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1. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial

Author

Cipolla, C.M., Cardinale, D., Ciceri, F., Latini, R., Sandri, M.T., Maggioni, A.P., Labianca, R., Tettamanti, M., Senni, M., Finzi, A., Grosso, F., Vago, T., Civelli, M., Gramenzi, S., Masson, S., Balconi, G., Bernasconi, R., Salvatici, M., Nicolis, E., Barlera, S., Magnoli, M., Buratti, M.G., Ojeda Fernandez, M.L., Franzosi, M.G., Staszewsky, L., Vasamì, A., Malossi, A., Sicuro, M., Thiebat, B., Barè, C., Corzani, A., Coccolo, F., Colecchia, S., Pellegrini, C., Bregni, M., Appio, L., Caico, I., G.Rossetti, Mesenzani, O., Campana, C., Giordano, M., Gilardoni, M., Scognamiglio, G., Corrado, G., Battagin, D., De Rosa, F., Carpino, C., Palazzo, S., Monopoli, A., Milandri, C., Giannessi, P.G., Zipoli, G., Ghisoni, F., Rizzo, A., Pastori, P., Callegari, S., Sesenna, C., Colombo, A., G.Curigliano, Fodor, C., Mangiavacchi, M., Cavina, R., Guiducci, D., Mazza, R., Turazza, F.M., Vallerio, P., Marbello, L., Sala, E., Fragasso, G., Trinca, S., Aquilina, M., Rocca, A., Farolfi, A., Andreis, D., Gori, S., Barbieri, E., Lanzoni, L., Marchetti, F., Falci, C., Bianchi, A., Mioranza, E., Banzato, A., Re, F., Gaibazzi, N., Gullo, M., Turina, M.C., Gervasi, E., Giaroli, F., Nassiacos, D., Verusio, C., Barco, B., Bertolini, A., Cucchi, G., Menatti, E., Sinagra, G., Aleksova, A., Guglielmi, A., Pinotti, G., Gueli, R., Mongiardi, C., Vallini, I., Cardinale, Daniela, Ciceri, Fabio, Latini, Roberto, Franzosi, Maria Grazia, Sandri, Maria Teresa, Civelli, Maurizio, Cucchi, GianFranco, Menatti, Elisabetta, Mangiavacchi, Maurizio, Cavina, Raffaele, Barbieri, Enrico, Gori, Stefania, Colombo, Alessandro, Curigliano, Giuseppe, Salvatici, Michela, Rizzo, Antonio, Ghisoni, Francesco, Bianchi, Alessandra, Falci, Cristina, Aquilina, Michele, Rocca, Andrea, Monopoli, Anna, Milandri, Carlo, Rossetti, Giuseppe, Bregni, Marco, Sicuro, Marco, Malossi, Alessandra, Nassiacos, Daniele, Verusio, Claudio, Giordano, Monica, Staszewsky, Lidia, Barlera, Simona, Nicolis, Enrico B., Magnoli, Michela, Masson, Serge, and Cipolla, Carlo M.

Published
2018
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2. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial

Author

Cardinale, D, Ciceri, F, Latini, R, Franzosi, M, Sandri, M, Civelli, M, Cucchi, G, Menatti, E, Mangiavacchi, M, Cavina, R, Barbieri, E, Gori, S, Colombo, A, Curigliano, G, Salvatici, M, Rizzo, A, Ghisoni, F, Bianchi, A, Falci, C, Aquilina, M, Rocca, A, Monopoli, A, Milandri, C, Rossetti, G, Bregni, M, Malossi, A, Nassiacos, D, Verusio, C, Giordano, M, Staszewsky, L, Barlera, S, Nicolis, E, Magnoli, M, Masson, S, Cipolla, C, Curigliano, Sicuro, M, Rossetti, Maggioni, A, Labianca, R, Tettamanti, M, Senni, M, Finzi, A, Grosso, F, Vago, T, Gramenzi, S, Balconi, G, Bernasconi, R, Buratti, M, Ojeda-Fernandez, M, Vasami, A, Thiebat, B, Bare, C, Corzani, A, Coccolo, F, Colecchia, S, Pellegrini, C, Appio, L, Caico, I, Mesenzani, O, Campana, C, Gilardoni, M, Scognamiglio, G, Corrado, G, Battagin, D, De Rosa, F, Carpino, C, Palazzo, S, Giannessi, P, Zipoli, G, Pastori, P, Callegari, S, Sesenna, C, Fodor, C, Guiducci, D, Mazza, R, Turazza, F, Vallerio, P, Marbello, L, Sala, E, Fragasso, G, Trinca, S, Farolfi, A, Andreis, D, Lanzoni, L, Marchetti, F, Mioranza, E, Banzato, A, Re, F, Gaibazzi, N, Gullo, M, Turina, M, Gervasi, E, Giaroli, F, Barco, B, Bertolini, A, Sinagra, G, Aleksova, A, Guglielmi, A, Pinotti, G, Gueli, R, Mongiardi, C, Vallini, I, Cardinale D., Ciceri F., Latini R., Franzosi M. G., Sandri M. T., Civelli M., Cucchi G., Menatti E., Mangiavacchi M., Cavina R., Barbieri E., Gori S., Colombo A., Curigliano G., Salvatici M., Rizzo A., Ghisoni F., Bianchi A., Falci C., Aquilina M., Rocca A., Monopoli A., Milandri C., Rossetti G., Bregni M., Malossi A., Nassiacos D., Verusio C., Giordano M., Staszewsky L., Barlera S., Nicolis E. B., Magnoli M., Masson S., Cipolla C. M., Sicuro M., Maggioni A. P., Labianca R., Tettamanti M., Senni M., Finzi A., Grosso F., Vago T., Gramenzi S., Balconi G., Bernasconi R., Nicolis E., Buratti M. G., Ojeda-Fernandez M. L., Vasami A., Thiebat B., Bare C., Corzani A., Coccolo F., Colecchia S., Pellegrini C., Appio L., Caico I., Mesenzani O., Campana C., Gilardoni M., Scognamiglio G., Corrado G., Battagin D., De Rosa F., Carpino C., Palazzo S., Giannessi P. G., Zipoli G., Pastori P., Callegari S., Sesenna C., Fodor C., Guiducci D., Mazza R., Turazza F. M., Vallerio P., Marbello L., Sala E., Fragasso G., Trinca S., Farolfi A., Andreis D., Lanzoni L., Marchetti F., Mioranza E., Banzato A., Re F., Gaibazzi N., Gullo M., Turina M. C., Gervasi E., Giaroli F., Barco B., Bertolini A., Sinagra G., Aleksova A., Guglielmi A., Pinotti G., Gueli R., Mongiardi C., Vallini I., Cardinale, D, Ciceri, F, Latini, R, Franzosi, M, Sandri, M, Civelli, M, Cucchi, G, Menatti, E, Mangiavacchi, M, Cavina, R, Barbieri, E, Gori, S, Colombo, A, Curigliano, G, Salvatici, M, Rizzo, A, Ghisoni, F, Bianchi, A, Falci, C, Aquilina, M, Rocca, A, Monopoli, A, Milandri, C, Rossetti, G, Bregni, M, Malossi, A, Nassiacos, D, Verusio, C, Giordano, M, Staszewsky, L, Barlera, S, Nicolis, E, Magnoli, M, Masson, S, Cipolla, C, Curigliano, Sicuro, M, Rossetti, Maggioni, A, Labianca, R, Tettamanti, M, Senni, M, Finzi, A, Grosso, F, Vago, T, Gramenzi, S, Balconi, G, Bernasconi, R, Buratti, M, Ojeda-Fernandez, M, Vasami, A, Thiebat, B, Bare, C, Corzani, A, Coccolo, F, Colecchia, S, Pellegrini, C, Appio, L, Caico, I, Mesenzani, O, Campana, C, Gilardoni, M, Scognamiglio, G, Corrado, G, Battagin, D, De Rosa, F, Carpino, C, Palazzo, S, Giannessi, P, Zipoli, G, Pastori, P, Callegari, S, Sesenna, C, Fodor, C, Guiducci, D, Mazza, R, Turazza, F, Vallerio, P, Marbello, L, Sala, E, Fragasso, G, Trinca, S, Farolfi, A, Andreis, D, Lanzoni, L, Marchetti, F, Mioranza, E, Banzato, A, Re, F, Gaibazzi, N, Gullo, M, Turina, M, Gervasi, E, Giaroli, F, Barco, B, Bertolini, A, Sinagra, G, Aleksova, A, Guglielmi, A, Pinotti, G, Gueli, R, Mongiardi, C, Vallini, I, Cardinale D., Ciceri F., Latini R., Franzosi M. G., Sandri M. T., Civelli M., Cucchi G., Menatti E., Mangiavacchi M., Cavina R., Barbieri E., Gori S., Colombo A., Curigliano G., Salvatici M., Rizzo A., Ghisoni F., Bianchi A., Falci C., Aquilina M., Rocca A., Monopoli A., Milandri C., Rossetti G., Bregni M., Malossi A., Nassiacos D., Verusio C., Giordano M., Staszewsky L., Barlera S., Nicolis E. B., Magnoli M., Masson S., Cipolla C. M., Sicuro M., Maggioni A. P., Labianca R., Tettamanti M., Senni M., Finzi A., Grosso F., Vago T., Gramenzi S., Balconi G., Bernasconi R., Nicolis E., Buratti M. G., Ojeda-Fernandez M. L., Vasami A., Thiebat B., Bare C., Corzani A., Coccolo F., Colecchia S., Pellegrini C., Appio L., Caico I., Mesenzani O., Campana C., Gilardoni M., Scognamiglio G., Corrado G., Battagin D., De Rosa F., Carpino C., Palazzo S., Giannessi P. G., Zipoli G., Pastori P., Callegari S., Sesenna C., Fodor C., Guiducci D., Mazza R., Turazza F. M., Vallerio P., Marbello L., Sala E., Fragasso G., Trinca S., Farolfi A., Andreis D., Lanzoni L., Marchetti F., Mioranza E., Banzato A., Re F., Gaibazzi N., Gullo M., Turina M. C., Gervasi E., Giaroli F., Barco B., Bertolini A., Sinagra G., Aleksova A., Guglielmi A., Pinotti G., Gueli R., Mongiardi C., and Vallini I.

Abstract

Background: Troponin changes over time have been suggested to allow for an early diagnosis of cardiac injury ensuing cancer chemotherapy; cancer patients with troponin elevation may benefit of therapy with enalapril. It is unknown whether a preventive treatment with enalapril may further increase the benefit. Methods: The International CardioOncology Society-one trial (ICOS-ONE) was a controlled, open-label trial conducted in 21 Italian hospitals. Patients were randomly assigned to two strategies: enalapril in all patients started before chemotherapy (CT; ‘prevention’ arm), and enalapril started only in patients with an increase in troponin during or after CT (‘troponin-triggered’ arm). Troponin was assayed locally in 2596 blood samples, before and after each anthracycline-containing CT cycle and at each study visit; electrocardiogram and echocardiogram were done at baseline, and at 1, 3, 6 and 12-month follow-up. Primary outcome was the incidence of troponin elevation above the threshold. Findings: Of the 273 patients, 88% were women, mean age 51 ± 12 years. The majority (76%) had breast cancer, 3% had a history of hypertension and 4% were diabetic. Epirubicin and doxorubicin were most commonly prescribed, with median cumulative doses of 360 [270–360] and 240 [240–240] mg/m2, respectively. The incidence of troponin elevation was 23% in the prevention and 26% in the troponin-triggered group (p = 0.50). Three patients (1.1%) -two in the prevention, one in the troponin-triggered group-developed cardiotoxicity, defined as 10% point reduction of LV ejection fraction, with values lower than 50%. Interpretation: Low cumulative doses of anthracyclines in adult patients with low cardiovascular risk can raise troponins, without differences between the two strategies of giving enalapril. Considering a benefit of enalapril in the prevention of LV dysfunction, a troponin-triggered strategy may be more convenient.

Published
2018

3. Real-life data on the cardiac toxicity of adjuvant fixed-dose subcutaneous trastuzumab in HER2-positive breast cancer

Author

De Sanctis, R., primary, D'Antonio, F., additional, Agostinetto, E., additional, Marinello, A., additional, Masci, G., additional, Zuradelli, M., additional, Losurdo, A., additional, Guiducci, D., additional, Tinterri, C., additional, Testori, A., additional, Gatzemeier, W., additional, Errico, V., additional, Torrisi, R., additional, and Santoro, A., additional

Published
2018
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16. Smart meter standardisation as a market enabler and flexible information demands

Author

Carciofi, C., MARINA BARBIROLI, Guiducci, D., Riva, G., C. Carciofi, M. Barbiroli, D. Guiducci, and G. Riva

Subjects
BUILDING PENETRATION LOSS, PROPAGATION, metropolitan mesh machine network, smart metering
Abstract

The increasing complexity of energy networks architecture, due to more distributed energy generation and to energy market liberalization, require new policies for management and optimisation of networkparameter and enable the development of new features and applications for the end user. The introduction of smart grids to handle the new distributed generation paradigm can effectively benefit from the adoption of smart metering devices at the customer premises. The main issues required for a smart meter are related both to controlling and reading functionalities. Control functionalities are typically managed by the energy operator, whereas reading functionalities can be of interest both to the operator, for instance for billing information, and to the end-user, as a “smart” energy consumption can be one of the major fallout of these new metering capabilities. In this scenario the communications strategies developed for energy smart metering can be applied to other remote sensing and management applications, such as water and gas smart metering, waste management or public lighting monitoring and control, designing a Metropolitan Mesh Machine Network (M3N), where different machine to machine devices are connected and provide suitable low cost, low power connectivity. M3N are self-organized network and allows new aggregations of nodes, multi hop transmissions and flexible connectivity among smart metering nodes. In this work we focus our attention on the identification of suitable wireless communication systems to be used for the development of the M3N, enabling the interconnection between smart metering nodes and the transmission of consumption or other data to the meter operator database through the broadband fixed network. In this paper Short Range Device (SRD) and WiFi systems are investigated to assess if, in different scenarios, their specific system characteristics such as transmitted power, and access mechanism as well as employed frequency band are adequate for Smart Meter applications. Considering that the huge majority of the endpoints are located below ground (e.g. water pit) the paper investigates influence of propagation phenomena on network performance, in terms of system throughput. It is also investigated the key role of electromagnetic field propagation to provide guidelines for the design, deployment and operation of M3N networks.

Published
2011

18. Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction

Author

Giannuzzi P., Temporelli P.L., Marchioli R., Maggioni A.P., Balestroni G., Ceci V., Chieffo C., Gattone M., Griffo R., Schweiger C., Tavazzi L., Urbinati S., Valagussa F., Vanuzzo D., Girardini D., Francesconi G., Vona M., Santoni R., Sarno C., Calisi P., Forzoni M., Boncompagni L., Tabouret G., Canci U., Rosato G., Stanco G., Gullace G., Carbone C., Gavazzi A., Mazzoleni D., Pinelli G., Frizzelli R., Tortelli O., Pantaleoni A., Mantovani E., Pettinati G., Storti G., Riccio C., Scrutinio D., Passantino A., Guiducci D., Zobbi G., Vanaria D., Barbanti P., Carini V., Coco R., Borrello G., Mazza M.L., Chiesa F., Sansoni C., Morbelli E., Rossi L., Ciglia C., Di Giovanni P., Cocchieri M., Dò V., Trudu A., Albonic D., Bendinelli S., Iori E., Balestra G., Giacometti N., Coppetti S., Priori S., Masotti G., Fattirolli F., Meniconi L., Paolucci P., Malinverni C., Quarenghi F., Fontanelli A., Marini R., Mandorla S., Provvidenza M., Giordano A., De Giuli F., Odoguardi L., Barsotti S., Moccetti T., Molteni A., Mauri F., Lecchi G., Bettini R., Bertoldi A., Zanettini R., Centeleghe P., Corallo S., Rainoldi M.L., Ferratini M., Tavanelli M., Leonetti G., Malfatto G., Pascotto P., Zanocco A., Buchberger R., Masaro G., Cobelli F., Sala L., Musca G., Cauteruccio M.A., Giallauria F., Mininni N., Morra P., Castello A., Sarullo F.M., Castelli D., Tramarin R., De Salvo M., Porcellati C., Giovagnoni F., Anniboletti P.F., Calisti M.G., Vergoni W., Iacopetti L., Zelaschi F., D'Cruz S., Lopizzo A., Caiazza M., Gigli G., Pastine J., Pulitanò G., Ruggeri A., Piovaccari G., Semprini P., Zavatteri G., Diaco T., Lumia F., Tamiz A.M., Oliva G., Galati A., Picelli A., Picelli F., Bosco R., Marcellini G., Zanchè E., Martin G., Masutti S., Milani L., Pizzolato G.M., Occhi G., Partesana N., Baldi N., Polimeni G., Furgi G., Nicolino A., Bevilacqua R., Ingignoli B., Massobrio N., Avogliero G., Pedretti R., Vaninetti R., Donnangelo L., Chiatto M., Gori P., Garbin R., RICCARDI, GABRIELE, VIGORITO, CARLO, Giannuzzi, P., Temporelli, P. L., Marchioli, R., Maggioni, A. P., Balestroni, G., Ceci, V., Chieffo, C., Gattone, M., Griffo, R., Schweiger, C., Tavazzi, L., Urbinati, S., Valagussa, F., Vanuzzo, D., Girardini, D., Francesconi, G., Vona, M., Santoni, R., Sarno, C., Calisi, P., Forzoni, M., Boncompagni, L., Tabouret, G., Canci, U., Rosato, G., Stanco, G., Gullace, G., Carbone, C., Gavazzi, A., Mazzoleni, D., Pinelli, G., Frizzelli, R., Tortelli, O., Pantaleoni, A., Mantovani, E., Pettinati, G., Storti, G., Riccio, C., Scrutinio, D., Passantino, A., Guiducci, D., Zobbi, G., Vanaria, D., Barbanti, P., Carini, V., Coco, R., Borrello, G., Mazza, M. L., Chiesa, F., Sansoni, C., Morbelli, E., Rossi, L., Ciglia, C., Di Giovanni, P., Cocchieri, M., Dò, V., Trudu, A., Albonic, D., Bendinelli, S., Iori, E., Balestra, G., Giacometti, N., Coppetti, S., Priori, S., Masotti, G., Fattirolli, F., Meniconi, L., Paolucci, P., Malinverni, C., Quarenghi, F., Fontanelli, A., Marini, R., Mandorla, S., Provvidenza, M., Giordano, A., De Giuli, F., Odoguardi, L., Barsotti, S., Moccetti, T., Molteni, A., Mauri, F., Lecchi, G., Bettini, R., Bertoldi, A., Zanettini, R., Centeleghe, P., Corallo, S., Rainoldi, M. L., Ferratini, M., Tavanelli, M., Leonetti, G., Malfatto, G., Pascotto, P., Zanocco, A., Buchberger, R., Masaro, G., Cobelli, F., Riccardi, Gabriele, Sala, L., Musca, G., Cauteruccio, M. A., Vigorito, Carlo, Giallauria, F., Mininni, N., Morra, P., Castello, A., Sarullo, F. M., Castelli, D., Tramarin, R., De Salvo, M., Porcellati, C., Giovagnoni, F., Anniboletti, P. F., Calisti, M. G., Vergoni, W., Iacopetti, L., Zelaschi, F., D'Cruz, S., Lopizzo, A., Caiazza, M., Gigli, G., Pastine, J., Pulitanò, G., Ruggeri, A., Piovaccari, G., Semprini, P., Zavatteri, G., Diaco, T., Lumia, F., Tamiz, A. M., Oliva, G., Galati, A., Picelli, A., Picelli, F., Bosco, R., Marcellini, G., Zanchè, E., Martin, G., Masutti, S., Milani, L., Pizzolato, G. M., Occhi, G., Partesana, N., Baldi, N., Polimeni, G., Furgi, G., Nicolino, A., Bevilacqua, R., Ingignoli, B., Massobrio, N., Avogliero, G., Pedretti, R., Vaninetti, R., Donnangelo, L., Chiatto, M., Gori, P., and Garbin, R.

Subjects
Male, medicine.medical_specialty, Myocardial Infarction, GOSPEL, Angina Pectoris, law.invention, Angina, Randomized controlled trial, law, Internal medicine, Myocardial Revascularization, Secondary Prevention, Internal Medicine, medicine, Clinical endpoint, Humans, Myocardial infarction, Life Style, Stroke, Heart Failure, Cardiac Rehabilitation, business.industry, Surrogate endpoint, Hazard ratio, Middle Aged, medicine.disease, Heart failure, Physical therapy, Female, business, Stress, Psychological
Abstract

Background Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a long-term, relatively intensive rehabilitation strategy after MI. Methods We conducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n = 1620) or usual care (control group; n = 1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. Results End point events occurred in 556 patients (17.2%). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1% vs 18.2%; hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2% vs 4.8%; HR, 0.67; 95% CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5% vs 4.0%; HR, 0.64; 95% CI, 0.43-0.94), and nonfatal MI (1.4% vs 2.7%; HR, 0.52; 95% CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. Conclusion The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. Trial Registration ClinicalTrials.gov Identifier:NCT00421876

Published
2008
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23. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group

Author

APPLEBY, P, BAIGENT, C, COLLINS, R, FLATHER, M, PARISH, S, PETO, R, BELL, P, HALLS, H, MEAD, G, DIAZ, R, PAOLASSO, E, PAVIOTTI, C, ROMERO, G, CAMPBELL, T, OROURKE, M, THOMPSON, P, LESAFFRE, E, VANDEWERF, F, VERSTRAETE, M, ARMSTRONG, P, CAIRNS, J, MORAN, C, TURPIE, A, YUSUF, S, GRANDE, P, HEIKKILA, J, KALA, R, BASSAND, J, BOISSEL, J, BROCHIER, M, LEIZOROVICZ, A, BRUGGEMANN, T, KARSCH, K, KASPER, W, LAMMERTS, D, NEUHAUS, K, MEYER, J, SCHRODER, R, VONESSEN, R, SARAN, R, ARDISSINO, D, BONADUCE, D, BRUNELLI, C, CERNIGLIARO, C, FORESTI, A, FRANZOSI, M, GUIDUCCI, D, MAGGIONI, A, MAGNANI, B, MATTIOLI, G, ROSSI, P, SAONTRO, E, TOGNONI, G, VISANI, L, ZENNARO, R, KANEMOTO, N, KAWAI, C, ARNOLD, A, BAR, F, SIMOONS, M, VERHEUGT, F, VERMEER, F, WHITE, H, SEABRAGOMES, R, FIGUERAS, J, LOPEZSENDON, J, GRIP, L, HERLITZ, J, KARLSSON, J, WALLENTIN, L, MONNIER, P, ADAMS, P, BEEN, M, CHAMBERLAIN, D, DEBONO, D, DOLL, R, DUFF, D, FOX, K, SREEHARAN, N, HILLIS, W, JULIAN, D, MALCOLM, A, MURRAY, R, PATTERSON, D, POCOCK, S, REID, D, SANDERCOCK, P, SIGWART, U, SKELDING, J, SKENE, A, SLEIGHT, P, TIMMIS, A, WARLOW, C, WILCOX, R, ALLEN, A, ANDERSON, J, BRAUNWALD, E, CALIFF, R, GOLD, H, GRANETT, J, GRAINGER, C, GUERCI, A, HENNEKENS, C, HONAN, M, KENNEDY, J, KNATTERUD, G, LEE, K, LEIMBERGER, J, LENERT, L, LITTLEJOHN, J, MAYNARD, C, NICKLAS, J, OHMAN, M, OLSON, H, PASSAMANI, E, RYAN, T, SELKER, H, STUMP, D, TOPOL, E, WEAVER, W, WILLIAMS, D, and WOODLIEF, L

Abstract

Large randomised trials have demonstrated that fibrinolytic therapy can reduce mortality in patients with suspected acute myocardial infarction (AMI). The indications for, and contraindications to, this treatment in some categories of patient are disputed, examples being late presentation, elderly patients, and those in cardiogenic shock. This overview aims to help resolve some of the remaining uncertainties. From all trials of fibrinolytic therapy versus control that randomised more than 1000 patients with suspected AMI, information was sought and checked on deaths during the first 5 weeks and on major adverse events occurring during hospitalisation. The nine trials included 58,600 patients, among whom 6177 (10.5%) deaths, 564 (1.0%) strokes, and 436 (0.7%) major non-cerebral bleeds were reported. Fibrinolytic therapy was associated with an excess of deaths during days 0-1 (especially among patients presenting more than 12 h after symptom onset, and in the elderly) but this was outweighed by a much larger benefit during days 2-35. This "early hazard" should not obscure the very clear overall survival advantage that is produced by fibrinolytic therapy. Benefit was observed among patients presenting with ST elevation or bundle-branch block (BBB)--irrespective of age, sex, blood pressure, heart rate, or previous history of myocardial infarction or diabetes--and was greater the earlier treatment began. Among the 45,000 patients presenting with ST elevation or BBB the relation between benefit and delay from symptom onset indicated highly significant absolute mortality reductions of about 30 per 1000 for those presenting within 0-6 h and of about 20 per 1000 for those presenting 7-12 h from onset, and a statistically uncertain benefit of about 10 per 1000 for those presenting at 13-18 h (with more randomised evidence needed in this latter group to assess reliably the net effects of treatment). Fibrinolytic therapy was associated with about 4 extra strokes per 1000 during days 0-1: of these, 2 were associated with early death and so were already accounted for in the overall mortality reduction, 1 was moderately or severely disabling, and 1 was not. This overview indicates that fibrinolytic therapy is beneficial in a much wider range of patients than is currently given such treatment routinely.

