Preoperative risk evaluation in patients over 75 years candidates to non-cardiac and cardiac surgery

In the 24th and 25thof June 2016, 80 national experts were invited to Rome from The Italian Society of Geriatric Cardiology and the Italian Association of Cardiovascular Prevention and Rehabilitation to revise the current knowledge on the perioperative risk in the elderly. Cardiologists, geriatricians, heart and general surgeons and anesthesiologists discussed the topic with the objective of reaching a consensus and to launch observational research and registries in the field of perioperative risk evaluation in the elderly. The introduction of objective measures of frailty on top of traditional cardiac evaluation in the different surgical contexts could allow for a more precise definition of "surgical risk", appropriate perioperative management and postoperative outcome.</p

Heart failure in the elderly: A geriatric syndrome. Picture of the modern situation

Among the older patients’ cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient’s history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration

Paziente scompensato con comorbilità. approfondimento su scompenso e ipertensione

La prevalenza dello scompenso cardiaco in Italia è di 600.000 soggetti, di cui 170.000 nuovi casi all’anno. • Nel paziente scompensato, la presenza di comorbilità, in particolare l’ipertensione, può modificare sensibilmente la prognosi. • L’aldosterone è responsabile di molteplici effetti che provocano rimodellamento cardiaco e danno renale. • Il razionale per l’impiego degli MRA nel paziente scompensato e iperteso è l’azione antifibrotica che contrasta il rimodellamento cardiaco, vasale e renale. • Nello studio AREA IN-CHF (467 pazienti scompensati, di cui circa il 50% ipertesi), canrenone, in aggiunta alla terapia standard dello SC, ha migliorato la prognosi dei pazienti senza alterarne l’assetto renale. • Nei grandi studi sullo SC, i pazienti in trattamento con MRA, hanno fatto registrare una variazione della creatinina, tra inizio e fine studio, trascurabile in termini assoluti, confermando l’elevato profilo di tollerabilità renale degli M

Diuretic therapy in heart failure: current controversies and new approaches for fluid removal

Hospitalization for heart failure is a major health problem with high in-hospital and postdischarge mortality and morbidity. Non-potassium-sparing diuretics (NPSDs) still remain the cornerstone of therapy for fluid management in heart failure despite the lack of large randomized trials evaluating their safety and optimal dosing regimens in both the acute and chronic setting. Recent retrospective data suggest increased mortality and re-hospitalization rates in a wide spectrum of heart failure patients receiving NPSDs, particularly at high doses. Electrolyte abnormalities, hypotension, activation of neurohormones, and worsening renal function may all be responsible for the observed poor outcomes. Although NPSD will continue to be important agents to promptly resolve signs and symptoms of heart failure, alternative therapies such as vasopressine antagonists and adenosine blocking agents or techniques like veno-venous ultrafiltration have been developed in an effort to reduce NPSD exposure and minimize their side effects. Until other new agents become available, it is probably prudent to combine NPSD with aldosterone blocking agents that are known to improve outcomes. J Cardiovasc Med 11:563-570 (C) 2010 Italian Federation of Cardiology

Research of the Additional Losses Occurring in Optical Fiber at its Multiple Bends in the Range Waves 1310nm, 1550nm and 1625nm Long

Article is devoted to research of the additional losses occurring in the optical fiber at its multiple bends in the range waves of 1310 nanometers, 1550 nanometers and 1625 nanometers long. Article is directed on creation of the external factors methods which allow to estimate and eliminate negative influence. The automated way of calculation of losses at a bend is developed. Results of scientific researches are used by engineers of "Kazaktelekom" AS for practical definition of losses service conditions. For modeling the Wolfram|Alpha environment - the knowledge base and a set of computing algorithms was chosen. The greatest losses are noted on wavelength 1310nm and 1625nm. All dependences are nonlinear. Losses with each following excess are multiplicative

Vegetation changes in a field abandoned after a wheat crop

The natural vegetation of well drained fields of Southern Santa Fe (Argentina) are a different kind of communities characterized by the abundance of several species of Stipa. When agricultural lands are abandoned, they are often recolonized by the original vegetation. The object of this paper is to analize the first ten years of secondary succession on a field under a long time of agriculture abandoned after a wheat crop. On the first year, wheat with annual weeds (Chenopodium album and Portulaca oleracea) appeared. After the first year, one plot was colonized by Baccharis salicifolia and the others by Carduus acanthoides, Cerastium glomeratum, Ammi majus, etc. The last years constitute another stage where diversity is reduced and a strong dominance of Baccharis salicifolia or Carduus acanthoides becomes visible. Johnson grass appeared at the begining of the succession and stayed for the whole period with high abundance values. So far no species of the natural communities have established on this field, possibly because not enough time has elapsed yet or because they are absent from the seed bank or in the neighbourhood.The natural vegetation of well drained fields of Southern Santa Fe (Argentina) are a different kind of communities characterized by the abundance of several species of Stipa. When agricultural lands are abandoned, they are often recolonized by the original vegetation. The object of this paper is to analize the first ten years of secondary succession on a field under a long time of agriculture abandoned after a wheat crop. On the first year, wheat with annual weeds (Chenopodium album and Portulaca oleracea) appeared. After the first year, one plot was colonized by Baccharis salicifolia and the others by Carduus acanthoides, Cerastium glomeratum, Ammi majus, etc. The last years constitute another stage where diversity is reduced and a strong dominance of Baccharis salicifolia or Carduus acanthoides becomes visible. Johnson grass appeared at the begining of the succession and stayed for the whole period with high abundance values. So far no species of the natural communities have established on this field, possibly because not enough time has elapsed yet or because they are absent from the seed bank or in the neighbourhood.The natural vegetation of well drained fields of Southern Santa Fe (Argentina) are a different kind of communities characterized by the abundance of several species of Stipa. When agricultural lands are abandoned, they are often recolonized by the original vegetation. The object of this paper is to analize the first ten years of secondary succession on a field under a long time of agriculture abandoned after a wheat crop. On the first year, wheat with annual weeds (Chenopodium album and Portulaca oleracea) appeared. After the first year, one plot was colonized by Baccharis salicifolia and the others by Carduus acanthoides, Cerastium glomeratum, Ammi majus, etc. The last years constitute another stage where diversity is reduced and a strong dominance of Baccharis salicifolia or Carduus acanthoides becomes visible. Johnson grass appeared at the begining of the succession and stayed for the whole period with high abundance values. So far no species of the natural communities have established on this field, possibly because not enough time has elapsed yet or because they are absent from the seed bank or in the neighbourhood

Fifteen years trends of cardiogenic shock and mortality in patients with diabetes and acute coronary syndromes

PURPOSE: Our study was intended to examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus. METHODS: We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units. RESULTS: Of 28,225 participants, 8521 (30.2%) had diabetes: as compared with patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all P &lt; .0001). Prevalence of diabetes and comorbidities increased over time (P for trend &lt; .0001). Cardiogenic shock rates were higher in patients with diabetes, as compared with those without diabetes (7.8% vs 2.8%, P &lt; .0001), and decreased significantly over time only in patients without diabetes (P = .007). Revascularization rates increased over time in patients both with and without diabetes (both P for trend &lt; .0001), although with persistingly lower rates in patients with diabetes. All-cause in-hospital mortality was higher in patients with diabetes (5.4 vs 2.5%, respectively, P &lt; .0001) and decreased more consistently in patients without diabetes (P for trend = .007 and &lt; .0001, respectively). At multivariable analysis, diabetes remains an independent predictor of both cardiogenic shock (odds ratio 2.03; 95% confidence interval, 1.77-2.32; P &lt; .0001) and mortality (odds ratio 1.95; 95% confidence interval, 1.69-2.26; P &lt; .0001). CONCLUSIONS: Despite significant mortality reductions observed over 15 years in acute coronary syndromes, patients with diabetes continue to show threefold higher rates of cardiogenic shock and lower revascularization rates as compared with patients without diabetes. These findings may explain the persistingly higher mortality of patients with diabetes and acute coronary syndromes