Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Impatto energetico dei sistemi acquedottistici: ruolo delle perdite idriche

Il prelievo e la distribuzione agli utenti della risorsa idrica potabile comportano l’impiego di un considerevole quantitativo di energia, dovuto in parte alla potabilizzazione, ma principalmente ad attività di pompaggio. Tra i fattori che incidono sui consumi energetici dei sistemi acquedottistici, accanto a quelli legati alla reperibilità della risorsa, all’altimetria del terreno ed all’efficienza di impianti e condotte, significativo è il ruolo delle perdite idriche in rete. Nel presente lavoro si propone una prima analisi dei consumi energetici della Regione Emilia Romagna legati ai sistemi acquedottistici, in particolare valutati alla luce dei corrispondenti livelli di perdita idrica. Nell’ottica di voler indagare la relazione che lega le perdite idriche ed il conseguente incremento di energia dovuto a pompaggio, vengono esposti alcuni risultati valutati su modello numerico per un caso di studio reale costituito da un distretto monitorato della rete acquedottistica di Modena e alimentato mediante pompe a giri variabili. In particolare è stato valutato l’impatto energetico delle perdite in relazione alla loro posizione nella rete di distribuzione. Il codice di calcolo utilizzato è stato EPANET

The Transformation of Healthcare Buildings: The Challenges of the University of Pavia for Urban Regeneration

The theme of urban regeneration is currently one of the main actions of transformation policies. It presents an opportunity for cities’ design, in particular historical centers, through joint actions aimed at creating synergies and connections between social, political, economic, and environmental aspects. It also becomes an opportunity to enhance the huge and complex Cultural Heritage, full of architectural values, memory, and history. At the same time, it appears increasingly inadequate and obsolete compared to the new needs of a changing society, of regulatory aspects, and of a general compatible approach to intervention to the more general policies of sustainable development, as required by the 2030 Agenda for Sustainable Development. A total of two case studies of the reuse and enhancement of hospital buildings of the University of Pavia are presented, which has a large building heritage spread throughout the city. In recent years, owing to the opportunities offered by funding, it has started transformation policies on some abandoned buildings through projects based on an interdisciplinary approach and a participatory design strategy. The article testifies to a potential method of intervention that can be exported to other contexts, after a previous test of the compatibility on the existing and on the urban context

Bilancio Di Genere

Il Bilancio di Genere del CNR, anno 201

Molecular and clinical features of the myeloproliferative neoplasm associated with JAK2 exon 12 mutations

Although approximately 95% of patients with polycythemia vera (PV) harbor the V617F mutation in JAK2 exon 14, several mutations in exon 12 have been described in the remaining patients. We conducted a European collaborative study to define the molecular and clinical features of patients harboring these mutations. Overall, 106 PVs were recruited and 17 different mutations identified. Irrespective of the mutation, two-thirds of patients had isolated erythrocytosis, whereas the remaining subjects had erythrocytosis plus leukocytosis and/or thrombocytosis. Compared with JAK2 (V617F)-positive PV patients, those with exon 12 mutations had significantly higher hemoglobin level and lower platelet and leukocyte counts at diagnosis but similar incidences of thrombosis, myelofibrosis, leukemia, and death. In a multivariable analysis, age more than 60 years and prior thrombosis predicted thrombosis. These findings suggest that, despite the phenotypical difference, the outcome of JAK2 exon 12 mutations-positive PV is similar to that of JAK2 (V617F)-positive PV