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Background Heart Failure (HF) is a relevant issue for public health issue: it affects more than 64 million people worldwide1, and its burden is anticipated to increase as the population ages. Dapagliflozin is an inhibitor of the sodium–glucose cotransporter–2 (SGLT2i). In the DAPA–HF trial, dapagliflozin reduced the risk of hospitalisation for HF and death in patients with HFrEF (with or without Type 2 Diabetes) compared to placebo2,3,4. Currently, there is a lack of data on characteristics, treatment profiles, and patient reported outcomes (PROs) of patients initiated on dapagliflozin for HFrEF in clinical practice: the EVOLUTION–HF programme is aimed at answering those questions by collecting real–world data in 13 European Countries, including Italy. The primary objective is to characterise patients initiated on dapagliflozin for the treatment of HFrEF and to estimate occurrence of treatment discontinuations. Secondary objectives include an assessment of Health–related Quality of Life (HR–QoL) by means of the Kansas City Cardiomyopathy Questionnaire (KCCQ), patient–reported adherence to prescriptions of pharmacological treatments for HF (Medication Adherence Report Scale – 5 Item), performance on 6–Minutes Walking Test. Methods The study has an observational, longitudinal, descriptive design. To be enrolled, patients must be 18 years old or older and have initiated treatment with dapagliflozin according to the approved HFrEF label. Patients with a diagnosis of Type 1 Diabetes or previously treated with any SGLT2i are excluded from the study. Follow–up lasts one year from start of treatment. Sample size has been estimated in 250 patients, that will be enrolled in 11 centres. Results The study is currently ongoing, and it will generate evidences on the use and tolerability of dapagliflozin, as well as on treatment patterns of other pharmacological therapies for HF and diabetes. Also, the study will generate data from PROs regarding change of KCCQ across time, adherence to HF therapies in clinical practice, and 6–Minutes Walking Tesst. Multivariate analyses will evaluate association between patients’ characteristics and interruption of treatment, adherence and HR–QoL. The interim analysis will be available in the first months of 2023. Conclusions The EVOLUTION–HF Italy study Il programma di studio EVOLUTION–HF supporterà la pratica clinica con dati originali sull‘uso nel mondo reale delle nuove terapie farmacologiche per l‘HFrEF.

Atrial thrombosis is an uncommon complication of cardiac transplant, especially when performed with standard technique. Pathogenetic mechanisms might involve atrial anatomy distortion and abnormalities in its contractile function, which induce flow stasis and thrombus formation, mostly on the surgical suture. A 77–year–old man underwent orthotopic heart transplantation in 2000 for post–ischemic dilated cardiomyopathy. In 2019 he was diagnosed with diffuse large B–cell lymphoma treated with chemotherapy. On March 2021, during follow up period, he had a total body CT scan which showed a submandibular space–occupying lesion, likely as a disease recurrence, and a large atrial mass (30x50 mm). For this reason, he was admitted to the emergency department. Echocardiography documented a massive hyperechogenic formation in an enlarged left atrium. In order to rule out a neoplastic nature, a cardiac CMR was performed, confirming the presence of an oval mass adhering to the posterior left atrial wall with partial involvement of pulmonary veins ostia, with inhomogeneous isointense signal on T1–weighted sequences and hyper–isointense signal on T2–weighted sequences, without significant contrast enhancement, likely representing an endoluminal thrombotic formation. Given the patient’s clinical status and his hemodynamic stability, a surgical excision was deferred. The patient was discharged on oral anticoagulant therapy with Warfarin (INR target 2–3). Three months later, a chest CT showed a meaningful mass reduction (11x18mm), which was no longer visible at echocardiography. About 9 months later, complete disappearance of the atrial mass was found at a CT scan. According to scientific literature, differential diagnosis of a newly discovered atrial mass in a transplanted heart includes thrombosis or neoplasia. Thrombosis occurs usually early after surgery, but due to promoting factors, it can arise after many years. The most likely triggering condition is an acquired prothrombotic status: in our case the likely lymphoma recurrence may have led to thrombogenesis. In order to exclude with confidence cardiac metastasis, histological examination would have been necessary. Nevertheless, the meaningful mass reduction, as early as three months after starting oral anticoagulation, and its disappearance nine months after, strongly suggests for atrial thrombosis.

Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery.The aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain.A randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication.The findings of this study indicate that foot massage significantly (p .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group.Providing non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants' satisfaction.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Experiments involving nano-focusing or coherence applications require positional stability of a few nanometers and angular stability of tens of nanoradians for all critical optical components along the beamline (in the range of 1 Hz up to 2.5 kHz). Several optical components based on high-precision mechatronics principles with optimized dynamics to cope with those stability requirements have been recently designed and developed at LNLS. An approach combining optical and mechanical design methodologies and processes was applied to new beamline projects. The process starts with optical design using ray-tracing and wave propagation simulations aiming for the specified beam parameters. In a second step, alignment tolerances and stability issues are addressed in the mechanical design of each component. If those requirements cannot be reached in the predictive models based on the available technologies, size and shape of the optics itself or the optical scheme may be redefined restarting the optical simulation. This work applies this beamline design process to the CATERETÊ beamline, which allows for plane-wave CDI experiments. Using side-bounce deflecting cylindrical mirrors and a four-crystal monochromator, a focused beam size of ~ 40 x 30 μm2 (at 9 keV) with a depth-of-focus of 12 m (plane-wave) and high degree of coherence is obtained. We review key aspects of the optical and mechanical designs. In addition, we further extend the modelling process to enable systematic commissioning support by simulating beam parameters on diagnostic elements located downstream each optical element.

The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center.Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed.Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions.Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

International audience; In this work, we analytically characterize the acoustic properties of a one-port nonlinear acoustic sample loaded on a waveguide. The classical reflection coefficient is extended as a scattering matrix relating the incident wave fundamental and harmonics amplitudes to the backward wave fundamental and harmonics amplitudes. Assuming that the acoustic load is defined as a nonlinear differential equation relating the acoustic pressure and the associated volume velocity, the scattering matrix is obtained by combining the harmonic balance method and the polyharmonic distortion approach. Theoretical and numerical aspects are considered. The proposed method is exemplified on two acoustic nonlinear absorbers.

Background Streptococcus pneumoniae (SP) is a major cause of pneumonia worldwide representing a significant problem from the public health viewpoint. The aim of our study was to assess the frequency of SP in hospitalized patients with pneumonia and investigate its relationship with patients' characteristics. Methods A deterministic record linkage of hospital discharge and microbiology laboratory surveillance databases of a teaching hospital in Rome was used to identify all patients over 15 years old (y) with a diagnosis of pneumonia and a microbiological ascertainment between November 2010 and March 2013. Pneumonia ICD-9-CM codes were used to identify the study population. The frequency of SP was assessed with respect to patients' characteristics. Results 1216 (64% males) of a mean age 65 (SD = 18) y patients with pneumonia were identified. Of them, 707 (58%) had a positive microbiological result. Among the latter, mixed bacterial co-infections were detected in 552 (74%) cases. The most frequently isolated organism was SP in 288 (41%) cases. Nevertheless, SP was the sole isolated agent in only 6 (0.8%) cases. There were no significant differences between men and women with respect to the frequency of SP. Eventually, the frequency of SP among patients with a positive microbiological result was higher in the age group 15-64 y than in 65+ y (45% vs 37%, p = 0.038). When considering only subjects with at least one comorbidity the frequency of SP was higher among the 15-64 y age group (53% vs 44% in 15-64 y and 65+ y respectively, p = 0.040). Conclusions Our study revealed that SP was the most frequent isolated pathogen in hospitalized patients with pneumonia. However, the SP coexistence with other pathogens was present in the vast majority of cases. Interestingly, SP was highly frequent among people with comorbidities, in particular in the age group 15-64 y. This emphasizes the importance of vaccination in this group of patients. Key messages This study shows that more than 40% of pneumonia with a positive microbiological result are caused by Streptococcus pneumoniae. Preventive strategies to limit Streptococcus pneumoniae infections among adults and individuals affected by comorbidities are needed.

