Assessing the Malignant Ventricular Arrhythmic Substrate in Patients With Brugada Syndrome.

Background: Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada syndrome and induced ventricular tachyarrhythmias, but there is no evidence supporting it. Objectives: This prospective registry study was designed to explore clinical and electrophysiological predictors of malignant ventricular tachyarrhythmia inducibility in Brugada syndrome. Methods: A total of 191 consecutive selected patients with (group 1; n = 88) and without (group 2; n = 103) Brugada syndrome–related symptoms were prospectively enrolled in the registry. Patients underwent electrophysiological study and substrate mapping or ablation before and after ajmaline testing (1 mg/kg/5 min). Results: Overall, before ajmaline testing, 53.4% of patients had ventricular tachyarrhythmia inducibility, which was more frequent in group 1 (65.9%) than in group 2 (42.7%; p < 0.001). Regardless of clinical presentation, larger substrates with more fragmented long-duration ventricular potentials were found in patients with inducible arrhythmias than in patients without inducible arrhythmias (p < 0.001). One extrastimulus was used in more extensive substrates (median 13 cm2; p < 0.001), and ventricular fibrillation was the more frequently induced rhythm (p < 0.001). After ajmaline, patients without arrhythmia inducibility had arrhythmia inducibility without a difference in substrate characteristics between the 2 groups. The substrate size was the only independent predictor of inducibility (odds ratio: 4.51; 95% confidence interval: 2.51 to 8.09; p < 0.001). A substrate size of 4 cm2 best identified patients with inducible arrhythmias (area under the curve: 0.98; p < 0.001). Substrate ablation prevented ventricular tachyarrhythmia reinducibility. Conclusions: In Brugada syndrome dynamic substrate variability represents the pathophysiological basis of lethal ventricular tachyarrhythmias. Substrate size is independently associated with arrhythmia inducibility, and its determination after ajmaline identifies high-risk patients missed by clinical criteria. Substrate ablation is associated with electrocardiogram normalization and not arrhythmia reinducibility. (Epicardial Ablation in Brugada Syndrome [BRUGADA_I]; NCT02641431; Epicardial Ablation in Brugada Syndrome: An Extension Study of 200 BrS Patients; NCT03106701

Endothelial function as a marker of pre-clinical atherosclerosis: assessment techniques and clinical implications

Endothelium plays a key role in maintenance of vascular homeostasis. Cardiovascular risk factors promote development of endothelial dysfunction, characterized by increased vasoconstriction and by procoagulant/pro-inflammatory endothelial activities. In coronary artery, endothelium-dependent dilation improves blood flow, while the occurrence of endothelial dysfunction reduces myocardial perfusion, so new methods have been developed for assessment of endothelial function in coronary and peripheral arteries. The quantitative angiography with intracoronary infusion of acetylcholine remains the “gold standard” to assess the endothelium-dependent vasodilatation. The use of this technique is restricted to patients who have a clinical indication for coronary angiography, so new imaging methods have been considered for noninvasive diagnosis of coronary microvascular disease, such as magnetic resonance imaging phase contrast and positron emission tomography. The advent of new techniques has facilitated testing of endothelial dysfunction in peripheral arteries with non-invasive methods. This review presents available invivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic tools include local vasodilatation by venous occlusion plethysmography and assessment of flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, laser Doppler flowmetry. The possibility to detect endothelial dysfunction as an early marker of atherosclerosis makes these instruments useful for early stratification of patients at risk for cardiovascular events. Aim of this review is to summarize the characteristics of non-invasive assessment of endothelial function in order to optimize cardiovascular risk management

New perspectives in cardiovascular risk reduction: focus on HDL

Cardiovascular diseases represent the leading cause of morbidity and mortality worldwide, mostly contributing to hospitalizations and health care costs. Dyslipidemias represent one of the major cardiovascular risk factor and its management, throughout life-style modifications and pharmacological interventions, has shown to reduce cardiac events. The risk of adverse cardiovascular events is related not only to elevated LDL blood levels, but also to decreased HDL concentrations, that exhibit protective effects in the development of atherosclerotic process. Aim of this review is to summarize current evidences about defensing effects of such lipoproteins and to show the most recent pharmacological strategies to reduce cardiovascular risk through the increase of their circulating levels

