Search

Abstract: Objective: Post-infarction ventricular remodelling has been graded (I–III) according to the loss of systolic left ventricular silhouette curvature changes. Although surgical ventricular restoration (SVR) has been extended to type III ischaemic cardiomyopathy, the results are less satisfactory. We sought to identify geometric and functional predictors of late outcome after SVR. Methods: Among 144 patients who underwent SVR since 1998, a subgroup of 31 patients (age: 65.2±7.6 years) was analysed. Inclusion criteria were: type III cardiomyopathy, no associated procedure except coronary artery bypass grafting, prior anterior infarction, absent-to-2+ mitral regurgitation, elective operation, follow-up ≥18 months (mean: 44±26; longest: 96 months). Probability of events was estimated with the Kaplan–Meier method. A Cox multivariable regression model was constructed selecting eight potential predictors of four adverse events: death, cardiac death, recurrent heart failure (New York Heart Association class III or IV) and left ventricular re-remodelling, defined as a 25% increase of end-systolic volume index after SVR, or an end-systolic volume index ≥50ml·m−2. Results: Early and late mortality were zero and 6% (2/31 patients, one cardiac-related death). NYHA class and all echocardiographic functional variables significantly improved early after SVR. Freedom (±standard error (SE)) from heart failure was 97%±3%, 93%±5%, 77%±11% and 64%±15%, whereas freedom from left ventricular re-remodelling was 97%±3%, 80%±8%, 60%±12% and 39%±15%, respectively, 1, 3, 5 and 7 years after SVR. Multivariable analysis identified baseline mitral regurgitation degree and sphericity index as independent predictors of recurrent heart failure (p =0.025; hazard ratio (HR)=7.80 (95% confidence intervals (CIs): 1.29–47.19)) and left ventricular re-remodelling (p =0.047; HR=2.84 (95% CIs: 1.01–7.95)). Both predictors also correlated with a higher recurrence of end-systolic volume index ≥50ml·m−2 at late follow-up. Conclusions: Despite advanced cardiomyopathy, SVR determines left ventricular volume reduction and improved systolic function. Baseline absent-to-moderate mitral regurgitation and a more spherical left ventricular geometry predict a less favourable clinical and functional outcome, suggesting a possible rationale for wider indications for combined correction of 2+ mitral regurgitation and undersizing of the mitral annulus, particularly in patients with sphericity index ≥0.75. [Copyright &y& Elsevier]

Background: The correlation between thalassemia and malignancies other than hepatocellular carcinoma (HCC) and the possible relationship between other hemoglobinopathies and tumor risk have been poorly evaluated. Methods: Eight Italian specialized centers evaluated the incidence of malignant neoplasms in hemoglobinopathies as well as their sites and features. The study cohort included 4631 patients followed between 1970 and 2021 (transfusion‐dependent β‐thalassemia, 55.6%; non–transfusion‐dependent thalassemia, 17.7%; sickle cell disease, 17.6%; hemoglobin H disease, 8.3%). Results: A total of 197 diagnoses of cancer were reported (incidence rate, 442 cases per 100,000 person‐years). The liver was the most frequent site of tumors in both sexes, with a higher incidence (190 cases per 100,000 person‐years) in comparison with the general population found in all types of hemoglobinopathies (except hemoglobin H disease). In recent years, tumors have become the second cause of death in patients with transfusion‐dependent thalassemia. A lower risk of breast and prostate cancer was observed in the whole group of patients with hemoglobinopathies. The first cancer diagnoses dated back to the 1980s, and the incidence rate sharply increased after the 2000s. However, although the incidence rate of cancers of all sites but the liver continued to show an increasing trend, the incidence of HCC showed stability. Conclusions: These findings provide novel insights into the relationship between cancer and hemoglobinopathies and suggest that the overall risk is not increased in these patients. HCC has been confirmed as the most frequent tumor, but advances in chelation and the drugs that have led to the eradication of hepatitis C may explain the recent steadiness in the number of diagnoses that is reported here. Except for hepatocellular carcinoma, cancers are not more frequent in patients with hemoglobinopathies in comparison with the general Italian population. The incidence of hepatocellular carcinoma over time showed an increasing trend until 2012; since then, there has been a steady number of new diagnoses despite the increasing age of patients with hemoglobinopathies. [ABSTRACT FROM AUTHOR]

Furthermore, cirrhosis was present in 83% of patients with transfusion-dependent thalassemia (45 of 54), in 92% of patients with non-transfusion-dependent thalassemia (12 of 13), and in 75% of patients with sickle cell disease (6 of 8; I p i = .5). Only for 30 of the patients with cirrhosis do we have the date of the diagnosis: 25 of 30 (83%) had a previous diagnosis, and 5 of 30 (17%) had a simultaneous diagnosis. We thank Dr Mancuso and colleagues for their knowledgeable comments about our study.[1] In particular, one point raised is that the study does not address the question of the rates of patients with hepatocellular carcinoma (HCC) with and without concomitant cirrhosis. [Extracted from the article]

The role of mass media in the construction of debated environmental issues is discussed, with reference to biodiversity conservation policies. The articles in a local daily newspaper (Il Tirreno) about the designation of the Tuscan Archipelago National Park in Italy have been content analyzed, before and after the park designation. In a quantitative study, two lexical correspondence analyses were conducted, on the titles and bodies of a selection of articles, respectively. A qualitative content analysis of the selected material was also performed to deepen and broaden the quantitative study. Results revealed the salience of a local-regional political conflict in the representation of the park designation, with particular emphasis on the issue of local identity: Local activism appears to function as a territorial defense against external intrusion from a centralized authority. This authority is perceived as limiting the interests and freedom of local communities. The implications of the results are discussed. [ABSTRACT FROM AUTHOR]