Published
1994

31. A study on roof-to-street propagation

Author

Vittorio Degli-Esposti, Fuschini, F., Guiducci, D., Degli Esposti, V, Fuschini, F., and Guiducci, D.

Subjects
Wireless propagation, Roof-to-street
Abstract

In Over-Roof-Top (ORT) propagation, Roof- To-Street (RTS) propagation represents the fundamental mechanisms which allows the radio signal to reach the mobile at street level. In the present work RTS propagation is analyzed and modeled in a complete way, also including diffuse scattering, which is evaluated with the 'effective roughness' approach. Simulation results show that RTS plays a fundamental role, and its complete modeling can sensibly increase the accuracy of the prediction with respect to conventional models.

32. Evaluation and analysis of the hidden node margin for cognitive radio system operation in a real scenario

Author

MARINA BARBIROLI, Carciofi, C., Guidotti, A., Guiducci, D., M. Barbiroli, C. Carciofi, A. Guidotti, and D. Guiducci

Subjects
White Space Device, COGNITIVE RADIO, DTT system, hidden node
Abstract

In this paper the hidden node problem for cognitive radio systems is addressed in real environments. The hidden node margin related to the implementation of spectrum sensing algorithms in autonomous operation, has been evaluated with two different methodologies: ray-tracing deterministic and statistical approaches. The hidden node margin simulation results are shown for different urban scenarios and as a function of the topological parameters (e.g. street width).

33. Characterization of WiMAX propagation in microcellular and picocellular environments

Author

MARINA BARBIROLI, Carciofi, C., Esposti, V. D., Fuschini, F., Grazioso, P., Guiducci, D., Robalo, D., Velez, F. J., M. Barbiroli, C.Carciofi, V. Degli Esposti, F. Fuschini, P. Grazioso, D. Guiducci, D. Robalo, and F. J. Velez

Subjects
URBAN PROPAGATION, WIMAX, FIELD MEASUREMENTS, RAY-TRACING
Abstract

In this paper different propagation models for coverage prediction of WiMAX microcellular and picocellular urban environments and for WiMAX indoor femtocells at 3.5 GHz are compared with experimental data. Results obtained for different urban and indoor environments show that statistical models are quite far from good agreement with experimental data while deterministic ray-tracing models provide appropriate prediction in all different complex analyzed environments.

34. Effects of a screening program for hypertension in a community

Author

Radice M, Alli C, Fausto Avanzini, Di Tullio M, Guiducci D, Mariotti G, and Taioli E

Subjects
Adult, Male, Time Factors, Attitude of Health Personnel, Blood Pressure, Middle Aged, Italy, Risk Factors, Hypertension, Prevalence, Humans, Mass Screening, Female, Attitude to Health, Antihypertensive Agents
Abstract

The effect of a population screening for hypertension was assessed through a subsequent survey performed 1 year later. All the hypertensives identified at the first visit (239 subjects, 15.6% of the whole screened population) were invited for a re-examination: the adhesion rate was 84.5%. After the screening, a high proportion of subjects (74.7%) had contacted their physicians because of their blood pressure. The most common advice physicians gave was to have further measurements of blood pressure (72.8%). Laboratory tests were prescribed in 62 patients (41.1%), but a complete assessment of a target organ damage was carried out in few cases (1.9%). Only 19.5% of patients started a course of treatment during the year following the screening and no more than one-third of those with moderate to severe hypertension. Out of the 176 subjects showing other cardiovascular risk factors at the screening, only 12 reported they had modified their habits 1 year later. Our results suggest that a screening for hypertension, when performed without any liaison with other medical facilities, seems to have a poor impact on physicians' and patients' attitudes towards hypertension.

37. Assessment of Population and Occupational Exposure to Wi-Fi Systems: Measurements and Simulations

Author

Claudia Carciofi, Marina Barbiroli, Doriana Guiducci, Barbiroli M., Carciofi C., and Guiducci D

Subjects
RADIO PROPAGATION, education.field_of_study, Electromagnetics, Computer science, Population, Condensed Matter Physics, Atomic and Molecular Physics, and Optics, Radio propagation, Wireless lan, Electronic engineering, Radiowave propagation, Wide band, Occupational exposure, MEASUREMENTS, NEAR FIELD, Electrical and Electronic Engineering, Wideband, education, Simulation, RAY-TRACING
Abstract

In this study, the impact of Wi-Fi access points is investigated in terms of electromagnetic field exposure evaluations. Installations, typically present in common living contexts, have been analyzed by means of both wideband and narrow-band measurements and simulation-prediction tools. The obtained results show that exposure due to these systems is compliant with the limits provided by regulation.

Published
2011

38. Soft tissue changes during orthopedic therapy: An in vivo 3-dimensional facial scan study.

Author

Pellitteri F, Albertini P, Brucculeri L, Cremonini F, Guiducci D, Falconi V, and Lombardo L

Abstract

Introduction: The aim was to compare the soft tissue changes in pretreatment and posttreatment facial scans of patients who had undergone various orthopedic treatments vs a control group of untreated growing patients., Methods: Facial scans were performed before (T0) and after (T1) orthopedic treatment in 15 patients prescribed rapid palatal expander (RPE), 15 cervical headgear (HG), and 15 facemasks (FM), as well as 6 months apart in 15 untreated growing patients. After best-fit scan alignment using Geometric Control X software (3D Systems Inc, Rock Hill, SC), a 3-dimensional (3D) analysis of soft tissue changes was performed, comparing 3D reference points (total 22) and 8 areas on T0 and T1 scans. Kruskal-Wallis nonparametric tests and pairwise comparison with Bonferroni's correction were applied to identify any statistically significant differences among groups (P <0.05). All analyses were conducted with SPSS software (version 28; IBM, Armonk, NY)., Results: At T1, reduced soft tissue projection was found at the nose and upper lip in the HG group, the lower lip in the HG and RPE groups, and the chin in the FM and RPE groups. The RPE group displayed a statistically significant increase in facial divergence, confirmed by gnathion position (RPE vs FM [P = 0.018] and RPE vs control [P = 0.046]), as well as an increase in the soft tissue projection of both cheeks (left cheek in range of 1-2 mm [P = 0.030] and range of 0 to -1 mm [P = 0.022]; right cheek in range of 1-2 mm [P = 0.003] and range -1 to -2 mm [P = 0.001]). There were no clinically significant differences among groups in mandibular right and left body areas., Conclusions: The 3D facial analysis revealed significant differences in soft tissues among orthopedic treatments, especially at the upper and lower lip and chin areas, as compared with untreated patients., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Published
2024
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39. Compliance with Headgear Evaluated by Force- and Temperature-Sensitive Monitoring Device: A Case-Control Study.

Author

Cremonini F, Karami Shabankare A, Guiducci D, and Lombardo L

Abstract

The aim was to objectively assess compliance in patients prescribed headgear and evaluate the impact of monitoring awareness, treatment duration, gender, and age on compliance levels. A total of 22 patients with Class II malocclusion wore the headgear integrated with the force and temperature sensitive Smartgear monitoring system (Smartgear, Swissorthodontics AG, Cham, Switzerland). Patients were instructed to wear the headgear for 13 h daily over a 3-month period. Randomly, 11 patients were informed that they monitored and 11 were not informed. Data were organized using Microsoft Excel and analyzed using R for statistical estimates, graphs, and hypothesis testing. Smartgear recorded an average daily compliance of 6.7 h. No statistically significant differences were found in cooperation between study group and control group over the 3 months of treatment, regardless of gender and age. However, there was slight greater cooperation in the first month than in the other months, and patients ≤10 years of age had almost 2 h more cooperation than their older counterparts. Moreover, the informed group exhibited an average of 1.1 more hours of cooperation per day than the uninformed group, which may carry clinical significance. This cooperation primarily occurred at night and was found to be statistically significant. Compliance among young patients typically remained lower than the prescribed level, regardless of their gender and psychological maturity. Although an awareness of monitoring does not seem to improve compliance, implementing such systems could still offer dentists a valuable means of obtaining objective information about their patients' adherence.

Published
2024
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40. Class III treatment with skeletal alternating rapid maxillary expansion and constriction protocol and facemask followed by clear aligners.

Author

Palone M, Guiducci D, Albertini P, Cremonini F, and Lombardo L

Subjects
Humans, Female, Orthodontic Appliance Design, Male, Cephalometry, Tooth Movement Techniques instrumentation, Tooth Movement Techniques methods, Adolescent, Palatal Expansion Technique instrumentation, Malocclusion, Angle Class III therapy, Extraoral Traction Appliances
Published
2024

41. CAD/CAM-based 3D-printed and PVS indirect bonding jig system accuracy: a systematic review, meta-analysis, and comparative analysis of hard and soft CAD/CAM transfer trays.

Author

Palone M, Fazio M, Pellitteri F, Guiducci D, Cremonini F, Pozzetti I, Tola M, and Lombardo L

Subjects
Prospective Studies, Printing, Three-Dimensional
Abstract

Background: The widespread use of CAD/CAM transfer trays warrants evaluation of their accuracy as compared to PVS transfer trays., Objectives: To quantify the accuracy of CAD/CAM and PVS transfer trays, investigating any differences between soft and hard trays CAD/CAM transfer trays., Search Methods: Eight different databases (Scopus, Web of Science, PubMed, Google Scholar, ProQuest, Embase, Cochrane Library, ClinicalTrials.gov) were searched, without restrictions, up to an end date of February 2023., Selection Criteria: Clinical trials (randomized and non-randomized) and in vitro studies reporting average imprecision values for bracket positioning obtained by digital superimpositions of digitally planned and real positions., Data Collection and Analysis: Data eligibility, data extraction, and risk of bias (RoB-2 and ROBINS-I) were conducted independently. The data, where possible, were synthesized and quantitatively analysed (meta-analysis of mean differences with 95% confidence intervals). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) analysis of the quality of evidence was performed. The t-test for independent samples was used to compare the transfer accuracy of hard and soft CAD/CAM transfer trays., Results: Thirteen studies were synthesized in this systematic review, and then eight studies were included in the quantitative meta-analysis. As regards linear measurements, there was a mean transfer error of 0.0752 mm (95%CI: 0.0428, 0.1076) for mesiodistal measures, 0.0943 mm (95%CI: 0.0402, 0.1484) for vertical, and 0.0815 mm (95%CI: 0.0469, 0.1160) for buccolingual. As for angular measurements, there was an average transfer error of 1.2279° (95% CI: 0.6011, 1.8548) for inclination, 0.9397° (95%CI: 0.4672, 1.4123) for angulation, and 0.8721° (95%CI: 0.4257, 1.3185) for rotation. CAD/CAM transfer trays were less accurate than polyvinylsiloxane (PVS) transfer trays, with those made of soft material being more accurate than the hard ones, except for vertical dimension. The GRADE quality of evidence ranged from very low to moderate., Conclusions and Implications: CAD/CAM transfer trays provide high bracket positioning accuracy, with soft transfer trays offering greater precision than rigid ones. Future randomized prospective trials are required to enhance the strength of the available evidence., Registration: Prospero (CRD42023401278 number)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Published
2024
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42. Evaluation of effectiveness and efficiency of fixed orthodontic treatment comparing standard and computer-aided design and manufacturing conventional bracket systems using indirect bonding for both: A retrospective study.

