946-103 Incremental Prognostic Power for Perioperative Cardiac Events of Clinical History and Semi·Quantitative Dobutamine Before Major Vascular Surgery

Using the presence of stress induced ischemia with dobutamine-atropine stress echocardiography (DSE) for predicting perioperative cardiac events (CE) in patients undergoing major vascular surgery has a high negative but low positive predictive value (PPV).Aim of the studyto improve the PPV of DSE by combining the value of clinical markers and DSE.Methodsin 300 consecutive patients clinical risk factors (diabetes, angina, Q waves on ECG, age>70 years, and history of ventricular arrhythmias) where assessed. DSE results were analyzed by quantifying the extent and severity of new wall motion abnormalities (NWMA) at peak stress. Also, heart rate threshold (HR-Thres) at which NWMA occurred was noted. Low HR-Thres was defined as NWMA at<70% of maximal age and sex related heart rate.Results27 CE occurred of which 5 cardiac deaths, 12 myocardial infarctions and 10 patients with unstable angina. One-hundred patients had no clinical risk factors, 200 one or more. All but 1 CE occurred in patients with 1 Or more risk factors. In 27 of 72 patients with a positive DSE a CE occurred (PPV 38%). Quantifying the extent and severity of NWMA at peak stress provided no additional information. The HR-Thres at which ischemia occurred improved PPV In 30 patients with a low HR-Thres, 20 CE occurred (PPV 67%). In the remaining 42 patients with a high HR-Thres, only 7 CE occurred (16%). The improvement of PPV from 38% to 67% is statistically highly significant (P < 0.01). All patients with a fatal CE and 8 of 12 patients with a myocardial infarction had a low HR-threshold.Conclusions1) in patients with no clinical risk factors additional stress testing is not efficient. 2) in patients with one or more risk factors semiquantitative DSE allows stratification of patients in low, intermediate, and high risk groups for CE

Seroprevalence of sars-cov-2 antibodies in adults and healthcare workers in southern italy

Background: This study was carried out to estimate the seroprevalence of SARS-CoV-2 antibodies in a Southern Italian population. Methods: The study was performed among students and workers of the University of Campania “Luigi Vanvitelli” and the relative Teaching Hospital. Participants were invited to undergo a blood sampling, an interview or to complete a self-administered questionnaire. Results: A total of 140 participants (5.8%) tested positive for SARS-CoV-2 antibodies. Positive SARS-CoV-2 test results increased significantly during the months of testing, and those who had had at least one symptom among fever, cough, dyspnea, loss of taste or smell and who had had contact with a family member/cohabitant with confirmed COVID-19 were more likely to test positive. Faculty members were less likely to have a positive test result compared to the healthcare workers (HCWs). Among HCWs, physicians showed the lowest rate of seroconversion (5.2%) compared to nurses (8.9%) and other categories (10%). Nurses and other HCWs compared to the physicians, those who had had at least one symptom among fever, cough, dyspnea, loss of taste or smell, and who had had contact with a family member/cohabitant with confirmed COVID-19 were more likely to test positive. Conclusions: The results have demonstrated that SARS-CoV-2 infection is rapidly spreading even in Southern Italy and confirm the substantial role of seroprevalence studies for the assessment of SARS-CoV-2 infection circulation and potential for further spreading

Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography

Objectives: This study sought to optimize preoperative cardiac risk stratification in a large group of consecutive candidates for vascular surgery by combining clinical risk assessment and semiquantitative dobutamine-atropine stress echocardiography. Background: Dobutamine-atropine stress echocardiography has been used for the prediction of perioperative cardiac risk in a small group of patients scheduled for elective major vascular surgery on the basis of the presence or absence of stress-induced regional left ventricular wall motion abnormalities. Methods: Clinical risk assessment and dobutamine-atropine stress echocardiography were performed in 302 consecutive patients presenting for major vascular surgery. The extent and severity of stress wall motion abnormalities and the heart rate at which they occurred, in addition to the presence of wall motion abnormalities at rest, were assessed. Results: The absence of clinical risk factors (angina, diabetes, Q waves on the electrocardiogram, symptomatic ventricular tachyarrhythmias, age >70 years) identified a low risk group of 100 patients with a 1% cardiac event rate (unstable angina). Dobutamine-atropine stress echocardiographic findings were positive in 72 patients. Twenty-seven patients had a perioperative cardiac event (cardiac death in 5, nonfatal infarction in 12, unstable angina pectoris in 10); all 27 patients had positive stress test results (positive predictive value 38%, negative predictive value 100%). The semiquantitative asse

