Gender effect on the Relation between Diabetes and Hospitalization for Heart Failure

Aims: Cardiovascular risk among diabetic patients is at least twice as much the one for nondiabetic individuals and even greater when diabetic women are considered. Heart failure (HF) is a common unfavorable outcome of cardiovascular disease in diabetes. However, since the comparison among sexes of heart failure prevalence in diabetic patients remains limited, this study is aimed at expanding the information about this point. Methods: We have evaluated the association between diabetes and HF by reviewing the medical records of all subjects discharged from the Internal Medicine and Cardiology Units of all hospitals in the Tuscany region, Italy, during the period January 2002 through December 2008. In particular we sought concomitance of ICD-9-CM codes for diabetes and HF. Results: Patients discharged by Internal Medicine were on average older, more represented by women, and had a lesser number of individuals coded as diabetic (p < 0.05 for all). Relative risk for HF (95 % CI) was signifi cantly higher in patients with diabetes, irrespective of gender 1.39 (1.36– 1.41) in males; 1.40 (1.37–1.42) in females. When the diabetes-HF association was analyzed according to decades of age, a “horse-shoe” pattern was apparent with an increased risk in 40–59 years old in female patients discharged by Internal Medicine. Conclusions: Although there is not a diff erence in the overall HF risk between hospitalized male and female diabetic patients, women have an excess risk at perimenopausal ag

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Tests for a Strong Electroweak Sector at Future e^+e^- High Energy Colliders

The study of the scattering at high energy of the gauge bosons W and Z, in particular longitudinally polarized W and Z, can clarify the mechanism of spontaneous symmetry breaking in the Standard Model of the electroweak interactions. Different models of strong electroweak sector, based on the effective lagrangian approach are briefly reviewed. They include models with no resonance, with scalar resonance, additional vector and axial-vector resonances. The effective Lagrangians are derived from the chiral symmetry of the symmetry breaking sector. Limits on these models from existing measurements, mainly LEP and Tevatron, are considered. We study also direct and indirect effects of the new interactions at high energy future e^+e^- linear colliders, through WW scattering and the direct production of these new vector gauge bosons.Comment: 74 pages, 19 figures and 4 tables included, Latex, uses epsf, to appear in La Rivista del Nuovo Cimento, some minor change

Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE).

AbstractDiabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community

Value of team approach combined with clinical pathway for diabetic foot problems: a clinical evaluation

Aims: To evaluate the effectiveness of management of diabetic foot problems (DFP) by the National University Hospital (NUH) Multidisciplinary Diabetic Foot Team combined with a clinical pathway in terms of average length of stay (ALOS), readmission rates, hospitalisation cost per patient, major reamputation rate, and complication rate. Methods: 939 patients admitted to the Department of Orthopaedic Surgery, NUH, for DFP from 2002 (before team formation) to 2007 (after team formation). It consisted of six cohorts of patients – 61 for 2002, 70 for 2003, 148 for 2004, 180 for 2005, 262 for 2006, and 218 for 2007. All patients were managed by the NUH Multidisciplinary Diabetic Foot Team combined with a clinical pathway. Statistical analyses were carried out for five parameters (ALOS, hospitalisation cost per patient, major amputation rate, readmission rate, and complication rate). Results: From 2002 to 2007, the ALOS was significantly reduced from 20.36 days to 12.20 days (p=0.0005). Major amputation rate was significantly reduced from 31.15 to 11.01% (p<0.0005). There was also a significant reduction in complication rate from 19.67 to 7.34% (p=0.005). There were reductions in the hospitalisation cost per patient and readmission rate after formation of the multidisciplinary team but they were not statistically significant. Conclusion: Our evaluation showed that a multidisciplinary team approach combined with the implementation of a clinical pathway in NUH was effective in reducing the ALOS, major amputation rate, and complication rate of DFP

Degenerate BESS Model: The possibility of a low energy strong electroweak sector

We discuss possible symmetries of effective theories describing spinless and spin 1 bosons, mainly to concentrate on an intriguing phenomenological possibility: that of a hardly noticeable strong electroweak sector at relatively low energies. Specifically, a model with both vector and axial vector strong interacting bosons may possess a discrete symmetry imposing degeneracy of the two sets of bosons (degenerate BESS model). In such a case its effects at low energies become almost invisible and the model easily passes all low energy precision tests. The reason lies essentially in the fact that the model automatically satisfies decoupling, contrary to models with only vectors. For large mass of the degenerate spin one bosons the model becomes identical at the classical level to the standard model taken in the limit of infinite Higgs mass. For these reasons we have thought it worthwhile to fully develop the model, together with its possible generalizations, and to study the expected phenomenology. For instance, just because of its invisibility at low energy, it is conceivable that degenerate BESS has low mass spin one states and gives quite visible signals at existing or forthcoming accelerators.Comment: 37 pages, LaTeX, 14 figures (uuencoded