Nocturnal Arrhythmias and Heart-Rate Swings in Patients With Obstructive Sleep Apnea Syndrome Treated With Beta Blockers

Background: The higher cardiovascular variability and the increased prevalence of arrhythmias in patients with obstructive sleep apneas may contribute to their higher rate of fatal events during sleep. In this regard, the use of beta blockers (BB) is debated because they may induce bradyarrhythmias and alter the pattern of heart rate changes induced by apneas. Thus, the aim of our study is to quantify peri-apneic heart-rate swings and prevalence of nocturnal bradyarrhythmias in BB-treated and BB-naive patients with obstructive sleep apnea. Methods and Results: Our real-life, retrospective, cohort study analyzed data from patients with obstructive sleep apnea after a basal cardiorespiratory polysomnography. Among 228 eligible participants, we enrolled 78 BB-treated and 88 BB-naive patients excluding those treated with antiarrhythmic drugs or pacemakers, or with uninterpretable ECG traces during polysomnography. In each patient, type and frequency of arrhythmias were identified and peri-apneic changes of RR intervals were evaluated for each apnea. BB-treated patients were older and with more comorbidities than BB-naive patients, but had similar obstructive sleep apnea severity, similar frequency of arrhythmic episodes, and similar prevalence of bradyarrhythmias. Apnea-induced heart-rate swings, unadjusted for age, showed lower RR interval changes in BB-treated (133.5 +/- 63.8 ms) than BB-naive patients (171.3 +/- 87.7 ms, P=0.01), lower RR interval increases during apneas (58.5 +/- 28.5 versus 74.6 +/- 40.2 ms, P=0.01), and lower RR interval decreases after apneas (75.0 +/- 42.4 versus 96.7 +/- 55.5 ms, P0.05). Conclusions: BB appear to be safe in patients with obstructive sleep apnea because they are not associated with worse episodes of nocturnal bradyarrhythmias and even seem protective in terms of apnea-induced changes of heart rate

Erythropoietin as a Neuroprotective Drug for Newborn Infants: Ten Years after the First Use

Protective strategies against perinatal brain injury represent a major challenge for modern neonatology. Erythropoietin (Epo) enhances endogenous mechanisms of repair and angiogenesis. In order to analyse the newest evidence on the role of Epo in prematurity, hypoxic ischemic encephalopathy (HIE) and perinatal stroke, a critical review using 2020 PRISMA statement guidelines was conducted. This review uncovered 26 clinical trials examining the use of Epo for prematurity and brain injury-related outcomes. The effects of Epo on prematurity were analysed in 16 clinical trials. Erythropoietin was provided until 32-35 weeks of corrected postnatal age with a dosage between 500-3000 UI/kg/dose. Eight trials reported the Epo effects on HIE term newborn infants: Erythropoietin was administered in the first weeks of life, at different multiple doses between 250-2500 UI/kg/dose, as either an adjuvant therapy with hypothermia or a substitute for hypothermia. Two trials investigated Epo effects in perinatal stroke. Erythropoietin was administered at a dose of 1000 IU/kg for three days. No beneficial effect in improving morbidity was observed after Epo administration in perinatal stroke. A positive effect on neurodevelopmental outcome seems to occur when Epo is used as an adjuvant therapy with hypothermia in the HIE newborns. Administration of Epo in preterm infants still presents inconsistencies with regard to neurodevelopmental outcome. Clinical trials show significant differences mainly in target population and intervention scheme. The identification of specific markers and their temporal expression at different time of recovery after hypoxia-ischemia in neonates might be implemented to optimize the therapeutic scheme after hypoxic-ischemic injury in the developing brain. Additional studies on tailored regimes, accounting for the risk stratification of brain damage in newborns, are required

Vegetation Map of Viola Bormina Valley (Province of Sondrio)

La presente tesi di Dottorato vuole essere un contributo alla conoscenza ed interpretazione delle tipologie di vegetazione presenti in Val Viola, per la maggior parte interessata dalla presenza di un Sito di Importanza Comunitaria, denominato IT2040012 - Val Viola Bormina - Ghiacciaio di Cima dei Piazzi. A tal scopo è stata realizzata una carta fitosociologica della vegetazione con restituzione a scala 1:10.000, basata sull’integrazione tra fotointerpretazione e rilievi di campo. L'area di studio è rappresentata dalla Val Viola Bormina (1700-3400 m s.l.m.), inserita nel gruppo delle Alpi Retiche, in provincia di Sondrio. La metodologia adottata ha previsto la realizzazione di un apposito GIS, comprendente 6 carte tematiche di base (in formato vettoriale), redatte ex novo: carta fitosociologica della vegetazione (scala, l: 10.000), carta dei lineamenti morfologici (1: 10.000), carta delle fasce altimetriche (1: 10.000), carta dell'acclività (1:10.000), carta dell'esposizione (1: 10.000) e carta della radiazione solare annua incidente (1:10.000). Tali tematismi, sono stati successivamente gestiti in ambiente GIS per l’interpretazione della distribuzione e delle caratteristiche ecologiche della vegetazione rilevata su campo. Sono stati effettuati circa 300 rilievi fitosociologici, che hanno permesso l’individuazione e la descrizione di 53 tipi vegetazionali (associazioni, varianti e aggruppamenti), ascrivibili alle seguenti classi fitosociologiche: Vaccinio-Piceetea Br.-Bl. in Br.-Bl. et al. 1939, Loiseleurio-Vaccinietea Eggler 1952, Mulgedio-Aconitetea Hadač et Klika in Klika et Hadač 1944, Molinio-Arrhenatheretea R. Tx. 1937 em. R. Tx. 1970, Caricetea curvulae Br.-Bl. 1948, Salicetea herbaceae Br.-Bl. 1948, Scheuchzerio-Caricetea nigrae R. Tx. 1937 nom. mut. propos., Montio-Cardaminetea Br.-Bl. Et R. Tx. Ex Klika et Hadač 1944 em. Zechmeister 1993, Littorelletea R. Tx. 1947, Thlaspietea rotundifolii Br.-Bl. 1948, Asplenietea trichomanis (Br.-Bl. in Meier et Br.-Bl. 1934) Oberd. 1977

Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers

BACKGROUND/OBJECTIVES: To compare the number of eye surgical procedures performed in Italy in the 2months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control).METHODS: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant.RESULTS: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65-0.80 and 0.61-0.75, respectively, p<0.001 for both).CONCLUSION: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic

Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers

BACKGROUND/OBJECTIVES: To compare the number of eye surgical procedures performed in Italy in the 2months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control).METHODS: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant.RESULTS: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65-0.80 and 0.61-0.75, respectively, p<0.001 for both).CONCLUSION: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic