Natural history and mid-term prognosis of severe tricuspid regurgitation: A cohort study.

OBJECTIVES The objective of this study was to characterize a population of patients with severe tricuspid regurgitation (TR) evaluated at a tertiary care center, assess mid-term clinical outcomes, and identify prognostic factors. BACKGROUND The impact of TR on morbidity and mortality is increasingly recognized. Clinical characteristics and long-term outcomes of patients suffering from TR remain unclear. METHODS This is a retrospective observational single-center study from a tertiary care hospital including patients with echocardiographic diagnosis of severe TR between January 2017 and December 2018. We used the Kaplan-Meier method to estimate survival for up to 4 years. After excluding patients with tricuspid valve (TV) intervention and surgery during follow-up, a multivariate analysis was performed to assess predictors of 2-year mortality using the Cox regression model. RESULTS A total of 278 patients (mean age 74.9 ± 13.7 years, 47.8% female) with severe TR were included in the study. The majority (83.1%; n = 231) had secondary TR. Comorbidities such as atrial fibrillation (AFib) (68.0%; n = 189), severe renal failure (44.2%; n = 123), pulmonary hypertension (PHT) (80.9%; n = 225), and right ventricular (RV) dysfunction (59.7%; n = 166) were highly prevalent. More than half of patients with a cardiac implantable electronic device (CIED) (54.3%; n = 44) showed echocardiographic signs of lead-leaflet interaction causing or contributing to TR. The estimated 2- and 4-year all-cause mortality was 50 and 69%, respectively. Using multivariate analysis, age, severe renal failure, heart failure with reduced ejection fraction (HFrEF), and vena contracta width ≥14 mm were identified as predictors of 2-year mortality. Nine percent (n = 25) of the study cohort underwent transcatheter or surgical treatment for TR during follow-up. CONCLUSION Our study shows the high burden of morbidity and the dismal survival of patients with severe TR. It also highlights the extent of the therapeutic need, since the vast majority of patients were left untreated. Additionally, CIED RV lead-associated TR was prevalent suggesting a need for more attention in clinical routine and research

Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction.

Background Microvascular obstruction (MVO) and Late Gadolinium Enhancement (LGE) assessed in cardiac magnetic resonance (CMR) are associated with adverse outcome in patients with ST-elevation myocardial infarction (STEMI). Our aim was to analyze the diagnostic performance of segmental strain for the detection of MVO and LGE. Methods Patients with anterior STEMI, who underwent additional CMR were enrolled in this sub-study of the CARE-AMI trial. Using CMR feature tracking (FT) segmental circumferential peak strain (SCS) was measured and the diagnostic performance of SCS to discriminate MVO and LGE was assessed in a derivation and validation cohort. Results Forty-eight STEMI patients (62 ± 12 years old), 39 (81%) males, who underwent CMR (i.e., mean 3.0 ± 1.5 days) after primary percutaneous coronary intervention (PCI) were included. All patients presented with LGE and in 40 (83%) patients, MVO was additionally present. Segments in all patients were visually classified and 146 (19%) segments showed MVO (i.e., LGE+/MVO+), 308 (40%) segments showed LGE and no MVO (i.e., LGE+/MVO-), and 314 (41%) segments showed no LGE (i.e., LGE-). Diagnostic performance of SCS for detecting MVO segments (i.e., LGE+/MVO+ vs. LGE+/MVO-, and LGE-) showed an AUC = 0.764 and SCS cut-off value was -11.2%, resulting in a sensitivity of 78% and a specificity of 67% with a positive predictive value (PPV) of 30% and a negative predictive value (NPV) of 94% when tested in the validation group. For LGE segments (i.e., LGE+/MVO+ and LGE+/MVO- vs. LGE-) AUC = 0.848 and SCS with a cut-off value of -13.8% yielded to a sensitivity of 76%, specificity of 74%, PPV of 81%, and NPV of 70%. Conclusion Segmental strain in STEMI patients was associated with good diagnostic performance for detection of MVO+ segments and very good diagnostic performance of LGE+ segments. Segmental strain may be useful as a potential contrast-free surrogate marker to improve early risk stratification in patients after primary PCI

miRNA-mRNA integrative analysis in primary myelofibrosis CD34+ cells: role of miR-155/JARID2 axis in abnormal megakaryopoiesis

Primary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by megakaryocyte (MK) hyperplasia, bone marrow fibrosis, and abnormal stem cell trafficking. PMF may be associated with somatic mutations in JAK2, MPL, or CALR. Previous studies have shown that abnormal MKs play a central role in the pathophysiology of PMF. In this work, we studied both gene and microRNA (miRNA) expression profiles in CD34(+) cells from PMF patients. We identified several biomarkers and putative molecular targets such as FGR, LCN2, and OLFM4. By means of miRNA-gene expression integrative analysis, we found different regulatory networks involved in the dysregulation of transcriptional control and chromatin remodeling. In particular, we identified a network gathering several miRNAs with oncogenic potential (eg, miR-155-5p) and targeted genes whose abnormal function has been previously associated with myeloid neoplasms, including JARID2, NR4A3, CDC42, and HMGB3. Because the validation of miRNA-target interactions unveiled JARID2/miR-155-5p as the strongest relationship in the network, we studied the function of this axis in normal and PMF CD34(+) cells. We showed that JARID2 downregulation mediated by miR-155-5p overexpression leads to increased in vitro formation of CD41(+) MK precursors. These findings suggest that overexpression of miR-155-5p and the resulting downregulation of JARID2 may contribute to MK hyperplasia in PMF

Financing and acceptance by the target group concerning a Facebook page for the Telebasel News Broadcast 7vor7

Mit dieser Bachelorthesis wird überprüft, ob sich der Schweizer Lokalsender Telebasel eine Facebook-Seite für die Nachrichtensendung „7vor7“ leisten kann. Um dies herauszufinden wird untersucht, ob sich die Werbekunden von Telebasel vorstellen können, auf einer Facebook-Seite der Nachrichtensendung „7vor7“ Werbung zu schalten. Zudem wird die Frage geklärt, ob das Zielpublikum der Sendung an einer möglichen Facebook-Seite interessiert ist. Um eine Antwort auf diese beiden Fragen zu bekommen, werden zwei schriftliche Befragungen durchgeführt. Die Resultate beider Umfragen werden zueinander in ein Verhältnis gesetzt, damit eine Antwort auf die Fragestellung formuliert werden kann. Die Arbeit besteht aus drei Teilen: Zu Beginn wird der Leser an das Thema herangeführt. Im zweiten Abschnitt der Arbeit wird der Stand der Forschung beschrieben. Anschliessend folgt das Kapitel der beiden empirischen Untersuchungen. Danach folgt ein Fazit über die Arbeit. Ein Ausblick schliesst die Arbeit ab.This bachelor thesis explores if the Swiss local TV station Telebasel can afford a Facebook site for the News Broadcast „7vor7“. A survey of Telebasel advertisers will be conducted to determine if the project could be financially supported through the placement of advertisements on the Facebook page of News Broadcast „7vor7“. A second survey will be conducted with a target audience of the broadcast to measure the level of interest in having a Facebook page. The results of the surveys will be used as the main supporting factors for the conclusions and recommendations regarding implementation of a News Broadcast „7vor7“ Facebook page. This thesis consists of three parts: The first section introduces the reader to the objectives of the thesis project. The second section describes the current state of research. The thesis concludes with a discussion of the main conclusions and recommendations based on the findings of the research

Questa è la mia storia. Per una valutazione di impatto dei percorsi di inclusione socio-lavorativa attraverso i racconti di vita

Il volume presenta i risultati della valutazione d'impatto dei percorsi finalizzati all'inclusione socio-lavorativa di persone svantaggiate, sostenuti dalla Sovvenzione Globale "Esprit3" (FSE POR Toscana, Obiettivo 2, 2007-2013). Rispetto alle tradizionali modalità di valutazione, la ricerca utilizza un approccio innovativo di tipo qualitativo, coinvolgendo sul campo le persone che, a vario titolo, partecipano ai progetti finanziati. In primo luogo, sono stati coinvolti i "beneficiari finali", vale a dire le persone svantaggiate, al fine di comprendere meglio ciò che è accaduto concretamente nelle loro vite attraverso il lavoro, le risorse personali riattivate, i punti di svolta incontrati, le speranze accese, l'autostima e la dignità riconquistate, l'acquisizione della fiducia e dell'autonomia individuale, la consapevolezza dell'importanza della cura di sé. In secondo luogo, sono stati coinvolti i "beneficiari intermedi", ossia le organizzazioni che hanno promosso i progetti di inclusione finanziati, che hanno supportato e coadiuvato il processo di inserimento lavorativo attraverso un vero e proprio accompagnamento e tutoraggio attivo. In questo caso, la ricerca valutativa si è concentrata sull'analisi dei principali cambiamenti organizzativi accaduti dall'erogazione del finanziamento, approfondendo aspetti quali la rispondenza delle azioni rispetto ai bisogni precedentemente rilevati, le potenzialità del lavoro in rete, i possibili punti di svolta per l'organizzazione stessa

Questa è la mia storia. Per una valutazione di impatto dei percorsi di inclusione socio-lavorativa attraverso i racconti di vita

Il volume presenta i risultati della valutazione d'impatto dei percorsi finalizzati all'inclusione socio-lavorativa di persone svantaggiate, sostenuti dalla Sovvenzione Globale "Esprit3" (FSE POR Toscana, Obiettivo 2, 2007-2013). Rispetto alle tradizionali modalità di valutazione, la ricerca utilizza un approccio innovativo di tipo qualitativo, coinvolgendo sul campo le persone che, a vario titolo, partecipano ai progetti finanziati. In primo luogo, sono stati coinvolti i "beneficiari finali", vale a dire le persone svantaggiate, al fine di comprendere meglio ciò che è accaduto concretamente nelle loro vite attraverso il lavoro, le risorse personali riattivate, i punti di svolta incontrati, le speranze accese, l'autostima e la dignità riconquistate, l'acquisizione della fiducia e dell'autonomia individuale, la consapevolezza dell'importanza della cura di sé. In secondo luogo, sono stati coinvolti i "beneficiari intermedi", ossia le organizzazioni che hanno promosso i progetti di inclusione finanziati, che hanno supportato e coadiuvato il processo di inserimento lavorativo attraverso un vero e proprio accompagnamento e tutoraggio attivo. In questo caso, la ricerca valutativa si è concentrata sull'analisi dei principali cambiamenti organizzativi accaduti dall'erogazione del finanziamento, approfondendo aspetti quali la rispondenza delle azioni rispetto ai bisogni precedentemente rilevati, le potenzialità del lavoro in rete, i possibili punti di svolta per l'organizzazione stessa

MANUALE DI PATOLOGIA CHIRURGICA

2nonenoneFegiz-Marrano-Ruberti; Risaliti A. et al.Fegiz Marrano, Ruberti; Risaliti, Andre

The physiotherapy intervention for shoulder pain in patients treated for breast cancer: systematic review

Pain and joint dysfunction of the upper limb following treatment for mammary carcinoma are defined as the most frequent side effects of surgery for mammary carcinoma by calculating a prevalence range in the USA that varies between 12% and 51% with regard to pain and between 1.5% and 50% for joint dysfunction. This objective of this study was to describe physiotherapy interventions that demonstrate efficacy based on the type of pain present in patients with shoulder pain who have been treated for breast cancer. We conducted a search for relevant publications in the last 10 years (2009-2019) on the PubMed, Medline, CINAHL, and Cochrane databases. The articles obtained were selected on the basis of correlation criteria, with themes concerning shoulder pain after mammary carcinoma and physiotherapy performed to treat this pain. Studies suggest treating musculoskeletal pain through active exercises, joint and tissue mobilization techniques, with accessory joint mobilization and neurodynamics performed by experienced physiotherapists. In order to treat radio-induced and drug-induced neuropathic pain, both aerobic and strengthening exercises are supervised by an experienced physiotherapist and carried out twice weekly for a total of 150 minutes of exercise. Finally, the treatment suggested to deal with chronic pain uses a multidisciplinary approach, including pain education interventions, pharmacological interventions, psychological interventions, and physiotherapy interventions. To conclude. the classification of different types of shoulder pain following mammary carcinoma treatments requires specific and targeted physiotherapy interventions in which active therapeutic exercise has a central rol

Gastrointestinal Infection Could Be New Focus for Coronavirus Diagnosis

It's not news to tell you that the coronavirus, known as COVID-19, is a worldwide pandemic. The initial outbreak of this novel virus in Wuhan in the Hubei province of China, first described in December 2019, has since moved on to being declared a pandemic by the World Health Organization. The classic description of COVID-19 is a respiratory illness that manifests with fever, dry cough, and dyspnea on exertion. However, gastrointestinal (GI) complication of COVID-19 is emerging as well. This was observed with similar viral respiratory illnesses, such as severe acute respiratory syndrome (SARS), which emerged in 2003, and the Middle East respiratory syndrome (MERS), which emerged in 2012. In a recently published, single-center case series of 138 consecutive hospitalized patients with confirmed COVID-19, investigators reported that approximately 10% of patients initially presented with GI symptoms, prior to the subsequent development of respiratory symptoms. Common and often very subtle symptoms included diarrhea, nausea, and abdominal pain, with a less common symptom being nonspecific GI illness. New studies are expanding our understanding of the possible fecal transmission of COVID-19. Assessment by polymerase chain reaction (PCR) has provided evidence of the virus in the stool and the oropharynx outside the nasopharynx and respiratory tract. Virus in the stool may be evident on presentation and last throughout the course of illness resolution for up to 12 days after the respiratory virus evidence is gone. In fact, in one of the most recent studies looking at 73 patients, approximately 24% remained positive in their stool for evidence of the virus, though not necessarily infection, after showing negative in respiratory samples. The Centers for Disease Control and Prevention (CDC) recommends that after two negative respiratory tests separated by ≥ 24 hours, patients can be dismissed from having transmissibility infection risk for COVID-19. The potential for fecal-oral transmission of COVID-19 needs to be strongly considered. Considering these cases and the lessons from SARS, many authors recommend that real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from feces should be performed routinely in SARS-CoV-2 patients

Physical health and psychosocial considerations during the coronavirus disease 2019 outbreak

In addition to the respiratory damage caused by pulmonary fibrosis, patients will face psychiatric and neuropsychiatric symptoms. Having said this, respiratory rehabilitation for patients after COVID-19 will also and, above all, have to take into account psychological well-being issues. To date, there are no standard rehabilitation protocols, but given the large number of patients, it will be necessary to integrate and modulate the new respiratory rehabilitation protocols together with a psychological treatment program that should not be underestimated for the success of the therapy. In addition, health care professionals are put to the test during these situations of great health emergencies, thus developing the probability of being subject to psychosocial disorders because of accumulated stress in the workplace. One of the most significant and little investigated aspects is the psychological stress related to the emergency. Often, health care workers have to face intensive shifts with the adoption of personal protective equipment that put the subject's physical and psychological endurance to the test. To face this problem and guarantee the psychophysical well-being of employees, health care facilities must guarantee the adoption of preventive and protective measures, including psychological support through dedicated pathways