Cognitive Function and Heart Failure: The Role of the Adrenergic System

Heart Failure (HF) and cognitive impairment (CI) represent two high incident diseases worldwide, with extremely elevated mortality and morbidity rates. Their prevalence is expected to further increase in the next years due to the aging population, thus they pose enormous clinical, social and economic challenges. Sympathetic nervous system hyperactivity is known to play a pivotal role in HF pathophysiology and progression. In fact, increased cardiac and circulating catecholamine levels are responsible for several molecular and structural abnormalities with detrimental effects on the failing heart. The proof of this latter concept is represented by the clinical success of .-Blocker therapy that is able to attenuate HF-related morbidity and mortality. Recently, adrenergic system alterations have been implied also in the pathogenesis of CI and dementia opening the window for new fascinating and promising therapeutic opportunities

Proceedings of the eip on aha: a3 action group on frailty

The present issue of TranslationalMedicine@ UNISA provides a sample of the activities of the partners of the EIP on AHA that are contributing to transform ageing from a burden into an opportunity for the EU, and beyond. It is the expression of a multifaceted approach to a societal challenge that can be only tackled by using inclusive strategy that exploit and valorizes the good practices of multiple stakeholders

MiR-200c-3p maintains stemness and proliferative potential in adipose-derived stem cells by counteracting senescence mechanisms

Adipose-derived mesenchymal stem cells (ASCs) are promising therapeutic tools in regenerative medicine because they possess self-renewal, differentiation and immunomodulatory capacities. After isolation, ASCs are passaged multiple times in vitro passages to obtain a sufficient amount of cells for clinical applications. During this time-consuming procedure, ASCs become senescent and less proliferative, compromising their clinical efficacy. Here, we sought to investigate how in vitro passages impact ASC proliferation/senescence and expression of immune regulatory proteins. MicroRNAs are pivotal regulators of ASC physiology. Particularly, miR-200c is known to maintain pluripotency and targets the immune checkpoint Programmed death-ligand 1 (PD-L1). We therefore investigated its involvement in these critical characteristics of ASCs during in vitro passages. We found that when transiently expressed, miR-200c-3p promotes proliferation, maintains stemness, and contrasts senescence in late passaged ASCs. Additionally, this miRNA modulates PD-L1 and Indoleamine 2,3-Dioxygenase (IDO1) expression, thus most likely interfering with the immunoregulatory capacity of ASCs. Based on our results, we suggest that expression of miR-200c-3p may prime ASC towards a self-renewing phenotype by improving their in vitro expansion. Contrarily, its inhibition is associated with senescence, reduced proliferation and induction of immune regulators. Our data underline the potential use of miR-200c-3p as a switch for ASCs reprogramming and their clinical application

Implementing an ict-based polypharmacy management program in Italy

Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses on multimorbidity and polytherapy management are encouraged. Furthermore a multidisciplinary approach integrating different health care professionals (physicians, pharmacists, and nurses) may positively impact on reducing the sense of fear related to discontinue or substitute drugs prescribed by others; the fragmentation of therapy among different specialists; reducing costs; and improving adverse drug reaction detection and reporting. Aiming at achieving the individualized pharmacotherapy, a multidisciplinary approach starting with identification of patients and risk for drug-related problems, followed by medication review overtime and use of inappropriateness criteria, supported by computerized systems has been proposed

Durability of bioprosthetic aortic valve replacement in patients under the age of 60 years - 1-year follow-up from the prospective INDURE registry.

OBJECTIVES We report 1-year safety and clinical outcomes in patients <60 years undergoing bioprosthetic surgical aortic valve intervention. METHODS The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, multicentre registry to assess clinical outcomes of patients <60 years. Patients with planned SAVR with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance, and quality of life (QoL) at 1 year were assessed. RESULTS 421 patients were documented with a mean age of 53.5 years, 76.5% being male, and 27.2% in NYHA class III/IV. Outcomes within 30 days included cardiovascular-related mortality (0.7%), time-related valve safety (VARC-2; 5.8%), thromboembolic events (1.7%), valve-related life-threatening bleeding (VARC-2; 4.3%), and permanent pacemaker implantation (3.8%). QoL was significantly increased at 6 months and sustained at 1 year. Freedom from all-cause mortality at 1 year was 98.3% (95%CI 97.1;99.6) and 81.8% were NYHA I vs. 21.9% at baseline. No patient developed structural valve deterioration Stage 3 (VARC-3). Mean aortic pressure gradient was 12.6 mmHg at 1 year and effective orifice area was 1.9 cm2. CONCLUSIONS The 1-year data from the INSPIRIS RESILIA valve demonstrate good safety and excellent haemodynamic performance as well as an early QoL improvement. CLINICALTRIALS NUMBER NCT03666741

PharmaCare 2018

[Italiano]: Il farmaco, nella sua accezione più ampia e generale, può essere ritenuto un bene sociale, la cui valenza simbolica e curativa varia in relazione alla dimensione ambientale e culturale nel quale si inserisce. In tal senso, le prescrizioni farmaceutiche rappresentano un indicatore privilegiato per la conoscenza del sistema salute di un determinato territorio, poiché costituiscono un punto di intersezione ideale tra la prospettiva medica e quella di mercato. Siffatte considerazioni hanno sollecitato l’elaborazione di questo Report che si pone, come obiettivi dichiarati, quello di essere uno strumento utile alla pianificazione di interventi di sanità pubblica, quanto quello di svolgere analisi approfondite sulle caratteristiche dei soggetti che usano i farmaci e sulle modalità di trattamento degli stessi, permettendo studi di appropriatezza prescrittiva su specifiche aree di rilevanza clinica e su specifiche coorti di soggetti. “PharmaCaRe Report 2018” è stato realizzato dal CIRFF (Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione) dell’Università degli Studi di Napoli Federico II, in collaborazione con la Direzione Generale della Tutela della Salute della Regione Campania, per delineare un quadro dettagliato circa il consumo e la prescrizione dei farmaci in Campania nel 2018. Questo Report intende infatti fornire una fotografia dettagliata dell’utilizzo che, in Campania, viene fatto dei farmaci in termini di spesa, volumi e tipologia. Le analisi dei dati prodotte offrono spunti importanti per correlare la prevalenza delle patologie nel territorio con il corrispondente utilizzo dei farmaci e suggeriscono un’interpretazione dei principali fattori che influenzano la variabilità nella prescrizione. La disponibilità di una banca dati che copre una popolazione assistibile di circa sei milioni di abitanti è d’altronde un potente strumento di ricerca per studiare gli effetti dell’utilizzo dei farmaci in condizioni di Real-World. La conoscenza delle dinamiche prescrittive, in termini qualitativi (appropriatezza d’uso), oltre che quantitativi (volumi di utilizzo) è la condizione necessaria per inquadrare in un contesto razionale la politica del farmaco, anche sotto il profilo della valutazione degli effetti degli interventi che il mercato, le normative o la cultura del farmaco sviluppano nel tempo. Per tali ragioni, “PharmaCaRe Report 2018” rappresenta un utile quanto prezioso supporto ai decisori per individuare strategie volte a ottimizzare l’allocazione delle risorse, nonché migliorare i percorsi di cura attraverso un monitoraggio costante, la promozione di più elevati standard di cura e l’uso sicuro, efficiente ed efficace dei farmaci ./[English]: In its broadest and most general sense, the drug can be considered a public resource, whose symbolic and curative value varies in relation to the environmental and cultural dimension in which it is embedded. In this sense, pharmaceutical prescriptions represent a privileged indicator for the knowledge of the health system of a given territory, since they constitute an ideal intersection point between the medical and the market perspective. Such considerations prompted the preparation of this Report. “PharmaCaRe Report 2018” has been produced by CIRFF (Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione) of the Federico II University of Naples, in collaboration with the Directorate-General for Health Protection of the Campania Region, to provide a detailed overview of the pharmaceutical consumption and prescriptions in Campania in 2018. This Report aims to provide a detailed picture of the use of medicines in the general population in Campania, in terms of expenditure, volumes and type. The analyses of the data produced offer important clues for correlating the prevalence of diseases in this area with the respective use of medicines and suggest an interpretation of the main factors influencing prescriptions' variability. The availability of a database covering a patient population of around six million is a powerful research tool for studying the effects of drug use in Real-World conditions. Knowledge of the dynamics of prescription, in qualitative terms (appropriateness of use), as well as quantitative (volumes of use) is the necessary condition to frame the drug policy in a rational context, also in terms of evaluating the effects of the interventions that the market, regulations or drug culture develop over time. For these reasons, “PharmaCaRe Report 2018” represents a useful and valuable tool for political decision-makers in identifying strategies aimed at optimizing the allocation of resources, as well as improving care pathways through constant monitoring, the promotion of higher standards of care and safe, efficient and effective use of drugs

Durability of bioprosthetic aortic valves in patients under the age of 60 years - Rationale and design of the international INDURE registry

Background: There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. Methods: The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INS

Innovative approaches to active and healthy ageing: Campania experience to improve the adoption of innovative good practices

The demographic projections on the European population predict that people aged over 60 will increase by about two million/year in the next decades. Since 2012, the Campania Reference Site of the European Innovation Partnership on Active and Healthy Ageing supports the innovation of the Regional Health System, to face up demographic changes and sustainability. Campania Reference Site provides the opportunity to connect loco-regional stakeholders in social and health care services (universities, healthcare providers, social services, local communities and municipalities), with international organizations, in order to adopt and scale up innovative solutions and approaches. This paper describes the building process of Campania Reference Site and the main results achieved, that have been allowing it to become a hub for open innovation in the field of active and healthy aging at regional, national and international level

Health tourism: an opportunity for sustainable development

In February 2017, the “Programma Mattone Internazionale Salute” (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "AgeFriendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities