STATUS DELLA VITAMINA D NELLA MALATTIA RENALE CRONICA ED EFFETTO DELLA SUPPLEMENTAZIONE CON COLECALCIFEROLO

Questo studio investiga i fattori legati all' ipovitaminosi D, in una popolazione di 405 pazienti con CKD dagli stadi 2 a 4, che vivono in Italia e che sono seguiti presso La Nefrologia della AOUP . Nello studio viene anche valutato un sottogruppo di 100 pazienti con ipovitaminosi D, che hanno ricevuto un trattamento per 12 mesi con colecalciferolo alla dose 10000 unità una volta alla settimana La carenza di vitamina D, ovvero valori al di sotto dei 20 ng/ml, sono stati ritrovati in 269 pazienti (66,4 %), mentre uno stato di insufficienza di vitamina D, ovvero valori tra 21 e 30 ng/ml (oggi viene considerato 30ng/ml il valore necessario di vitamina D per parlare di quantità sufficiente ), è stato ritrovato in 67 pazienti (16,5%). In pazienti diabetici il deficit della 25(OH)vitD raggiungeva l' 80% dei casi. Nei pazienti con età superiore ai 65 anni il deficit raggiungeva l' 89 % dei soggetti. I livelli di 25(OH)vitD erano negativamente correlati a età, PTH, proteinuria, Charlson index; al contrario, una relazione positiva era emersa con i valori di emoglobina. L’ analisi di regressione multipla mostrava che l' età e il PTH sono indipendentemente associati con i livelli di vitamina D, mentre non compariva una relazione tra i livelli della 25(OH)vitD e la funzione renale. I livelli sierici della 25(OH)vitD non differivano tra soggetti con dieta libera e soggetti che facevano una dieta a basso contenuto di fosfati e proteine. Dodici mesi di terapia con 10000 unità di colecalciferolo una volta alla settimana aumentavano i valori di idrossivitamina D e abbassavano i livelli sierici di PTH. In sintesi, lo stato di carenza e insufficienza di vitamina D è presente nella maggior parte dei soggetti (83%) con CKD in Italia; i livelli della 25 (OH)vitD sono maggiormente legati ai livelli sierici di PTH e all' età avanzata piuttosto che ad altri fattori. L' assunzione orale di colecalciferolo migliora i livelli della 25 (OH)vitD e riduce i livelli sierici di PTH, quindi dovrebbe sempre essere raccomandata nei pazienti con CKD e ipovitaminosi D, o quando non fosse disponibile il dosaggio della 25(OH)vit

Sentiment Analysis for Performance Evaluation of Maintenance in Healthcare

This paper presents a framework which makes use of Sentiment Analysis techniques for retrieving Real World Data (RWD) starting from scheduled and corrective maintenance data. The scope of the analysis is to automatically extract features from maintenance work orders, in order to calculate Key Performance Indicators of maintenance operations on medical devices, for Health Technologies Assessment purposes. Data are extracted from Computerized Maintenance Management System reports of healthcare facilities

Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan

Aim: Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan. Methods and results: In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m2 ) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e': ≥ or <15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Profile-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and followed-up for 12.3 months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable Cox proportional-hazards models. Twelve sites enrolled 727 patients (64 ± 12 year old; LVEF: 29.8 ± 6.2%). Profile-D had more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103 mg BID) was more likely reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P < 0.001). Event-rate (per 100 patients per year) progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P < 0.0001). By covariate-adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P < 0.01). Adding this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improvement (0.329; P < 0.001). Intermediate and high-dose sacubitril/valsartan reduced the event's risk independently of haemodynamic profile. Conclusions: Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemodynamic profiles

Loop Diuretic Administration in Patients with Acute Heart Failure and Reduced Systolic Function: Effects of Different Intravenous Diuretic Doses and Diuretic Response Measurements

Background: Despite the fact that loop diuretics are a landmark in acute heart failure (AHF) treatment, few trials exist that evaluate whether the duration and timing of their administration and drug amount affect outcome. In this study, we sought to evaluate different loop diuretic infusion doses in relation to outcome and to diuretic response (DR), which was serially measured during hospitalization. Methods: This is a post-hoc analysis of a DIUR-HF trial. We divided our sample on the basis of intravenous diuretic dose during hospitalization. Patients taking less than 125 mg of intravenous furosemide (median value) were included in the low dose group (LD), patients with a diuretic amount above this threshold were inserted in the high dose group (HD). The DR formula was defined as weight loss/40 mg daily of furosemide and it was measured during the first 24 h, 72 h, and over the whole infusion period. Outcome was considered as death due to cardiovascular causes or heart failure hospitalization. Results: One hundred and twenty-one AHF patients with reduced ejection fractions (EF) were evaluated. The cardiovascular (CV) death/heart failure (HF) re-hospitalization rate was significantly higher in the HD group compared to the LD group (75% vs. 22%; p &lt; 0.001). Both low DR, measured during the entire infusion period (HR 3.25 (CI: 1.92&ndash;5.50); p &lt; 0.001) and the intravenous diuretic HD (HR 5.43 [CI: 2.82&ndash;10.45]; p &lt; 0.001) were related to outcome occurrence. Multivariable analysis showed that DR (HR 3.01 (1.36&ndash;6.65); p = 0.006), intravenous diuretic HD (HR 2.83 (1.24&ndash;6.42); p=0.01) and worsening renal function (WRF) (HR 2.21 (1.14&ndash;4.28); p = 0.01) were related to poor prognosis. Conclusions: HD intravenous loop diuretic administration is associated with poor prognosis and less DR. Low DR measured during the whole intravenous administration better predicts outcome compared to DR measured in the early phases. ClinicalTrials.gov Acronym and Identifier Number: DIUR-HF; NCT01441245; registered on 23 September 2011

Primi dati sul comportamento migratorio delle alzavole Anas crecca svernanti in Italia.

Il comportamento migratorio degli anatidi europei non è stato fino ad ora indagato con metodologie satellitari se non per quel che riguarda le specie di maggiori dimensioni. Informazioni dettagliate sulla fenologia della migrazione, le rotte percorse e la posizione delle principali aree di sosta sono però cruciali per la corretta gestione di queste specie a scala europea. Un tale quadro informativo non può però essere ottenuto utilizzando solo metodologie classiche, ma necessita di avanzate tecniche di tracking che consentano di restituire il pattern di spostamento a scala continentale. Il presente lavoro riporta i risultati ottenuti nei primi due anni del progetto AnaSat, volto a indagare il comportamento migratorio di alcune specie di anatidi di superficie tramite la telemetria satellitare. La specie indagata è stata l'alzavola Anas crecca, la più piccola e una tra le anatre di superficie europee più diffuse. Gli animali (tutti di sesso femminile) sono stati catturati tra la fine di dicembre e l'inizio di gennaio in tre siti dell'Italia centrale e settentrionale [Tenuta di San Rossore (PI; 43.70°N, 10.29°E; n = 10); Valle Morosina (PD; 45.28°N, 12.15°E; n = 11); Quinzano d'Oglio (BS; 45,29°N, 10.01°E; n = 4)] e quindi dotati di PTT (Microvawe Telemetry, USA; peso del dispositivo = 9.5 g, <5% del peso dell'animale) applicati sull'animale tramite una imbracatura a zaino in Teflon. La gran parte delle alzavole ha lasciato i siti di svernamento tra la fine di febbraio e l'inizio di marzo, muovendosi principalmente verso E-NE. Mentre alcune femmine hanno terminato la loro migrazione nell'Europa centrale, una frazione consistente di individui ha percorso diverse migliaia di chilometri, raggiungendo talora quartieri riproduttivi posti nella Russia artica. Questo pattern di migrazione conferma in parte le evidenze raccolte tramite l'attività di inanellamento e le analisi effettuate mediante isotopi stabili. E' però interessante osservare che gli animali che si impegnano negli spostamenti di entità maggiore utilizzano aree di sosta prevalentemente dislocate nell'Europa sudorientale, rimanendo nel medesimo sito anche per periodi superiori ad un mese. I tempi di permanenza e le deviazioni effettuate dalle alzavole per raggiungere queste aree testimoniano l'importanza di questi siti di sosta, che probabilmente svolgono un ruolo ecologico centrale nella migrazione della specie. Tali aree sembrano inoltre costituire siti di stopover significativi anche durante la migrazione autunnale. Il pattern osservato testimonia come la raccolta di informazioni dettagliate sugli spostamenti degli uccelli migratori rappresenti un fattore imprescindibile per la corretta gestione di queste specie a scala continentale

