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The mosquito Aedes aegypti is the major vector of arboviruses like dengue, Zika and chikungunya viruses. Attempts to reduce arboviruses emergence focusing on Ae. aegypti control has proven challenging due to the increase of insecticide resistances. An emerging strategy which consists of releasing Ae. aegypti artificially infected with Wolbachia in natural mosquito populations is currently being developed. The monitoring of Wolbachia-positive Ae. aegypti in the field is performed in order to ensure the program effectiveness. Here, the reliability of the Matrix‑Assisted Laser Desorption Ionization‑Time Of Flight (MALDI‑TOF) coupled with the machine learning methods like Convolutional Neural Network (CNN) to detect Wolbachia in field Ae. aegypti was assessed for the first time. For this purpose, laboratory reared and field Ae. aegypti were analyzed. The results showed that the CNN recognized Ae. aegypti spectral patterns associated with Wolbachia-infection. The MALDI-TOF coupled with the CNN (sensitivity = 93%, specificity = 99%, accuracy = 97%) was more efficient than the loop-mediated isothermal amplification (LAMP), and as efficient as qPCR for Wolbachia detection. It therefore represents an interesting method to evaluate the prevalence of Wolbachia in field Ae. aegypti mosquitoes., (© 2021. The Author(s).)

Background: Subcutaneous implantable cardioverter defibrillator (S-ICD) is a well-established therapy for sudden death prevention. Considering the painful nature of the procedure anaesthesia may be required for analgo-sedation. Hypnosis is emerging as a promising therapeutic strategy for pain control. Few data are available regarding the use of hypnosis as adjunctive technique for pain control during S-ICD implantation., Methods: Thirty consecutive patients referred to our centre for S-ICD implantation were prospectively and alternatively allocated with 1:1 ratio in two groups: A) Standard analgo-sedation approach (Hypnosis non responder patients) B) Standard analgo-sedation approach with the addition of hypnotic communication (Hypnosis responder patients). Peri-procedural pain perception and anxiety, perceived procedural length, type and dosage of administered analgesic drugs have been measured using validate scores and compared., Results: Hypnotic communication was offered to 15 patients of which was successful in 11 patients (73%). There were no statistical differences between the two study groups according to baseline characteristics. Hypnosis communication resulted in significant pain perception reduction (Group A 6,9 ± 1,6 Vs Group B 1,1 ± 0,9, p value < 0,01), peri -procedural anxiety (Group A 3,5 ± 1,6 Vs Group B 1,9 ± 0,5, p value < 0,01) and reduced perceived procedural length (Group A 58,7 ± 13,4 min Vs Group B 44,7 ± 5,5 min, p value < 0,01). Fentanyl dosage was significantly lower in Group B patients., Conclusions: Our results demonstrated a significant reduction of perceived pain, anxiety, procedural time and use of analgesic drugs in hypnosis responder patients. These results reinforce the beneficial effects of the hypnotic technique in patients undergoing S-ICD implantation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

The Prevenzione Aterosclerosi Studio Torino (P.A.S.T.) was a prospective, randomized trial testing the effect on carotid and femoral atherosclerotic lesions of lipid-lowering therapy, as assessed by duplex scanning (DS) technique, in 85 patients (12 women, 73 men), forty-five to fifty-five years old, with ischemic heart disease (IHD), and randomly assigned to a hypolipidemic diet or diet + 250 mg acipimox (a nicotinic acid compound) two to three times/day. Forty-one patients, without inclusion criteria, were compared with the randomized groups as a reference population. All three groups were submitted to DS and to hematic monitoring of lipid levels at the beginning and at the end of the study. During three years of treatment, there was a significant reduction (-6.5%) in total plasma cholesterol in the diet + drug group (P = 0.04) and a simultaneous elevation of high-density lipoprotein cholesterol, significant in the treatment groups (respectively, +15% P = 0.02 in the diet and +16% P = 0.016 in the diet + drug group). Every group showed a trend toward the increasing number of lesions in all explored areas and toward the progression in size of the already existing ones. Whereas in the initial DS the prevalence of lesions was significantly lower in the nonrandomized group in every site, at the end of the study the total number of lesions did not differ among groups, and there was a significant increase of plaques in carotid area in the nonrandomized group in comparison with the treatment groups. The final number of stable plaques was greater in the treatment groups as compared with the nonrandomized group (P = 0.01 diet vs nonrandomized, P = 0.03 diet + drug vs nonrandomized). In conclusion, lipid-lowering treatment, with diet and with diet + drug, was useful in slowing the natural progression of atherosclerosis; particularly, it reduced the development of new lesions in the carotid and femoral arteries and increased the stability of the already existing ones. In these patients, diet was equivalent to diet + drug in regard to progression of lesions. The most favorable results in the treatment groups seem to correlate with high-density lipoprotein cholesterol, significantly increased in comparison with the nonrandomized group.

To evaluate the effectiveness, tolerance and safety of simvastatin (MK 733), a new HMG-CoA reductase inhibitor, a 28-week, single blind study with placebo was carried out on 10 patients suffering from primary hypercholesterolaemia. All patients followed the AHA Phase 1 or Phase 2 diet and underwent active treatment for 24 weeks with increasing doses of simvastatin from 10 to 40 mg in a single evening administration. A reduction in plasma levels of total cholesterol (-29%, p less than 0.001 and -41%, p less than 0.001), LDL cholesterol (-35%, p less than 0.001 and -49%, p less than 0.001), VLDL cholesterol (-9%, ns and -38%, ns), Apo-B (-27%, p less than 0.005 and -37%, p less than 0.001), Apo-A2 (-3%, ns and -3%, ns), and triglycerides (+2%, ns and -10%, ns), was obtained in the VIth and XXIVth week. There was also an increase in HDL cholesterol (+4%, ns and +17%, p less than 0.05), HDL2 subfractions (+9%, p less than 0.05 and +36%, p less than 0.05), HDL3 (+3%, ns and +11%, ns) and Apo-A1 (+7%, ns and +4%, ns). In all patients, simvastatin was generally tolerated and there were no clinical, laboratory or ophthalmological side-effects related to the drug. If long-term studies confirm its safety, simvastatin will offer excellent prospects for the prevention of ischaemic cardiopathy.

Secondary hyperlipoproteinaemia necessitates direct management of the main disease (hypothyroidism, nephrosis, etc.), whereas primary forms are essentially handled by dietary regimens adapted to subject types, as classified by Fredrickson-Levy-Lees and adopted by the WHO. These regimens are described and discussed schematically. Drugs may be employed if diet proves ineffectual. Anionic exchange resins, d-thyroxine, clofibrate and nicotinic acid have been shown effective for this purpose. Their mechanisms, doses and side-effects are described. The criteria governing their selection are explained in the light of the recent literature and with reference to the six phenotypes proposed by Fredrickson-Levy-Lees.

An improvement can be obtained in the surgical prognosis of the cardiopathic by working on the main risk factors. Congestive decompensation must usually be treated with diuretics; digitalis in only indicated in certain cases. In patients with ischaemic cardiopathy, angina therapy should be continued during the perioperative period, replacing the oral route; in the postoperative period. ECG monitoring is advisable up to Day III-V. Valve defects should be assessed carefully, including haemodynamically (especially severe aortic stenosis) because correction of the defect may become a priority. In hypertrophic cardiomyopathy hypovolaemia and loss of sinus rhythm should be avoided. Valve prostheses involve particular problems represented by antibacterial prophylaxis and perioperative anti-coagulation. Congenital cyanogenic cardiopathies often require a lowering of the haematocrit and careful control of hypotension. Postoperative arrhythmias generally have medical causes and require control of the latter before possible antiarrhythmic therapy. The implantation of a temporary prophylactic pacemaker is rarely needed; for patients with definitive pacemakers, some precautions are needed for the use of the thermocautery. It is very important to deal with poor general medical conditions that might affect prognosis. Control of hypertension is less important than control of hypotension.

To evaluate the cardiac risk in patients undergoing noncardiac surgery, it has been identified by the multivariated analysis some major and independent correlates of fatal or life-threatening cardiac complications. The most important ones were the history of previous myocardial infarction in the preceding six months, clinical signs of congestive heart failure, third heart sound or jugular venous distention, and for some Authors instable angina class IV CCS. Other predictive factors of complications were premature ventricular and atrial contractions or ectopic rhythms within cardiac diseases, age over 70 years, intraperitoneal, intrathoracic, aortic or emergency operation, severe valvular aortic and mitral stenosis and poor general medical conditions. Stable angina, hypertension, hyperlipidemia and smoking habit were less important. The global evaluation of cardiac risk can be performed by multifactorial index subdividing the patients into four very different risk classes. This is obtained by scores assigned to each statistically significant factor.

A recent ultrasound technique, Duplex Scanning (D-S), endowed with significant sensitivity, specificity and accuracy has been used to screen atherosclerotic disease in subjects at risk. Within the context of a transverse investigation aimed at identifying the multi-district nature of atherosclerotic plaques, the sensitivity and specificity values and the concordance index of Doppler C.W. (D-CW) have been checked using the D-S in carotid districts as a reference test in 205 patients suffering from ischaemic cardiopathy, asymptomatic for carotid vasculopathy, aged between 45 and 55. 170 patients had the D-CW and the D-S in 340 carotid vessels. D-CW revealed atherosclerotic changes in 122 carotids (prevalence 36%) while the D-S in 119 districts (prevalence 35%) revealed plaques greater than simple thickening, of which 89 (26%) with stenosis less than 30% and 30 (9%) with stenosis greater than 30%. Of the latter, 25 were greater than 60% and 5 less than 60%: one of them provoked a stenosis greater than 75%, the limit beyond which the change becomes haemodynamically significant. D-CW showed 46% sensitivity, a specificity of 70% and a concordance percentage of 59% with respect to D-S. D-CW sensitivity proved apparently low as did the concordance percentage between C-CW and D-S. However, considering that the lesions encountered were prevalently all haemodynamically non-significant, these values may become acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

The animal proteins in a low-lipid, low-cholesterol diet were substituted with a textured soybean preparation for 127 outpatients with stable type II hyperlipoproteinaemia selected from eight Italian and one Swiss lipid clinics. Eight weeks of the modified diet reduced plasma cholesterol by 23.1% in the 67 participating male patients and by 25.3% in the 60 females. No significant changes in plasma triglycerides, high-density lipoprotein cholesterol, and body weight were recorded. Better reductions in plasma cholesterol occurred in non-familial cases and in very young male patients. The acceptable taste of the soybean preparation used in this study, and its easy handling, indicate that this type of dietary treatment may be suitable for outpatients.

Sufficient evidence exists today pointing to the relationship between high levels of plasma cholesterol and coronary atherosclerosis. Up to now, however, the last criterion for validating the aetiopathogenetic relationship between dyslipidemia and CHD, i.e., the demonstration that reduction of plasma cholesterol reduced the formation or progression of the plaque and the incidence of its fatal or non-fatal cardiac and vascular complications, has been lacking. For more than two decades, numerous trials have had this aim in mind but until very recently results have not been substantiated owing to various deficiencies in the method. Before publication of the NHLBI Task Force of Atherosclerosis, eleven major randomised clinical studies based on hypolipidemia interventions were completed. The three studies involving dietetic interventions were considered non-conclusive overall because of the lack of a double-blind factor and of other important epidemiological criteria. Of three pharmacological trials only two involved studies of primary prevention carried out on a population of hypercholesterolaemics. These produced partial results on certain cardiac end-points but not on total deaths and at times not even on deaths from CHD. Multifactorial studies, finally, were even less demonstrative. Taken together, however, the trials based on hypolipidemia interventions point to interesting though not definitive evidence of a reduction in blood cholesterol levels to reduce the incidence and mortality from CHD. According to the NHLBI, many of these studies lacked important features that were codified and suggested for later studies.(ABSTRACT TRUNCATED AT 250 WORDS)