Cardiomyopathy in Duchenne Muscular Distrophy: Clinical Insights and Therapeutic Implications

Duchenne muscular dystrophy cardiomyopathy (DMD-DCM) is characterized by progressive ventricular dilation and dysfunction that can begin at any age and worsens over time. Thanks to the lengthening of life expectancy due to better management of respiratory involvement, end-stage heart failure (HF) is becoming the main cause of death for DMD patients. Therefore, from the time of DMD diagnosis, every effort should be focused to early detect the onset and the worsening of the DMD-DCM, with the aim of starting and modulating the therapy to slow the progression of cardiac dysfunction. In cardiac evaluation, biomarkers, electrocardiograms, and echocardiograms must be considered, but cardiac magnetic resonance (CMR) is now acquiring a leading role due to its sensitivity in the earlier identification of cardiac involvement. The management of DMD-DCM at end stage is a difficult challenge that requires a multidisciplinary team composed of clinical cardiologists, electrophysiologists, cardiac surgeons, neuromuscular specialists, and psychologists. Because of the lack of specific drugs for DMD, we will review the actual cardiovascular armamentarium including drugs used for HF

Results of the COVID-19 mental health international for the general population (COMET-G) study.

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Effects of flooding on coastal vegetation and salt marshes

This thesis examines the effects of flooding on coastal and salt marsh vegetation. I conducted a field experiment in Bellocchio Lagoon to test the effects of different inundation periods (Level 1 = 0.468 or 11.23 hours; Level 2 = 0.351 or 8.42 hours; Level 3 = 0.263 or 6.312 hours; Level 4 = 0.155 or 3.72 hours; Level 5 = 0.082 or 1.963 hours; Level 6 = 0.04 or 0.96 hours) on the growth responses and survival of the salt marsh grass Spartina maritima in summer 2011 and 2012. S. maritima grew better at intermediate inundation times (0,351 hours; 0,263 hours, 0,115 hours; 0,082 hours), while growth and survival were reduced at greater inundation periods (0,468 hours). The differences between the 2011 and 2012 experiment were mainly related to differences in the initial number of shoots (1 and 5, respectively in 2011 and 2012). In the 2011 experiment a significant lower number of plants was present in the levels 1 and 6, the rhizomes reached the max pick in level 4, weights was major in level 4, spike length reached the pick in level 3 while leaf length in level 2. In the 2012 experiment the plants in level 6 all died, the rhizomes were more present in level 3, weights was major in level 3, spike length reached the pick in level 3, as well as leaf length. I also conducted a laboratory experiment which was designed to test the effects of 5 different inundation periods (0 control, 8, 24, 48, 96 hours) on the survival of three coastal vegetation species Agrostis stolonifera, Trifolium repens and Hippopae rhamnoides in summer 2012. The same laboratory experiment was repeated in the Netherlands. In Italy, H. rhamnoides showed a great survival in the controls, a variable performance in the other treatments and a clear decrease in treatment 4. Conversely T. repens and A. stolonifera only survive in the control. In the Netherlands experiment there was a greater variability responses for each species, still at the end of the experiment survival was significantly smaller in treatment 4 (96 h of seawater inundation) for all the three species. The results suggest that increased flooding can affect negatively the survival of both saltmarsh and coastal plants, limiting root system extension and leaf growth. Flooding effect could lead to further decline and fragmentation of the saltmarshes and coastal vegetation, thereby reducing recovery (and thus resilience) of these systems once disturbed. These effects could be amplified by interactions with other co-occurring human impacts in these systems, and it is therefore necessary to identify management options that increase the resilience of these systems

L\u2019approccio di relationship marketing nel sistema del valore dell\u2019arredamento. Il caso Snaidero Group

none2noneCHIARVESIO M.; GRANDINETTI R.Chiarvesio, M.; Grandinetti, Robert

Modelli e metodi di ottimizzazione nella progettazione, organizzazione e gestione dei Centri di Distribuzione

Dottorato di Ricerca in: Ricerca Operativa, XXIV Ciclo SSD, a.a. 2011Università della Calabri

Service customisation and standardisation in combinatory knowledge-intensive business services

The trade-off between customisation and standardisation in service offerings has been widely debated in the literatures on service in general and on knowledge-intensive business services (KIBS) specifically. Moving beyond this trade-off, this paper introduces a new type of service offering, called combinatory KIBS, distinguished by their capability to combine customisation and standardisation. Based on a sample of approximately 500 KIBS, our results show that combinatory KIBS develop specific business strategies which achieve superior performance in customisation and standardisation. They pair customer interaction aimed at service customisation and knowledge codification useful in providing standard services, while also investing in networking