Patterns of self-care in adults with heart failure and their associations with sociodemographic and clinical characteristics, quality of life, and hospitalizations: A cluster analysis

Background: Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. Objectives: The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. Methods: This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and [chi]2 test were used to examine the characteristics of each cluster. Results: Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. Conclusion: The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients

Contribution to Electrical System Inertia of Dual Fuel two-stroke Engines in Isolated Grid: A Case Study

The paper analyzed the dynamic performance of dual two-stroke engines with respect to classical Diesel gensets and the contribution to increase the rotating inertia of an isolated electrical grid with significant penetration of Renewable Energy Sources (RESs). The role of genset capable to provide better inertia and primary frequency regulation is essential for the integration of renewable generation in order to provide frequency stability and better power quality

Mixture of calcium, magnesium and seaweed affects leaf phytoalexin contents and grape ripening on vines with grapevine leaf stripe disease

Grapevine leaf stripe disease (GLSD) is a tracheomycosis caused by Phaeomoniella chlamydospora and Phaeoacremonium minimum. Impacts on yields of grapes were correlated with the incidence and severity of GLSD symptoms on vine canopies. In 2012 and 2013, vines in two vineyards were treated with nine applications of a mixture of leaf fertilizers containing calcium, magnesium and seaweed extracts. At different growth stages, leaves were sampled from treated and control plots of healthy, GLSD-asymptomatic, or GLSD-symptomatic vines and contents were measured of the phytoalexins trans-resveratrol, trans-ε-viniferin, trans-δ-viniferin and trans-pterostilbene. Grape ripening was also monitored from veraison to harvest during both vintages. The treatments caused significant reductions in canopy symptom expression. Increased phytoalexin contents were measured from ‘fruit set’ to ‘berries developing colour’ stages. Trans-resveratrol peak was recorded in asymptomatic diseased vines at the ‘berries pea-sized’ stage, and trans-ε-viniferin and trans-δ-viniferin increased at the ‘berries beginning to touch’ stage, compared to the contents recorded in untreated asymptomatic vines. From ‘berries developing colour’ to harvest, all treated vines had lower amounts of phytoalexins than the control ones. At harvest, treated healthy and symptomatic vines produced berries with similar amounts of total sugars compared to untreated vines. Treated asymptomatic vines produced berries with greater amounts of total sugars compared to the untreated vines. These results indicate that increased phytoalexin content recorded from ‘fruit set’ to ‘berries beginning to touch’ in asymptomatic vines treated with the mineral/seaweed mixture may reduce symptoms of GLSD

An introduction to the early Holocene eolian deposits of Grotta Romanelli, Apulia, Southern Italy

Due to its geographic position and geomorphological configuration, Grotta Romanelli acted as a sediment trap since at least MIS 5. The so-called ‘terre brune’ sequence is a deposit mainly of eolian origin bearing upper Palaeolithic artefacts and fossil remains of vertebrate fauna; it was deposited during the Glacial-Interglacial transition and the Holocene. Sedimentology and mineralogy of this deposit are investigated. The stratigraphic sequence provides a promising archive within which both human and climatic impacts can be studied

Patterns of phytoalexins in the grapevine leaf stripe disease (esca complex)/grapevine pathosystem

Vineyards containing vines affected with grapevine leaf stripe disease (GLSD), one of the diseases of the esca complex, suffer losses in grape yield and quality every growing season. To examine the relation between GLSD foliar symptoms and levels of phytoalexins in grapevine, phytoalexin levels were monitored in the leaves of symptomatic, asymptomatic/diseased, and healthy grapevine leaves, at various growth stages, in two vineyards in Italy, over four growing seasons. At the same time, the leaf symptoms of the vines at some of those growth stages were recorded in each vineyard and in each growing season. The compounds extracted and identified were: trans-resveratrol, trans-pterostilbene, trans-ε-viniferin and trans-δ-viniferin. The most common phytoalexin found was resveratrol. Amounts of all the phytoalexins were generally greater in symptomatic leaves than in asymptomatic/diseased or healthy leaves. In symptomatic leaves, resveratrol levels were greatest at pre-bunch closure, and peaks in pterostilbene occurred at the same time. Leaves of each category (symptomatic, asymptomatic/diseased, healthy) had lower amounts of these compounds at veraison and generally higher amounts at the stages of harvesting and/or the softening of berries. It seems therefore that the formation and pattern over time of the phytoalexins was linked to the growth stage of the vines. Leaf symptoms never occurred before pre-bunch closure, but became much more common from veraison to harvest. This study provides evidence of a relationship between the levels of phytoalexins, grapevine growth stage, and the seasonal pattern of development of GLSD symptoms

Patterns of phytoalexins in the grapevine leaf stripe disease (esca complex)/grapevine pathosystem

Vineyards containing vines affected with grapevine leaf stripe disease (GLSD), one of the diseases of the esca complex, suffer losses in grape yield and quality every growing season. To examine the relation between GLSD foliar symptoms and levels of phytoalexins in grapevine, phytoalexin levels were monitored in the leaves of symptomatic, asymptomatic/diseased, and healthy grapevine leaves, at various growth stages, in two vineyards in Italy, over four growing seasons. At the same time, the leaf symptoms of the vines at some of those growth stages were recorded in each vineyard and in each growing season. The compounds extracted and identified were: trans-resveratrol, trans-pterostilbene, trans-ε-viniferin and trans-δ-viniferin. The most common phytoalexin found was resveratrol. Amounts of all the phytoalexins were generally greater in symptomatic leaves than in asymptomatic/diseased or healthy leaves. In symptomatic leaves, resveratrol levels were greatest at pre-bunch closure, and peaks in pterostilbene occurred at the same time. Leaves of each category (symptomatic, asymptomatic/diseased, healthy) had lower amounts of these compounds at veraison and generally higher amounts at the stages of harvesting and/or the softening of berries. It seems therefore that the formation and pattern over time of the phytoalexins was linked to the growth stage of the vines. Leaf symptoms never occurred before pre-bunch closure, but became much more common from veraison to harvest. This study provides evidence of a relationship between the levels of phytoalexins, grapevine growth stage, and the seasonal pattern of development of GLSD symptoms

Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVF

Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL)

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. Methods This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. Results We observed a significant decrease in NPS from a median value of 6 (IQR 5–6) at baseline to 1.0 (IQR 0.0–2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49–70) at baseline to 11 (IQR 6–21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. Conclusions Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell