apical hypertrophic cardiomyopathy and multiple coronary artery left ventricular fistulas a case report

n/

Politiche di gestione dei Rifiuti Solidi Urbani. Il caso di un Comune della Basilicata

La direttiva 2008/98/CE individua i principi fondamentali per le politiche virtuose sui rifiuti, che devono essere finalizzate alla riduzione al minimo di conseguenze negative per la Salute umana e per l’Ambiente. Attraverso al cune iniziative l’UE ha stabilito obiettivi di riciclaggio e di riduzione del ricorso alle discariche tra cui il riciclo di al meno il 55% di Rifiuti Urbani (RU) entro il 2025, del 60% entro il 2030 e del 65% entro il 2035 oltre alla riduzione dello smaltimento in discarica che deve essere pari al massimo al 10% del totale di RU entro il 2035. L’obiettivo di questo Studio è di descrivere la gestione dei RU di un Comune della Basilicata nel periodo 2014-2018 in relazione alla produzione dei Rifiuti, allo smaltimento in discarica ed al conseguente andamento della Raccolta Differenziata (RD) anche in confronto con i dati della Regione Basilicata e proporre semplici strumenti di valutazione del grado di engagement dei Cittadini anche attraverso una Survey e conseguenti interventi formativi/educativi. E’ stata condotta un’indagine per verificare il flusso dei rifiuti solidi urbani in un Comune della Regione Basilicata di medie dimensioni. In un database sono stati riportati i dati comunali di: Produzione totale dei Rifiuti, percentuale di RD e quantità di RU conferiti in Discarica per gli anni 2014-2018. Successivamente sono stati confrontati con gli stessi dati riportati sui Rapporti RU di ISPRA per la Regione Basilicata. I dati evidenziano che, dal 2014 al 2018, la produzione totale dei rifiuti per il Comune oggetto di analisi è aumenta ta di 3 T (2.079 T VS 2.082 T) a fronte di una riduzione di circa 1.500 Tonnellate (201.130 T VS 199.425 T) in Regio ne Basilicata. Lo smaltimento in discarica si è ridotto di 90 T (1.575 T VS 1.485 T) mentre per la Regione Basilicata si è ridotto di 66.000 T (105.000 T VS 39.000 T) e la RD ha avuto un incremento del 4,5% (24,2% VS 28,7%) mentre per la Regione Basilicata l’incremento è stato del 19,7% (27,6% VS 47,3%). Possiamo affermare che esiste una differenza sostanziale tra le performances comunali e regionali. In tale contesto appare evidente che sarebbe necessario intervenire con strumenti di governance appropriati per dare più impulso alla gestione dei RU. Semplici strumenti di educazione/sensibilizzazione della Popolazione come l’introduzione di materiale divulgativo (brochures informative) o la progettazione di momenti formativi ad hoc nelle Scuole pos sono contribuire ad orientare la Comunità ed i decisori politici verso nuovi indirizzi di Policy virtuose in materia ambiental

Antiphospholipid syndrome-induced ischemic stroke following pembrolizumab: Case report and systematic review

Immune checkpoint inhibitors (ICI) improve the prognosis of patients with advanced non-small cell lung cancer. However, clinicians should be aware of potentially life-threatening immune-related adverse events (irAEs). We report a case of a 67-year-old man with lung adenocarcinoma who developed an acute ischemic stroke after the second administration of pembrolizumab. The patient benefited from thrombolysis and mechanical thrombectomy with improved neurological outcome. An anti-phospholipid syndrome (APS) was diagnosed. Simultaneously, he developed a grade IV autoimmune hepatitis. Both manifestations were considered irAEs and the ICI treatment was discontinued. Steroids were initiated resulting in irAEs resolution. Remarkably, the patient achieved a complete oncological response and persistent remission after one year follow-up despite early discontinuation of pembrolizumab. Of note, APS is rarely reported as irAE. To our knowledge, this is the first case reported in the context of lung cancer. A systematic review of the literature is provided.SCOPUS: re.jinfo:eu-repo/semantics/publishe

The Crosstalk between Gut Microbiota, Intestinal Immunological Niche and Visceral Adipose Tissue as a New Model for the Pathogene-sis of Metabolic and Inflammatory Diseases: The Paradigm of Type 2 Diabetes Mellitus

Gut microbiota (GM) comprises more than one thousand microorganisms between bacterial species, viruses, fungi, and protozoa and represents the main actor of a wide net of molecular interactions, involving, among others, the endocrine system, immune responses, and metabolism. GM influences many endocrine functions, such as adrenal steroidogenesis, thyroid function, sexual hormones, IGF-1 pathway and peptides, produced in the gastrointestinal system. It is fundamental in glycaemic control and obesity, while also exerting an important function in modulating the immune system and associated inflammatory disease. The result of this crosstalk in gut mucosa is the formation of the intestinal immunological niche. Visceral adipose tissue (VAT) produces about 600 different peptides and it is involved in lipid and glucose metabolism, and some immune reactions, through several adipokines. GM and VAT interact in a bidirectional fashion: while gut dysbiosis can modify VAT adipokines and hormone secretion, VAT hyperpla-sia modifies GM composition. Acquired or genetic factors leading to gut dysbiosis or increasing VAT (i.e., Western diet) induce a pro-inflammatory condition, which plays a pivotal role in the development of dysmetabolic and immunologic conditions, such as diabetes mellitus. Diabetes is associated with specific patterns of GM alterations, an abun-dance or reduction of GM species involved in controlling mucosal barrier status, glycaemic levels and exerting a pro-or anti-inflammatory activity. All these factors could ex-plain the higher incidence of several inflammatory conditions in Western countries; fur-thermore, besides the specific alterations observed in diabetes, this paradigm could repre-sent a common pathway acting in many metabolic conditions and could pave the way to new, interesting therapeutic approaches

The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns

: In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.  Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit

Neura: a specialized large language model solution in neurology

Large language models’ (LLM) ability in natural language processing holds promise for diverse applications, yet their deployment in fields such as neurology faces domain-specific challenges. Hence, we introduce Neura: a scalable, explainable solution to specialize LLM. Blindly evaluated on a select set of five complex clinical cases compared to a cohort of 13 neurologists, Neura achieved normalized scores of 86.17% overall, 85% for differential diagnoses, and 88.24% for final diagnoses (55.11%, 46.15%, and 70.93% for neurologists) with rapid response times of 28.8 and 19 seconds (9 minutes and 37.2 seconds and 8 minutes and 51 seconds for neurologists) while consistently providing relevant, accurately cited information. These findings support the emerging role of LLM-driven applications to articulate human-acquired and integrated data with a vast corpus of knowledge, augmenting human experiential reasoning for clinical and research purposes

Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Background: The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and >= 40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions: This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers