Renin-Angiotensin-Aldosterone System Inhibitors, Statins, and Beta-Blockers in Diabetic Patients With Critical Limb Ischemia and Foot Lesions

Medical therapy for secondary prevention is known to be under-used in patients with peripheral artery disease (PAD). Few data are available on the subgroup with critical limb ischemia (CLI). Prescription of cardiovascular preventive therapies was recorded at discharge in a large, prospective cohort of patients admitted for treatment of CLI and foot lesions, stratified for coronary artery disease (CAD) diagnosis. All patients were followed up for at least 1 year. The primary endpoint was major adverse cardiovascular events (MACE). 618 patients were observed for a median follow-up of 981 days. Renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, beta-blockers, and antithrombotic drugs were prescribed in 52%, 80%, 51%, and 99% of patients, respectively. However, only 43% of patients received optimal medical therapy (OMT), defined as the combination of RAAS inhibitor plus statin plus at least one antithrombotic drug. It was observed that the prescription of OMT was not affected by the presence of a CAD diagnosis. On the other hand, it was noticed that the renal function affected the prescription of OMT. OMT was independently associated with MACE (HR 0.688, 95%CI 0.475-0.995, P = .047) and, after propensity matching, also with all-cause mortality (HR 0.626, 95%CI 0.409-0.958, P = .031). Beta-blockers prescription was not associated with any outcome. In conclusion, patients with critical limb ischemia are under-treated with cardiovascular preventive therapies, irrespective of a CAD diagnosis. This has consequences on their prognosis

Transcriptomic profiling of calcified aortic valves in clonal hematopoiesis of indeterminate potential carriers

Clonal hematopoiesis of indeterminate potential (CHIP) is characterized by the presence of clones of mutated blood cells without overt blood diseases. In the last few years, it has emerged that CHIP is associated with atherosclerosis and coronary calcification and that it is an independent determinant of cardiovascular mortality. Recently, CHIP has been found to occur frequently in patients with calcific aortic valve disease (CAVD) and it is associated with a poor prognosis after valve replacement. We assessed the frequency of CHIP by DNA sequencing in the blood cells of 168 CAVD patients undergoing surgical aortic valve replacement or transcatheter aortic valve implantation and investigated the effect of CHIP on 12 months survival. To investigate the pathological process of CAVD in CHIP carriers, we compared by RNA-Seq the aortic valve transcriptome of patients with or without CHIP and non-calcific controls. Transcriptomics data were validated by immunohistochemistry on formalin-embedded aortic valve samples. We confirm that CHIP is common in CAVD patients and that its presence is associated with higher mortality following valve replacement. Additionally, we show, for the first time, that CHIP is often accompanied by a broad cellular and humoral immune response in the explanted aortic valve. Our results suggest that an excessive inflammatory response in CHIP patients may be related to the onset and/or progression of CAVD and point to B cells as possible new effectors of CHIP-induced inflammation

Work addiction and its association with personality traits, general distress, and self-esteem among adult Italian workers

Background: Work addiction has become a topic of increasing research interest but has been little studied in Italy. Therefore, the aim of the present study was to investigate the associations between work addiction, assessed with a recently validated psychometric scale (i.e., Italian version of Bergen Work Addiction Scale, [BWAS]) and other psychological constructs. Methods: The sample comprised 367 Italian workers (Mean 16.11 years; SD±11.28) who completed a survey including the BWAS (Mean 19.422; SD±6.365), Depression Anxiety Stress Scales-21 (Mean 40.866; SD±29.865), Dutch Workaholism Scale (Mean 24.837; SD±6.488), Need for Recovery Scale (Mean 12.946; SD±7.340), Ten Item Personality Inventory (TIPI, Extraversion (Mean 4.253; SD±1.506); Agreeableness (Mean 5.431; SD±1.111), Conscientiousness (Mean 5.792; SD±1.067), Neuroticism (Mean 4.507; SD±1.480), Openness (Mean 4.801; SD±1.122), and Rosenberg’s Self-Esteem Scale (Mean 21.850; SD±6.796). Results: The results indicated that work addiction was positively associated with stress, anxiety, and depression, as well as with the number of hours worked and need for recovery. Moreover, BWAS scores explained 20.1% of an individual’s general psychological distress (i.e., depression, anxiety, and stress). Personality variables explained only a small amount of the variance in work addiction (15.4%). Conclusion: In the present study, a positive and significant association was found between the BWAS (assessing work addiction) and the DUWAS (assessing workaholism). Although work addiction and workaholism are different constructs, they have many characteristics in common. The study expands the work addiction literature base and demonstrates important associating factors in the Italian context

Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

Ferrara IV

To ensure that a population-based programme is recognised, accepted, and followed, it is necessary to work on two levels: to inform the population about it and to share its content widely. These two pathways are not easy but, at least, should run in parallel and travel together. Let’s examine all of the steps that we took for ‘Ferrara, City of Prevention’

Ferrara v

Awareness of the project ‘Ferrara, City of Prevention’ and of all its opportunities, especially at the beginning of the campaign is a major goal. In the previous report,1 we illustrated how we made the logo known throughout the city. Alone, this is insufficient of course. It is necessary to involve and rely on the local and national media to promote the programme. This is almost a job in itself and requires an ad hoc office to assist with coverage, particularly at the national level

Ferrara VI

Ferrara, City of Prevention is a 6-year long project. It follows that the results are expected at the end of this period. As for all preventative actions, even after 6 years, it will be difficult to capture the real impact of the project. We are not randomizing the participants. Just the participation in the programme per se constitutes a bias. The willingness to adhere to the programme means that the individuals already take care of their health. We will not be able to timely follow-up all the participants, but we hope to have long-term data..

Characterization of Dermal Stem Cells of Diabetic Patients

Diabetic foot ulcers (DFUs) are lesions that involve loss of epithelium and dermis, sometimes involving deep structures, compartments, and bones. The aim of this work is to investigate the innate regenerative properties of dermal tissue around ulcers by the identification and analysis of resident dermal stem cells (DSCs). Dermal samples were taken at the edge of DFUs, and genes related to the wound healing process were analyzed by the real-time PCR array. The DSCs were isolated and analyzed by immunofluorescence, flow cytometry, and real-time PCR array to define their stemness properties. The gene expression profile of dermal tissue showed a dysregulation in growth factors, metalloproteinases, collagens, and integrins involved in the wound healing process. In the basal condition, diabetic DSCs adhered on the culture plate with spindle-shaped fibroblast-like morphology. They were positive to the mesenchymal stem cells markers CD44, CD73, CD90, and CD105, but negative for the hematopoietic markers CD14, CD34, CD45, and HLA-DR. In diabetic DSCs, the transcription of genes related to self-renewal and cell division were equivalent to that in normal DSCs. However, the expression of CCNA2, CCND2, CDK1, ALDH1A1, and ABCG2 was downregulated compared with that of normal DSCs. These genes are also related to cell cycle progression and stem cell maintenance. Further investigation will improve the understanding of the molecular mechanisms by which these genes together govern cell proliferation, revealing new strategies useful for future treatment of DFUs