Search

Objectives To evaluate the trend of prescription of the four foundational therapies, and their impact on 30-day urgent re-admissions and all-cause death in patients with heart failure and reduced ejection fraction (HFrEF) following an acute decompensation event.Design Retrospective.Setting One tertiary referral centre.Participants 999 consecutively patients admitted with a primary diagnosis of HFrEF between January 2020 and June 2023 were identified through a validated, high‐performance technology infrastructure based on artificial intelligence. The entire cohort was divided into three time periods based on two time points: September 2021 (ie, the release of the latest European guidelines) and January 2022 (ie, reimbursement for sodium-glucose cotransporter 2 (SGLT2) inhibitors).Primary and secondary outcome measures Trends and predictors of the prescription of each of the four foundational therapies and of the composite of all-cause death and rehospitalisation for urgent causes at 30 days.Results Among the 999 included patients, β-blockers were prescribed in 93% of patients, ACE inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin–neprilysin receptor inhibitor (ARNi) in 73%, mineralocorticoid receptor antagonist in 30% and SGLT2 inhibitors in 18%. Over time, an increase in the prescription rate occurred only for SGLT2 inhibitors (3% vs 10% vs 32%, p

Poor treatment adherence and lack of self-care behaviors are significant contributors to hospital readmissions of people with heart failure (HF). A transitional program with non-invasive telemonitoring may help sustain patients and their caregivers to timely recognize signs and symptoms of exacerbation.We will conduct a Randomized Clinical Trial (RCT) to evaluate the feasibility and acceptability of a 6-month supportive intervention for patients discharged home after cardiac decompensation. Forty-five people aged 65 years and over will be randomized to either receive a supportive intervention in addition to standard care, which combines nurse-led telephone coaching and a home-based self-monitoring vital signs program, or standard care alone. Four aspects of the feasibility will be assessed using a mixed-methods approach: process outcomes (e.g., recruitment rate), resources required (e.g., adherence to the intervention), management data (e.g., completeness of data collection), and scientific value (e.g. 90- and 180-day all-cause and HF-related readmissions, self-care capacity, quality of life, psychological well-being, mortality, etc.). Participants will be interviewed to explore preferences and satisfaction with the intervention. The study is expected to provide valuable insight into the design of a definitive RCT.

Abstract Aims Several mechanisms have been identified in the aetiopathogenesis of heart failure with preserved ejection fraction (HFpEF). Among these, coronary microvascular dysfunction (CMD) may play a key pathophysiological role. We performed a systematic review and meta‐analysis to investigate the prevalence, echocardiographic correlates, and prognostic implications of CMD in patients with HFpEF. Methods and results A systematic search for articles up to 1 May 2023 was performed. The primary aim was to assess the prevalence of CMD. Secondary aims were to compare key echocardiographic parameters (E/e′ ratio, left atrial volume index [LAVi], and left ventricular mass index [LVMi]), clinical outcomes [death and hospitalization for heart failure (HF)], and prevalence of atrial fibrillation (AF) between patients with and without CMD. Meta‐regressions according to baseline patient characteristics and study features were performed to explore potential heterogeneity sources. We identified 14 observational studies, enrolling 1138 patients with HFpEF. The overall prevalence of CMD was 58%. Compared with patients without CMD, patients with HFpEF and CMD had larger LAVi [mean difference (MD) 3.85 confidence interval (CI) 1.19–6.5, P

Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) have recently been observed to spread rapidly worldwide. New Delhi metallo-β-lactamase (NDM) producing clones of Klebsiella pneumoniae (K. pneumoniae) cause a significant healthcare burden, particularly in Indian sub-continent, where this clone is circulating widely. However, in Italy, data on the incidence of these new clones is limited, and an ST437 NDM-producing K. pneumoniae strain has not been reported to date. A sacral ulcer infection caused by a K. pneumoniae strain was identified in an 85-year-old Italian male patient with several comorbidities. Antimicrobial susceptibility testing revealed an extensive resistance to a wide range of antimicrobials, including novel agents such as cefiderocol and ceftazidime/avibactam. Genomic analysis identified the pathogen as an ST437 K. pneumoniae strain harboring blaNDM-5, blaOXA-232 and blaCTX-M-15 genes. Following the identification of this first case, several infection control measures were implemented in healthcare settings, including direct precautions and reinforcement of standard cross-transmission control measures. The emergence of pathogenic microbial clones carrying new genetic determinants, particularly in a little city, requires prompt diagnosis and therapeutic protocols. An effective infection control system for the early detection and/or control of the transmission of NDM-producing Enterobacteriaceae is also needed. Further investigations are required to better understand the potential transmission routes and evolution of these clones.

