PANIC DISORDER, ANXIETY, AND CARDIOVASCULAR DISEASES

Different data indicate that psychological and/or emotional disorders may play an important role in the natural history of heart diseases. Although the major evidence is that related to depression, epidemiological data would indicate that anxiety and panic disorders are highly represented in cardiac patient, thus influencing mortality and morbidity. The diagnosis of panic disorder in patients with chest pain is crucial to a correct therapeutic approach, as well as to reduce the risks and costs of inappropriate treatments. Anxiety and panic may accelerate different direct and indirect processes involved in the pathogenesis of cardiovascular diseases: lifestyle risk factors, arterial hypertension, myocardial perfusion, autonomic nervous system or hypothalamus-pituitary-adrenal axis, platelet activation, and inflammation processes. Panic disorder seems to correlate particularly with sudden death: this suggests that it may be considered one of the main inducers of life-threatening arrhythmias, rather than to be linked to the development and progression of coronary atherosclerosis. Beyond hard outcomes, panic disorders produce negative effects on both global adjustment and life quality that may impair the course of the cardiac diseases. Interestingly, specific antipanic and anxiolytic agents seem to be particularly effective upon life quality. In any case, adequate controlled clinical trials are necessary in order to confirm the possibility of cardiovascular risk reduction by means of anxiety and panic disorder treatment

Age- and sex-based reference ranges for non-invasive ventricular repolarisation parameters.

SummaryBackground Some electrocardiographic parameters are able to assess indirectly ventricular repolarisation homogeneity. It is consequently essential to discriminate between normal and abnormal values in clinical decision-making. Considering there is still not a consensus about normal cut-off values, the aim of this study was to document reference intervals in all age groups of a healthy population, providing for age- and sex-percentile tables, which can be used easily and quickly in clinical practice. Methods We evaluated repolarisation markers in 606 sex-matched participants aged 1 day–94 years. Each subject underwent a 12-lead electrocardiogram at rest, and the following parameters were measured: QT, corrected QT, QTpeak, Tpeak-Tend, Tpeak-Tend dispersion, Tpeak-Tend/QT and QTpeak/QT ratio. Results A relationship was demonstrated between age and QTpeak, Tpeak-Tend, QT and QTc. In children, QTpeak, Tpeak-Tend and QT intervals increased linearly with age. In adolescents, all the three parameters remained stable. In adults, QTpeak and QT showed a further significant increase. On the contrary, Tpeak-Tend interval was longer in adults aged between 20 and 64 years than in participants aged 65 years or over, but the difference was not statistically significant. Male vs female participants showed longer Tpeak-Tend intervals; this sex difference was not statistically significant at birth and during childhood, whereas it was in adolescents and in adults. Conclusions Repolarisation parameters showed age- and sex-based variations, which are important to know to differentiate normal from pathological values

Thromboembolic and hemorrhagic risk stratification in patients with atrial fibrillation. Part II: hemorrhagic risk and guidelines recommendations

Robust evidence exists on the efficacy of traditional anticoagulant oral therapy in the prevention of thrombo-embolic risk in patients with non valvular atrial fibrillation, but fears and concerns of hemorrhagic events for the physicians and logistic difficulties related to the periodic International Normalized Ratio evaluation for the patients are at the basis of a noticeable under-utilization of the therapy with vitamin K antagonists in the real world. Stratification of the hemorrhagic risk has, thus, particular importance; for this objective we may use now several score system, among whom the more suggested is the HASBLED, with the principal aim to select and trait modifiable risk factors for bleeding. These score systems have been evaluated in some recent clinical trials. During the last years, a number of national and international guidelines on the prevention of the thrombo-embolic risk in patients with non valvular atrial fibrillation have been updated. These guidelines, generally, recommend the use of the CHA2DS2VaSC score for the evaluation of the thrombo-embolick risk, and of the HAS-BLED score for the evaluation of the hemorrhagic one. The consequent risk stratification is fundamental as a clinical guide for the use of oral anticoagulant therapy

Exploring the links between cancer and placenta development

The development of metastatic cancer is a multistage process, which often requires decades to complete. Impairments in DNA damage control and DNA repair in cancer cell precursors generate genetically heterogeneous cell populations. However, despite heterogeneity most solid cancers have stereotypical behaviours, including invasiveness and suppression of immune responses that can be unleashed with immunotherapy targeting lymphocyte checkpoints. The mechanisms leading to the acquisition of stereotypical properties remain poorly understood. Reactivation of embryonic development processes in cells with unstable genomes might contribute to tumour expansion and metastasis formation. However, it is unclear whether these events are linked to immune response modulation. Tumours and embryos have non-self-components and need to avoid immune responses in their microenvironment. In mammalian embryos, neo-antigens are of paternal origin, while in tumour cells DNA mismatch repair and replication defects generate them. Inactivation of the maternal immune response towards the embryo, which occurs at the placental-maternal interface, is key to ensuring embryonic development. This regulation is accomplished by the trophoblast, which mimics several malignant cell features, including the ability to invade normal tissues and to avoid host immune responses, often adopting the same cancer immunoediting strategies. A better understanding as to whether and how genotoxic stress promotes cancer development through reactivation of programmes occurring during early stages of mammalian placentation could help to clarify resistance to drugs targeting immune checkpoint and DNA damage responses and to develop new therapeutic strategies to eradicate cancer

RICOVERI PER EFFETTI INDESIDERATI DA SOVRADOSAGGIO DI FARMACI PRESSO UN\u2019UNIT\uc0 OPERATIVA CARDIOLOGICA NEL PERIODO 2011-2013

Introduzione: Le statistiche dei casi di ricovero ospedaliero per effetti indesiderati da sovradosaggio farmacologico sono utili per valutare l\u2019incidenza di tale fenomeno nel mondo reale. Un sovradosaggio farmacologico pu\uf2 avvenire come conseguenza di un\u2019insufficiente o inadeguata comunicazione tra medico e paziente, per autoprescrizione o erronea assunzione di dosaggi superiori a quelli necessari, per erronea assunzione di due farmaci identici come molecola ma con nome commerciale diverso o per effetti collaterali imprevisti. Materiali e metodi: Sono state esaminate, retrospettivamente, le cartelle cliniche relative a tutti i ricoveri avvenuti presso l\u2019Unit\ue0 Operativa di Cardiologia del P.O. S. Antonio Abate di Trapani (ASP 9 - Sicilia) nel triennio compreso tra gennaio 2011 e dicembre 2013. Sono state ricercate le ospedalizzazioni avvenute per effetti indesiderati da sovradosaggio di farmaci appartenenti a varie classi quali digitalici, ACE-inibitori, betabloccanti e antiaritmici, in particolare l\u2019amiodarone. Risultati: Nel triennio in oggetto, su un totale di 7269 ospedalizzazioni, quelli per effetti indesiderati da sovradosaggio farmacologico sono stati 76 (1.05% del totale dei ricoveri). I pazienti ricoverati per tale motivo, 33 di sesso maschile e 43 di sesso femminile, avevano un\u2019et\ue0 compresa tra 62 e 90 anni. La Figura1 mostra le percentuali relative ai singoli farmaci interessati, secondo cui la principale causa di ricovero ospedaliero per effetti indesiderati da sovradosaggio farmacologico \ue8 attribuibile all\u2019amiodarone, antiaritmico di classe III, per i noti effetti collaterali a carico della tiroide e degli occhi. Segue la digitale, che ha causato nei pazienti bradiaritmie e in alcuni casi vere e proprie intossicazioni e, in percentuali minori, gli ACE-inibitori, cause di ipotensione e i betabloccanti, causa di bradicardia e ipotensione. Per tutti i casi l\u2019intervento mirava alla reversione della sintomatologia e alla momentanea sospensione dell\u2019assunzione. Per nessuno dei casi monitorati si \ue8 proposto il ricovero in terapia intensiva. Discussione: I ricoveri ospedalieri per effetti indesiderati da sovradosaggio farmacologico sono ancora un problema abbastanza diffuso nel mondo reale. Gli operatori sanitari, tra cui Medici e Farmacisti, dovrebbero ulteriormente mirare a una corretta informazione dei pazienti e dei loro familiari, in particolare al momento della dimissione, come prezioso e fondamentale strumento di prevenzione di questi danni iatrogenici che, a prescindere dei costi evitabili per il Sistema Sanitario Nazionale, possono comportare, se non adeguatamente trattati, rischi e gravi conseguenze per la salute

Neighbors-Aware Proportional Fair scheduling for future wireless networks with mixed MAC protocols

Abstract In this paper, we consider a beyond-5G scenario, where two types of users, denoted as scheduled and uncoordinated nodes, coexist on the same set of radio resources for sending data to a base station. Scheduled nodes rely solely on a centralized scheduler within the base station for the assignment of resources, while uncoordinated nodes use an unslotted Carrier Sense Multiple Access (CSMA) protocol for channel access. We propose and evaluate through simulations: (a) a novel centralized resource scheduling algorithm, called Neighbors-Aware Proportional Fair (N-PF) and (b) a novel packet length adaptation algorithm, called Channel-Aware (CA) Packet Length Adaptation algorithm for the scheduled nodes. The N-PF algorithm considers the uplink channel state conditions and the number of uncoordinated nodes neighboring each scheduled node in the aggregate scheduling metric, in order to maximize packet transmission success probability. The CA algorithm provides an additional degree of freedom for improving the performance, thanks to the fact that scheduled nodes with lower number of hidden terminals, i.e., having higher packet capture probability, are assigned longer packet transmission opportunities. We consider two benchmark schemes: Proportional Fair (PF) algorithm, as a resource scheduling algorithm, and a discrete uniform distribution (DUD) scheme for packet lengths distribution. Simulation results show that the proposed schemes can result in significant gain in terms of network goodput, without compromising fairness, with respect to two benchmark solutions taken from the literature

Heterogeneous Networks for the IoT and Machine Type Communications

The Internet of Things promises to be a key-factor in the forthcoming industrial and social revolution. The Internet of Things concept rely on pervasive communications where ’things’ are ’always connected’. The focus of the thesis is on Heterogeneous Networks for Internet of Things and Machine Type Communications. Heterogeneous Networks are an enabling factor of paramount important in order to achieve the ’always connected’ paradigm. On the other hand, Machine Type Communications are deeply different from Human-to-Human communications both in terms of traffic patterns and requirements. This thesis investigate both concepts. In particular, here are studied short and long range solutions for Machine-to-machine applications. For this work a dual approach has been followed: for the short-range solutions analysis an experimental approach has been privileged; meanwhile for the long-range solutions analysis a theoretical and simulation approach has been preferred. In both case, a particular attention has been given to the feasibility of the solutions proposed, hence solutions based on products that already exist in the market have been privileged