How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

The Cayley transform and uniformly bounded representations

Let G be a simple Lie group of real rank one, with Iwasawa decomposition KA \bar N and Bruhat big cell NMA\bar N: Then the space G/MA \bar N may be (almost) identi\ufb01ed with N and with K /M, and these identi\ufb01cations induce the (generalised) Cayley transform C : N \to K /M. We show that C is a conformal map of Carnot\u2013Caratheodory manifolds, and that composition with the Cayley transform, combined with multiplication by appropriate powers of the Jacobian, induces isomorphisms of Sobolev spaces on N and on K/M. We use this to construct uniformly bounded and slowly growing representations of G

The Impact of the Introduction of the Breast Unit Model in a Northwestern Italian Region

: Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014-2015) and after (2017-2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis-surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality.Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014–2015) and after (2017–2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis–surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality

Utility of serological screening for measles, mumps and rubella in immunocompromised patients

Marchi et al. in their article (Measles in pregnancy: a threat for Italian women? Hum Vaccin Immunother. 2019 Jun 20:1–3) observed that 96.9% of pregnant women were positive for anti-measles IgG (with a higher risk of contracting measles in those aged 19–29 years) emphasizing the importance of serological screening before pregnancy. We evaluated seroprotection/seropositivity rates to Measles, Mumps and Rubella in 324 adults with an acquired immune-deficiency needing an immunization program. We found that younger patients (20–29 years) had a seroprevalence below 85%. Overall, a relevant proportion (21.6%, 54/250) of patients was susceptible to at least one infection needing immunization. Our results confirm the usefulness of proper strategies for identifying individuals susceptible to vaccine-preventable infections and protecting them through vaccination

Utility of serological screening for measles, mumps and rubella in immunocompromised patients

Marchi et al. in their article (Measles in pregnancy: a threat for Italian women? Hum Vaccin Immunother. 2019 Jun 20:1\u20133) observed that 96.9% of pregnant women were positive for anti-measles IgG (with a higher risk of contracting measles in those aged 19\u201329 years) emphasizing the importance of serological screening before pregnancy. We evaluated seroprotection/seropositivity rates to Measles, Mumps and Rubella in 324 adults with an acquired immune-deficiency needing an immunization program. We found that younger patients (20\u201329 years) had a seroprevalence below 85%. Overall, a relevant proportion (21.6%, 54/250) of patients was susceptible to at least one infection needing immunization. Our results confirm the usefulness of proper strategies for identifying individuals susceptible to vaccine-preventable infections and protecting them through vaccination