Dobutamine-atropine stress echocardiography and clinical data for predicting late cardiac events in patients with suspected coronary artery disease

purpose: To compare the relative value of clinical variables with dobutamine-atropine stress echocardiography to predict cardiac events during long-term follow-up. Dobutamine stress echocardiography is increasingly used for the detection of coronary artery disease, but little is known of its prognostic value. patients and methods: A total of 430 patients (310 men; mean age 61 years, range 22 to 90) were enrolled in the study. Patients were referred for chest pain complaints and were unable to perform an adequate exercise stress test. All patients underwent dobutamine-atropine stress test (incremental dobutamine infusion: 10 to 40 μ/kg/minute, continued with atropine 0.25 to 1 mg intravenously if necessary to achieve 85% of the age predicted maximal heart rate, without symptoms or signs of ischemia) and clinical cardiac evaluation. Follow-up was 17 ± 5 months, with a minimum of 6 months; 3 patients were lost to follow-up. Cardiac events were defined as cardiac death, nonfatal myocardial infarc

The CABB dataset: A multimodal corpus of communicative interactions for behavioural and neural analyses

We present a dataset of behavioural and fMRI observations acquired in the context of humans involved in multimodal referential communication. The dataset contains audio/video and motion-tracking recordings of face-to-face, task-based communicative interactions in Dutch, as well as behavioural and neural correlates of participants’ representations of dialogue referents. Seventy-one pairs of unacquainted participants performed two interleaved interactional tasks in which they described and located 16 novel geometrical objects (i.e., Fribbles) yielding spontaneous interactions of about one hour. We share high-quality video (from three cameras), audio (from head-mounted microphones), and motion-tracking (Kinect) data, as well as speech transcripts of the interactions. Before and after engaging in the face-to-face communicative interactions, participants’ individual representations of the 16 Fribbles were estimated. Behaviourally, participants provided a written description (one to three words) for each Fribble and positioned them along 29 independent conceptual dimensions (e.g., rounded, human, audible). Neurally, fMRI signal evoked by each Fribble was measured during a one-back working-memory task. To enable functional hyperalignment across participants, the dataset also includes fMRI measurements obtained during visual presentation of eight animated movies (35 minutes total). We present analyses for the various types of data demonstrating their quality and consistency with earlier research. Besides high-resolution multimodal interactional data, this dataset includes different correlates of communicative referents, obtained before and after face-to-face dialogue, allowing for novel investigations into the relation between communicative behaviours and the representational space shared by communicators. This unique combination of data can be used for research in neuroscience, psychology, linguistics, and beyond

Vaccination against hepatitis b virus: are Italian medical students sufficiently protected after the public vaccination programme?

The development of a vaccine against hepatitis B virus (HBV) has been a major achievement in terms of prevention of HBV infection. For the present study, we analysed the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities.Background: The development of a vaccine against hepatitis B virus (HBV) has been a major achievement in terms of prevention of HBV infection. For the present study, we analysed the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities. Methods: A cross-sectional study of undergraduate and postgraduate students attending the Medical School of the Second University of Naples was conducted between September 2012 and December 2014. HBV serum markers were determined and multivariate logistic regression analysis was used to identify factors associated with the level of long-term immunogenicity. Results: Of the 2,932 subjects evaluated, only 33 (1.1 %) declared no history of vaccination. All vaccinated subjects were HBsAg/anti-HBc negative, 459 of which had an anti-HBs titre <10 IU/L. The latter were younger, more likely to be attending a healthcare profession school (i.e., dental hygienists, nursing, paediatric nursing, radiography and midwifery) than a medical school (at either undergraduate or postgraduate level) and more likely to have been vaccinated in infancy. Conclusion: The results of this study suggest that assessment of HBV serum markers in workers potentially exposed to hospital infections is useful to identify small numbers of unvaccinated subjects or vaccinated subjects with low antibody titre, all of whom should be referred to a booster series of vaccinations