Imaging techniques for assessment of coronary flow reserve

The assessment of coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease (CAD). Invasive techniques, such as intracoronary Doppler ultrasound and pressure-derived method, directly assess CFR velocity and fractional flow reserve. Positron emission tomography (PET) has emerged as an accurate noninvasive technique to quantify CFR. Nevertheless, this approach has not been applied to routine studies because of its high cost and complexity. Recently, attempts to estimate CFR with single-photon emission computed tomography (SPECT) tracers have been made in order to obtain, with noninvasive methods, data for quantitative functional assessment of CAD. This review analyzes the relative merit and limitations of CFR measurements by cardiac imaging techniques and describes the potential clinical applications

Endothelial dysfunction in type 2 diabetic patients with normal coronary arteries. A peripheral arterial tonometry study

Aim: to evaluate endothelial function (EF) in diabetic and non-diabetic patients without CAD by peripheral artery tonometry (PAT) technique. Methods: a cohort of 94 patients (55 men and 39 postmenopausal women; mean age 63±9 years) undergoing coronary angiography was divided into 2 groups: 58 patients with DM and (group 1) and 36 patients without DM. Endothelial dysfunction (ED) was assessed by digital pulse amplitude, using a fingertip peripheral arterial tonometry (PAT). As a measure of ED, reactive hyperemia index (RHI) was calculated as the ratio of the digital pulse volume during reactive hyperemia following 5 min ischemia and its basal value. Results: prevalence of cardiovascular risk factors was similar between the two groups. RHI values were significantly lower in diabetic patients compared to non-diabetics (1.72±0.34 vs 2.00±0.44; p<0.005) and they correlated with levels of glycosylated hemoglobin (p=0.05; r=-0.266). Conclusion: despite similar level of other risk factors, EF was much more impaired in diabetic patients than in non-diabetics. These evidences further support the impact of DM on cardiovascular risk

Equità e qualità nei testi dei POF

Una delle principali innovazioni conseguenti all'autonomia scolastica è l'introduzione del Piano dell'Offerta Formativa (POF), che può essere interpretato come una sorta di carta d'identità della scuola. L'interpretazione di questo oggetto è una delle possibili chiavi di lettura dei processi di traduzione dell'autonomia in atto nelle scuole. A tal fine è stata condotta un'analisi dei POF attraverso tecniche di analisi testuale semi-automatica e interpretativa.One of the main innovations resulting from the introduction of school autonomy is the school plan of classes (POF), which can be interpreted as a sort of identity card of the school. The interpretation of this object is one of the possible interpretations of the processes of translation of autonomy in schools. To this end, an analysis was conducted of the POF through techniques of textual analysis and semi-automatic interpretation

La scuola tuttofare. I progetti, le immagini e i valori di alcune scuole romane attraverso l'analisi testuale dei loro POF

Un'analisi testuale realizzata sui POF di 16 scuole pubbliche (medie, comprensivi, licei, istituti tecnici, professionali) fa emergere una auto rappresentazione delle scuole come agenzie di socializzazione tout-court, che devono possono e sanno occuparsi degli aspetti indispensabili per il rafforzamento dello studente, ben al di là dei curricula formativi, con l'ambizione di formare il cittadino, recuperare il disagio sociale dei ragazzi e valorizzarne i comportamenti specifici.Textual analysis carried out on POF of 16 public schools reveals a self-representation of schools as socializing agencies tout court, that can and must know how to deal with the issues of reinforcing student, well beyond the curricula, with the ambition to educate the good citizen, recover the social distress of children and enhance specific behaviors

Con i loro occhi. L'immaginario mafioso tra i giovani

“Con i loro occhi” presenta i risultati di un lavoro di ricerca, avviato da Libera nel 2009, sulle rappresentazioni del fenomeno mafioso da parte dei più giovani. Le indagini hanno coinvolto studenti di scuole superiori della Toscana (nel 2010), del Lazio (nel 2011) e della Liguria (nel 2012). Come suggerisce l’introduzione: «L’investimento di una realtà come Libera nel campo della ricerca sociale ha come obiettivo non secondario, oltre quello della conoscenza in sé, quello di fornire strumenti analitici per il miglioramento del lavoro pedagogico e culturale dell’associazione nelle scuole e sul territorio». La ricerca è stata curata da Francesca della Ratta, Ludovica Ioppolo e Giuseppe Ricotta. Ludovica Ioppolo. E' stato chiesto ai ragazzi di rispondere ad un questionario strutturato, con delle modalità di risposta predefinite. Agli studenti è stato poi richiesta una narrazione libera su un fatto di mafia. L’elemento narrativo rappresenta un’innovazione e garantisce, inoltre, una libertà maggiore nelle risposte. Dalla storia raccontata dal singolo studente emerge l’immaginario del fenomeno mafioso."With their eyes" presents the results of a research project, started in 2009 by Libera, on the representations of the Mafia by younger. The investigations have involved students from high schools in Tuscany (2010), Lazio (in 2011) and Liguria (in 2012). The research was directed by Francesca della Ratta, Ludovica Ioppolo and Joseph Ricotta. Ludovica Ioppolo. The students answered to a structured questionnaire. Students also produced a free narrative of a fact of the Mafia. The narrative element is an innovation and also ensures a greater freedom in the responses. From the story told by the individual students has been analysed the representation of the Mafia

Vista dal Nord Educazione antimafia e immaginario mafioso in Piemonte e Lombardia

"Vista dal Nord"è il frutto di un lavoro di ricerca sull'immaginario dei giovani studenti lombardi e piemontesi sui fenomeni mafiosi e sull'antimafia, condotto dai Ludovica Ioppolo, Francesca della Ratta-Rinaldi e Giuseppe Ricotta, che già avevano curato degli studi su questo tema tra gli studenti delle scuole superiori in Toscana (2010), nel Lazio (2011), in Liguria e in provincia di Trento (2012). Il lavoro, coordinato da Libera Formazione e dai ricercatori, in collaborazione con i coordinamenti territoriali di Lombardia e Piemonte, è iniziato nel 2013 e nel 2014, con la somministrazione ad un campione di studenti delle scuole superiori di un questionario on-line. Vista dal Nord riporta gli esiti di quanto emerso da questo lavoro, analizzando la grande ricchezza di dati quantitativi e qualitativi emersi, approfondendo in particolare gli effetti delle azioni di educazione antimafia e alla cittadinanza portate avanti da docenti e associazioni nelle scuole italiane."View from the North" is the result of a research work on the imagery of the young students in Lombardy and Piedmont on the mafia and 'antimafia, led by Ludovica Ioppolo, Francesca della Ratta-Rinaldi and Giuseppe Ricotta, who had already taken care of studies on this issue among high school students in Tuscany (2010), in Lazio (2011), in Liguria and in the province of Trento (2012). The work, coordinated by Libera and by the three researchers, in collaboration with the regional coordination of Libera Lombardy and Libera Piedmont, began in 2013 and in 2014, by administering to a sample of high school students of an online questionnaire. View from the North shows the results of the findings of this work, analyzing the great wealth of quantitative and qualitative findings, especially focusing on the effects of anti-Mafia education and citizenship actions carried out by associations and teachers in Italian schools

Con i loro occhi. L'immaginario mafioso tra i giovani. Indagine su rappresentazioni e atteggiamenti nei confronti della mafia e dell'antimafia tra gli studenti della Toscana, del Lazio e della Liguria.

Il libro presenta i risultati di un lavoro di ricerca, avviato da Libera nel 2009, sulle rappresentazioni del fenomeno mafioso da parte degli studenti. In particolare, sono sintetizzati e commentati gli esiti di tre indagini che hanno coinvolto studenti di scuole superiori della Toscana (nel 2010), del Lazio (nel 2011) e della Liguria (nel 2012). Il lavoro si pone innanzitutto l’obiettivo di contribuire all’approfondimento delle rappresentazioni sociali del fenomeno mafioso, secondo un approccio sociologico di tipo culturale che restituisca centralità alle dimensioni simboliche, morali e cognitive della mafia.The book presents the results of a research project, initiated by Libera in 2009, on the representations of the mafia phenomenon by students. In particular, are summarized and commented the results of three surveys that involved students of high schools in Tuscany (in 2010), Lazio (in 2011) and Liguria (in 2012). The work primarily aims to contribute to the deepening of social representations of the mafia phenomenon, according to a cultural sociological approach that emphatizes the symbolic, moral and cognitive dimensionsof the mafia