Dry eye in systemic sclerosis patients: Novel methods to monitor disease activity

Background: In systemic sclerosis (SSc) patients, dry eye syndrome (DES) is the most frequent ocular feature. The aim of this study was to investigate ocular DES-related SSc patients and to establish any correlation with the severity of the disease. Methods: Retrospectively, data from 60 patients with SSc underwent ophthalmic examination, where non-invasive film tear break-up time (NIF-TBUT), tear film lipid layer thickness (LLT), anesthetic-free Schirmer test I, tear osmolarity measurement (TearLab System), and modified Rodnan skin score (mRSS) data were collected. The visual analog scale (VAS) and Symptom Assessment in Dry Eye (SANDE) methods were utilized. The results were correlated with mRSS and the duration of SSc. Results: Severe DES occurred in 84% of cases, and was more severe in women. The eyelids were involved in 86.6%, secondary to meibomian gland disease (MGD). A direct correlation was found between the tear osmolarity (mean 328.51 ± 23.8 SD) and skin score (mRSS) (r = 0.79; p < 0.01). Significantly reduced NIF-TBUT, LLT, and Schirmer test I values were observed in the case of severe skin involvement. Conclusions: SSc patients show lipid tear dysfunction related to the severity and duration of the disease due to inflammation and the subsequent atrophy of the meibomian glands

Design and partial-load operation of a reversible Solid Oxide Cell system with molten salts thermal storage

The increasing penetration of renewable energy sources in the electricity mix requires efficient storage solutions on the seasonal scale. Reversible Solid Oxide Cell (rSOC) systems are receiving increased attention as viable options to fulfil this requirement. In this work, a MW-scale rSOC system capable of working over a large operating window is studied via modelling on Aspen Plus®. To ease the thermal integration, a molten salt thermal storage is coupled to the system, enabling heat recovery in fuel cell mode, which is then exploited for water evaporation in electrolysis mode. The rSOC stack is designed to operate exothermically in the electrolysis mode at nominal load. In both modalities, the air mass flow rate is regulated to control the stack temperature, while limiting the in-out gradients within 100°C. At nominal load, the system achieves an electrical efficiency of 52% in fuel cell mode and of 87% in electrolysis mode. The operation at low partial loads, due to the decrease of the air flow rate, requires an additional high-temperature heat source to guarantee the heat integration. In this regard, the adoption of an electrical resistance in electrolysis mode and a hydrogen-fed combustor in fuel cell mode are selected as viable solutions to amplify the operating range of the system. As a results, the system can be operated down to the 30% of the stack nominal power in both modalities, where the system achieves an electric efficiency of 44% and 80% in fuel cell and electrolysis mode, respectively

The role of attachment patterns and family functioning on psychophysical well-being in children with Cystic Fibrosis Preliminary Results

(1) Introduction Scientific literature evidences a link between the quality of personal relationships and health status: the attachment style has a role on health and growth outcomes (Feeney, 2000) especially in chronic illness representing a threatening situation (Ciechanowski, 2003). Cystic fibrosis (CF) is a chronic genetic condition compromising the exocrine glands functioning and requiring intensive daily therapies (White et al., 2009). In pediatric condition, infant-mother relationship constituted an important element for nutritional status in CF children (Simmons et al., 1995; Anthony et al. 1999) which is one of the major factors contributing to improve longevity and quality of life. The study aims to explore attachment patterns of CF children and their mothers, and to examine their relationship with children health status, in terms of quality of eating behaviors and treatment adherence. (2) Method At this stage, 29 mothers of CF children (age ranged 4-7 years, M=5,2; SD=1,3) completed Relationship Questionnaire (Bartholomew and Horowitz, 1991) to assess attachment pattern, and Children's Eating Behavior Questionnaire (Wardle et al., 2001) to assess children's eating behaviors. With Separation Anxiety Test (Klagsbrun and Bowlby, 1976) we assessed children's attachment styles. Diet adherence evaluation by FC Centre\u2019s nutritionist, socio-demographic and disease information were recorded and correlated with other outcomes. (3) Results/discussion No mother reported Preoccupied attachment pattern and distribution across Secure (N=9), Dismissing (N=11) and Fearful one (N=9) is balanced. According to the literature on clinical group (Cassiba et al., 2011), we found an high rate of insecure infants (N=20). The most frequent children insecure attachment style is disorganized (N=9) which is mostly linked with maternal dismissing attachment. Significant correlation between dysfunctional eating behaviors (low food responsiveness and enjoyment, high satiety responsiveness, slowness and fussiness) and compromised health status (low BMI, high hospitalizations number) confirms multidimensionality and dynamicity of pediatric adherence construct (De Civita, Dobkin, 2004). Furthermore, relation between maternal Fearful Attachment and dietary adherence (r=441; p<0,05) confirms how the family functioning plays an important and complex role on the well-being in children with chronic illness (Rolland, 1993) and with CF (Spieth et al., 2001; Zindani et al., 2006)

