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Funding Acknowledgements Type of funding sources: None. Background The incidence of death and infections in patients implanted with cardiac implantable electronic devices (CIEDs) are not fully known yet (1,2). Purpose To describe the incidence of death and device’s infection and its potential predictors in a contemporary cohort of CIED patients. Methods All consecutive patients implanted with a CIED at our tertiary institution were prospectively enrolled. Follow-up was performed every six months and clinical events recorded by expert electrophysiologists. For the purpose of the present analysis, we considered patients with a potential follow-up of at least 24 months. Results Between 01/09/2018 and 01/09/2020, a total of 838 patients were enrolled (34.6% female; age 77 [70-84]; PADIT score 2 [2-4]). Pacemaker (PM) and implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy and defibrillator (CRT-D) were implanted in 569 (68%) and 269 (32%) patients respectively. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, 212 (25.5%) patients died and 5 (0.6%) had a CIED infection. Four out of five patients required CIED extraction, while 1 patient antibiotics only. At multivariate Cox-regression analysis, age (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.05-1.10) and dialysis (HR 6.18; 95%CI 3.40-11.25) were independently associated with death, while first implant was associated with a lower risk as compared to subsequent procedures (HR 0.63; 95%CI 0.46-0.85) (Figure 1). Conclusions In large contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED infections was low.

Introduction From the beginning of the current coronavirus disease 2019 (COVID-19) pandemic, there is cumulative evidence suggesting that patients hospitalized due to this disease are at a high risk for venous thromboembolism (VTE). The association between mild non-hospitalized illness and VTE is unclear. The purpose of this research is to assess the association between VTE and mild COVID-19 infection. Methods A case-control study was conducted. The cases were adult patients diagnosed with VTE from March 1, 2020 to March 31, 2021. The controls were randomly chosen adult patients who required healthcare services that were equivalent to those of the cases, for any cause, during the same time period, without a VTE diagnosis. To assess the association between mild COVID and VTE, a multivariate logistic regression analysis was conducted, considering other thromboembolic risk variables, such as age, gender and active cancer, among others. A p-value

This study aimed to explore post-migration lifestyle and weight changes in a sample of migrant women recruited in Modena, Italy. Taking into account the importance of the perceived personal susceptibility in improving prevention and treatment seeking behaviors, we further investigated women's self-recognition of overweight/obesity. We also examined the changes in self-perceived quality of life after the arrival in Modena.A cross-sectional study was conducted among 97 female migrants visiting a family counseling in Modena. Socio-demographic information, post-migration changes in lifestyle, dietary habits and self-perceived quality of life were obtained by administering an anonymous questionnaire, created ad hoc with expert consultation and previously tested in a pilot study. Thereafter blood pressure, height and weight were measured.More than half of the sample met criteria for overweight/obesity and 58% reported a weight increase after the arrival in Italy. The increased risk of weight gain after migration was significantly associated with women age, lower education level, African ethnicity and post-migration increased consumption of cheese and snacks/sweets. After applying a conditional multiple logistic regression, ethnicity, age and increased post-migration cheese consumption remained the main predictors of weight gain. More than half of subjects with BMI ≥ 25 Kg/m² were not aware of their own overweight or obesity. Such weight underestimation was more common in African migrants than in other ethnicities. Findings about the perceived quality of life showed an overall improved economic situation, although more than half of women revealed deterioration in their social relationships after migration.Our results are important to identify the gaps in the current migrant populations' health promotion in Modena and suggest that strategies to support female migrants to reinforce good dietary patterns may be the key in preventing unhealthy weight gain. Indeed, understanding immigrant women's culture, beliefs and traditions of their country of origin, as well as food acculturation, is essential to improve the efficiency of these interventions.

1. The content of oxy-radical scavenging enzymes is decreased in Morris hepatomas in a fashion which is inversely related with the growth rate of the tumour. 2. Hepatoma microsomal membranes are more resistant than normal rat liver membranes to lipid peroxidation induced in vitro by organic hydroperoxides or superoxide radicals. 3. In tumour membranes the most relevant rate-limiting factor of peroxidation is the low availability of polyunsaturated fatty acids (PUFA). Besides lipids, some proteins (particularly cytochrome P-450) act as controlling factors of peroxidation. 4. Tumour microsomes are more ordered and less fluid than liver microsomes. The latter, exposed to superoxide radical attack, exhibit chemical (fatty acid composition) and physical (molecular order) properties that are similar to those of transformed cell membranes. 5. These data indicate an aberration in the oxy-radical metabolism of cancer cells, and a sequence of events is hypothesized that could drive the transformed cell towards uncontrolled proliferation.

The relationship between steroid binding and protein subunit interactions of rabbit sex steroid binding protein (rSBP) has been studied by steady-state and time-resolved fluorescence spectroscopy. The high-affinity (Ka approximately 10(8) M-1 at 4 degrees C), fluorescent estrogen d-1,3,5(10),6,8-estrapentaene-3,17 beta-diol [dihydroequilenin (DHE)] was used as a fluorescent probe of the steroid-binding site. Perturbation of the binding site with guanidinium chloride (Gdm.Cl) was monitored by changes in the steady-state fluorescence anisotropy of DHE as well as by changes in fluorescence quenching of DHE with acrylamide. The results of acrylamide quenching at 11 degrees C show that, while between 0 and 1 M Gdm.Cl the steroid-binding site is completely shielded from bulk solvent, there is decreased DHE binding. To study the subunit-subunit interactions, rSBP was covalently labeled with dansyl chloride in the presence of saturating 5 alpha-dihydrotestosterone (DHT), which yielded a dansyl-conjugated protein that retained full steroid-binding activity. The protein subunit perturbation was monitored by changes in the steady-state fluorescence anisotropy of the dansyl group. At 11 degrees C, the dansyl anisotropy perturbation, reflecting changes in global and segmental motions of the dimer protein, occurs at concentrations of Gdm.Cl above 1 M. The Gdm.Cl titration in the presence of steroids with equilibrium association constants less than 10(8) M-1 shows a plateau near 3 M Gdm.Cl at 11 degrees C; at this Gdm.Cl concentration, no DHE is bound. No plateau is observed at 21 degrees C. At higher Gdm.Cl concentrations, the dansyl fluorescence anisotropy decreases further and shows no steroid dependence. Recovery of steroid-binding activity (assayed by saturation binding with [3H]DHT), under renaturation conditions, is dependent on both steroid concentration and affinity. Both unlabeled and dansyl-labeled protein recovery the same amount of activity, and according to fluorescence anisotropy, dansyl-labeled rSBP re-forms a dimer upon dilution below 1 M or removal of Gdm.Cl. From the steroid requirement for recovery of steroid-binding activity, it appears that a conformational template is required for the dimeric protein to re-form a steroid-binding site with native-like properties.

AD is characterized by a widespread cognitive impairment and deficit in functional competency to perform activities of daily living (ADL). The longitudinal reliability of cognitive and functional performance indices and the strength of relationship between patients cognitive impairment and their functional competence are still open issues. The aim of this study has been to evaluate, in a selected sample of patients with AD treated with AChEl, the slopes of cognitive impairment and disability. Among 249 AD patients, according to DSM-IV criteria, with presence/absence of associated vascular lesions (AD + VD), eligible for AChEl treatment, we selected subjects with mild to moderate cognitive impairment, without high comorbidity and severe psychiatric disease, with caregiver who resided with, or had frequent contact with the patient. Patients that changed treatment shifting from one AChEl to another, that didn’t tolerate inhibitors (drop-out), and that presented behavioral and psychological symtoms of dementia (BPSD) requiring neuroleptic treatment during the study period were excluded from the final analysis. A sample of 99 subjects (30 males, 69 females; mean age of 79.4 ± 5.0 years), completing a 15 months follow-up was considered. Cognitive performance remained stable after 15 months of treatment, but disability increased. No difference was found due to the AChEl compound used. The same hold true for the subgroups with presence/absence of a vascular components, whereas subgroup with mild cognitive performance showed a cognitive decline, parallel to the functional one. Our data underline the efficacy of AChEl in the treatment of AD with presence/absence of vascular component. Nevertheless, the judgement on the level of efficacy of AChEl could be biased by the level of reliability of the indices considered.

The new generation of Implantable Cardioverter Defibrillators (ICDs) allows storage of intracardiac electrograms (EGMs) recorded immediately before the onset of malignant ventricular tachyarrhythmias (VTs) and during their course. Although all devices base most of diagnostic parameters on the bipolar EGMs, some of them allow two types of EGM recordings: bipolar (potential is obtained between two electrodes at the tip of the electrocatheter) and far-field (potential is recorded between the tip of the electrocatheter and the active can device). The main objective of this work is to study which differences can be observed from the analysis of bipolar or far-field EGMs when deterministic chaos methods are being applied to bipolar or far-field EGM recordings. For this analysis we considered 20 EGMs obtained from 6 patients with ICDs. Some of the EGMs contain VT episodes, other are collected in basal heart conditions. Within the limited set of EGM considered in this work, results indicate that far field recordings, monitoring the whole heart activity, allow better characterization of heart substrate, and they are more indicated when deterministic chaos analysis would be applied.

This work investigates the correlation between the cardiac electrical activity underlying spontaneous ventricular tachyarrhythmias and their modes of onset. We analyzed 81 episodes of spontaneous ventricular tachycardia (VT) and ventricular fibrillation (VF) lasting at least 5 seconds from 17 patients. The cardiologist classified VT/VF malignancy by considering fast VT as more malignant. We study 3 modes of onset: (i) premature ventricular contraction (PVC group); (ii) PVC preceded by a short-long-short cycle (SLS group); (iii) PVC preceded by a paced beat after a previous PVC compensatory pause (PM group). In 4 patients more than one mode of VT/VF onset is present, in the other 13 patients VT/VF always started with the same mode. Cardiac electrical activity is characterized by power spectral density and correlation dimension analyses; statistical analysis is carried on using one way ANOVA in order to test significant differences among the mean values of PVC, SLS and PM populations. Preliminary results shows significant differences at 5% level in two of the considered quantitative parameters. Although initial significant differences have been obtained, the limited number of ICDs and the small variability of the intra-subject characterization suggest that further research is needed to conclude that dynamics underlying VT/VF and the VT/VF mode of onset are strictly related.

The in vitro effects of hydroxystearic acid on the proliferation of human colon carcinoma cells (HT29) and human embryonic intestine cells (I407) were examined and compared to previous results obtained in murine C108 lung carcinoma cells. The cells were cultured in the presence, or in the absence, of hydroxystearic acid and tested for cell proliferation and viability; the distribution of cells in the cell cycle was evaluated by flow cytometry. Results show that hydroxystearic acid is also an inhibitor of human cell proliferation, and not only of murine C108 cells. Differently from C108 cells, which upon treatment with hydroxystearic acid accumulate in G2-M phases, hydroxystearic acid-treated HT29 cells increase significantly in numbers in G0-G1; I407, embryonic cells used as a control, when treated show only a slight increase in G0-G1.

It was suggested that Doppler study of pulmonary venous flow (PVF) in combination with mitral flow is useful to evaluate ventricular function. In order to investigate the utility of PVF study in patients with total A-V block treated with pacemaker DDD, we performed transesophageal echocardiography pulsed Doppler of PVF and mitral flow in 12 patients. We measured the following parameters in PVF: peak systolic velocities (S1 and S2), peak diastolic velocity (D) reversal atrial flow diastolic deceleration time. In mitral flow we measured: E wave, A wave and deceleration time of E. We compared our results with the same patients with pacemaker inhibited. In patients with total A-V block with pacemaker inhibited we reported one systolic wave of PVF, a larger D wave with a shortened deceleration time. The PVA seems to disappear. Transmitral flow slowed a higher E wave in patients A-V block with pacemaker inhibited. In patients with total A-V block stimulated by DDD pacemaker we restored the atrioventricular sequentialty; therefore electric stimulation determines the onset of S1 peak and the reduction of S2 peak and the systematic presence of the atrial-pulmonary regurgitant wave.