Laboratory testing for Q fever (Coxiella burnetii) is essential for a differential diagnosis, yet little is known about Q fever diagnostic testing practices in the United States. We retrospectively analyzed Q fever immunoglobulin G (IgG) indirect immunofluorescence assay (IFA) testing data between 1/1/2012–10/31/2016 from ARUP, LabCorp, Mayo Medical Laboratories, and Quest Diagnostics. Data included IgG phase I and phase II titers, patient age and sex, and state and date of specimen collection. On average, 12,821 specimens were tested for Q fever annually by the participating laboratories. Of 64,106 total specimens, 84.1% tested negative for C. burnetii-specific antibodies. Positive titers ranged from 16 to 262,144 against both phase I and phase II antigens. Submission of specimens peaked during the summer months, and more specimens were submitted from the West North Central division. Testing occurred more frequently in males (53%) and increased with age. In conclusion, few U.S. Q fever cases are reported, despite large volumes of diagnostic specimens tested. Review of commercial laboratory data revealed a lack of paired serology samples and patterns of serology titers that differ from case reporting diagnostic criteria.

Aims and Objectives To explore Somali Bantu refugee women's reproductive health decision making, as influenced by their resettlement in the U.S. Background Available literature on reproductive health of refugee women is mostly from the healthcare provider perspective, neglecting the lived experience of the population. Design Qualitative Descriptive. Methods A purposive sample of 30 women was recruited for five focus groups. Data was collected via demographic survey and semi-structured focus group discussion. Content analysis was used to analyze the data. Results Our study revealed that Somali Bantu women considered children as wealth. Reproductive health decision making was influenced by three main factors: family influence, cultural/religious ideas, and experience with various hormonal birth control methods. Conclusions Nurses and other healthcare providers would better serve refugee women if equipped with a more nuanced understanding of factors in their reproductive healthcare decision-making. This study can inform tailored and cultural relevant interventions to improve reproductive health among those at greatest need. Relevance to clinical practice Our findings can serve to guide nurses and other healthcare providers’ clinical approach to a subset of the population whose cultural beliefs and practices regarding reproductive health may be unfamiliar. Incorporating the perspective of the Somali Bantu women will facilitate the provision of person-centered care and ensure women receive appropriate, efficient, and quality care that meets their needs, which may potentially reduce financial costs to the healthcare system. This article is protected by copyright. All rights reserved.

Pregnant and parenting adolescents often experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative Exposure Therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are threefold: a) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents, b) describe NET’s theoretical principals, its therapeutic process, and provide review of existing evidence and c) to discuss NET as a potential treatment to address that mental health burden among adolescents experiencing IPV-related PTSD and depression.

Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [ Journal of Psychosocial Nursing and Mental Health Services , 55 (6), 23–29.]

Background: In vitro mechanisms link IL-6 to poor outcome in breast cancer via inflammatory pathways, activated JAK/STAT tumor signaling and upregulation of aromatase, leading to an aggressive tumor phenotype. Epidemiological data from our group and others support these mechanisms in women with ER-positive (+) disease. We therefore hypothesized that the JAK inhibitor, ruxolitinib (RUX, INCB018424; Incyte), would enhance activity of exemestane (EXE) in women with ER+ breast cancer who relapsed after non-steroidal aromatase inhibitor therapy, particularly among carriers of a germ-line polymorphism in IL-6, conferring elevated levels of IL-6 in the tumor microenvironment. Methods: The “JAKEE trial” is a phase II trial to determine the safety and efficacy of RUX + EXE in postmenopausal women with relapsed, ER+ advanced breast cancer. Eligible patients were required to have progressed on a non-steroidal AI and either measureable or bone-only disease. CRP, a putative biomarker of tumor microenvironment inflammation, was measured at baseline and serially during treatment. Using a Simon 2-stage design, we treated 15 patients with RUX at 25 mg BID and EXE at 25mg daily on a continuous 28-day schedule. First stage results were previously presented (AACR, 2014). Accrual proceeded to second stage after no patient met the pre-defined stopping rule of grade (G) 3/4 toxicity requiring discontinuation from the study within the first treatment cycle. Due to the substantial rate of anemia requiring dose reductions, however, RUX dose was reduced to 15 mg BID in second stage. Results: A total of 25 patients were enrolled; 24/25 had progressed on AI in metastatic setting; 1 relapsed on adjuvant AI. RUX+EXE was well-tolerated overall, with only 2 G4 events (creatinine elevation, hepatic failure); both were due to disease progression. 16% had G3 fatigue, anemia or hypertension; 12% had G3 neutropenia or depression. Other lower grade toxicities in >20% included musculoskeletal pain, increased ALT, and headache. Overall, patients stayed on therapy for a median of 3 cycles (range 2 – 21). There were no CR or PR, but 6/25 (24%) had prolonged disease control (SD> 6 months). Median CRP at study entry was 6.4 (range 0.3-38.9), with 8/25 (32%) having CRP>10. Achieving SD>6 months was not associated with baseline CRP (CRP>10 in 32% with vs. 33% without SD>6 months, p(exact)=1.0). A novel pharmacodynamic assay to assess STAT3 phosphorylation in peripheral blood mononuclear cells after RUX exposure demonstrated differential effects in patients with response. Conclusions: Targeting JAK/STAT signaling in AI-resistant breast cancer with RUX+EXE was safe and well-tolerated. 24% of patients had prolonged SD, but baseline CRP level did not predict response. Correlative studies to determine whether host and/or tumor biomarkers predict response to therapy, including germline IL-6 genotype, immune profiles, p-STAT3 and estradiol levels, are currently underway. Citation Format: DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-08-03.

Introduction The systematic evaluation of the quality of medical records is crucial. Nevertheless, even if the improvement of medical records quality represents a priority for every health organization, it might be difficult to realize. This is the first study to assess the efficacy of internal audit as a tool to improve the quality of medical records in hospital setting. Methods The program was carried out in a third level teaching hospital. Trained ad hoc evaluation teams carried out two retrospective assessments of quality of medical records using a random sampling strategy. The quality assessment was performed using a 48-items evaluation grid divided into 9 domains: General; Patient Medical History and Physical Examination; Daily Clinical Progress Notes; Daily Nursing Progress Notes; Drug Therapy Chart; Pain Chart; Discharge Summary; Surgery Register; Informed Consent. After the first evaluation of 1.460 medical records, an audit departmental program was set up. The second evaluation was carried out after the internal auditing for 1.402 medical records. Results Compared to the first analysis, a significant quality amelioration in all the sections of the medical chart was shown with the second analysis, with an increase of all the scores above 50%. The differences found for each section of medical records between the first and second analysis are all significant (p, Journal of Preventive Medicine and Hygiene, Vol 60 No 3 (2019): 2019603

Objective:Recent evidences suggested that aldosterone may induce the activation of p66shc in vascular smooth muscle cells. This in vivo study sought to investigate whether aldosterone may induce functional and structural alterations in part through p66shc-dependent manner.Design and method:P66shc−/−

Many urban, low-income adolescents experience violence, often resulting in posttraumatic stress disorder (PTSD) and depression. Narrative Exposure Therapy (NET) facilitates therapeutic processing of traumatic memories. This purpose of this study is to examine the feasibility of NET among adolescents at-risk for PTSD and depression. Two community-based agencies hosted five focus groups with adolescents (n = 28), aged 18–21, predominantly African- American (71 %) and female (61 %) and one with adolescent service providers (n = 11). Pope’s coding framework (2000) and the Socio-Ecological Model for violence prevention (Krug et al. in The Lancet, 360(9339), 1083–1088, 2002) elicited perceived barriers and facilitators to NET. Individual, relationship, and community level barriers and facilitators to NET therapy engagement were identified. The findings indicate participants have favorable attitudes about NET and the provision of the therapy within trusted community agencies. The results will inform the next steps of NET implementation, training, and psychoeducation.

Background To date, there are few studies that examine the perspectives of older survivors of childhood brain tumors who are living with their families in terms of their sense of self and their role in their families. Objective The aim of this study was to describe how adolescent and young adult survivors of childhood brain tumors describe their health-related quality of life, that is, their physical, emotional, and social functioning. Methods This qualitative descriptive study included a purposive sample of 41 adolescent and young adult survivors of a childhood brain tumor who live with their families. Home interviews were conducted using a semistructured interview guide. Directed content analytic techniques were used to analyze data using health-related quality of life as a framework. Results This group of brain tumor survivors described their everyday lives in terms of their physical health, neurocognitive functioning, emotional health, social functioning, and self-care abilities. Overall, survivors struggle for normalcy in the face of changed functioning due to their cancer and the (late) effects of their treatment. Conclusions Neurocognitive issues seemed most compelling in the narratives. The importance of families went beyond the resources, structure, and support for functioning. Their families provided the recognition that they were important beings and their existence mattered to someone. Implications for practice The value and complexity of care coordination were highlighted by the multifaceted needs of the survivors. Advocacy for appropriate and timely educational, vocational, and social support is critical as part of comprehensive cancer survivorship care.