Cardiomyopathy represents the most important life-limiting condition of Duchenne muscular dystrophy (DMD) patients after the age of 20. Genetic alterations in the DMD gene result in the absence of functional dystrophin protein, leading to skeletal/cardiac muscle impairment. The DMD incidence is one in 5000 live male births. Identifying the genetic background, in addition to DMD disease-causing variants, is one of the unmet needs in understanding the cardiac disease’s pathogenetic mechanisms and its prognostic implications. The clinical scenario is made even more intricate by the difficulty in predicting the onset and progression of cardiomyopathy, as no clear genotype/phenotype correspondence has been found thus far. The evaluation of genes involved in the onset of primary cardiomyopathies could explore the hypothesis that changes in cytoskeletal and sarcomeric protein function are the modulators of ventricular dysfunction in DMD patients. In the last decade, with the advent of next-generation sequencing (NGS) technology, many disease-causing genes and modifiers have been identified. Assessing the genetic origin of the phenotypic variability of the disease in both the onset and progression of cardiomyopathy in DMD would be extremely helpful in managing these patients. This review article aims to spotlight the genetic background associated with Cardiomyopathy in DMD patients toward a more predictive personalized model of care.

Background and Objectives: Third molar (wisdom tooth) extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Traditional rotary instruments and burs have long been the standard tools for this procedure. However, recent advancements in surgical techniques, such as piezoelectric surgery, have gained popularity due to their purported advantages in terms of precision, safety, and postoperative outcomes. This systematic review aims to evaluate the efficacy, safety, and clinical outcomes of third molar surgery performed using burs versus piezoelectric surgery. Materials and Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using the PubMed, Scopus, Web of Science, and Cochrane databases to identify relevant studies published up until October 2024. Randomized controlled trials (RCTs), clinical trials, and comparative studies assessing third molar surgery using either burs or piezoelectric instruments were included. The primary outcomes evaluated were surgical time, postoperative pain, swelling, nerve damage, and healing time. The data extraction and quality assessment were performed independently by two reviewers using standardized tools, and any discrepancies were resolved by a third reviewer. Results: A total of five studies met the inclusion criteria, and the meta-analysis revealed that piezoelectric surgery resulted in significantly lower postoperative pain and swelling compared to traditional bur techniques (p < 0.05). Additionally, the incidence of nerve injury was lower in the piezoelectric group, though the difference was not statistically significant. Surgical time was found to be longer with piezoelectric devices, but this was offset by improved healing outcomes and patient comfort. Conclusions: Piezoelectric surgery offers a less traumatic alternative to traditional burs for third molar extraction, with reduced postoperative morbidity and enhanced patient outcomes. Although the longer surgical duration may be a drawback, the overall benefits, particularly in terms of pain management and tissue preservation, support the adoption of piezoelectric techniques in clinical practice. Further high-quality randomized trials are recommended to strengthen the evidence base for these findings.

The purpose of this pilot study was to evaluate the possible effect of two natural enzymes, bromelain and escin (test), in the treatment of post-operative sequelae after open flap implant placement in the posterior area compared with painkiller medications (control). Fourteen patients were enrolled and randomly assigned to test and control groups. Bromelain and escin were administered in the test group, and a placebo was administered in the control group. Oedema, pain, and trismus were evaluated at the baseline, 2 and 7 days after surgery. Trismus was assessed using an analogue method; oedema was assessed using analogue and digital methods, while pain was reported using a numerical rating scale (NRS). Descriptive analysis and not paired-test were performed. The analogue data for oedema for the test and control groups was 10.73 ± 0.77 cm and 10.67 ± 0.74 cm (p-value baseline–7 days = 0.1004) at 7 days post-surgery. The digital analysis showed at 7 days post-surgery 0.41 ± 0.24 mm for the test group and 0.56 ± 0.52 mm for the control group (p-value baseline–7 days = 0.3140). Pain (NRS 0–10) was higher for the test group at each time point. Trismus was accentuated in the test group at each time point after the surgery. Statistically significant differences were found for the analogue oedema evaluation between baseline and day 2, for trismus in both baseline and day 2 and baseline and day 7 comparison, and for paracetamol tablets intake at day 2. Further observations of more patients are needed.

