Dobutamine stress echocardiography for assessing the role of dynamic intraventricular obstruction in left ventricular ballooning syndrome

<p>Abstract</p> <p>Background</p> <p>Dynamic intraventricular obstruction has been observed in patients with left ventricular ballooning syndrome (LVBS) and has been hypothesized as a possible mechanism of the syndrome. The aim of this study was to assess the prevalence and significance of dynamic intraventricular obstruction in patients with LVBS.</p> <p>Methods and Results</p> <p>Dobutamine stress echocardiography was carried out in 22 patients with LVBS (82% apical), all women, aged 68 ± 9 years. At baseline 1 patient had a > 30 mmHg LV gradient; during stress a LV gradient > 30 mm Hg developed in 6/21 patients (28%) and was caused by systolic anterior motion of the mitral valve in the 3 patients with severe gradient (mean 116 ± 29 mmHg), who developed mitral regurgitation and impaired apical wall motion and by obstruction at mid-ventricular level in the other 3 with a moderate gradient (mean 46 ± 16 mmHg). Compared with patients without obstruction those with obstruction had a greater mean septal thickness (11.6 ± .6 vs 9.8. ± 3, p < .01), a higher prevalence of septal hypertrophy (71% vs 7%, p < .005) and a higher peak wall motion score index (1.62 ± .4 vs 1.08 ± .4, p < .01).</p> <p>Conclusion</p> <p>Spontaneous or dobutamine-induced dynamic LV obstruction is documented in 32% of patients with LVBS, is correlated with the presence of septal hypertrophy and may play a role in the development of LVBS in this subset of patients. In those without septal hypertrophy a dynamic obstruction is rarely induced with dobutamine and is unlikely to be a major pathogenetic factor of the syndrome.</p

Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence

none34noopende Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina; Andreose, Suor; Basso, Pasquale; Beneduce, Rossella; Bertolotti, Pietro; Braida, Vanda; Bonelli, Marina; Bongiorno, Fanny; Bussi, Riccardo; Castagno, Elisa; Dominicis, Fabio; Ghersi, Loredana; Greppo, Stefania; Sodano, Alessandro Jaretti; Leporatti, Massimo; Presti, Eleonora Lo; Milone, Valeria; Panigada, Fausto; Pasquadibisceglie, Livia; Rigamonti, Danilo; Rillosi, Lucianade Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina; Andreose, Suor; Basso, Pasquale; Beneduce, Rossella; Bertolotti, Pietro; Braida, Vanda; Bonelli, Marina; Bongiorno, Fanny; Bussi, Riccardo; Castagno, Elisa; Dominicis, Fabio; Ghersi, Loredana; Greppo, Stefania; Sodano, Alessandro Jaretti; Leporatti, Massimo; Presti, Eleonora Lo; Milone, Valeria; Panigada, Fausto; Pasquadibisceglie, Livia; Rigamonti, Danilo; Rillosi, Lucian

Role of dynamic intraventricular obstruction and protective effect of beta-blocking therapy in left ventricular apical ballooning syndrome: A case report

This paper reports on a 58-year old woman with left ventricular apical ballooning syndrome (LVABS), who after interruption of beta-blocking therapy had a recurrence of symptoms and developed a severe dynamic left ventricular obstruction (LV-DYN-O) during sympathetic stimulation with dobutamine

An index based on the biodiversity of cetacean species to assess the environmental status of marine ecosystems

The Marine Strategy Framework Directive (MSFD) requires the assessment of the environmental status in relation to human pressures. In this study the biodiversity of the cetacean community is proposed as MSFD descriptor of the environmental status and its link with anthropogenic pressures is investigated. Functional groups are generally favoured over indicator species since they are thought to better reflect to anthropogenic stressors. Cetaceans are in many situations the most well known component of pelagic ecosystems. Their habitat requirements are known and can be used to evaluate the theoretical biodiversity that should be expected in a certain area. The deviations between the theoretical biodiversity and the actual biodiversity may be used to detect the impacts of human activities. Based on this analysis fishery resulted to be by far the most significant of the existing pressures. Among all the species, bottlenose dolphin was found the most correlated with the fishery sector dynamics

Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study

Abstract Background Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy. Methods PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2–3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples

Mucosal delivery of a vectored RSV vaccine is safe and elicits protective immunity in rodents and nonhuman primates

Respiratory Syncytial Virus (RSV) is a leading cause of severe respiratory disease in infants and the elderly. No vaccine is presently available to address this major unmet medical need. We generated a new genetic vaccine based on chimpanzee Adenovirus (PanAd3-RSV) and Modified Vaccinia Ankara RSV (MVA-RSV) encoding the F, N, and M2-1 proteins of RSV, for the induction of neutralizing antibodies and broad cellular immunity. Because RSV infection is restricted to the respiratory tract, we compared intranasal (IN) and intramuscular (M) administration for safety, immunogenicity, and efficacy in different species. A single IN or IM vaccination completely protected BALB/c mice and cotton rats against RSV replication in the lungs. However, only IN administration could prevent infection in the upper respiratory tract. IM vaccination with MVA-RSV also protected cotton rats from lower respiratory tract infection in the absence of detectable neutralizing antibodies. Heterologous prime boost with PanAd3-RSV and MVA-RSV elicited high neutralizing antibody titers and broad T-cell responses in nonhuman primates. In addition, animals primed in the nose developed mucosal IgA against the F protein. In conclusion, we have shown that our vectored RSV vaccine induces potent cellular and humoral responses in a primate model, providing strong support for clinical testing

Additional file 1: of Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study

List of local Ethics Committees which approved the study. (DOC 25 kb