Relazione tra i parametri di funzione diastolica ventricolare sinistra e gli indici di rimodellamento ventricolare in una popolazione di pazienti ipertesi

Background: L'ipertrofia ventricolare sinistra è una forma di rimodellamento adattativo che si instaura in risposta ad un cronico sovraccarico pressorio e rappresenta un importante fattore di rischio indipendente per eventi cardiovascolari in pazienti con ipertensione arteriosa. Parallelamente, l'ipertensione arteriosa, inducendo dei cambiamenti nella geometria ventricolare, determina alterazioni del rilasciamento del ventricolo sinistro e del riempimento, che costituiscono nel loro insieme la disfunzione diastolica. Scopo: Abbiamo analizzato la relazione tra gli indici ecocardiografici di funzione diastolica ventricolare sinistra e i parametri di rimodellamento ventricolare in una popolazione di pazienti ipertesi. Materiali e metodi: Lo studio ha incluso 111 pazienti ipertesi (età 60 ±13 anni, 32% donne) con valori pressori medi di 141/80 mmHg, l’84.7% dei quali in trattamento antipertensivo ed il 18,8 % con diabete ti tipo 2 (T2DM). I pazienti sono stati sottoposti ad ecocardiogramma transtoracico per la valutazione della massa ventricolare sinistra indicizzata (LVMi), dello spessore relativo di parete (RWT) e degli indici di funzionalità diastolica (velocità di picco di riempimento ventricolare rapido – onda E – e tardivo – onda A, il rapporto E/A, la velocità protodiastolica mitralica anulare al Doppler tissutale - e'm - ed il rapporto E/e'm) ed il volume atriale indicizzato (LAVi), calcolato mediante il metodo biplano area-lunghezza. Risultati: Nella popolazione in esame sono stati riscontrati valori di LVMi di 124,1 ± 23,2 g/m2, E/A di 0,95 ± 0,35, E/e’m di 8,92 ± 3,07 e LAVi di 30,6 ± 13,2 ml/m2. Ad un’analisi univariata il LAVi, il rapporto E/A ed il rapporto E⁄e'm correlavano in maniera statisticamente significativa con la LVMi (rispettivamente p<0.00001, R=0.42; p<0.0001, R= -0.43; p<0.00001, R=0.58) e con RWT (rispettivamente p<0.001, R= -0.44; p<0.005, R= -0.25; p<0.005, R=0.27). Tuttavia all’analisi multivariata solo il rapporto E⁄e'm ed il LAVi correlavano alla LVMi in maniera indipendente da fattori confondenti (età, BP, T2DM). Conclusioni: Sebbene l’età, i valori pressori medi e la presenza di diabete mellito rappresentino di per sé determinanti di disfunzione diastolica, il rapporto E⁄e'm ed il LAVi appaiono indici ecocardiografici in grado di correlare con la LVMi in maniera indipendente, confermando la relazione tra ipertensione e disfunzione

Pleuroparenchymal Fibroelastosis-like Lesions in Clinical Practice: A Rare Entity? Review of a Radiological Database

Background: Pleuroparenchymal Fibroelastosis (PPFE) is a rare disease that consists of elastofibrosis that involves the pleura and subpleural lung parenchyma; it is an unusual pulmonary disease with unique clinical, radiological and pathological characteristics. According to recent studies, PPFE may not be a definite disease but a form of chronic lung injury. The aim of this retrospective study is to determine the incidence and to evaluate the distribution, severity and progression of this radiological entity on high-resolution CT (HRCT) exams of the chest, performed in routine clinical practice. In total, 1514 HRCT exams performed in the period January 2016–June 2018 were analyzed. For each exam, the presence of PPFE was evaluated and a quantitative score was assigned (from 0 to 7 points, based on the maximum depth of fibrotic involvement of the parenchyma). When available, two exams with a time interval of at least 6 months were compared for each patient in order to evaluate progression (defined as the increase in the disease score). Patients were divided into different groups according to exposure and their associated diseases. Statistical analysis was performed by using the Wilcoxon test and Kruskal–Wallis test. Results: PPFE was detected in 174 out of 1514 patients (11.6%), with a mean score of 6.1 ± 3.9 (range 1–14). In 106 out of 174 patients (60.9%), a previous CT scan was available and an evolution of PPFE was detected in 19 of these (11.5%). Among these 19 patients with worsening PPFE, 4 had isolated PPFE that was associated with chronic exposure or connective tissue disorders, and the other 15 had an associated lung disease and/or a chronic exposure. In this group, it was found that the ventral segments of the upper lobes, fissures and apical segments of the lower lobes had a greater statistically significant involvement in the progression of the disease compared to the non-progressive group. In 16 of 174 patients (9.2%, 7 of which belonged to the radiological progression group) a biopsy through video-assisted thoracoscopic surgery or apicoectomy confirmed PPFE. Conclusion: PPFE-like lesions are not uncommon on HRCT exams in routine clinical practice, and are frequently found in patients with different forms of chronic lung injury. Further studies are necessary to explain why the disease progresses in some cases, while in most, it remains stationary over time

Best practices in European restructuring contractualised distress resolution in the shadow of the law. Italian National Findings Italian National Report

The general trend away from traditional, formal insolvency proceedings opens up a vast area to private ordering, with all the associated opportunities and risks. The transition can be less costly if the resulting uncertainty is reduced to a minimum. This presents national legislators with a delicate challenge. They should not be overly prescriptive and should effectively delegate decision-making to stakeholders and expert professionals, who are likely to be better informed and better incentivised. At the same time, the law must provide for information to fow where needed and for the creation of optimal incentives. Against this background, guidance on best practices can be of great value. It may assist policymaking in one jurisdiction by drawing attention to successes and failures in others, and it may allow professionals, advisors, debtors, creditors and courts to fnd common ground in the formulation of high-quality distress resolution plans and in distinguishing viable and non-viable distressed debtors. Based on extensive empirical research in four European Union states, this book takes up the challenge of unearthing and crystallising some of the most critical best practices in the various stages of a distress resolution process. Drawing on these best practices, it provides lawmakers with several \u2018Policy Recommendations\u2019, and other key stakeholders with a set of \u2018Guidelines\u2019. Special attention is given to the particular needs of micro, small and medium enterprises