVBs at the ET. A total of 403 single PVBs and four monomorphic couples were observed; a polymorphic pattern was present in only three athletes, and only five had exercise-induced PVBs at peak. None had acute events or major arrhythmias. The difference in PVBs prevalence in BAV athletes vs. controls (PVBs 6.25%) was not significant (p > 0.05). Conclusions: The prevalence of PVBs is low in BAV athletes and appears not to differ from athletes without BAV. Despite this, the behaviour of PVBs at the ET should be considered for the major suspicion for arrhythmic events. More data in this field could optimize the cost/effectiveness ratio for eventual ECG Holter indications.

BACKGROUND: Knee injuries have been identified as the most common injury in rugby. Knee valgus has been identified as a risk factor for ligament injuries in athletes and predictors of knee valgus may assist in the design of knee injury prevention programs. PURPOSE: The purposes of this study were to use postural stability (PS) and strength measures to predict knee valgus angle during dynamic tasks, identify relationships between PS and strength, and compare measures between positions. METHODS: Participants presenting positive during a gluteal dysfunction screening exam were enrolled. Participants performed PS, isokinetic strength, and biomechanical assessments. Stepwise multiple linear regression analyses were performed to identify predictors of knee valgus. Correlation coefficients identified relationships between PS and strength, and independent t-tests compared forwards and backs. RESULTS: Backs had significantly ( p< 0.05) better PS and greater strength as compared to forwards. Hip abduction strength was correlated (r = �0.52–�0.71, p< 0.05) withall eyes open staticPSmeasures. Regression analysis failed toidentify predictors of knee valgus angle. CONCLUSION: Although PS and strength were not multivariate predictors of knee valgus in male rugby players, bivariate correlations suggest that hip abduction strength training may be beneficial for enhancing PS.

Chinese people are one of the fastest growing immigrant populations in Europe, and their health has become a key issue to host nations. Although type 2 diabetes (T2DM) is a big burden among migrant populations, data on Chinese immigrants in Europe are limited.A cross-sectional survey was performed in 2014, adopting principles of community-based participatory research to investigate T2DM, diagnosed by the American Diabetes Association fasting criteria, in Chinese first-generation migrants aged 16 to 59 years settled in Prato (Italy). Association with different factors was investigated using logistic regression.Of the 1608 participants, 177 had T2DM (11.0%), 119 being newly diagnosed (7.4%). Among subjects with diabetes, 58 (32.8%) were aware of the disease; among subjects with diabetes aware of their condition, 46 (79%) were treated with glucose lowering drugs. Age-standardized (World Health Organization 2001 population) prevalence of T2DM was 9.6% (95% CI 9.1 to 10.2%), being 12.0% (95% CI 11.0 to 12.9%) in men, and 7.8% (95% CI 7.1 to 8.4%) in women. At adjusted logistic regression, diabetes was associated with hypertension, current smoking, adiposity indices (waist circumference, waist-to-hip ratio, waist-to-height ratio, and body mass index), and high triglycerides. T2DM, adiposity indices, and high triglycerides were not associated with duration of stay in Italy.The high prevalence of T2DM among first-generation Chinese immigrants in Europe stresses the need for specific health programs for T2DM early diagnosis, treatment, and prevention. There is an urgent need for policies to support this group because current policies will produce major social and economic costs. Copyright © 2016 John WileySons, Ltd.

Left ventricular (LV) function is normally improved after renal transplant, however, cardiovascular mortality remains elevated. Moderate physical activity has a positive impact on myocardial function, however, few data are available about the role of 2D echocardiography (2DE) and 2D speckle tracking echocardiography (2DSTE) on renal transplant recipients (RTR). From a large cohort of RTR submitted to a supervised exercise as the prescription program, 10 subjects who were regularly trained were studied for sixth months. They underwent periodically an echo evaluation (ESAOTE MyLab 50), cardiopulmonary test (CPT) and strength test for the lower and upper limbs. The LV function study was completed with the speckle tracking longitudinal strain (Lo Strain) measure calculated by dedicated software (XStrain–Esaote) at the end of the protocol. All of the cardiovascular parameters were normal: the ejection fraction (EF) increased significantly (from 62.7 ± 4 to 67.2 ± 2.3 with p &lt, 0.05), as well as the anaerobic threshold (15.3 ± 6.8 to 20.5 ± 10.1 with p &lt, 0.05). Particularly, the global longitudinal strain (GLS) values were within the normal range (−19.2% ± 5.1), maintaining the physiological gradient from the basal (−13.2 ± 4.1, −16.5 ± 5.21) to the apex level (−21 ± 2.3, −25.7 ± −7.0). 2D speckle tracking echocardiography (2DSTE) can be effectively used to confirm the presence of preserved physiological myocardial function in post-renal transplantation subjects submitted to a physical training.

Sexual activity before competition has been considered as a possible cause for reduced performance since ancient Greece and Rome. Recently, the hypothesis that optimal sport performance could be influenced by a variety of factors including sexual activity before competition has been investigated. However, few scientific data are available, with the exception of anecdotal reports of individual experiences. The present systematic review focused on the current scientific evidence on the effects of sexual activity on sport performance regardless of sport type. Data were obtained following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, using PubMed/MEDLINE, ISI/Web of Science, the Cochrane Collaboration Database, Cochrane Library, Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, ProQuest, and Scopus, all searched from inception further, to broaden the search, no time filter nor language restriction have been applied. Also, the gray literature was mined using Google Scholar. Only relevant scientific articles reporting outcomes of athletic performance after sexual activity were considered. The impact of sexual activity before a sport competition is still unclear, but most studies generally seem to exclude a direct impact of sexual activity on athletic aerobic and strength performance. The most important aspect seems to be the interval from the time of the sports competition that affects negatively the performance if it is shorter than 2 h. There are possible negative effects from some possible concurrent wrong behaviors such as smoking or alcohol abuse. There are no investigations about the effect of masturbation in this context. There is a need to clarify the effects of sexual activity on competition performance. The present evidence suggests that sexual activity the day before competition does not exert any negative impact on performance, even though high-quality, randomized controlled studies are urgently needed.

Spontaneous behavior of ventricular extrasystoles (VE) was analysed. From a database containing 578 athletes with VE, 84 males and 11 females (29.9 ± 18.1 years) having ≥ 100 VE or repetitive VE [ventricular couplets (VC) or ventricular tachycardias (VT)] at first 24-hour Holter electrocardiographic monitoring (24-h-HM) (baseline) and at least 1-year of follow-up (3.1 ± 2.2 years) over the past 10 years were selected. The baseline was compared with the last 24-h-HM to establish DVE (VE reduction of at least 98%/24 h in the absence of VC or VT). SDVE was calculated as standard deviation of the number of VE on serial 24-h-HMs. DVE and SDVE were considered as dependent variables. Independent variables were: age, sex, type of sport, symptoms, baseline VE rate (BVE), baseline VC and VT, VE morphology, VE behavior during the baseline training session, disqualification from competitive sports, echocardiographic abnormalities. DVE occurred in 32 athletes (34%). SDVE varied from 0 to 12,658 VE/24 h (1916 ± 2649.9). Disappearance of VE during the baseline training session (DVET) correlated to DVE (P = 0.0319). BVE directly correlated to SDVE (P = 0.0008). Athletes' VE are highly variable over time, their variability depending on BVE, and they not infrequently tend to disappear. The only useful variable for predicting DVE is DVET.

The aim of the present study was to try to identify which parameters of blood pressure (BP) ambulatory monitoring are better related to the presence of left ventricular hypertrophy in hypertensives. Fifty-six ambulatory hypertensive patients were investigated. Patients were subdivided into two groups of comparable casual and twenty-four-hour ambulatory pressure but with different nighttime decrements of the mean BP (respectively>10%, n=29, and ≤10%, n=27). When all the patients were considered, no significant correlation between left ventricular mass index (LVMI) and casual pressure values was found. On the contrary significant relationships between LVMI and systolic ambulatory twenty-four-hour (p

The daily evaluation of the life style is funda- mental for the “exercise as prescription” to re- duce the cardiovascular risks factors. The reg- istration by an accelerometer can identify active from inactive subjects. The aim of the present study is to verify, in a small cohort of subjects at high risk level (obese–hypertensive), the health outcomes. A group of 22 subjects were evalu- ated by the questionnaire and also by an accel- erometer positioned on belt for 5 days to estab- lish the daily Physical Activity Level (PAL).The anthropometrics parameters, Body Mass Index (BMI), Waist Circumference, Hip Circumference, Fat Mass, Free Fat Mass, Total Body–Intracellular and Extracellular Water and Phase Angle (PA) were measured at the beginning and after 3 months of regular exercise. The amount of the exercise prescribed for three months and at least 3 times in a weak, was determined by the Cardiopulmonary test at the 60% of the VO2. Sta-tistical analysis included T-Student test for paired data with a significance at P < 0.05value. Respect of the questionnaire the accelerometer report showed a predominantly inactive life style (PAL = 1.49 ± 0.13). After three months the BMI was significantly reduced in all (p < 0.05) and in addi-tion a trend toward a reduction was also observed for Fatty Mass and for the body composition parameters. The employment of the accelerometer is therefore associated to an improvement of the parameters strongly related with the cardiovascular risk. The results obtained are suggestive for an educational role of this tool in subjects at high risk level.

Introduction: Renal transplant recipients (RTRs) are at high cardiovascular risk (CV) compared to the general population, especially after surgical treatment. The literature supports the role of supervised exercise intervention, however no data are available regarding the effects of unsupervised exercise programs. We investigated whether a home exercise program could reduce CV risk in RTR based on possible changes in renal and cardiometabolic parameters and myocardial performance measured by echocardiography. Methods: From a large cohort of 60 RTRs, 30 RTRs (12 females and 18 males 48.3 &plusmn, 12.3 years) participated in individualized and unsupervised training programs for 6 months, at moderate intensity. Cardiometabolic risk factors, anthropometric parameters, lipid and glycemic blood sample profiles were studied as was myocardial performance from the 2D echo examination at T0, and T6 months. Results: The lipid profile remained in the range of a low level of risk, although there was no significant improvement, whereas myocardial performance, in particular the EF, was significantly improved. Conclusions: A home exercise program for at least 6 months produces positive effects on myocardial function and helps maintain a low cardiovascular risk profile. The trend supports the importance of highlighting the role of a correct reconditioning of lifestyle in RTR, from the exercise program without supervision to moderate intensity, where well tolerated.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder with an autosomal dominant inheritance and incomplete penetrance. It predominantly affects the right ventricle (RV), predisposing to the origin of ventricular arrhythmias and sudden death (SD). The structural basis of the disease consists of the progressive loss of myocardium with fibro-adipose replacement. ARVC is a “desmosomes” disease involving mutations of proteins such as placoglobin, desmoplachine, placophylline, desmoglein, and desmocollin. In the “classical” form, the disease mainly implicates the RV chamber, while the left ventricle (LV) is involved in advanced stages. Genotype-phenotype correlation studies have identified some phenotypic variants characterized by an early participation of the LV, which can proceed in parallel toward the two ventricles (“biventricular” variant) or prevails over the RV (variant to “left dominance”). These data led to the evolution of the initial definition of ARVC, which is currently considered a genetic disease of both ventricles and, therefore, deserves the denomination “arrhythmogenic cardiomyopathy”. Many aspects of diagnosis, treatment, and indications for a correct lifestyle are important in sports medicine. This paper will discuss the clinical management of ARVC, with particular reference to diagnosis, risk stratification, therapy, and indications for physical activity.

Objective:Cardiovascular adaptation to sport training is influenced by many factors, including the intensity and the kind of sport practiced. The “Morganroth hypothesis” asserted that a static exercise characterized by a pressure load and dynamic (isotonic) exercise which involves a volume load to t

Cancer is the second leading cause of death, and the most common diagnosis among the general population is breast and colon cancer. Recently, an increasing number of new cases of invasive breast and colon cancer have been estimated, and more people die from these diseases. In addition to the genetic pattern, diet and lifestyle including smoking, alcohol consumption, and sedentary behaviour have also been identified as potential risks factors. Recent studies of cancer survivors have shown the beneficial effects of regular physical activity to reduce the prevalence of comorbidity, muscle atrophy, weight changes, reduced aerobic capacity, fatigue, depression, and reduced quality of life. Dedicated and individual programs are crucial for achieving the goals of improving quality of life and reducing comorbidities. A multidisciplinary approach is fundamental: lifestyle assessment, including estimating the level of physical activity, as well as nutritional habits, may be the first step. A periodic cardiovascular examination is crucial for detecting asymptomatic early myocardial failure. According to current ACSM guidelines, different levels of exercise (low-moderate 40% and moderate up to 60% of the maximal HR) may be prescribed, and patients enrolled may follow the exercise program if in the absence of contraindications. The current paper reports observations from our clinical practice and provides practical strategies that bridge contemporary, published guidelines into practice within a multi-disciplinary team working with cancer survivors in Italy.

Summary Background: Left ventricular hypertrophy (LVH) may be an adaptative remodelling process induced by physical training, or result from pathological stimuli. We hypothesized that different LVH aetiology could lead to dissimilar spatial distribution left ventricular (LV) contraction, and compared different components of LV contraction using 2-dimensional (2-D) speckle tracking derived strain in subjects with adaptative hypertrophy (endurance athletes), maladaptative hypertrophy (hypertensive patients) and healthy controls. Method: We enrolled 22 patients with essential hypertension, 50 endurance athletes and 24 healthy controls. All subjects underwent traditional echocardiography and 2-D strain evaluation of LV longitudinal, circumferential and radial function. LV basal and apical rotation and their net difference, defined as LV torsion, were evaluated. Results: LV wall thicknesses, LV mass and left atrium diameter were comparable between hypertensive group and athletes. LV longitudinal strain was reduced only in hypertensive patients (P

Objective: Bicuspid Aortic Valve (BAV) is normally asymptomatic for a long time in both the general population and regularlytrained athletes. The study aimed to evaluate the role of physical stress echocardiography in early identification of any possible dissimilarities in the Left Ventricle (LV) performance and the valve functioning of asymptomatic BAV athletes as compared to the Tricuspid Aortic Valve (TAV) athletes. Design: Data were collected for BAV and TAV athletes from echocardographic examinations to evaluate any possible differences between them. Setting: Sport Medicine Center University of FlorenceItaly. Participants: 66 male BAV athletes and 45 TAV athletes Assessment of risk factors: decrease in LV performance and aortic valve dysfunction during stress test. Main outcome measures: Measure of the standard echocardiographic parameters. Comparison of LV Ejection Fraction (EF) and Aortic Peak Flow Velocity (APFV) data in the two groups at rest and after stress. Results: At rest, values were normal in both groups, although LV systolic diameters tended to be higher in BAV. After physical effort, APFV and EF showed a significant increase in both groups, and for the former the values were at the upper limits in BAV (2.55 m/s BAV 2.12 m/s TAV). Conclusions: The data confirm normal LV performance in asymptomatic BAV athletes. Considering the tendency of this group to show slight enhancement of both APFV and LV dimensions in this group periodical evaluation with physical stress echography might be proposed as a followup procedure for early detection of any additional effect of physical exercise.