USURA E MODUS. IL PROBLEMA DEL SOVRAINDEBITAMENTO DAL MONDO ANTICO ALL'ATTUALITA'

Il libro Usura e modus. Il problema del sovraindebitamento dal mondo antico all’attualità non riguarda solo il fenomeno dell’usura, ma abbraccia il tema, di più ampio respiro, della misura dei debiti e in particolare degli interessi dovuti a fronte del prestito di danaro. Si scorge un sottile filo conduttore: il sovraindebitamento non è dannoso soltanto per il debitore insolvente ma anche per il creditore, se il peso che grava sul debitore diventa insopportabile e quindi il credito non può essere soddisfatto. I rischi che ne derivano, quando questa situazione colpisce larghi strati della società, sono anche per l’ordine pubblico, la libertà e la democrazia, come i tanti episodi via via ricordati nel lavoro lasciano intendere.La monografia è divisa in tre capitoli. Il primo, intitolato Usura e avaritia, attraverso l’esame delle fonti evidenzia il collegamento fra la brama smodata di denaro (avaritia) e la pratica del prestito ad interesse non finalizzata alla produzione o allo scambio: una pratica, nei cui riguardi, a Platone e soprattutto ad Aristotele risalgono le basi “filosofiche” di un atteggiamento di “ripugnanza”. Attraverso un vasto panorama di testimonianze si ricostruisce sia il susseguirsi a Roma dei provvedimenti normativi in materia di prestiti con gli interessi (c.d. leges fenebres), sia di quegli interventi talora diretti alla cancellazione o dilazione dei debiti. Non mancano episodi tratti dalle fonti che si prestano ad una comparazione storica con la situazione attuale. Un caso di particolare interesse è quello della crisi di liquidità provocata da debiti eccessivi che determinarono di conseguenza un blocco del credito sotto Tiberio, il quale vi pose rimedio con efficaci iniziative. Il discorso prosegue con la rassegna dei procedimenti e delle pene contro gli usurai. Dalla trattazione emerge un contrasto tra prassi e divieto di prestare denaro a interesse: il che suscita dubbi in ordine alla certezza e assolutezza del divieto. Il secondo capitolo si caratterizza per l’analisi dei brani dei giuristi romani dai quali emerge l’esistenza sia di una “misura legittima” (modus legitimus) che di una “misura ragionevole” (modus probabilis) degli interessi: criteri che il mos regionis, come risulta da alcuni testi, orienta nel loro concreto modo di operare. Si passa poi all’esame dei provvedimenti imperiali in materia di tassi di interesse. Vista nel suo complesso la legislazione, soprattutto quella di cui è artefice Giustiniano, tende a favorire i debitori ora con forme di alleggerimento dell’ammontare dei debiti, ora rendendone più agevole l’adempimento. Il terzo capitolo chiude il lavoro con uno sguardo all’attualità segnata dalla crisi economica internazionale: una situazione in buona parte determinata da debiti eccessivi contratti sia dagli Stati che dai privati. Una pericolosa bolla finanziaria nella quale l’entità dei debiti è progressivamente cresciuta a causa di vari fattori. Uno di questi è l’anatocismo, che in Italia ha avuto “peculiari vicende”. Recenti orientamenti giurisprudenziali consentono anche una corretta interpretazione della normativa antiusura formatasi negli anni, a cominciare dalla L. 108 del 1996. Il libro si conclude con uno sguardo alle contromisure – e spicca l’exceptio doli generalis, di cui è chiara la matrice romanistica - alle quali possono fare ricorso i debitori per difendersi quando il rapporto contrattuale presenta vistosi squilibri