International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches

Cardiovascular disease (CVD) is the leading cause of mortality and disability in developed countries. According to WHO, an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to major adverse cardiac and cerebral events. Early detection and care for individuals at high risk could save lives, alleviate suffering, and diminish economic burden associated with these diseases. Carotid artery disease is not only a well-established risk factor for ischemic stroke, contributing to 10%–20% of strokes or transient ischemic attacks (TIAs), but it is also a surrogate marker of generalized atherosclerosis and a predictor of cardiovascular events. In addition to diligent history, physical examination, and laboratory detection of metabolic abnormalities leading to vascular changes, imaging of carotid arteries adds very important information in assessing stroke and overall cardiovascular risk. Spanning from carotid intima-media thickness (IMT) measurements in arteriopathy to plaque burden, morphology and biology in more advanced disease, imaging of carotid arteries could help not only in stroke prevention but also in ameliorating cardiovascular events in other territories (e.g. in the coronary arteries). While ultrasound is the most widely available and affordable imaging methods, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), their combination and other more sophisticated methods have introduced novel concepts in detection of carotid plaque characteristics and risk assessment of stroke and other cardiovascular events. However, in addition to robust progress in usage of these methods, all of them have limitations which should be taken into account. The main purpose of this consensus document is to discuss pros but also cons in clinical, epidemiological and research use of all these techniques

Malnutrition in COVID-19 survivors: prevalence and risk factors

Background: Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients. Aim: To assess the prevalence of malnutrition and identify its associated factors in COVID-19 survivors. Methods: Study cohort included 1230 COVID-19 survivors aged 18-86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: Prevalence of malnutrition was 22% at 4-5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher frequency of malnutrition compared to those who needed hospitalization (26% versus 19%, p < 0.01). Malnutrition was found in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p < 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01-1.03) and in male participants (OR 5.56; 95% CI 3.53-8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73-3.62), and dysgeusia (OR 4.05; 95% CI 2.30-7.21) during acute COVID-19. Discussion: In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4-5 months from acute illness. Conclusions: Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Going Online While Purchasing Offline: an Explorative Analysis of Omnichannel Shopping Behaviour in Retail Settings

Retail customers are now omnichannel both for attitude and behaviour. Shoppers are also demanding a different and higher level of experience within retailer’s brand, channel, contact point and the way in which the retail is accessed. Such shoppers avoid retailers who are ill-equipped to deliver a seamless brand experience online, in-store and across multichannel media, both consistently and continuously (PwC & Kantar Retail, 2012). Therefore, a new and improved strategy aimed at delivering information and product to customers is becoming mandatory for retailers. Recently some retailers are showing an increasing interest in the application of advanced systems developed to enhance the shopping experience by providing customers with innovative tools able to engage them with multiple channels simultaneously to obtain deeper insights, save time and feel more independent while shopping. Such technologies can help retailers to better react to those emerging settings by (i) acquiring a positive image and reputation, being at the same time perceived as innovator; (ii) reducing management costs; (iii) maintaining and acquiring loyal consumers; (iv) making imitation strategies as difficult as possible for competitors; (v) reaching a unique and differentiated positioning. Consequently, many retailers have recently introduced advanced technologies in their stores such as self-service technologies equipped with radio frequency identification systems (RFID), interactive touch screen displays, digital signage and mobile applications, informative touch points and contactless technologies for mobile payments. Furthermore, the development of ubiquitous computing allowed companies to create virtual stores based on QR tags which can be located everywhere and enable consumers to purchase by their mobile devices. These technologies modify both consumer behavior and corporate approach to retail process, by changing the way customers access to information and firms reach their customers. Since individuals interact with multiple channels throughout their shopping journey, even simultaneously (Omnichannel Retailing), retailers must consider all channels holistically as consumers do, in order to provide them with a unified shopping experience. Preliminary result of our multiple case study involving 15 retailers, operating in different industries of the Italian market, shows that customers are increasingly willing to use the in-store innovations in order to obtain richer shopping experiences, while retailers achieve a stronger brand loyalty as well as a better and updated brand image. A deeper understanding of positive effects and threats resulting from early technology adoption by retailers will be essential for improving the omnichannel customer management, thus increasing business performance

Mobility recovery after arthroscopic rotator cuff repair

BACKGROUND: Mobility recovery after arthroscopic rotator cuff repair in different tears size. AIM: To investigate, after arthroscopic rotator cuff repair, the range of motion (ROM) progression in different sized tears (small, large and massive), and evaluating ROM changes in the pre- and postoperative periods of each group. DESIGN: Cohort study. SETTING: Policlinico Umberto I, "Sapienza" University, Rome, Italy. POPULATION: Ninety-two patients with reparable rotator cuff tears. METHODS: Patients were divided in three groups: group A (small lesions), group B (large lesions) and group C (reparable massive lesions) composed by 29, 31 and 32 patients, respectively. ROM were measured preoperatively (TO), and after 45 (T1), 70 (T2) and 100 (T3) days after the arthroscopic treatment.. RESULTS: From TO to T3, small lesions are associated to excellent results, with an improvement of all parameters; the same in patients with large lesions, except for flexion parameter; in reparable massive lesions only external and internal rotation improved. CONCLUSIONS: Not all parameters recover in the same way: postoperative rehabilitative protocol is an integral contributor to favorable outcomes in patients with rotator cuff tears

The Role of Sentinel Events in the Measurement of Work-Related Stress

Literature has shown that sentinel events may be considered as markers for measuring work- related stress levels. This aspect has been recognized by the Italian legislation, which requires its recognition for the measurement of occupational stress. This study aims to understand the role of sentinel events in the measurement of work-related stress. Samples of 249 subjects were divided in two balanced and proportional categories (inside sentinel events and outside sentinel events). At the samples the Organizational and Psychosocial Risk Assessment (OPRA) questionnaire was administered. The tests T-student and ANOVA from the OPRA results didn’t show any statistically significant differences between the subjects belonging to the sentinel events and those not be- longing

Different dysregulations in adrenal steroid biosynthesis as a prevalent cause of hyperandrogenism in women from southern Italy.

OBJECTIVE: To investigate the presence of a dysregulation in steroid biosynthesis in women from southern Italy. DESIGN: Controlled clinical study. SETTING: Normal and hyperandrogenic women referred to the Endocrinology Unit of Federico II University Medical School of Naples. PATIENT(S): One hundred fifty untreated young hyperandrogenic women and 50 normal age-matched women. INTERVENTION(S): Morning (basal) blood samples obtained in the early follicular phase and after a long (360 minute) ACTH stimulation test. MAIN OUTCOME MEASURE(S): The adrenal maximal response was calculated as stimulus under curve areas (AUCa), and all steroids were assayed using RIA methods. RESULT(S): A dysregulation of 21-hydroxylase was found in 22 patients (14.7%), with a prevalent increase of 17 alpha-hydroxyprogesterone AUC, whereas in 9 hirsute women (6%), there was a prevalent significant increase in 11-deoxycortisol AUC. In 5 women (3.3%), DHEA and DHEAS basal and AUCs plasma levels were increased, suggesting an impaired 3 beta-olo-dehydrogenase activity. The remaining 114 hyperandrogenic women (76%) compose the nonadrenal group, with a probable diagnosis of primitive functional ovarian hyperandrogenism. CONCLUSION(S): Considering the high prevalence of hirsutism and oligomenorrhea in our female hyperandrogenic population, we suggest an adrenal hyperresponsiveness likely due to a dysregulation in enzymes related to androgen adrenal steroidogenesis