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Introduction: The study aimed to investigate binaural cues in the rehabilitation of unilateral occluded ears with a bone conduction hearing aid. Methods: The study sample consisted of 40 adult volunteers with normal hearing. Unilateral pseudo-conductive hearing loss was induced by inserting an earplug into the external auditory canal (EAC) and silicone material in the concha for ear impression. The adaptive speech-in-noise test (Italian Matrix test) was performed in three spatial orientations to assess binaural cues (summation, squelch, and head shadow effects). All evaluations were performed in the normal condition, after EAC occlusion, and after application of an adhesive bone conduction hearing aid. Binaural contrast differences were calculated in the three conditions. Results: In the EAC occlusion condition, there was a significant increase in the signal-to-noise ratio (SNR) in both the S0N0 (2.4 dB) and the S90N−90 (7.7 dB) settings, and a slight albeit significant increase in the S0N90 setting (1.35 dB). After fitting the BC hearing aid, there was a reduction of −1.8 dB SNR (p < 0.001) in the S0N0 setting and −2 dB (p = 0.003) in the S90N−90 setting. There was no improvement in the SNR (p = 0.405) in evaluation of the squelch effect (S0N90). These data were corroborated by a better binaural contrast due to a reduction in the summation effect in the monaural occlusion condition and a subsequent reduction in binaural contrast after fitting the hearing aid due to an increase in the summation effect (−2.5 dB vs. 0.3 dB; p < 0.001). Conclusions: Application of a bone conduction hearing aid in unilateral pseudo-conductive hearing loss strengthens speech recognition of noise by improving the summation effect and impeding the shadow effect of the head; however, there appears to be no improvement in speech perception in noise due to spatial release from masking.

Introdução: O trato gastrointestinal é envolvido por um complexo sistema que tem suma importância no cotidiano na homeostasia intestinal. O intestino é responsável pela produção da serotonina e a baixa e/ou alta concentração desse hormônio, talvez seja, o causador da doença diverticulite. Objetivo: mostrar a hipótese da serotonina na doença diverticulite. Metodologia: Foi realizado o levantamento bibliográfico para construção dessa revisão integrativa nas bases de dados MEDLINE/PubMed (via National Library of Medicine), ScienceDirect (Elsevier), SCOPUS (Elsevier) e SciELO.ORG e google acadêmico. Resultado: Foram encontrados 88 artigos seguindo os métodos de pesquisa, nenhum dos artigos foram excluídos, então foram divididos entre os autores, lidos por completos, restando 7 para construção das pesquisas, sendo apresentado na tabela com a principal hipótese dos autores. Conclusão: Devido a carência das pesquisas e as delimitações dos estudos relacionando serotonina e as doenças gastrointestinais, esse artigo demonstrou que é fundamental desenvolver mais estudos para evidenciar a real relação do surgimento dessa patologia com hormônio qual como hipótese da 5-hidroxitriptamina na inflamação da diverticulite.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were initially developed for the treatment of diabetes due to their antihyperglycemic activity. However, in the light of the most recent clinical studies, they are revolutionizing the approach to cardiovascular disease in patients with and without diabetes. We aimed to generate real-world data about the use of SGLT2i in patients with T2DM and coronary artery disease (CAD), focusing on their effectiveness in glycemic control, adherence, long-term efficacy, and safety outcomes. On the basis of the inclusion and exclusion criteria, 143 patients were enrolled. Patients were treated with canagliflozin (n = 33 patients; 23%), dapagliflozin (n = 52 patients, 36.4%), empagliflozin (n = 48 patients; 33.6%), or ertugliflozin (n = 10 patients; 7%) as monotherapy or in combination with other antidiabetic drugs. All patients performed a clinical visit, and their medical history, blood sampling, and anthropometric parameters were measured at discharge and at 1-year follow-up. The reduction in HbA1c % value at 12 months was significant (8.2 vs. 7.4; p < 0.001). Trends in body weight and body mass index also confirmed the positive effect of the treatment (p < 0.0001), as did the reduction in abdominal adiposity (expressed via waist circumference). At 1-year follow-up, 74.1% of patients were adherent to the treatment, and 81.1% were persistent to the treatment. A total of 27 patients (18.8%) had to discontinue treatment early due to drug intolerance caused by genitourinary infections (11.9%), the drub being permanently ineffective (HbA1c not at target or decreasing: 4.9%), or because of expressing. a desire not to continue (2%). No major drug-related adverse events (diabetic ketoacidosis, Fournier’s gangrene, lower-limb amputations) occurred at follow-up, while MACE events occurred in 14 patients (9.8%). In real-world patients with T2DM and CAD, SGLT2i have been effective in long-term glycemic control and the improvement in anthropometric indices with good tolerance, high adherence, persistence to treatment, and no major adverse events at 1-year follow-up.

