Randomized controlled trial on occupational graduated compression clinical and cost-effectiveness

Background: Subjects exposed to occupational standing are at risk of developing chronic venous disease. Graduated compression stockings (GCS) counteract venous hypertension. Aim of the present investigation was to assess GCS clinical and cost effectiveness in prolonged standing up workers. Methods: Randomized controlled trial involving 75 healthy healthcare professionals working in 6 hours standing up shifts without or with GCS (group A and B, respectively). Outcome measures were performed before and after the shift, at baseline (T0), at 1 (T1), 6 (T6) and 12 (T12) months and included lower limb volume, air plethysmography (APG), quality of life, and dedicated cost-effectiveness questionnaires. Results: Seventy-two subjects completed the data collection. Leg volume increased in group A and decreased in B at all assessment points (T0, 1, 6, 12) (P<0.0001). Venous filling index did not change within the 12 months, but, after every shift, its value was lower in B compared to A (P<0.0001). At 12 months, VVSymQ worsened in A and improved in B (P<0.0001) and CIVIQ significantly worsened in A (P<0.0001), while in B it significantly improved (P<0.0001). Perceived disability was higher in A at 12 months (P<0.001) and the cost calculation revealed a saving of 1510 euro per year in B. Conclusions: GCS counteracted occupational oedema and positively influenced venous filling index, while improving vein specific quality of life measurements in addition to cost savings

An unusual case of venous thoracic outlet syndrome in relation to the anatomical position of the subclavian vein valves in a young athlete

Venous Thoracic Outlet Syndrome (vTOS) consists of upper extremities oedema, sometimes with varicose dilation of the superficial veins of the arm in consequence of compression and/or thrombosis of the subclavian vein. More specific factors, such as muscle hypertrophy, have additionally been registered in athletes. The case focuses on a 20-year-old male student in medicine, with an intense training activity in body building. The subject has presented symptoms of upper limbs oedema he has also reported heaviness and paresthesia in the left arm and hand. Varicose dilation of a superficial vein close to the axillary fossa was visible at naked eye. Both Doppler ultrasound evaluation and Angio TC were negative for venous thrombosis and/or complete obstruction from external compression. These reports depict an uncommon clinical scenario, which correlate an intense upper body training activity with the presence of a second valve distally of the first valve into the subclavian vein

Extraction of the jugular venous pulse and carotid profile using a cervical contact plethysmography system

The Jugular Venous Pulse (JVP) is considered a reliable parameter for the assessment of Central Venous Pressure (CVP). Here, the functionality of a cervical contact plethysmography system designed for non-invasive and operator-independent acquisition of the JVP signal, is shown. To validate the signal, it was recorded in supine and sitting positions, together with the reference Electrocardiography (ECG), on 26 healthy subjects. In the supine acquired signal, the characteristic JVP waves (a, c, v) and the negative deflections (x, y) are well recognizable. In the sitting recorded signal, the systolic peak b and the d incisura of the Common Carotid Artery (CCA) waveform are recognized. For each signal, we calculated the Fraction of the Cardiac Cycle (ccf) represented by the time intervals between the JVP peaks and the ECG peaks, in the form: ΔtaP, ΔtcR, ΔtxP, ΔtvT, Δtyv, Δtvx, and Δtxa. The same was done for the CCA waveform, in the form: ΔtbS, ΔtbT, Δtdb, ΔtdS, and ΔtdT. This system could mitigate risks and costs associated with central venous catheterization and its potential extends to applications in telemedicine, sports medicine, and space medicine

The Effect of Active Stretching Training in Patients with Chronic Venous Insufficiency Monitored by Raster-Stereography

(1) Background: Musculoskeletal disorders can be associated with advanced clinical stages of chronic venous insufficiency (CVI). The aim of the study is to investigate the effect of active stretching (AS) training on lower limb venous function and quality of life in patients affected by CVI. (2) Methods: A prospective two-armed pilot randomized controlled was conducted. Twenty (20) CVI patients were randomly assigned to an AS training or to a control group (C) who did not receive any exercise indication. At baseline and after three months all the participants were tested for leg volumetry (LV), air plethysmography (APG), and quality of life (QoL) measured by a disease specific validated questionnaire (VVSymQ), ankle range of motion (ROM), and postural deformities using an optoelectronic body posture machine. (3) Results: At the end of the training in the AS group a significant leg volume reduction was detected (from 2340 ± 239 mL to 2239 ± 237 mL (4.3%); p p 2 = 0.6790; p p p p < 0.01 respectively). (4) Conclusion: The AS training impacts on the APG parameters related to the musculoskeletal pump efficiency, opening a further possibility in the management of CVI patients by means of an appropriate adapted physical exercise program

Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients

Background: Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients. Methods: Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported. Results: All the patients were categorized as physically inactive: average activity time 235.6 (155.2) MET-minutes per week. At the end of the study, a significant leg volume reduction was found (-16%; p &lt; .002). Significant improvement in lower limb strength (p &lt; .0001), endurance (p &lt; .006), rapidity and balance (p &lt; .05) together with decrease in resting heart rate (-1.8%, p &lt; .0001) and systolic blood pressure (-1.1%, p &lt; .04) were reported, significant improvement in bodily pain (p &lt; .0005) and social function (p &lt; .002) QoL items were observed. Conclusions: The proposed exercise protocol in thermal aquatic environment demonstrated to be an effective treatment modality improving both cardiovascular and musculoskeletal outcomes and QoL in sedentary CVD patients. Aquatic environment investigations require proper analysis of the various factors involved, in a standardized and reproducible way. The herein report can be a reference for further studies on different health related conditions

The Effect of Submaximal Exercise on Jugular Venous Pulse Assessed by a Wearable Cervical Plethysmography System

The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 &plusmn; 3, BMI 21 &plusmn; 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the &Delta;ax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and &Delta;ax were found between static and exercise conditions (p &lt; 0.0001, p &lt; 0.0001, p &lt; 0.0001), respectively. Particularly, the &Delta;ax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value

Whole genome sequencing for the molecular characterization of carbapenem-resistant Klebsiella pneumoniae strains isolated at the Italian ASST Fatebenefratelli Sacco Hospital, 2012–2014

Abstract Background The emergence of carbapenem-resistant Klebsiella pneumoniae strains is threatening antimicrobial treatment. Methods Sixty-eight carbapenemase-producing K. pneumoniae strains isolated at Luigi Sacco University Hospital-ASST Fatebenefratelli Sacco (Milan, Italy) between 2012 and 2014 were characterised microbiologically and molecularly. They were tested for drug susceptibility and carbapenemase phenotypes, investigated by means of repetitive extra-genic palindromic polymerase chain reaction (REP-PCR), and fully sequenced by means of next-generation sequencing for the in silico analysis of multi-locus sequence typing (MLST), their resistome, virulome and plasmid content, and their core single nucleotide polymorphism (SNP) genotypes. Results All of the samples were resistant to carbapenems, other β-lactams and ciprofloxacin; many were resistant to aminoglycosides and tigecycline; and seven were resistant to colistin. Resistome analysis revealed the presence of blaKPC genes and, less frequently blaSHV, blaTEM, blaCTX-M and blaOXA, which are related to resistance to carbapenem and other β-lactams. Other genes conferring resistance to aminoglycoside, fluoroquinolone, phenicol, sulphonamide, tetracycline, trimethoprim and macrolide-lincosamide-streptogramin were also detected. Genes related to AcrAB-TolC efflux pump-dependent and pump-independent tigecycline resistance mechanisms were investigated, but it was not possible to clearly correlate the genomic features with tigecycline resistance because of the presence of a common mutation in susceptible, intermediate and resistant strains. Concerning colistin resistance, the mgrB gene was disrupted by an IS5-like element, and the mobile mcr-1 and mcr-2 genes were not detected in two cases. The virulome profile revealed type-3 fimbriae and iron uptake system genes, which are important during the colonisation stage in the mammalian host environment. The in silico detected plasmid replicons were classified as IncFIB(pQil), IncFIB(K), ColRNAI, IncX1, IncX3, IncFII(K), IncN, IncL/M(pMU407) and IncFIA(HI1). REP-PCR showed five major clusters, and MLST revealed six different sequence types: 512, 258, 307, 1519, 745 and 101. Core SNP genotyping, which led to four clusters, correlated with the MLST data. Isolates of the same sequencing type often had common genetic traits, but the SNP analysis allowed greater strain tracking and discrimination than either the REP-PCR or MLST analysis. Conclusion Our findings support the importance of implementing bacterial genomics in clinical medicine in order to complement traditional methods and overcome their limited resolution

Assessing the Relationship between Body Image Satisfaction and Physical Activity in Italian Adolescents: A Cross-Sectional Investigation

Purpose: The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V ̇ O2peak) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program. Methods: Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V ̇ O2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V ̇ O2peakEST). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V ̇ O2peak determination (V ̇ O2peakMEAS). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT. Results: Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V ̇ O2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V ̇ O2peakMEAS and V ̇ O2peakEST. Compared with CPX results, the 1km-TWT underestimated the V ̇ O2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P &gt; .05). Conclusions: The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V ̇ O2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs

Additional file 1: Table S1. of Whole genome sequencing for the molecular characterization of carbapenem-resistant Klebsiella pneumoniae strains isolated at the Italian ASST Fatebenefratelli Sacco Hospital, 2012–2014

MICs (Οg/ml) of antimicrobial agents for carbapenem-resistant K. pneumoniae strains tested in this study. (XLS 31 kb