Deaths from COVID-19 in healthcare workers in Italy - what can we learn?

This letter examines healthcare worker deaths by category and medical speciality during the COVID-19 emergency in Italy, and underlines factors that may have contributed to the elevated number of fatalities among healthcare personnel. These data are now available because Italy was the first western country to be severely affected. These are matters for urgent discussion as development goes forward

Refining the Enrolment Process in Emergency Medicine Research

Research in the emergency setting involving patients with acute clinical conditions is needed if there are to be advances in diagnosis and treatment. But research in these areas poses ethical and practical challenges. One of these is the general inability to obtain informed consent due to the patient’s lack of mental capacity and insufficient time to contact legal representatives. Regulatory frameworks which allow this research to proceed with a consent ‘waiver’, provided patients lack mental capacity, miss important ethical subtleties. One of these is the varying nature of mental capacity among emergency medicine patients. Not only is their capacity variable and often unclear, but some patients are also likely to be able to engage with the researcher and the context to varying degrees. In this paper we describe the key elements of a novel enrolment process for emergency medicine research that refines the consent waiver and fully engages with the ethical rationale for consent and, in this context, its waiver. The process is verbal but independently documented during the ‘emergent’ stages of the research. It provides appropriate engagement with the patient, is context-sensitive and better addresses ethical subtleties. In line with regulation, full written consent for on-going participation in the research is obtained once the emergency is passed

A histopathological classification scheme for abdominal aortic aneurysm disease

Objective: Two consensus histopathological classifications for thoracic aortic aneurysms (TAAs) and inflammatory aortic diseases have been issued to facilitate clinical decision-making and inter-study comparison. However, these consensus classifications do not specifically encompass abdominal aortic aneurysms (AAAs). Given its high prevalence and the existing profound pathophysiologic knowledge gaps, extension of the consensus classification scheme to AAAs would be highly instrumental. The aim of this study was to test the applicability of, and if necessary to adapt, the issued consensus classification schemes for AAAs. Methods: Seventy-two AAA anterolateral wall samples were collected during elective and emergency open aneurysm repair performed between 2002 and 2013. Histologic analysis (hematoxylin and eosin and Movat Pentachrome) and (semi-quantitative and qualitative) grading were performed in order to map the histological aspects of AAA. Immuno- histochemistry was performed for visualization of aspects of the adaptive and innate immune system, and for a more detailed analysis of atherosclerotic lesions in AAA. Results: Because the existing consensus classification schemes do not adequately capture the aspects of AAA disease, an AAA-specific 11-point histopathological consensus classification was devised. Systematic application of this classification indicated several universal features for AAA (eg, [almost] complete elastolysis), but considerable variation for other aspects (eg, inflammation and atherosclerotic lesions). Conclusions: This first multiparameter histopathological AAA consensus classification illustrates the sharp histological contrasts between thoracic and abdominal aneurysms. The value of the proposed scoring system for AAA disease is illustrated by its discriminatory capacity to identify samples from patients with a nonclassical (genetic) variant of AAA disease. (JVSeVascular Science 2021;2:260-73.) Clinical Relevance: The pathophysiology of abdominal aortic aneurysm (AAA) disease remains an enigma. Histological evaluation is critical for appreciation of the tissue remodeling and spatial aspects of AAA disease. Histopathological classification schemes have been devised for aortic pathology. Unfortunately, these schemes do not specifically address the most common aortic pathology, AAA disease. In order to facilitate interstudy comparisons and pathophysiologic understanding of AAA disease, we here present a multiparameter consensus histopathological AAA classification scheme. The scheme clearly discriminates AAA disease from thoracic aortic aneurysm disease. Systematic implementation of this AAA classification system indicates a substantial biological variation for AAA disease, and stresses the need for adequate group sizes in order to adequately cover the natural variability. Examples illustrating the diagnostic value of the classification system are provided

Metabolomic Profiling in Acute ST-Segment-Elevation Myocardial Infarction Identifies Succinate as an Early Marker of Human Ischemia-Reperfusion Injury.

BACKGROUND: Ischemia-reperfusion injury following ST-segment-elevation myocardial infarction (STEMI) is a leading determinant of clinical outcome. In experimental models of myocardial ischemia, succinate accumulation leading to mitochondrial dysfunction is a major cause of ischemia-reperfusion injury; however, the potential importance and specificity of myocardial succinate accumulation in human STEMI is unknown. We sought to identify the metabolites released from the heart in patients undergoing primary percutaneous coronary intervention for emergency treatment of STEMI. METHODS AND RESULTS: Blood samples were obtained from the coronary artery, coronary sinus, and peripheral vein in patients undergoing primary percutaneous coronary intervention for acute STEMI and in control patients undergoing nonemergency coronary angiography or percutaneous coronary intervention for stable angina or non-STEMI. Plasma metabolites were analyzed by targeted liquid chromatography and mass spectrometry. Metabolite levels for coronary artery, coronary sinus, and peripheral vein were compared to derive cardiac and systemic release ratios. In STEMI patients, cardiac magnetic resonance imaging was performed 2 days and 6 months after primary percutaneous coronary intervention to quantify acute myocardial edema and final infarct size, respectively. In total, 115 patients undergoing acute STEMI and 26 control patients were included. Succinate was the only metabolite significantly increased in coronary sinus blood compared with venous blood in STEMI patients, indicating cardiac release of succinate. STEMI patients had higher succinate concentrations in arterial, coronary sinus, and peripheral venous blood than patients with non-STEMI or stable angina. Furthermore, cardiac succinate release in STEMI correlated with the extent of acute myocardial injury, quantified by cardiac magnetic resonance imaging. CONCLUSION: Succinate release by the myocardium correlates with the extent of ischemia

RGS1 regulates myeloid cell accumulation in atherosclerosis and aortic aneurysm rupture through altered chemokine signalling

Chemokine signalling drives monocyte recruitment in atherosclerosis and aortic aneurysms. The mechanisms that lead to retention and accumulation of macrophages in the vascular wall remain unclear. Regulator of G-Protein Signalling-1 (RGS1) deactivates G-protein signalling, reducing the response to sustained chemokine stimulation. Here we show that Rgs1 is upregulated in atherosclerotic plaque and aortic aneurysms. Rgs1 reduces macrophage chemotaxis and desensitizes chemokine receptor signalling. In early atherosclerotic lesions, Rgs1 regulates macrophage accumulation and is required for the formation and rupture of Angiotensin II-induced aortic aneurysms, through effects on leukocyte retention. Collectively, these data reveal a role for Rgs1 in leukocyte trafficking and vascular inflammation and identify Rgs1, and inhibition of chemokine receptor signalling as potential therapeutic targets in vascular disease

A critique of teaching approach on the higher education level

Na visokoškolskim institucijama u Hrvatskoj nastavnom se radu nažalost ne pridaje značenje kakvo mu pripada. Ukorak s rehabilitacijom vrednovanja nastavnog rada na fakultetima treba razvijati svijest o potrebi sustavne izobrazbe nastavnika na fakultetima za rad u nastavi s ciljem podizanja kvalitete nastave. Danas smo suočeni i s izazovom permanentne motivacije studenata; od motivacije za upis, pa nadalje. Zadaća je fakulteta koncipirati i provoditi politiku usmjerenu ponajprije na studente, od potencijalnih studenata pa do upisanih, dakle i prije upisa, tijekom čitavog studija, ali i poslije, u okviru cjeloživotnog učenja. Aktualni i zanimljivi programi bez kvalitetnih nastavnika nisu dostatni. Uspješnijem studiranju ne pridonosi samo razvijenost strategija i vještina učenja studenata nego i način poučavanja nastavnika. Od čitavog spektra načina poučavanjai nastavnih metoda uglavnom se koriste frontalni rad i metoda usmenog izlaganja. Opisivanje je pretežito znanstveno, nedostatno se provjerava razumijevanje tijekom samoga nastavnog procesa, needucirani nastavnici nisu dorasli didaktičkom vođenju studenata... To su samo neke od slabosti koje bitno umanjuju kvalitetu visokoškolskog obrazovanja. Rješavanje mnogih problema s kojima se susreću nastavnici i njihovi studenti zahtijeva od nastavnika i znanja iz područja didaktike, psihologije i metodike. Stoga je prijeko potrebno u tom smjeru uvesti značajne promjene na razini visokoškolskog obrazovanja. U radu su korišteni i neki rezultati istraživanja provedenog nad studentima prve godine Kemijsko-tehnološkog fakulteta u Splitu s ciljem ispitivanja učinkovitosti strategija učenja.In higher educational institutions class activities unfortunately do not have the importance they deserve. Following the rehabilitation of higher education class evaluation, the level of consciousness about the necessity of college teachers’ systematic education should be increased in order to improve the quality of education. Today, we face the challenge of students’ permanent motivation; from enrollment onwards. The task of college is to draft and apply an agenda that is primarily student oriented, towards both potential and registered ones; which is to be realized before enrolment, during the entire study, and later in the context of lifelong learning. Current interesting programs, without competent teachers are not suffi cient. Not only that the development of certain strategies and students learning skills contributes to successful studying, but also the teaching methods are crucial. From a wide range of teaching and educational methods, frontal work and the method of speech presentation are mostly used. Description is predominantly scholarly, comprehension is rarely questioned during class, uneducated teachers are not competent enough to didactically direct students; and these are only a few weaknesses which signifi cantly reduce the quality of higher education institutions. Solving many problems that teachers and their students encounter demands teachers’ knowledge in didactics, psychology and methodic. Therefore it is highly necessary to introduce certain changes on the level of higher education. This work incorporates results from survey conducted on students of Faculty of Chemistry and Technology in Split due to exploring the learning strategy effectiveness