The rising age of retirement may result in a larger number of workers with health problems. This is important since health is a key element in all aspects of life, including work. Although much research has been carried out into how work-life balance influences occupational health, very few studies have focused on how the ability to balance health needs and work demands (work-health balance) affects different organizational variables such as perceived work ability and affective job satisfaction. In a context in that the age of retirement is constantly rising, it is vital to explore those factors may help extend people’s working life in a balanced manner. The aim of this study was, therefore, to explore the mediating role of work-health balance in the relationship between perceived work ability (physical and mental) and affective job satisfaction. Using a cross-sectional sample of 294 workers aged 39 years and over, the study analysed the mediating role of the different dimensions of work-health balance (health climate, work-health incompatibility and external support) in the relationship between work ability (physical and mental) and affective job satisfaction. The data suggest that the health climate and work-health incompatibility dimensions mediate the relationship between work ability (physical and mental) and affective job satisfaction. Our findings are consistent with the current understanding of the role played by the balance between occupational health and the well-being of older workers., Sve kasnija dob odlaska u mirovinu mogla bi rezultirati većim brojem zaposlenika sa zdravstvenim problemima. Taj je podatak važan jer je zdravlje ključan element svih aspekata života, uključujući i zaposlenje. Iako su mnoga istraživanja ispitivala utjecaj ravnoteže između posla i života na zdravlje na radnome mjestu, mali se broj istraživanja usmjerio na ispitivanje utjecaja sposobnosti za balansiranje zdravstvenih potreba i radnih zadataka (ravnotežu između posla i zdravlja) na različite organizacijske varijable poput percipirane radne sposobnosti i afektivnoga zadovoljstva poslom. U uvjetima u kojima je dob umirovljenja u stalnome porastu ključno je ispitati čimbenike koji bi mogli pomoći u produljenju čovjekova radnoga vijeka na uravnotežen način. Stoga je cilj ovoga istraživanja bio istražiti medijacijsku ulogu ravnoteže između posla i zdravlja u odnosu između percipirane radne sposobnosti (mentalne i tjelesne) i afektivnoga zadovoljstva poslom. Korištenjem kros-sekcijskoga uzorka od 294 zaposlenika iznad 39 godina starosti u istraživanju je analizirana medijacijska uloga različitih dimenzija ravnoteže između posla i zdravlja (zdravstvena klima, nekompatibilnost posla i zdravlja te vanjska podrška) u odnosu između radne sposobnosti (mentalne i tjelesne) te afektivnoga zadovoljstva zdravljem. Podaci pokazuju da su zdravstvena klima i nekompatibilnost posla i zdravlja medijatori odnosa između percipirane radne sposobnosti (mentalne i tjelesne) i afektivnoga zadovoljstva poslom. Dobiveni su nalazi u skladu s trenutačnim razumijevanjem uloge koju ima ravnoteža između zdravlja na radnome mjestu i dobrobiti starijih zaposlenika.

BACKGROUND The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover. AIMS We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively. METHODS The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively. RESULTS The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover. CONCLUSIONS The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.

Background In the GLOBAL LEADERS trial, ticagrelor monotherapy beyond 1 month compared with standard antiplatelet regimens after coronary stent implantation did not improve outcomes at intention‐to‐treat analysis. Considerable differences in treatment adherence between the experimental and control groups may have affected the intention‐to‐treat results. In this reanalysis of the GLOBAL LEADERS trial, we compared the experimental and control treatment strategies in a per‐protocol analysis of patients who did not deviate from the study protocol. Methods and Results Baseline and postrandomization information were used to classify whether and when patients were deviating from the study protocol. With logistic regressions, we derived time‐varying inverse probabilities of nondeviation from protocol to reconstruct the trial population without protocol deviation. The primary end point was a composite of all‐cause mortality or nonfatal Q‐wave myocardial infarction at 2 years. At 2‐year follow‐up, 1103 (13.8%) of 7980 patients in the experimental group and 785 (9.8%) of 7988 patients in the control group qualified as protocol deviators. At per‐protocol analysis, the rate ratio for the primary end point was 0.88 (95% CI, 0.75–1.03; P =0.10) on the basis of 274 versus 325 events in the experimental versus control group. The rate ratio for the key safety end point of major bleeding was 1.00 (95% CI, 0.79–1.26; P =0.99). The per‐protocol and intention‐to‐treat effect estimates were overall consistent. Conclusions Among patients who complied with the study protocol in the GLOBAL LEADERS trial, ticagrelor plus aspirin for 1 month followed by ticagrelor monotherapy was not superior to 1‐year standard dual antiplatelet therapy followed by aspirin alone at 2 years after coronary stenting. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01813435.

Imaging assessment of liver lesions is fundamental to predict therapeutic response and improve patient survival rates. Dual-Energy Computed Tomography (DECT) is an increasingly used technique in the oncologic field with many emerging applications. The assessment of iodine concentration within a liver lesion reflects the biological properties of the tumor and provides additional information to radiologists that is normally invisible to the human eye. The possibility to predict tumor aggressiveness and therapeutic response based on quantitative and reproducible parameters obtainable from DECT images could improve clinical decisions and drive oncologists to choose the best therapy according to metastasis biological features. Moreover, in comparison with standard dimensional criteria, DECT provides further data on the cancer microenvironment, especially for patients treated with antiangiogenic-based drugs, in which tumor shrinkage is a late parameter of response. We investigated the predictive role of DECT in the early assessment of liver metastasis response to treatment in comparison with standard dimensional criteria during antiangiogenetic-based therapy.

Myocardial bridging (MB) is the most frequent congenital coronary anomaly characterized by a segment of an epicardial coronary artery that passes through the myocardium. MB is an important cause of myocardial ischemia and is also emerging as a possible cause of myocardial infarction with non-obstructed coronary arteries (MINOCA). There are multiple mechanisms underlying MINOCA in patients with MB (i.e., MB-mediated increased risk of epicardial or microvascular coronary spasm, atherosclerotic plaque disruption and spontaneous coronary artery dissection). The identification of the exact pathogenetic mechanism is crucial in order to establish a patient-tailored therapy. This review provides the most up-to-date evidence regarding the pathophysiology of MINOCA in patients with MB. Moreover, it focuses on the available diagnostic tools that could be implemented at the time of coronary angiography to achieve a pathophysiologic diagnosis. Finally, it focuses on the therapeutic implications associated with the different pathogenetic mechanisms of MINOCA in patients with MB.

Background: It remains unclear whether P2Y12 inhibitor monotherapy preserves ischemic protection while limiting bleeding risk compared with dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI). Objectives: We sought to assess the effects of P2Y12 inhibitor monotherapy after 1-month to 3-month DAPT vs standard DAPT in relation to PCI complexity. Methods: We pooled patient-level data from randomized controlled trials comparing P2Y12 inhibitor monotherapy and standard DAPT on centrally adjudicated outcomes after coronary revascularization. Complex PCI was defined as any of 6 criteria: 3 vessels treated,≥3 stents implanted,≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60mm, or chronic total occlusion. The primary efficacy endpoint was all-cause mortality, myocardial infarction, and stroke. The key safety endpoint was Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding. Results: Of 22,941 patients undergoing PCI from 5 trials, 4,685 (20.4%) with complex PCI had higher rates of ischemic events. The primary efficacy endpoint was similar between P2Y12 inhibitor monotherapy and DAPT among patients with complex PCI (HR: 0.87; 95%CI: 0.64-1.19) and noncomplex PCI (HR: 0.91; 95%CI: 0.76-1.09; Pinteraction=0.770). The treatment effect was consistent across all the components of the complex PCI definition. Compared with DAPT, P2Y12 inhibitor monotherapy consistently reduced BARC 3 or 5 bleeding in complex PCI (HR: 0.51; 95%CI: 0.31-0.84) and noncomplex PCI patients (HR: 0.49; 95%CI: 0.37-0.64; Pinteraction=0.920). Conclusions: P2Y12 inhibitor monotherapy after 1-month to 3-month DAPT was associated with similar rates of fatal and ischemic events and lower risk of major bleeding compared with standard DAPT, irrespective of PCI complexity. (PROSPERO [P2Y12 Inhibitor Monotherapy Versus Standard Dual Antiplatelet Therapy After Coronary Revascularization: Individual Patient Data Meta-Analysis of Randomized Trials]; CRD42020176853).

After percutaneous coronary interventions (PCIs), patients remain at high risk of developing recurrent cardiovascular events. Despite advances in interventional cardiology, the correct management of residual low-density lipoprotein cholesterol (LDL-C) risk continues to be crucial for improving long-term outcomes after PCI. However, several observational studies have demonstrated suboptimal LDL-C control, poor adherence to statin therapy, and underutilization of high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors in real-world clinical practice despite a strong endorsement from international guidelines. Recent studies have shown that early intensive lipid-lowering therapy stabilizes atheromatous plaque and increases fibrous cap thickness in patients with acute coronary syndrome. This finding emphasizes the importance of achieving therapeutic targets by establishing an effective treatment as early as possible. The aim of this expert opinion paper of the Interventional Cardiology Working Group of the Italian Society of Cardiology is to discuss the management of lipid-lowering therapy in patients undergoing PCIs according to Italian reimbursement policies and regulations, with a particular focus on the discharge phase.

Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient’s hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients—the Cardiomyopathy Team.

In geotechnical engineering, physical and numerical models seek to shed light on multiphase phenomena that threaten earth structure stability. This is the case of river levees: when subjected to non-ordinary hydraulic loads, local and global failures with consequent floods could occur. If, on one hand, centrifuge models can replicate the real phenomena, exploiting the enhanced gravity, while scaling geometrical features and time, on the other, numerical models extend the possible case studies by capturing key elements, governing the hydro-mechanical behaviour of the earthworks. However, the two techniques could complement and benefit each other. In this research, a potential failure mechanism, induced by the development of uplift pressures beneath the toe of a levee characterized by a peculiar stratigraphic profile, is investigated. The foundation consists of a shallow weak low-permeability layer, overlying a coarser and more permeable one, this latter acting as a hydraulic preferential flow path between riverside and landside. Results of a preliminary numerical study carried out with different methods are presented and discussed. The study aims to improve understanding of complex failure mechanisms and to encourage the development of more robust forecasting methods. Indeed the results have provided fundamental guidance for a centrifuge experimental set up.

Single antiplatelet therapy represents the cornerstone of thrombosis prevention in atherosclerotic cardiovascular disease. Dual antiplatelet therapy (DAPT), consisting of aspirin plus a P2Y(12) inhibitor, is the standard of care for patients with acute coronary syndrome or undergoing both coronary and peripheral percutaneous interventions. Recent data suggest the efficacy of DAPT also after minor stroke. In this setting, a large body of evidence has documented that genetic and acquired patients' characteristics may affect the magnitude of platelet inhibition induced by antiplatelet agents. The implementation of tools allowing the identification and prediction of platelet inhibition has recently been shown to improve outcomes, leading to an optimal balance between antithrombotic efficacy and bleeding risk. We are therefore clearly moving towards tailored antiplatelet therapy. The aim of this paper is to summarize the available evidence on the evaluation of platelet inhibition in patients with coronary, peripheral, or cerebrovascular atherosclerosis. We will here focus on antiplatelet therapy based on both aspirin and P2Y(12) inhibitors. In addition, we provide practical insights into the clinical settings in which it appears reasonable to implement antiplatelet therapy monitoring.