Gel-type polyacrylic resins cross-linked with trimethylolpropanetrimethacrylate: the issue of their nanostructure unveiled with a combination of Inverse Steric Exclusion Chromatography (ISEC), ESR and CP MAS 13C NMR spectrometries

Abstract: Six gel-type functional resins, that is, three poly-DMAA-co-TMPTP (DMAA=N,N-dimethylacrylamide, TMPTP=trimethylolpropyltrimethacrylate) samples with different degrees of cross-linking (0.6, 1.2, 1.7% mol) and three poly-DMAA-co-MA-co- TMPTP (MA=methacrylic acid, ca. 5.5% mol) samples with 1.7, 3.5, and 7% mol cross-linking were investigated with ISEC (inverse steric exclusion chromatography), and ESR and CPMAS (cross polarization magic angle spinning) 13C NMR spectroscopy after swelling in water and other solvents. This unprecedented combination of conceptually independent physicochemical techniques provides a thorough overall consistent picture of the morphology of the resins on the nanometer scale and of the molecular accessibility of the swollen polymer framework to the paramagnetic probe TEMPONE (2,2,6,6-tetramethyl-4-oxo-1- oxypiperidine) and to selected solvents

The illness perceptions in chronic obstructive pulmonary disease: a qualitative study.

Introduction: A few studies have explored the illness perceptions as well as the mutual connection between respiratory and physical status and emotional experiences in Chronic Obstructive Pulmonary Disease (COPD). Aims and objectives: The main aim was to investigate the illness perceptions of people affected by COPD. Secondarily, beliefs about the connection between mind and respiratory symptoms were explored. Methods: A qualitative study using ad hoc semi-structured interviews, based on the framework approach of Interpretative Phenomenological Analysis, was carried out at the Respiratory Rehabilitation Unit of Fondazione Don Carlo Gnocchi, Milan (Italy) between February and June 2018. Results: Twenty-seven participants with mild to severe COPD (15 males and 12 females; Mean Age= 72.37, SD= 9.44) were involved. The thematic analysis resulted in four master themes: \u201cillness experience\u201d, \u201cmind-body relationship\u201d, \u201cexpertise\u201d, and \u201cfuture\u201d. The major concern reported by participants was that of limitation, which contributed to their housebound and fears. These issues, together with feelings of anxiety, sadness, annoyance and nervousness, inspire to existential themes and the possible future implications. Conclusions: COPD participants believe in a strong and negative link between mind and body, whose impact on rehabilitation process, respiratory outcomes and health-related behaviours should be study further

Cumulative effect of complete left bundle-branch block and chronic atrial fibrillation on 1-year mortality and hospitalization in patients with congestive heart failure. A report from the Italian network on congestive heart failure (in-CHF database).

Background Many clinical variables have been proposed as prognostic factors in patients with congestive heart failure. Among these, complete left bundle-branch block and atrial fibrillation are known to impair significantly left ventricular performance in patients with congestive heart failure. However, their combined effect on mortality has been poorly investigated. The aim of this study was to determine whether left bundle-branch block associated with atrial fibrillation had an independent, cumulative effect on mortality for congestive heart failure. Methods and Results We analysed the Italian Network on congestive heart failure (IN-CHF) Registry that was established by the Italian Association of Hospital Cardiolo- gists in 1995. One-year follow-up data were available for 5517 patients. Complete left bundle-branch block and atrial fibrillation were associated in 185 (3·3%) patients. In this population the cause of congestive heart failure was dilated cardiomyopathy (38·4%), ischaemic heart disease (35·1%), hypertensive heart disease (17·3%), and other aetiologies (9·2%). This combination of electrical defects was associated with an increased 1-year mortality from any cause (hazard ratio, HR: 1·88; 95% CI 1·37–2·57) and sudden death (HR: 1·89; 95% CI 1·17–3·03) and 1-year hospitalization rate (HR: 1·83; 95% CI 1·26–2·67). Conclusions In patients with congestive heart failure, the contemporary presence of left bundle-branch block and atrial fibrillation was associated with a significant increase in mortality. This synergistic effect remained significant after adjusting for clinical variables usually associated with advanced heart failure. We can conclude that this combi- nation of electrical disturbances identifies a congestive heart failure specific population with a high risk of mortality. (Eur Heart J, 2002; 23: 1692–1698, doi:10.1053/euhj.2001. 3157

Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic.

ContextNo information is available on oncology patients' level of stress and symptom burden during the coronavirus disease 2019 (COVID-19) pandemic.ObjectivesTo evaluate for differences in demographic and clinical characteristics, levels of social isolation and loneliness, and the occurrence and severity of common symptoms between oncology patients with low vs. high levels of COVID-19 and cancer-related stress. In addition, to determine which of these characteristics were associated with membership in the high-stressed group.MethodsPatients were 18 years and older; had a diagnosis of cancer; and were able to complete an online survey.ResultsOf the 187 patients in this study, 31.6% were categorized in the stressed group (Impact of Event Scale-Revised [score of ≥24]). Stressed group's Impact of Event Scale-Revised score exceeds previous benchmarks in oncology patients and equates with probable post-traumatic stress disorder. In this stressed group, patients reported occurrence rates for depression (71.2%), anxiety (78.0%), sleep disturbance (78.0%), evening fatigue (55.9%), cognitive impairment (91.5%), and pain (75.9%). Symptom severity scores equate with clinically meaningful levels for each symptom.ConclusionWe identified alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer, exceeding those previously benchmarked in this population and on par with noncancer patients with post-traumatic stress disorder. Given that the COVID-19 pandemic will likely impact cancer care for an indefinite period, clinicians must exhibit increased vigilance in their assessments of patients' level of stress and symptom burden. Moreover, an increase in referrals to appropriate supportive care resources must be prioritized for high-risk patients

Prognostic impact of diabetes and prediabetes on survival outcomes in patients with chronic heart failure: a post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial

Background-The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial.Methods and Results-We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n= 2852), pre-DM (n= 2013), and non-DM (n= 2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively).Conclusions-Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure

Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers

Background-Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results-A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P<0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P<0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders. Conclusions-We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633