Cardiac evaluation of stroke or transient ischemic attack (TIA) patients includes transthoracic and transesophageal echocardiography to identify potential cardiac source of embolism. In the present study transesophageal echocardiography was performed in 53 consecutive patients with non valvular atrial fibrillation and a previous embolic stroke. All patients were referred to our department because of an episode of atrial fibrillation. They all underwent computed tomography (CT) scan: 31 patients had a positive scan whereas 22 had a negative scan with a positive history of TIA diagnosed from a neurologist during hospitalization. In the group of 31 patients with a positive scan 9 patients with no history of a previous ischemic attack were found. The transesophageal echocardiography was performed in all the study subjects: 7 patients had a thrombus in the left atrial appendage, 2 patients had a thrombus in the right atrium. Spontaneous echo contrast was reported in 15 patients. Evaluating the interatrial septum we observed a patent foramen ovale in 4 patients, a defect in 2 patients and a fossa ovalis aneurysm in 3 patients. The mitral valve analysis showed a leaflet prolapse in 3 patients. The entire thoracic aorta was imaged in each patient: in 12 an abnormal atherosclerotic plaque was found. Transesophageal echocardiography is an important component of the comprehensive evaluation of potential sources of embolism in patients with ischemic cerebral attack and nonrheumatic atrial fibrillation.

The short-term clinical efficacies of furosemide, 25 mg/day, and torasemide, 10 mg/day, have been compared in 2 groups of 12 patients with severe heart failure. In each group there were similar numbers of patients in whom heart failure was due to coronary heart disease, high blood pressure, or idiopathic dilated cardiac myopathy. The design of the study was open and the diuretics were added to baseline treatment with digoxin. Treatment for 8 days with the 2 loop diuretics resulted in similar substantial and significant improvements in symptoms and exercise tolerance as judged by the increase in total body oxygen consumption, and reductions in radiographic evidence of pulmonary congestion and in right heart filling pressure as judged from the jugular venous pressure wave. The results of this short-term comparative study confirm that furosemide and torasemide are equally efficacious in inducing substantial improvements in the clinical status of patients in severe heart failure.

Reasons why nurses left a general Hospital were analyzed through a questionnaire sent to all nurses who abandoned their position over the last 5 years (218). 50.6% of these nurses do not live in Lombardy region. 127 (57.7%) answered the questionnaire. 35% of whom answered the questionnaire would get back to work in the hospital. The main reason for hospital leave is related to family reasons (children and parents) for registered nurses and to shift work state enrolled nurses. Low salary is the main problem for 21-30 years old nurses. According to nurses who answered the questionnaire, more efficient recruitment and retention strategies should include higher salaries, riqualification of the profession in general and improvement of working conditions and organization.

Female mongrel dogs fed a marine fish diet rich in long-chain polyenoic fatty acids had improved patency of small-diameter arterial prosthetic grafts as compared to controls. Also, in vivo platelet function as measured by bleeding times was significantly prolonged. Eicosapentaenoic acid, not found in the serum of control animals, was present in relatively high concentrations in both the serum and a platelet-rich fraction of the marine oil-fed group. Eicosapentaenoic acid, unlike arachidonic acid, does not induce platelet aggregation and this phenomonon may account for the altered platelet function demonstrated in our animals and hence the improved graft patency. These data lend further support to the role of platelets in determining the patency of vascular grafts.

A case is presented of a twenty-eight-year-old man in whom renal failure developed at age twenty-four from polycystic kidney disease known to be present since childhood. He also had cutaneous manifestations of the tuberous sclerosis complex. Intrarenal hemorrhage led to bilateral nephrectomy. Microscopic examination disclosed typical polycystic disease and multiple angiomyolipomas in each kidney. In addition several renal cell carcinomas of oncocytic, papillary, and clear cell type were found. Review of the literature disclosed the uncommon coexistence of any two of these lesions and did not uncover any reported case of the simultaneous existence of all three.

Our experience with 16 retroperitoneal tumors seen over a 13 year period has been reported. Patients presented with either an abdominal mass or abdominal pain associated with a large retroperitoneal tumor. Delineation of the tumor is best accomplished with computerized tomography and venacavography. Exploration and resection is possible in most patients. Postoperative radiotherapy and chemotherapy are recommended in most patients. Local recurrence frequently occurs and should be diagnosed early and resected aggressively if found.