Abstract Objective We recently demonstrated that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) leads to an increase in myocardial flow reserve in patients with type 2 diabetes (T2D) with stable coronary artery disease (CAD). The mechanism by which this occurs is, however, unclear. One of the risk factors for cardiovascular disease is inflammation of epicardial adipose tissue (EAT). Since the latter is often increased in type 2 diabetes patients, it could play a role in coronary microvascular dysfunction. It is also well known that SGLT-2i modify adipose tissue metabolism. We aimed to investigate the effects of the SGLT-2i dapagliflozin on metabolism and visceral and subcutaneous adipose tissue thickness in T2D patients with stable coronary artery disease and to verify whether these changes could explain observed changes in myocardial flow. Methods We performed a single-center, prospective, randomized, double-blind, controlled clinical trial with 14 T2D patients randomized 1:1 to SGLT-2i dapagliflozin (10 mg daily) or placebo. The thickness of visceral (epicardial, mediastinal, perirenal) and subcutaneous adipose tissue and glucose uptake were assessed at baseline and 4 weeks after treatment initiation by 2-deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography during hyperinsulinemic euglycemic clamp. Results The two groups were well-matched for baseline characteristics (age, diabetes duration, HbA1c, BMI, renal and heart function). Dapagliflozin treatment significantly reduced EAT thickness by 19% (p = 0.03). There was a significant 21.6% reduction in EAT glucose uptake during euglycemic hyperinsulinemic clamp in the dapagliflozin group compared with the placebo group (p = 0.014). There were no significant effects on adipose tissue thickness/metabolism in the other depots explored. Conclusions SGLT-2 inhibition selectively reduces EAT thickness and EAT glucose uptake in T2D patients, suggesting a reduction of EAT inflammation. This could explain the observed increase in myocardial flow reserve, providing new insights into SGLT-2i cardiovascular benefits.

Background: Starting from March 2020 until December 2021, different phases of Covid-19 pandemic have been identified in Italy, with several containing/lifting measures progressively enforced by the National government. In the present study, we investigate the change in occupational risk during the subsequent pandemic phases and we propose an estimate of the incidence of the cases by economic sector, based on the analysis of insurance claims for compensation for Covid-19. Methods: Covid-19 epidemiological data available for the general population and injury claims of workers covered by the Italian public insurance system in 2020–2021 were analyzed. Monthly Incidence Rate of Covid-19 compensation claims per 100,000 workers (MIRw) was calculated by the economic sector and compared with the same indicator for general population in different pandemic periods. Results: The distribution of Covid-19 MIRw by sector significantly changed during the pandemic related to both the strength of different waves and the mitigation/lifting strategies enforced. The level of occupational fraction was very high at the beginning phase of the pandemic, decreasing to 5% at the end of 2021. Healthcare and related services were continuously hit but the incidence was significantly decreasing in 2021 in all sectors, except for postal and courier activities in transportation and storage enterprises. Conclusion: The analysis of compensation claim data allowed to identify time trends for infection risk in different working sectors. The claim rates were highest for human health and social work activities but the distribution of risk among sectors was clearly influenced by the different stages of the pandemic.

The emergence of pathological manifestations on facades persists globally, with recurring failures occurring often due to repeated construction details or design decisions. This study selected a building with a recurring architectural design and evaluated the stain pattern on its facade using a UAV with an infrared thermal camera. The results showed that advanced technology offers a non-invasive and efficient approach for comprehensive inspections, enabling early detection and targeted interventions to preserve architectural assets without requiring ancillary infrastructure or risking workers at height. The precise identification of damage clarified the real causes of the observed pathological manifestations. Capturing the images allowed accurate inspection, revealing hollow and damp spots not visible to the human eye. Novel results highlight patterns in the appearance of dirt on facades, related to water flow that could have been redirected through proper geometric element execution. The presented inspection methodology, staining standards, and construction details can be easily applied to any building, regardless of location. Sills, drip pans, and flashings must have drip cuts, adequate inclination, and projections to prevent building degradation.