Author

Palone M, Bizzocchi C, Guiducci D, Cremonini F, Pellitteri F, Spedicato GA, Verducci A, and Lombardo L

Subjects
Male, Female, Humans, Child, Adolescent, Retrospective Studies, Models, Dental, Computer-Aided Design, Dental Bonding methods, Orthodontic Brackets
Abstract

Background: To compare the effectiveness and efficiency of orthodontic treatment (OT) with standard versus computer-aided design and computer-aided manufacturing (CAD/CAM) indirect bonding of conventional brackets., Methods: This retrospective study examined two groups: standard indirect bonding group (12 males, 13 females; mean age 12.21 ± 0.52 years), and digital indirect bonding group (11 males, 14 females; mean age 12.76 ± 1.32 years), treated via a CAD/CAM indirect bonding system. Conventional brackets were used in both groups. Pretreatment and post-treatment records were acquired for all subjects. Weighted Peer Assessment Rating (W-PAR) index was used to assess the effectiveness of OT, in conjunction with five angular cephalometric measurements (ANB°, Sn-GoGn°, U1-PP°, IMPA° and FMA°) and comparatively analyzed using generalized mixed-effects models and post hoc test. Treatment efficiency was assessed in terms of the numbers of bracket repositionings, archwire bends, accidental bracket debondings, appointments and treatment months. Comparative analysis of efficiency was performed using the asymptotic Wilcoxon-Mann-Witney test. Statistical significance was set at 5%., Results: Total W-PAR and W-PAR component scores decreased significantly during treatment for both groups and in a similar way. Cephalometric measures ANB° and IMPA° significantly decreased and increased, respectively. Significantly fewer bracket repositionings, number of appointments and treatment months were recorded in group digital indirect bonding., Conclusions: Although both methods investigated were effective to achieve good outcomes, CAD/CAM indirect bonding method increased the efficiency of OT, when conventional brackets are used., (Copyright © 2023 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Published
2023
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43. A non-invasive system to manage impacted teeth associated with a large dentigerous cyst.

Author

Maltoni M, Maltoni I, Santucci G, Guiducci D, Cremonini F, and Lombardo L

Subjects
Humans, Male, Tongue, Cuspid, Tooth, Impacted complications, Tooth, Impacted diagnostic imaging, Tooth, Impacted therapy, Dentigerous Cyst complications, Dentigerous Cyst diagnostic imaging, Dentigerous Cyst surgery
Abstract

A male patient aged 11 years presented a large dentigerous cyst in the lower left quadrant associated with retained deciduous lower lateral incisor and canine and impacted, unerupted corresponding permanent ones. The treatment consisted in marsupialisation and placement of a modified lingual arch that held a tube for decompression used for irrigation of the cystic cavity in a comfortable way for the patient and for the clinician.The same lingual arch was later used as an anchorage method for traction of the retained teeth. The final records showed complete resolution of the cyst and retained teeth were successfully Aligned into the oral cavity., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2023
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44. Combined use of F22 aligners and intermaxillary elastics in mild skeletal Class II: Two case reports.

Author

Palone M, Cremonini F, Guiducci D, and Lombardo L

Subjects
Humans, Cephalometry, Overbite therapy, Malocclusion, Angle Class II diagnostic imaging, Malocclusion, Angle Class II therapy
Abstract

Introduction: The aim of these two case-reports is to illustrate and compare the therapeutic effects of Class II elastics in combination with F22 aligners in an adult and an adolescent patient, respectively., Case Presentation: Two patients with a mild skeletal Class II malocclusion, associated with mild-to-moderate crowding, presented for orthodontic treatment. The first patient was 12 years old, while the second was 40 years old. In both cases, the goal was to obtain bilateral molar and canine Class I with ideal overjet and overbite, and Class II skeletal relationship improvement in the young patient as well. Both treatments were approached without extractions and using clear aligners (CAs) in combination with Class II elastics, giving the patient the opportunity to take advantage of a therapy that is both comfortable and aesthetic., Discussion: Final records of both cases demonstrate how appropriate analysis and diagnosis enable CAs in conjunction with Class II elastics to be used with considerable efficiency and efficacy for Class II treatment. In the first case, the key to success was exploiting residual jaw growth, while in the second case it was careful orthodontic digital planning., Conclusion: In the presence of good patient compliance, CAs associated with Class II elastics provide satisfactory occlusal outcomes if biomechanics and digital set-up are carefully evaluated and executed and if diagnosis is appropriate.

Published
2023
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46. Clinical predictors of cardiac toxicity in HER2-positive early breast cancer patients treated with adjuvant s.c. versus i.v. trastuzumab.

Author

De Sanctis R, Giordano L, D'Antonio F, Agostinetto E, Marinello A, Guiducci D, Masci G, Losurdo A, Zuradelli M, Torrisi R, and Santoro A

Subjects
Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal therapeutic use, Antineoplastic Agents therapeutic use, Chemotherapy, Adjuvant, Female, Humans, Middle Aged, Retrospective Studies, Trastuzumab therapeutic use, Antibodies, Monoclonal adverse effects, Antineoplastic Agents adverse effects, Breast Neoplasms drug therapy, Cardiotoxicity epidemiology, Heart drug effects, Receptor, ErbB-2 analysis, Trastuzumab adverse effects, Ventricular Function, Left drug effects
Abstract

Background: Few data are available about real-life cardiotoxicity associated with s.c. versus i.v. trastuzumab treatment of early-stage, HER2-positive breast cancer, and little is known about its predisposing factors., Patients and Methods: We retrospectively reviewed data of 363 adult patients treated with adjuvant trastuzumab for HER2-positive breast cancer. Univariate statistical analysis was performed, and a multivariable logistic model was developed to identify independent risk factors of cardiac toxicity., Results: Within 5 years, the overall incidence of events meeting our criteria was 11.8%, and an early discontinuation of trastuzumab was recorded in 20 patients (5.5%). No cases of congestive heart failure occurred, neither multiple events per patient were observed. A total of 184 patients received i.v. and 179 received s.c. trastuzumab. Compared with the s.c. formulation, a higher cardiotoxicity rate for the i.v. administration (15.2% vs 8.4%) was found, and particularly in those patients with cardiovascular risk factors (19.3% vs 8.7%), at the univariate and multivariate analyses. Although more patients with prior anthracycline-based chemotherapy experienced cardiac events, the association of this therapy with cardiac events was not significant. The incidence of cardiac events was not influenced by anthropometric data (e.g. body mass index) or a diagnosis of diabetes mellitus. 5-year event-free survival was 91.7% in the overall population; event-free survival rates were similar between the s.c. and the i.v. groups., Conclusion: Our study shows a more favorable safety profile of s.c. versus i.v trastuzumab administration. The use of s.c. trastuzumab could be advisable in at-risk patients., Competing Interests: Declaration of competing interest Armando Santoro has received honoraria from BMS, AstraZeneca, MSD, Lilly, Bayer, Takeda, Roche, Mundipharma, Novartis, Servier, Amgen, ArQule, Celgene, Incyte, AbbVie, Gilead, Pfizer, Daiichi, Sandoz, and Sanofi. Rita De Sanctis has received honoraria form EISAI, Kyowa Kirin and Novartis. The other authors have no funding and conflicts of interests to disclose., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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47. Reading the landscape: Legible environments and hominin dispersals.