Proton NMR and 13C-NMR studies on the configuration of CoQn homologues show that the polyisoprenoid side-chain is in the all-trans configuration and confers a higher degree of rigidity to the quinones with respect to the acyl-chains of the phospholipids within the membrane bilayer. The quinonoid ring appears to be specifically involved in the redox function of the coenzyme while the side-chain length only affects the lipophilicity of the molecule. LIS data show that the ring strongly interacts with metals as a consequence of the high pi-electron density on the carbonyls that is somewhat larger on the carbonyl oxygen to alpha to the isoprenoid chain.

During the past nine years, 54 patients underwent interposition graft shunting for variceal bleeding in 48 and intractable ascites in six, either electively (35 instances) or as an emergency (13 instances). Autogenous jugular was used in 41 instances, homologous vena cava in nine and Dacron in five. The interposition graft was placed between superior mesenteric vein and vena cava in 36 instances and the portal vein and vena cava in 19. Using Child's Clinical Classification 44 were Class C and 10 Class B. There were six (11%) operative deaths with one (2.4%) in the elective and five (38%) in the emergency group. Encephalopathy was seen in 4 (10%) of those surviving more than one year. Two Dacron and two homografts thrombosed. Eight of the autografts were patent at autopsy, 18 on angiography and 15 assumed to be patent because patients were asymptomatic. Only one of 12 late deaths was related to grafts failure. Apparently the operation controls ascites and the autogenous jugular vein is the ideal material. Interposition "H" grafting is a simple safe procedure that can be used for portal decompression in patients with bleeding varices.

Hidradenitis suppurativa remains a poorly understood disease involving the apocrine sweat glands. Management of 23 patients with the advanced form of the disease has been reviewed. Local therapy and incision and drainage all have an unacceptable rate of recurrence. From our experience, we recommend wide and deep excision of the area involved combined with individualized closure.

The clinical characteristics and course of 90 patients in whom 121 arterial emboli occurred from 1968 to 1978 were reviewed. The factor that correlated most significantly with a favorable outcome was the interval from onset of symptoms until arterial embolectomy was performed. The results of embolectomy were excellent in the patients operated on within 6 hours of symptoms (amputation rate 4 percent, mortality rate 15 percent), but less favorable in the patients operated on within 6 to 12 hours of onset of symptoms (amputation rate 27 percent, mortality 40 percent). Mortality (48 percent) and amputation (52 percent) rates in the patients operated on 12 to 48 hours after onset of symptoms were excessive. It is recommended that immediate embolectomy be performed in all potentially viable extremities in patients who present within 12 hours of symptoms, but that after 12 hours only those limbs with obvious viability (not paralyzed or anesthetic) should be operated on. Alternatives for the remainder are high dose intravenous heparinization or expedient amputation. In patients who present greater than 60 hours after the onset of symptoms, embolectomy can be performed with low morbidity and mortality.

Our experience with 16 retroperitoneal tumors seen over a 13 year period has been reported. Patients presented with either an abdominal mass or abdominal pain associated with a large retroperitoneal tumor. Delineation of the tumor is best accomplished with computerized tomography and venacavography. Exploration and resection is possible in most patients. Postoperative radiotherapy and chemotherapy are recommended in most patients. Local recurrence frequently occurs and should be diagnosed early and resected aggressively if found.

Two cases of chylous ascites secondary to lymph node dissection for testicular tumors are reported. Non-surgical management failed to control the ascites in either patient. The use of the LeVeen shunt promptly and permanently controlled the ascites in 1 patient.

Our experience from 1960 to 1976 with total infrarenal aortic thrombosis (Leriche syndrome) was reviewed. Sixteen heavy smokers (14 men and 2 women) with an average age of fifty-four years underwent thrombectomy with aortoiliac (12 patients) or aortofemoral (4) Dacron bypasses. The last ten patients were hydrated for 12 hours preoperatively with 3,000 ml of Ringer's solution containing supplemental potassium. Mannitol (25 g), furosemide (20 mg), and heparin (120 u/kg) were given intraoperatively. Thrombectomy was accomplished by transection of the aorta, with proximal manual control of the aorta after the renal arteries were occluded. With this technic there were no deaths or renal complications, whereas previously, three of the six patients developed renal complications and one died. Ninety-two per cent of the grafts have remained open. We recommend that the direct transabdominal approach be continued rather than the extraanatomic bypass (axillobilateral-femoral), since further propagation of the aortic thrombosis may then lead to infarction of the kidneys or other viscera.