The Aerobic Threshold (AerT), is an aged cardiovascular parameter not commonly used to evaluate the heart’s performance in athletes. It indirectly evaluated by ventilator parameters during Cardio Pulmonary Test (CPT). Considering that” exercise as prescription therapy “for the diseases, includes training normally established around at the 40% of the peak VO2, this parameter could be taken in care as initial level for the effort prescribed. The aim of the study was to estimate the behavior of the AerT and also Anaerobic Threshold (AT), VO2max in sedentary people. A group of athletes coming from different sports at the same and highest dynamic component were enrolled as control. A group of 41 athletes (16 soccer, 10 basket and 15 cyclists) and 9 healthy subjects were submitted to a CPT. The AerT, AT (assessed by Vslope method) and VO2max were evaluated. The statistical analysis was performed with T student test (P < 0.05 significant). As expected in sedentary all the values were lower than athletes, however for Aer T value appears to be not significantly inferior respect of this one, with the exclusion of the comparison with the cyclists. In sedentary the AerT measure seems to give additional information in evaluating the cardiovascular performance. The VO2max and AT remain the main parameters in defining the athletes performance. Therefore we cannot exclude any further utility of the AerT in normal subject but regularly trained.

Background Standard 12-lead electrocardiogram (ECG) has several limitations in solving the differential diagnosis between physiologic left ventricular hypertrophy (PLVH) and hypertrophic cardiomyopathy (HCM), given the high rate of false-positive results in athletes. The aim of this study was to assess the usefulness of several arrhythmic risk indexes in differentiating PLVH from HCM. Methods A multiparametric ECG analysis (extended-length ECG) was performed on 30 male athletes with PLVH and 30 male patients with HCM, with homogeneous age distribution. Results The combination of 4 extended-length ECG variables, namely, corrected QT interval (Bazett), QT dispersion, mean resting heart rate, and low-amplitude signal duration at 25 Hz (low-amplitude signal duration at the end of filtered QRS) displayed remarkable diagnostic accuracy (area under receiver operating characteristic curve, 94%). The same accuracy was obtained replacing QT dispersion with T-wave complexity index. Conclusions Extended-length ECG can be considered an effective, low-cost, and low time-consuming clinical tool for distinguishing between PLVH and HCM.

Aim: Bicuspid aortic valve (BAV) is a common congenital cardiac condition. The presence of BAV in non-elite athletes has been poorly investigated; it is usually asymptomatic until valvular stenosis, regurgitation or other vascular alterations are evident. Design: Over a three-year period, 2273 competitive athletes were consecutively investigated with transthoracic echocardiography. The traditional parameters, the aortic root dimensions at four levels and the systolic and diastolic flow of aortic valve, were studied with continuous Doppler according to the echo guidelines. Setting: The study protocol included all the non-elite athletes investigated for the first evaluation to obtain eligibility. Patients: 2273 competitive athletes aged 8–60 years from several sports and regularly trained were evaluated with anamnesis, clinical check-up and echocardiography in order to exclude subjects with systemic or congenital heart disease. Results: BAV was diagnosed in 58 athletes (2.5%). Of these, nine had normal valvular function, 47 had abnormal valvular function with mild–moderate aortic regurgitation, and two had moderate stenosis. Aortic root dimensions at all levels were significantly greater in athletes with BAV than in athletes with a normal tricuspid valve. No relation was found with age, body surface area, aortic regurgitation or years of training. Conclusions: BAV is a relatively common congenital cardiac disease in athletes and commonly asymptomatic for a long time. This study suggests the usefulness of evaluating young athletes using echocardiography at least once when they start their sporting activity.

Introduction: The role of flow on the progression of left ventricular (LV) remodeling has been presumed, although measurements are still limited and the intraventricular flow pattern in remodeling hearts has not been systematically evaluated in a clinical setting. Comparative evaluation of intraventricular fluid dynamics is performed here between healthy subjects and dilated cardiomyopathy (DCM) patients. Methods: LV fluid dynamics is evaluated in 20 healthy young men and in 8 DCM patients by combination of 3D echocardiography with direct numerical simulations of the equation governing blood motion. Results are analyzed in terms of quantitative global indicators of flow energetics and blood transit properties that are representative of the qualitative fluid dynamics behaviors. Results: The flow in DCM exhibited qualitative differences due to the weakness of the formed vortices in the large LV chamber. DCM and healthy subjects show significant volumetric differences; these also reflect in flow properties like the vortex formation time, energy dissipation, and sub-volumes describing flow transit. Proper normalization permitted to define purely fluid dynamics indicators that are not influenced by volumetric measures. Conclusion: Cardiac fluid mechanics can be evaluated by a combination of imaging and numerical simulation. This pilot study on pathological changes in LV blood motion identified intraventricular flow indicators based on pure fluid mechanics that could potentially be integrated with existing indicators of cardiac mechanics in the evaluation of disease progression.