The Camp Coragemis formed by thirty-six families that were affected by the Estreito Hydroelectric Power Plant (MA), and currently occupy a territory in Palmeiras do Tocantins (TO), claiming the occupation rights, and the cultural practices that were violated by the advent of the construction of the enterprise. When expropriated, they find in the territory they formed since October 2015 ways to continue exercising their ways of life. Thus, the objective of this work is to identify the conflicts faced by the camped population in the struggle for land and in their process of resistance and occupation of the community. The methodological paths of the present study are guided by qualitative research, using exploratory interviews and participant observation, seeking to understand riverside experiences and their occupation trajectories on the banks of the Tocantins

The focus on building energy efficiency using alternative materials in structures, especially concrete, and the main technical and environmental challenges therein, aligns with Sustainable Development Goals (SDG). This study proposes a review that analyzes structures made with recycled concrete, relating to the energy efficiency of buildings. A classification structure was proposed, addressing the following questions: (i) What are the various dimensions in which research into energy-efficient recycled concrete is concentrated? (ii) What are the themes and classes of research associated with these dimensions? (iii) What are the main shortcomings of current approaches, and what would be a good research agenda for the future development of energy-efficient recycled concrete? A bibliometric analysis was carried out, presenting geographical and cluster maps to understand different research trends and refine future research. This was followed by a bibliographic analysis, reviewing the most relevant studies from the last five years (2019–2024). The results showed some residual alternative materials (around 45 types from five different industries) used in the production of energy-efficient concrete. And, as a negative effect, as substitution rates increase, porosity is the property with the greatest impact on energy efficiency. The greater the number of pores and the greater their interconnection, the lower the material’s thermal insulation.

This study investigates the corrosion behavior of 5 mm diameter prestressed wires in concrete beams under chloride attack, a prevalent issue for coastal infrastructure. The study simulated aggressive chloride environments to understand their impact on structural integrity and service life. Utilizing a combination of advanced digital image correlation (DIC) techniques and a novel machine learning-based predictive model, the research provides a nuanced analysis of the interplay between stress levels, corrosion rates, and concrete strength. Empirical findings reveal a significant correlation between increased prestress levels and accelerated corrosion, indicating a crucial consideration for the design and maintenance of prestressed concrete structures. Notably, this study found that beams with a 95% prestress level exhibited a corrosion rate of 0.64 mm/year, significantly higher than the 0.37 mm/year for non-prestressed beams. The predictive model’s accuracy was validated with a mean squared error of 0.517 and an R2 value of 0.905, offering a valuable tool for quantifying the impact of corrosion. Therefore, the predictive model is a valuable tool for quantifying the impact of corrosion, enhancing the ability to assess and improve the durability of such infrastructure. This study’s insights highlight the necessity for a balanced approach to design and regular monitoring, especially in chloride-rich environments. By helping to develop more resilient construction practices and contributing to sustainable development goals, this study can significantly impact the safety and service life of coastal bridges and structures, aligning with global efforts to create more sustainable and durable infrastructure.

Recent investigations on music performances have shown the relevance of singers' body motion for pedagogical as well as performance purposes. However, little is known about how the perception of voice-matching or task complexity affects choristers' body motion during ensemble singing. This study focussed on the body motion of choral singers who perform in duo along with a pre-recorded tune presented over a loudspeaker. Specifically, we examined the effects of the perception of voice-matching, operationalized in terms of sound spectral envelope, and task complexity on choristers' body motion. Fifteen singers with advanced choral experience first manipulated the spectral components of a pre-recorded short tune composed for the study, by choosing the settings they felt most and least together with. Then, they performed the tune in unison (i.e., singing the same melody simultaneously) and in canon (i.e., singing the same melody but at a temporal delay) with the chosen filter settings. Motion data of the choristers' upper body and audio of the repeated performances were collected and analyzed. Results show that the settings perceived as least together relate to extreme differences between the spectral components of the sound. The singers' wrists and torso motion was more periodic, their upper body posture was more open, and their bodies were more distant from the music stand when singing in unison than in canon. These findings suggest that unison singing promotes an expressive-periodic motion of the upper body.