Postoperative necrotizing fasciitis of the abdominal wall is usually caused by peritonitis in patients who have undergone multiple procedures for complications of emergency laparotomy. Better patient survival may be achieved by the following method: thorough peritoneal exploration to drain abscesses, excision of necrotic fascia, temporary Marlex placement, and delayed closure of the wound with skin flaps.

Light scattering by suspension of biological particles has proven to be a convenient indicator of some physiological processes. Changes in rates of phosphorylation, electron transport, etc., and changes in the osmolarity of the medium can modify the scattering properties of mitochondria. Presumably the changes in scattering properties reflect changes in particle conformation (Latimer et al. 1968).

The effect of the insertion of coenzyme Q10 and some of its shorter chain homologues in membrane models (Reverse Micelles, Small Unilamellar Vesicles and Liposomes) has been studied by NMR and IR spectroscopies. By 1H-NMR we have found that the stretched conformation of the isoprenoid side-chain observed in solution is maintained in membrane models. Interaction between the quinonoid moiety of the Q's and the phosphatidic groups of the phospholipids has been evidenced by 31P-NMR. A large effect of this interaction on the water microdynamics and distribution around the charged groups of the phospholipids has been observed by measurements of 1H and 2H relaxation times and by infrared spectra. The 13C-NMR spectra of the backbone of the acyl chains of phospholipids does not seem to be influenced to a noticeable extent by the presence of the Q's.

The serum lipoproteins of Macaca fasicularis monkeys subjected to portacaval shunts were compared to those of sham-operated on both chow and cholesterol-fat diets. On either diet, only the HDL (high-density lipoprotein) cholesterol levels were found to be significantly different between sham-operated and shunted monkeys. The HDL cholesterol of the shunted were a third lower on the chow diet (P < .025) and 50% lower on the cholesterol diet (P < .005) by both direct isolation of the VLDL, LDL, and HDL lipoprotein components and by heparin-manganese precipitation measurements of the HDL remaining in the supernatant of serum previously assayed for total cholesterol. This decrease in HDL occurred in only the HDL2 fraction (d < 1.125 g/ml), the HDL3 remaining constant. The proportion of faster floating LDL (low-density lipoproteins) was increased for cholesterol-fed shunted monkeys over the sham-operated at all levels of LDL cholesterol (comparing only groups equivalent in LDL cholesterol).

Electron microscopic studies on a closed colony of rabbits with an 18.5 per cent incidence of spontaneous onset insulin-dependent diabetes mellitus revealed that the beta-cells of the islets of Langerhans of the diabetic animals were hypergranulated. This finding contrasts with most other animal models of spontaneous diabetes mellitus which show degranulation of the beta-cells. There was no evidence of hyperplasia, insulitis, amyloid, or fibrosis of the islets by either light or electron microscopy. Correlation of our morphologic findings with physiologic data suggests a defect in insulin secretion. Rabbits with normal glucose metabolism showed a normal degree of granulation of their beta-cells. The alpha and delta cells were within normal limits in all animals. No other abnormalities associated with diabetes in humans or other animals were noted except for minimal fusion of the glomerular epithelial foot processes and mineralization of the proximal tubules and Bowman's capsules.

Diverticulitis is a complex disease and demands careful cooperation between physician and surgeons, because although it is a benign disease, the presence of complications makes it potentially lethal. For successful management, knowledge of the treatment in past decades should be integrated with current surgical technics. A retrospective review of forty-one patients with perforated diverticulitis revealed a significant decrease in morbidity and hospital stay for the group of patients undergoing the Hartmann procedure versus the group undergoing the classic three stage approach. In addition, the Hartmann group required fewer additional surgical procedures for drainage of abscesses. In view of these results as well as those of others, we believe that resection is the primary goal of therapy. The two stage approach therefore offers significant decrease in morbidity with acceptable mortality.