Elevated soluble receptor for advanced glycation end product levels in patients with acute coronary syndrome and positive cardiac troponin I

Objectives High levels of soluble receptor for advanced glycation end products (sRAGE) have been shown to have an atheroprotective role; however, no data are available on this molecule in acute coronary syndromes (ACS). We evaluated sRAGE levels in patients with non-ST segment elevation ACS (NSTE-ACS) or with chronic stable angina. Methods We studied 265 patients, 190 of whom had NSTE-ACS and 75 had chronic stable angina. Results Plasma sRAGE values were comparable in the two groups (P= 0.19). However, in the patients with NSTEACS,sRAGE levels were significantly higher in patients with cardiac troponin-I (cTnI) of more than or equal to 0.04 lg/l compared with those with cTnI of less than 0.04 lg/l [758 pg/ml (493-1536 pg/ml) vs. 454 pg/ml (167-899 pg/ml); P = 0.0037]. A significant correlation(r= 0.323, P = 0.0045) was found between sRAGE and cTnI levels in patients with NSTE-ACS.Conclusion Plasma sRAGE levels are elevated in patients with NSTE-ACS with positive cTnI, suggesting that they could be related to myocardial cell damage

Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study

Background: Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective: With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods: The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results: The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions: Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population

Técnicas para Detección y Estimación Eficiente de Potenciales Evocados

Los potenciales evocados (PE) en sus distintas modalidades (auditivos, visuales y somatosensoriales), se han convertido actualmente en un estudio de diagnóstico de patologías del sistema nervioso casi rutinario. Estos son señales eléctricas registradas mediante electrodos en el cuero cabelludo, que se producen como respuesta de los sistemas sensoriales a la aplicación de un estímulo adecuado. Sin embargo en su adquisición, además de la respuesta evocada por el estímulo, se registran potenciales generados por diversas fuentes fisiológicas y no fisiológicas; obteniéndose una relación señal a ruido (RSR) muy desfavorable que puede llegar a -20 dB en el caso de los potenciales evocados auditivos de tronco cerebral (PEATC).La técnica comúnmente utilizada para mejorar la RSR, y estimar la señal de PE, es la promediación coherente o sincronizada; la cual consiste en aplicar sucesivos estímulos y promediar la actividad eléctrica registrada en forma sincronizada con el instante de tiempo en que se aplica el estímulo. Si bien la promediación es de uso masivo, presenta limitaciones que justifican buscar alternativas a esta. Una es el tiempo requerido para lograr una estimación confiable del PE, que dependiendo de la modalidad del mismo puede insumir más o menos tiempo; en el caso de los PEATC puede ser de hasta 5 minutos. Otra es que se asume que la señal de PE se mantiene constante de época a época y que el ruido (el resto de los potenciales) es del tipo blanco con media cero, hipótesis que no es cierta para la mayoría de los casos. En consecuencia el resultado obtenido de la promediación es una mala estimación de la señal real de PE. Asimismo, hay situaciones en las que no se necesita estimar la morfología de la señal y solo basta con saber si la señal está presente, como por ejemplo la detección automática de hipoacusias.En este proyecto se propuso revisar, evaluar y desarrollar técnicas y/o algoritmos que permitan detectar la señal de PE así como también estimar de manera más eficiente que la promediación coherent

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

BACKGROUND: Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. METHODS: We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. RESULTS: We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. INTERPRETATION: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

I nuovi rischi, ESG risk e data governance: sfide e opportunità

Il capitolo illustra le nuove categorie di rischio (misconduct, cyber risk) e focalizza l'attenzione sull'ESG risk o meglio su una sottocategoria dello stesso (Climate&Enviromental) di cui prone le indicazione del Regulator europeo (ECB Guide) circa la necessità della sua integrazione nel processo di pianificazione strategica delle banche e nella risk governance. La seconda parte del capitolo espone l'importanza della data governace per l'efficacia dell'azione del Risk Manage

Seismic Vulnerability Evaluation within the structural and functional Survey Activities of the COM bases in Italy

The paper describes technical and functional surveys on COM buildings (Mixed Operative Centre). This activity started since 2005, with the contribution of both Italian Civil Protection Department and the Regions involved. The project aims to evaluate the efficiency of COM buildings, checking not only structural, architectonic and functional characteristics but also paying attention to surrounding real estate vubierability, road network, railways, harbours, airports, area morphological and hydro-geological characteristics, hazardous activities, etc. The first survey was performed in eastern Sicily, before the European Civil Protection Exercise "EUROSOT 2005". Then, since 2006, a new survey campaign started in Abruzzo, Molise, Calabria and Puglia Regions. The more important issue of the activity was the vulnerability assessment. So this paper deals with a more refined vulnerability evaluation technique by means of the SAVE methodology, developed in the V^ task of SAVE project within the GNDT-DPC programme 2000-2002 (Zuccaro, 2005); the SAVE methodology has been already successfully employed in previous studies (i.e. school buildings intervention programme at national scale; list of strategic public buildings in Campania, Sicilia and Basilicata). In this paper, data elaborated by SAVE methodology are compared with expert evaluations derived from the direct inspections on COM buildings. This represents a useful exercise for the improvement either of the survey forms or of the methodology for the quick assessment of the vulnerability