Author

Guiducci D and Burke A

Subjects
Animals, Hominidae, Archaeology methods, Environment, Geographic Information Systems, Software, Spatial Navigation physiology
Abstract

Wayfinding, or the ability to plan and navigate a course over the landscape, is a subject of investigation in geography, neurophysiology, psychology, urban planning, and landscape design. With the prevalence of GPS-assisted navigation systems, or "wayfinders," computer scientists are also increasingly interested in understanding how people plan their movements and guide others. However, the importance of wayfinding as a process that regulates human mobility has only recently been incorporated into archeological research design. Hominin groups were able to disperse widely during the course of prehistory. The scope of these dispersals speaks to the innate navigation abilities of hominins. Their long-term success must have depended on an ability to communicate spatial information effectively. Here, we consider the extent to which some landscapes may have been more conducive to wayfinding than others. We also describe a tool we have created for quantifying landscape legibility (sensu Gollege), a complex and under-explored concept in archeology, with a view to investigating the impact of landscape structure on human wayfinding and thus, patterns of dispersal during prehistory. To this end, we have developed a method for quantifying legibility using a Geographic Information System (GIS) and apply it to a test case in prehistoric Iberia., (© 2016 Wiley Periodicals, Inc.)

Published
2016
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48. Exploring the impact of climate variability during the Last Glacial Maximum on the pattern of human occupation of Iberia.

Author

Burke A, Levavasseur G, James PM, Guiducci D, Izquierdo MA, Bourgeon L, Kageyama M, Ramstein G, and Vrac M

Subjects
Climate, Humans, Models, Theoretical, Portugal, Spain, Archaeology, Climate Change, Population Dynamics
Abstract

The Last Glacial Maximum (LGM) was a global climate event, which had significant repercussions for the spatial distribution and demographic history of prehistoric populations. In Eurasia, the LGM coincides with a potential bottleneck for modern humans and may mark the divergence date for Asian and European populations (Keinan et al., 2007). In this research, the impact of climate variability on human populations in the Iberian Peninsula during the Last Glacial Maximum (LGM) is examined with the aid of downscaled high-resolution (16 × 16 km) numerical climate experiments. Human sensitivity to short time-scale (inter-annual) climate variability during this key time period, which follows the initial modern human colonisation of Eurasia and the extinction of the Neanderthals, is tested using the spatial distribution of archaeological sites. Results indicate that anatomically modern human populations responded to small-scale spatial patterning in climate variability, specifically inter-annual variability in precipitation levels as measured by the standard precipitation index. Climate variability at less than millennial scale, therefore, is shown to be an important component of ecological risk, one that played a role in regulating the spatial behaviour of prehistoric human populations and consequently affected their social networks., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Published
2014
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49. Early effects of exercise training on on- and off-kinetics in 50-year-old subjects.

Author

Fukuoka Y, Grassi B, Conti M, Guiducci D, Sutti M, Marconi C, and Cerretelli P

Subjects
Adult, Exercise Test, Heart Rate physiology, Humans, Male, Middle Aged, Pulmonary Gas Exchange physiology, Aging physiology, Oxygen Consumption physiology, Physical Endurance physiology
Abstract

We tested the hypothesis that, in healthy middle-aged subjects ( n=11, age 51.0 +/- 3.0 years, x +/- SD), the effects of exercise training on pulmonary O(2) uptake (VO(2)) on- and off-kinetics would appear earlier than those on peak. The subjects underwent a standard training program (combined endurance and resistance training) in a health club, and were evaluated before training ("time 0", T0), and after 7 (T7), 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days of training. Breath-by-breath pulmonary O(2) uptake (VO(2)), heart rate (HR), systolic (SBP) and diastolic blood pressure, and capillary blood lactate concentration ([La](b)) were determined at rest and at each workload (w during a cycle ergometer incremental exercise test. The "heart rate x blood pressure product" was calculated as (HR x SBP). The day following the incremental test, the subjects performed three repetitions of a square-wave exercise at 50% of VO(2), for the determination of pulmonary VO(2) on- and off-kinetics. VO(2) and [La](bpeak) tended to increase with training; the increases became significant at T60 or T90. HR(peak)and (HR x SBP)(peak) were unaffected by training. The time constant of the "primary" component of the VO(2) on-kinetics (tau(2)) was 46.9 +/- 17.3 s (T0), 38.1 +/- 14.2 s (T7), 34.4 +/- 12.6 s (T15), 28.8 +/- 6.8 s (T30), 30.2 +/- 8.0 s (T60), and 30.4 +/- 12.4 s (T90); a significant difference compared to T0 was observed from T15 onward. From T15 onward, tau(2) were not significantly different from values obtained (29.2 +/- 5.3 s) from a group of healthy untrained young controls ( n=7, 21.6 +/- 0.5 years). The same pattern of change as a function of training was described for the VO(2) off-kinetics. It is concluded that in 50-year-old subjects VO(2) on- and off-kinetics are more sensitive to exercise training than other physiological variables determined at peak exercise.

Published
2002
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50. Effects of a screening program for hypertension in a community.

Author

Radice M, Alli C, Avanzini F, Di Tullio M, Guiducci D, Mariotti G, and Taioli E

Subjects
Adult, Blood Pressure physiology, Female, Humans, Hypertension physiopathology, Hypertension prevention & control, Hypertension psychology, Italy epidemiology, Male, Middle Aged, Prevalence, Risk Factors, Time Factors, Antihypertensive Agents therapeutic use, Attitude of Health Personnel, Attitude to Health, Hypertension epidemiology, Mass Screening
Abstract

The effect of a population screening for hypertension was assessed through a subsequent survey performed 1 year later. All the hypertensives identified at the first visit (239 subjects, 15.6% of the whole screened population) were invited for a re-examination: the adhesion rate was 84.5%. After the screening, a high proportion of subjects (74.7%) had contacted their physicians because of their blood pressure. The most common advice physicians gave was to have further measurements of blood pressure (72.8%). Laboratory tests were prescribed in 62 patients (41.1%), but a complete assessment of a target organ damage was carried out in few cases (1.9%). Only 19.5% of patients started a course of treatment during the year following the screening and no more than one-third of those with moderate to severe hypertension. Out of the 176 subjects showing other cardiovascular risk factors at the screening, only 12 reported they had modified their habits 1 year later. Our results suggest that a screening for hypertension, when performed without any liaison with other medical facilities, seems to have a poor impact on physicians' and patients' attitudes towards hypertension.

Published
1991

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