orthostatic hypotension does not increase cardiovascular risk in the elderly at a population level

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Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model

Background: Improvements in perinatal care have substantially decreased mortality rates among preterm infants, yet their neurodevelopmental outcomes and quality of life persist as a pertinent public health concern. Family-centered care has emerged as a holistic philosophy that promotes effective alliances among patients, families, and healthcare providers to improve the quality of care. Aims: This longitudinal prospective study aims to evaluate the neurodevelopmental outcomes and brain MRI findings in a cohort of preterm newborns admitted to a neonatal intensive care unit (NICU) adopting a family-centered care model. Methods: Very low birth weight (VLBW) infants admitted to the NICU of Modena between 2015 and 2020 were enrolled. Infants who underwent conventional brain magnetic resonance imaging (MRI) at term-equivalent age were included. Neurodevelopmental follow-up was performed until the age of 24 months by a multidisciplinary team using the Amiel-Tison neurological assessment and the Griffiths Mental Developmental Scales (GMDS-R). Neurodevelopmental outcomes were classified as major sequelae (cerebral palsy, DQ ≤ 70, severe sensory impairment), minor sequelae (minor neurological signs such as clumsiness or DQ between 71 and 85), and normal outcomes (no neurological signs and DQ > 85). Risk factors for severe outcomes were assessed. Results: In total, 49 of the 356 infants (13.8%) died before hospital discharge, and 2 were excluded because of congenital disorders. Of the remaining 305 infants, 222 (72.8%) completed the 24 month follow-up and were included in the study. Neurodevelopmental outcomes were classified as normal (n = 173, 77.9%), minor (n = 34, 15.3%), and major sequelae (n = 15, 6.8%). Among 221 infants undergoing brain MRI, 76 (34.4%) had major lesions (intraventricular hemorrhage, hemorrhagic parenchymal infarction, periventricular leukomalacia, and large cerebellar hemorrhage). In the multivariate regression model, the retinopathy of prematurity (OR 1.8; p value 0.016) and periventricular–intraventricular hemorrhage (OR 5.6; p value < 0.004) were associated with major sequelae. Conclusions: We reported low rates of severe neurodevelopmental outcomes in VLBW infants born in an Italian NICU with FCC. Identifying the risk factors for severe outcomes can assist in tailoring and optimizing early interventions on an individual basis, both within the NICU and after discharge

Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: Study protocol for a randomized controlled trial

Background: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. Methods/design: In this study, 206 spontaneously breathing infants born at 24+0-27+6 weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. Discussion: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. Trial registration: ClinicalTrials.gov identifier: NCT02482766. Registered on 1 June 2015

Stress related components in patients with acute myocardial infarction

Objective: The present work aims to describe the psychological characteristics emerging in a group of infarcted subjects using tests to detect some aspects of the personality and typical behaviours of patients who have been diagnosed with serious cardiovascular disease. In the scientific literature, a number of biological predispositions have been already identified and well described such genetic predisposition, sex, age, hypercholesterolemia, hypertension etc. Furthermore, multiple psychological factors: personality traits, the ability or to feel emotions, like an-ger and hostility, particular behavioural patterns and lifestyles, seems to plays an important role in the etiology of cardiovascular diseases. In addition, as evidence of the close body-mind relationship and the importance of the patient’s over-all management, there is the fact that pathological alterations of the mood can be risk factors about the course of most of organic disease and even represent real predictors of mortality. Materials and methods: 25 subjects (23 male and 2 female) aged between 40 and 60 with a diagnosis of Acute Myocardial Infarction were examined. The following tests were administered before angioplasty: Symptom Questionnaire, Illness Behaviour Questionnaire and P Stress Questionnaire. After two weeks, during the cardiological rehabilitation, the Cognitive Behavioural Assessment battery and a second Symptom Questionnaire were administered. Results: The results in the P Stress Questionnaire highlight dysfunctional behaviours; in particular, patients show high scores in the Hyperactivity and Vigor subscales while the Illness Behaviour Questionnaire highlights the tendency to deny emotions. In addition, comparing the results between the first and second administration of the Symptom Questionnaire reveals a decrease in hostility. Conclusions: This study confirms what has already been described in the literature about the presence of stable personality traits and the tendency to adopt risky behaviours for stress-related physical disorders in a group of infarcted patients and highlights the need for a multidimensional and multidisciplinary approach in order to promote psychological well-being, encourage the improvement of physical conditions and prevent any relapses

Reminiscing on acute and chronic events in children with cancer and their parents: An exploratory study

