Pharmacological effects of raas blockade in ischemic nephropathy

Background: The management of ischemic nephropathy due to atherosclerotic renal artery stenosis has become increasingly conservative in the modern era, with current guidelines recommending optimized medical therapy as the initial step. The doubts raised by the recently published trials of revascularization strategies have led to a renewed focus on pharmacological strategies promoting blood pressure control and renal protection. It is essential to further elucidate the pathophysiological mechanisms underlying hypoperfusion induced renal microvascular dysfunction with subsequent tissue injury and fibrogenesis. The role of renin angiotensin aldosterone system as a mediator of the main pathophysiological consequences of ischemic nephropathy is well known. However, more recent experimental evidence on the adrenergic system and intrarenal tubular feedback mechanisms has stimulated new interest towards a multi-target therapeutic approach. Methods: This review focuses on the pharmacology of the principle therapeutic drug classes currently used in the treatment of atherosclerotic renal artery stenosis with an analysis of their metabolic aspects and use in clinical practice based on evidence from clinical trials. Results and Conclusions: An optimal pharmacologic approach is crucial for a successful prevention of renal injury and cardiovascular events in this high-risk population. Antihypertensive treatment should include renin angiotensin aldosterone system blockade medication not only for their antihypertensive properties, but especially for those cardio and renoprotectiv

Fusion beat in patients with heart failure treated with left ventricular pacing: may ECG morphology relate to mechanical synchrony? A pilot study

<p>Abstract</p> <p>Background</p> <p>Electrical fusion between left ventricular pacing and spontaneous right ventricular activation is considered the key to resynchronisation in sinus rhythm patients treated with single-site left ventricular pacing.</p> <p>Aim</p> <p>Use of QRS morphology to optimize device programming in patients with heart failure (HF), sinus rhythm (SR), left bundle branch block (LBBB), treated with single-site left ventricular pacing.</p> <p>Methods and Results</p> <p>We defined the "fusion band" (FB) as the range of AV intervals within which surface ECG showed an intermediate morphology between the native LBBB and the fully paced right bundle branch block patterns.</p> <p>Twenty-four patients were enrolled. Echo-derived parameters were collected in the FB and compared with the basal LBBB condition. Velocity time integral and ejection time did not improve significantly. Diastolic filling time, ejection fraction and myocardial performance index showed a statistically significant improvement in the FB. Interventricular delay and mitral regurgitation progressively and significantly decreased as AV delay shortened in the FB. The tissue Doppler asynchrony index (Ts-SD-12-ejection) showed a non significant decreasing trend in the FB. The indications provided by the tested parameters were mostly concordant in that part of the FB corresponding to the shortest AV intervals.</p> <p>Conclusion</p> <p>Using ECG criteria based on the FB may constitute an attractive option for a safe, simple and rapid optimization of resynchronization therapy in patients with HF, SR and LBBB.</p

Correlazione tra alitosi e trattamento ortodontico? Questioni di corretti stili di igiene orale. Case report

Nel trattamento delle malocclusioni, la terapia ortodontica fissa è la più suffragata (Fig. 1a). Anche se uno degli obiettivi del trattamento ortodontico in soggetti con malocclusioni è migliorare oltre che la funzione anche la salute parodontale, la terapia stessa può provocare una maggiore incidenza di infiammazioni con conseguente sanguinamento gengivale, recessioni e la ritenzione di placca1. Poiché la rugosità superficiale e l’energia libera di superficie sono correlati con l’accumulo di placca2, la presenza di un dispositivo ortodontico aumenta tale deposito con conseguente infiammazione gengivale in soggetti con malocclusione3. È ben documentato che il trattamento ortodontico con apparecchi fissi si accompagni a un aumentato rischio di gengiviti dovuto all’accumulo di placca batterica attorno agli attacchi2,3 (Figg. 1b-1d). L’alitosi di origine orale è associata con il metabolismo microbico sul dorso lingua, nella saliva e nella placca dentale4 (Figg. 2a-2b); dunque l’intensità dell’alito cattivo è significativamente associata con la quantità di composti volatili endorali contenenti solfuro. Questi composti sono prodotti da batteri gram-negativi orali che metabolizzano aminoacidi presenti nella dieta e producono gas, come solfuro di idrogeno (H2S)5. Ci sono generalmente tre metodi accettati per la valutazione del cattivo odore orale: misurazione organolettica, gas cromatografia (GC) e monitoraggio solfuro portatile6. Studi hanno dimostrato la correlazione a breve termine del cattivo odore orale nella terapia ortodontica fissa, mentre effetti a lungo termine non sono ancora stati documentati7-10

Implementation of a Simulating Code for Heating and Cooling Networks for Residential, Commercial and Tertiary Buildings☆

Abstract In the present energy scenario in which efficiency and sustainability will take the primary role in the decision making process it becomes more and more important to dispose of reliable simulating codes which allow to highlight the pros and cons of a given energy installation. New and old (forgotten) technologies are nowadays challenging the traditional technologies in different sectors of energy transformation from power generation down to heating and air conditioning. In the present situation of fuel cost oscillations and with the perspective of long-term scarcity of fuels, new, less energy demanding systems must be employed to maintain the actual comfort level. The present work aims at creating a reliable tool for correct evaluation of energy performance of heating and cooling networks. A code has been implemented in Simulink environment to simulate the network behaviour in summer and winter weather condition and to evaluate the primary energy indexes for comparison with the traditional configuration of a distributed heating and cooling plants common in residential, commercial and tertiary sectors. The code has been validated and the results will show the energy, economic and environment feasibility and convenience of one solution with respect to another for different climatic regions in Italy

