Thalassemia and the heartquake

On May 2012 the city of Ferrara and the surrounding region were hit by several earthquakes. We had the chance to observe the behavior of one thalassemic heart during the shocks, because of a 24-h electrocardiogram recording had been put in place a few hours before the shocks

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Comuni-care in comunità per minori

Questo volume cerca di fornire un’alternativa alla solitudine e alla denigrazione di cui sono oggetto le comunità per minori fornendo una diversa prospettiva: un’esperienza possibile di formazione/supervisione a matrice relazionale con uno scambio comunicativo intenso e regolare tra decine di professionisti dell’intero territorio italiano per un anno si sono confrontati quotidianamente sulle tematiche centrali dell’intervento di comunità sulla piattaforma on line del Master “Tutela, diritti e protezione dei minori” dell’Università di Ferrara. Comuni_care in comunità per minori è l’espressione di una nuova dimensione didattica, formativa e di supervisione che supera i vincoli di spazi e tempi, senza rinunciare a un ambiente relazionale autenticamente connotato, che è principio fondante di ogni comunità. Alla presentazione di un modello di formazione/supervisione a matrice relazionale fa seguito l’approfondimento, attraverso l’accurata disamina di dilemmi educativi, di narrazioni di casi presi in carico, di riflessioni sul proprio operato in comunità, degli aspetti centrali di un intervento di comunità che non vuole rinunciare al suo mandato di accoglienza e cura individualizzata. Nella seconda parte del volume vengono presentate tre diverse metodologie che consentono di operare - con la mediazione del linguaggio cinematografico, tramite la narrativa per ragazzi e attraverso la co-costruzione di un personale progetto educativo - in vista della costruzione di alleanze di lavoro con i ragazzi e le ragazze delle comunità non rinunciando mai a considerarli/e innanzitutto persone uniche e destinatarie di specifici progetti di vita

Thalassemia and the heartquake

On May 2012 the city of Ferrara and the surrounding region were hit by several earthquakes. We had the chance to observe the behavior of one thalassemic heart during the shocks, because of a 24-h electrocardiogram recording had been put in place a few hours before the shocks

OUP accepted manuscript

The story of heart failure (HF) traces a path from the oldest records of human healing practices several millennia ago, winding through various changing models of physiology, sickness and health. It passes through today’s landscape of neurohormonal modulation, device therapy, and assist devices, towards a future of therapies, some in development today, some as-yet unimagined, based on pathophysiological insights yet to come. This review attempts to follow the path and notes the traces left by earlier travellers, as well as the therapeutic improvements made possible by the developments in our understanding of HF that followed from their successes and failures. As we focus on pathophysiology, transplantation and mechanical assist devices will be treated more cursorily. Likewise, as this is a history of the development of modern (sometimes ‘Western’ although more properly ‘global’ or ‘scientific’) medicine, alternative therapies are not discussed in this paper

Predicting return to work after acute myocardial infarction: Socio-occupational factors overcome clinical conditions

Return to work after acute myocardial infarction (AMI), a leading cause of death globally, is a multidimensional process influenced by clinical, psychological, social and occupational factors, the single impact of which, however, is still not well defined. The objective of this study was to investigate these 4 factors on return to work (RTW) within 365 days after AMI in a homogeneous cohort of patients who had undergone an urgent coronary angioplasty

Plasma soluble HLA-G levels in a cohort of heart failure patients exposed to chemicals.

Heart failure (HF) is a syndrome caused by structural and/or functional cardiac abnormalities, resulting in a reduced cardiac output and/or elevated intracardiac pressures. Several studies reported a crucial role of immune activation and inflammation in the chronic heart failure (HF) pathogenesis, suggesting that pro-inflammatory and anti-inflammatory mediators could be predictive markers of the HF development and/or progression. Human Leukocyte Antigen-G (HLA-G), a tolerogenic and anti-inflammatory class I non-classical major histocompatibility complex molecule, was reported to be upregulated in patients diagnosed with HF, suggesting a tentative to regulate the inflammatory condition. We evaluated soluble (s)HLA-G plasmatic levels in patients with stable chronic heart failure at baseline visit and after 6 and 12 months. The 14 bp Insertion/Deletion polymorphisms of the HLA-G gene was also analyzed. We showed that in HF subjects, sHLA-G levels were higher in NYHA class II and III subjects (mild-severe symptoms) (6.11 ± 1.15 ng/ml; 8.25 ± 2.27 ng/ml, respectively) in comparison with NYHA class I subjects (no symptoms) (2.35 ± 0.43 ng/ml) (I vs II: p = 0.0156; I vs III: p = 0.0122). Moreover, the exposure to chemicals seems to affect sHLA-G levels, with higher sHLA-G levels in exposed patients (3.36 ± 5.12 ng/ml) in comparison with unexposed subjects (2.01 ± 2.84 ng/ml). The HLA-G 3'UTR 14 bp INS/DEL polymorphism correlated with sHLA-G, with the 14 bp INS/INS genotype associated with higher sHLA-G levels during the 12 months follow-up in unexposed subjects (p = 0.008). In conclusion, these results support a correlation between sHLA-G levels, genetics and HF disease in presence of work chemical exposition