An intriguing possibility to partially circumvent extragalactic background light (EBL) absorption in very-high-energy (VHE) observations of blazars is that photons convert into axion-like particles (ALPs) $\gamma \to a$ inside or close to a blazar and reconvert into photons $a \to \gamma$ in the Milky Way magnetic field. This idea has been put forward in 2008 and has attracted a considerable interest. However, while the probability for the back-conversion $a \to \gamma$ has been computed in detail (using the maps of the Galatic magnetic field), regretfully no realistic estimate of the probability for the conversion $\gamma \to a$ inside a blazar has been performed, in spite of the fact that the present-day knowledge allows this task to be accomplished in a reliable fashion. We present a detailed calculation that fills this gap, considering both types of blazars, namely BL Lac objects (BL Lacs) and flat spectrum radio quasars (FSRQ) with their specific structural and environmental properties. We also include the host elliptical galaxy into account. Our somewhat surprising results show that the conversion probability in BL Lacs is strongly dependent on the source parameters -- like the position of the emission region along the jet and the strength of the magnetic field therein -- making it effectivelly unpredictable. On the other hand, the lobes at the termination of FSRQ jets lead to an effective "equipartition" between photons and ALPs due to its chaotic nature, thereby allowing us to make a clear-cut prediction. These results are quite important in view of the planned VHE detectors like the CTA, HAWK and HiSCORE., Comment: 9 pages, 3 figures, to appear in the proceedings of "Science with the New Generation of High Energy Gamma-ray experiments", 10th Workshop 04-06 June 2014, Lisbon - Portugal

Regular physical exercise plays a role in improving cardiovascular and muscular fitness in many metabolic diseases. This study aims to verify any possible benefits, including the eventual influence on any associated risk factors, in a group of kidney transplant recipients after a short period of personalized training programs with mixed exercises. In January 2013, at the Sports Medicine Center of the University of Florence, Italy, we began studying a group of 20 kidney transplant recipients. After 6 months of exercise, they underwent Cardiopulmonary Test (CPET), ECG, skin fold, bioimpedance analysis and stress test for the lower and upper limbs. EF increased significantly from 63.38 ± 4 to 67.30 ± 5.9 with p

The aim of this study was to review current evidence on interventional studies aimed at the prevention of type 2 diabetes in Asian population with lifestyle interventions. Prevalence of type 2 diabetes sharply increased in most Asian countries during the last decades. This issue has now also relevant implication for Europe where different surveys are also consistently revealing an higher prevalence of type 2 diabetes and other and major CVD risk factors among subjects originating from Asian Countries than in the native population. Nutrition and lifestyle transition seem to play a role in disclosing the predisposition for the development of type 2 diabetes and great interest is now shown toward the possibility to intervene with lifestyle intervention on at risk populations. A meta-analysis of Randomized Controlled Trials showed that lifestyle interventions are highly effective also in the Asian population. All studies were, however, conducted with an individual approach based on the identification of high-risk individuals. When ethnic minority groups have to be addressed, an approach directed to the community rather than to the individual might, however, be more effective. This review reinforces the importance for policy-makers to consider the involvement of the whole community of minority immigrant groups with lifestyle intervention programs.

The idea that photons can convert into axion-like particles (ALPs) $\gamma \to a$ in or around an AGN and reconvert back into photons $a \to \gamma$ in the Milky Way magnetic field has been put forward in 2008 and has recently attracted growing interest. Yet, so far nobody has estimated the conversion probability $\gamma \to a$ as carefully as allowed by present-day knowledge. Our aim is to fill this gap. We first remark that AGN that can be detected above 100 GeV are blazars, namely AGN with jets, with one of them pointing towards us. Moreover, blazars fall into two well defined classes: BL Lac objects (BL Lacs) and Flat Spectrum Radio Quasars (FSRQs), with drastically different properties. In this Letter we report a preliminary evaluation of the $\gamma \to a$ conversion probability inside these two classes of blazars. Our findings are surprising. Indeed, while in the case of BL Lacs the conversion probability turns out to be totally unpredictable due to the strong dependence on the values of the somewhat uncertain position of the emission region along the jet and strength of the magnetic field therein, for FSRQs we are able to make a clear-cut prediction. Our results are of paramount importance in view of the planned very-high-energy photon detectors like the CTA, HAWK, GAMMA-400 and HISCORE., Comment: 12 pages, 4 figures, accepted for publication in Physics Letters B

We consider the largest observed sample including all intermediate-frequency peaked (IBL) and high-frequency peaked (HBL) flaring blazars above 100 GeV up to redshift $z = 0.6$. We show that the best-fit regression line of the emitted spectral indices $\Gamma_{\rm em} (z)$ is a concave parabola decreasing as $z$ increases, thereby implying a statistical correlation between the $\{\Gamma_{\rm em} (z) \}$ distribution and $z$. This result contradicts our expectation that such a distribution should be $z$-independent. We argue that the above correlation does not arise from any selection bias. We show that our expectation naturally emerges provided that axion-like particles (ALPs) are put into the game. Moreover, ALPs can also explain why flat spectrum radio quasars emit up to 400 GeV, in sharp contradiction with conventional physics. So, the combination of the two very different but consistent results -- taken at face value -- leads to a hint at an ALP with mass $m = {\cal O} (10^{-10} \, {\rm eV})$ and two-photon coupling in the range $2.94 \times 10^{- 12} \, {\rm GeV}^{- 1} < g_{a \gamma \gamma} < 0.66 \times 10^{- 10} \, {\rm GeV}^{- 1}$. As a bonus, the Universe would become considerably more transparent above energies $E \gtrsim 1 \, {\rm TeV}$ than dictated by conventional physics. Our prediction can be checked not only by the new generation of observatories like CTA, HAWC, GAMMA-400, LHAASO, TAIGA-HiSCORE and HERD, but also thanks to the planned laboratory experiments ALPS II (upgraded), STAX, IAXO and with other techniques now being developed by Avignone and collaborators., Comment: 13 pages, 14 figures. This version matches the published paper: MNRAS 493, 1553 (2020)

Carcinoid tumor is an uncommon tumor that has often already developed metastases at the time of diagnosis. The primary site of tumors are the gastrointestinal tract, breast, and bronchus. The first manifestation of "carcinoid syndrome" occurs as a result of hormone production and cardiac involvement can be recognized in approximately half of the patients. The tricuspid or pulmonary valves are often affected, while, more rarely, the myocardial wall is of interest. A 51-year-old female patient affected by a primary pancreatic carcinoid showed interventricular septum carcinoid disease diagnosed by 2D echocardiography.

The study was designed to evaluate the prognostic value of the 6-min walk test (6MWT) in patients with mild to moderate congestive heart failure (CHF).Two hundred and fourteen patients (119 men and 95 women, mean age 64 years) were followed for a mean period of 34 months to assess event-free survival (death, heart transplantation). Sixty-six patients (34%) died (63 cardiovascular causes, 2 cancer and 1 stroke) and five patients underwent heart transplantation. For patients who walked300 m during the 6MWT, survival was 62% compared with 82% in patients who walked 300-450 m or450 m. With univariate analysis, NYHA class was the strongest predictor of death. LVEF (P0.0001), aetiology of heart failure (P0.001), LV filling pattern (P=0.002) and 6MWT distance (P0.01) were all significantly related to survival. No significant relationship was found between survival, peak oxygen consumption or anaerobic threshold. Multivariate analysis using the Cox-stepwise regression model showed that LV fractional shortening (P0.009) and 6MWT distance (P0.0005) were the strongest prognostic markers.A 6MWT distance of300 m is a simple and useful prognostic marker of subsequent cardiac death in unselected patients with mild to moderate CHF.