Spring migratory routes and stopover duration of satellite tracked Eurasian Teal Anas crecca wintering in Italy

Identifying an organism’s migratory strategies and routes has important implications for conservation. For most species of European ducks, information on the general course of migration, revealed by ringing recoveries, is available, whereas tracking data on migratory movements are limited to the largest species. In the present paper, we report the results of a tracking study on 29 Eurasian Teals, the smallest European duck, captured during the wintering period at three Italian sites. The departure date of spring migration was determined for 21 individuals, and for 15 the entire spring migratory route was recon- structed. Most ducks departed from wintering grounds between mid-February and March following straight and direct routes along the Black Sea-Mediterranean flyway. The breeding sites, usually reached by May, were spread from central to north-Eastern Eur- ope to east of the Urals. The migratory speed was slow (approximately 36 km/day on average) because most birds stopped for several weeks at stopover sites, mainly in south- eastern Europe, especially at the very beginning of migration. The active flight migration segments were covered at much higher speeds, up to 872 km/day. Stopover duration tended to be shorter when birds were closer to their breeding site. These results, based on the largest satellite tracking effort for this species, revealed for the first time the main features of the migratory strategies of individual Teals wintering in Europe, such as the migration timing and speed and stopover localization and duration

Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan

Aim: Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan. Methods and results: In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:&lt; or ≥2.0&nbsp;L/min/m2 ) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e': ≥ or &lt;15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Profile-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and followed-up for 12.3&nbsp;months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable Cox proportional-hazards models. Twelve sites enrolled 727 patients (64&nbsp;±&nbsp;12&nbsp;year old; LVEF: 29.8&nbsp;±&nbsp;6.2%). Profile-D had more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103&nbsp;mg BID) was more likely reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P&nbsp;&lt;&nbsp;0.001). Event-rate (per 100 patients per year) progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P&nbsp;&lt;&nbsp;0.0001). By covariate-adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P&nbsp;&lt;&nbsp;0.01). Adding this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improvement (0.329; P&nbsp;&lt;&nbsp;0.001). Intermediate and high-dose sacubitril/valsartan reduced the event's risk independently of haemodynamic profile. Conclusions: Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemodynamic profiles

Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study

Background: Sacubitril/valsartan improves outcome in patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF, HFrEF). However, little is known about possible mechanisms underlying this favourable effect. Purpose: To assess changes in echocardiographically-derived hemodynamic profiles induced by sacubitril/valsartan and their impact on outcome. Methods: In this multicenter, open-label study, 727 HFrEF outpatients underwent comprehensive echocardiography at baseline (before starting sacubitril/valsartan) and after 12 months. Estimated LV filling pressure (E/e') and cardiac index (CI, l/min/m2) were combined to determine 4 hemodynamic profiles: profile-A (normal-flow/normal-pressure); profile-B (low-flow/normal-pressure); profile-C: (normal-flow/high-pressure); profile-D: (low-flow/high-pressure). Changes among categories were recorded, and their associations with rates of the composite of death/HF-hospitalization were assessed by multivariable Cox analysis. Results: At baseline, 29% had profile-A, 15% had profile-B, 32% profile-C, and 24% profile-D. After 12 months, the hemodynamic profile improved in 53% of patients (all profile-A achievers, or profile-D patients achieving either C or B profile), while it remained unchanged in 39% patients and worsened in 9%. Prevalence of improved profile progressively increased with increasing dose of sacubitril/valsartan (P &lt; 0.0001). After the second echocardiography, patients were followed up 12.6 ± 7.6 months: event-rate was lower in patients with improved profile (12.3%, 95%CI: 9.4-16.1) compared to patients in whom hemodynamic profile remained unchanged (29.9%, 24.0-37.3) or worsened (31.2%, 20.7-46.9, P &lt; 0.0001). Improved hemodynamic profile was associated with favourable outcome independent of LVEF and other covariates (HR 0.65, 95%CI: 0.45-0.95, P &lt; 0.05). Conclusion: In HFrEF patients, the beneficial prognostic effects of sacubitril/valsartan are associated with improvement in hemodynamic conditions