SmartHeart CABG Edu

The paper reports on the SmartHeart CABG Edu Android app. The app was conceived to be an innovative and up-to-date tool for patient education, the first of its kind in the Italian context. In particular, the app was developed to provide educational material for patients about to undergo Coronary Artery Bypass Graft (CABG) surgery, a set of self-assessment tools concerning health status (i.e., BMI calculator, LDL cholesterol calculator and anxiety assessment tool) and usability questionnaires (i.e., SEQ and SUS). The paper initially describes the app, then reports on its evaluation, concerning both the app usability and the pre-operative anxiety, and ends by showing the improvements -- derived from the usability evaluation -- put into practice

Giant metastatic myxoid liposarcoma of the mediastinum: A case report

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Perinatal Mood and Anxiety Disorders in Women Undergoing Medically Assisted Reproduction

Background: Women taking advantage of medically assisted reproduction (MAR) techniques may differ from spontaneously conceiving women (nonMAR) in risk of depression and/or anxiety. We aimed to investigate possible differences between MAR and nonMAR through the use of the Edinburgh Postnatal Depression Scale in a sample of Italian-speaking women at their third trimester of pregnancy. Methods: We administered the Edinburgh Postnatal Depression Scale (EPDS) to two groups of pregnant women, MAR and nonMAR, at the third trimester of pregnancy (T0), one month after delivery (T1), and three months after delivery (T2) from February 2013 to December 2019. EPDS total scores cutoffs were ≥9 for risk of depression, 9–11 mild depression, ≥12 major depression, and the EPDS-3A cluster ≥4 was a proxy for anxiety. Results: Included were 1303 nonMAR women and 92 MAR, an expected disproportion. NonMAR and MAR women did not differ on depression or anxiety at any assessment timepoint. MAR women were older than nonMAR, consumed more alcohol and medical drugs, and displayed more complications during pregnancy. Scoring over the threshold on depression risk was associated with foreign nationality, unemployment, psychiatric history of the patient, family or partner, psychiatric problems in past pregnancies, hyperemesis, premenstrual syndrome (PMS), and stressful life events in the last year at baseline, and, for some of them, at other timepoints. In contrast, MAR past or current was associated with having suprathreshold depression at the first-month postpartum follow-up. Conclusions: Taken together, our data show that women opting for MAR do not differ from spontaneously conceiving women regarding psychiatric outcomes but do differ on some sociodemographic and clinical variables

Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass surgery

Background and Objectives Since the impairment of platelet function may cause excess peri-operative bleeding, pre-operative discontinuation of aspirin and heparin bridging are common for cardiac surgery. We evaluated the impact of pre-operative administration of enoxaparin and unfractionated heparin (UFH) on coagulation parameters and peri-operative bleeding in patients undergoing elective coronary artery bypass grafting (CABG) surgery after discontinuation of aspirin. Design and Methods Forty-three patients with three-vessel coronary artery disease undergoing elective CABG surgery discontinued aspirin and were randomized to receive either UFH 180 UI/Kg × 2/day s.c. or enoxaparin 100 UI/Kg × 2/day s.c. until 12 h before surgery (median pre-operative treatment 8 days, range 6–12 days). Surgery was performed as usual with UFH. Neither UFH nor any low molecular weight heparin was given in the immediate post-operative period. The effects of UFH and enoxaparin were monitored by the activated partial thromboplastin time (aPTT) and the Enox-test (sensitive to factor Xa inhibition) using a Rapidpoint® Coagulation Analyzer. aPTT and factor Xa activity were also measured by standard methods. Peri-operative bleeding and the nadirs of hemoglobin concentration, hematocrit and platelet count were monitored post-operatively. Results Patients in the two groups were similar for number of bypasses, on-pump time, total surgery time, and time from the last heparin administration. Coagulation parameters increased significantly and similarly at 30 min and 6 h with both treatments, but returned within the normal range at 12 h. Hemoglobin, hematocrit and platelet counts significantly decreased to the same extent after CABG and re-normalized at the same time. Transfusional requirements of blood and plasma units were similar in the two groups. Interpretation and Conclusions From the kinetics of coagulation parameters and the evaluation of bleeding, enoxaparin is a safe alternative to UFH as a bridging therapy to CABG after discontinuation of aspirin

Klebsiella pneumoniae infections in COVID-19 patients: a two-month retrospective analysis in an Italian hospital

Italy has experienced one of the harshest and earliest COVID-19 epidemics, with the number of patients infected that followed, from the end of February up to the end of March, an exponential trend [1]. Between the 6 March and the 2 May, 394 patients were confirmed positive for SARS-CoV-2 at the University Hospital of Rome Policlinico Umberto I (PUI) [2]. At the PUI, 5 COVID-19 devoted wards were organized, including two brand new ICUs, counting 32 dedicated to COVID-19 patients: the first was the old general ICU converted into a dedicated COVID-19 ICU, while the second was created in the spaces of four operating rooms (new ICU). In the period of this study, a total of 80 COVID-19-affected patients were hospitalized in the two ICUs at PUI. Among them, 65 patients were screened for carbapenemase producing Enterobacterales (CPE) colonization (Brilliance™ CRE medium plates, Oxoid LTD, Basingstoke, UK): 41 out of 47 SARS-CoV-2 patients hospitalised in the old ICU and 24 out of 33 in the new one. Carbapenemase-producing K. pneumoniae were detected in 14/41 patients (34%) only in the old ICU. No CPE were detected from rectal swabs tested in patients hospitalized in the new ICU. In the same period, 11 CPEs were identified from the 39 rectal swabs out of 48 SARS-CoV-2-negative patients (28%) hospitalized in the non-COVID-ICU of the same hospital. Seven COVID-19 patients developed CPE co-infection (5 bronchoalveolar lavages and 2 blood cultures tested positives for carbapenemase-producing K. pneumoniae), while in the non-COVID-19 ICU 7 bloodstream infections (BSIs) also occurred (Table 1). Symptomatic patients were successfully treated with ceftazidime-avibactam

Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: Six-year clinical outcome

ObjectivesWe sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar.MethodsFrom November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n = 597) or on pump (n = 597).ResultsThe overall 30-day mortality was 1.5% (1.2% in the off-pump group and 1.8% in the on-pump group, P = .342). There was no difference for all the other complications between the 2 groups. Mean follow-up was 5.2 ± 1.8 years. Forty-two patients died over the follow-up period (22 in the off-pump group and 20 in the on-pump group), 15 of them of cardiac causes (7 in the off-pump group and 8 in the on-pump group). Six-year outcomes (freedom from death, cardiac death, acute myocardial infarction and reoperation in all or in the grafted area, target cardiac events, and any other event) were similar for both categories. After a mean of 30.7 ± 20.1 months, 202 patients had a postoperative angiography showing similar results.ConclusionsOur results with extensive arterial revascularization clearly show that with the technical improvements achieved in the most recent years, off-pump operations can be performed safely with the same quality of late results as those obtained with on-pump operations

Adherence and Reactogenicity to Vaccines against SARS-COV-2 in 285 Patients with Neuropathy: A Multicentric Study

Background: The safety of the new vaccines against SARS-CoV-2 have already been shown, although data on patients with polyneuropathy are still lacking. The aim of this study is to evaluate the adherence to SARS-CoV-2 vaccination, as well as the reactogenicity to those vaccines in patients affected by neuropathy. Methods: A multicentric and web-based cross-sectional survey was conducted among patients affected by neuropathy from part of South Italy. Results: Out of 285 responders, n = 268 were included in the final analysis and n = 258 of them (96.3%) were fully vaccinated. Adherence to vaccination was higher in patients with hereditary neuropathies compared to others, while it was lower in patients with anti-MAG neuropathy (all p < 0.05). The overall prevalence of adverse events (AEs) was 61.2% and its occurrence was not associated with neuropathy type. Being female and of younger age were factors associated with higher risk of AEs, while having an inflammatory neuropathy and steroids assumption were associated with a lower risk (all p < 0.05). Younger age, having had an AE, and COVID-19 before vaccination were factors associated with symptoms worsening after vaccination (all p < 0.05). (4) Conclusions: Patients with neuropathy showed a high level of adherence to COVID-19 vaccination. Safety of vaccines in patients with neuropathies was comparable to the general population and it was more favorable in those with inflammatory neuropathy

Technology and technique for left ventricular assist device optimization: A Bi-Tech solution

Background We investigated the synergistic effect of the new cone-bearing design of Jarvik 2000 (Jarvik Heart Inc., NY) together with a minimally-invasive approach to outcomes of LVAD patients. Methods We retrospectively reviewed all patients from 5 institutions involved in the Jarvik 2000 Italian Registry, from October 2008 to October 2016. Patients were divided into three groups according to pump design and implantation technique: pin-bearing design and conventional approach (Group 1); cone-bearing and conventional approach (Group 2); cone-bearing and minimally-invasive implantation (Group 3). Results A total of 150 adult patients with end-stage heart failure were enrolled: 26 subjects in Group 1, 74 in Group 2, and 50 in Group 3. Nineteen patients (73%) in Group 1, 51 (69%) in Group 2, and 36 (72%) in Group 3 were discharged. During follow-up, 22 patients underwent transplantation, while in 3 patients the LVAD was explanted. The overall 1-year survival was 58 +/- 10%, 64 +/- 6%, and 74% +/- 7% in Groups 1, 2, and 3, respectively (p = 0.034). The competing-risks-adjusted cumulative incidence rate for adverse events was 42.1 [27-62.7] per 100 patient-years in Group 1, 35.4 [25.3-48.2] in Group 2, and 22.1 [12.4-36.4] in Group 3 (p = 0.046 for Group 1 vs. 3). Conclusions The association of the modern cone-bearing configuration of Jarvik 2000 and minimally invasive surgery improved survival and minimized the risk for cardiovascular events, as a result of combining technology and technique

Reendothelization of porcine heart valve scaffolds with WJ-MSC: a new approach in the heart valve tissue engineering.

Heart valve substitution, based on biosynthetic or mechanical prosthesis replacement, is one of the most frequent surgical approach to treat heart valve diseases. Even if the prosthesis implantation gives a good life quality for patients, there are many long-term disadvantages related to the substitution, such as structural deterioration, non-structural dysfunction and re-intervention. The heart valve tissue engineering (HVTE), a novel branch of regenerative medicine, is developing innovative models and testing new methods to overcome the above reported limitations. In the present study, we investigated the possibility to reendothelize a porcine heart valve scaffold, previously decellularized, by using two cell types: Wharton’s Jelly mesenchymal stem cells (WJ-MSC) and human umbilical vein endothelial cells (HUVEC), the last used as control cells for the reendothelialization process. Both cell types showed, by fluorescence microscopy, that they were able to reconstitute a valid and functional monolayer of neo-endothelium, characterized by the surface expression of typical endothelial markers (i.e. CD144 and CD146). All together, these data suggest that both HUVEC and WJ-MSC are suitable for in vitro autologous endothelium regeneration, opening new perspectives in the field of HVTE