Cost-effectiveness analysis of initial HIV treatment under Italian guidelines

INTRODUCTION: Since the mid-1990s, highly active antiretroviral therapy (HAART) has modified the clinical course of human immunodeficiency virus (HIV) infection, reducing the rate of disease progression, the incidence of opportunistic infections, and mortality. The authors of this paper performed an economic analysis to estimate the cost-effectiveness of the HAART regimens in Italy for managing HIV-infected patients according to national guidelines. PATIENTS AND METHODS: The incremental cost-effectiveness analysis was carried out by means of a Markov model, which through a decision-analytic approach, made it possible to compare the studied antiretroviral regimens. The population considered in the model consisted of adult subjects with HIV who received antiretroviral HAART treatment for the first time. The population considered in the analysis reflects the patients' characteristics according to one of the regional surveillance systems HIV/AIDS infection report currently operating in Italy. The analysis was carried out from the point of view of the Italian health care system. The considered outcome measures were quality-adjusted life years (QALYs) and direct health costs calculated for the year 2010. Both the outcomes (QALYs) and the costs were discounted by 3.5%. The time horizon adopted in the model was 10 years. RESULTS: The model shows, in terms of cost per gained QALY, single tablet regimen (STR) appeared to be the most cost-effective therapeutic choice (22,017), followed by tenofovir (TDF) + lamivudine + efavirenz (EFV) (24,526), and TDF/emtricitabine (FTC) + nevirapine (26,416), and TDF + FTC + EFV (26,558); the remaining strategies have an incremental cost-effectiveness ratio (ICER) value varying from 28,000 to 41,000 per QALY. The sensitivity analysis on the main variables confirmed the validity of the base case scenario. CONCLUSION: STR is the most cost-effective treatment strategy, compared with the other therapeutic regimens recommended by the Italian guidelines. All the ICER values of the various regimens considered by the Italian guidelines were lower than the threshold value of 50,000 commonly accepted at the international level. The model developed represents a tool for policy makers and health care professionals to make short- and long-term cost projections and thus evaluate their impact on the available budgets for HIV patients

Performance assessment for intermodal transportation systems: A case study

Abstract: This paper proposes a methodology to evaluate an Intermodal Transportation System (ITS). These systems are very complex and a lot of different actors are involved. The evaluation process should take into account concurrent needs and goals. Moreover, the data and the importance of different indicators are strictly related to the judgments of individual experts. Then it is necessary to have a methodology able to collect all the independent judgments and merge them in order to evaluate the whole system performances. The paper proposes a general methodology based on the Analytic Hierarchy Process to evaluate the behavior of the ITS system. Moreover, the hierarchy including the typical factors that compose a logistic system has been identified. In order to show the effectiveness of the proposed methodology, we present a real case study consisting of the port of Trieste (Italy), the intermodal terminal and the highway connecting them. Several Key Performance Indicators are evaluated to provide assessment procedure

Risk Factors for Testicular Cancer: Environment, Genes and Infections-Is It All?

: The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk factors have been identified. The reasons for the increase in testicular cancer are however unknown while risk factors are still poorly understood. Several studies have suggested that exposure to various factors in adolescence as well as in adulthood could be linked to the development of testicular cancer. Nevertheless, the role of environment, infections, and occupational exposure are undoubtedly associated with an increase or a decrease in this risk. The aim of this narrative review is to summarize the most recent evidence regarding the risk factors associated with testicular cancer, starting from the most commonly evaluated (cryptorchidism, family history, infections) to the newer identified and hypothesized risk factors

Does the continuation of low-dose acetylsalicylic acid during the perioperative period of thyroidectomy increase the risk of cervical haematoma? A 1-year experience of two Italian centers

Background: A growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75–150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified. The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy. Methods: Patients undergoing thyroidectomy in two high-volume thyroid surgery centers in Italy, between January 2021 and December 2021, were retrospectively analysed. Enrolled patients were divided into two groups: those not taking ASA were included in Group A, while those receiving this drug in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analysis was employed to evaluate the use of low-dose ASA as independent risk factor for cervical haematoma. Results: A total of 412 patients underwent thyroidectomy during the study period. Among them, 29 (7.04%) were taking ASA. Based on the inclusion criteria, 351 patients were enrolled: 322 were included in Group A and 29 in Group B. In Group A, there were 4 (1.24%) cervical haematomas not requiring surgical revision of haemostasis and 4 (1.24%) cervical haematomas requiring surgical revision of haemostasis. In Group B, there was 1 (3.45%) cervical haematoma requiring surgical revision of haemostasis. At univariate analysis, no statistically significant difference was found between the two groups in terms of occurrence of cervical haematoma, nor of the other early complications of thyroidectomy. At multivariate analysis, the use of low-dose ASA did not prove to be an independent risk factor for cervical haematoma. Conclusions: Based on our findings, we believe that in patients receiving this drug, either for primary or secondary prevention of thrombotic events, its discontinuation during the perioperative period of thyroidectomy is not necessary

Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease

Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 (p = 0.24) and 0.55 (p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 (p = 0.38) for the intermediate and 0.47 (p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP