The mutual relationship between heart failure and atrial fibrillation

Atrial fibrillation (AF) and Heart Failure (HF) are evolving epidemies, together responsible for substantial human suffering and health-care expenditure. The simultaneous co-existence of the two conditions is associated with higher mortality rates than those observed in individuals with only one or none of them. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies. Recent data have suggested that these patients may respond differently if compared to those with HF or AF alone. These results highlight the clear clinical need to identify and treat these diseases according to best evidence, in order to prevent adverse outcomes and reduce the huge burden er that HF and AF are expected to have on global healthcare systems in the future

Danze rituali nella Roma arcaica. Tra processioni saliari e Lusus Troiae

The analysis of the sources about ritual dances in archaic Rome confirms that these rituals  belonged to the Roman cultural and religious facies since the beginning. This paper focuses on the Salian priesthood, on the possible route they followed during their processions and their movements. Furthermore, several points of contacts between the Salian dance and the Lusus Troiae described by Vergil are highlighted through the study of the testimonies, including those concerning Theseus’s γέρανος.L’analisi delle fonti sulle danze rituali nella Roma arcaica conferma come queste appartenessero alla facies culturale/religiosa romana sin dagli albori. Questo lavoro si concentra sui Salii, sul possibile percorso da essi compiuto durante le loro processioni e sulla tipologia dei loro movimenti. Tramite lo studio delle testimonianze, comprese quelle relative al γέρανος di Teseo, vengono poi evidenziati diversi punti di contatto tra la danza saliare e il Lusus Troiae descritto da Virgilio

Exercise training in patients with chronic heart failure: A new challenge for Cardiac Rehabilitation Community

Exercise training (ET) is strongly recommended in patients with chronic stable heart failure (HF). Moderate-intensity aerobic continuous ET is the best established training modality in HF patients. In the last decade, however, high-intensity interval exercise training (HIIT) has aroused considerable interest in cardiac rehabilitation community. In HF patients, HIIT exerts larger improvements in exercise capacity compared to moderate-continuous ET. Since better functional capacity translates into symptoms relief and improvement in quality of life in patients with HF, this training modality is collecting growing interest and consensus, not revealing major safety issues. HIIT should not replace other training modalities in HF but should rather complement them. Inspiratory muscle training, another promising training modality in patients with HF, exerts beneficial effect on inspiratory muscle strength and inspiratory endurance, on exercise capacity and quality of life. In conclusion, taking into consideration the complecity of HF syndrome, combining and tailoring different ET modalities according to each patient's baseline clinical characteristics (i.e. exercise capacity, comorbidity, frailty status, personal needs, preferences and goals) seem the most wily approach for exercise prescription

Physical activity and cardiovascular mortality risk: possible protective mechanisms?

INTRODUCTION: The biological mechanisms through which increased physical activity or structured exercise training lowers the risk of recurrent cardiac events are incompletely understood. We examined the extent to which modification of primary risk markers explains the association between physical activity and cardiovascular death in participants with diagnosed cardiovascular disease (CVD). METHODS AND RESULTS: In a prospective study of 1429 participants with physician-diagnosed CVD living in England and Scotland (age = 66.5 ± 11.1 yr (mean ± SD), 54.2% men), we measured physical activity and several risk markers (body mass index, total-to-HDL cholesterol ratio, diagnosed diabetes, systolic blood pressure, resting heart rate, C-reactive protein) at baseline. The main outcome was CVD death. There were a total of 446 all-cause deaths during an average of 7.0 ± 3.1 yr of follow-up, of which 213 were attributed to cardiovascular causes. Participation in moderate to vigorous physical activity at least three sessions per week was associated with lower risk of CVD death (hazard ratio = 0.61, 95% confidence interval = 0.38-0.98). Physically active participants demonstrated significantly lower levels of body mass index, diabetes, and inflammatory risk (C-reactive protein). Metabolic (body mass index, total-to-HDL cholesterol ratio, and physician-diagnosed diabetes) and inflammatory risk factors explained an estimated 12.8% and 15.4%, respectively, of the association between physical activity and CVD death. CONCLUSIONS: Physical activity may reduce the risk of secondary CVD events, in part, by improving metabolic and inflammatory risk markers

Takotsubo cardiomyopathy and sepsis: a systematic review

Takotsubo cardiomyopathy (TTC) is characterized by a systolic dysfunction localized in the apical and medial aspect of the left ventricle. It is usually related to physical or emotional stress. Recent evidence highlighting the role of infection led us to analyze the links between TTC and sepsis. A systematic review of the literature was undertaken to assess any trends in clinical findings, diagnosis, and outcomes in such patients. We identified 23 selected papers reporting a total of 26 patients, having sepsis, in whom TTC occurred. For each case, we collected data identifying population characteristics, source of sepsis, clinical disease description, and the results of cardiovascular investigations. The majority of patients were females (n = 16), mean age was 62.8 (14.0 standard deviation) years, and clinical outcome was favorable in 92.3% of the cases once the management of sepsis was initiated. A better understanding of the mechanisms of sepsis-associated TTC may generate novel strategies to treat the complications of this cardiomyopathy and may even help predict and prevent its occurrence

Pengaruh Evaluasi Kerja, Pelatihan Dan Pengawasan Terhadap Peningkatan Mutu Kinerja Karyawan Pt.Nutrihub Medan

This research was conducted to determine the effect of job evaluation, training and supervision on the quality of employee performance of PT. Nutrihub Medan. The purpose of this research is to find out and analyze how work evaluations are given to employees, how training is given to employees, how supervision is given to employees, and to find out how the e ffect of work evaluation, training and supervision simultaneously on the quality of employees performance of PT. Nutrihub Medan. This research uses quantitative methods with descriptive research types. Sampling was carried out using a saturated sampling technique, with a total of 76 respondents. The calculation process is processed with the help of (SPSS) ver 24 for windows. The data analysis technique used is multiple linear regression analysis. Based on the results of this study, simultaneously the variables of work evaluation, training, and supervision have a significant effect on employee performance by 54.2%. The conclusion of this study is that work evaluation, training and supervision have a positive and significant effect on the quality of employee performance of PT. Nutrihub Medan. Keywords: Job Evaluation, Training, Supervisio