Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

The effects of the neighboring landscape patterns, park history and local management on taxonomic and functional Collembola communities in soils of Mediterranean urban parks : Naples (Italy) and Montpellier (France) study cases

L’urbanisation aboutit à une grande diversité environnementale, paysagère, historique des espaces verts en ville, avec également des pratiques de gestion très variées, qui, peuvent affecter la biodiversité qu’ils abritent. Or, la composante du sol reste très peu étudiée et les communautés de Collemboles présentes dans les parcs urbains constitue une thématique de recherche jusqu’à présent relativement ignorée. Si ces Arthropodes sont de petite taille (de l’ordre du millimètre), ils sont en effet très nombreux dans les sols et aujourd’hui reconnus comme de bons indicateurs pour le monitoring des sols.Les effets de différents filtres abiotiques ont été testés en appliquant à la fois une approche taxonomique et fonctionnelle des communautés de Collemboles dans les parcs urbains de Naples et de Montpellier. La thèse se développe alors en trois axes correspondant à l’étude des effets:- de la composition et fragmentation de la mosaïque urbaine proche- des dynamiques temporelles propres aux parcs- des pratiques de gestion courantesL’analyse conduite à Montpellier a permis de mettre en évidence l’existence de plusieurs groupes homogènes de paysages auxquels étaient associées des structures de communautés différentes. En effet, les paysages urbains les plus hétérogènes favorisent le développement et le maintien de communautés mieux structurées et plus riches en espèces.Par ailleurs, l’étude menée à Naples a montré que le maintien d’un couvert végétal spécifique et principalement boisé, conjointement à la présence de litière au sol, apparaissent comme les facteurs les plus importants pour permettre l’établissement de communautés mieux structurées et plus riches en espèces. Dans une moindre mesure, l’âge des parcs et le précédant usage du sol étaient également déterminants.Enfin, une analyse fonctionnelle (étude de traits morphologiques et préférences de microhabitats) a été envisagée pour évaluer l’intensification de la gestion du sous-bois au sein des habitats boisés des parcs des deux villes. Un gradient abiotique clair a été observé. En revanche, contrairement aux hypothèses énoncées et à la littérature récente sur le sujet, les communautés de Collemboles étaient mieux discriminées du point de vue taxonomique que du point de vue fonctionnel. Il semblerait donc que l’intensification de la gestion du sous-bois ne soit pas un filtre environnemental imposant des changements dans les patterns de traits des espèces présentes.Si d’un côté les études développées dans cette thèse apportent des connaissances fondamentales sur l’écologie des Collemboles présents dans les parcs urbains, de l’autre elle vise à intégrer ces résultats pour un développement plus durable en termes d’aménagement et de gestion des espaces verts urbains.Urbanization causes a huge diversity in landscapes, environmental conditions and green spaces history. This phenomena also induces different vegetation management practices, which may affect urban fauna. However, scarce attention has been paid to belowground communities in cities and Collembola hosted by soils of urban parks represent a neglected research topic. These taxa are very common in most soils and have been recognized as proper indicators for soil monitoring programs.The effects of diverse abiotic filters on Collembola in Naples and Montpellier public parks has been studied from both taxonomic and functional points of view. In particular, the PhD work was developed based on three principal axes, aiming to test the effects of:- the neighboring landscape context,- the park historical dynamics,- the current park management.The analyses carried out in Montpellier showed different neighboring landscape patterns to which belonged diverse species communities. Indeed, more heterogeneous landscape patterns guarantee the richest and most structured species communities.The study conducted in Naples highlighted that maintaining a specific land cover, especially a canopy cover, jointly to a litter layer on soils are the main factors assuring more structured species communities. To a less extent, park age and the previous land use of the area were also important drivers in modelling species assemblages.Finally, a functional analysis (i.e. morphological traits and microhabitat preferences) was applied to evaluate the brushwood management intensification in woody areas of both cities parks. A clear abiotic gradient was observed. By contrast, functional responses of Collembola communities to brushwood management intensification contradicted our research hypothesis based on the recent literature. Thus, it seems that brushwood removal does not cause shifts in species trait patterns in urban parks.This PhD work increased fundamental knowledge on urban park Collembola ecology, and it strives to integrate these findings in a more suitable landscaping and management of urban green spaces

Effets de la mosaïque paysagère proche, de l’histoire et des pratiques de gestion locales sur les communautés taxonomiques et fonctionnelles des Collemboles du sol des parcs urbains méditerranéens : les cas de Naples (Italie) et Montpellier (France)

Urbanization causes a huge diversity in landscapes, environmental conditions and green spaces history. This phenomena also induces different vegetation management practices, which may affect urban fauna. However, scarce attention has been paid to belowground communities in cities and Collembola hosted by soils of urban parks represent a neglected research topic. These taxa are very common in most soils and have been recognized as proper indicators for soil monitoring programs.The effects of diverse abiotic filters on Collembola in Naples and Montpellier public parks has been studied from both taxonomic and functional points of view. In particular, the PhD work was developed based on three principal axes, aiming to test the effects of:- the neighboring landscape context,- the park historical dynamics,- the current park management.The analyses carried out in Montpellier showed different neighboring landscape patterns to which belonged diverse species communities. Indeed, more heterogeneous landscape patterns guarantee the richest and most structured species communities.The study conducted in Naples highlighted that maintaining a specific land cover, especially a canopy cover, jointly to a litter layer on soils are the main factors assuring more structured species communities. To a less extent, park age and the previous land use of the area were also important drivers in modelling species assemblages.Finally, a functional analysis (i.e. morphological traits and microhabitat preferences) was applied to evaluate the brushwood management intensification in woody areas of both cities parks. A clear abiotic gradient was observed. By contrast, functional responses of Collembola communities to brushwood management intensification contradicted our research hypothesis based on the recent literature. Thus, it seems that brushwood removal does not cause shifts in species trait patterns in urban parks.This PhD work increased fundamental knowledge on urban park Collembola ecology, and it strives to integrate these findings in a more suitable landscaping and management of urban green spaces.L’urbanisation aboutit à une grande diversité environnementale, paysagère, historique des espaces verts en ville, avec également des pratiques de gestion très variées, qui, peuvent affecter la biodiversité qu’ils abritent. Or, la composante du sol reste très peu étudiée et les communautés de Collemboles présentes dans les parcs urbains constitue une thématique de recherche jusqu’à présent relativement ignorée. Si ces Arthropodes sont de petite taille (de l’ordre du millimètre), ils sont en effet très nombreux dans les sols et aujourd’hui reconnus comme de bons indicateurs pour le monitoring des sols.Les effets de différents filtres abiotiques ont été testés en appliquant à la fois une approche taxonomique et fonctionnelle des communautés de Collemboles dans les parcs urbains de Naples et de Montpellier. La thèse se développe alors en trois axes correspondant à l’étude des effets:- de la composition et fragmentation de la mosaïque urbaine proche- des dynamiques temporelles propres aux parcs- des pratiques de gestion courantesL’analyse conduite à Montpellier a permis de mettre en évidence l’existence de plusieurs groupes homogènes de paysages auxquels étaient associées des structures de communautés différentes. En effet, les paysages urbains les plus hétérogènes favorisent le développement et le maintien de communautés mieux structurées et plus riches en espèces.Par ailleurs, l’étude menée à Naples a montré que le maintien d’un couvert végétal spécifique et principalement boisé, conjointement à la présence de litière au sol, apparaissent comme les facteurs les plus importants pour permettre l’établissement de communautés mieux structurées et plus riches en espèces. Dans une moindre mesure, l’âge des parcs et le précédant usage du sol étaient également déterminants.Enfin, une analyse fonctionnelle (étude de traits morphologiques et préférences de microhabitats) a été envisagée pour évaluer l’intensification de la gestion du sous-bois au sein des habitats boisés des parcs des deux villes. Un gradient abiotique clair a été observé. En revanche, contrairement aux hypothèses énoncées et à la littérature récente sur le sujet, les communautés de Collemboles étaient mieux discriminées du point de vue taxonomique que du point de vue fonctionnel. Il semblerait donc que l’intensification de la gestion du sous-bois ne soit pas un filtre environnemental imposant des changements dans les patterns de traits des espèces présentes.Si d’un côté les études développées dans cette thèse apportent des connaissances fondamentales sur l’écologie des Collemboles présents dans les parcs urbains, de l’autre elle vise à intégrer ces résultats pour un développement plus durable en termes d’aménagement et de gestion des espaces verts urbains

Relationships between Quercus ilex L. litter characteristics and soil microarthropod community in an urban environment at different climatic conditions

In urban environments, climatic conditions and air pollution affect metal content, morphology and physiology of leaves with implications for litter morphology and palatability affecting structural and functional diversity of the soil microarthropod community. As leaf morphology rapidly responds to different environmental factors, recently, functional leaf traits are considered good indicators of plant health status. Aim of the research was to relate Quercus ilex (good monitor of air pollution) leaf, litter and soil microarthropod community characteristics taking into account metal pollution and climatic conditions. The research was performed in an urban environment of the Mediterranean area. Leaves an litter were characterized for Cd, Cr, Cu, Ni and Pb concentrations and for the main functional traits. The soil microarthropod community was investigated for abundance and richness as well as for habitat and diet preferences. The main results were that leaf metal accumulation and climatic condition contextuall affected the litter characteristics both in terms of metal composition and morphological traits. Litter quality discriminated different microarthropod taxa assemblages according trophic preferences whereas climatic conditions strongly affected microarthropod habitat distribution

Spatial patterns and scales of Collembola taxonomic and functional diversity in urban parks

Anthropogenic pressures can affect the distribution of species and elicit the appearance of spatial patterns that provide insights into the species’ responses to environmental filtering, mediated by their functional traits. Due to the functional redundancy in ecological communities, the spatial variations of species and functional traits can occur at different scales, but little is known on this topic, especially for soil arthropods with limited dispersion capabilities and highly dependent on environmental characteristics. The present research aims at shedding light on the spatial ecology of both the taxonomic and functional biodiversity of collembolan communities colonizing urban parks, adopted as model taxa for their functional traits, diversity and sensitivity to environmental drivers. To this end, the spatial patterns and scales of collembolan communities from 8 parks in Naples (Italy) and 14 in Montpellier (France) were investigated through an approach based on Moran eigenvector maps, modified to allow for evaluating the community spatial connectivity and the scales underpinning the spatial variation of each species and functional trait. The obtained findings demonstrate a limited spatial connectivity of collembolan communities in terms of both taxonomic and functional diversity, with mostly species-specific micro-scale variations that may be shaped by environmental constraints