Long term effectiveness dual site left ventricular cardiac resynchronization therapy in patients with congestive heart failure

This article describes a case of cardiac resynchronization therapy (CRT) performed with dual site left ventricular pacing. The main clinical and functional long-term results are in agreement with the most recent data regarding traditional CRT. Furthermore, this innovative pacing modality allowed optimal inter- and intraventricular resynchronization

Ruolo delle metodiche di imaging cardiologico nella terapia di resincronizzazione cardiaca: position paper AIAC.

Overwiev sul ruolo delle metodiche di imaging cardiaco nella terapia di resincronizzazione cardiac

Defining research priorities in cystic fibrosis. Can existing knowledge and training in biomedical research affect the choice?

The aim of this report is to assess whether the research issues priorities are perceived differently according to the Stakeholders (SH)'s individual knowledge of research topics and degree of training in biomedical research. Four groups of SH were enrolled in this study: 1. Skilled SH, specifically trained in biomedicine; 2. Unskilled untrained SH who responded to a written questionnaire in 2015; 3. SH who were trained for one year in a course delivered by professionals; 4. Untrained SH who responded to an online questionnaire in 2017. The large ranking order variability observed among groups addresses the question that the choices are markedly influenced by the SH's backgrounds. Such results emphasize the need to consider the education level and the delivery of ad hoc training activities by professionals to broaden the base of SH who may be considered qualified to transfer the Patient Centered Outcome Research principles into practice

The scar: the wind in the perfect storm—insights into the mysterious living tissue originating ventricular arrhythmias

Background: Arrhythmic death is very common among patients with structural heart disease, and it is estimated that in European countries, 1 per 1000 inhabitants yearly dies for sudden cardiac death (SCD), mainly as a result of ventricular arrhythmias (VA). The scar is the result of cardiac remodelling process that occurs in several cardiomyopathies, both ischemic and non-ischemic, and is considered the perfect substrate for re-entrant and non-re-entrant arrhythmias. Methods: Our aim was to review published evidence on the histological and electrophysiological properties of myocardial scar and to review the central role of cardiac magnetic resonance (CMR) in assessing ventricular arrhythmias substrate and its potential implication in risk stratification of SCD. Results: Scarring process affects both structural and electrical myocardial properties and paves the background for enhanced arrhythmogenicity. Non-uniform anisotropic conduction, gap junctions remodelling, source to sink mismatch and refractoriness dispersion are some of the underlining mechanisms contributing to arrhythmic potential of the scar. All these mechanisms lead to the initiation and maintenance of VA. CMR has a crucial role in the evaluation of patients suffering from VA, as it is considered the gold standard imaging test for scar characterization. Mounting evidences support the use of CMR not only for the definition of gross scar features, as size, localization and transmurality, but also for the identification of possible conducting channels suitable of discrete ablation. Moreover, several studies call out the CMR-based scar characterization as a stratification tool useful in selecting patients at risk of SCD and amenable to implantable cardioverter-defibrillator (ICD) implantation. Conclusions: Scar represents the substrate of ventricular arrhythmias. CMR, defining scar presence and its features, may be a useful tool for guiding ablation procedures and for identifying patients at risk of SCD amenable to ICD therapy