Infective endocarditis is a disease with a high mortality rate; mortality increases with the number of new episodes. Patients with relapsing endocarditis have a higher mortality rate per year (20%) than patients with a single episode (9%); moreover, the episodes of infective endocarditis on the prosthetic valve have a worse prognosis, with a mortality rate of 45% for each episode. In relapsing endocarditis, the following are distinguished: the relapses, characterized by the same germ, less than six months after the previous episode, and the reinfections, which may be caused by a different germ, or by the same germ, more than six months after previous episode. A recent analysis of the risk factors of recurrent bacterial endocarditis showed that the use of intravenous drugs, hemodialysis, immunosuppression and previous episodes of infective endocarditis played a major role, especially if they occurred on the prosthetic valve and if caused by S. aureus. Recurrent infectious endocarditis occurs more frequently in young male patients with HIV seropositivity, who routinely use intravenous drugs. We have analyzed the clinical case of a 36-year-old immunocompetent man with a long history of parenteral drug abuse, who has presented 6 new episodes of relapsing infective endocarditis on mitral valve and 2 reinfections since 2013. Between 2013 and 2016, the patient underwent two mitral valve replacements with a biological prosthesis implant and a mitral valve replacement with a mechanical prosthesis implant and a tricuspid annuloplasty. The remaining episodes were treated with medical therapy only. Currently in the literature 6 episodes of relapsing infective endocarditis and 1 reinfection in a single patient is the highest number of reported events.

Transmitted HIV-1 exhibiting reduced susceptibility to protease and reverse transcriptase inhibitors is well documented but limited for integrase inhibitors and enfuvirtide. We describe here a case of transmitted 5 drug class–resistance in an antiretroviral (ARV)-naïve patient who was successfully treated based on the optimized selection of an active ARV drug regimen. The value of baseline resistance testing to determine an optimal ARV treatment regimen is highlighted in this case report.

The World Health Organization has recognized the relevance of databases on craniofacial anomalies since . To date, there is no universal standard instrument/database focused on risk factors, clinical and genetic data collection, and follow-up that enables comparison between different populations and genotype-phenotype correlation. Although studies have shown that specific genes would impact outcomes, knowledge is not sufficient to subsidize cost-effectiveness strategies for diagnosis, surgical decision, and a multi-professional approach toward personalized medicine.Based on a clinical genetic approach, a Web-based application named CranFlow-Craniofacial Anomalies: Registration, Flow, and Management has been developed. It prospectively collects clinical and genetic information for the Brazilian Database on Craniofacial Anomalies (syndromic and nonsyndromic orofacial cleft, 22q11.2 deletion syndrome, and other craniofacial related disorders). A comprehensive list of CranFlow's features is provided.We present preliminary results on 1546 cases already recorded and followed, which allows recognizing 10% of diagnosis changes.The identification of risk factors, consistent genetic approach associated with clinical data and follow-up result in valuable information to develop and improve personalized treatment and studies on genotype-phenotype correlation. Adoption of CranFlow in different clinical services may support comparison between populations. This application has the potential to contribute to improvements in healthcare, quality of services, clinical and surgical outcomes, and the standard of living of individuals with craniofacial anomalies. Birth Defects Research 110:72-80, 2018. © 2017 Wiley Periodicals, Inc.

Objective Our aim was to expand research on predictors of health-related quality of life (HRQOL) for adolescent and young adult survivors of childhood brain tumors who are not living independently by evaluating the mediating role of family functioning in the association of disease severity/treatment late effects with survivor self-report and caregiver-proxy report of physical and emotional HRQOL. Methods Mothers (N = 186) and their survivors living at home (N = 126) completed self-report and caregiver-proxy report of physical and emotional HRQOL. Mothers completed family functioning measures of general family functioning, caregiving demands, and caregiver distress. Medical file review and caregiver report were used to evaluate disease severity/treatment late effects. Results Using structural equation models, family functioning was adjusted for sociodemographic factors. Disease severity/treatment late effects had significant direct effects on self-report and caregiver-proxy report of physical and emotional HRQOL. Family functioning had a significant direct effect on caregiver-proxy report of physical and emotional HRQOL, but these findings were not confirmed for self-report HRQOL. Model-fit indices suggested good fit of the models, but the mediation effect of family functioning was not supported. Conclusions Disease severity/treatment late effects explained self-report and caregiver-proxy report of physical and emotional HRQOL for these adolescent and young adult survivors of childhood brain tumors. Family functioning was implicated as an important factor for caregiver-proxy report only. To enhance physical and emotional HRQOL, findings underscore the importance of coordinated, multidisciplinary follow-up care for the survivors who are not living independently and their families to address treatment late effects and support family management. Copyright © 2014 John Wiley & Sons, Ltd.

Objective: RDW is a measure of the variation of red blood cell width, reported as part of standard complete blood count; many paper reported results about the role of RDW in heart failure; the role of RDW in Acute Coronary Syndromes (ACS) is less known. Methods: We enrolled 173 consecutive patients, admitted to the coronary care unit of our hospital, with a diagnosis of ob- structive ACS, documented by the evidence of obstructive coronary lesions on coronary angiography. We divided patients into two Groups: Group 1, with normal values of RDW; Group 2, with RDW values higher than normal range. Ventricular systolic function, was measured with echocardiography. Results: Patients of group 1 had a greater Ejection Fraction (p=0.03) and lower values of NT-proBNP (p=0.001). Finally we found a lower eGFR in patients of group 2, than in pa- tients of group 1 (p=0.0001). Conclusions: Our results suggest that RDW is a routine and inexpensive test that can provide information concerning se- verity of clinical condition in acute phase of an ACS, both as regards the cardiac contractility, both with regard to renal function. These variables are important prognostic factors in patients after ACS.

Background Drug resistance testing and co-receptor tropism determination are key components of the management of antiretroviral therapy for HIV-1-infected individuals. The purpose of this study was to examine trends of HIV-1 resistance and viral evolution in the past decade by surveying a large commercial patient testing database. Methods Temporal trends of drug resistance, viral fitness and co-receptor usage among samples submitted for routine phenotypic and genotypic resistance testing to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), as well as for tropism determination were investigated. Results Within 62,397 resistant viruses reported from 2003 to 2012, we observed a decreasing trend in the prevalence of three-class resistance (from 25% to 9%) driven by decreased resistance to PIs (43% to 21%) and NRTIs (79% to 57%), while observing a slight increase in NNRTI resistance (68% to 75%). The prevalence of CXCR4-mediated entry among tropism testing samples ( n=52,945) declined over time from 47% in 2007 to 40% in 2012. A higher proportion of CXCR4-tropic viruses was observed within samples with three-class resistance (50%) compared with the group with no resistance (36%). Conclusions Decreased prevalence of three-class resistance and increased prevalence of one-class resistance was observed within samples reported between 2003 and 2012. The fraction of CXCR4-tropic viruses has decreased over time; however, CXCR4 usage was more prevalent among multi-class-resistant samples, which may be due to the more advanced disease stage of treatment-experienced patients. These trends have important implications for clinical practice and future drug discovery and development.

BACKGROUND In 2005, the Robert Wood Johnson Foundation established the Interdisciplinary Nursing Quality Research Initiative (INQRI) program to produce rigorous evidence regarding linkages between nursing and quality of health care. The purpose of this paper is to describe scientific advances in understanding relationships between nursing, care processes, and the outcomes of the people supported by this discipline in 2004 (year before INQRI's launch) and in 2009 (5 years after INQRI was established). METHODS Comprehensive literature reviews for the years 2004 and 2009 were conducted using a conceptually based search strategy and multidisciplinary engines. The designs, methods, results, and conclusions of included papers were summarized, synthesized, and analyzed. RESULTS The literature search identified 389 studies (161 in 2004; 228 in 2009), which examined the relationship between nursing and patient care quality. The number of published papers in all categories of study designs-nonexperimental (72 in 2004; 97 in 2009), quasi-experimental (55 in 2004; 80 in 2009) and experimental (34 in 2004; 51 in 2009)-increased between the years 2004 and 2009. This line of inquiry also has expanded its reach through publications in a greater diversity of journals and journals with higher impact ratings. DISCUSSION The body of evidence regarding linkages between nursing and quality of care has increased in the nature and depth of science between 2004 and 2009, as seen in higher rates and quality of publications, enhanced methodological rigor, and evidence of stronger interdisciplinary collaboration. Although the unique contribution of INQRI to this expanded body of knowledge is unclear, the evidence supports the increased importance of INQRI's goal of measuring and enhancing nursing's contributions to the quality of patient care.

Background:The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care