Cardiac rehabilitation outcome after transcatheter aortic valve implantation.

Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR). Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI

M. Ponticelli, M.L. Bellone, V. Parisi, A. M. Iannuzzi, A. Braca, N. De Tommasi, D. Russo, A. Sileo, P. Quaranta, G. Freer, M. Pistello

Viral infections have always been the main global health challenge, as a number of potentially lethal viruses, including the hepatitis virus, herpes virus, and influenza virus, have affected human health for decades. Unfortunately, most of the licensed antiviral drugs are characterized by many adverse reactions and, in the long-term therapy, also develop viral resistance; for these reasons, researchers have focused their attention on the investigation of potential antiviral molecules from plants. Natural resources indeed offer a variety of specialized therapeutic metabolites that have been demonstrated to inhibit viral entry into the host cells and replication through the regulation of viral absorption, cell receptor binding, and competition for the activation of intracellular signaling pathways. A wide variety of active phytochemicals, including flavonoids, lignans, terpenoids, coumarins, saponins, alkaloids, etc., have been identified as potential candidates for preventing and treating viral infections. Using a systematic approach, this review summarises the knowledge obtained to date on the in vivo antiviral activity of specialized metabolites extracted from plant matrices by focusing on their mechanism of action

Maintenance in myeloma patients achieving complete response after upfront therapy: a pooled analysis

Purpose: Maintenance demonstrated to improve survival in newly diagnosed multiple myeloma (NDMM) patients and the achievement of complete response (CR) is a strong predictor of survival. Nevertheless, the role of maintenance according to response after induction/consolidation has not been investigated so far. To evaluate the impact of maintenance according to response, we pooled together and retrospectively analyzed data from 955 NDMM patients enrolled in two trials (GIMEMA-MM-03-05 and RV-MM-PI-209). Methods: Primary endpoints were progression-free survival (PFS)1, PFS2 and overall survival (OS) of CR patients randomized to maintenance and no maintenance. Secondary endpoints were PFS1, PFS2 and OS in very good partial response/partial response (VGPR/PR) patients. Results: Overall, 213 patients obtained CR after induction/consolidation, 118 received maintenance and 95 no maintenance. In patients achieving CR, maintenance significantly improved PFS1 (HR 0.50, P &lt; 0.001), PFS2 (HR 0.58, P 0.02) and OS (HR 0.51, P 0.02) compared with no maintenance; the advantage was maintained across all the analyzed subgroups according to age, International Staging System (ISS) stage, cytogenetic profile and treatment. Similar features were seen in VGPR/PR patients. Conclusion: Maintenance prolonged survival in CR and in VGPR/PR patients. The benefit in CR patients suggests the importance of continuing treatment in patients with chemo-sensitive disease. Trial registration: The two source studies are registered at ClinicalTrials.gov: identification numbers NCT01063179 and NCT00551928

SEPOLTURE ANOMALE NELLE TOMBE DEL BA I-III DI TELL ES-SULTAN/ GERICO (SCAVI J. GARSTANG)

La letteratura scientifica inerente i contesti funerari del Levante, si è limitata ad una descrizione superficiale delle sepolture senza procedere nello specifico ad un’analisi dettagliata dei resti osteologici, fondamentale per la comprensione e l’interpretazione dei rituali funerari. In questo contributo si vogliono analizzare in particolar modo le tombe di Gerico scavate dalla prima missione inglese condotta da J. Garstang dal 1930-al 1936. L’importanza di questa necropoli deriva soprattutto, dall’estensione cronologica e dalla continuità delle sequenze stratigrafiche che vanno dall’inizio dell’urbanizzazione in Palestina fino al Bronzo Tardo. Sono state analizzate le fasi del Bronzo Antico, estremamente importanti per comprendere la struttura economica, sociale e ideologica connessa con il fenomeno della sedentarizzazione. L’interesse risiede anche nell’impiego coincidente con la prima esperienza urbana gerichiota che è ben visibile nella necropoli ed è testimoniata dal passaggio dalla sepoltura secondaria a quella primaria, questo a conferma della sedentarizzazione, a partire dal Bronzo Antico IB, degli abitanti di Gerico. Le sepolture primarie prese in esame si distinguono per la singolare posizione fatta assumere al defunto, al momento della deposizione e in alcuni casi anche per il corredo funerario ad esso associato. Si tratta di sepolture provenienti dalla grande tomba A e dalla tomba 351; ognuna delle quali è caratterizzata da un’anomalìa che non trova immediati confronti nel territorio palestinese. La metodologia adottata parte dall’analisi dei diari di scavo e di tutta la documentazione edita e inedita, fino ad una rielaborazione grafica delle piante originali. L’obiettivo finale è comprendere la simbologia che sta dietro al gesto intenzionale per poter così intuire il pensiero religioso che ha portato al singolare trattamento del defunto