Background: Children with cancer live through intense emotional experiences that call for coping with stressful events. The narration of these events allows them to construct a detailed memory system, fostering the elaboration and attribution of meaning to the disease experience. In particular, shared memory between the parent and the child about past events (i.e., reminiscing) helps children to deal with negative emotional experiences, encouraging emotional regulation and adaptive coping strategies. The present study aims to investigate reminiscing in parent–child with cancer dyads, focusing on parents' reminiscing habits, parents' reminiscing style about acute and chronic events, and children's well‐being, assessed with respect to emotional regulation and coping skills. Method: Fifteen children from ages 4 to 8 years admitted to a paediatric haematology and oncology ward of an Italian hospital, and their parents were engaged in a reminiscing conversation about acute and chronic events related to disease. Moreover, some questionnaires have been proposed to evaluate parents' reminiscing habits and children's emotional regulation and coping skills. Descriptive and quantitative analyses were conducted. Results: The data showed that parents frequently practise reminiscing in everyday life, focusing on directive and socioemotional functions. In reminiscing conversations about acute and chronic events concerning their child's illness, they use an elaborative reminiscing style and an emotional reminiscing style mainly concerning chronic events. A positive correlation between this reminiscing style and children's adaptive coping strategies was found mainly in acute events. A negative correlation emerged between parents' emotional terms (emotional reminiscing) and children's difficulties in emotional regulation. Conclusion: This study underlines the benefits of elaborative and emotional reminiscing conversation, in order to help children with cancer and their families to cope with acute and chronic stressful events. Reminiscing can be a useful methodology for health professionals with a view to collecting information on patients' memories of illness

Cognitive Functions across the GNB3 C825T Polymorphism in an Elderly Italian Population

To verify whether the C825T polymorphism of the GNB3 influences the response to neuropsychological tests, mini-mental state examination, digit span (DS), immediate and delayed prose memory, memory with interference at 10 and 30 seconds (MI 10 and 30), trail making tests (TMTs) A and B, abstraction task, verbal fluency (VF) test, figure drawing and copying, overlapping figures test and clock test were performed in 220 elderly men and women free from clinical dementia and from neurological and psychiatric diseases randomly taken from the Italian general population and analysed across the C825T polymorphism. The performance of DS, immediate and delayed prose memory, VF, and TMTs was worse in subjects who were TT for the polymorphism in comparison to the C-carriers. The performance of all tests declined with age. In the case of DS, immediate and delayed prose memory, MI 10 and VF, this trend was maintained in the C-carriers but not in TT. In the case of prose memory, of memory with interference, and of VF, schooling reduced the detrimental interaction between age and genotype. The C825T polymorphism of GNB3 gene therefore influences memory and verbal fluency, being additive to the effects of age and partially mitigated by schooling

Endoscopic approach to geniculate ganglion: a multicentric experience

Purpose: A variety of lesions could arise from the GG area, or extend into this region from adjacent sites. The management of perigeniculate lesions includes observation, surgery, and radiation, according to the nature, the size of the lesion, and the accompanying symptoms. Preliminary experiences on the exclusive transcanal endoscopic approach to the GG area have shown safety and feasibility avoiding of any postauricular incision, or brain manipulation. The experience from two referral centers on patients treated for a GG lesion with a totally endoscopic approach is herein reported. Methods: Data about patients who underwent exclusive endoscopic approach to the GG area at the Otolaryngology Departments of the University Hospitals of Modena and Bologna between May 2017 and February 2022 were retrospectively collected. Results: The total number of patients included in our study was 11. 10 patients (91%) had progressive unilateral facial paralysis and 1 patient (11%) presented with chronic otorrhea. The mean largest diameter of the treated lesions was of 8 mm. The resection was extended to the fundus of the IAC in 2 patients (expanded approach). The remaining 9 patients (82%) underwent partial ossicular replacement prosthesis (PORP). No major complications occurred. Facial nerve outcomes were good in all patients and the mean ABG worsened from 12 dB pre-operatively to 22 dB post-operatively. Conclusions: The exclusively endoscopic approach to GG lesions represents a viable alternative to traditional microscopic approaches and may be included in the armamentarium of ear surgeons

Plasma Torquetenovirus (TTV) microRNAs and severity of COVID-19

Background Torquetenovirus (TTV), a widespread anellovirus recognized as the main component of the healthy human virome, displays viremia that is highly susceptible to variations in immune competence. TTV possesses microRNA (miRNA)-coding sequences that might be involved in viral immune evasion. Among TTV-encoded miRNAs, miRNA t1a, t3b, and tth8 have been found in biological fluids. Here, the presence of TTV DNA and TTV miRNAs in the plasma of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected subjects was investigated to monitor the possible association with coronavirus disease 2019 (COVID-19) severity. Methods Detection of TTV DNA and miRNA t1a, t3b, and tth8 was investigated in plasma samples of 56 SARS-CoV-2-infected subjects with a spectrum of different COVID-19 outcomes. TTV DNA and TTV miRNAs were assessed with a universal single step real-time TaqMan PCR assay and miRNA quantitative RT-PCR miRNA assay, respectively. Results The TTV DNA prevalence was 59%, whereas at least one TTV miRNA was found in 94% of the patients tested. miRNA tth8 was detected in 91% of subjects, followed by miRNAs t3b (64%) and miRNAt1a (30%). Remarkably, although TTV DNA was unrelated to COVID-19 severity, miRNA tth8 was significantly associated with the degree of disease (adjusted incidence rate ratio (IRR) 2.04, 95% CI 1.14-3.63, for the subjects in the high severity group compared to those in the low severity group). Conclusions Our findings encourage further investigation to understand the potential role of TTV miRNAs in the different outcomes of COVID-19 at early and late stages